sjburnell@focused-on.com's Comments
Comment on: Nicholson: 'more' community focused care required
Was DN suggesting more Care @ Home or the expansion of Supported Housing or a different use of Community / Cottage Hospitals? In any event, greater Carer Support is essential as we must not continue to expect a very old spouse to bear the full burden of caring for the very infirm. I would also like to DN throw his considerable power full-square behind an effective Dementia Strategy as the levels of Diagnosis & Support are far too low and often far too late. If there ever was a sensible place to re-invest some of the £20Bn then it is an invest-to-save Dementia Strategy.
Comment on: Hunt: Unsafe staffing 'totally unacceptable'
Of course, nobody will argue for unsafe staffing levels and everyone knows that the NHS needs to transform on so many different levels, yet everyone defends their status quo including local MP's! The Government tried to bring about the required Culture Change with Competition + Reform via GP Power, but this has already failed + Sir DN is reported as telling MP's that the NHS lacks quality leaders in depth. Perhaps we are simply faced with too many conflicting & overly powerful forces which cannot be reconciled until the collective sole thought is "The Patient is King". Only then will the people, processes, & culture running our NHS realign themselves full-square behind every Patient's best interests & wholeheartedly seek new ways to improve quality of care & thereby reduce unit costs?
Comment on: Trust found to have altered waiting times figures
Dear Insideperspective, I'm familiar with Vanguard & Lean Thinking. Your "hook or by crook" comment points to a big cultural flaw in the NHS plus a clear lack of 'ownership' of the required 'care standard' & no deep understanding of how best to pursue & sustain improved care above & beyond a reasonable minimum quantified standard (a 'target' by any other name), especially in the face of changing conditions. The issue arises if a culture demands instant universal success at any cost, except the actual cost of doing the hard thinking, putting in the required time & effort, and delivering evidence-based changes needed to hit target performance levels systematically instead of by applying only localised sheer brute force which can't be sustained, especially when a new / extra standard / goal/ target / KPI / objective / aspiration is introduced e.g. 18-Weeks or PbR Penalties. Agreed, gaming or worse achieves nothing for the Patient & ultimately reduces our trust in the service.
Comment on: Commissioners have rationed cataract surgery on inferior evidence, Keogh admits
Words of Wisdom from Sir Bruce. Let's hope this kind of powerful clinician/commissioner teamwork grows rapidly & becomes widespread.
Comment on: Trust found to have altered waiting times figures
Nothing wrong with "Targets" per se, especially if they quantify an agreed level of performance that can be achieved & sustained and if their 'owners' are properly motivated to achieve them. Problems are likely without wholehearted 'ownership' & failure is inevitable if Targets are simply achieved by brute pressure & sheer dint of effort rather than by evidence-based intelligent design & optimum resourcing. Pure effort cannot be sustained & can't flex with demand. A&E performance relies on many complex, inter-dependent, system-wide factors, both in & outwith the Hospital. An NHS culture of Bullying & Quick-fixing is corrosive & must be replaced by one of Care & Responsibility.
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
Hi Sheena - thanks for your further thoughts, which I do follow. Totally agree with Equal Need=Equal Care (rich or poor / thick or clever). But not clear if you are saying: £12K per Cancer Patient is wastefully excessive & £6k woefully inadequate & both Patients need ~£9K or that £12K should be reduced to £6K & the Saving spent more intelligently by someone else doing something else or just Saved by UK PLC? Although not your example, I still imagine (say) high Obesity will end up with high incidence of premature Diabetes = high prevalence of very expensive (albeit avoidable) LTC's. I have absolutely no idea, but, very broadly, how many £Bn's WASTE should move from NHS & be SAVED or given to (say) LA to ACTUALLY remove Health Inequalities? Or are you arguing +£100Bn NHS is OK but just not allocated fairly + £BN needed for other LA stuff too?
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
Sheena, I think I follow your logic but according to a parallel article in HSJ, LA's have only been given £2.2Bn (~2%) ring fenced for Public Health. Long-Term Conditions including Diabetes & COPD are costing the NHS a disproportionate fortune and excess prevalence rates are life-style related. I also read that Alcohol misuse is rocketing. And, I hear on TV that Kids have never been so Fat. And, we learn more each day that some incidences of Dementia (not just Vascular) can be mitigated. Surely, a penny (or £Bn) invested on effective prevention must be worth many more times that amount spent on downstream Treatment? I'm not arguing that all parts of the NHS can be equally effective in solving these problems, but we do need some valid ideas & facts of where best how much money ought to be spent. Is there any correlation between prevalence of LTC's and Deprivation? If (& whilst) there is, then Deprived Areas will have higher overall Needs & Costs. So, how do we persuade the NHS to alter its spending patterns for more optimum allocations? Perhaps a system of Integrated Care & shifting more money to LA's against desired Quantified PH Outcomes to reward Success designed to equalise Demand & mitigate any Deprivation bias? What is the required role of Health & Wellbeing Boards & are they able to perform & deliver the desired impact and will they be given the Time?
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
Are the latter comments suggesting that more money should be taken from the NHS & given to Public Health & Social Services and so leave the NHS funded & solely focused on Treatment? Is the suggestion that GP / Primary Care cannot do more to identify People @ Risk and help them appropriately? Specifically, how much do you think ought to be reallocated away from the NHS & what should it be best spent on to narow the agreed Health Inequalities?
Comment on: Minister casts doubt on use of tariff across mental health
Surely, it was the "centre" that set the original Key Performance Targets focused on Physical Health & not Mental Health & so signalled any "insitutional bias" to local commissioners? Surely, it was the "centre" that introduced PbR Tariffs for elements of Acute Physical Healthcare, excluding 100% of Mental Health & so signalled or reinforced any "institutional bias"? Surely, Systems, Processes & Policies that support both Physical & Mental Healthcare Services will be all the better informed & more intelligently designed? Mental Health must be given the same opportunities & challenges as Physical Health and it is up to the MH Professionals to step up to this and even give leadership in finding ways to deliver greater Care. Might this pause in introducing PbR Tariff for MH be used to design a Remuneration system focused on Outcomes & true Results and not purely Activity?
Comment on: Full coverage: Commissioning board sets priorities and rules for 2013-14
Whilst top-down imposed Targets are often less effective and often have more unintended consequences than well informed & more consensual key performance indicators, I would suggest that they have at least initiated some service improvement. Was a typical Patient's experience of A&E or Wait for Treatment better before the introduction of such Targets? On the other hand, if some Targets are considered 'poor' or 'inappropriate' or even 'statistically unsound' or easily 'gamed' then surely it is up to the Professionals & their Colleges to offer to meet better & more appropriate Service Levels that will give the Patient better experiences with better outcomes that Commissioners would be delighted to see & support? Please, tell us the Public, what you really ought to be giving us if it is not what the DH are telling you that we want.
