Sunday, 2 March 2014

The Big Question - on Hospital Downgrades

The Big Question on BBC 1 this morning took a look at Hospital downgrades.

Hospital downgrades are always contentious, and they are starting to shape up to be one of the major flash points for the next election.

The program gave us in a nutshell the key reasons why this is going to matter.  The leading contribution was from Professor Terence Stephenson.  He represents the top ranking clinicians who are driving the re-configuration of the health service.  These are the people to whom Andrew Lansley handed power over the health service with the Health and Social Care act.  Professor Stephenson is head of the royal college of Paediatricians and he believes strongly in the need to centralise the medical treatment of children.

We also heard from Julia Manning who is part of the “independent think tank” 2020 health which has strong links with the Conservative party and with the insurance industry. Here is an article about Ms Manning Ms Manning is all in favour of creative thinking to do health care differently – making it fit for the challenges of this century.   

We heard from Clive Peedell. Clive is an Oncologist, who is co- founder of the NHA party and has just announced that he will be standing for election against David Cameron in Witney, making sure that the NHS will be a central issue in 2015.  Clive speaks out for the role of generalist hospitals, and calls for adequate funding of the NHS.

Caroline Molloy who is the editor of “Our NHS” was there to speak on behalf of the many hospitals that are facing downgrades.

The program was filmed at Peterborough which is in special measures under Monitor and where it looks increasingly likely that the hospitals deep rooted financial problems may be resolved by private sector take over

Perhaps no one really knew what the results of the Health and Social Care Act would be, but we are starting to find out.

The confusing process that we have just been through with the Administrators at Stafford shows how it works.   The Secretary of State has given the power over the health service to clinicians – the CCG.  If, as increasingly happens, they hit a financial problem in the management of the hospitals that they cannot resolve then this means calling in Monitor or the TDA who will involve one or more of the big 4 accountants to act as TSAs.  The Accountants take the advice of the CAGs or clinical advisory groups which are newly created bodies packed with people like Professor Stephenson. The CAGs advise the TSAs on a model of care which is appropriate for the hospital. This is generally likely to include a strong element of centralisation.   The TSA can then invite bids from care providers willing to provide the model of care that has been stipulated, for the money available. Once the bids are in – and this is a process shrouded in secrecy, there is a consultation with the public, which the TSA seems to be at liberty to brush aside.  Monitor and the Secretary of State then rubber stamp the final recommendations.

All the stages of the administration process are controlled by the administrators who appoint the various experts, and minute the meetings. 

In a process that looks like this it is unsurprising that the end result is that there is a recommendation that there should be a downgrade.

The power over the future of the NHS is now in the hands of accountants and of a small number of powerful clinicians who strongly support centralisation.

These clinicians are probably acting in what they consider to be the best interests of patients, but they are not politicians, they do not appear to have a clear idea of the major political impact that their decision will have, and they are probably unprepared for what will happen when politicians across the country begin to wake up to the scale of the threat.

There are good reasons for doing things differently in the NHS.  One of the frustrations for those communities caught up in the process of reconfiguration is that the issues have not been aired nationally.  They need to be.  To make the NHS work for the future, to gain public support for any changes that have to be made it is essential that the public are openly and honestly given the information they need in order to  choose the changes and work with the clinicians to develop the systems we need.   

The paternalistic nature of the processes we are seeing now will simply not work.

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