Measuring Performance
Here's a thoroughly shameful article by Polly Toynbee which makes a mockery of the words 'political debate' by describing the health secretary Jeremy Hunt as the NHS bully-in-chief.
I would say that La Toynbee is an uncritical cheerleader for the Labour Party these days, and she seems to have forgotten that the last labour Government was responsible for ensuring that targets play a much bigger role in the NHS.
Rightly so in many ways because targets are a crucial way of measuring performance across a whole range of public services.
Because targets are good not a bad thing, generally speaking, although the key point is that they should not become an obsession and create tick box culture that loses sight of the big picture which is about patient care and customer satisfaction.
The real question that ought to be asked is how do some parts of the NHS do so well while others do so badly, comparatively speaking, when they both have the same resources.
But in Polly's world the role of independent Care Quality inspectors is to terrorise the NHS rather than look at services from the standpoint of patients which is a ridiculous statement and a cynically partisan one with a general election only 80 days away.
When I worked in a hospital's operating theatre years ago a speck of blood left on a patient trolley or on a piece of equipment was regarded as a really big deal, serious risk and a sign of someone not doing their job properly - and that was more than 30 years ago.
I detect a sense of desperation in the Labour camp and that's where I would place Polly Toynbee these days - campaigning for one side and a particular outcome no matter what the evidence says.
My local GP practice is excellent, by the way, and although I haven't asked I'd bet a pound to a penny that its medical staff earn a awful lot more that £60,000 a year.
Who dares confront Jeremy Hunt, NHS bully-in-chief?
By Polly Toynbee - The Guardian
The climate of fear is created by the health secretary. It’s no wonder doctors and other frontline staff increasingly feel like quitting
'When Jeremy Hunt calls to bully, chief executives should give an honest whistleblower’s reply: No, minister, it can’t be done.' Photograph: Oli Scarff/Getty Images
A “climate of fear” pervades the NHS, warns a report by Robert Francis QC. Over 19,000 NHS staff gave evidence that speaking out about poor care is a career-threatening risk. Jeremy Hunt, the health secretary, responded by promising a whistleblowers’ protection law before the election: “The message must go out that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.”
Quite right. But Hunt might ask where this “climate of fear” comes from? He points the finger at others below him, but bullying starts at the top. Every Monday at midday Simon Stevens, the head of NHS England, is summoned – along with the heads of Monitor, the NHS regulator and the Trust Development Authority – to name and shame any laggard hospital failing to hit targets. No 10 sends in Sir Jeremy Heywood, Eric Pickles and Francis Maude to oversee this: bad news from the NHS, and heads roll. Hunt hands it on down, personally calling the manager of any hospital breaching the four-hour emergency targets, or operation waiting times, and terrifying the life out of them. In his office he shows off his noticeboard with “Never Events” listing medical disasters, with no matching board for “Excellent Events” – all stick, no carrot. He is bully-in-chief.
Sadly, Francis’s 2013 report into appalling treatment at the Mid Staffordshire trust has increased the “climate of fear” he criticises in last week’s Freedom to Speak Up review. He called for tougher Care Quality Commission inspections, but these now make the NHS shudder. A coachload of 50 inspectors descend with anonymous numbers on their lapels, charging through looking for faults: terror is their mission. Small failings – a tiny blood spec on an emergency wall in one hospital I visited, for example – can result in a big black X on their results. This is understandable, for CQC itself is under intense pressure: the last head was sacked ignominiously, so everyone looks over their shoulder. Targets and league tables are useful, but in the NHS have become implements of torture. No wonder many vacancies for hospital chief executives go unfilled.
I’ve just spent a few days where Hunt’s buck stops, with a GP near Mexborough, outside Sheffield, to see life on the front line. Dr Krishna Kasaraneni, originally from India and the 34-year-old scion of a remarkable family of 14 doctors, is a partner in a practice short of two GPs. They have advertised; they’ve had no applicants.
Kasaraneni’s mentors were a GP couple, who had just left with their five children for Alberta, Canada; another GP has gone to Australia’s Gold Coast: each cost £400,000 to train. As chair of the British Medical Association’s (BMA) GP education, training and workforce committee, he sees the growing national shortage: there was a 6% drop in applications last year, 9% the year before, and many places left empty.
Why don’t doctors want to be GPs? The first thing to note is the relentless work: when I visited there were three-week waits for appointments. Kasaraneni arrives at 7.30am, stays until 7.30pm, with lunch an unhealthy white bap and crisps at his desk. On the phone and in person he had 42 morning patients, with four home visits; in the afternoon 46 patients, with 107 letters to read, 74 test results to examine, seven urgent clinical emails from consultants and a pile of prescriptions to sign. Each partner earns £60,000 a year, no longer fat-cat wages. But he loves it, and still makes each patient feel he has all the time in the world.
What good value we get when the NHS pays him just £120 per patient per year – less than a Sky TV package – and GPs provide 90% of NHS care. They are the magic ingredient that put the NHS top in the US Commonwealth Fund table for value, quality, access and equity.
On average patients visit 6.5 times a year, but I saw one mother bringing her healthy two-year-old for a 69th visit because “she has problems: she needs to me to say everything’s OK”. There was the drug addict trying to cheat a prescription; the old man who wets the chair; the depressive who said she was trying not to cry; the labourer with severe arthritis who needs to lose weight, the patients with coughs and colds – some indignant to leave without antibiotics; the three-year-old with possible autism; and the man with a skin complaint who says the walk-in centre near his job has a two-week wait (so much for walking in). On a home visit, we saw a 93-year-old. Her drug addict grandson lives with her and steals her money. “But I love him to bits,” she said. Kasaraneni’s practice awaits an imminent CQC inspection. Hardly what it needs? It needs staff and equipment to cope with rising numbers of people with multiple conditions: “We’re fire-fighting,” he says.
GPs used to command 10% of the NHS budget; that’s been cut to 8%. Nationally, 40% of district nurses have gone since 2010. Most hospitals are in debt, beds are cut to 2.95 per 1,000 people (compared with Germany’s 8.2). Meanwhile, 4,000 community mental health nurses are gone, plus 1,500 mental health beds. The tyranny of A&E targets results in operations cancelled to save bed space. Half our hospitals have 10% of beds blocked by social care cases, and that dovetails with 26% cuts in community care. The NHS has never suffered a squeeze like it: its average annual rise since 2010 of 0.6% is five times less than the average for the previous six decades.
Who should be blowing whistles loudest on all of this? Staff in the wards and the community, of course, but the loudest blasts should come from managers. They are under unbearable pressure to obey political targets, despite unprecedented per capita cuts in resources. When Hunt calls to bully them, chief executives should give an honest whistleblower’s reply: No, minister, it can’t be done .
The NHS is just holding together with a £700m pre-election bung, but the BMA knows the truth. Yesterday it launched its “No More Games” campaign to warn politicians that wheezes and quick fixes won’t do. Voters need to know about funding: the UK spends less than similar countries, and the NHS needs a lot more money.
Bullying from Hunt’s office is no substitute for cash. Still if he really believes there is “no place” for intimidation, he could first rehabilitate all those whistleblowers whose careers have been wrecked. Gut-wrenching stories were told by victimised doctors, nurses and managers at a BMA meeting last week: Charlotte Monro, an occupational therapist, was sacked for warning her local council health scrutiny committee about a 33% cut in beds for stroke patients at Whipps Cross hospital, east London. What will bully-in-chief Hunt do for her?
A “climate of fear” pervades the NHS, warns a report by Robert Francis QC. Over 19,000 NHS staff gave evidence that speaking out about poor care is a career-threatening risk. Jeremy Hunt, the health secretary, responded by promising a whistleblowers’ protection law before the election: “The message must go out that we are calling time on bullying, intimidation and victimisation which has no place in our NHS.”
Quite right. But Hunt might ask where this “climate of fear” comes from? He points the finger at others below him, but bullying starts at the top. Every Monday at midday Simon Stevens, the head of NHS England, is summoned – along with the heads of Monitor, the NHS regulator and the Trust Development Authority – to name and shame any laggard hospital failing to hit targets. No 10 sends in Sir Jeremy Heywood, Eric Pickles and Francis Maude to oversee this: bad news from the NHS, and heads roll. Hunt hands it on down, personally calling the manager of any hospital breaching the four-hour emergency targets, or operation waiting times, and terrifying the life out of them. In his office he shows off his noticeboard with “Never Events” listing medical disasters, with no matching board for “Excellent Events” – all stick, no carrot. He is bully-in-chief.
Sadly, Francis’s 2013 report into appalling treatment at the Mid Staffordshire trust has increased the “climate of fear” he criticises in last week’s Freedom to Speak Up review. He called for tougher Care Quality Commission inspections, but these now make the NHS shudder. A coachload of 50 inspectors descend with anonymous numbers on their lapels, charging through looking for faults: terror is their mission. Small failings – a tiny blood spec on an emergency wall in one hospital I visited, for example – can result in a big black X on their results. This is understandable, for CQC itself is under intense pressure: the last head was sacked ignominiously, so everyone looks over their shoulder. Targets and league tables are useful, but in the NHS have become implements of torture. No wonder many vacancies for hospital chief executives go unfilled.
I’ve just spent a few days where Hunt’s buck stops, with a GP near Mexborough, outside Sheffield, to see life on the front line. Dr Krishna Kasaraneni, originally from India and the 34-year-old scion of a remarkable family of 14 doctors, is a partner in a practice short of two GPs. They have advertised; they’ve had no applicants.
Kasaraneni’s mentors were a GP couple, who had just left with their five children for Alberta, Canada; another GP has gone to Australia’s Gold Coast: each cost £400,000 to train. As chair of the British Medical Association’s (BMA) GP education, training and workforce committee, he sees the growing national shortage: there was a 6% drop in applications last year, 9% the year before, and many places left empty.
Why don’t doctors want to be GPs? The first thing to note is the relentless work: when I visited there were three-week waits for appointments. Kasaraneni arrives at 7.30am, stays until 7.30pm, with lunch an unhealthy white bap and crisps at his desk. On the phone and in person he had 42 morning patients, with four home visits; in the afternoon 46 patients, with 107 letters to read, 74 test results to examine, seven urgent clinical emails from consultants and a pile of prescriptions to sign. Each partner earns £60,000 a year, no longer fat-cat wages. But he loves it, and still makes each patient feel he has all the time in the world.
What good value we get when the NHS pays him just £120 per patient per year – less than a Sky TV package – and GPs provide 90% of NHS care. They are the magic ingredient that put the NHS top in the US Commonwealth Fund table for value, quality, access and equity.
On average patients visit 6.5 times a year, but I saw one mother bringing her healthy two-year-old for a 69th visit because “she has problems: she needs to me to say everything’s OK”. There was the drug addict trying to cheat a prescription; the old man who wets the chair; the depressive who said she was trying not to cry; the labourer with severe arthritis who needs to lose weight, the patients with coughs and colds – some indignant to leave without antibiotics; the three-year-old with possible autism; and the man with a skin complaint who says the walk-in centre near his job has a two-week wait (so much for walking in). On a home visit, we saw a 93-year-old. Her drug addict grandson lives with her and steals her money. “But I love him to bits,” she said. Kasaraneni’s practice awaits an imminent CQC inspection. Hardly what it needs? It needs staff and equipment to cope with rising numbers of people with multiple conditions: “We’re fire-fighting,” he says.
GPs used to command 10% of the NHS budget; that’s been cut to 8%. Nationally, 40% of district nurses have gone since 2010. Most hospitals are in debt, beds are cut to 2.95 per 1,000 people (compared with Germany’s 8.2). Meanwhile, 4,000 community mental health nurses are gone, plus 1,500 mental health beds. The tyranny of A&E targets results in operations cancelled to save bed space. Half our hospitals have 10% of beds blocked by social care cases, and that dovetails with 26% cuts in community care. The NHS has never suffered a squeeze like it: its average annual rise since 2010 of 0.6% is five times less than the average for the previous six decades.
Who should be blowing whistles loudest on all of this? Staff in the wards and the community, of course, but the loudest blasts should come from managers. They are under unbearable pressure to obey political targets, despite unprecedented per capita cuts in resources. When Hunt calls to bully them, chief executives should give an honest whistleblower’s reply: No, minister, it can’t be done .
The NHS is just holding together with a £700m pre-election bung, but the BMA knows the truth. Yesterday it launched its “No More Games” campaign to warn politicians that wheezes and quick fixes won’t do. Voters need to know about funding: the UK spends less than similar countries, and the NHS needs a lot more money.
Bullying from Hunt’s office is no substitute for cash. Still if he really believes there is “no place” for intimidation, he could first rehabilitate all those whistleblowers whose careers have been wrecked. Gut-wrenching stories were told by victimised doctors, nurses and managers at a BMA meeting last week: Charlotte Monro, an occupational therapist, was sacked for warning her local council health scrutiny committee about a 33% cut in beds for stroke patients at Whipps Cross hospital, east London. What will bully-in-chief Hunt do for her?
