Lets hope he is running with a peg on his nose?
“More than a third of the GPs who sit on the CCGs have stakes in private firms or organisations that can bid for work from the new boards”.
http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/article1238517.ece

Dave & Nick calculated correctly that a nice car and additional holidays in Portugal would be enough to entice a certain sort of collaborator, sorry I meant GP to get with the program.

Anyway, must dash or I might miss Hunt’s anti-NHS rant – I don’t think he has highlighted yet more failings for almost 2 hours now.

My initial reaction on reading this amazing news about a doctor running from Leeds to Sheffield was delight at the revival of political satire. I was reminded of that delicious Peter Cook sketch: We need a futile gesture at this stage of the war.

Perhaps more to the point are these items in the news:

GPs’ links to private healthcare firms spark fears of conflict of interest. One in three GPs in clinical commissioning groups are linked to private firms, study finds [Guardian 14 March 2013]

The majority of GPs feel no more involved in commissioning decisions than they did before the formation of CCGs, according to a Pulse survey which lays bare the profession’s concerns on the eve of the 1 April handover.

Pulse’s snapshot survey of 303 GPs in England reveals the extent of GPs? disengagement with clinical commissioning just days before the profession assumes responsibility for budgets. Some 55% of respondents said they did not have any more involvement now than they did under PCTs. Just 36% said they did feel more involved.

One in five GPs said they had not signed their CCG constitution, raising questions over the depth of GP engagement at CCGs. Of the 48 GPs who said they had not signed their constitution, most said they had not been asked to, while three said it had not been finalised or had only just been circulated in draft form.
http://www.pulsetoday.co.uk/commissioning/commissioning-topics/ccgs/revealed-majority-of-gps-no-more-involved-with-commissioning-under-ccgs/20002440.article

In later news::::

Bored libertarian to protest at bloated, incompetent NHS and the artificially inflated salaries paid to consultant oncologists.

He will do a couple of sit ups.

Since the Scottish and Welsh health services are devolved, haven’t we had an English Health Service for some time?

The situation in the NHS with the so called reforms is so bad that I even find myself on the same side as
Melanie Phillips.

Things really are bad!

Cause for celebration: clinical negligence cases are no longer eligible for legal aid.

The head of Britain’s largest medical defence organisation is calling for a change in the law to curb the soaring cost of negligence claims which threatens to bankrupt the NHS.

Christine Tomkins, chief executive of the Medical Defence Union, which insures 200,000 doctors mostly in the UK, said the bill facing the NHS was now £18bn and rising – enough to pay the annual running costs of a dozen large teaching hospitals. But her proposals could mean victims of medical negligence would see their damages claims halved. [Independent Decmber 2012]
http://www.independent.co.uk/life-style/health-and-families/health-news/negligence-payouts-bankrupting-nhs-8432384.html

Almost 12,000 patients are dying needlessly in NHS hospitals every year because of basic errors by medical staff, according to the largest and most detailed study into hospital deaths ever performed in the UK.

The researchers from the London School of Hygiene and Tropical Medicine and colleagues found something went wrong with the care of 13 per cent of the patients who died in hospitals. An error only caused death in 5.2 per cent of these – equivalent to 11,859 preventable deaths in hospitals in England.

Helen Hogan, who led the study, said: “We found medical staff were not doing the basics well enough – monitoring blood pressure and kidney function, for example. They were also not assessing patients holistically early enough in their admission so they didn’t miss any underlying condition. And they were not checking side-effects… before prescribing drugs.” [Independent 13 July 2012]

Botched care in pregnancy and childbirth has led to more than 5,000 successful negligence claims against the maternity services over the last decade – costing the NHS £3.1bn.

The sums paid out would be enough to build a dozen new obstetric units and hire thousands of extra consultants and midwives which could make childbirth safer. [Independent October 2012]

Fair play to the doc.

Good to see that someone is doing something.

Aww. I read the title and hoped it was the plot of a new thriller.

Getting back to the traditional ways of industrial action in Yorkshire – any comments on this news about the caring NHS?

Ambulance workers strike in Yorkshire

Unite members are protesting against £46m in cuts and plans to replace ambulance technicians with care assistants
http://www.guardian.co.uk/society/2013/apr/02/ambulance-workers-strike-yorkshire

News update

NHS failed to meet four-hour A&E targets for past two months

Government figures show casualty departments falling short of goal of dealing with 95% of patients within timeframe
Guardian: 2 April 2013
http://www.guardian.co.uk/society/2013/apr/02/nhs-four-hour-targets-aande

The NHS has failed for the last two months to meet its target of dealing with 95% of A&E patients within four hours, according to official figures that underline the growing pressures on hospitals.

@10. Bob B: “NHS failed to meet four-hour A&E targets for past two months”

There are at least three reasons why hospitals fail to meet an A&E target:
1. Uselessness of hospital.
2. Uselessness of target.
3. Desire to meet another target.

From the Guardian article: “Labour highlighted DoH data showing that as a whole hospitals offering consultant-led A&E care, so-called type 1 A&E departments, which treat more than 60% of all emergency patients, have not met the target for 26 consecutive weeks.”

The figures show that patients attending A&E at hospitals with the most able doctors wait longer. That is all that the numbers tell us.

Guardian again: “The Department of Health data emerged just after the East of England ambulance service took the unprecedented step of erecting a “major incident tent” in which to treat patients outside the Norfolk and Norwich hospital, to relieve pressure on its A&E unit over the Easter weekend.”

Which may make us think about realistic use of target based assessment.

Charlieman: “Which may make us think about realistic use of target based assessment.”

Alternatively, whether A&E departments are under-resourced in relation to the demand.

However, an issue at my local hospital – which had an A&E department that was transmuted to an “Urgent Care Department” a few months ago – is whether all those going for treatment really need the specialist skills at A&E or could be treated at their GP’s surgery.

There can be a financial incentive for patients to prefer A&E as the hospital will likely treat patients with drugs and/or appliances without making the standard NHS prescription charge (*) which the patient would likely have to pay on GP prescriptions unless the patient comes into one of the exemption groups: children, pensioners and those with chronic ailments.

(*) The NHS prescription charge in England increase by 20p from £7.65 to £7.85 for each quantity of a drug or appliance from 1 April 2013.

I’ve heard anecdotal evidence of patients going to A&E with minor ailments – such as sprains – which could be treated by a GP. OTOH a friend with a malfunctioning heart pacemaker who went to the local A&E on a Saturday night was turned away and told to go and see her GP on the Monday morning. On getting back home, she phoned her GP on his private number. He happened to be at home on a Saturday night and ordered an ambulance to take her to a larger acute hospital, further away, which specialises in cardio-vascular care, where she was kept in for a few days while her malfuncting pacemaker was sorted.

Btw in the early 1960s I went to an academic seminar where the late Prof Alec Nove made a presentation on how planning targets in the Soviet system led to resource misallocations. He was a native Russian speaker and based his research on reports in the Soviet press which had become more “liberal” after Khruschev’s denunciation of Stalin in 1956.

One example was planning targets for roofing materials set in metric tonnes with bonus payments for meeting or exceeding the target. The outcome was that factories making roofing material tended to make heavy-duty rather than light-duty roofing as fewer units of heavy-duty roofing would meet the official target and thereby gain the incentive bonus for the factory. At the time, Nove was a leading expert on the Soviet economy and his assessments became widely available in a series of text on: The Soviet Economy.

Very obviously, Frank Dobson, the first New Labour health minister, knew nothing about any of this. On coming into office, Dobson had introduced targets for reducing hospital waiting lists along with dire threats to sack clinical staff if the targets weren’t met. The predictable happened – easier cases were treated above serious, complex cases because that got waiting lists down faster. Management by targets and rewards for achieving targets needs to be done very carefully to avoid creating perverse incentives – just as banking bonuses generated the conditions for the financial crisis.

Ever since Alec Nove’s seminar, I’ve had an appropriately detached view about managing by targets.

@12. Bob B: “Alternatively, whether A&E departments are under-resourced in relation to the demand.”

In the case of the Norfolk and Norwich tent (assuming the story to be true), it may have been an appropriate response (functionally and/or by delivering a political message). Or it may have been a distraction manoeuvre.

I dunno and you dunno, and only the people working there will really know.

But let’s go to an extreme, the 7/7 2005 bombing attacks — without commentary about the politics of the bombing. We can presume that London hospitals received a huge number of casualties who were extraordinary to those treating them.

The bomb attacks were an extreme set of events but many patients didn’t go home on 8/7. They required long term treatment.

What happened to targets? Were targets suspended or statistically adjusted to address problems that were outside their parameters?

My recollection of the 7/7 bombings in London in 2005 is that many hospitals in central London rolled out pre-arranged plans for emergency situations and went into overdrive as the NHS had a set a target for all hospitals to have such plans.

I can’t recall any complaints from that time about the treatment the injured received – and some were severely injured. Try this report from the inquest:

Indeed, coroner Lady Justice Hallett said: “One of the most impressive things we’ve learnt is how fellow passengers went to see what they could do to answer those cries for help and… went into a war zone.”

Passengers swung from handrails into wrecked carriages and cradled the injured as they took their last breath, while trained medics, off and on duty, put their own horror aside to help save lives.

Their courage is all the more remarkable as it goes against what psychologists call “bystander apathy” – a reaction which leads many of us to walk away from extreme situations.
http://www.bbc.co.uk/news/uk-12154040

Complaints were directed at the security services for not following more diligently some early leads they had to one or two of those who became the suicide bombers. The trouble in these situations is that security services are likely to have many leads to potential bombers with little indication as to which of them will mature into anything more serious than fantasy. A sign of our times in the today’s news:

Pakistan’s youth favour Sharia law and military rule over democratic governance [Independent]

On ‘perverse incentives’ try this list of mostly amusing examples in Wikipedia:
http://en.wikipedia.org/wiki/Perverse_incentive

Our ancestors recognised perverse incentives centuries ago even though the principal-agent literature is relatively modern.

From the times when criminals convicted by juries could be judicially sentenced to hang for theft, robbery and rape, as well as for murder, we have that old adage: Might as well be hanged for a sheep as a lamb. Hanging, drawing and quartering was introduced in 1351 on the recognition that the prospect of just hanging wouldn’t be a sufficient deterrent for really serious offences, such as treason.

Civil servants, legislators and NHS administrators need to have mandatory courses on principal-agent issues IMO.

For those with nostalgic sentiments about hanging:

“Some thirty-five thousand people were condemned to death in England and Wales between 1770 and 1830, and seven thousand were ultimately executed, the majority convicted of crimes such as burglary, horse theft, or forgery. Mostly poor trades people, these terrified men and women would suffer excruciating death before large and excited crowds.”

From the publisher’s blurb for: VAC Gatrell: The Hanging Tree – Execution and the English People 1770-1868 (Oxford UP, 1996)