Excessive Centralisation

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  • DEPARTMENT OF HEALTH 97/351 Tuesday 18th November 1997 FRANK DOBSON ANNOUNCES ACTION ON WAITING LISTS AND TIMES
  • Waiting List Pledges Will Be Delivered - Says Frank Dobson.  Department of Health Press Release 98/064 Thursday 19th February 1998
  • Spread Innovation, Says Dobson.  Department of Health Press Release 98/111 Wednesday 25th March 1998
  • Rewards For Hitting Waiting List Targets - Frank Dobson - Patients To Gain From Extra Cash For Operations.  Department of Health Press release 98/139 Thursday 09th April 1998
  • Government Gets Tough On Waiting List Targets - List Buster Appointed To Head New Team.  Department of Health Press Release 98/166 Thursday 30th April 1998
  • Ministers were warned yesterday by the outgoing chief executive of the NHS that the drift towards excessive centralisation of the health service was in danger of squeezing out the local initiative essential for meeting patients' needs. Guardian 29 June 2000
  • Hit squads were yesterday ordered in to seven English hospital trusts "named and shamed" after a sharp rise in outpatient waiting lists left the government embarrassed.Guardian 8 August 2000.
  • Labour's approach to the NHS is increasingly "Bevanite". Tony Blair sounds as if he wants to be held responsible for every dropped bedpan in every ward. In education, too, this centralising approach has got stronger. The logic of league tables for schools and surgery is yet more central intervention to secure uniform standards. The danger is that teachers and nurses spend their time ticking boxes, afraid to use their professional initiative. Guardian, 15 January 2001.
  • Britain's health service is stuck in the Forties with too many patients queueing for treatment, overstretched staff and a paternalistic attitude that does not put the public first, the Government has admitted. Observer 18 February 2001.
  • NHS reform falters - ministers must let go of the reins Leader Guardian Unlimited Tuesday April 24, 2001
  • The government's drive to cut NHS waiting lists distorted the clinical judgment of doctors and caused suffering for some of their most seriously ill patients, says a report today by the national audit office, parliament's spending watchdog.  John Carvel, social affairs editor Guardian Thursday July 26, 2001
  • MS drugs likely to stay off health service list. Sarah Boseley, health editor Guardian Tuesday August 7, 2001.  But see Guardian Society Monday February 4, 2002
  • Watchdog says hospital waiting lists were fiddled.   Audit office says patients were betrayed by massaging of figures.  Guardian Society Wednesday December 19, 2001
  • Opposition flays Blair over waiting list 'fiddles'.   Guardian Society Thursday December 20, 2001
  • End the numbers games The NHS needs targets, but the right ones.  Leader Guardian Thursday December 20, 2001
  • Doctor who blew the whistle and suffered a reign of terror Stoke Mandeville is one of Britain's most famous hospitals, but when a doctor in A&E warned about a consultant she was ignored - then the anonymous threats began.  David Rose. Observer Sunday January 27, 2002
  • Comment Oh, just get on with it.  Hand control of the NHS to faceless administrators? Actually, we could do a lot worse.  Mary Riddell Observer Sunday January 27, 2002
  • Stop meddling and let us get on.  Richard Lilford argues that it may be time to set doctors and nurses free from political interference.   Observer Sunday January 27, 2002
  • Fight for MS drug fails.   Guardian Saturday January 26, 2002  But see next item.
  • Patients' groups have welcomed a £50m scheme which will ensure that thousands of multiple sclerosis sufferers receive the "banned" drug beta interferon on the NHS.  Guardian Society Monday February 4, 2002
  • The issue explained: beta interferon Why has the drug beta interferon, used in the treatment of multiple sclerosis, proved so controversial?  Guardian Society Monday February 4, 2002
  • The National Institute of Clinical Excellence, the body set up by the Government to decide what drugs the NHS should prescribe, said it would severely restrict the use of the drug irinotecan for treating bowel cancer, which kills 16,000 people a year.  The new drug is now standard treatment across the Continent and the United States, and the effective ban means that thousands of NHS patients will have to make do with drugs 40 years old.  Observer Sunday March 10, 2002
  • The government's hospital construction programme is one of its few outright errors of policy, the independent King's Fund said yesterday in an otherwise upbeat post-budget audit of Labour's health initiatives.  David Walker Guardian Thursday May 9, 2002
  • Freedom to create more NHS bureaucracy.  Plans for foundation hospitals are an extension of the government's carrot-and-stick approach to public services and the real winners could be the bureaucrats, says Simon Parker.  Society Wednesday May 22, 2002
  • NHS trusts 'strangled by bureaucracy'.  John Carvel, social affairs editor Guardian Thursday May 23, 2002
  • Milburn urged to portion out health powers.  David Batty Society Thursday May 23, 2002
  • Health service 'slow' to devolve power.  David Batty Society Thursday May 23, 2002
  • Cancer specialists attack drug curbs.  Colorectal patients 'condemned to poor treatment'.  Sarah Boseley, health editor Guardian Saturday June 8, 2002
  • Organisations representing the blind and partially sighted last night said they were outraged by the recommendation of a government advisory body that patients suffering the leading cause of age-related blindness should have treatment only for their better eye.  Thursday June 13, 2002 The Guardian
  • Thanks for the money, now set us free.  Luton, a testbed for Labour's spending plans - and its survival as the governing party - sends out a clear message. Jonathan Freedland Guardian Tuesday July 16, 2002
  • NHS mergers fail to boost service, say researchers.  James Meikle, health correspondent Guardian Friday August 2, 2002
  • Thousands of people could be denied eyesight-saving surgery because of plans to withhold a new blindness treatment from NHS patients, it was claimed today. Monday October 14, 2002
  • A fresh row has broken out over centralisation of the NHS, with calls for the resignation of a senior civil servant over the departures of two experienced hospital managers. Mark Gould Wednesday January 8, 2003 The Guardian
  • Incentives to encourage every hospital to appoint a "modern matron" in its accident and emergency department were offered yesterday by Alan Milburn, the health secretary, following the matrons' success in raising standards elsewhere. John Carvel, social affairs editor Tuesday April 8, 2003 The Guardian
  • How Britain is losing the drugs war. Today, the Guardian launches the biggest investigation of the criminal justice system ever conducted by a British newspaper. Beginning a series which will run throughout the year, Nick Davies looks at the government's attempt to deal with the most prolific of offenders - the drug users who commit an estimated 7.5 million crimes a year. Thursday May 22, 2003 The Guardian
  • Britain's new drug policy in the dock. Leader Friday May 23, 2003 The Guardian
  • The government's obsession with performance targets means the NHS is driven by "tick boxes" rather than the needs of individual patients, the leader of Britain's doctors warned today. Monday June 30, 2003
  • BMA blinkers. Doctors need a dose of realism. Leader Monday June 30, 2003 The Guardian
  • The leader of Britain's 124,000 doctors warned Tony Blair yesterday that the government would not be able to keep a manifesto promise to cut the maximum wait for an NHS operation to six months by 2005 without causing unnecessary suffering for the sickest patients.  John Carvel Social affairs editor Tuesday July 1, 2003 The Guardian
  • MPs opposed to plans to put fluoride in public water are preparing to take the government on in court if they lose a crucial vote in the Commons next week. Sarah Hall, political correspondent Wednesday October 29, 2003 The Guardian
  • The Department of Health (DoH) is set to slash 1,400 Whitehall jobs and review the future of 19,000 other staff in health and social care quangos in the "first and largest" downsizing in Whitehall, the health secretary, John Reid, has told MPs. Tash Shifrin Friday October 31, 2003 This seems to be a move away from excessive centralisation.
  • Sweeping new measures to allow fluoride to be added to large parts of Britain's water supply are set to provoke a huge political row amid fears that 'mass medication' may harm children and lead to more tooth disease. Kamal Ahmed and Mark Townsend Sunday November 2, 2003 The Observer
  • Fluoride in the water - saving children from the dentist, or an abuse of our civil rights? Edward Baldwin and Ian Wylie disagree. Saturday November 8, 2003
  • The Department of Health used bully-boy tactics to force local NHS trusts to sign contracts with foreign healthcare corporations for treatment centres they did not need, according to the chairman of a primary care trust (PCT) who lost his job for resisting the scheme. John Carvel, social affairs editor Tuesday June 1, 2004 The Guardian
  • There were allegations of 'bullyboy tactics' when Whitehall and the leaders of local health organisations clashed over plans for a new privately-run treatment centre. John Carvel reports. Wednesday June 2, 2004 The Guardian
  • We should value NHS chairs who are prepared to rock the boat, says John Carvel. Wednesday June 23, 2004 The Guardian
  • Rural healthcare 'neglected'.  Government NHS reforms are designed for cities and neglect the health needs of people living in the countryside, the British Medical Association (BMA) warned in a report published today. Lack of public transport in rural areas means that patients without access to a car - particularly the elderly or the young - have problems travelling to health services outside their immediate community, according to the report, entitled Healthcare in a rural setting. People living in rural areas are also at risk from worse health outcomes compared to people who live in towns because they have difficulty reaching services which have been centralised. Debbie Andalo Friday January 21, 2005
  • RADICAL proposals to transform key public services in Rugby could put lives at risk, a leading councillor has warned. The changes, which are part of Government attempts to reorganise the delivery of major public services across the country, would affect police, health, fire and ambulance provisions in the town. Rugby Advertiser 10 November 2005
  • Superbug hospital chairman resigns. The chairman of the NHS hospital trust where 90 patients died from Clostridium difficile infection accused the government last night of singling it out for vilification when ministers knew scores of other trusts had worse infection rates. James Lee resigned as chairman of Maidstone and Tunbridge Wells NHS trust, after Alan Johnson, the health secretary, launched fresh inquiries into his role in organising a £250,000 pay-off for the chief executive, Rose Gibb. Mr Lee, a film executive and former director of the Financial Times, was already under investigation by the South-east Coast strategic health authority for the part he played during two outbreaks of C difficile between April 2004 and September 2006. The Healthcare Commission said last week that 1,176 patients were infected with C difficile during two outbreaks when 345 patients died. It said 90 of the deaths were definitely or probably caused by the infection and blamed slack management for failing to contain it. Last night Mr Lee released the text of a four-page letter to Mr Johnson admitting there was no excuse for what happened at the trust's three hospitals. He said: "I am deeply saddened by these terrible events and take full responsibility for my part as chairman of the board for the past five years. I apologise unreservedly." But he hit back at the unreasonable pressures imposed on the trust by the government. "We have been struggling with a state pretty close to bankruptcy," he said. The trust's clinical income last year increased by 1.5% in cash terms when staff pay rates were rising by over 5%. "We knew the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the coalface." As income fell, hospital activity rose by 11%. The trust cut costs by more than £40m in an attempt to break even. It struggled to cut maximum waiting times to 18 weeks. But this was "never really achievable". Mr Lee said attempts to get rid of a small minority of poor nurses were ineffective because "NHS employment practices make it difficult to take action, even against transparent incompetence". He sent the letter, labelled strictly private and confidential, before he knew whether Mr Johnson would back him or accept his resignation. He denied any impropriety in the severance payment to Ms Gibb. The government was persisting in treating Maidstone as a "rogue trust", when it knew there were 83 acute trusts in Britain with higher C difficile rates in the first three months of this year. "We are now so discredited that we are no longer believed," he said, appealing to Mr Johnson to explain the facts to the public. He added: "The NHS is run on the basis of command and control. I personally have never experienced such centralised or detailed control ... This way of managing things is fundamentally incompatible with the whole concept of independent trusts ... I have done my best." Mr Lee broke his silence after Mr Johnson told MPs he had ordered a departmental review of the chairman's role in agreeing severance terms for Ms Gibb. John Carvel, social affairs editor Tuesday October 16, 2007 The Guardian
  • The fruits of Kiwi health reform. Slowly but surely, the health reform tide in England is turning. Gordon Brown and health ministers have signalled their intention to place much greater emphasis on public health than their predecessors, alongside a continuing commitment to improve the performance of the NHS. Lord Darzi's interim report on the NHS specifically highlighted the need to make more progress in tackling health inequalities. With a boy born in Manchester likely to die almost 10 years earlier than a boy born in Kensington and Chelsea, a concerted drive to improve health by focusing on people most in need seems certain to loom large in the next stage of health reform. Last week's announcement that the government is planning 10 eco cities, designed to make it easier for people to exercise, is an indication of the way in which ministers are thinking. The risk with this approach is that it will become just another initiative unless it is part of a well-designed public health strategy. Ministers should look to New Zealand for lessons on how to avoid risk. Recent analysis showed that the widening of health inequalities there has been stemmed and, to some degree, reversed. Although the precise reasons are not fully known, inequalities in New Zealand appear to have been tackled successfully as a result of a long-term commitment to public health and primary care. Under prime minister Helen Clark, New Zealand turned its back on the failed internal market experiment of the 1990s, and set up health boards - integrated organisations whose members are made up of some people elected by the public and others appointed by the health minister - with responsibility for planning and providing health and disability support services. Health inequalities in New Zealand are most evident in the poorer health experienced by Maori and people from the Pacific Islands. To address these inequalities, Clark's government developed a health strategy in 2000 in which public health received as much attention as healthcare services. The strategy included health boards working with public agencies and third sector organisations to implement population-wide programmes to address risk factors such as unhealthy diet and lack of exercise. A major focus of these programmes has been to target support at hard-to-reach groups by working with Maori and Pacific Island organisations. In the case of people from the Pacific Islands, health boards have capitalised on the role that religious life plays in these communities, by delivering health advice and medical care with and through churches. Similarly, tribal structures have been engaged to reach the groups most in need among Maori. Equally important has been the emphasis on primary healthcare. Concerned at the adverse effects of charging patients to see a GP, Clark's government developed a primary care strategy that has resulted in an investment of NZ$2.2bn (£0.81bn) over seven years. The fees paid by patients and the costs of prescriptions have fallen considerably, making it easier for families on low incomes to get care. This has contributed to a stronger emphasis on prevention in primary care, with a particular focus on the management of people with diabetes. Patients in New Zealand find it much easier to make an appointment than their counterparts in the UK because GPs lose income if patients seek primary care from a practice other than the one where they are registered. The Brown government would do well to consider how to adapt this arrangement. An option would be to claw back funds GPs receive from the government where practices have higher than expected use of services by patients out of hours. This could be done while maintaining care free to patients at the point of access - an aspect of the NHS superior to that found in New Zealand. Another lesson from New Zealand is the value of local people involved in health boards. The two-thirds of members elected by the public are chosen every three years, with elections held at the same time as those for local authorities. Turnout is around 40%, and most candidates stand as independents. New Zealand's system has the twin virtues of engaging the community directly and avoiding the risks of overcentralisation to which the NHS is so prone. There is a greater willingness to deal with the challenges of the health system at a local level, instead of pulling these challenges in to the government in Wellington. At a time when the NHS is entering a much more difficult financial climate, Brown and health ministers may well be attracted to an arrangement where the blame for the NHS no longer gravitates towards Whitehall, but is dealt with by locally-accountable bodies. Chris Ham The Guardian Wednesday November 7 2007

     

 

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Sheila Porter-Williams
Campaign for Health Service Democracy
Green Haven, Halfway Lane
Dunchurch
Rugby, Warwickshire CV22 6RD
sheilaCHSD@porter-williams.freeserve.co.uk