Sir Nigel Crisp - contracts & private firms

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This morning I awoke to correspondence from SOCAP about Sir Nigel's statement that :

PCT's must take steps to divest themselves of clinicians in direct employment and transfer those individuals to alternative employment contracts.

Is this even legal? Are there not employment laws?

Private companies e.g. Capio are making aggressive in roads in clinical service provisions in a growing number of localities. Is this latest directive a way to assist those companies to recruit NHS staff, which appears to be a problem for those firms.

As an example, locally, an Orthopaedic Surgeon is flown in from Germany every Saturday, to provide foot surgery. We have practically a non existent waiting list for foot surgery locally but this does not seem to affect the policy makers decision to introduce this service on the back of supporting the "waiting list" effort. Little additional foot surgery seems to be taking place.

This does not seem to be a costly deterrant if, as has been suggested, foot surgery is already part of the overall package. Private companies such as Capio seem to have limitless resources, in part funded by the NHS. This kind of funding if available to NHS clinical staff invariably would improve service delivery also.

Capio support staff are getting a taxi service to be transported 40 miles to and from their work place. All the best, latest equipment is purchased. Those same staff have been recruited from foreign parts and, Iam told, some clinics run without a single member of staff capable of speaking English. Staff turn over also seems high. At the same hospital there are willing and able NHS staff to provide service support. Senior clincal staff observing those clinics have told me those patients are "like lambs to the slaughter". None of this, of course, is presented as the public face of such an initiative.

The inital impression of such initiatives seems is one of a parasitic infestation - without the NHS infrastructure such services seemingly cannot exist or survive but are flourishing with top level support. Is this the future or another ill conceived attempt to (mis) manage NHS demand but destined ultimately to eventually kill the host (NHS) through a heady mix of starvation of funds, political spin, and devolved staffing, in the most global sense.

In turn, re-deployed NHS staff can look forward to a dilution of job security, TU representation, etc etc.

 

re contracting out

Dear All,

I would have hoped that this Govt would have looked at previous efforts of contracting out to the

lowest bidder

I have seen in my own area what happened to the Hotel services.

eg : Cleaners Porters Catering etc etc.

The staff went from being directly employed by the NHS to a private contractor.

This Contractor was bought out by the losing contractor in the bidding war.

So the staff changed employer again.

Standards due to the nature of the contract dropped and staff left.

The contract is not renewed and the staff came back in house.

It was a sorry mess to watch all of the above.

If this happens to clinical staff it will be a real BEAN FEST.

The NHS runs on the goodwill of its staff. So take away the goodwill and replace with a LEGALLY BINDING CONTRACT and that is what you will get.

NO MORE NO LESS.

So no flexibility in the system as flexibility is expensive and when there is no leeway in the contract then there is no leeway PERIOD.

Do i want to work in 3 GP practices and have 3 separate employers with possibly 3 sets of terms and conditions.

Do i want to work for ROGEREMALL MULTIBASTARD CORP.

The answer is NO.

I have spent the last year working with agenda for change and now KSF.

What will happen to this?

Will it bite the dust?

So this could be real fun.

regards David

 

Hi David,

They never learn do they? You have my sympathy! Unfortunately it does seem to fit with privatization by the back door yet again.

Regards,

Colin.

PS. I think it's called giving control to the Patient!

 

Patient power ...... return of the nail nippers?

Add to that Sir Nigel's determination that soon, very soon, services will be controlled by GP (and nurse!) commissioning. Since GP's / Nurses are apt to yield to patient power, how long before Podiatry takes a few giant leaps back and "cut & come again" and pedicure will rule. Soon there will be calls for free foot and leg massage and free advice on nail varnish.

Why? Because the 'professional' patient is skillful and adept at manipulating GP's for a referral to have their toenails cut. It won't be long before the news spreads in the bingo halls, on the bowling greens and in the lounge of nursing homes . This is the third time this week a patient complains to a GP they can't cut their toe-nail (easily). Clearly my patients need this service (for which we should read - I am sick and tired of listening to this a dozen times a week - hey I didn't spend a decade in medical school to deal with OAP's toe-nail stories!). Its easy now to demand this service by commissioning on the back of "to be responsive to patients needs."

There will be jubilation and celebrations as OAP's realise that once again the system can be bent and manipulated and that free access to limitless nail trimming is back - just so long as the appointment won't clash with the purple rinse or shopping trip!

Perhaps we will see pedicurists flown in Business class from far distant parts to make sure that Aunt Betty gets her toe-nail trimmed?

 

That we may. Joint Common Platforms way well result in the migration of EU Nationals into the job market – the NHS already encourages supplementary work by doctors and surgeons from many European countries. There’s no reason why it couldn’t do so in foot health services.

The real question is whether the commissioning health scheme will bring new money into NHS podiatry. Certainly commissioning will bring about a level of competition that we haven’t enjoyed before and that in itself will make the service more productive. But it is unrealistic to expect that changes to the employment status alone will be enough to service the growing demand for care. If the government is serious about all services being ‘free at the point of source’, then it will need to increase the spend on foot health services considerably. More realistically, we may see (at last) the introduction of charges for non-essential/non-specialist care, with exemptions (hopefully, as this is a Labour administration) for those on low incomes.

What will be interesting is how the profession reorganises itself in the new marketplace. At a guess, probably 90% of the graduate workforce considers themselves “specialists” rather than “general practitioners” whereas market demand is probably 90% for common foot disorders – the domain of general podiatric practice –and 10% acute and specialist care.

There is an obvious imbalance here and we cannot complain too much if the government tries to solve the problem, especially when the profession is unwilling or unable to do so itself.

Kind regards

Mark Russell

 

Nail Cutting?

Hi All,

A possible aside at this time but is there someone within the NHS. with the knowledge of whether NAIL CUTTING has been, or will be transfered from medical treatment to social care, (Similar to hand-nail or hair cutting?)!

If so are we as Pod's. really going to be involved, it won't concern the GP. at all, he will not need to make a decision?

Regards,

Colin.

 

More money?

Mark,

Ever hopeful !

I see no statement from Sir Nigel or Tony@numberten.co.uk that this latest tedious NHS re-shuffle will benefit from any cash injection least of all to Podiatry and soon after Capio secured tens of millions of pounds to provide surgical services etc.

There is not enough funding to meet NHS demand, period. The goverment surrenders the will to try (raising taxes is political suicide) and so the buck is passed on.

 

yeehaa history repeats

Dear All,

Great we can all go back to the heady days of:

Pts apply 2 years before relevant birthday.

At least 2 year waiting lists, hence above.

Every body seen every 3 months regardless of need. So those with greatest need go privately leaving the NHS with the high volume no risk lots of unit contact treatment regimes of yore.

That did not work.

Are we to be measured on the number of treatments regardless of efficacy and result/outcome.

Or are we to be measured on the outcome of a treatment plan.

Wait till i put in peoples pension books.

Free 3 monthly massages from physio.

Free basket weaving classes with OT.

Free Cooking classes with Dietitians every week.

If this is managed badly then it will put the professions back 30 years.

I thought that we were supposed to provide evidence based best practice for our patients.

Here comes the wind i think i will open my flies and micturate.

regards david

 

Mhmm. Neither - I guess in future your care will be measured by your patients who will assume the role of ultimate arbiter if they have the choice. Innovative, huh?

 

When a little insanity is good for you!

Hi David,

I cannot argue with this last one? That's the trouble I should be able to argue with you! Are we about to step back into "Cloud Cuckoo Land" again. I was laughing when I started to read the beginning of your Posting, trouble is I was believing you when I got to the end!!!

Regards,

Colin.

 

As Peter Ustinov once put it, the point of living and of being an optimist, is to be foolish enough to believe the best is yet to come.

I guess we need to wait until we see the details when they are published in the autumn. What we have now is the determination of policy. How it is funded - and implemented -will be critical.

More accurately would be to say, 'there is insufficient public funding to meet the demand for health'. The NHS is simply the vehicle through which the State provides its healthcare. What the government have realised, alongwith many other independent observers, is that the way the NHS is structured may not be the optimum model through which care can be delivered. Hence the shift in policy direction. Personally I can see many benefits for the profession and its patients alike, but of course there are many caveats too, and like most others I am sceptical whether these reforms can be executed in the timeframe proposed.

Should be fun though.

Mark

 

A PS. My main problem with Sir Nigel's proposals is brought about because fairly regularly I will see a Patient who will tell me exactly what is wrong with her and she is instructing me to do this, that, and the other because her best friend or a relation has told her already what is wrong, and they know you know!!!

The trouble is that nine out of ten times what she has described is a load of rubbish! Not only that on some occasions if I listened and ignored my experience and knowledge and just went along with her I could quiet easily do her feet permanent damage?

But the customer is always right! So what was the point in training in the first place! Informed consent, (Written informed consent!), could take up more time than the treatment.

This form of policy making reminds me of something I used to experience in my past work in another place. Incompetence always generates paper! Lot's and lot's of paper. The big white chiefs want to be able to go home at night and sleep whilst the minions suffer and worry in the junior management just below them! Paper has always been used to hide incompetence and allow it to grow in the system. Strip surgically the paper away, and guess what there the cancerous incompetence is still there growing and multiplying at a faster rate because the paper is hiding this fiasco! But I'm sure the Health Service which will take over from the much reduced NHS. will also learn how to deal with this incompetence of ignorant patients making ill informed decisions and some one is about to correct me and show me why I am wrong?

Regards,

Colin.

PS. to the PS.:-HS. = NHS. + PCT.

....................NHS./2 = HS. - PCT. NHS reduced by half?

......................................................................... HS.=Health Service.

.........................................................................NHS.=As now.

.........................................................................PCT.=Primary Care Trusts.

 

Good News Patient Led Health Care

Dear All ,

A thought.

Pts may decide to dispense with Evidence Based Medical Care and opt for Complimentary Therapies.

So all of us from a medical / para medical background will be out.

The Lunatics will be running their own Asylums.

People will travel by Horse and Cart to see the (careful now david) Complimantary Therapist of their choice to receive a holistic package of whatever which has no evidence to support it's use.

This will greatly reduce the needs for Medicine, as i understand it, as people will calmly exit this mortal coil.

They will be calm.

But very probabaly deceased.

As an aside a friend has just about survived 5 hours of radical abdominal surgery to remove most of the organs riddled with a very nasty cancer.

Morbidity is < 3 years post op. Probably as little as 18 months even after this level of surgery.

He is unwell and not eating and losing weight already.

But surgery was a last chance saloon , as he had less than a few weeks without surgery.

Only 2 Hospitals in this Country have the knowledge and expertise to deal with him. So this is very rare and very nasty. Oh yeah to add insult to injury he is also having vicious Chemo.

Poor Bastard.

Any way puts things into perspective.

regards David

 

Mark - I really kind of doubt the government is 'solving' Podiatry or that Podiatry should even play a tiny part in any of the innovative strategic thinking - instead I put my money on a hefty backhander from the private institutions to the 'government'. I doubt any official is loosing sleep over Podiatrists.

I am puzzled why you think that directives that Trusts should divest themselves of existing staff contracts would be to the advantage of the profession. Or that professional disempowerment affected by GP / Nurse commissioning is in any way useful in the overall scheme of foot health advancement. I just don't see that.

Peter Ustinov (RIP) was a great man but as sure as day follows night he would never hold this sunny disposition had he been a Podiatrist. Some optimists also thought the HPC would be a great move forward!

 

Sorry to hear that David!

Hi David,

I'm sorry to hear that about your friend! I know what he is going through, the Chemo makes you feel as though nothing moves and you wish you were dead! It can work sometimes, I'm here, and the new chemo has not got the side effects that existed about fifteen years ago when I had it! I don't know which was worse the chemo or loosing a good part of me in the operation! (I'm assuming we are talking about Chemical not radio active, The end product pain wise is the same I believe!).

I wondered David whether something was wrong? You were writing the way I'm feeling tonight! In my case though lack of sleep! A strange way to put it but from where he is at there is only one way, ( And excuse my grammar), But it is UP!

Now this really is the nitty-gritty of fiddling with peoples lives by altering large monolith type systems like the NHS.? Can you imagine what would have happened if your friend had been left to make up his own choices in this.

I was told that I was ill when serving with the Chalice in Church one Sunday? That was the first I had heard of it. Even friends and family had not noticed the very slow change in me? Doctor on Monday morning! He took one look at me and he was speaking on the phone to one of the top surgeons in my area, as I sat there! Three days later and five pints of blood and I was in the city hospital having the operation. Fortunately there was enough plumbing left to join myself back together again! Do you think I would be here today if I was left to hunt around myself for my own surgeon? Four people to pass the message down the line before the surgeon even knew I existed?

Tell your friend if it's appropriate that there is hope and light at the end of the tunnel but the chemo can be worse than the knife a real painful Hell, (Better not tell him that last bit?). It's really hard to describe what death warmed up really feels like. I and those in prayer and intercession will have a name passed around to label your friend for prayer!

Even if he has crossed the line in this life holding someone in prayer, the Loving arms of Jesus, is a worth while thing to do? Even if you and I don't think so!

Without dwelling on mine to much, false hopes etc.? I went into the Sunderland Hospital and that same day my head of religious faculty went into Newcastle Hospital, I survived he didn't come out of theatre. But I know that one day I will have a welcome discussion with him. I still really miss him, a mentor, Friend and tutor! And even with Metaphysic's I will never be able to prove it? Not even using physics can we prove this! But I pray that a touch of the Lord will be felt by him, (As I felt it at the time!), with your Friend from this time on anyway?

When you have been where he is at David this is real! This is not what I was supposed to be at when I started this Post.

Regards,

Colin.

 

I think we'll have to wait and see all the details when they're published in the autumn, Dieter. There are just too many "if's and but's" at present and all we are doing is speculating. There are, however, many drawbacks with the existing directly employed model of employment and the way podiatry services are structured and funded. Whether these proposals offer any improvement will be dependent on a number of factors, but it will be some years before we can make an honest appraisal.

It's difficult enough to keep debate on an even keel, especially where politics is concerned - even then (from the comments I've read here and on thatfootsite this morning) it can prove difficult and frustrating. But if politics is a difficult dimension in podiatry, religion (or superstitious mumbo-jumbo, if you prefer) will be intolerable. Could we refrain in future?

Best wishes

Mark

 

Hi Mark and Colin

I totally agree Mark .

I find the introduction of this wholly inappropriate and certainly not the setting for religious advice.

Whilst I understand it was part of a message of condolence an meant with good intentions I would have thought the message would have been better sent on a "private basis" by email or PM Not via the debating floor of the arena.

Just my opinion

Cheers

Derek

 

Dieter,

This concept has actually helped me as I work as a private contractor to the NHS within my role of Co-Head of Hospital Podiatry (3 days a week). I also work 3 days a week in a private clinic. This means good news for my taxes and good news for the NHS as I have to meet targets in my NHS contract, or they boot me out!

Bizarrely, part of my NHS contract role is managerial and, since reading about the re-emergence of GP commisioning, I have instigated a total service patient satisfaction survey, an audit of each specialist Podiatric area and am accummulating any evidence available nationally re Pod input in all areas concerned (lamentably little I have to say!).

As far as I see it, we only need to be patient-led by those patients with foot pathology (i.e. those we are seeing), not by the rest of the retired population who happen to have toenails (i.e. no foot pathology). I anticipate the survey will reveal good and bad, but it looks like evidence is what you need!

I can't see how this is going to work though as, should GP's commission elsewhere for whatever reason, what do they do with the staff left in the under-comissioned areas? It's practically impossible to sack someone in the NHS (as we all know), so I can't see how they can sack a whole bunch of us!

Most likley they will do what they're doing in Peterborough with finance cuts i.e. offer an 'equivalent' post (not equivalent in pay though) and if you don't want it, you can leave, but you won't get redundancy!

In the trust I work in, it seems like there will be a 'community trust' which will employ the AHP's etc formerly employed by the PCT and their services will be commisioned from there i.e. no change in the majority of cases (except for stationary....again! But in the case of some fanatical, power-hungry GP's, it's inevitable they will dump us and employ god knows who! ). Having said that, no Podiatrist in the world can offer their services cheaper than NHS Podiatrists, it's just that they will pay much, much more in room rental (our PCT currently pays GPs £4/session for our use of their rooms!).

Ever thought of going private?

Or, perhaps, we could do a dentistry job and all go private, then we could have foot care assistants galore, do the specialist work ourselves and never have to look at another KSF document again!

Basically, it's a complete waste of space as usual, but, also, a case of adapt or die I suppose!