Lansley: medical profession has “inertia”

Andrew Lansley challenged the medical profession today for its “institutional and professional inertia” as he sought to flesh out his “cast-iron determination” to reform and improve the NHS. He also appeared to be at odds with his party’s commitment to a moratorium on closure when he said that “something had to happen” when you have a failing hospital.

Speaking at the launch of a National Endowment for Science, Technology and the Arts (Nesta) discussion paper “The Human Factor“, Lansley outlined what he saw as the two key problems with the NHS:

“First, the NHS is too much of a secret garden where people inside the secret garden know what’s going on and people outside do not. We have to literally open the door … Second, there is institutional and professional inertia, and unwillingness to look beyond the boundaries of how we do things.”

The NESTA discussion paper outlines that, “The NHS does not have to choose between saving money and saving lives, or between cost reduction and reform.” Stian Westlake, head of policy and research at NESTA, called for “radical innovation that puts power in the hands of patients.” He went on, “These savings cannot be made by top-down efficiency targets … it has to go hand in hand with real innovative reform.” The paper estimates that health care services could save the NHS £20bn by 2014 if it followed the recommendations. Also speaking at the event, Tim Kelsey of Dr Foster Intelligence set out the need for information and “digitial interactive tools” to enable innovation.

Mr Lansley went on to say that, “When you have a failing hospital, something has to happen.” It was unclear whether this contradicted the party’s “vociferous” opposition to changes such as closing accident and emergency units. David Cameron said on Monday, “we will immediately stop the proposed closures of vital local services.” But Cameron was accused on Monday of misleading the public over the closure of a stroke unit in London. The party’s health policy has also been criticised this week for creating a new super-quango and scaremongering over paperwork burdens.

Trev

I am surprise LFF didnt make more of the commitments in Cameron’s NHS speech this week (beyond the inaaccuracy over a N london Stroke unit).Reading the actual speech it is hard not to be struck by its naivety:

- leave commissioning to GPs: simply a recipe for chaos.Ask anyone in the NHS , including GPs – they will take you they dont want to take it on.
- scrap all targets: sounds like the NHS in 1997, with postcode lottery as standard. Does this mean we lose the 2 week maximum wait to see a cancer specialist for example?
– pay based on outcomes: its already begun, with somehting called Best Practice Tariff from 2010. Hospitals showing better care for hip fractures for example will get extra funding to incentivise best practice.
– more competition/private providers: but who will hold them to account to create a seamless service with “bureaucracy” decimated and commisisoning handed over to GPs?

Overall it looks like a recipe for more money for acute care at the expense of chronic disease, prevention and community services.

Cameron says: “Instead of bureaucratic accountability there will be democratic accountability. The boss won’t be some pen-pusher at a distant PCT but the woman who needs a cataract operation, the parent of the child in A&E, the man given physiotherapy as an outpatient after a stroke. ”

Naive, or is it a deliberate recipe for chaos and privatisation? Either way the left need to shine more light on these dangerous plans. Labour has a lot to be proud of in improving the NHS since 1997.
Roger

Agree that LFF is not zeroing in on the real issues in the Tories healthcare plans.

Identifying single inaccuracies (which in the case of Hampstead is arguable as there is a reconfiguration of services involved and Cameron is at worst exaggerating or obfuscating rather than outright lying about it) or apparent contradictions between different Tory statements is just minor party political point scoring – and completely useless now that the mainstream media is no longer in thrall to the Number 10 Press Office and won’t obediently take up any of these points for us.

What we need to focus on are the much bigger political issues about the unwanted (by GPs) resurrection of fundholding, the abdication of democratic control involved in setting up a super-quango, the extension of private sector provision for purely ideological reasons etc.

There is so much ammunition lying around and we seem to be systematically avoiding using it because so much of the Tory rhetoric is uncomfortably close to the Blairite orthodoxies of just two years ago.
http://www.leftfootforward.org/2009/11/look-left-the-week-in-fast-forward-06-11-09/ Look Left – The Week in Fast Forward | Left Foot Forward

[...] stroke unit closures and nurses’ paperwork – and his Shadow Health Secretary appeared to contradict him as [...]
Richard Blogger

I would be a bit wary about anything from Dr Foster. My local hospital has very good outcomes, and gets very high reports from the Care Quality Commission, but even so, they dispute the standardised mortality ratio (SMR) published by Dr Foster. Their SMR values are excellent, but like many hospitals they want to improve. Their complaint is twofold: first, Dr Foster are not open in their methodology; second, the hospital is in an area with a higher than national average elderly people. When the local population has more older people than average then the death rate will inevitably be higher. Since Dr Foster are not open about their methodology it is not clear how much of the SMR comes from unavoidable deaths of the elderly. Without knowing their methodology it is not easy for the hospital to identify any weaknesses. This uncertainty makes Dr Foster’s results suspect.
Richard Blogger

Trev, I agree, their policy is extremely suspect.

The first point to make is that the 2003 Health Bill introduced Foundation Trusts as the *only* Trust model in the NHS and all acute hospitals will have to become FTs at some point in the future. The important point about an FT is that it is fully within the NHS but is more autonomous – they get greater choice how to spend their money and the services they provide. Further, there is *greater* local governance because the governors are elected from the local population. The nature of FT hospitals is that there is no longer central political control – neutralising exactly the focus of Cameron criticisms of the Labour party’s handling of the NHS. Eventually all hospitals will be Foundation Trusts, it is just a matter of time as hospitals prove they have achieved the high standards required. This is a huge improvement and I am surprised that the Labour party are not shouting louder about it. Cameron says that he will give more power to FTs but in his policy document he does not say how. In fact FTs are already autonomous from the SHA and DoH so there is no further “power” they can get.

But let me return back to the issue of payment by outcomes. Their policy to reward outcomes not the procedure is pure nonsense because they are saying that only successful procedures will be rewarded. This does not improve outcomes over all because it encourages hospitals to avoid the procedures that are more risky. Would a hospital offer you an expensive life-saving procedure with a less than 100% outcome? No. They cannot risk spending their money and not having a guarantee of payment. So that is why the current system (rather badly named “Payment by Results”, it should be Payment by Procedure) is much better because the hospital gets paid to perform the procedure that a clinician has recommended and NICE has approved. As to guaranteeing the outcome, well that is what targets are for. This is a better model than proposed by the Toreis because there is still encouragement to improve while still paying hospitals for the work they do.

Another policy that you need to examine further is the Tories plan for drugs: “value based pricing”. This is more nonsense, they say: “we should encourage the NHS to use whichever medicines are clinically effective, and agree to pay the drugs companies according to the therapeutic benefit and innovative
value.” Clinicians decide which drugs are effective, we do not need Cameron telling them what to use. But the last part of the sentence is interesting. How will they persuade the drug company to accept the payment that the NHS thinks is appropriate based on its “therapeutic benefit and innovative
value”? Now there is more nonsense in their resoning. If you look at their policy document (on the Conservative web site) they use the Lucentis fiasco as an example.

Let me explain. Avastin is a bowel cancer drug (ie used in quantity) but patients with age related macular degeneration found their condition improved. Trials showed that a tiny injection of Avastin effectively halted “wet” ARMD. So the drug company altered the drug to remove the cancer active part and called it Lucentis. The drug company says openly that the cost of Lucentis was chosen not for the cost of production or development, but for what they thought people would pay to save their sight. In clinical terms Avastin and Lucentis are *exactly* the same. The company applied, and got, a licence for Lucentis in the UK, *but refused to apply for a licence for Avastin*. Now the kicker: Lucentis costs 1000 times more than Avastin.

NICE had to provide a treatment for wet-ARMD and they cannot approve unlicenced drugs, so they came up with this frankly ludicrous agreement that the NHS pays the first 14 treatments (at £1000 each) and the drug company pays for subsequent treatments. Most patients do not need all 14 treatments, very few patients need more than 14. So this is effectively paying the drug company what they want. It is not an agreement to be proud of. Note that if Avastin is used in this treatment, 14 treatments costs less than twenty quid, if Lucentis is used it costs the NHS £14,000. If the patient approves Avastin can be used instead of Lucentis, NICE approval is only needed to recoup the cost, but as you can imagine £1 per treatment is effectively treated as being ‘free’.

The Tories say that this is the model that they want to see repeated in the future. I am aghast that they want to reward this blatent gouging by a drug company. But this is the sort of “private partnership” that they will being into the NHS.