Tuesday, August 30, 2011

Ministers Try To Shift Blame To GPs & Nurses For NHS Failures and For Rising Waiting Times

One of the first things the Conservative  Health Secretary, Andrew Lansley did within the NHS upon taking office, was to abolish the 18 week referral to treatment target which had been implemented by the previous Labour government.  Nothing is ever perfect and some clinicians thought that targets interfered with clinical decision making because some patients needs would always be more urgent than others. However, in this case the benefits of having this target outweighed the drawbacks. The initial drawback was not an insurmountable problem as GPs and hospital clinicians always had the option of using their initiative and discretion when considering people for appointments etc. For those patients suspected of having a more serious conditions such as cancer or a heart condition, the previous Labour government had also introduced the right for patients to be seen by a consultant more urgently - usually within 2 weeks of being referred by their GP.

When abolishing  the 18 week target Andrew Lansley maintained that lifting the target would have limited effect upon waiting times, all things considered, it is hard to try and understand how he arrived at that decision as before the 18 week target was introduced people were waiting many months for an hospital appointment, and it was for this very reason that the 18 week referral to treatment target was introduced in the first place! After the introduction of the target most people were seen within the target time and waiting times fell dramatically so it was seen as very successful.

Before the Conservatives took over and the NHS was still reasonably funded and waiting times had been brought under control, perhaps GPs and hospitals could have worked together to remove the targets, and provided patients were being seen appropriately and timely manner the NHS could have moved on and replaced targets with their own innovations in order to keep waiting times down, nothing is set in stone and the NHS will innovate itself given the chance. However, that action has now been made impossible by the government forcing hospitals to cut their budgets by a collective £20 billion. By forcing hospitals to "save/cut" £20 billion  is why we are seeing hospital waiting times now beginning to rise sharply. In any case funding cut or no funding cut, wouldn't it have been altogether better idea and more thought out and planned if Mr Lansley had trialled removing the targets in certain areas judging how the trial areas went *before* rolling it out nationally?

No matter how the government tries to "spin" it the Treasury (Chancellor Osborne) has cut funding to the NHS by £20 billion. When Cameron, Lansley and Clegg announced their "listening exercise"  they preferred to call it "savings", however, call it what they will "cuts" or "savings" at the end of the day the government is forcing the NHS to make "savings" of £20 billion and that will result in money *not* being spent in the health service and even if it us used in another part of the NHS it doesn't change the fact that the NHS has to try and manage on £20 billion less and that it will ultimately lead to a major impact and cuts in patient services somewhere within the health service.

This is now evident as we see cracks appearing all over the NHS and especially in patient waiting times. Freeing PCTs from the 18 week referral to treatment target may have been OK when the NHS has ample funds under the previous labour government however, figures now prove that  the proportion of patients made to wait longer than 18 weeks has increased along with the average waiting times, and that is very bad news for patients waiting for a diagnosis at an often very worrying and distressing time. Andrew Lansley's rather  laissez-faire decision to get rid of the target  as soon as he was installed as health secretary in the Department of Health is proving to be an ill-thought out premature and foolish decision, one born out of ignorance and inexperience.
Bizarrely, just like his colleague chancellor George Osborne tried to blame the snow for the economy's poor performance,  Andrew Lansley also tried to blame the snow for longer waiting times  when the health charity The Kings Fund also warned about increasing waiting times!
It is now an indisputable fact that people waiting on lists to be diagnosed has increased by ninefold in the past 15 months since Mr Lansley abolished the 18 week GP referral - to treatment target.
  "The NHS Confederation, which represents managers across the NHS, warned the gains that had been made to reduce waiting times were already being lost as finances were squeezed, and that NHS managers were concerned about a ‘deterioration in standards' The number of people waiting more than 13 weeks for one of the tests. In June, there were 1,763 people waiting more than 13 weeks, up from just 190 in June 2010.
The DH figures show that in June, there were 12,521 people waiting more than six weeks for one of 15 key tests, including MRI, CT and heart scans, ultrasound, barium enemas and colonoscopies. This is up on the 3,510 waiting more than six weeks in June 2010".

The NHS Confederation is a respected body and it isn’t  usually known for speaking out and causing problems where none exist so when it starts warning of the dangers of ‘further declines in access to appointments and treatments perhaps we should all start sitting up and take notice? 
The problem now is that it will be GPs who are likely to be blamed for the increase in waiting times and on several different fronts  (some of which are already happening).
Delay to diagnosis is already the most common cause of legal action against GPs and claims against GPs have jumped by a fifth in the last year. View the latest statistics from Medical Defence Union  Here..
GPs will be blamed for long waits for diagnostic tests as NHS waiting times Increase.
Then we get into the very complicated "thorny" realms of GPs’ increasing responsibilities as commissioners, which mean it will be general practice that takes the blame as waiting times continue to go up, particularly so as GPs are a much more accessible target for angry patients than PCTs ever were.
The Government is rushing to wash its hands of any responsibility for rising waits, by insisting – as junior health minister Simon Burns did– that its funding for the NHS is leaping by £12.5 billion by 2015. What the government do not tell you is that the increase in funding is barely keeping pace with inflation.
Ministers say they are doing their part so if waits go upwards it will be because GPs are failing to do theirs.
Yet the DH’s claims about increases in funding in real terms are only true in a purely technical sense – failing to take account of the money set aside to cover shortfalls in the social care budget, or the fact NHS inflation typically runs above that of the economy in general, or the fact the headline inflation rate is higher than had been anticipated.
Under the last Conservative administration, it should not be forgotten that not only were waiting lists for appointments very long, the actual time people spent waiting on lists for treatment were also extremely long. In fact some people died while they were on the waiting lists waiting for treatment and others were forced to wait in agony for up to two years for operations like hip and knee replacements. In many cases patients were or became immobile while a waiting for their surgery costing the NHS far more than if they were given their operations immediately.

Just remember that when apportioning blame for the failures in the NHS and for the total mess that is now being made of it, don't just blame the health secretary Andrew Lansley, blame David Cameron and his infamous poor judgement as well because the mess is as much Cameron's (and Nick Clegg's for that matter) as it is Lansley's! They have all been warned repeatedly by clinicians, GPs, nurses, health charities and other organisations that what they were attempting to do is unworkable but they steadfastly refuse to heed the dire warnings. They have all previously voted on these reforms in parliament, not once, but twice and both Cameron and Clegg  publicly offered Lansley their 100% support before the public outcry forced their "listening exercise".  A listening exercise where they all promised to "pause, listen and reflect"  and then just days after announcing their so-called "listening exercise" they were shown to be "ploughing on regardless" with the restructuring of the health service in after it was revealed in a leaked letter that the head of the NHS, Sir David Nicholson, had instructed staff to "maintain momentum" for the planned changes during the listening exercise being undertaken by ministers. It was all just a very big, very expensive sham!

The BMA have asked the government to withdraw its reforms bill entirely so in view of this rather than the BMA going ahead an making plans just in case the government does not withdraw the bill night it be better that they threaten action? In order  to stop the lies of Cameron and  Lansleys when they claim of 90% of the country is now being covered by consortia and that somehow it is all "magically" working so well, GP’s need to get tough and threaten to pull out of consortia- period! GPs can do this as they have all the power because without them on board, the government could not go ahead with its planned "reforms"anyway! Doctors trained to be doctors they did not train to be accountants! It is simply unbelievable that GPs have behaved so mildly andlike the  proverbial  sheep all meekly following each other into these consortia! What are they all waiting for, someone to come along and dye them with a number? I know that many feared the collapse of the NHS if they did not do cooperate, but perhaps non cooperation is what was needed and then the government would have been forced to stop this madness?

If GPs fail to do anything now then they will be the ones who ultimately get saddled with the blame for when things go badly wrong and this is something that Andew Lansley has already made abundantly clear when he issued a stark message to nurses –informing them that there is quite simply “no excuse” for the most serious failings in care. Although when Lansley did his medical training and ran a 30 bed high dependency unit on a skeleton staff  which gave him the experience and knowledge to make such a sweeping judgement is yet to be revealed!This government are fine ones to talk about responsibility, when they were all out of the country on holiday at the same time refusing to come back and taken control when the country suffered from anarchic riots and looting recently when four innocent people lost their lives! However, it is clear that this health secretary intends to blame the snow, the wind, the rain, doctors, nurses anything or anyone else rather than admit to his own culpability when things go wrong as they undoubtedly will. he is already lining up his "scapegoats"! No wonder is it then that nurses have accused Andrew Lansley of not being up to the job and have passed a motion of having "no confidence" in him, time for GPs to make a stand!.

The BMA really does need to challenge the Government more robustly on its claims for NHS funding, because the more the public comes to believe that the health service is being amply funded over the years to come, the more GPs and nurses etc will take the blame for any failure to deliver - which is all the more reason why GPs and all concerned parties need to get together, unify and act now!

1 comment:

Nicky said...

Great work as ever, Gracie.

Norman Tebbit, whom Lansley worked closely with in the 80s as a civil servant, has also condemned these so-called 'reforms'. Even a dogmatic ideologue such as Lansley must dimly realise he's doing something extremely wrong when his oldest friend in politics warns him about it.

Tebbit headed a charity with close links to an NHS hospital and saw for himself the pitfalls that interfering with the NHS causes.

As you say, Cameron should shoulder a large portion of the blame for this disaster in the making. People won't forget the broken promise about the NHS on those posters featuring his shiny bulbous face.

The scapegoating of NHS workers for Tory screw-ups is morally bankrupt and everyone involved in the NHS needs to fight their corner. I think most people will realise who is really to blame when things go wrong.