From Allen Keep

Saturday, 9 February 2013

As a frequent contributer to the old thread and self confessed slave to socialist dogma I can confirm that my views are exactly the same following the report on Mid Staffs. Wasn't it precisely the imperatives of the market rather than the meeting of patients' needs that lay behind so many of the failings? And yes, Labour started it as they did the prviatisation of education - simply because they, like Joe, have accepted the values and principles of the capitalist market system.

Works really well doesn't it?

From Joe Ridley

Wednesday, 13 February 2013

Yes Allen. Not really a fair assessment of the reasons for the dreadful circumstances at Mid-Staffs.

Top down management driving targets through the system was stated as a major contributor to the disaster. Couple this with hopeless managers and a 'job for life' culture and you can see the results.

Don't forget who masterminded this frightening disaster. Comrade David Nicholson, an ex-communist who, far from being sacked has been promoted. He certainly agrees with the principle of the market when it comes to his remuneration;£200,000 salary; £50,000 expenses; benefits in kind of £37,600. Up the workers eh Allen?

From Graham Barker

Wednesday, 13 February 2013

What happened at Mid Staffordshire has little to do with ideology or markets. It has to do with individuals in caring professions caring about no one but themselves. Individual failings cumulatively became corporate failings, in a way that George Orwell would have found familiar.

If we can't rely on professionalism and human decency to make individuals more caring, we must use a bigger hammer. NHS immunity from criminal prosecution must end and managers especially must not be allowed to evade personal liability. There seem now to be some moves in that direction, so we can only hope they don't fizzle out.

Mid Staffordshire should have been inconceivable under any regime, capitalist or socialist. The fact that it happened tells us that we need to go beyond tinkering with 'systems'. It's a sorry reflection on the state we're in, but only when culpable individuals of all ranks start doing serious prison time will the culture of the NHS improve. And it wouldn't harm to begin by putting David Nicholson in the dock.

From Allen Keep

Thursday, 14 February 2013

Joe cites top down management forcing through a target driven culture as a major contributor to what happened at Mid-Staffs. I agree – it seems our assessment of what happened may not be so far apart?
Why Joe translates this analysis into a diatribe against “socialist dogma” and the “bleating” of health care professionals is beyond me.

Leaving aside the titillating but entirely irrelevant news that David Nicholson was a communist 35years ago what is “socialist” about a culture, as the Francis report discovered, of corporate self interest focused on cost control?

And I’m sorry Joe but this culture hasn’t arisen because of a bit of tinkering – there has been a fundamental change in the way in which the NHS is structured and managed and my fear is that this will lead to more, not less, situations like Mid-Staffs.

If you listen to the “bleating” of health care professionals - those actually delivering care rather than managing a system geared increasingly for private profit, you will hear a familiar story repeated in social care and now, increasingly, in education too.

The story is that we have dedicated and committed professionals in our hospitals, social services and schools whose priority is to provide for the needs of their patients, clients or pupils. But they work within a system, particularly in the NHS, which has a different set of priorities, driven by the imperatives of competition and cost that not only constantly threatens the working conditions of those delivering the care (no jobs for life here) but fragments and erodes the service they can provide.

That system is delivered and driven by people far removed from the delivery of care - by a bureaucratic class who understand targets, policies and finance but do not understand care and compassion, a class which understands directives but does not know how to listen and respond to front line staff and patients’ concerns.

The ever increasing divide between these groups of people crates organisations with a “hollow centre” which are just not responsive to need - leaving patients and front line carers alike trapped and buffeted by forces over which they have no control and very little say.

Within this divisive and destructive space - overshadowed by what Francis described as a culture of fear in a top down system driven by the imperatives of the market - tragedies like Mid-Staffs are shocking and disturbing but not unlikely.

I’m afraid you can’t lay that at the door of socialism or those who believe in its values nor individual health care professionals trying to do the best for their patients.

From Joe Ridley

Thursday, 14 February 2013

Patients were treated so appallingly because individuals working in the health service neglected their duties and lost compassion for their fellow humans. I don't think their culpability should be hidden or excused as you appear to be suggesting Allen.

I blame the system also because it is led by people like David Nicholson who prosper despite their obvious failings. Anybody who challenges the system and attempts to highlight the failings are either bullied into submission or paid large amounts of public money to leave and 'keep schtum' (see the news today). Whilst all this is happening, keep shouting to the world how amazing our NHS is.

Under David Nicholson's leadership the Trust promised all staff "a job for life, it may not be the job you are doing now, but you have a job for life with this trust". Seems pretty clear to me Allen.

Any attempts at change, either in Education or Health are met with the kind of hullabaloo we saw on this thread last year and being perpetuated by Allen now. Until there is strong local management that puts the patient/student ahead of the system/ideology we will never get progress in our public services.

The last thing we need is to be told that waiting times are down, exam results are up or that we have a health and education service that is the envy of the world (Tractor production is at a record high comrades). It's just not true and won't be true whilst those within the system remain wedded to an ideology that just doesn't deliver.

From Susi Harris

Sunday, 17 February 2013

Dear Joe I am not sure why you think the changes to the NHS coming in on April 1st are 'tinkering' when Lansley himself posted that the reforms "were so big that can be seen from space".

From what I've witnessed in Calderdale, Bradford and Leeds, the reallocation of Personnel from the old PCTs into the new NHS structures is frankly farcical - it's almost as if there is a deliberate effort to ensure the new people in post will have no knowledge or experience of what they are supposed to be doing now. And redundancies are going to be very expensive. Within this chaos, I believe another Mid-Staffs may be much more likely after April 1st.

There could be two mitigating factors, patients and GPs. The gradual erosion of the patient advocacy organisations (now morphed into the toothless 'Healthwatch') means that people on the ground have much less power to influence things than previously in the days of the old Community Health Councils.

GPs are suddenly very thin on the ground. The coincidental timing of these reforms with a demographic inevitability of the mass retirement of the single handed (mostly Asian) GPs plus the early retirement of several GPs (I know of at least 4 in Calderdale) due to these reforms and another set of hoops that have to be jumped through (revalidation) is reducing numbers to critically low levels.

Don't forget of course that in every practice one GP has to spend half a day a week in commissioning group (CCG) meetings, and if the practice has a CCG board member (10 in Calderdale). they can expect to lose that GP's clinical commitment from 1-2 full days a week. To harken to another thread on this forum, maybe that's why you can't seem to get an appointment these days?