[Offwidth]

Its an emailed commentary that you subscribe to free and are encouraged to forward as an email. I'm aware of his work with Kings Fund but it didn't seem to link to his regular postings.

[Sloper]

Steve, how would you feel if the Kings Fund dismissed your research and so on as 'stupidly simplistic'?

As for the Government being i/c and therefore responsible for what happens now, do you think the SoS can just push a button on his desk in Whitehall and magic up 1000 A&E consultants, 5000 A&E doctors and 10000 A&E nurses, if so you're delusional.

There's probably at least a 5 year lead in / lag for policy to take effect in the NHS, some systems i.e. policing will have a much shorter lag between policy change and practical change.

Finally, your point about there being no wide spread crisis, I can't remember the stat but something like <5% of hospitals have delcared major events or what ever they're called.

there was a 'winter crisis' in the NHS pretty muh every year under Labour and this will probably be repeated under this and the next government: it's to do with a massive spike in demand.

The system now is under more pressure than before, the population has increased and the number of older people has increased.

Here's a good paper on the NHS under Labour, I think it's far too soon for a comparable retrospective on this government.  http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf

Now any chance of you admitting that your comments about QE were total bollox?

[petekitso]

I really don't know why I am getting involved in this but . . .

If you cite a paper published in 2011 it is clearly not going to cover activity after that date. I think that QE - in terms of the ongoing purchase of assets - has increased by £175bn since then. The most recent large purchase was in July 2012. I am basing this on the Bank of England's own figures.

http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx

You will note that the ongoing reinvestment of maturing assets - and potentially the maintenance of a £375bn portfolio - amounts to an ongoing policy of QE.

[Offwidth]

Steve, how would you feel if the Kings Fund dismissed your research and so on as 'stupidly simplistic'?

etc...

The research is mostly fine what is wrong is a "myth" / "no myth" black and white answer, thats just journalistic junk. Same nonsense Ch4 news have a habit of using to ruin the possibility of perfectly good nuanced reporting. The main issue as I've said is as a source its not answerring my question (nor yours, even though you pretend it is) as I've expressed no beleif the NHS is going to be fully privatised in the near term by the conservatives.

You clearly wont agree this is the most serious crisis the NHS has yet faced... its not just declarations from trusts (a symptom) its the biggest ever gap between funding and needs, the complete mess in council led social care due to the cuts (and the feedthrough into hospital beds etc), the views of the vast majority of staff I know who work in various parts of the sector. Prove me wrong on that.

The idea nothing can be done in  a term is nonsense and yes Im aware of feed through issues.

[Offwidth]

Here's a good paper on the NHS under Labour, http://sticerd.lse.ac.uk/dps/case/spcc/wp02.pdf

Indeed, pretty fair I'd say, and it paints a very different picture to the very biased one you do.

[Sloper]

I really don't know why I am getting involved in this but . . .

If you cite a paper published in 2011 it is clearly not going to cover activity after that date. I think that QE - in terms of the ongoing purchase of assets - has increased by £175bn since then. The most recent large purchase was in July 2012. I am basing this on the Bank of England's own figures.

http://www.bankofengland.co.uk/monetarypolicy/Pages/qe/qe_faqs.aspx

You will note that the ongoing reinvestment of maturing assets - and potentially the maintenance of a £375bn portfolio - amounts to an ongoing policy of QE.

A large slice of humbe pie barman  tis a fiar cop guvnor,

[Offwidth]

Latest:

http://www.theguardian.com/society/2015/jan/17/nurses-nhs-stress-leave-staff-breaking-point

[Sloper]

Isn't it odd when the tories make reference to problems in the NHS they're 'doing it down' 'damaging it' 'causing a crisis in moral'?

Or are we now saying it's fare game for naked political point scoring?

[Offwidth]

Human frailty eh? Management over-defend their structures by understating problems, unions when presented  with real stress evidence use this too much as a weapon. Political parties use rhetoric to try to defeat their opponents. Naked point scoring applies to so many people, including a poster above who picks all the bad bits from a paper and none of the good to encourage us to vote their way and along the path accuses those of us with different view of moronic acts and factual error (even in the face of their own failings). In the meantime another aspect of the NHS is headline news, which was the point of providing the link.

[Sloper]

Incoherent gibberish

[mrjonathanr]

Don't be so hard on yourself Sloper. Some of your posts do actually cohere.

[Sloper]

Don't be so hard on yourself Sloper. Some of your posts do actually cohere.

The law of probability in action.

[tomtom]

Don't be so hard on yourself Sloper. Some of your posts do actually cohere.

The law of probability in action.

[Sloper]

The NHS cannot continue in its present form.

http://www.theguardian.com/society/2015/jan/19/nhs-we-have-not-fit-for-future-warns-top-doctor-bruce-keogh

[GCW]

And only one party leader agrees with that.....

[Sloper]

 he's liberated by the fact he won't be in number 10; further that basically everything other than immigration / the EU is a 'whoosh' issue for most Kippers.

[GCW]

Yeah, the other leaders are well aware of the agenda to bring in privatisation but still refuse to acknowledge it.

[tomtom]

From my limited understanding (that should send warning bells ringing about the upcoming content)...

Is one of the problems of revising/changing/updating the NHS a mixture of legacy systems/operation and the 'turning the supertanker' analogy.. to explain what I mean...

1. Because everyone is used to how it operates, bringing in a completely different system (ie some form of state/private insurance and private/non profit providers) would probably make the system different for people to use and thus prove befuddling to the masses..
2. Its so big you cannot just switch from the old system to the new system overnight... meaning some sort of slow transition (probably painful due to 1) would occur...

[Offwidth]

From that guardian article with Uncle Bruce (after denying there is a crisis):

"Keogh said that the NHS would have to undertake a “complete transformation” of the way it operates over the next few years in order to keep itself sustainable. That would require hospital consultants to visit patients in their GP surgery and the sickest patients being given much more time to discuss their health than the usual 10-minute appointment with a family doctor.

In future, many patients will be able to get much of their care, including diagnostic tests and an expanded range of treatments, at their GP surgery to save them having to go to their local hospital.

Providing many more services under one roof would, Keogh said, reduce patients’ frustration at having to undertake appointments in different places. “Too many patients find the NHS fragmented [and] confusing. They find that they get pushed from pillar to post; they feel like a ball in a pinball machine at times.”

But he added that NHS England was confident that the major changes outlined in October in its Five Year Forward View blueprint for the service’s future, including an unprecedented build up of services delivered outside of hospitals, would help the NHS remain viable. The main priority in future would be to keep as many patients as possible out of hospital “dormitories” where they do not want to be and could catch an infection.

Keogh pinpointed the lack of local services such as district nurses, beds in community hospitals and mental health support as a key cause of the ever-rising demand for care from A&E units and for hospitals running out of beds. All those services are “very, very busy” because of the rising number of older people with complex medical needs and therefore have waiting lists."


I hope he is being misquoted as one asks: has he not seen from past changes what complete transformations of the NHS will require? As an example on his detail how on earth do you get expensive consultants efficiently to GP surgeries to see patients: is Scotty gonna knock him up some matter transporters (alongside magical contract changes). Also, are not the sickest patients the very ones who need sending straight to hospital where better diagnosis and response are available.

The pillar to post argument is completely missing the main point. Its not about GP surgeries (where tweaking will only help a bit and only then if they can get most GPs back onside), it happens because there is no proper linkage with social care and because primary and secondary care don't link as well as they should. In fact secondary care doesnt even always link internally (anyone who has had an operation unexpectedly delayed or witnessed two consultants fighting a turf war over a patient with complex problems will know that).

Towards the end he starts to rhetorically hit one obvious nail on the head but this was all known years ago and so why are they still talking about it instead of doing it. Social workers dealing with community care packages are stretched to breaking point, most council run care homes have closed and the private sector replacements are struggling, district nurse numbers have halved in recent years: just as a few examples. What is Bruce doing to ensure the government protect (and start to reverse damage in) social care in hard pressed councils: standing by while they are planning to make even more cuts with no workable ringfencing in place? When will he admit choice will be affected if budgets dont increase?

Crisis, what crisis? 5 year plans will weather the storms and bring summer to january. Yeah, right.

[Sloper]

Tub thumping electronic engineer academic vs person i/c of the NHS, now call me a cynic but I'd say he was slightly better placed to comment on the subject than you.

As for the rest, you'd be better of standing by the Lions and selling the Socialist Worker.

[Offwidth]

Childish and dishonest ad hominen distractions aside, I had high hopes for Bruce, but that article is depressing. Are we as citizens to bow down to a Bruce Almighty without challenge? I thought 5 year near impossible transformations were the realm of communist, regimes. Back on the detail does anyone seriously think moving consultants to see patients in GP surgeries is a good idea at the huge cost per hour we pay them and the time wasted in travel that cuts their ability to see others?

[a dense loner]

No and I've never heard anything as ridiculous

[Sloper]

Childish and dishonest ad hominen distractions aside, I had high hopes for Bruce, but that article is depressing. Are we as citizens to bow down to a Bruce Almighty without challenge? I thought 5 year near impossible transformations were the realm of communist, regimes. Back on the detail does anyone seriously think moving consultants to see patients in GP surgeries is a good idea at the huge cost per hour we pay them and the time wasted in travel that cuts their ability to see others?

So, the Kings Fund say that the 'privatisation agenda is a myth' and you call that stupidly simplistic (in summary) and Sir Bruce Keogh writes a considered piece and you in effect dismiss it and blame him for not challenging the government for something that is outside his remit.

The NHS is facing grave challenges and the sort of childish, tribal party political drivel you post makes sensible discussion of his and therefore necessary reform more difficult.

[Duma]

.... the sort of childish, tribal party political drivel you post makes sensible discussion .... more difficult.

 

[Offwidth]

I'm sure he's delighting in the wind-up and irony. He must remember I'm a bit too indepedant minded to have joined any political party, am very middle ground politically and have devoted a good amount of time opposing SWP idiocy in my academic union.  I have also never been an Electrical Engineer (but have worked with them).

He is right I was ranting a little bit but that article did annoy me. Its like nearly all promising cheif execs turn into cloned political mice whilst their pay spirals up to encourage reward for (unapparent) leadership. In my area of course its increasingly grey vice-chancellors who's pay is the highest its ever been relative to the average...and before the tory troll pops up again  its not a jealousy or structural thing for me as I dont mind higher pay if it delivers clear success. It looks like a giant con to me that such roles are almost defined as having superior leadership because of the money and when the con merchants say and do stupid stuff of course anger is all too easliy a result.