News from Nowhere 82  December 2019

No prisoners

A lot of nonsense is written about privatisation of the NHS, and some of it is so eloquent that it gets into the London Review of Books. Eloquence and nonsense are compatible, of course, as two letter writers point out in the 5th December issue. Their target is an article by John Furse about secret plans to dismantle and privatise the NHS, which Helen Buckingham of the Nuffield Trust and Mary Guy of Lancaster University take apart succinctly. For a good political read have a look at  Letters tend to be shortened versions of longer arguments, of course, and there may well be more forensic analysis to come. News from Nowhere looks forward to it.

Source: London Review of Books 5th December 2019 page 4


Waxing and waning

Anecdotes are not the plural of evidence, but sometimes they shine lights in dark places. An NfN mole with wax in his ear – a recurrent problem, apparently – went to his GP for ear syringing only to be told that NICE had recommended only micro-suction for this problem. Micro-suction requires some special kit and so the GPs were referring individuals with compacted ear wax to the local ENT clinic. 

Had this referral decision gone past the Clinical Commissioning Group because of its implications for commissioning? It had not. Had the decision been discussed with ENT services, to allow deployment of staff to ear suctioning? It had not. Could the ENT clinic offer treatment (it only takes a few minutes)? Yes it could, in five months’ time. So our partially deaf NfN mole shelled out £60 to a private clinic for his ears to be unblocked a couple of days later. 

This is a story from the NHS, which as we all know, intends to expand investment in primary care to reduce demand on hospitals. So is there a hidden message from the real NHS (the people who do the work)?  Whilst we wait for this investment to happen we should go to hospital if we have a problem, even if it is a private one.

Source: Cannot be named


Wish-list for Santa

What do you think are the most pressing public health challenges that any future Government should commit to, in order to champion the public’s health? Here’s what the Royal Society for Public Health suggests:

  • The decriminalisation of possession of illegal drugs and a public health approach to drugs policy more generally;
  • The use of health and wellbeing measures alongside GDP in Government Budgets;
  • The roll-out of minimum unit pricing for alcohol to the rest of the UK;
  • The extension of the sugar levy on soft drinks manufacturers to other products high in sugar (remember NfN’s Pudding Tax?);
  • A mandatory targets-based framework for salt, to support the 7g per day target.

This is a serious list, but what about the ageing population, ask NfN moles? Where’s the campaign against loneliness? (Only kidding!)



The costs of ‘Down time’

A brief analysis published in the Clinical Medicine Journal sums analyses ‘careless costs’, which are defined as time spent by an NHS employee on activity that does not relate to patient care. The article argues that if all doctors in the English NHS wasted an average of 10 minutes per day on such activities, those wasted minutes would cost over £143 million (per year, I assume) based on current salaries. The implication is that a little bit of investment – for example, making the IT systems work faster – could recoup careless costs and generate massive savings.

This really bugs a writer in the Academic Health Economists Blog (a source NfN has long cherished), for two reasons. First, it is normal to have a bit of downtime. Nobody operates at maximum productivity for every minute of every day. Those 10 minutes that are displaced cannot be considered equivalent in value to 10 minutes of patient contact time. The second reason is that there is no intervention that can fix this problem at little or no cost. Investments cost money. The potential savings from improvement in IT may very well be closer to zero than to the estimates given in this paper.

Sources: Careless costs related to inefficient technology used within NHS England. Clinical Medicine Journal Published 8th November 2019. Plus Chris Sampson’s journal round-up for 18th November 2019


Capital follows confidence (when there is any)

The commercial healthcare sector is jittery. A report based on responses from over 500 senior leaders within the healthcare sector, from major investors to CEOs – Jefferies Healthcare Temperature Check – shows the causes of worry.   Concerns over political uncertainty have grown and are now cited by 50% as the biggest risk to healthcare. More than two-thirds think of Brexit as having a negative effect. There are more mergers and acquisitions to come in 2020; over 80% see deal flow as either higher or at the same level next year. But 44% of respondent cite concerns about the ability of European stock markets to support healthcare growth companies. Sentiment has turned bearish on equity markets: 70% believe the FTSE 100 will be lower or the same this time next year. 

Tommy Erdei, Joint Global Head and European Head of Healthcare Investment Banking, says: “..we have found greater caution around the market outlook – reflecting the increased level of risk present for investors – and there is no doubt that 2020 will be a year to watch very closely.”

Defenders of the NHS please note, fending off the circling vultures of privatisation may become a little easier in the coming year.

Source: Jefferies Healthcare Temperature Check 2019


Bottlenecks ‘r’ us

Another story: One of NfN’s moles woke on November 12th with a painful joint. After some self-care (paracetamol by another name) she decided the next day to seek advice from her GP. Knowing that GP telephones melt between 8.30am and 10am, she rang to ask for an appointment at 10.20am. An appointment was made for 11.30am the same day. The GP thought an Xray was needed, so on the following day our mole went to the local hospital, clutching the XRay request. She was called in within three minutes of handing over the request form, Xrayed and sent home within seven minutes more. The staff were jolly and said that it was not always this quick. Two days later our mole received an email from the hospital (where she has a ‘Patient knows best’ account) to say that the Xray result would be disclosed to her in one month. She did not complain because after 5 days her symptoms had gone.

News from Nowhere draws some conclusion from this mole’s story. First, it confirms that bottlenecks are normal in the NHS. Just because one part of the system works well does not mean the next part down the “pathway” will. Second, general practices don’t have to be on their knees, other ways of serving the public seem possible. Third, if Xrays are being shipped as digital images by the NHS to Australia for reading, this hospital either has no such arrangement or uses it selectively, perhaps judging that the clinical history given did not warrant high priority attention. Other conclusions welcome! 

Source: cannot be named


Six years and still no electronic patient record

South Tees Hospital Foundation Trust is apparently the only major trauma unit in England without an e-prescribing system. The Trust argues that investment in a new electronic patient record (EPR) system is “critical” in order to reduce patient risk, but a major IT upgrade is on hold as the integrated care system (ICS) it is a part of (The North East and North Cumbria) has not yet approved its business case, while NHS Improvement will not approve it until the ICS has done so. It is not clear where the money will come from to fund this development.

The planned new EPR would replace the existing but unintegrated systems for patient administration, workflow, theatres, emergency department, maternity, bedside observations, spinal injuries, orthopaedic trauma, clinical utilisation review and cancer management. Currently, the Trust does not have e-prescribing and medicine administration functionality. The Trust first began looking at the case for an EPR six years ago and had hoped to begin the programme by April 2020.

According to the Trust, the lack of an e-prescribing system “increases the risk of prescribing and drug administration errors”. The Trust lacks a clinical decision support solution to guide good practice and improve patient safety. Clinicians do not have timely access to clinical information, and the majority of patient records are still paper-based with variable availability.

Ageing IT infrastructure limits the flow of clinical information, reduces clinicians’ confidence and has an impact on patient care. According to the Trust, staff (in particular trainees) are choosing not to work in South Tees due to the lack of electronic records.


Source:  Trust: Patients ‘at risk’ as ICS delays new IT system  Matt Discombe, HSJ 22 November 2019


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