My younger son was born in Addenbrooke's hospital. For that and other reasons I have a great deal to thank that hospital for.
And today the hospital is in special measures. It is in crisis because it cannot afford the staff it needs to supply its services.
But Addenbrooke's is not, by any stretch of the imagination, a failing institution. And it is one where it seems the medical staff had and have confidence in the senior management who have resigned in the last week, seemingly in protest at the suggestion made that the hospital is in crisis.
Addenbrooke's clearly has a problem. But the problem is not in Cambridge. The problem is in Whitehall.
Addenbrooke's knows what it has to do.
Whitehall will not give it the funding to do it.
And medical care in Cambridge may not have failed as yet as a result, but the implication of what is happening is that it is tottering on the brink of doing so.
In that case, though, who needs to be in special measures? Those who know how to provide the medical care or those who, for ideological reasons based solely on a deluded belief that the government's books must balance, have pushed Addenbrooke's into this situation?
Isn't the answer glaringly obvious?
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Healthcare has open-ended demand: a little honesty and accountability in setting priorities would go a long way.
Although I suspect that openly and honestly stating the priority to be maximising profit isn’t going to work.
Meanwhile, Addenbrookes is a teaching hospital, a major research centre, and a centre of excellence that takes on the complex and difficult cases from other hospitals.
This is inherently inefficient and extremely undesirable if you measure medical benefit in purely financial terms.
In cost-accounting, the excellence and complex cases should simply stop. Tip them off the bedds into the streets or into dumpsters: there are cheaper cases to be treated.
For profit-maximisation, the picture is uglier: complex treatment is costly , but that’s an open-ended opportunity to gouge the paying customer (we don’t say ‘patient’) into bankruptcy. Antd *then* it’s tip-them-off-the-bed time, same as the profitless paupers who never got treated.
Of course, we don’t tip them off the bed. Yet.
We just keep on treating them, draining a shrinking pot of money set – arbitrarily – by applying a cost-accounting collar to a hospital, while fetishising an ‘internal market’ that incentivises cost inflation: and this ‘market’ imposes parasitic costs from layers of administration purely devoted to managing arbitrary financial transfers.
Special measures, indeed.
I’m afraid it’s the same old story:-
1. Starve public service of funds sold politically through bogus household budget narratives.
2. Wait until said public service begins to fail.
3. Point out ‘inefficiencies’ and ‘waste’ in the service.
4. Sell public service to their friends to so they can extract rent from people’s needs.
This is what Conservative governments do.
The electorate need to wake up and start voting in their interests before they find that their grannies have also been sold.
nhsmanagers.net
You be the judge
The news that Addenbrooke’s has been put into ‘special measures’ by the CQC is the lead story across the news media this morning.
The Trust have had problems with recruiting staff, they have suffered from Social Service cuts, making it impossible to discharge patients safely and they are running out of money.
The best solution we have is to send in the clod-hopping CQC, spend nearly a million pounds ‘inspecting’ and pronounce them ‘failing’. This unwarranted epithet will make it even more difficult to recruit, will not solve any discharge difficulties and demoralise and already bewildered staff.
As far as I can see the Trust have good outcomes, low infection rates and the staff, exhausted by the effort, are dumb-stuck that all this has conspired to end with the chief executive walking away.
An enthusiastic group of consultant backed staff have pleaded with him to stay. The Board have been all but silent.
These events bring into sharp focus the contagion spreading through the NHS.
Today’s eletter is a postcard; there are no words for me that can better describe this predicament than this BBC Cambridge interview with the outgoing chief executive. (Link below)
Please find a moment in your busy day to have a look and you be the judge of the man, his approach and the extent to which the NHS has, today, driven out a class-act.
Something like two thirds of Trusts can’t balance their books, half have problems with the CQC and around a third have no permanent chief executive.
It’s time for Whitehall to wake up. Is it an exaggeration to claim the NHS is crumbling? Is it true to say the Tinker-Man has no answers. Is it right to point out we are regulating the health service into a cul-de-sac?
You be the judge.
http://www.bbc.co.uk/programmes/p0332fcn
Just listened:
if only politicians had his openness and humility!
” great place to go if you’re a patient”
” fixed budget and cuts in social care”
” regulation and inspection taking money from the frontline”
says it all.
I’m saddened to hear that yet another hospital is struggling. For your readers that aren’t aware, Addenbrookes is a PFI hospital and and you can see the repayment scheme here: http://www.pfi-explorer.co.uk/project/296
At least £9 million p/a is required to meet the charges until 2036, with a peak in 2035 of £15million p/a – to be clear, these charges aren’t all servicing interest on debt, although from my naive reading of the company accounts it looks like the interest is about £4 million p/a (on the £60mil capital that’s about 6.6% which seems inline with other PFIs)
Since Companies House have (tentatively) starting publishing company accounts for free, this information is much more readily accessible to everybody. For anyone interested, you can view the accounts for the holding company in question for free from this page: https://beta.companieshouse.gov.uk/company/05094413/filing-history (choose the most recent annual report).
The reason I feel it’s important to highlight the technical details is because, sadly, this won’t be the last story you’ll hear about PFI hospitals in special measures and I feel there needs to be an increased public and political awareness of the PFI/PPP landscape. From reading the accounts in this particular case, we can start to identify common themes e.g.
“Credit risk
The company’s main customer is Cambridge University Hospitals NHS Trust, with which the company has a concession agreement. This concession agreement includes clauses whereby should the company not be paid by Addenbrooks Hospital NHS Trust then the company does not pay the relevant supplier for the services provided that company is the cause of the non payment. The company therefore, does not consider its exposure to credit risk to be material.”
I read this to mean “the PFI gets paid first, health suppliers second”. How common is this across PFIs? This is the kind of question that needs better public knowledge so that the public sector can manage it’s own “material risk” of being without adequate infrastructure and healthcare.
Money always comes first
Quite right, Richard. There is no crisis in the NHS. As a country we spend less on healthcare than most other western European nations. The frequent appearance of crises in the press is promoted by the government to try to shift public opinion to support further privatisation and take out private health insurance.
They have created much of the crisis by closing local Doctor’s surgeries and A&E’s and the resulting pressures that this has caused.
It’s about time the opposition were much more vocal on the deliberate hobbling of NHS services and the creeping privatisation. People are still much too complacent about this.
People are not complacent: They don’t know any different.
I believe the phrase “captured press” explains much.
Addenbrookes is itself the cause of [much of] its decline.
Cases get sent to that hospital that local hospitals COULD handle themselves, were they financially able to do so.
My local hospital has an MSK contract with Addenbrookes, even though much of what gets sent there could easily be handled by the Bedford NHS trust hospital.
The other hospital I attend is NHS Papworth, another specialist hospital dealing with cardiac and pulmonary illness. That too is feeling the pinch, and for much the same reason (NHS Papworth is/was/maybe due to move to the Addenbrooks medical complex).
You can look for a single point of blame, and maybe the gov is that point. But probably not for the reason you are thinking.
My ailment is well-known, well-researched, and the treatment is also know. The illness is not cureable. The treatment however, while known, is not one that a GP can prescribe for. The hospital can though. So, I get sent to a hospital even though the GP knows what is needed, but cannot treat because the needed medication, and the duration of that medication, is one she is not “allowed” to prescribe.
And an awful lot of hospital work comes from the same source, for the same reason.
It’s called shifting the cost…..from primary care, to secondary care.
Agreed
East Sussex Healthcare Trust goes the same way this morning:
http://www.bbc.co.uk/news/uk-england-sussex-34314044
A steady drip-drip of these coming through now, as has been predicted ever since the Tories got their mitts on the tiller.
I totally agree with this.
I know about the effects PFI is having – read John Seddon’s ‘The Whitehall Effect’ for one.
Scandalous.
PFI = Profits For Industry or Patient’s Fate Ignored.
But the most fitting one I can think of is ‘Programmed For Insolvency’.
Her Majesty’s Government set up these contracts and HM Government needs to bail the Trusts out. There should be a public enquiry.
But of course they don’t give a damn. They are in raptures over the gold rush that is to come. So many parliamentarians with links to private healthcare companies. I think we all know the trajectory, pity is we voted for them, though other parties did not have the passion or commitment to fight for this truly wonderful health service.
A lot of trained NHS staff now work in the private sector. That isn’t necessarily due to better pay; it could be better employment conditions, less paperwork, craic with the patients or simply not having to walk half a kilometre to have an e-cigarette when on duty.
Nevertheless and if you forgive the pun, it is wholly ridiculous that a private sector circumcision performed for cultural not medical reasons by NHS trained surgeons is free of VAT.
As a friend posted on Facebook: “Of course there is a staffing problem at Addenbrooks Hospital. Have you seen house prices in Cambridge?”
Comments all point to a need to completely change our system of government. We need the resources of this country to be taken out of the hands of the few and democratically managed in the interests of us all.
TUSC candidates (myself and others) stood on a platform to keep the NHS public and free at the point of use. Specifically; scrap PFI – don’t pay the debt, reverse council cuts to social care, remove private companies from the NHS and bring the profit-hungry drugs companies into public ownership.
Excuse the political diatribe but we are past “sticking plaster” time now.
Addenbrookes is in crisis, but still not nearly as badly as the social care system. I know somebody getting good care there after a fall and ready to go home. But she can’t leave because the funding is not there to put a package of care in place so that she can make the transition to living at home without an unacceptable risk of falling again and coming straight back, perhaps with broken bones next time.
Interesting section (17) on page 13…..
http://chpi.org.uk/wp-content/uploads/2014/08/CHPI-PatientSafety-Aug2014.pdf
Looks like “going private” may be both expensive, and fatal…