This particular Sacred Cow is undergoing clinical examination with a vengeance today!
The day started with a letter to the Telegraph painting a frightening picture of care - or lack of it - for the elderly in the NHS: - - -
++++++
Dying patients
A group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death.
SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science.
Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care.
The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death.
As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong.
It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came about after terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better.
P. H. Millard
Emeritus Professor of Geriatrics University of London
Dr Anthony Cole
Chairman, Medical Ethics Alliance
Dr Peter Hargreaves
Consultant in Palliative Medicine
Dr David Hill
Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons
Dr Elizabeth Negus
Lecturer, Barking University
Dowager Lady Salisbury
Chairman, Choose Life
+++++++
The news item talks of patients under this system being first heavily sedated and then denied liquids and consequently dehydrated. All this leads to accelerated death. But heigh-ho it releases a bed!
The NHS thinks it is untouchable and so does the government . Soi nithing is ever put right. Read on through the expewnsive McKinsey report which the moment it was published was rejected by the government. Comments on this will flow and so they should. See the last item especially from Janet Daly
Christina
====
HEALTH SERVICE JOURNAL 3.9.09
DH is told 137,000 NHS posts must go in next five years
BY SALLY GAINSBURY
The Department of Health has been told the NHS in England will need to slash its workforce by 137,000 if it is to achieve its planned £20bn savings by 2014, HSJ can exclusively reveal.
This would mean the NHS losing 10 per cent of its workforce. The estimate was given to the DH in a confidential report commissioned from the consultancy firm McKinsey and Company, and seen by HSJ.
Although the DH has said the report was “purely advice and does not constitute government policy”, it bears the department’s logo and has been disseminated among senior NHS managers.
++++++++++++++++++++++++++++++++++
Proposed cuts
30,800 non-clinical posts, saving £600m
£3bn - saving potential of increasing staff productivity in NHS hospitals
£1.9bn - savings projected by cutting external contracts and supply costs such as waste and food
£1.3bn - saved by cutting unneeded appointments and procedures
£8.3bn - estimated value of hospital estates which could be freed up and sold
++++++++++++++++++++++++++++++++++
The McKinsey report makes clear the cuts will need to be felt as much among clinical staff as administrators.
Based on its analysis of different staff group efficiencies, it says the cut required to full time equivalents for an NHS hospital with a clinical staff of 300 would be: two consultants, one registrar, 10 nurses, 10 healthcare assistants, three allied health professionals and eight non-clinical staff.
The report recommends a range of “potential actions in the next six months” that should be considered. These include: a recruitment freeze starting in the next two years; a reduction in medical school places starting in October, to avoid oversupply in five years; and an early retirement programme “to be implemented in the next two years” to encourage older GPs and community nurses to make way for “new blood/talent”. [This means experienced professionals would go, to be replaced with less experienced staff. Not something most would welcome! -cs]
The consultants also recommend that plans to increase staffing levels and investment, such as those set out in the national stroke strategy and the children’s service strategy, should be “reviewed”.
It says up to £600m could be saved by acute providers if those with above average ratios of non-clinical to clinical staff cut their administrators down to nearer the average level. Their £600m calculation was based on losing 30,800 non-clinical staff on an average salary of £20,000.
The analysis was presented to the DH in March [that’s 6 months ago! -cs] this year and was shared with senior managers at strategic health authority level - several weeks before NHS chief executive David Nicholson said publicly the NHS should be planning to make up to £20bn in savings by 2013-14. Although some of the findings have been cited outside senior management circles the full analysis has been on restricted access.
The analysis sets out how up to £8.8bn of new recurrent annual spending could be cut from the NHS by 2013-14. It says the biggest chunk - up to £3bn - could be saved by increasing staff productivity in NHS hospitals. The second biggest saving is in non-acute staff productivity (up to £1.9bn) and in driving down costs of external supplies and contractors such as waste and food (up to a total of £1.9bn in savings).
McKinsey’s breakdown of the types of NHS organisation the savings are likely to come from reveals that acute providers will be hardest hit, with cuts equivalent to up to 38 per cent of their 2008-09 spending by 2013-14.
The smallest savings would fall on primary care, where spending would reduce by up to 13 per cent. Community care budgets could be cut by up to 28 per cent.
HSJ asked the DH whether the report - which earlier this year McKinsey won a competitive contract to write - concurred with the department’s own analysis and policy.
In response health minister Mike O’Brien played down its significance. He said: “Advisers advise but minsters will decide after taking a range of advice.”
He added: “The McKinsey work… is not in any sense an NHS plan of action. They are just making some suggestions which will be looked at with many other ideas.”
NHS Confederation policy director Nigel Edwards said some proposals looked at odds with current policy: “We’ve just spent a fortune on stopping GPs retiring. Isn’t the rest of the strategy to shift care out of hospitals and into primary care?”
He added that early retirement plans would take a long time to yield any savings, unless McKinsey was recommending the DH “reneges” on the NHS pension scheme.
==
SKY NEWS at 0714
3.9.09
Job cuts "not the right medicine" for NHS, says health minister
• Mike O'Brien, Health minister
Mr O'Brien said the government rejected a report recommending a 10% cut in NHS jobs in order to find savings in the health service, insisting that job cuts were not "the right medicine".
"We don't believe it is the right medicine. We take advice from a number of sources and we believe there are much more effective ways of ensuring we deliver the health service for people.
"We have created 80,000 nurses jobs and 40,000 doctors jobs and you think we're going to cut them? Labour created the health service we want to see it improve," he said.
He insisted that the savings could be found instead by "focussing on quality, focussing on innovation, focussing on the way in which we improve service will reduce the overall cost without reducing the number of staff."
He added: "We want to ensure we improve the quality service and get efficiencies yes, but we will get efficiencies by improving the quality of the service not by across the board cuts like the Tories."
[This boils down to we’ll do absolutely nothing! -cs]
=====
PoliticsHome 3.9.09
Come clean over cost of report, say Tories
Andrew Lansley has called for the government to come clean over the cost of the rejected McKinsey report, after the Department claimed the report was not individually itemised and so cannot be costed
The cost of a specially commissioned report on the NHS by management consultants McKinsey and Co, that was this morning roundly rejected by the government, will not be disclosed by the Department of Health.
"It was part of existing work that McKinsey was doing for the department," a Department of Health spokesman told PoliticsHome. "There isn't a breakdown of the individual cost of the report."
Shadow Health Secretary Andrew Lansley said it was further evidence of "failing to be straight with the British people":
"Labour now claim to have rejected these ideas, but why were they spending taxpayers’ money on management consultants to draw up this report if they had no intention of using the findings? Labour need to come clean on how much money they have wasted on this whole exercise.”
====
TELEGRAPH 3.9.09
Government says it won't cut NHS jobs: not even the useless ones
By Janet Daley
Surprise! Labour government fighting for its life on every front says it will not - repeat not - cut jobs in the NHS. The only real mystery here is why heaven only knows how much taxpayers’ money was spent on a management consultant study (McKinsey doesn’t come cheap) to say what management consultants always say: that the outift in question needs to cut jobs.
Did whoever it was in Whitehall who commissioned this report expect that it would offer any other solution to the problem of NHS expenditure, given that the brief was presumably limited by the existing parameters of healthcare funding arrangements? What the McKinsey team is saying presumably is that given the way the NHS is now paid for - out of taxation - it is simply not possible to sustain the present workforce numbers, let alone the expanding ones which are planned. For Government ministers (and, I’m sorry to say, opposition spokesmen) being handed this common sense message is like having a hand grenade with the pin pulled out lobbed into their laps. So eager are they to hurl it out the window that they are unable even to consider the possibility that there are indeed considerable numbers of management and administration jobs which could be cut in the NHS without damaging its front line services, as most doctors and nurses would tell you.
The McKinsey report actually suggested cutting back on doctors and nurses, too but there is no law that says you have to obey every word of the management consultants’ advice. What is shocking is the absolute refusal to contemplate any cuts at all, as if every pen-pusher and box-ticker in the hospital service (even those whose jobs did not exist ten years ago but were created by the target culture) was absolutely essential. But even more important is the whole possible dimension of future healthcare funding which McKinsey was clearly advised to disregard: the possibility of an additional stream of revenue which could be provided by a new kind of insurance system. Such a system would spring into existence almost immediately if this government or some future one were to declare that all patients would henceforth be free to top up their NHS care with private provision.
Insurance companies would then create inexpensive “top-up only” policies which would be accessible to millions of individuals and families - or could be offered on group terms to employers. The fees paid to the hospital trusts would supplement their tax funding and actually help to provide more resources for those whose care was entirely funded by the NHS. Why is there no front bench politician of any party who is prepared (at least publicly) to endorse such a solution? It would probably be less unpalatable to the vested interests of which they are so terrified (the health service unions and the Royal Colleges) than the prospect of job cuts.
Posts
