Thursday, 19 September 2013

Are super CEOs the answer for "failing hospitals"?

This morning’s piece on the BBC about getting the managers from “successful hospitals” to sort out “failing hospitals” made me feel pretty weary for a whole range of reasons.

The exercise is predicated on mortality statistics, which are increasingly and rightly being questioned, because they are simply not the robust indicators of quality that the media still persists in believing they are.  

The article predictably began with coverage of Mid Staffs that as usual presents historical anecdotal evidence as fact, with no context being given, but after five years of this, people in Stafford are pretty used to this!  

Julie Moore, who is one of the CEOs who will be parachuted in to save failing hospitals, made it clear that her starting point is that DGHs have had their day. To me that is problematic, as there are a great many people who actively question her view. It is certainly a view that needs national debate before it is allowed to re-shape our NHS by stealth.

The Interviewer took the view that it would probably be best to close down a lot of DGHs, but that this will not happen because politicians will not agree.  This analysis is simplistic, and it completely misses the point that politicians who resist hospital downgrades or closures are doing so because they represent their constituencies. Having been through the last year at Stafford, where we have been facing the active threat to our hospital, and having marched with the 50,000 who came out to support the hospital in April, I have learned a great deal about the way in which people here value their hospital and why it is important to them.  I have seen the political leaders from all parties in the borough marching side by side as a powerful response to the people of the borough. This is a process that has changed out town, for the good.

It is certainly true to say that some hospitals, probably a lot of hospitals are struggling in the current climate. The BBC article did not make any attempt to try to analyse this.  There was for instance no reference to the effects of the tariff system, where the shrinking income is forcing hospitals to concentrate treatments into larger units, in order to cover the costs. There was no mention of the way in which the tight budgetary constraints on hospitals and on commissioners are forcing hospitals to run with minimum numbers of staff, leading to increased pressure on staff, and staff burnout. There was no mention of the way in which small hospitals struggle to recruit specialists in areas where there are national shortages, and end up having to rely on expensive agency staff.

Chris Ham usefully made the point that the suggestions while far from perfect are infinitely preferable to trying to use either Management consultants or temporary CEO fixers to sort out the problems. Having seen both of these in action at Mid Staffs I would certainly agree with that.

He is right. Hospitals that are struggling need long term support, and they need access to networks of clinicians who can build a relationship with them over time.  He believes that a better option than the super heads would lie in these support networks.  I would agree with that. It is better for District General Hospitals to be working together to work out what their future role should be and how to support it, rather than being told how to act, by the leaders of super hospitals whose interests will be quite different.

Super hospitals have a role, so do District general hospitals. They are different kinds of organisations, with different functions.

Currently there are two drivers which are currently pointing the NHS in different directions.

There is the drive towards the big centres of technical excellence. These are the places to which all ambitious clinicians automatically gravitate. These centres of excellence require the surrounding hospitals to shrink and become feeders. Keeping these huge hungry hospitals functioning requires a constant stream of patients and the revenue that comes with them to feed the machine.

There is the drive towards integration, which really requires seeing hospitals in a different way, as part of a continuum of care which begins in the community, and brings Primary Community and Secondary care much closer together.  With this vision the patient, the individual, is central to the picture.  The Super hospitals are simply a part in this patient centred continuum. This is something that many people see as the future, but it really has not been explored or developed in the way that needs to happen. 

What I am seeing in Stafford now is what happens to a community where these two forces are in play.  The next few months will let us see if the combined influences of the Management consultants, the ambition of neighbouring super heads, and the way in which the politicians represent the people will help to find a solution that will satisfy the 50,000 people who marched for this hospital.
Stafford is an opportunity to reshape the NHS in a way that works for the people who use it. It needs to be seen as that.

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