New directions

This blog has been running for nearly two years. In that time it has had some real successes - stories have been taken up by Sunday Times, Sunday Telegraph, Daily Mail, Private Eye (twice) to name just a few. Other stories have moved onto major political websites such as Guido Fawkes.

We have certainly exposed some of the nonsense of a target obsessed NHS.

But times change. The message has been put centre stage. At the same time, a few people have taken things rather personally, which has never been our intention; in any case, blogs are getting a bit "old hat".

For that reason, we are going to post much less frequently. There are other, perhaps better, and certainly more subtle means of getting the message across. We shall use them.

To paraphrase George Orwell "Big brother, we are watching you". The campaign is moving to a new and better level. We have never been more confident of success.

Ho, Ho!

I've just re-read this Q&A that the Independent conducted with Gordon Brown on 27 June, 2007. One of our Dear Leader's responses jumped out at me. Here it is, with the question that prompted it:

How will life be different under a Brown government?
JOHN BROOKS, by email

I will let you answer that question in a year's time. I hope you'll say you feel safer on the streets and more prosperous, more confident in your local schools and hospitals, and you'll have a bit more trust in the political system.

More choose and book nonsense

Despite Choose and Book becoming available to most GP-referred patients to choose a hospital appointment, two thirds of patients surveyed by University College London were given no choice of date or time. Just under a third had no choice of hospital, and 86 percent had a selection of fewer than four hospitals.

Choose and Book started to go live in January 2006, and allows patients referred to hospital by their GPs to choose the location and time they visit, while at the GP surgery, online or on the phone.

It is part of the much-delayed £12.7 billion NHS National Programme for IT, which will replace paper patient data with centrally stored Summary Care Records, provide an electronic prescriptions service, and allow online booking of hospital appointments.

UCL surveyed 104 patients who had used the system for referral to Hillingdon hospital in London, for its report, ‘Does Choose & Book fail to deliver the expected choice to patients?’. Only one patient was offered the four options promised by the scheme.

Patients trying to book online also experienced some technical problems, UCL said. As a result a number of patients were unable to book online, and ended up ringing the booking line or going back to their GP to book the appointment.

The report also warned that there has been “considerable bad feeling associated with Choose and Book with criticism about risks to patient confidentiality, reliability and speed”.

Dr Henry Potts at the UCL Centre for Health Informatics and Multiprofessional Education, who oversaw the study, said Choose and Book was a vital system because patient choice has regularly been touted by the government as central to NHS transformation.

But he added: “It is clear from these results that these patients were not experiencing the degree of choice that Choose and Book was designed to deliver.” This “could be typical” of the system around the country, he said.

The NHS had not even attempted to find out whether patients liked the system, Potts warned. “It is striking that nobody, up until to this point, has actually asked patients about their experience of the system,” he added.

There are also concerns over patients’ understanding of the system, UCL said in its report. Nearly two thirds were not aware they could choose the hospital they visited. Potts said: “This study also raises many wider questions such as what patients understand by choice and, indeed, whether they actually want choice.”

An NHS spokesperson said he recognised the results in the survey, but preferred to point to another a more recent report, which said 67 percent of Choose and Book users were able to go to the hospital they chose.

Polyclinics, what's really going on?

Ministers have repeatedly insisted that government plans for 300 super-surgeries, housing up to 25 GPs, will not be imposed, but agreed through consultations with local communities.

However, information gathered from primary care trusts (PCTs) leaves those pledges in tatters.

Half of the PCTs that responded said they would not consult on plans to build centres and some cited advice from the Department of Health as the reason for their decision.

The disclosures, from 100 of England’s 152 PCTs, appear to render meaningless recent promises by Alan Johnson, the Health Secretary, who said last month he would “insist” that all decisions on the centres be “taken in consultation with local people”, later adding that there was “no argument for imposing” the plans.

Andrew Lansley, the shadow health secretary, said the new information, gathered by the Conservatives under the Freedom of Information Act, demonstrated the Health Secretary’s pledges to be “no more than spin”.

Mr Lansley said: “Labour has claimed that they are not imposing polyclinics on local people, but these figures expose that lie for what it is.”

The BMA said this confirmed its fears that a policy that could push smaller practices out of business was being forced through, regardless of opposition.

The disclosures show that just 44 of the 100 PCTs that responded intend to subject their plans to formal consultation. Six have yet to decide, while 50 said they would not be consulting the public.

Several mentioned DoH advice, quietly issued in January, that there is no legal obligation to carry out a formal consultation, and that it is a matter for local discretion. Others said they could not consult on something which was a Government directive, or that they had not been given the time to seek the views of the public.

The Government is spending £250million introducing polyclinics, which will bring groups of GPs together in large centres offering services such as minor surgery and diagnostic tests. Each PCT is expected to create at least one in its area.

So far, the plans have encountered opposition from doctors and patients. More than one million people signed a petition opposing the policy.

The Conservatives claim as many as 1,700 practices across England could be forced to close as a result of the move.

Ministers have repeatedly said that while the plan to introduce 300 new practices across the country, including 150 in London, is government policy, proposals about where they are sited, and what each scheme involves, should be subject to local consultation.

England’s 152 PCTs have until the end of next month to draw up a shortlist of bidders to run the new services. Big businesses such as Sir Richard Branson’s Virgin Healthcare are expected to enter the market, while others will be run by groups of GPs.

Mr Lansley said: “Rather than attempt to debate polyclinics with local people and win them over with the facts, Labour has instead resorted to spin and obfuscation. They know how unpopular their plans to shut down local GP services are, and are simply running scared.”

Dr Beth McCarron-Nash, of the BMA’s GP committee, said they had repeatedly warned that much of the consultation had been patchy and that without proper debate, centres would be built in the wrong parts of the country.

The Department of Health said all PCTs had been told it was their legal duty to “involve” patients in the planning of services, and those who had not done so formally had used focus groups and road shows to involve the public.