Some of you will realise that compared to the truly dreadful Sir David Nicholson (Chief executive NHS England) so often described as ‘The Man with no Shame’ I hold Sir Bruce Keogh in some regard. He’s the NHS England Medical Director and has different priorities.
He’s just issued a report on Accident and Emergency treatment and it’s quite good. ‘Quite’ because I have some issues, good because it is at least intended to improve things.
1) Reduce the number of A and E’s dealing with Strokes, Heart Attacks and Trauma.
Great idea – in London the number of Stroke units were reduced from over 20 to 8 with the result that the death rate fell dramatically and outcomes improved.
For these three areas specialising works really well, getting early, good treatment is vital.
Before stroke victims waited all weekend for someone to turn up – by then it was too late. Heart Attacks are not the killers they were because of specialisation. Complex trauma needs highly skilled surgeons.
2) A revamped and improved 111 service – with more clinicians and Nurses available on the phone to reduce the number of A and E admissions. Great idea – that’s what we were arguing for when NHS England closed down NHS direct which did that.
Sir David Nicholson – well done again. You just finished off NHS Direct and still have time to watch the failing 111 service being turned back into a pale shadow of NHS Direct at enormous public expense to try and put right another mistake of yours.
3) Improved paramedics, dealing with more cases at home rather than taking them to A and E – who could object to that.
1) Where I have a real problem was watching Sir Bruce on a ‘Newsnight’ interview last night. He repeated the nonsense that 40% attending A and E do not need to do so.
It’s nonsense because no one knows that until after the event. The 40% includes all who attend with suspected broken bones for an X-Ray, the abdominal pains, the suspected thrombosis etc. All require tests no Doctor does or paramedic can do. Failing to send those people in for the tests is just negligent; no Doctor would take the risk. So the 40 % includes those who needed a test but luckily they then didn’t need treatment.
2) Keogh expects to downgrade 70 out of 170 A and E’s.
The problem with that is that we have a pretend market not planning. It won’t be the best A and E’s that survive it will be the pushiest, grabbiest Foundation trusts. The others will lose the revenue from admitted patients and decline further.
Losing Cardiology, Stroke and Trauma will remove a massive proportion of any hospitals revenue and that means more closures.
No planning means no concern for local communities and no real search for expertise.
PFI contracts are so binding (an act of parliament could easily unbind them) that being lumbered with a catastrophic PFI is likely to safeguard a poor and inefficient hospital rather than ensure that quality survives.
So Sir Bruce, this paper doesn’t get full marks from me, which is a shame. You were doing quite well up till now. Don’t forget that while you may be thinking about best practise, the managers are only thinking about money.
(a don’t stop till you drop production)
I’m sorry if you are a reader of helpmesortoutthenhs.blogspot.com
If you are you will already have seen this article last night. I’m not so well and yesterday I spent five and a half exhausting hours waiting at Anti-coag only to find that after two and a half weeks they have made things worse rather than better. Doctors are not my favourite people at the moment.
So, I’m having to ration out my energy. I'm on my way to Tesco's.