Wednesday, July 31, 2013

NHS & Lewisham: Barricades & Bloodshed!

Expect further bloodshed as A&E reorganisation leads to departments being replaced with low-key urgent care centres.

But the reorganisation of stroke and trauma care happened below the radar. A&E is highly visible. NHS medical director Sir Bruce Keogh will soon put forward plans to rationalise it, which will have to mean closing some hospital departments and replacing them with low-key urgent care centres.

Politicians inevitably join their constituents at the barricades to defend local services, as they did at Lewisham and in north-west London, where there are also closure plans. Consensus seems impossible. Bloodshed is far more likely.

Plans to slash services at a successful London hospital have been declared unlawful, in a blow to the health secretary Jeremy Hunt, which could have major repercussions for future NHS hospital shake-ups.

In an unexpected triumph for local campaigners, a High Court judge ruled yesterday that cuts at Lewisham Hospital, approved by Mr Hunt earlier this year, should never have been recommended in the first place.

NHS A & E: Lewisham downgrade!

A genius has decided you can have a 75% heart attack or stroke as he has decreed that Lewisham will run a 75% A&E department. Wow!

The truth may be simpler: in an internal market system soon to be exposed to external market forces, A & E is the only department where CCGs have very little control over. Punters, (sorry patients) still hope they might see a real doctor at the A & E (soon to be ¾ doctor). Government figures showed that attendance figures are not dropping.

Punters have little faith in OOH services and UCCs as well and can you blame them? In health care, death is certainly not reversible.

So the genius has decided not to use UCC for Lewisham and that is why he is a genius. But when the rumour is that the rest of the hospital will gradually be “3-quartered”, call it anything you want.

In time over a third of A & Es will have to be downgraded to reverse the rising trade! Read more in a previous blog post:

NHS A & E: Unpredictable, Unruly & Ungainly

As I wandered through the forests of Sibelius' Finland, I marvelled at how well the different plants co-exist in an integrated fashion. 

Why can't our NHS be integrated like this forest? With berries and mushroom growing in abundance! Looks like our A & E departments will be the first of the Hospital Services to be culled. 


 ©Am Ang Zhang 2012

It must be hard to believe that with the number of highly paid management consultants working for the government that any apparent oversight is due to cock-up rather than conspiracy. Yet reading through the Select Committee reports one begins to wonder.

Could it be that for too long, accountants dominated the NHS reforms and somehow nobody took any notice of what the doctors are saying anymore?

On the other hand, could the need to pass health care provision to private providers before anybody could raise enough objections be the reason or was it simply a means to contain cost and let the patients blame their GPs?

Can politicians really blame us for not trusting them? They did in Japan, didn’t they?

A & E (ER to our US readers) is perhaps something accountants would like to get rid of. It is unpredictable, unruly (literally) and ungainly as there is a need for the specialist backups. In the era of PCTs and Hospital Trusts, serious battle is fought around A & E. The silly time limit set has caused more harm than the good it is suppose to achieve. That many major A & E departments are staffed by Trust staff and the new GP Commissioners will try their best to avoid paying for A & E attendance & any unplanned admission. 

All too messy.

Hospitals tried their best to make more money from A & E and admissions in order to survive. Where is the patient in this tug-of-war of primary care and Hospitals!

What happens when there is a major E. Coli disaster. Who is going to pay for all the dialysis?

There is no better illustration to the wasteful exercise then in all of this internal market and cross charging during recent years and one must be forgiven for concluding that the purpose was to allow private involvement in our National Health Service.

We must be forgiven for not believing that all these AQPs are not great philanthropists and are all there not for the profit but for the common good.

Christmas and New Year will be here soon. The count this year is that over 20 million patients would have attended A & E: A rise from 12 million around 10 years ago!

It is not difficult for anyone in the NHS to see how the internal market has continued to fragment and disintegrate our health service.

Look at major hospitals in England: Urgent Care Centres are set up and staffed by nurse practitioner, emergency nurse practitioners and GPs so that the charge by the Hospital Trusts (soon to be Foundation Trusts)  for some people who tried to attend A & E could be avoided. It is often a time wasting exercise and many patients still need to be referred to the “real” A & E thus wasting much valuable time for the critically ill patients and provided fodder for the tabloid press. And payment still had to be made. Currently it is around £77.00 a go. But wait for this, over the New Year some of these Centres would employ off duty A & E Juniors to work there to save some money that Trusts could have charged.

A decision is expected later on plans to close the Accident and Emergency department at Lewisham Hospital in south-east London and downgrade its maternity unit.
The proposal came after neighbouring South London Healthcare NHS Trust (SLHT) ran up debts of £150m.

What hope is there for the NHS when a hospital without the problems of Mid Staffordshire face downgrading? Would it not be better for bankruptcy and a true default of the PFI? Or should we bankrupt the government?

After all, Metronet did, didn't they?

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