As the Guardian reports this morning:
Serco, the leading private contractor of government services, fiddled its data when reporting to the NHS on targets it had failed to meet, according to the National Audit Office (NAO).
The independent watchdog's investigation into Serco's out-of-hours GP service in Cornwall, published on Thursday, comes after the Guardian revealed last May that whistleblowers had concerns that the privatised service was regularly so short-staffed as to be unsafe and that its performance data was being manipulated.
I think we can safely say that the private sector offers no way out of the Mid-Staffs style crisis.
But actually, it's possible to say more than that. Serco and Mid-Staffs have a lot in common. Patient care has suffered and people have been harmed whilst data has been misreported and all for one reason, which is to satisfy market driven performance criteria.
I was asked recently what my one change to the #NHS would be if I had my way. Well, there's a simply answer. I'd take the market out of it. Private contracting would be used at manager's discretion. GPs would be salaried. And the farce of the internal market would be abolished.
If one thing has cost the #NHS money and inefficiency it is the internal market. The concept of profit and loss is absurd when the patient does not pay at the point of delivery: surplus or deficit is the result of demand and whether or not best clinical and management practice is applied or not. But that does not require a market with the enormous management and accounting costs involved. It does require a matrix of weighted key performance indicators based on patient satisfaction, clinical standards, referral management, resource usage and other factors. But that could be done simply and effectively largely based on medical record keeping with no market overlay.
The we could have a cheaper, patient focussed, medic lead, efficient NHS. We won't get that when money is the determinator of service quality, and data supply.
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Following the orgy of contracting out and privatisation that’s occured over the last few years – and will continue until at least 2015 as this government continues its shock doctrine, anti-state, tactics – we can expect to see numerous and growing examples of such manipulation, false reporting and worse.
What will make this situation far, far worse is not simply the scale of the opportunities that have been created for such abuses, but the lack, or willful under-resourcing of inspection and regulatory systems. This is further compounded by a selection and recruitment process that has been underway for many years: the people in positions of leadership and control are (ideologically) predisposed to take a light touch approach to using any powers they might have. And to that must be added the politicisation of regulatory and inspection bodies (e.g. OFSTED). Result: scandals of the Mid Staffs variety stretching over the next decade and perhaps more.
The sad, annoying and scandalous thing is, there have always been a multitude of ways to ‘modernise’, ‘restructure’, ‘reform’, ‘reengineer’- or whatever you want to call it – public services, just as there are for any type of organisation. But the truth is that as the policy process in the UK (and particularly as it applies to England – as Scotland, and Wales to a lesser extent, escaped thanks to devolution) has become more and more dominated by corporate interests the ability of anyone to promote alternative views, however rational and sensible, gradually disappeared. And since the last election what few opportunities remained have been ruthlessly closed off – whatever minister may claim. The result is that by 2015 – and for the first time since the early 19th century – we will truly have returned to a system of government and policy making based entirely on ideology and individual and corporate self interest. Still, at least that’s consistent with the government’s approach to the demonisation of welfare and the poor, so at least there evidence of strategic thinking at some level of government. Bravo!
Apologies for the typos 🙁
Agreed
In the news today, 111 is going to have fewer people, not qualified, and nearly a third fewer tele offices, but expected to take 33% more calls. They are sacking loads of 0845 staff, usually nurses. The new 111 staff will be on lower pay.
Have you noticed how the CQC keeps being given more work to do but fewer staff to do it?
The interesting thing on their website is that they have kept up more or less with the expected percentage of inspections in NHS hospitals, but are way down on the percentage in private health companies.
All worrying
Especially CQC. Thatcher tried to create the regulated market but it fails without a regulator