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Bob Neilans's Comments

  • Comment on: PCT halts funding for over 30 procedures to 'remain sustainable'

    Bob Neilans's comment 26-Oct-2010 3:50 pm

    Agree fully with Anon 3.42PM - If these elective procedures aren't enough to prevent the PCT overspending, what is next to be stopped? And of course, because of the funding structure of the NHS we will end up with expensive real estate, equipment and professionals idle. Delaying I can understand, but stopping?

  • Comment on: Essex PCT plans to shed over 220 staff in £5.7m savings bid

    Bob Neilans's comment 13-Oct-2010 4:50 pm

    One would have thought that it was not beyond the wit of man to have begun to set up GP consortia and "sold" them a ready made admin function to look after the entirety of the consortia requirements. Of course what will happen is that staff will be made redundant and then rehired (at considerable unnecessary trauma and state expense) into their erstwhile jobs!

  • Comment on: First GP consortia launched in Cambridgeshire

    Bob Neilans's comment 1-Oct-2010 8:38 am

    Dear Joe Bloggs - I've no doubt they'll be concerned about the all the regulatory framework but they only need to employ administrators accountable to their board to carry out the tasks and relieve them of the "doing" - Regards

  • Comment on: GP pay revealed by NHS Information Centre

    Bob Neilans's comment 17-Sep-2010 6:21 pm

    When the BMA negotiated with the DoH over the Out of Hours contribution and the main contract they couldn't believe their luck - The work of a GP is now more structured in respect of what they have to deliver but no more arduous than a GP in the 1990's and the increase in salary has been exponiential.

  • Comment on: White paper leads to shake up in top posts at SHAs

    Bob Neilans's comment 10-Sep-2010 7:20 pm

    How incorrect Anon at 0703PM?

  • Comment on: Labour must challenge cuts agenda says Balls

    Bob Neilans's comment 27-Aug-2010 6:23 pm

    Yadda Yadda

  • Comment on: GP largesse alarms Lansley’s colleagues

    Bob Neilans's comment 26-Aug-2010 12:59 pm

    Before PbR, HRG costs, tariff prices etc, if budgets were being overspent the Health Authority simply slammed on the brakes and activity was seriously reduced - result; financial balance and increased waiting lists. It seems today that we are trying to make a monolithic soviet style system behave as if it were an efficient and rational business (which it isn't). And as for cash allocation, that also needs to be rational rather than weighted towards "deprived" areas - this bias (RAWP et al) obviously hasn't worked else there would not be such a large gap in life expectancy as was recently evidenced. We need to change the NHS to a more european model of state cum insurance funding - it may not be perfect but at least patients get their cancer drugs!

  • Comment on: Andy Burnham calls for higher taxes to pay deficit

    Bob Neilans's comment 24-Aug-2010 7:20 pm

    And so Brown's profligacy which rewarded those who have no intention of working, and empowered the state to spray other peoples' taxes about with gay abandon now seeks to recoup the debt by taxing those who supplied the funds inthe first place - I don't think so!

  • Comment on: Mixed sex wards and ennui

    Bob Neilans's comment 19-Aug-2010 5:54 pm

    Oh Gawd! Not another word some Chief Exec has looked up in Roget's Thesaurus - Ennui is the new buzzword - Cop this - Notre ennui, nos mœurs fades sont le résultat du système politique No I don't know what it means either - Bob

  • Comment on: PCT and UnitedHealth end deal

    Bob Neilans's comment 18-Aug-2010 6:03 pm

    Re Joe Bloggs piece - Isn't it time that HSJ became a tad more inquisitive rather than just reporting the bald facts - United Health will not be cheap but will be radical whereas the PCT was probably not be able to step outside the constraints of the NHS bureaucracy!

  • Comment on: 'Postcode lottery in end of life care provision'

    Bob Neilans's comment 11-Aug-2010 8:15 pm

    A countywide (PCT) palliative care co-ordination centre which receives all referrals for packages of care for end of life and puts them in place is really the first step in bringing together all the necessary services to ensure that patients are managed across organisations and over the 24 hour period - We have one in Lincolnshire - come visit us at St Barnabas Hospice in Lincoln and see how it simplifies what is a very complex process.

  • Comment on: HSBC boss warns against stringent cuts

    Bob Neilans's comment 10-Aug-2010 4:40 pm

    And this from a Banker!!

  • Comment on: GP consortia management budgets could be as low as £9 per person

    Bob Neilans's comment 22-Jul-2010 2:49 pm

    Don't forget that there is quite a lot of management expertise already embedded in general practice so one won't require quite as much investment to bring the consortia up to strength!

  • Comment on: East of England opens up hospital quality figures

    Bob Neilans's comment 21-Jul-2010 7:05 pm

    This is a great idea but I fear we need to learn that the information will be sourced from iPhones as well as laptops - User friendly it is not nor is it all open to the public - Registration is necessary to access some of the SMR data and I don't think we should assume that only NHS cognoscenti can understand this. But its a good first step.

  • Comment on: Government warned reform plans will 'turn NHS upside down'

    Bob Neilans's comment 12-Jul-2010 6:32 pm

    The smart commissioners will be helping GP consortia like there's no tomorrow - which of course there isn't for PCTs - and for the obvious reasons. And why not!

  • Comment on: Dangers of putting GPs in charge outweigh the rewards

    Bob Neilans's comment 15-Jun-2010 7:46 am

    My neighbour recently went into hospital for an operation on his hand - he can exercise but not use the fingers for dressing, cooking etc - the operation was performed in a hospital 60 miles away from his home. You would not believe the trouble and downright obstruction in organising transport, social services, physio treatment etc - Any system that improves on the current which is very good at delivering the intervention but useless at after care has got my vote! So we may ruminate on whether GPs or PCTs should commission - I'd just like a system that works!

  • Comment on: NHS reputation is on a par with Iceland chain

    Bob Neilans's comment 3-Jun-2010 10:55 am

    Phew! I thought they meant the country.

  • Comment on: PCT tells patients the cost of their care and services

    Bob Neilans's comment 20-May-2010 8:44 am

    These costs seem extraordinarily low and seriously understimate the true costs of care - A & E attendance for £59 - I don't think so!

  • Comment on: Manager suspended on full pay for five years

    Bob Neilans's comment 13-May-2010 9:05 pm

    I think they just forgot about him! And what's £315k in this man's NHS?

  • Comment on: GP practice manager jailed for theft and fraud

    Bob Neilans's comment 11-May-2010 5:54 pm

    She isn't the first by any means - the weakness lies in the GP's not instigating control systems such as evidence of bankings made and inspecting the payroll for the staff names - pretty basic stuff but very important. GPs are so busy that they tend to devolve all responsibility to the Practice Manager whereas one GP should be responsible for oversight of the important controls.

  • Comment on: Election 2010: fight for marginal puts hospitals in the hot seat

    Bob Neilans's comment 22-Apr-2010 5:50 pm

    Excuse me if I'm old fashioned but the purpose of the DoH is to ensure we have health services delivered - not draft political heat maps! Everything is politicised these days essentially because there is so little left for politicos to influence that they hang onto those that they can; NHS, Education, Police - Oh for the good old days when they could get involved in car making, digging coal, railways, building ships, flying aircraft, delivering the post, generating electricity or gas etc etc - and they weren't much good at those either!

  • Comment on: PCTs pave the way for GP cash budgets in 2011-12

    Bob Neilans's comment 15-Apr-2010 5:36 pm

    Much depends on what is included within "hard budgets" - will it include drugs and emergency care as well as the routine elective activity? To be successful all elements (apart from perhaps the truly esoteric conditions) should be included in budgets with the individual practice answerable to the cluster if they overspend and the cluster answerable to the PCT if they, as a whole, overspend. The PCT, or larger concern, would need to manage the whole situation. All elements need to be in the hard budgets else the centrally held budget (say for emergency care) gets squeezed when overspening occurs within the cluster budgets. However, fundholding overspending wasn't a facet of all practices (including dispensing practices) and much innovative near patient testing and consultations reduced travel and increased patient satisfaction. However the PCT would need to be really firm with those practices that overspent and not back down in the face of profit generation in rural (dispensing) practices. Someway would need to be found to ensure that the patients did not suffer because of this.

  • Comment on: PCTs pave the way for GP cash budgets in 2011-12

    Bob Neilans's comment 15-Apr-2010 12:55 pm

    Much depends on what is included within "hard budgets" - will it include drugs and emergency care as well as the routine elective activity? To be successful all elements (apart from perhaps the truly esoteric conditions) should be included in budgets with the individual practice answerable to the cluster if they overspend and the cluster answerable to the PCT if they, as a whole, overspend. The PCT, or larger concern, would need to manage the whole situation. All elements need to be in the hard budgets else the centrally held budget (say for emergency care) gets squeezed when overspening occurs within the cluster budgets. However, fundholding overspending wasn't a facet of all practices (including dispensing practices) and much innovative near patient testing and consultations reduced travel and increased patient satisfaction. However the PCT would need to be really firm with those practices that overspent and not back down in the face of profit generation in rural (dispensing) practices. Someway would need to be found to ensure that the patients did not suffer because of this.

  • Comment on: King's Fund accuses Tories over cancer drug promise

    Bob Neilans's comment 6-Apr-2010 9:15 pm

    Any argument that the funds for this scheme would have to come from elsewhere within the NHS budget and, by default, deprive other patients of much needed treatment is fatuous. Were medical priorities decided by clinicians and not by diktat, considerable pressure could be taken out of the system and release the £200m many times over! Or, if you wish to generate the funding from elsewhere, then demand a credit card from drunks in A & E at the weekend - £500 a throw - that'll do nicely.

  • Comment on: Dr Anna Donald

    Bob Neilans's comment 6-Apr-2010 5:52 pm

    Very sad - Commiserations to her family

  • Comment on: High turnover in senior roles 'down to weak candidates'

    Bob Neilans's comment 3-Apr-2010 6:16 pm

    The short tenure of NHS CE's is because they have to try to square circles, i.e. Government targets vis a vis patient care (although not necessarily mutually exclusive). Removal of a top down infrastructure with more locally set (and achievable) targets is the way forward but alas not under the present incumbents.

  • Comment on: Trust 'named and shamed' over plans to cut beds

    Bob Neilans's comment 13-Mar-2010 1:45 pm

    How many terminally ill patients are being held inappropriately in acute care? - many of these patients would be far better off in either residential/nursing home or, if complex, hospice beds; or indeed, with appropriate hospice at home staff input, in their own homes. An evaluation of hospital bed usage estimated 5% of patients needed palliative care. The difficulty with hospital beds (no matter how many you have) is that they will be filled! Reducing beds in acute hospitals as part of a shift in patient management and with money following the patient is to be applauded.

  • Comment on: NHS market reforms are not linked with better care

    Bob Neilans's comment 3-Mar-2010 5:23 pm

    The report says "still a bit early to say" - rather like the French Revolution. I rather think that Fundholding in the mid 90's brought primary care GPs and secondary care consultants into a constructive dialogue which improved the patient experience but whether it improved healthcare is a moot point! Again it was too early to say as it only ran for 5 years (as Labour came to power and stopped it) and one has to comment that the current reforms are a Labour slant on a Conservative idea (Ken Clarke's to be precise).

  • Comment on: Plans to scrap GP practice boundaries draw fire

    Bob Neilans's comment 3-Feb-2010 1:40 pm

    Practice boundaries were important at one time when GPs were responsible for providing 24 hour healthcare for their patients. Now that they are not, the issue of being able to access patient notes during out of hours is ever more important so that the attending physician has full knowledge of the patient. Anecdotal press reports suggest that not all Out of Hours care is of a high standard. Continuity of care is the only real criterion for successful healthcare plus being happy with the service that one gets from the GP/Practice. I can envisage that where there is only one practice in a large rural area, choice is effectively non-existent and, if a patient is willing to travel, then they should be allowed to secure their healthcare where they will. Whether the chosen practice is then willing to visit the patient is another matter! Personally I find that my healthcare is delivered best by a GP I know and trust with Out of Hours delivered by a good co-op with access to my notes.

  • Comment on: NHS North East backs £464m hospital build plan

    Bob Neilans's comment 4-Dec-2009 2:46 pm

    If this is to be done through PFI then its just added some more to the £40,000 debt owed by each family in the UK! Enough is enough!

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