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Editor's blog Tuesday 9th March 2010: A Panoramic view, cupboard love and NFR's biscuit contraception

Hello. Last night's BBC Panorama had got themselves a real-life whistleblowing consultant, Milton Pena of Tameside Hospital. It was fascinating that one spur to Pena's doing the unthinkable - telling the outside world that bad care is going on - was, in his words, "seeing people treated without dignity".

Tameside will be in the shit today. And it would appear, quite deservedly so.

Reporter Simon Boazman (who looks and acts like a chubby Ross Kemp, and committed the fatal solecism of wearing brown shoes in town) reported Pena's claim that he had no access to the trust's non-executive directors. Tameside proudly countered by reporting that they had a whistleblowing policy in place.

But Boazman had an internal email, which read, “All communications with non-executive directors have to be authorized by the chief executive and the chair”.

Some whistle-blowing policy.

Nik Patten, CE of Peterborough - found to have mis-self assessed in three categories -started out calm and clear in explaining that much of the trouble related to poor reporting rather than poor practice, but on hearing an awkward question about his own role, made the schoolboy error of asking the film crew to pause.

Cupboard love
Nursing Times had a good media take-up of their survey-based story about nurses delivering patient care in cupboards and other potentially inappropriate or risky locations.

Some of this may not matter - it depends on the condition of the patient. But sometimes, it very definitely does, as some of the 900 survey respondents point out. Nearly 80% of the respondents believed the practice of putting extra beds on wards was putting the safety of patients at risk, citing concerns over access to call bells, water and suction facilities; missing emergency equipment; and infection risk.

One respondent reported, "If a patient's condition suddenly deteriorated resulting in them having a cardiac arrest we would not be able to get the crash trolley to them."

From real nurses to surreal Nurses For Reform, purveyors of biscuit contraception
Which segues quite neatly to the latest instalment of the Telegraph's series on NHS heated debate.

It is from the rather fabulous Helen Evans of Nurses For Reform: a group whose organising principle appears to be that of biscuit contraception.

Because they're fucking crackers.

In her article, Evans proposes that we should depoliticise the NHS by:
- de-nationalising all provision;
- over-ruling local planning consent and local government scrutiny on healthcare new build;
- offering providers complete freedom to advertise;
- abolishing public health, beyond "those areas that specifically overlap with, and are akin to, warfare: for example, natural disasters and pandemics"
- and abolishing national pay bargaining and training arrangements

Yep, that will get the politics out of it nicely.

No word here on what you will do about services nobody can make financially viable. No thought on the lessons from competitive advertising in the pharma industry (clue here Helen, look at the PMPCA website).

Helen, her husband Dr Tim Evans and freelance journalist Stephen Pollard run a PR company called Farsight SPI. Dr Evans was PR manager for the long-failed Independent Healthcare Association, and is currently President of the Libertarian Alliance; CEO of the Cobden Centre; Senior Fellow for Personal Liberties at the Adam Smith Institute; and a Senior Fellow with the Centre for the New Europe.


He also chairs Global Health Futures, who are so futuristic that they don't even have a website, but there is something about them online here.

Interesting stuff.

Meanwhile, back in the real world ...
James Gubb of Civitas has a reasoned and intelligent piece in the Telegraph, loking at the role of PCTs.

Gubb's position is that instead of another "redisorganisation" of structures and systems, we should try to make the extant system work, subject to four broad changes:
"One, government must be committed to PCTs acting as vigorous purchasers – including making difficult decisions such as closing hospitals and switching services to non-NHS providers where appropriate.
Two, PCTs must develop commissioning skills familiar to commercial operators. Japanese car-makers would be a good place to start.
Three, providers must accept they are in a market place, work maturely with PCTs, and develop proper systems of cost control.
And four, barriers to entry and exit, such as over-prescriptive contracts and – dare it be said – the pension disparities between the NHS and private/voluntary sectors, need to be removed".

There is a big hairy 'oops' on number two, given Toyota's current media profile for mechanical reliabilioty and openness.

And finally ... Treasury select committee criticise reporting policy on PFI
You love a bit of financial gubbins.

No, you do. So do I, sort of.

To which end, I waded through lots of the Treasury Select Committee's new report, Administration and expenditure of the Chancellor’s departments, 2008–09.

And found this little nugget on PFI.

You may remember that it has been proposed that as we move to implement International financial Reporting standards (IFRS), PFI debt go fully onto the books at the national, pan-Government level.

Obviously, the government aren't wildly thrilled about the prospect of a load of handily-hidden debt - whose risk was of course all transferred to the private sector, every last little bit - plunging them deeper into the red.

The Treasury select committee's report reads, "42. The Government has committed to preparing public sector accounts in accordance with International Financial Reporting Standards (IFRS). In our report last year we noted that the Government’s timetable for achieving this had slipped from 2008–09 to 2009–10.

"In oral hearings this year, Ministers confirmed that the implementation of IFRS to the revised timescale remains “important”. Ministers also reassured us that the Government remains on-track to publish Whole of Government (WGA) accounts for the first time in July 2010 for the 2009–10 financial year.

"In our Pre-Budget Report we noted that while PFI contracts will show on balance sheet in departmental accounts prepared under IFRS, they will not appear in the calculations of net debt in whole of government accounts. We reiterate our view that future Pre-Budget and Budget Reports should include a reconciliation between Public Sector Net Debt calculated on a national accounts basis, and the same figure calculated using the IFRS principles which apply to departmental accounts (their emphasis)".

I'll quote it again: "while PFI contracts will show on balance sheet in departmental accounts prepared under IFRS, they will not appear in the calculations of net debt in whole of government accounts".

And the Treasury select committee are strongly warning that this approach is wrong.

Watch this space.