More than:
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
A & E (ER to our US
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 one of the most contentious parts of the NHS reforms. Both the College and the King’s Fund have consistently questioned the evidence base and the clinical and cost effectiveness for this major policy change2 3. Surprisingly many of the NHS pathway groups still recommend such units. The public will be very confused by the desire of some Clinical Commissioning Groups (CCGs) to re-name the ED as an “Urgent Care Centre” for ambulatory patients.
The perceived problem that CCGs are trying to solve
There is a perception that many patients attending the ED should be treated in primary care. The College’s view is that a relatively small number are clearly non-urgent primary care problems that should have been seen by their general practitioner. A larger group of patients with urgent problems could be seen by primary care if there was timely access to the patient’s GP or out-of-hours services - e.g. at weekends. The College believes that improving access to GPs is the best way of dealing with this issue. At most we think that 25% of ED patients might be treated by general practitioners in an ED setting. There is no evidence to support the contention that 50-60% of ED attendances can be treated in Urgent Care Centres.
The approach of setting up an urgent care centre in front of every ED is an example of demand management. This has already been shown to be unsafe when tried in the USA
This is certainly not how Kaiser Permanente would run things: all integrated and no such thing as “cross charging”. In fact the doctors are not on a fee-for-service basis but like Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital
Q143 Chair: No. I am sorry. My point is that if, as a commissioner, you have to have A&E and you have the power to defend whatever is required to deliver A&E, why do you need a power to designate?
Dr Bennett: On the designation question, the issue there is what happens if the provider of the service is the only provider of that particular service that is available to its local community but the provider gets into difficulty. Designation is all about making sure that there is continuity of the provision of the service even if the provider themselves gets into difficulty where there is no alternative provider.
On the integrated care for A&E, yes, there are similarities. I think the critical issue is where you draw the boundaries. If you finish up in a situation where you define the boundaries around A&E as being the whole of the DGH, then you have somewhat frustrated the policy, but I don’t think that should be necessary.
Dr David Bennett is head of Monitor and is NOT a medical doctor.
"Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the DH but not published by it estimated these to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed. We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time."
See Prof Waxman in an earlier post:
The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford , when it is not Oldham or Oxford
…….Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.
2 comments:
Thank you , as a nurse I worked briefly in an urgent care centre & referred to it as the emperors new clothes, what a monumental waste of time ( for the patient) and money. I have a suspicion that using nurses as docs is a false economy, I hope there are some long term studies of patient outcomes being done somewhere. I worked with some excellent nurse practitioners but also with some downright dangerous ones. Managing and prescribing for long term conditions or in specialist areas is OK but I dint feel the course nurses undertake in anyway is enough preparation to make diagnoses .
Also unless it was a minor illness patients eend up having to go to a & e or back to gp for follow up.
I as a junior doctor learnt a lot from nurses. We all have a role to play in the care of our patients and we have our different responsibilities. What is happening now is very sad for patients and sadder still, the govt. pretend not to know.
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