NHS – Joined up thinking?

In the last week three items regarding the NHS have come to my attention. I am sure you have seen them as well. Firstly we have Dr Prit Buttar representing the Oxfordshire local medical committee (LMC) who in turn represent the NHS GPs in the county. The LMC has begun planning a system in which doctors can treat and charge patients so as not to conflict with their contractual arrangements with the NHS.

Former Abingdon GP and Oxfordshire LMC chairman Dr Prit Buttar said: “The purpose of this is to get around a ridiculous restriction that stops GPs charging their own patients for stuff, even if the NHS doesn’t fund it.

To get around the problem the LMC has proposed that GPs offer services to patients through a third-party company, which would take payment from patients and pay GPs for their time.

Dr Buttar said: “Through this mechanism, people who would have to pay for treatment anyway can get it with someone they know and trust. It is stupid we have to resort to these sorts of gymnastics to get around the rule.”

Secondly, the Clinical Commissioning groups in Worcestershire have announced they plan to only treat the most severe cases where pain interferes with daily life and ability to sleep. CCG documents said a “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”.

The plans would focus on treating “severe to the upper end of moderate” cases, and people who are obese with a body mass index of 35 or over needing to lose 10% of their weight unless their problems were very severe.

Redditch and Bromsgrove, South Worcestershire, and Wyre Forest are the CCGs behind the proposals, estimated to lead to around 350 fewer operations a year. The CCGs said changing the scoring system to cut operations will save £2m a year.

Finally, Oxford University Hospitals in conjunction with Oxfordshire CCG are planning to downgrade services at the Horton Hospital in Banbury and concentrate them in Oxford at the already extremely busy John Radcliffe Hospital. Yes the John Radcliffe Hospital that is almost impossible to access by road and car, unless you have several hours to waste getting there and getting a parking space. On correspondence the hospital issue for appointments they even brazenly state, no doubt under the mistaken belief of being helpful, “Our car park spaces are quite limited. If you plan to come by car, please allow at least an hour to find a parking space”.

What do these news stories have in common? The gradual degradation of the NHS service we have come to expect and indeed perhaps was originally the overall aim when it was founded. The pressures that the NHS face make some of these choices although unpalatable, understandable on the face of it or are they?

In short, no they are not. There are some truths that NHS bosses may not want to hear but they need to listen. According to their own accounts for 2015/16 Oxfordshire CCGs employee costs were £6.3m, Redditch and Bromsgrove CCG’s employee costs were £1.8m, South Worcestershire CCG’s employee costs were £3.5m and Wyre Forest CCG’s employee costs were £1.4m. Just these 4 CCGs cost in 2015/16 £13m to operate. A significant figure to most of us, but in the scale of the NHS budget, a mere drop in the ocean. However, this is the money that the government through the Department of Health, gives to these CCGs to run them efficiently and improve the services delivered.

So your hard earned taxes contribute to the funds given to the CCGs to improve services in the NHS. Let’s look at those figures now in light of the reduction of services, the inability to deliver services when they are needed (look at the waiting times and way A&E patients are waiting in corridors) and the desire to undertake private work when the same GPs complain about working longer hours to serve patients in the NHS. Each year these same people in the CCGs come out with another plan to transform services due to a shrinking budget, which in reality means cuts for patient services. This really leads to a major question that never seems to be asked and even likely to be answered, why should we believe them, and why should we allow them to continue to take our money, and fail in their duty, and then continue in that role. Where is the accountability? Where is the performance management? Where is the honour?