Saturday, 9 May 2015

Private practice hurts the NHS says leading cardiologist.

Private practice directly affects the quality of care that NHS patients receive and doctors should not be allowed to work on both sides of the divide, writes a senior doctor in The BMJ this week.

Recently I sat waiting for a urology test. The clinic was already running late.  When I arrived it was running 45 minutes late, but now the 'estimate' had been changed on the white board to 90 minutes.  I sat patiently waiting. It was not unusual. I had come prepared with a newspaper to read.  A woman opposite broke the 'silence'.

"I went private last time!" she declared.

Some of us looked up, wondering whether this was the solution to waiting.

"It was the same doctor!" She declared, and we wondered how a busy consultant could work both for the NHS and have a private clinic.  To whom did he owe his loyalty?

It has been an accepted part of the NHS since its foundation.  At the heart of the NHS has always been this conundrum. Does it matter? Is there a conflict of interest?  At least some doctors think so and are prepared to say so.

John Dean, a consultant cardiologist at Royal Devon and Exeter NHS Foundation Trust Hospital, describes how he quit private practice after realising it has direct adverse effects on the NHS.

To begin with, he says he felt that he needed the money to renovate the house, educate the children, and so on. And he was sure that he could keep the private work separate from the NHS work. But, he says, it became increasingly difficult to keep the lid on the private jar as the contents expanded, and spillage was inevitable.

The fact is that the business of medicine and the practice of medicine are at odds, he argues. Private medicine encourages doctors to make decisions based on profit rather than on need.

No matter how high I set my own moral and ethical standards, I could not escape the fact that I was involved in a business for which the conduct of some involved was so venal it bordered on the criminal - the greedy preying on the needy, he says.

He believes that private work has direct adverse effects on the NHS. A consultant cannot be in two places at once, he writes, and time spent in the private sector deprives the NHS of this valuable resource.

And he points out that, although patients think they are paying for higher quality medicine, the main advantage is simply to jump the NHS queue. “Private hospitals are five star hotels but for the most part no place to be if you are really sick.

But the most pernicious aspect of private medical work, he says, is the indirect effect it has on a consultant's NHS practice. It is difficult to justify subjecting private patients to unnecessary tests and treatments if you avoid doing them to NHS patients. So you have to operate the same system in both wings of your practice to ease the stress of this cognitive dissonance.

Private practice also creates a perverse incentive to increase your NHS waiting times, he adds.

The inescapable fact is that money is at the root of it all, he says, which is why he left private practice and why he believes the rulers of healthcare should draw an uncrossable line between private and public medicine and tell doctors to choose: you cannot work on both sides of the divide.

Friday, 1 May 2015

RCN warns of fewer nurses, providing more care.

We know now that the NHS is stretched to breaking point.  The doctors and nurses tell us so.  This is not an organisational issue.  This is an issue of funding.  With increased demands, with flat-line funding year on year for the past five, and fewer nurses, the system is creaking.  This is the reality on the ground.

In a pre-election report, the Royal College of Nursing  says that the he fragile frontline also highlights other areas which the next Government must address as a matter of urgency.

The community nursing workforce has been cut by over 3,300, despite NHS plans to move care from hospitals to the community. And the recent increases to student nursing places are not enough to make up for previous cuts, increasing demands on an ageing workforce.

The report also reveals that last year over 30,000 potential nursing students were turned away as over 50,000 people applied for just 21,205 places. Yet figures from UCAS show that there is no shortage of potential nurses to increase the workforce.  This is a matter of political decision and funding.

Dr Peter Carter, Chief Executive & General Secretary of the RCN said:

“We warned that cutting the workforce numbers to fund the NHS reorganisation and to find the efficiency savings was the wrong course to take.

“The cuts were so severe that we are only just catching up with where we were five years ago. Many areas, like district nursing and mental health, are even worse off."

This is a crisis of the governments making.  Five years ago the NHS was in a relatively healthy state with funding having increased on average by 5.7 per cent in real terms.  Now the NHS is almost bankrupt 50% of hospital Trusts running deficits.  This is the tragedy.

The Coalition set out with the promise of ring-fenced funding for the NHS.  That pledge was broken. Mr Cameron said there would be 'no top down reorganisation of the NHS.  That pledge was broken.  Now Tory pledges on the NHS are predicated on a further £22 billion of efficiency savings.

The NHS crisis is one of the government's making.  With savage cuts in social care the demand on the NHS has increased.

Dr Peter Carter continued by saying: “While the health service has spent the last five years running on the spot, demand has continued to increase. Whoever forms the next Government must learn from this report and take immediate action to grow the nursing workforce, and ensure it can keep up with demand with a sustainable and long-term plan.

“Unlike many problems facing the health service, the solution to the nursing workforce is very simple, and is a matter of political will. With more people wanting to nurse than ever, the next Government has the power to increase training places and expand the supply of nurses. If it does not, it will be failing a generation of patients.

“As the election approaches there will be a lot of promises, and many will be forgotten. But the next Government can rest assured that it will be judged in five years’ time on whether we have a properly funded health service which is fit for the 21st Century.”