Friday, 9 January 2015

And Now - Hinchingbrooke

Over the last few weeks we have seen dozens of hospitals declaring major incidents. As Chief executives take to the airways a consensus has emerged. The same words are heard.

Accident and Emergency is coming under “unprecedented demand” and the patient flow through hospitals becomes impossible because of “delayed discharges”.

Coincidentally or not these represent the political explanations of the phenomenon from Conservatives and Labour respectively.

To me the point where the rash of major incidents became predictable came with the resignation of one of the most respected CEOs Dr Mark Newbold, some weeks ago.  He appeared to go because of the pressure applied from above to meet targets that had effectively become impossible to meet, for reasons beyond his control.

I think what we may be seeing with the contagious major incidents is a sign both of the instability within the wider health economy, and the refusal of management to continue to carry the can for problems that lie outside their hospital walls.

Hinchingbrooke was effectively the test bed for a private sector body running an NHS hospital. This presupposes the possibility of being able to do the job and make a profit. Because of the very peculiar structure of the tariff system this is only possible if there is the right balance between elective care and emergency care.  The announcement that Circle is withdrawing from the Hinchingbrooke contract , because of unprecedented demand for A&E and the problem of delayed discharges is about as clear a signal as we need that making a profit from the NHS at the moment, given the structure of the Tariff system and the state of social and community care, is simply not a realistic possibility.

Controlling spending within the NHS is a perfectly legitimate aspiration. Managers have a role to play in ensuring that money is spent well, but if we expect hospital managers to provide answers to the incoherent structures of our health and social care systems then I think that we are likely to be disappointed.  If we want to judge our hospitals on their "financial sustainability", which is what has been happening for the last few years then health service managers need at the very least to have a climate that makes sustainability possible.

The current crisis is a useful wake up call. What we need from our politicians is the courage to ask difficult questions, not least about funding health and social care, and to provide the framework for the different organisations involved to begin to work towards a more coherent system.

There are just a few weeks for politicians to give clear signals that they intend to do so.
Some of the coverage on Hinchingbrooke.

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