Over the last few weeks we have seen dozens of hospitals
declaring major incidents. As Chief executives take to the airways a consensus
has emerged. The same words are heard.
Accident and Emergency is coming under “unprecedented demand”
and the patient flow through hospitals becomes impossible because of “delayed
discharges”.
Coincidentally or not these represent the political
explanations of the phenomenon from Conservatives and Labour respectively.
To me the point where the rash of major incidents became
predictable came with the resignation of one of the most respected CEOs Dr Mark
Newbold, some weeks ago. He appeared to
go because of the pressure applied from above to meet targets that had effectively
become impossible to meet, for reasons beyond his control.
I think what we may be seeing with the contagious major
incidents is a sign both of the instability within the wider health economy,
and the refusal of management to continue to carry the can for problems that
lie outside their hospital walls.
Hinchingbrooke was effectively the test bed for a private
sector body running an NHS hospital. This presupposes the possibility of being
able to do the job and make a profit. Because of the very peculiar structure of the tariff
system this is only possible if there is the right balance between elective
care and emergency care. The
announcement that Circle is withdrawing from the Hinchingbrooke contract ,
because of unprecedented demand for A&E and the problem of delayed
discharges is about as clear a signal as we need that making a profit from the
NHS at the moment, given the structure of the Tariff system and the state of
social and community care, is simply not a realistic possibility.
Controlling spending within the NHS is a perfectly legitimate
aspiration. Managers have a role to play in ensuring that money is spent well, but
if we expect hospital managers to provide answers to the incoherent structures
of our health and social care systems then I think that we are likely to be
disappointed. If we want to judge our hospitals on their "financial sustainability", which is what has been happening for the last few years then health service managers need at the very least to have a climate that makes sustainability possible.
The current crisis is a useful wake up call. What we need
from our politicians is the courage to ask difficult questions, not least about funding health and social care, and to provide the framework for the different organisations involved to
begin to work towards a more coherent system.
There are just a few weeks for politicians to give clear signals that
they intend to do so.
http://www.theguardian.com/society/2015/jan/09/circle-exit-private-contract-hinchingbrooke-nhs
http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/franchising-hinchingbrooke-peterborough-stamford-hospitals/
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