The slippery slope

This evening I attended a meeting at my local NHS hospital. These are public meetings and are intended to inform the public about the services the hospital delivers. The people who attend are typically those active in local patient support groups and FT governors also attend. These meetings are held once a month, and I usually attend every other one because they usually clash with another regular meeting that I want to attend and so I alternate them. At the meetings I have attended over the last five years, I have never seen a local politician (district or county councillor, or MP) attend these meetings, even though the topics are detailed informative and important to their constituents. I would have hoped that those councillors who sit on the Health and Wellbeing Board would attend these meetings, because it would give them an insight into the health issues in the area, and the issues of delivering healthcare to the entire population.

This evening's topic was phlebotomy, the taking of blood, and pathology, the testing of that blood. It was very interesting, especially the part where the manager told us that blood tests are done on the day the blood is taken and GPs are informed electronically as soon as the result is available: hence test results should be available for patients the next day, or within 48 hours at the latest, and not the situation my GP tells me. (I have a GP diabetic clinic in two weeks time and the surgery tells me I have to have a blood test at least two weeks before the clinic.)

At the end of the talk, the manager of the service moved onto to the topic of future developments, one of which was a domiciliary service. The conversation went like this:

Manager: We are looking into running a service where phlebotomists visit patients at home.Chair: Is this intended to be for housebound patients?Manager: Yes. However, there are some private plebotomists who provide the service for people who are not housebound - I think they charge about £15.Chair: There is no reason why we can't do that too. We could offer this service for those patients who would prefer to pay for the phlebotomist to visit them rather than them having to visit the hospital.

What the Chair was saying was that visiting the hospital is not convenient for many people (the Trust is rural, so some people have to travel quite far to get there) but those people willing and able to pay a fee could get around this inconvenience. Those without the money would still have to have the inconvenience. A two-tiered service.

This is the effect of the Health and Social Care Act. Currently the Trust has no private patients. The Chair of the Trust is thinking like a businessman, looking for new income for the Trust. A couple of years ago he would not have voiced this idea because it was simply not acceptable for NHS hospitals to think about delivering a two-tiered service, yet the H&SCA has legitimised this type of thinking. It is a slippery slope.

BBC's reporting of Hinchingbrooke

31 January 2012 BBC News website:

"If Circle makes a success of Hinchingbrooke, maintains NHS standards and pays off the debt, money can be handed over to the company's private backers."

Note the order: first Circle has to make a surplus, then it has to pay off the debt, and when all that has been done, finally, Circle get some profits.

Now we know the truth.

3 May 2012 BBC News website (filching the story from HSJ):

"If it succeeds in reversing the hospital's fortunes then the first £2m of any yearly surplus goes to Circle. It will then keep a quarter of any profits between £2m and £6m, and of third of those between £6m and £10m. All income above that level in any year will go towards paying the hospital's debts, currently £40m."

The actual contract gives a different order: first Circle has to make a surplus, then it takes the first £2m of that surplus, finally, if there is anything left, the surplus will go to pay off the debt.

So why is it that the BBC got the order wrong? The first version sounds so much better to the public, it sounds like Circle are being squeezed hard to make any profit. We know that Circle won't be squeezed. Indeed, HSJ have calculated that for Circle to pay off Hinchingbrooke's £40m debt they will have to make £70m surplus. That is, Circle will be handsomely rewarded by being paid almost £30m.

The first BBC article was published while the Health and Social Care Bill was going through Parliament. The Bill, now the Act, has a clause specifically to allow "franchises" like Hinchingbrooke. The government hopes that there will be many more such franchises* and the BBC, through printing government press releases, were helping to spin for the government. The government's aim was to make the Hinchingbrooke deal look better for the taxpayer than it actually was as part of their effort to get the Bill passed.

[* The next franchise is likely to be George Eliot in Nuneaton. There are three NHS bids for this trust, but the Strategic Health Authority, who have to agree to the final tender, have made it known that they would prefer a franchise with one of the private sector bids. The government ought to spend some time in Nuneaton: there is no support at all for a private sector franchise. The local Nuneaton MP, and the nearby North Warwickshire MP, are both Conservative, and have tiny majorities. If only for their sake, it is about time the Government reigned in the privatisers in the Midlands and East SHA cluster, because if this deal goes ahead it will be a significant factor at the next election.]

How did this happen? It's called churnalism: journalism by Press Release. The government manages the news agenda by releasing Press Releases, journalists re-word and publish the PR, in effect, saying exactly what the government wants to be said. This is not how journalism should work. Is it complicity? Probably not. There is a twin problem with today's journalism. First, twenty four hours news means that there is a huge pressure to produce a large amount of content, and second, the web and the public's reluctance to pay for content on the web, means that editors have fewer resources to provide quality journalism. When presented with a ready written article, an editor sees content for the gap they have to fill and all for free.

Journalism is in decline. When I started as a technology writer in 1996 it was a job that paid me to play with technology: as long as I wrote a report about the playing that I did, I could make a living. (At one point I was a columnist on three US magazines and writing features for two others.) Now most of the magazines I used to write for have closed down, and the remainder have moved to the web in an attempt to survive on online advertising. In response, I have crossed the Rubicon and I now write for the companies whose technology I used to write about: I provide the white papers which journalists will churn into their own content. This is modern journalism. In the past, my vocation was to point out where the technology failed and how to work around the failure, now my job is to show only how the technology works.

Churnalism removes all criticism, even constructive criticism, since it only reports one side of the argument. The result is that the public is doubly short-changed: they get poor journalism, and since there is a lack of criticism (even constructive criticism) services will not be improved. This is what we have seen with the churnalism from the BBC. If, at the time that the Hinchingbrooke deal was announced the BBC presented the whole story (in effect, doing the work that HSJ eventually did) then the law could have been phrased to ensure that in any franchising deal trust deficits - and the taxpayer - were put before profits.

Burnham Vindicated

Whenever Labour try to land a blow on Cameron over NHS funding, he always brings out the tired and incorrect statement that "we have protected the NHS budget; but Labour would have cut it". This is incorrect, but sadly Labour have failed to even both to refute it. I have given the details why this is incorrect on my NHS Future site.

The "evidence" for the Tory assertion comes from June 2010. Andy Burnham misinterpreted Cameron's pledge to "ringfence the NHS". Burnham (and, I suspect, most of the public) thought that would mean that the NHS would continue to get the real terms increases that is has had for the last 30 years. The Guardian reported this in July 2010:

He said he assumed the Conservative commitment on the spending would lead to extra NHS expenditure, amounting to more than 1% a year, coming to more than £4bn over the parliament, which would mean even larger reductions for schools and local government. 

Burnham, fully knowing that Osborne was intending to cut £80bn of public spending over the parliament spoke out saying that a 1% real terms increase for the NHS would mean cuts in social care, which themselves would affect the NHS:

"If this goes ahead [1% real terms increase in funding] they will hollow out social care to such a degree that the NHS will not be able to function anyway, because it will not be able to discharge people from hospital. If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support."

Now we find that Andy Burnham was absolutely right. This week the Daily Telegraph reported:

New figures from the Department of Health show that the total number of days patients have been delayed in hospital has increased by 10 per cent in the last month. The problem – often referred to as "bed blocking" – has increased 29 per cent when compared with figures from August 2010. Patients are frequently delayed in hospital and cannot be discharged until suitable care has been arranged, either in a nursing home or in their own home, to aid their recovery. Councils have faced significant cuts to their budgets and experts have previously warned there would be a knock-on effect on the NHS. However, patients can also be delayed because they need to be transferred to other hospitals.

This is exactly the problem that Andy Burnham was highlighting in 2010: if the government cuts local authority funding this will mean that there will be less money for social care and the result will be increases in delayed discharges: bed blocking.