NHS STILL GOING ROUND IN CIRCLES

Plenty of huffing and puffing but nobody has got a blind clue how to fix it. One day they may realize that it is unfixable and that privatizing it all is the only solution

The time for excuses is past, the Health Secretary told the NHS yesterday. Failure to tackle long-standing problems was no longer an option, Patricia Hewitt declared after a seminar at No 10 chaired by the Prime Minister. The Government, rocked by the large deficits run up by some NHS trusts despite a doubling of NHS spending, is struggling to retain credibility. Yesterday it organised a carefully staged event at which some of those responsible admitted errors and promised to do better.

No magic elixirs emerged. Sir Ian Carruthers, the acting chief executive, rehearsed money-saving strategies familiar to a generation of NHS managers - more day surgery, quicker discharges, better use of operating theatres, reducing admissions from accident and emergency departments and cutting agency costs - while Tony Blair nodded sagely.

The "narrative" remains that the bulk of the NHS is in balance and relatively few trusts are responsible for most of the deficits. But nobody explained why an NHS harried by targets and with managers lurking on every corridor had been unable to implement basic changes of the type outlined by Sir Ian.

Mr Blair concluded the seminar by saying that retreating from the reform plans was not an option. "We have to hold our nerve and be confident that the changes will deliver a better service," he said. "We have a huge ambition: to end the process of waiting in the NHS. There is no way we are going to do it by the old way of working. If we back away, we are doing no favours to patients at all. It will be a challenging year, there's no doubt about that at all. But turnaround can be done and has to be done."

The seminar's participants came from organisations that had been in trouble but had recovery plans in place. Tom Taylor, chief executive of Shrewsbury and Telford Trust, said: "No change is not an answer. We could not carry on losing 10-12 million pounds in public expenditure every year." Duncan Newton, medical director of Bradford Teaching Hospitals NHS Foundation Trust, said that managers should talk to clinicians. "They know where the problems are," he said. "They've known about it for years. If it were industry, these problems would have been sorted out years ago." Anthony Sumara, chief executive of North Staffs NHS Trust, said: "You don't need to be a rocket scientist to see how to improve." But he offered no explanation of why such changes had not been made before.

The Department of Health announced approval of two new Private Finance Initiative contracts, at University Hospitals Birmingham Foundation Trust and St Helens and Knowsley Hospitals, worth more than œ1 billion. Ms Hewitt also announced a new structure of ten enlarged strategic health authorities, each covering a region in England. These bear a remarkable similarity to the regional offices of the NHS abolished in 2001.

Andrew Lansley, the Shadow Health Secretary, said that billions of pounds had been given to the NHS without increasing productivity. "It is clear that the meeting was cobbled together at the last minute in an attempt by Downing Street to get a grip after the Department of Health lost control over NHS finances," he said. "The NHS needs reform, which is what Blair and Brown promised years ago. But, even today, reforms are confused and inconsistent."

Gill Morgan, chief executive of the NHS Confederation, said: "We hope that today's announcement will signal the start of a proper debate about the challenges and opportunities that the service faces." Niall Dickson, the chief executive of the King's Fund think-tank, said that reorganising the strategic authorities was the right policy at the wrong time. "This reorganisation, the latest in a very long line, has simply thrown the NHS into even greater turmoil."

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Public hospital surgery up under political pressure

This shows what could have been happening all along if they had not been spending all the money on bureaucracy. The facilities and the staff were obviously available

Queensland's two largest hospitals performed a record amount of surgery last month, Health Minister Stephen Robertson said yesterday. Despite the news, Mr Robertson warned it might take some time for surgical waiting lists to significantly improve. Statistics released to The Courier-Mail show the Princess Alexandra Hospital operated on more patients in March than at any other time in its history. Additionally, the Royal Brisbane and Women's Hospital set a March record for surgery. More than 1700 patients were operated on at the PA Hospital in March, including 441 emergency cases and 1271 elective cases. "At no point in the history of the PA Hospital has so much surgery ever been performed in one month," Mr Robertson said. "The previous record was 1540 cases in February this year." The volume of patients was a marked increase from the six-month average of 1450 patients a month. Other figures released yesterday showed the RBH operated on more than 2000 patients last month, up from 1956 in March last year and 1664 in March 2004.

Mr Robertson said the surgical records were a result of additional funding for more beds and more doctors and nurses at both hospitals. While he expected surgical activity would increase further, Mr Robertson cautioned that surgery waiting lists may not return to normal for some time. "Over the next five years we will pour an additional $259.7 million into elective surgery and an extra $280.3 million into our emergency departments," he said. "However, we continue to face high demands for elective surgery and it may take some time before waiting lists return to a more acceptable level."

In the most recent waiting list report released in February this year, the number of people waiting more than 30 days for urgent category-one surgery in the last quarter of 2005 increased by more than 500 per cent compared to 2004. Also the number of people waiting more than 90 days for semi-urgent category-two operations increased by 281 per cent in the same period last year. The latest waiting list report is due in the next few weeks.

Coalition health spokesman Bruce Flegg described the data as "meaningless" and accused the Government of picking figures they could put a positive spin on to run an overt political agenda. He said the real reason for the increase in surgery was because emergency cases were being funnelled to the RBH and PA from struggling nearby emergency departments. "They haven't released the waiting list data, they haven't released the number of elective surgery operations across the state," he said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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