News from Nowhere 99 June 2021

Hindsight not needed

Dominic Cumming’s revelations about the Prime Minister and the management of the Covid-19 pandemic made for gripping television, but did they tell us anything we did not already know? If you have doubts look at Coronavirus: 38 days when Britain sleepwalked into disaster, by Sunday Times’ journalists Jonathan Calvert, George Arbuthnot & Jonathan Leake, on April 28th 2020. It’s almost all there, except for the mishandled autumn second wave.

An unnamed Downing Street advisory told the Sunday Times in April 2020: “One day there will inevitably be an inquiry into the lack of preparations during those “lost” five weeks from January 24. There will be questions about when politicians understood the severity of the threat, what the scientists told them and why so little was done to equip the National Health Service for the coming crisis. It will be the politicians who will face the most intense scrutiny”. Roger that!

Source: https://www.thetimes.co.uk/article/coronavirus-38-days-when-britain-sleepwalked-into-disaster-hq3b9tlgh

Medical-industrial complex

Last year the University of Glasgow was awarded £38m in funding to create the Precision Medicine Living Lab, a potentially ‘game-changing’ project focused on translating cutting-edge science and innovation into real-world clinical settings. Precision medicine is a medical model that aims to customize healthcare to the individual, with medical decisions, treatments, practices, or products being tailored to a subgroup of patients, instead of a one‐therapy‐fits‐all model. It utilises advanced medical tools such as more precise diagnostics, imaging, genomics and artificial intelligence.

This sounds like a good idea, but like many promising things in medicine, it may yield less benefit than we hope. Glasgow University has the tough job of testing the scientific idea in the real world. If that were all there is to the Precision Medicine Living Lab we could leave it to the boffins. But there is more.

Globally, the precision medicines market is project to reach $134bn by 2025. Working with Glasgow City Council and Glasgow City Region City Deal, the Living Lab is supported by over £22m from industrial partners and an investment of £27.5m from the council and city region deal alongside its UKRI Strength in Places funding. The Living Lab is projected to deliver 446 high-value jobs and £136m Gross Value Added over an 8-year period.

The Living Lab will help companies to develop and commercialise products and processes, encourage business start-ups and offer the NHS substantial savings by implementing Precision Medicine in the UK’s largest hospital. University of Glasgow Principal, Professor Sir Anton Muscatelli, said: …as well as being a game-changer for Precision Medicine in Scotland and the UK, this project will deliver a real impact for the local and national economy.  This is an area of the city synonymous with Glaswegian leadership in heavy industry – and it is deeply exciting that the University is helping to lead the way in reimagining this great industrial legacy for the 21st century.

Precision Medicine in Glasgow means different things to different people. One is an expansion of the medical-industrial complex beyond pharmaceuticals and hardware into new technologies. Another is a tonic for a de-industrialised city, even if there are only 446 ‘high value’ jobs on offer.

Source: National Health Executive 26.06.20

Integrated care

At a recent gathering of NHS Confederation members working on developing Integrated Care Systems a News from Nowhere mole asked a question: is the integration work being hampered by the noise about privatisation? Not in the slightest, said all but one of the senior managers, who denied any such influence on their collaborations. Our mole left the discussion unsure of what is going on. Is the anti-privatisation lobby now thoroughly marginalised and dismissed as conspiracy theorists, or is senior NHS management really that far out of touch? 

Source: NfN mole; no names, no pack-drill.

Self-interest always prevails?

Talking of Manchester, one of the highest profile NHS reconfigurations has been “quietly dropped”, according to the Health Service Journal. The proposed consolidation of high-risk general surgery in Greater Manchester, which fought off a judicial review brought by doctors at Wythenshawe Hospital in 2016, will not continue. The plans, which were central to Manchester’s Healthier Together consultation, would have consolidated all high-risk general surgery at four of nine hospitals. 

The hospital sites that were set to lose high risk surgery were North Manchester, Wythenshawe, Tameside, Bolton, and Wigan. Those retaining specialist surgical centres were Manchester Royal Infirmary, Salford, Stockport, and Oldham. It was claimed that centralising care into four specialist sites would improve patient outcomes and reduce deaths. 

Five years ago, the successful public consultation and victory in the judicial review were seen as central to Greater Manchester’s ability to disrupt the competitive culture of foundation trusts and transform services for patients. However, local sources told the HSJ that some aspects of the reconfiguration had been implemented, such as recruiting additional consultant surgeons and merging some clinical teams. These changes may have improved patient safety and the quality of surgical care enough to weaken the planned reconfigurations.

Comments lodged by (mostly anonymous) observers in the HSJ discussion were characteristically robust. For example: 

This was supposed to be about improving clinical safety and patient outcomes – people in Stockport getting the same access to clinical quality as Central Manchester and Salford offered. Fiefdoms and Consultant jobs seem to have been the determining factor in killing this off”.

 And “….the covert and overt lobbying to undermine [Healthier Together] is the perfect example of why they [Providers] will never make the right decisions for health outcomes for a population – self-interest always prevails”.

Source: Lawrence Dunhill   Landmark reconfiguration that promised to save 300 lives a year ‘quietly dropped’    Health Services Journal  28 May 2021

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5 Replies to “News from Nowhere 99 June 2021”

  1. With regard to the ICS and anti-privatisation lobby, my guess is that a proportion of managers and clinicians driving ICSs in localities ARE aware of “keep our NHS public” “centre for healthcare in the public interest” and other such groups and individuals who have legitimate concerns about creeping privatisation. However, they are pragmatic people just trying to crack on with delivering ICS working with the policy and contractual and resourcing and staffing framework they have been given and thinking about needs of local population (and yes, of course – what it means for their organisation and their professional tribe and their work and their influence). So they are not unduly troubled because they are pragmatists and doers rather than ideologues and thinkers (about policy at least).

    It could be that they are so focussed on the practical and immediate that they are blind to the risks of privatisation by stealth which the anti-privatisers would say is happening right under their noses. Or it could be that they just don’t see it as big a risk as the campaigners do

    Personally, as someone who is 100% pro publicly funded, publicly provided NHS and doesn’t want more marketisation or privatisation and who is on the social democratic centre left politically and hates Toryism, I find myself alienated by the one eyed campaigning zealotry and self-importance and conspiracy lens of the arch anti-privatisers. And yet I also think they have often been proved right and I have proven complacent. e.g. with all the cronyism, contacts, contracts and key appointments around Covid

    1. I don’t think the crony contract stuff is an example of privatisation, or even marketisation, because there was no public sector provider being displaced. It’s corruption, I think

  2. ……apart from the fact that they could have pumped money into existing public health teams and let them do all the boots on the ground tracing which they are trained for and know their local patch

  3. Yes, that’s an example of privatisation, assuming the public health departments did have the capacity and the pandemic preparations were truly in place – there seems to be some doubt about the latter.

  4. ….but the sustained attacks on public health and local government funding and the failure to put in place adequate public health protection policy are ideologically driven

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