Wednesday, 6 February 2013

Do they care?

We are all getting old so this stuff matters a lot!

The truly dreadful report on the quality of care at Mid Stafford NHS Trust, which was published today, is an important reminder that 'our' National Health Service is in a terrible mess. The main headline was that there were between 400 and 1,200 more deaths than would have been expected, due to poor care.

Inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.  He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.  Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.  He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.  Actually he doesn't believe any of that guff as he is enthralled with 'our NHS' and like his 'Heir' (Tony Blair) he is in no position to deal with the underlining issue, which is the NHS is too big to save.

After the countless re-organisations over the last 70 years and specifically since 2001 the patient (NHS) is in a critical condition.  Like an obese man who hasn't the will power change his diet the NHS lumbers on towards a cardiac arrest

Some of the re-organisations over the last 10 years

We need to answer the question – is it possible to run an organisation of the scale and complexity of the NHS and consistently get improving outcomes?

Here are some statistics

  • NHS net expenditure was £106 bn in 2012/13
  • That’s  £1,979 per capita
  • The organisation consists of 2,312 hospitals and 10,500 GP practices in the UK
  • There are 1.35 million staff employed by the NHS  - 143,836 doctors, 370,327 qualified nursing staff, and 38,214 managers.  (What do the rest do?)
  • The NHS deals with over 1 million patients 
  • Currently the NHS has over £18bn of outstanding clinical negligence claims for poor care outstanding 
To a simple management consultant it just looks too cumbersome.  To improve care (which is generally pretty poor) and to reduce costs we need to do the unthinkable - break it up and get more market dynamics into this monopoly of mediocrity.

How do we stack up?

Okay actually but my guess is that the other health services are rubbish as well!!

Column1 UK France  Spain Germany
Total population 62,036,000 62,787,000 46,077,000 82,302,000
Gross national income per capita (PPP international $) 35,840 34,750 31,800 38,100
Life expectancy at birth m/f (years) 78/82 78/85 78/85 78/83
Probability of dying under five (per 1 000 live births) 5 4 4 4
Probability of dying between 15 and 60 years m/f (per 1 000 pop) 95/58 117/54 94/43 99/53
Total expenditure on health per capita (Intl $, 2010) 3,480 4,021 3,027 4,332
Total expenditure on health as % of GDP (2010) 9.6 11.9 9.5 11.6

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