£1.50p well spent

If you have £1.50p to spare, do buy a copy of this week's Private Eye.

The magazine has an excellent, well researched and highly readable account of the government's massively expensive, useless and dysfunctional IT system Connecting for Health which is currently bankrupting the NHS but making some computer boffins very rich indeed.

I quote from the introduction:

"Waste and inefficiency in the NHSis intolerable",declared Health Secretary Patricia Hewitt one year ago amid mounting deficits."A penny wasted is a penny stolen from a patient". This is the story of the theft of 1,240,000,000,000 pennies from patients through an IT project that wasn't wanted and doesn't work. It tells how political vanity, official incompetence and vested interests have wreaked havoc on the health service - and calls for a halt to the ultimate in a long line of New Labour computer cock-ups before it's too late.

Please read this important article

Thanks

My friend Dr Bob Hodges has sent me this:

Take a bow, Wayne

Wayne Jaffe is a distinguished plastic andreconstructive surgeon: this story is from the Daily Telegraph.

A NHS surgeon today exposed how cash-strapped hospitals were being barred from operating on cancer patients who had not waited long enough.

Wayne Jaffe laid the blame for the appalling state of affairs at the feet of Tony Blair, with his vision of reduced waiting times and 24-hour surgery. In a withering assessment of the financial management of the health service, Mr Jaffe said that doctors were being restricted in getting waiting lists down by financial limitations and ever-changing targets.

The consultant plastic and reconstructive surgeon, who specialises in skin cancer and breast reconstruction, said he and his colleagues are being prohibited from operating in non-urgent cases unless the patient has been waiting for a minimum of 20 weeks.

This is because the hospital would not get paid – even if the patient and staff were ready for the operation.

Mr Jaffe said the Prime Minister's pledge to have patients waiting no longer than 18 weeks between referral and treatment would be "impossible" unless more money was made available to primary care trusts.

He rubbished the Government's vision of 24-hour surgery, saying that after normal working hours only a skeleton staff was available.

"We are trying to do what the Prime Minister wants us to do but we cannot do it properly because there is no money," he said.

"Waiting lists will only go up if, as is the case, doctors cannot perform operations unless the patient has been waiting for more than 20 weeks. It's absurd."

Mr Jaffe, who works at the University Hospital of North Staffordshire NHS Trust, said the 20-week ruling was a "global issue" within the NHS and not just a problem at UHNS. He claimed that he was unable to fill his evening lists because of the 20-week constraint, and that patients were having to wait longer to be seen than necessary.

He said: "Doctors across the country are talking about the same thing and it's happening everywhere."

Saving her own neck

This story appears in today's Sunday Telegraph:

Almost half of NHS hospitals across England are now deliberately delaying operations to save money.

Patricia Hewitt, the beleaguered Health Secretary, has vowed to resign if the NHS fails to balance its books by the end of the financial year
Patricia Hewitt has vowed to resign if the NHS fails to balance its books by the end of the financial year

"Minimum waiting times" have been imposed by at least 43 per cent of Acute NHS Trusts, a survey for Channel 4's Dispatches programme found. Treatments are often postponed for more than 20 weeks, despite staff and equipment being available.



So Mrs Hewitt has cynically decided to save her own neck rather than provide timely care to NHS patients waiting for treatment

Closer to home?

One of the cornerstones of Mrs Hewitt's deranged plans for the NHS is that care should be provided "closer to home". If this really is the masterplan, then how does she explain that the number of health visitors has fallen to the lowest numbers for twelve years, and that training places for health visitors have been cut by 40%.

What is Mrs Hewitt's real vision for the NHS? I think that we are entitled to know.

What's going on?

It is difficult for an outsider to really understand what is going on in the NHS at the moment, but there are a number of excellent "blogs" on the web written from the coal face. None of them, in my opinion "tells it how it is" better than www.drrant.net

It uses, I am afraid, some strong language, but it is well worth reading.

Today in parliament

There was a debate in parliament today, and I quote vertatim the contribution of Alistair Burt, MP for North Bedfordshire:

Last summer, the trust decided that it could not replace an orthopaedic surgeon, but the flow of orthopaedic work did not diminish as expected. At Christmas time, staff were made redundant and wards were closed—that happened under Labour, I remind the Minister. Now, in the new year, it suddenly appears that there is so much orthopaedic work to be done that patients’ waiting times will hit the cliff edge of the new 18-week target that has been agreed, so more money has been found in order to make sure that that does not happen.

In fact, the treatments proposed will be more expensive than would have been the case if the trust had been able to replace the consultant and follow a normal pattern of work from summer until the end of the year. More money will go into the private sector, and money will be spent on evening operations if the staff can be found to do them, because Bedford Hospital NHS Trust is now readvertising for staff whom they sacked just a few weeks ago in the round of cuts at Christmas time. If the Minister can sit before us and think that he is presiding over an efficient and effective national health service as far as economics and financing are concerned, I am extremely surprised at him. He has a mess in those regards, which he must deal with. How can we have any confidence in the review if that is the economic basis underpinning it and under which hospitals will run?

Well said, Alistair

Madness

Tony Blair has today announced that hospitals could shorten waiting lists by offering 24 hour a day operating.

There is overwhelming evidence that having an operation done at night, when the surgeon, anaesthetist and the rest of the team, are potentially tired, is far more dangerous than having the same operation done in the daytime. Would you, for example, let your child have its tonsils removed at 3 a.m ; I know I wouldn't, it would be madness.

Running the NHS effectively is a complex business; it isn't made easier by politicians spouting nonsense.

£213,116

That's the amount of money that Bedford Hospital spent on management consultants between April and December 2006.

No wonder there's no money for clinical services

A date for your diary

Don't miss Dispatches on Channel 4 on Monday 26th February.

The programme is about where all the money has gone in the NHS (mostly on management consultants and computer systems that will never work). I have been interviewed for the programme, and I hope that my comments haven't all been edited out.

Make a note in your diary now.

The flagship is sinking

This story appeared in the Daily Telegraph today: Connecting for Health is the government's massive NHS computer project, already billions of pounds over budget, and the flagship of its plans for the NHS.

Labour's multi-billion- pound project to create the NHS's first ever national computer system "isn't working and isn't going to work", a senior insider has warned.

The damning verdict on the ambitious £20 billion plans to store patients' records, and allow people to book hospital appointments, on a central computer network has been delivered by a top executive at one of the system's main suppliers.

Andrew Rollerson, the health-care consultancy practice lead at the computer giant Fujitsu, warned that there was a risk that firms involved in the project would end up delivering "a camel and not the racehorse that we might try to produce".

His bleak assessment was delivered in a speech on the health service's national programme for IT that he delivered to a conference of computer experts last week and which is reported in today's Computer Weekly magazine.

Fujitsu is one of the main firms involved in the project after winning a £896 million contract to deliver systems in the South of England.

Mr Rollerson underlined his message with a series of downbeat slides, including one showing a huge oil tanker being hit by a tidal wave, one with the word "Lost?" alongside a picture of a desert island and one with a man walking a tightrope.

Another slide declared "visionary leadership is still missing" alongside the famous World War One poster of Lord Kitchener declaring "Your country needs you".

His presentation even featured a picture of a huge alligator with the message "We have become obsessed by the alligators nearest the boat." The final slide showed two women mud-wrestling and asked: "Where would you rather be?"

In his speech, Mr Rollerson voiced concern at the direction of the NHS programme and the lack of vision on how the health service can make best use of new technology.

"What we are trying to do is run an enormous programme with the techniques that we are absolutely familiar with for running small projects. And it isn't working. And it isn't going to work," he told his audience.

"Unless we do some serious thinking about that — about the challenges of scale and how you scale up to an appropriate size — then I think we're out on a limb."

Mr Rollerson added: "There is a belief that the national programme is somehow going to propel transformation in the NHS simply by delivering an IT system. Nothing could be further from the truth. A vacuum, a chasm, is opening up."

His comments are the latest sign of problems in the ambitious project, which is expected to cost the taxpayer around £7.6 billion more than estimated.

Last year it emerged that there had been 110 "major incidents" involving the system in just four months.

A letter signed by 23 leading computer scientists urged the Commons health select committee to launch an inquiry to "establish the scale of the risks" facing the project.

Stephen O'Brien, the shadow health minister, said: "Even those from inside the programme are now telling the Government that it is coming apart at the seams.

"This is another example of the heavy-handed, top-down failing approach of this Labour Government."

The Department of Health last night insisted that the programme was a pivotal part of NHS reform.

A spokesman said: "David Nicholson, the chief executive of the NHS, is fully committed to the national programme for IT as it is a necessary part of modern health service.

"He sees this as one of his key strategic priorities as it is key to the successful delivery of patient centred care."

So there you are: one of the government's key strategies for the NHS is falling apart.

Fudging waiting lists : method two

I have been sent the following by a GP colleague in Hertfordshire:

GPs in Hertfordshire have been told by the PCTs and PEC Chairs that they are to stop all routine referrals until after April, and only refer "urgent cases". They have also been told that in so doing, any mishap befalling the patient not referred will not lead to their indemnification by the PCT.

All patients referred will wait at lease twelve weeks, and various patient access pathways have been set up, which lead to a longer pathway, and in many cases a blocked pathway to a Consultant Outpatient appointment.

Patients are now unaware, (in many cases) that referrals are now sent, not direct to outpatients or Consultant secretaries, but to a "clearing house" which vets the referrral. The "clearing house" is staffed by non clinical people, leading to a child with an eye problem, being seen in a general surgery clinic, despite the letter being clearly marked with the eye Consultant's name, and Ophthalmological Dept.

Dr Jean Turner

Dr Jean Turner is a retired GP from Glasgow. In the 2003 elections for the Scottish Parliament she stood as independent in protest against what she judged to be poorly planned changes in local health provision, and in particular the planned closure of her local hospital.

She won in a traditional staunch Labour constituency, and has now announced that she will be standing for re-election in the May 2007 Scottish election.

Save Bedford Hospital wishes her well; if you live in the Glasgow area, please support her campaign.

Meeting targets at all costs

On Thursday the weather was foul; schools shut and hospital transport was stopped. The forecast for Friday did not look any better.

One of my colleagues had a day case operating list for the Friday morning and noticed that three of the patients were very elderly; perhaps it would be safest for them to be cancelled and rebooked. A manager was consulted. "NO" the answer came, because if they were cancelled they would be breaching the waiting list target.

So, it's better for an 85 year old to risk falling on the ice and breaking a limb than imperil the government's entirely arbitrary waiting list targets. Have they no shame?

How to fudge a waiting list : method one

GPs in Bedford have been told by the local Primary Care Trust not to refer any cases to the orthopoedic department at Bedford Hospital (or anywhere else) until the new financial year. As one GP said to me yesterday, I just have to tell patients to come back in April and I'll try again. Of course these patients have not yet got on to a waiting list, so the government can perpetuate the lie that they have reduced waiting. These patients are now queueing to get on a waiting list.

Keep logging on and I will reveal some of the other tricks being used.

Improving patient choice

This week the Department of Health has surpassed their own extraordinary standards for mad pronouncements.

They have rolled out their master plan for improving maternal choice in childbirth; this is to be achieved by reducing the number of centres where mothers can go for maternity care!

No wonder no one believes anything they say; indeed I sometimes wonder whether they believe this nonsense themselves.

Getting ready

The Save Bedford Hospital party continues its preparations. A general election may come sooner than expected. I am in consultation with two other doctors who are planning similar local campaigns in other parts of the country.

Offers of help are always welcome, but in the meanwhile, do tell people about this website.

Choose and Book

Choose and Book is an essential feature of the government's much vaunted but massively overspent NHS IT programme Connecting for Health.

Choose and Book is already over budget and behind schedule. It is a hopelessly designed system which is almost universally unpopular with doctors and patients. To date, only 13% of GP referrals to hospital are being made on the system, against a target figure of 80%, and this despite the GPs being given financial inducements to use it. Some 30% of patients who the GPs think they are referring never manage to complete the complicated booking process and are just lost in cyberspace.

Most remarkable of all is the extraordinary cost of he scheme; at present prices, over the 10 year lifetime of the IT contracts it will cost a remarkable £125 to make every patient appointment. That's not the cost of the treatment, that's just the cost of making the appointment.

Going private

Bedford Hospital NHS Trust is millions of pounds in the red. In a desperate attempt to balance the books four wards are shut and retiring consultants have not been replaced. Surgeons are instructed not to treat patients unless they have waited the maximum allowable waiting time. In short, the place is barely functioning as an acute district hospital.

So what do the managers do now? Amazingly, they are planning to open a private wing (allegedly to "subsidize NHS activity").

Would it not be better for them to learn to run a proper NHS service first?

Normal Service is Resumed

Sorry for the absence of postings, but I have been in Washington DC; I hope that some political skills have rubbed off.

While I was away I read a most amazing book "Plundering the Public Sector" by David Craig; it describes how the Labour government are squandering millions of pounds of public money on largely useless IT projects such as Connecting for Health.

I'll give you a little taster from the introduction:

The results so far have been disastrous - billions taken out of front-line services to be wasted on worthless consulting and failed IT systems. Already we have seen administrative chaos, massive increase in management costs... The government is paying around £30billion for a new NHS IT system that is already showing all the symptoms of becoming a catastrophic failure. This will cripple patient care for years to come.

Please read this book...but be warned, it will make you very angry