News from Nowhere 75  April 2019

Too small to succeed

A small independent midwifery provider, Neighbourhood Midwives, closed suddenly in January of this year. Based in Waltham Forrest, the company ran a ‘continuity of care’ pilot, where each woman was looked after by a small team of midwives from early pregnancy to birth and post-natal care. The pilot closed 10 months earlier than planned despite praise from women who used it. It had heavyweight supporters, as well. NHS England called it “trailblazing”, its chief executive was part of the review panel for ‘Better Births, the 2016 national maternity review’ and the midwives were experienced.

The problem was that the company had £1 million in net liabilities after making a loss every year since 2013/14.  Nevertheless its contract had been awarded by the commissioners, who now have some explaining to do. News from Nowhere regrets that it must point out more lessons. First, the holy grail of continuity of care requires a bigger workforce than does an assembly line approach to maternity care. The assembly line always wins. We have known this for a long time, so why another pilot? Second, the semi-managed market that we call the NHS puts many obstacles in the way of small providers, and few survive, just as market theory predicts. Did somebody mention an organisation without a memory?

Economies of scale?

We have another tale of services that are ‘too small to thrive’. The National Health Executive news journal reported on March 22nd that the 150-year-old private health trust All Hallows Healthcare will have to close all services and make 280 staff redundant. The private trust has been providing care since 1872 and operates a 30-bed hospital, 50-bed nursing home, a domiciliary care service and a day care service, caring for over 250 daily. The Trust leadership said it was now impossible to balance income and costs, and therefore was engaged in detailed planning with commissioners to identify and arrange alternative care for its patients.

Oh joy!

You may not believe this, but you don’t have to be a conspiracy theorist to defend the NHS. Chris Bryant, Labour MP for Rhondda since 2001, said in an interview with the Health Service Journal (March 31st) that he “absolutely despises” politicians climbing aboard save our hospital “bandwagons. I don’t think the Tories hate the NHS, I don’t think they’re ‘vermin’… and I do hate it when people shroud wave as a form of political campaigning.”

This reminds News from Nowhere that a similar interview with Paul Johnson, director of the Institute of Fiscal Studies (HSJ 10th February) yielded similar gems. First he advocated tax rises with the argument that “as a fraction of national income our [personal and corporate] tax take is still on the low [side compared to most] European countries,” he explains. “We can certainly run a perfectly respectable economy with a tax take at 4 or 5 per cent of national income higher than it is at the moment”.

And then he got to his hobby horse: “Politicians very rarely talk about [the NHS] without saying something like, the NHS is wonderful – look at how they do it in the United States. When a politician contrasts the NHS with US healthcare then “you’re almost certainly going to hear a pile of nonsense”. The United States is the outlier among developed western countries and the NHS is really like most other developed countries’ healthcare systems. A sensible comparison would be to compare it with France or Germany or the Netherlands or Australia. And so say all of us at News from Nowhere.

Professional misconduct?

The National Health Executive news journal reported on April 3rd that two senior doctors on the BMA’s GP Committee (GPC) claimed that a tide of sexism, bullying and unfair treatment is pushing women leaders out of the profession. Dr Zoe Norris and Dr Katie Bramall-Stainer  made the charges in an article in ‘GP Online’ after Bramall-Stainer had complained last month about being called a “naughty girl” by a member of the committee. A number of other female GPC members have reported sexist behaviour within the BMA, with one doctor saying a male colleague had sent her an unsolicited naked photo and another who overheard “two senior people on GPC braying loudly their guesstimated bra size of a key committee member.” Dr.Chaand Nagpaul, chair of the GP Committee, has affirmed that such behaviour is unacceptable, and promises that there will be an “urgent and wholly independent investigation in response to these allegations”. News from Nowhere moles wonder whether names will be named, and the General Medical Council approached about GPs bringing their profession into disrepute.

Dr Nagpaul has had to manage bad behaviour at the BMA quite a lot recently. He is reported in the BMJ (30th March) as banning the payment of travel expenses to partners of senior officers who had taken trips abroad on official business. The hardworking members of the BMA had been unknowingly subsidising partners’ costs, a right only available to the BMA President. It seems this potential expenses scandal only involved officers who have since left the BMA, but there is a case for locking the stable door after the horses of entitlement have bolted.

Nationalisation by the back door?

An estimated extra quarter of a million patients a year could be referred to the private sector under new waiting list rules, according to the Health Service Journal (22nd March). The size of the elective waiting list and the average waiting time has steadily worsened over the past five years, with the average wait now 22.7 weeks. This will cheer the private sector, which as News from Nowhere reported last year, struggles when the supply of NHS patients decreases. For example, Ramsay Health Care UK, one of the largest private providers of NHS-funded care is almost a franchisee of the NHS – 79 per cent of its admissions are NHS-funded.

A pocket full of trouble

What’s the collective noun for a group of medical consultants? A pocket, as described in a leaked report by Deloitte into goings on at Barking, Havering and Redbridge University Hospitals Trust: “Specifically, our focus groups highlighted a range of material issues …. in relation to the culture amongst a pocket of medical consultants”. This pocket was criticised for intimidating and disrespectful treatment of colleagues, arrogance and a strong sense of entitlement, and covering-up poor clinical practice. News from Nowhere notes that one definition of pocket is grouparea, or mass of something that is separate and different from what surrounds it. But is the behaviour of this pocket so different from what surrounds it?  We await the publication of the full report to answer this.

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