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The BBC are reporting: NHS waiting lists are lowest ever
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NHS waiting lists in England have fallen to an all-time low according to Department of Health figures.
Between October and November 2006, NHS inpatient waiting lists dropped by 8,000 to 769,000.
This meant the number of patients waiting for treatment was the lowest since the records began in 1987.
However, Liberal Democrat Shadow Health Secretary, Norman Lamb MP said the figures should be taken with a "strong note of caution".
He said: "The government's emphasis on bringing down waiting times above all else has pushed many hospitals into the red as they are forced to manipulate resources to meet strict targets.
"Patient care can also suffer as resources in some hospitals are diverted solely to meet waiting time targets."
But Health Minister Andy Burnham said the new figures provided clear evidence of an improving National Health Service. He said the average wait for inpatient treatment was now around seven weeks.
More than three quarters of inpatients had waited less than 13 weeks, and the median waiting time of those still waiting at the end of November 2006 was 6.9 weeks.
For outpatients, 86.9% had waited under eight weeks, and the median waiting time of those still waiting was 3.6 weeks.
Mr Burnham said: "These figures show that the NHS has slashed waiting times and given patients the kind of certainty about their treatment that even up to a few years ago was not thought possible."
A spokesperson for the British Medical Association said: "The latest waiting lists figures are a testament to how hard all the doctors, nurses and other staff in the health service are working.
"There has been a lot of publicity recently blaming doctors' pay rises for the current NHS debt crisis. These figures demonstrate very clearly how intensely doctors have been working to bring down waiting lists."
However, Mr Burnham said there was still work needed to cut the NHS' hidden waiting lists.
He said: "Although there is still work ahead to achieve a maximum wait of 18 weeks from GP to treatment, bringing to an end the NHS' hidden waiting lists, I am confident that we will meet this challenging target and the NHS can continue to deliver the fastest access to care."
Mr Lamb also said the government was buying operations in from the private sector to help hit its targets, something he predicted was not sustainable.
He said: "With next year's slowdown in NHS spending and the forecast of hospitals cutting doctors' posts, there is a real danger that waiting times will start to go up again."
A British Medical Association spokesperson also said: "It is essential that sufficient resources are sustained to ensure that waiting list do not rise in the future."
Waiting times may be "the lowest in years" but this is simply because the NHS has restricted access through administrative measures for many thousands of patients. Operations and services continue to be cancelled yet politicians and NHS management portray this as "success". There is an interesting letter in The Times today, substitute 'podiatrists' for 'nurses' and you have a fairly accurate picture of foot health services and the prospects for the profession in state healthcare.
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NHS needs fresh ideas, not more cash
Sir, It is clear from Nigel Hawkes’s report (“Operations cancelled as NHS runs out of money”, Jan 4) that the “tractor production is rising” view of the NHS is finally running out of fuel. As our nationalised healthcare system implements swingeing cuts and delays countless operations, it is increasingly clear that nurses should no longer sign up for careers in public sector healthcare only to find they are unable to access the resources and autonomy they need to do their chosen work.
Today, too many nursing trade unions and representative bodies fail nurses because they invariably stick to old and outdated agendas. Instead of championing substantive reform — and in doing so, championing the rights of patients as consumers — they default to short-term platitudes such as demanding more taxpayers’ money or new forms of legislative favour. Such an approach is not only disastrous for nurses but it is catastrophic for patients.
Nurses for Reform (NFR) believes in fundamental change and in telling the truth. It believes that only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands in a genuine market that nurses will find themselves working in a sustainable environment with the incentives, resources and encouragement to deliver a responsive, popular and truly high-quality service.
HELEN EVANS
Director, Nurses for Reform
London SW6
Have to resist the temptation of saying "I told you so" but the NHS service is in dire straits. Organising a parliamentary lobby to highlight the value of podiatry is laughable - the government has set its course and will continue to commission services - and rightly so - and any opposition from health unions may very well damage future prospects of collaboration.
Happy New Year chap - original article from Nigel Hawkes below.
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Operations cancelled as NHS runs out of money
Nigel Hawkes, Health Editor
Patients told to wait for routine treatment
Casualty staff asked to turn people away
Patients are being denied basic operations, including treatments for varicose veins, wisdom teeth and bad backs, as hospitals try frantically to balance the books by the end of the financial year, The Times can reveal.
NHS trusts throughout the country are making sweeping cuts to services and delaying appointments in an attempt to address their debts before the end of March. Family doctors have been told to send fewer patients to hospital, A&E departments have been instructed to turn people away, and a wide range of routine procedures has been suspended.
In one example of the cash-saving strategies, seen by The Times, a primary care trust in Yorkshire has told hospitals that they will not be paid for some non-essential operations, while patients will not be given a hospital appointment in under eight weeks. Similar tactics have emerged at hospitals in Norfolk and Surrey, while dozens of trusts have resorted to closing beds and offering voluntary redundancy in recent months. Devon Primary Care Trust has offered voluntary redundancy to all 5,000 staff.
The cuts are widespread, although there are no central records to provide definitive figures. Among the most comprehensive plans are those from North Yorkshire and York Primary Care Trust, which faces a deficit of £24 million this year.
A letter from its chief executive, Janet Soo-Chung, says that all non-urgent admissions must be approved by an assessment team or they will not be paid for. A&E departments in Harrogate, Scarborough, South Tees and York have been told that they will not be paid for treating patients with minor ailments who could go elsewhere.
No patients will be given a hospital appointment in less than eight weeks, and none admitted for elective surgery unless they have waited a minimum of 12 to 16 weeks. Those treated quicker will not be paid for.
The trust also announced the immediate suspension of treatments for varicose veins, wisdom teeth, X-rays of the back, operations for carpal tunnel syndrome, bunions, arthroscopy of the knee, and grommets for the ear, among others. “We fully appreciate the difficulties that the introduction of these measures entail," Dr Soo-Chung's letter says. "However, the financial position of the PCT is such that there is absolutely no alternative to this programme if we are to avoid even more difficult decisions in the near future."
Norfolk PCT has issued similar instructions, telling hospitals not to treat patients who have waited less than 17 weeks — expected to rise to 18 weeks by February. Hilary Daniels, the interim chief executive, told hospitals to work out how many patients could be deferred until next financial year, and said that the trust would not pay for elective operations on smokers until they had attended smoking clinics.
Andrew Lansley, the Conservative health spokesman, said: “The Labour project has proved utterly incapable of running our NHS. Centrally imposed initiatives and costly targets have plunged the NHS into a record deficit. The NHS needs greater freedoms at a local level to return it on a stable and sustainable financial footing.”
In a report published this week, the think-tank Reform said that NHS deficits were deepening. It called for a one-off repayment of debt followed by a more rigorous financial regime and immediate administration for failing trusts. But the idea was rejected by the Department of Health.
On the delays to appointments and operations, a spokesman said it was a matter for the local NHS, provided that national targets were not breached. However, the department has not left it all to local managers but has introduced fines for hospitals that operate too fast. These can amount to millions of pounds.
Last year the NHS returned a net deficit of £512 million, a fraction of the total budget. But the scale of the problems was concealed by strategic health authorities saving large amounts of money largely by cutting education and training budgets.
I agree with your sentiments about a podiatry lobby in the UK, Mark and for the reasons you state. It is like locking the door after the horse has bolted.
However in the Antipodes there is probably more reason to lobby than not. The reason is, and I hate to even consider the synic's view of downunder, but at the risk of being burnt at the stake for saying it, you can set your watch back twenty years here in beauracratic terms.
One main advantage is of course, you can see what is coming. Unlike the New Year Celebrations in Edinburgh and Glasgow.
If 2006 was the "best year ever" for the NHS, according to Patricia Hewitt – a statement that made millions of us wonder if we inhabited the same universe, let alone planet, as the Health Secretary – then the start of 2007 hints at this being one of the grimmest.
Gerry Robinson spent six months studying Rotherham General Hospital
A week into the new year and hospitals are being told to delay surgery for as long as possible to ease budget problems; a leaked government report is predicting 37,000 health service jobs will be lost as hospitals battle to manage deficits, while also warning of a drastic shortage of doctors and nurses by 2010.
Health unions are already muttering about industrial action. And another report, from the Right-wing think tank Reform, claims that despite record levels of investment since 1997, quality of service is poorer than it was two years ago.
There is a growing sense that the NHS is beyond help, that no political party is prepared to introduce the reforms necessary to make it work, yet neither politicians nor civil servants can manage it in its existing state. Well, one of Britain's leading businessmen, Gerry Robinson, disagrees.
Sir Gerry, the former chairman of Granada, Allied Domecq, and the Arts Council, management guru and New Labour donor, conducted his own six-month investigation into the problems involved in running the NHS. He set himself the task of reducing waiting lists at a Yorkshire hospital and the results are revealed in Can Gerry Robinson Fix the NHS?, which begins on Monday on BBC2.
It was, says Sir Gerry, a fascinating, frustrating and ultimately fulfilling exercise that Ms Hewitt and her team should take note of.
He discovered the NHS to be riddled with practices that, in his words, "defied belief", and his solutions – which range from finding a "million-dollar" man or woman to run it, to banning hospital car-parking charges – are rooted in the common sense and good business practice that seem to have escaped the thousands of management consultants employed at great cost by the Department of Health to advise it.
Sir Gerry, 59, who lives with wife, Heather, and two children in a beautiful Georgian house in County Donegal, exudes warmth and good humour, but there is no doubt that this is allied to a fierce sense of discipline and resolve that forms the core of his management technique.
Yet one of the first lessons Sir Gerry learnt when he began his experiment at Rotherham General Hospital early last year was that a combination of charm and his reputation as a manager par excellence had absolutely no impact on surgeons, who, frankly, weren't that keen to work on a Friday afternoon.
"Without a doubt," he says now, leaning back in a plump leather chair in his study and smiling incredulously at the memory, "the biggest single surprise for me was seeing how under-utilised the operating theatres were. Theatres are the engine rooms of a hospital – most procedures have some connection to them. Orthopaedic work, ophthalmic, routine stuff, elective stuff – it all goes through theatre.
I thought they'd be packed – and that this was the reason there was a problem with waiting lists. But it really wasn't like that. The theatres simply weren't being managed in any way that I would recognise as being appropriate for an important and expensive resource.
"There was a schedule worked out, and kept to, by and large. But if somebody cancelled an operation, no one used that slot for something else. And then there were Fridays – the operating theatres were empty on a Friday afternoon."
Sir Gerry was assured by Rotheram's chief executive, Brian James, that this was acceptable, that the doctors worked their full complement of hours, but that they preferred not to operate when only weekend cover would be available as back-up after operations. There was, he says, also a sense of "this is the way we always do it here – we don't need to operate then".
"I said 'Hang on' " – Sir Gerry still sounds as shocked now as he did on camera confronting Mr James – " 'What do you mean we don't need it?' If you have waiting lists, surely the best thing any hospital can do is to utilise any available time and space to bring those numbers down.
"Not having them running on Friday afternoons was effectively cutting out 10 per cent of the hospital's work time. Not only was it wasteful in itself, but as the NHS system now means that money follows a patient – so the trust hospital where a patient is diagnosed as needing surgery must pay for that procedure even if it is carried out elsewhere – you are not earning the money you could be. It didn't make any sense."
Sir Gerry encountered numerous examples of this kind of institutionalised thinking: anaesthetists and surgeons at loggerheads over patient responsibility, operating schedules built around lunch breaks, accountants saving pennies buying surgical gloves that the consultants wouldn't use, antagonism between staffing groups, red tape, meetings, protocol – and the waiting lists that refused to come down.
"And all this was in a hospital that is not failing, is not in deficit, has achieved Foundation Trust status and is not threatened with any cuts," says Sir Gerry sadly. If Rotherham couldn't get it right, could anyone?
The real problem, in Sir Gerry's view – and one that underscores everything else – was the question of who was in charge. From cleaners and secretaries, from nurses to the highest-paid consultants, one answer came back: "The doctors." No one suggested the chief executive might be – not even the man himself. It was no surprise, really, that the consultants didn't want to work on Friday afternoons – no one was going to make them.
Sir Gerry admits now that if he had arrived at Rotherham with one preconception about the NHS it was that doctors were probably the root cause of the problems – partly because of their status, the clinical power they wield, and the respect that the public and non-medical hospital staff have for their profession.
"I had to overcome that myself when I arrived at Rotherham," he says. He understands why some managers might be daunted at the thought of carpeting a consultant who regularly shows up late for clinic.
But after a few weeks, far from seeing the medics as a problem, Sir Gerry realised that although consultants are, collectively, probably as difficult to manage as the opera singers he encountered at the Arts Council – "of course doctors are difficult; these are brilliant, extraordinary people" – the right manager could do so.
And here is the crux of Sir Gerry's prescription for the NHS. After a thorough examination of the patient, he has detected a pulse, albeit a faint one: "The NHS is not collapsing. It is constantly running out of money, but you do get treatment in the NHS and it works. What it needs is managing."
It requires a "million-dollar man" (or woman) to manage the whole system: not a civil servant or a politician but one of those rare individuals of whom there are, he says, not more than 100 in the country, capable of running the third-largest employer in the world.
And we should be prepared to pay the right person what he or she is worth – whatever that is. "One million, a million and a half, even five million. Who cares?' he says. "Unless you are prepared to pay that sort of money, you are not going to attract the best people from business or from medicine into the role – yet these are the people you need.
"I hate to think we are all driven by capitalist motives, but they do work. You have to be pragmatic. You need top-notch managers and for that you need to pay."
Sir Gerry acknowledges the right candidate would need "the skin of a rhinoceros" – and would be under constant scrutiny and enormous pressure.
"But so what?" he says. "This man's [or woman's] role is to take the flak – eliminate waiting lists in the NHS, and no one would care. Find the right person – someone like Terry Leahy at Tesco – with a proven track record and at the end of four years you would have a health system running efficiently.
"We need to be more confident managerially and start hiring people who do things, not talk about doing them – people who believe we can have change and that it won't cost a fortune."
Another crucial element of his plan to the fix the NHS is to "depoliticise" it. "The NHS is such a bloody hot potato, no one knows what to do. The Department of Health should not run it. Its job should be to find the right guy and then let him get on with it.
It should focus on strategy, not management. If a charity was spending the kind of money that the Government is spending in the actual running of the health service before even a penny gets to the operating theatres, we'd be furious. How much? Twenty, 30, 35 per cent [of the budget]? It's horrifying – there must be a huge sum of money that could be released to the sharp end here."
Sir Gerry accepts that some cuts will always be necessary. "I have no doubt that, in an organisation the size of the NHS, there are bits that need expanding and bits that need cutting. The way modern surgery is carried out means shorter in-patient stays and therefore the need for fewer beds and hence fewer wards.
Then something comes along like Aids that is completely new, so we need new treatments, new specialists. You won't always match the things you cut with things you grow – you do the best you can to marry them up. You have to take an intelligent approach because money is not endless."
To better utilise what money there is, Sir Gerry would sack all management consultants employed by the NHS immediately. "If the people who have been working in hospitals for 20 years don't know what the problems are and don't have ideas how to solve them, I don't know who does.
How are you going to get some magical thing from outside? What are we doing getting management consultants coming in at God knows what rates for an eight-hour study? Management isn't an amazing art – it is practical day-to-day stuff."
He identifies loss of morale as one of the biggest problems the NHS is facing, and his "million-dollar" man again would prove key to motivating and inspiring staff. "You are not making tins of baked beans here – you are working in a hospital. You go home at night knowing you have done something worthwhile. If you can't enthuse people working in this area, where can you? The esprit de corps of an organisation is really important."
To this end, he would discourage contracting out staff such as cleaners and encourage a team spirit that subscribes to the belief that "in this hospital we do it better than anyone else, smarter than anyone else, and we have the lowest waiting lists".
In addition, getting the health service unions – traditionally resistant to reform and a problem for every government – on side would be a vital element of the job for a new NHS chief, he says. "Being efficient and businesslike is not against the spirit of healthcare that is free to the user at the point of delivery. It is a good use of resources; it is a genuine aim to deliver.
'It's what we all want, to be able to say – hand on heart – we're part of something good. It comes down to leadership. Running a hospital ain't easy – it is remarkably difficult. You are dealing with people when they are most vulnerable.
You really have to work at it, but you need to keep your aims simple. The thing that seems to bug most people is being kept waiting – essentially, that's the issue. Therefore, that is the thing we should concentrate on to make the health service acceptable to the public.
"I'm not saying you aren't going to hit problems, because you are. Running an operation like the NHS is like getting on a ship and constantly having a discussion about whether we are going to Australia or New Zealand or Canada – as opposed to making up our minds that we are going to Australia, so now let's sail the ship.
"At times, I did feel we were always up on the bloody masthead and there's no point in that if you know exactly where you are going and you have navigation equipment. You need to be down there running it, making it happen, daily.
"I had really bought into the argument – we all have – that the NHS is so busy, everyone is run off their feet and they are so preoccupied fire-fighting that there is no time to get anything done. But have you ever been part of an organisation where the workers don't feel that? Everybody feels like that.
"Very often the staff were doing things they didn't need to do or telling you they were busy when they were not. There was plenty of time to think about things logically. But when I said to someone 'let's do that tomorrow'..." Sir Gerry breaks off to pull a face of horror, before roaring with laughter. "It was an alien environment. People in the NHS don't think change could or would happen."
One of his most controversial recommendations is that doctors be made to choose between the NHS or private practice. "I've no problem with private medicine – I buy it myself – but it is being driven by the NHS waiting lists. I don't care what doctors say about how purist they are – you need to get this distinction clear: whether you are working for the NHS or privately.
Surgeons get well paid for that work – stop them doing it and you have to compensate them for it. But then I don't care if you pay surgeons a quarter of a million a year – they deserve it. We must recognise, however, that private medicine is a disincentive for a national health service."
Another recommendation, and one that would be welcomed by all patients and their families, is that hospital car parks should be free. "Car-park fees are fine if you want to ration space. But to make money? It drives me mad. Someone is probably being employed just to administer the parking fees, and the [patient] telephones and those vending machines. I hate it.
When you are concentrating on that sort of thing, you miss the point. Do a few more operations. Good management is concentrated on the big things – don't piss people off with the small things. Penny pinching is a sure sign of bad management."
When filming ended, Sir Gerry says he was sad to leave. He had grown close to the hospital and its workers, but he was also surprisingly optimistic. "I came away thinking, yes, you could make this work. You could eliminate waiting lists without spending extra money, and, in fact, in the long run saving money. I do believe that if I went back in 18 months' time, and if they followed my advice, Rotherham would have the lowest waiting lists in the country.
He is, he says, a firm believer in the role of the NHS. "We have a responsibility to look after society from a health point of view."
So is Sir Gerry the million-dollar man, the superhero we need to save our ailing NHS? "Ah," he says, "I'm too old. You need someone younger prepared to get old fast."
Sir Gerry, looking younger by the moment, surveys his peaceful, orderly study, his dog sleeping at his side – and a wistful expression passes across his face.
"But what a wonderful job. Get this thing humming and every night you'd go home really pleased with yourself."
'Can Gerry Robinson Fix the NHS?' starts on BBC2 on Monday at 9pm.
Good management is concentrated on the big things – don't piss people off with the small things. Penny pinching is a sure sign of bad management."
I think those are the truest word I have seen written by any successful businessman and probably the best advice for any Podiatrist (or anyone else for that matter) who is running their own business.
We're losing our A & E department shortly. The nearest one is about an hour away in good traffic. I predict this will cut waiting lists for things like heart surgery dramatically. All the patients will be DOA!
Still Give the powers credit for thinking outside the box. Waiting lists will fall and one department is cheaper to run than two.
NHS waiting lists are lowest ever
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