Clarke's
Bill heads for fiasco
Whistling 'One wheel on my wagon", and with his eyes and ears firmly covered to keep out the obvious signs of opposition on all sides, Health
Secretary Kenneth Clarke is steering his NHS "reform"
bandwagon towards disaster.
As he prepares to follow up the Royal Assent to his NHS and
Community Care Bill by unveiling the first batch of hospitals to
"opt out" as self-contained businesses, many of the hospitals on his shortlist are already deep in while NHS financial crisis, managers at every Jevel are con fused, divided and demoralised.
Eighteen months of flashy sattelite teleconferences, secret briefings at top hotels, indoctrination and arm-twisting by ministers and civil servants desperate to 'sell' the new reforms have failed to get over one basic obstacle: even the most bone- headed managers are becoming
One reason general managers are becoming more anxious over opting out and the internal market is the publication of a new Department of Health letter spelling out the billing and settlement procedures.
'Buyers" will require not only a bill to be dispatched within a month of the treatment: in the case of accident and emergency patients, they will require an estimate of the costs of treatment within a week of admission, while in every case they will also require what is quaintly termed a "Goods received Note" giving additional information and certifying that treatment was given.
UPDATE convinced that the
'internal new market system will not work.
There are good reasons for these managers to be pessimistic:
The only
• simulation exercise that has tested out the probable results
*internal of the market', organised by pro-White Paper managers in
East
Anglia, produced chaos within the first year, worsening as time went on;
• A key element in this "testbed" failure was the shortfall in services, community care obstructing the discharge of patients from hospital: the Bill's plans for community care are a complete shambles, with many local authorities unprepared and under-resourced for their new responsibilities from next April.
Paperchase
Neither document alone will produce payment. But there is still no fixed procedure for
DHAs to check on what treatment is actually given to a particular patient at a distant hospital.
If the buyer' authority does not pay up, the worst that can happen to them is that after a two week delay the 'provider' unit can appeal to the
"buyer's' regional health authority and apply for the transfer of an equivalent portion of the 'buyer's' cash limit.
If readers can think of anything more complex or less businesslike, perhaps they could let us know.
ULALUNA
HOSTTAL
Clarke's desperate 'mailshol" to every home arises from huge opposition to the Act
• The pricing and billing system for accident and emergency and other cases where patients are treated outside their own"
district is a bureaucratic nightmare;
• The Commons Public Accounts Committee has been told that the computer systems to function the 'internal market" will not be fully on stream for five years - but the Act will take effect from next April;
• The computer software for budget-holding GPs does not yet exist - and will prove exorbitantly expensive because so few GPs will want to buy it.
More managers are recognising that
London's relatively expensive teaching hospitals - all of which lose at least a third of their funding under the
Bill - are likely to prove "losers"
in the internal market, as other health authorities send patients to cheaper alterative hospitals.
The of methods financing and payment are likely to leave some hospitals desperately short of cash within months of starting the new system;
• Top NHS managers are getting cold feet, doubting the abilities of their own subordinates, and fearful that the whole scheme could collapse into outright fiasco. Chief executive Duncan Nichol has begun calling not for radical change but a "steady state" after April, repor tedly worried that inadequate management skills mean the Bill will be implemented on a wing and a prayer"
• Nichol's deputy, Peter Griffiths, formerly gung-ho crusader for the White Paper, now wars health management: "Don't talk about business plans. Don't talk about marketing. Don't talk about market share and segmentation. Don't talk in the kind of commercial language that switches off every member of staff". Few NHS managers have talked of much else in the last 18 months.
• Damaging defections have begun. From the deck of Guy's Hospital, the flagship of opting out, the General Manager of Lewisham and North Southwark DHA, Dr Elaine Murphy, a one-time White Paper enthusiast, resigned last month in demoralisation, complaining to The Guardianthat: "At a time when waiting lists are growing ... and services are pretty stretched
and not of a high quality in inner London, we are spending all our time as general managers engaged in implementing the White Paper, in the organisation of contracts and in shifting stuff around". There are rumours that other top general managers in London are considering resignation.
• Fourteen of the front-line contenders for opting out have already withdrawn their bids - including Kings College Hospital in Camberwell and Northwick Park Hospital in Harrow - leaving just 71 on Clarke's list. Others among them St Thomas's Hospital in West Lambeth - are in such dire financial straits that they may be ruled out. Others, like St Helier Hospital in Merton and Sutton, are discovering they may not be viable and possibly contemplating withdrawal.
• Management are more acutely aware than Clarke of the immense opposition to the opt-out proposals. The BMA has just published results from ballots of consultants showing an overall 60% majority against opting out, and clear "no" votes in 21 out of 28 opting-out hospitals.
Every ballot of staff - whether "official" or "unofficial' has shown upwards of 75% of health workers against the plans: every opinion poll shows upwards of 70% of the public opposed. No wonder Clarke has had to insist that ballots must not be included in the so-called "consultation" process, and that Community Health Councils will be denied any right to consultation.
The fact is that the government has spent vast amounts of time, energy and taxpayers" money trying to promote its desperately unpopular measures, and has failed to persuade many managers that it will work, or that they will not take the rap if it fails.
For campaigners and