Wednesday, March 16, 2011

NHS & Starfish: Evolution or Revolution

Sea Stars in Bocas del Toro, Panama ©Am Ang Zhang 2011

There is so much we can learn from the Natural World.

Take the Sea Star (Starfish), it is one of the most highly evolved creatures there is. Fisherman chopped them up and threw them back in the ocean. Each piece will regenerate into a whole star.
Most Sea Stars also have the remarkable ability to consume prey outside their bodies by using tiny, suction-cupped tube feet, they pry open clams or oysters, and their sack-like cardiac stomach emerges from their mouth and oozes inside the shell. The stomach then envelops the prey to digest it, and finally withdraws back into the body.


Sea Stars that are stuck to underwater part of ships will break off small metal parts from the ship. The strength of this adherence is just as equal as the strength of the very metal. This glue is resistant to high temperature, acids, bases and solvents. It is possible this glue will one day be of interest to dentists and ophthalmologists because it does not change its properties in an aquatic environment.

Back on land, humans are not doing as well:

Q 21 Phil Wilson (Sedgefield) (Lab):  One of the main tenets of the Bill is ultimately to hand over to GPs a budget equivalent to the GDP of Hungary. Is that evolutionary or revolutionary? 
Sir David Nicholson: If you think at the moment that almost every PCT has some kind of practice-based commissioning arrangement set in it, where GPs have got real control over resource utilisation, you can see how you can build on that to get us somewhere; but of course the point I would make is that the consortia do not get their budgets until 2013. It is not as if they get them tomorrow. We have got some time now to work through and understand better what works and what doesn’t work; to hone the arrangements that we have and build capacity in consortia, so that by the time we get to 2013 we are in a position to authorise them. We are not just going to give them the money as a matter of right; they are going to have to demonstrate to the commissioning board that they can fulfil their responsibilities, through the authorisation process. 

Q 22 Phil Wilson:  So is it revolutionary or evolutionary? 
Sir David Nicholson: I think it is neither. I think it is bold and imaginative.

Q 23 Phil Wilson:  Bold and imaginative; a very nice way of putting it. So we are essentially going from first gear to fifth gear, missing out second, third and fourth, really. You have said yourself it is the largest reorganisation ever—you can see it from space. 

Sir David Nicholson: I am not going to underestimate how large it is. It is a significant change. I was in Tipton on Friday, where the consortium has been working through practice-based commissioning for some time. It is taking full responsibility for the budget from 1 April 2011 and is geared up and well capable of doing that. It has the experience. In some parts of the country they are a long way from doing that. Part of my job is to get them to a place, by 2013, where they are capable of doing it. 

Q 24 Phil Wilson:  The perception that is given with the Bill and what we read about in the press and hear in speeches is that it is like devolving the NHS to GPs and making it more globalised, essentially. Obviously the GPs know what is going on in their area—but you have a national commissioning board at the same time. You have said yourself in answer to a previous question that you will end up employing local people to administer all this. Does that mean you will end up re-employing people who have been made redundant from PCTs? 

Sir David Nicholson: There is a whole load of questions in all of that. The thing about the changes is—you are right—that they involve significant devolution and more local accountability; however, they involve some centralisation, in a way that will give patients more consistency and a clearer set of quality standards about the service that they provide. So with national quality standards all that sort of thing will provide consistency across the country for delivery. The point that you made is right: we will have local people administering parts of the system, but they will do so as part of a corporate whole—a national service that will deliver locally.

Will we ever employ people who have been made redundant by PCTs? Part of the process that we are going through and the HR system that we are trying to put in place is to keep that at an absolute minimum. We have had a series of schemes. We had the mutually agreed resignation scheme, and will have a second one. We are to have a scheme that keeps people who could take redundancy, making them stay another couple of years. That is what we need to do, because the last thing we need to do is spend money on redundancy and then re-employ people. We want to avoid that as far as we can.

Q 25 Phil Wilson:  So what you are saying is that it is the PCT structure by another name.

Public Bill Committee 
Tuesday 8 February 2011  

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