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.
Problems;
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.
Neil Harris
(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.
No comments:
Post a Comment