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Wednesday, 11 February 2015

Dorset Clinical Services Review, NHS: A Public Meeting in Bridport Town Hall; NHS Privatisation Deal



I attended the public information and consultation event in Bridport. The event was well organised and professionally presented. The evidence that improvements are needed in Dorset was self-evident. The case made for change covered the following points:

Scans for strokes are slow in Dorset; stroke after-care is problematic
There are problems of access to doctors at weekends and out of hours; 24/7 services  needed, where required
Not all surgeons meet national quality standards (lack of experience)
There are both staffing and financial shortfalls; recruitment problems
Better medical technology is needed
Dorset population increase (especially the over-65s)
Need for specialised units for rare cases (not specialised units in all three Dorset hospitals?)
Shortfall of staff for dementia cases
Need for more collaborative working (primary, secondary, social care), multidisciplinary teamwork and concentration of skills
Need to share same IT platform across services
Options for out-of-hospital care
Maternity wards: obstretician availability is not 24/7
Paediatric units: paediatrician availability is not 24/7
A and E, Urgent/Emergency Care; there is not a consultant in Dorset hospital A and E Depts all the time
Services not uniform across the county
People do not need to wait in hospitals for many routine diagnostic checks (X Rays etc)
Dorset Health Service not yet in crisis, but if services continue as at present, the county will be spending £167 million more than be afforded
Deprivation getting worse in some areas...



The Bridport Meeting, 10 February, 2015

The question-and-answer session was felt to be too short by some members of the public. Several people argued very strongly that the consultancy price tag of £2.75 million is unjustifiable. Others spoke passionately about the lack of emphasis given to acute mental health services. Personally, I left with the impression that, despite all the commendable efforts being made to consult and communicate the need for radical change, it is almost a foregone conclusion that the public is being prepared to expect a largely unwelcome change (if - arguably- necessary) in the range of specialist services available in future at either one or two of the three Dorset hospitals. Dorset currently has three hospitals offering "Yellow" services when the higher-grading "Green" services are needed. We are being prepared for an inevitable conclusion that some important "Green" services will be available in only one of possibly two of the hospitals when the review is implemented between 2015-2017.

If the population of Dorset rises to 800,000 and the funding shortfall should rise to £167 million per annum, the amount needed per head of population to maintain the current level of services is around £285 p.a. Suggestion boxes are a feature of the public consultations and review.

I wonder whether a substantial amount of money could not have been saved by conducting a review (in-house or with the help of external consultants) of hospitals and services over a wider region, of at least three counties (eg Dorset, Devon and Cornwall).

BACKGROUND

About the Review

Why Dorset's Health Services Need to Change

The pamphlet we were given

Case for Change

McKinsey Chosen

Management consultancy McKinsey is set to help Dorset Clinical Commissioning Group review its clinical services after being named the preferred bidder for a £2.75m consultancy contract

Management Consultancy Specification

2.2 The CCG will be tendering for a fixed price to deliver the solution design phase and indicative costed proposals for the subsequent phases. The CCG will reserve the right to seek alternative proposals should circumstances at the time require further competition.

2.3 The scope of the review will include core clinical services commissioned by the CCG and to take account of the whole patient pathway including (as appropriate/agreed) co-commissioned services; e.g. primary care, specialist commissioned services and public health.

2.4 Core services are currently defined as: elective, maternity and paediatrics, long term conditions, specialities, urgent care and primary and community health. Interdependencies with mental health, learning disabilities and social service need to be considered where appropriate.

2.5 The solution design phase will answer three interdependent “demand” questions and three interdependent “supply” questions faced by the CCG. • What are patients’ needs? • How are the services currently provided? • What services can meet those needs? • How should those services be configured? • Who is willing to meet the potential future pattern of provision? • How should the move to future services be managed?

UPDATE, The Guardian, 12 March 2015

"NHS agrees largest-ever privatisation deal to tackle backlog - Plan by NHS Supply Chain to deal with backlog of patients waiting for surgery and tests will see 11 companies paid £780m to diagnose and treat patients":

"The NHS agreed the biggest-ever privatisation of its services in a deal worth up to £780m intended to help hospitals tackle the growing backlogs of patients waiting for surgery and tests.

The deal will see 11 private firms paid by the NHS to carry out heart, joint and other types of operations and perform scans, X-rays and other diagnostic tests on patients.

Under the contract many services will be provided in mobile facilities rather than hospitals. The NHS has been using mobile services for breast screening programmes but the contracts mark a large expansion into other areas of treatment and testing. The system is seen as more patient-friendly but it will also allow the NHS to rapidly buy in services from firms to help meet key waiting times targets".

Update - Protest

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