News from Nowhere 98 May 2021


The Office for Health Promotion has been set up in the Department of Health and Social Care “to improve and level up the health of the nation”. It will explore how incentives can encourage healthier behaviour, inspired by Singapore’s system of health promotion rewards. In the latest National Steps Challenge round in Singapore, citizens who take between 5,000 and 7,499 steps a day will earn 10 health points, which can be redeemed for a range of goods and services. Will it catch on in the UK? “Yes,” says one commentator, “but we will see a lot of dogs wearing Fitbits”.

 Source: Jack Serle New health promotion unit to use Singapore-style rewards to prompt people to be healthier Health Service Journal 29 March 2021

Privatisation myths

Research carried out by the Policy Institute at King’s College London and the Health Foundation has found that the 2,056 people who took part in a survey in November & December 2020 had significant misperceptions which could undermine the sustainability of the NHS. Participants guessed that 36% of NHS England’s spending was on private sector providers in 2018 and 2019 – five times the reality of about 7%. About 70% of responders thought that ‘creeping privatisation’ is a fairly or very big problem for ensuring the NHS continues to exist in its current form. 

In 2015 Rudolph Klein asked: what is it about the NHS that prompts linguistic excess and muddle, apocalyptic prophesies and premature obituaries? And does this dramaturgy matter?  His answer was: precisely because the NHS is such a cherished national institution, politicians in opposition…have an incentive to exaggerate its failings. NHS professions do the same. Since NHS professionals cannot easily exit they must use voice to make the case for more resources and less pressure. What better way to make such a case than by dwelling on shortcomings and failings?”  It looks like it is catching. 

Sources: Kings College London Policy Institute & the Health Foundation Misperceptions about NHS risk undermining views of its sustainability 1st April 2021 and Rudolph Klein  Rhetoric and Reality in the English National Health Service  Int J Health Policy Management 2015;4(9): 621-3 

Productivity, productivity, productivity.

A former NHS finance director who simultaneously held three senior NHS positions without his employers realising has been jailed for fraud. Within a two-month period in 2012-13, Stephen Day simultaneously held full-time interim director of finance or equivalent posts at Merseyside Commissioning Support Unit, South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group, and Cheshire and Wirral Partnership Trust. He was able to earn a combined salary of more than £2,000 per day during this period. On top of his NHS posts, he had extensive private business interests. Does this suggest that doing three full-time NHS admin jobs is feasible, at least in the short term? Have we stumbled on an interim solution to the NHS’ workforce shortages?

Source: Lawrence Dunhill  Director jailed after holding three full-time NHS roles simultaneously  Health Service Journal 16 April 2021

Supplier induced demand?

The latest NHS Digital GP appointment data shows the number of face-to-face GP consultations dropped from just under 22 million consultations in January 2020 to just over 13 million in February 2021. So it is true, getting to talk to a GP (let alone see one) is getting harder.

The GPs themselves are also working harder, particularly with requests for information or discussion posted via the practice’s on-line consultation system. One supplier of these systems, eConsult, reports that one in 10 of the 3,500 practices with the platform switch to “self help only” at the weekends, offering patients advice rather than directing queries to the practice.

Murray Ellender, CEO of eConsult, is sure that “Online consultation platforms haven’t increased demand. They have simply unearthed the demand that has always existed — all those patients that were previously told on the phone ‘I am sorry, we have no more appointments today — please call back tomorrow’”.

This is implausible, think NfN moles. Denial of access by telephone requires an interaction, but problems lodged with practice consultation platforms face no resistance, and must be dealt with. The appointments system and the receptionist – designed to contain demand – have been undermined. General practice is back in the 1960s, thanks to 21st century technology. You could call it supplier induced demand. 

Source: Jasmine Rapson Overwhelmed GPs switching off online services at the weekend  Health Service Journal  22 April 2021

How green is my hospital?

The health service has a footprint of 24 million tonnes of CO2 every year and expels 3.4 billion kg of CO2 and 1.0 billion kg of NOx – just for procurement and without including commuting by its 1.3 million employees – making it the biggest single emitter in Britain. During the pandemic, the carbon footprint of the NHS grew with the mass importation of PPE equipment. At the height of the pandemic, care workers used 1 billion items in 36 hours. 


A kite flying?

Diagnostic networks are all the rage down at NHSE. Recent guidance on their organisation, developed  in consultation with The Royal College of Radiologists, Society of Radiographers and Institute of Physics & Engineering in Medicine, mentions “outsourcing the service in its entirety, including ownership of the capital assets required for delivery of the service, to a commercial partner”. NfN has always insisted that privatisation cannot happen by the back door, and that it would require Government action to bring it about. Could this be it? 

Source: Diagnostic imaging network commercial structure and operational governance guide NHSE April 2021

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