Social media seems to be the modern equivalent of the stocks. The main objective of the stocks was public humiliation. Nowadays, any member of the public can use social media to highlight grievances they might have against companies, organisations, and institutions and post them for all to see and comment on. more…

On the Today programme on Radio 4 on Monday morning there was a feature on these recently released data. Two areas were discussed. Hospital mortality is higher out of hours ie nights and weekends. The other item discussed was the smaller number of senior doctors in the hospital out of hours.

John Humphrys interviewed a spokesman for Dr Foster and one for the NHS Confederation. Unfortunately nobody who knows anything about the working of a hospital was interviewed. There is nothing unusual about this state of affairs. more…

Walking to the NHS Alliance’s annual conference through Manchester this morning, the streets were peppered with small pickets. University staff, civil servants, transport workers, all sorts of folk objecting to public sector cuts in general and in particular to their potentially diminished pensions.

One chap thrust a leaflet at me deploring the effect that cuts would have on his university’s provision and told me of the need to “fight for our lives.” more…

Here is my third and final blog on the USA trip: After Seattle’s integrated care organisations, we visited CalPERS. They fund $6.7bn worth of healthcare for 1.3 million people (roughly twice what we have per person in Lincolnshire). They see themselves as “active” purchasers: managing the market to reduce costs. About two thirds of their members are in capitated plans (for instance Kaiser) whilst the remainder are in a PPO plan (Preferred Provider Organisation). Simple examples of their interventions were to remove co-pay from preventative care for members, to have fiscal and chronic disease management targets and to set a tariff for knee replacement–it all felt familiar. What wasn’t was their analysis by price for knee replacement. It revealed a staggering variation from $15k to $120k. With 46 hospitals they agreed a tariff of $30k but patients could choose to use hospitals that refused the tariff – so long as they paid the difference. It made me think why a tariff for planned procedures may not be such a bad idea. more…

Too much hysteria is clouding reasonable criticism

If you watched Channel 4 news last night, you could only come away with the impression that the government is waging a secret war to privatise the entire NHS. You see, Channel 4 were “exclusively” “leaked” “proof” that “the government is planning to privatise the NHS.”

The proof was so exclusive and so leaked that a couple of weeks ago you could only read about it on dozens of websites including here, here, here, here, and here and you could only read the draft version over a month ago here after it was first published over a month ago…. here. more…

I doubt that anybody within airlines, financial services, or manufacturing goes to meetings to debate whether information technology can improve what they do. It already has. But in healthcare we’ve grown very sceptical about information technology.

In fact information technology already has improved healthcare and much of what is done now could not be done without the technology, pointed out Patrick Carter from McKesson, one of the world’s largest logistics companies, at the Cambridge Health Network meeting in London last week. But, he continued, the industry has “overpromised and underdelivered,” destroying trust. more…

The Commonwealth Fund’s survey of the experience of adults with complex care needs, published last week, paints a remarkably positive picture of the NHS. The results show that, of the eleven countries surveyed, the number of patients reporting that they did not use services because of concerns about cost was lowest in the United Kingdom. And while the absence of user charges in the NHS (with the exception of some prescription charges) means that this finding is not surprising, other results are equally encouraging. more…

Change may be the new constant, but it is always important to understand who embraces change most readily, and where. Doctors in general are traditionally conservative, as those outside the profession will be only too happy to confirm. We like to think we pioneer change both via behaviour (witness the change in smoking prevalence amongst doctors in the UK that preceded the change in prevalence in the wider population) and via technology (transplants, genetic research, new drugs). The resistance many doctors are showing to the current NHS reforms in England, suggests we are less engaged with that third pillar of large scale change: governance; the rules, regulations, laws, and incentives that determine how the system runs. more…

Last week marked a “humiliating climbdown” for the Health Secretary. Apparently. “Andrew Lansley is now in open retreat and is being forced to cave in on issues he previously fought to the hilt,” said his Labour nemesis Andy Burnham.

And so why does his acquiescence to an amendment demanding he take ultimate responsibility for the NHS feel less like a U-turn and more like a cup of tea at Charnock Richard services on a steady journey up the M6? Time and time again the amendment of this bill has been met with at worst a shrug, and at times a warm embrace. more…

To care for older people one vital ingredient is needed…time. Nothing can be rushed. Everybody needs to be washed, have their teeth cleaned, their mouths checked and cleaned, and their nails and hair sorted out. Don’t forget the never ending call for the commode, and if they don’t need help to get to the toilet they will need continence care. More rolling and washing, and swishing of curtains. more…