The coalition NHS shakeup Page 7

  • Tom_Servo 26 Mar 2012 21:36:09 18,079 posts
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    If you look at Ben Goldacre's Twitter account, it seems an early version of the NHS risk register has leaked.

    This is not a good time for the government (unless this is meant to distract from 'Cash for Cameron', of course).
  • chopsen 26 Mar 2012 23:05:43 19,995 posts
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  • Tom_Servo 26 Mar 2012 23:06:56 18,079 posts
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    Have you had a look at it, Chopsen?
  • chopsen 26 Mar 2012 23:15:58 19,995 posts
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    Yeah. A lot of if indicates that surrendering control to local CCGs means they'll have less control over quality and spending(duh). In fact, there are concerns in that document that services could be more expensive, and could possibly be worse (though it doesn't specify which would be more at risk, apart from saying the new system may be more difficult to navigate for patients). In multiple areas there is a risk that reforms will be poorly managed and the resulting system will be, well, shit.

    It quite openly states that many organisations could fail as a result of the reforms, and that GP CCG could go bankrupt.

    It does not state specific groups of patients that could be affected, which is what I thought it was. It basically says "it could very easily go wrong and we'll look stupid." There are no mitigating factors against the things which, imho, are more likely to be problems.
  • Deleted user 26 March 2012 23:18:28
    HMT risks (treasury?)
    > Inability to reduce running costs because of consortia
    numbers [System Design, Commissioning, Finance?].
    > Loss of clinical time by GPs due to consortium
    management responsibilities [Commissioning].
    > Failure to manage referral demand (insurance risk)
    > Financial instability in on-balance sheet providers if GPs
    successful in reducing hospital admissions [Finance,
    > Historic deficits left unmanaged [Finance?].
    > Postcode commissioning [Commissioning?].
    > Increase in catastrophic failure with no system
    management [Sytem Design?]
    > QIPP failure esp in area of changed clinical practice in long
    term conditions [NHS Coordination & Integration - JE?]
    > GPs manufacture increase in their remuneration by playing
    the system [Commissioning?].
    My bolding.

    Public reputation. There is a risk that the transition will be
    presented in a negative light via the media. Two of the
    biggest risks which have already surfaced in the media are i)
    that the reforms will continue to be characterised through the
    prism of privatisation and ii) financial cuts.
    No mitigating action listed for that one. Ho ho.

    Doesn't cover the recent changes, but tbh I still don't understand the thing anyway.
  • spamdangled 26 Jun 2012 10:16:22 31,614 posts
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    With all this stuff in the news today about (basically) declaring 22 NHS Trusts insolvent, does anyone else think this is just another way to get the Private Sector in public services?
  • Deleted user 26 June 2012 10:20:42
    Most would be out of money because of what labour did so probably not.
  • TheSaint 26 Jun 2012 10:22:35 17,702 posts
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    Isn't it Labour's rubbish PFI deals that are causing all the problems anyway?
  • chopsen 26 Jun 2012 10:22:39 19,995 posts
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    Patricia Hewitt said when labour were in power that trusts had to balance the books and would not be bailed out. Presumably this is just that policy coming home to roost.
  • Deleted user 26 June 2012 19:02:57
    The great thing is that the taxpayer continues paying the horrible PFI part, leaving an attractive cash-generating business up for grabs. Kerching!
  • Khanivor 26 Jun 2012 19:46:10 43,757 posts
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    Evil Tory scum privatising the NHS.

    Oh. Wait.
  • Deleted user 26 June 2012 23:09:58
    Maybe evil establishment scum privatising the NHS is more accurate.

    It's a great shame that the majority of politicians on any side seem to be utter cunts of the first order, beholden to money and ego rather than anything noble.

    Has it always been that way or is it worse now somehow?
  • 4gate 26 Jun 2012 23:47:20 362 posts
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    It is much, much worse.

    Foot, Benn and co vs Thatch, Tebbit etc was the last proper ideological battle in this country, then the Tories spun Kinnock out of his go, Labour worked out what spin was, and now it is just, as you say, a bunch of utter cunts out to enrich themselves. Professional politcians, out for a career in lying, at any cost, with all the social conscience of Jimmy Carr, to use a recent example. The Tories ofc tend to be rich in the first place, but the efforts of Tony, Mandy, Blindy and the rest have done much to level things up. The expenses scandal was a thoroughly cross-party affair, both in the greed before the fact and the indifference after.

    If one person is to blame, perhaps Bernard Ingham would be close to the top of the list. Whilst there were a lot of professional liars in politics before him, he seems to me to be one of the first who was absolutely bare-faced about it, who first used lies on a daily rather than occasional basis, forcing Labour (after a few outright disasters) to react in kind.

    If one person personifies everything that is bad about modern politicians, it is Tony Blair, who not content with being PM in the first place, wanted to be a statesman, with the result that this country participated in half a million murders in Iraq, based on an outright lie, which might yet catch up with him, though that seems very unlikely, because all the relevant documents are secret.

    The current shadow Chancellor and chums were involved in many of the PFI deals (not included in any national debt figures, handy that) now crippling NHS Trusts, based on plans put together by consultants under the Tories before them. In return Labour spent millions on consultants to investigate privatising (only backroom, honest guv) Police services, now giving the Tories something to do. They have both thoroughly fucked the railways, the buses, army housing and any number of other areas, creating companies where the directors take huge profits (80m to the owners of Stagecoach last year, mostly government subsidised) and the state covers any losses. All of these companies have boardrooms which welcome ex-politicians regardless of hue, it looks good on the letterhead.

    What mystifies me is why anyone would vote for any of them again, ever.

    Edited by 4gate at 00:56:17 27-06-2012
  • chopsen 11 Apr 2013 14:02:38 19,995 posts
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    This went live on the 1st of April btw. No more PCTs. Clinical Commission Groups free to commission whatever from whoever.

    Amazing eh? So any day now, it's all going to go to shit.
  • speedofthepuma 11 Apr 2013 14:05:52 13,418 posts
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    Wish you were here.
  • chopsen 11 Apr 2013 14:09:45 19,995 posts
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    I am currently working to performance based contract I signed last month with an organisation that no longer technically exists, to meet standards published for the first time a fortnight ago, using a software reporting system that hasn't be released yet, to be recorded using data codes that haven't been announced.

    So how are things over there?

    Edited by Chopsen at 14:10:15 11-04-2013
  • speedofthepuma 11 Apr 2013 14:11:38 13,418 posts
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    Everything's upside down, it's sunny all the time and money grows on trees.

    Are you going to come and visit for a holiday?
  • chopsen 11 Apr 2013 14:15:25 19,995 posts
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    Yeah, at some point. You do live really far away though, making it a bit of a faff.
  • speedofthepuma 11 Apr 2013 14:16:33 13,418 posts
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    I have a granny flat though.

    And a turtle. So, there's that.
  • cubbymoore 11 Apr 2013 14:16:37 36,688 posts
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    My gf was a temp for the NHS. She had her contract terminated with a weeks notice because HR were under the impression that as she was about to have been there for a year, they were obligated to grant her certain rights like being able to claim for unfair dismissal. So it's good to know that they have their priorities straight. Her bosses were desperate to keep her as she was one of the few PA's who knew how to do the job properly, but HR overruled them...

    Not to mention the fact she was a temp, so she wasn't an employee anyway, so those rights wouldn't have applied to her in the first place. So yeah, the NHS is not in a good place at the moment.
  • chopsen 11 Apr 2013 14:21:38 19,995 posts
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    Nah, even if you're a temp, if you're [s]employed[/s] working in one place long enough you gain employee rights as you are regarded as being employed. It's a tax dodge to have temps effectively act as employees.

    They didn't have to get rid of her permanently though. All they needed to do was say don't come to work for a month, and it'd be fine. (apart from the fact she still had no employee rights.)

    Edited by Chopsen at 14:23:37 11-04-2013
  • cubbymoore 11 Apr 2013 14:26:15 36,688 posts
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    They could have also given her more notice.

    Can't see anything about after a year here. Only after 12 weeks. Surely if this was a thing it would be up there.

    Edited by cubbymoore at 14:33:51 11-04-2013
  • chopsen 11 Apr 2013 14:45:00 19,995 posts
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    Oh ok, maybe it's 12 weeks. Didn't realise it was that short.

    One of the rights you don't have is notice period and redundancy pay. Also your "employer" doesn't need to pay employer's NI contributions, so it's a cheeky way of getting cheap staff you can get rid of easily.

    Edited by Chopsen at 14:45:18 11-04-2013
  • cubbymoore 11 Apr 2013 14:49:57 36,688 posts
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    Yeah, the NHS is going to do a lot more of it by the looks of it. Hopefully, not all the HR directors will be as clueless and shed good workers after a year because of people getting goddamned rights. But then this is the NHS.
  • spamdangled 11 Apr 2013 14:59:53 31,614 posts
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    Wasnt there a thing a whle back that the law had been changed to grant temps the same rights as regular works after a certain period of time?

    IIRC, it was after a year...
  • Deleted user 11 April 2013 15:30:20
    Yes, which makes it all the more important to ensure no contract lasts a year or more. :/
  • Deleted user 11 April 2013 16:36:50
    Yeah, you'll regularly find things like 11 month contracts for shitty jobs on jobsearch sites.
  • mal 29 Mar 2014 01:51:54 29,326 posts
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    I was in the doctor's earlier, and picked up a leaflet in there (snappily titled 'IMPORTANT CHANGES TO YOUR MEDICAL RECORDS') concerning the current government NHS computer project, the HSISC database, or The government sent me a leaflet a few weeks back ('Better information means better care') about this which outlines in nebulous and generic terms that collating patient information can be a good thing, while this pamplet rather highlighted the opposite side of the argument - namely that this being in this system or not won't mean your care is affected in any way, that it's not defined at this point who can access the database, and that if you opt out now you can always opt in later, while you can't do it the other way round. It is slightly scarily written, in that it is written to suggest that private companies will be able to see your medical records, BMI, drinking habits and all sorts without actually saying that in one sentence - it doesn't mention that such commercial access to the database should be anonymised.

    I don't really have an opinion on the worth of this database or not, although it's a good point that you can always opt back in later, I'm just a little surprised to see such stiffly worded stuff in an official NHS outpost. Guess they're not so keen on the plan either.
  • Kami 29 Mar 2014 07:10:58 2,663 posts
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    @mal; To be honest, it's administrative bollocks really. The problem about centralising all data isn't just that it can be accessed elsewhere where necessary; it's that getting second opinions could be THAT much harder!

    A second opinion often relies on a doctor making a fresh appraising based on your symptoms; I wonder if a centralised system may rob people of that option, seeing as any doctor can access it and may choose, for the sake of ease or perhaps not to shake the boat, to simply go along with a current diagnosis?

    Who uses the data is, at this stage of my life, of rather little consequence. But I did get a second opinion; it took a while, and it wasn't the news I wanted. But I can deal with that information now (although I admit, my siblings are currently; "Five years could be fifteen! You never know! You may even get a transplant" rather than, "Let's at least consider the possibility that life is precious, fleeting and we should prepare for the real possibility that we may not have all the time in the world.") - how many misdiagnoses will come about from doctors continuing a mistaken diagnosis? Or by not listening to the patient in front of them, because they have read notes beforehand?

    I do think there are many good doctors who will at least continue to listen to their patients; but that said, I know I've had a few who frankly couldn't prescribe a map out of their own arse. It's about listening to the patient; surprisingly, a patient may know more about how they are feeling than medical notes would suggest. Who knew?

    I just kind of hope in some sense this doesn't encourage shortcuts...
  • Deleted user 30 May 2014 14:00:46
    New boss, new idea.

    Or -being less kind- new boss, old idea, which we were told was inefficient and didn't work as recent as a few years ago.

    Maybe the 'new' part is knocking down the old small hospitals and building new small hospitals using PFI, which guarantees higher quality of care and a sustainable long term financial footing, as we all know.

    Edited by Bremenacht at 14:42:47 30-05-2014
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