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Readers' letters

Letters to Health Service Journal's editor.
  • The ever-changing NHS needs some blitz spirit

    24-Apr-2014 1:14 am

    What a marvellous article. Thank you Craig. I don't think the comparisons with PTSD symptoms are overly exaggerated, having counselled people with long service who've been hounded viciously out of posts because their faces no longer fit with the evangelists ready to fake belief in whatever the latest wheeze is to preserve and increase their salaries and status at the expense of others. I would be interested to hear about practical solutions. I work in the private sector now, and one organisation has formed a spin off for staff whose roles are no longer required, and through grants and a very innovative HRD, are able to redeploy and retrain people whilst retaining corporate memory. I wish the NHs could do something similar. I miss it but am too bruised by previous history to trust it again. Or at least, not until certain individuals leave or retire. Others like me, particularly clinicians, are a loss. I'm grateful to have found work and be in a less stressful environment but I do miss not being able to share the history of change that you describe. I'm very nostalgic but I know that my rose coloured specs also covered a time that was difficult for many others. But does the NHS ever forget and allow people to return after they've reinvented themselves?!

  • Doctors 'know best' on resources

    23-Apr-2014 11:16 pm

    Hello Peter. I've long been an admirer of your work. The HFMA have a large work stream on this called Transforming Healthcare, the role for the finance team, which was launched at our recent conference. If you know any local DoFs (apologies, I don't know where you're based) they would be delighted to hear from you. Have a look at the HFMA website for more info.

  • Liberation, preparation and participation: why foundation status matters more than ever

    23-Apr-2014 11:03 pm

    Retired CEO (or anyone else who reads this) - genuine question from youngish junior manager. I agree with your suggestion about the TDA but I also read Alistair's piece about how a merger with Monitor would be classic NHS displacement activity. What do you think of that comment and how could we do as you suggest but without wasting yet more time on structural tinkering? Thanks in advance for your thoughts and anyone else's insights.

  • Chief departs Hull and East Yorkshire Hospitals

    23-Apr-2014 7:21 pm

    Shocking man, and about time too! He should never be allowed to preside as an NHS CEO ever again. So many damaged people left in his wake!

  • NHS England steps up work on pooling budgets

    23-Apr-2014 5:57 pm

    Pick Me, me , I know a PCT!

  • What you need to know about the first emergency-only hospital

    23-Apr-2014 5:01 pm

    Any reference to the fact that it is being built only 8 miles away from the Royal Victoria Infirmary, a major trauma centre and a hospital that has all the acute specialties already?

  • Councils put the public health ethos into practice

    23-Apr-2014 4:47 pm

    We don’t talk about it anymore but there was a time but there was a time when local authorities were ambitious for their populations and felt their remit extended beyond the provision of services to a grander vision. Local authorities had a community leadership role and the vision was to bring a range of agencies together to improve the quality of life for local people. There were many measures of success that partnerships could use but the most dramatic had to be to close the gap in life expectancy. Chief executives of local authorities would open conferences by quoting the shocking figures on life expectancy between those who lived within one part of their Town/District/County and those who lived in another. Often the difference in life expectancy was as much as 10 years. This was a disgrace they would say but something they could aspire to change. The mantra was no single agency working in isolation could tackle could tackle such a complex multilayered problem but working together we could address health inequality whether its root be be homelessness, long-term unemployment, teenage pregnancies, drug abuse, poverty or discrimination. As a Director of Community services I attended many of these conferences and Directors of Public Health were always in attendance. Often a Director of Public Health was one of the key speakers. It was clear that they viewed local authorities and their chief executives as kindred spirits providing the leadership and commitment that was lacking from their own senior colleagues in the NHS. Directors of Public Health were frustrated by NHS colleagues who couldn’t see beyond hospital waiting lists, foundation Trust status and tackling the drugs budget. If only they were part of the Local Authority were people understood the big picture. And then their wish came true. Unfortunately in the meantime LA’s curtailed their ambitions, a new government, a series of austerity budgets and a more limited role for local government. Local Authorities were now preoccupied with closing libraries, swimming pools and museums, outsourcing IT, Payroll and HR, no longer leading schools, providing housing or commissioning care services. The Directors of Public Health once again find themselves isolated , marginalised and operating on the periphery. Transferred at the wrong time they must now hope that Health and Social care commissioners can see that bigger picture. Blair McPherson writer and commentator on the public sector www.blairmcpherson.co.uk R

  • E-prescriptions change the game for acute trusts

    23-Apr-2014 4:21 pm

    Shaun, Since EPMA usually stands for Electronic Prescribing and Medicines Adminstration, I'd be interested to hear how the Medicines Administration section works in primary care, particularly for complex medicines with variable doses and administration rates, including warfarin and variable dose infusions. I suspect that you've only really been using electronic 'prescribing' to print out FP10s which is a completely different ball game to full EPMA in the hospital setting. And, if the benefits are self evident, how come no-one's measured them and come up with a robust and realistic business case???? I would love to see the ROI in the panel published in a robust peer reviewed journal becuase if it's that good, we all need to see the evidence and the methodology used to collect it. Chris

  • The NHS needs bold policy to cope with grey tsunami

    23-Apr-2014 4:16 pm

    Michael's evocation of the palmy purlieus of the M4 Corridor cannot but call to mind our current Cabinet and the type of environment and institutions that formed many, or even most of them. It was, after all, another Tory grandee, Nigel Lawson, who in 2006 called the NHS the ‘closest thing we in Britain have to a national religion’. History does not record the spirit in which this remark was made, but his tone becomes clearer when we realise that he was speaking in his Memoirs of a Tory Radical as a former Chancellor of the Exchequer, and that the quotation continues ‘with those who practice it regarding themselves as a priesthood’. The tone is one of fond exasperation, like a posh pater whose son has blown his allowance again because he knows that his father will always good for another few thou’. I say all this because the lens matters, and what looks like a numbers game to some, may feel like a sword of Damocles for others, who may fear, however irrationally, that the NHS provision they, their parents and grandparents have known is about to be reduced, or even curtailed. The numbers are incontrovertible. NHS inflation is always higher than general inflation, and the strange paradox of health improvement is that greater life expectancy means greater deferred cost. The curve is an exponential one. But beware the shifting lens. The NHS that was spun not so long ago as the ‘envy of the world’, now looks more like a patient than many of its patients. And National Insurance, which until 1975 was a flat rate ‘stamp’ unlinked to earnings, is now broadly redistributive, and accounts for a whopping 21.4 per cent of HMRC’s receipts. Make no mistake, regardless of who is shifting the scenery, the cradle-to-grave NHS is the biggest, most inclusive, most all-embracing idea we’ve ever had in this country. The 1946 Act sets that idea out. It is to ‘secure improvement in the physical and mental health of the people’. It is to be ‘comprehensive’. And it is to be, overwhelmingly, free. Whatever the numbers say, the NHS today is exactly as sustainable as that monumental idea.

  • Tax rules raise doubts over CSU autonomy

    23-Apr-2014 2:29 pm

    Anon 12:02. As someone who works in a CSU I really do not recognise what you are saying. Most people I know working in the CSU are trying their damndest to do a good job, retaining NHS values, meeting the needs of [mainly] CCG clients who, with the best will in the world, are often very immature in their own understanding of what they themselves need. Sure, there remain many questions to be answered about the future for CSUs, but they are not deluded, they are simply playing out the cards they have been dealt as best they can.

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