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Subject: Risk register From: David Hunter, Professor of Health Policy and Management at Durham University
This is what happens when a government gets seriously out of step with professional and public opinion on a matter of life and death; normal rules no longer apply. The risk register is a lightning conductor for much of the anger and frustration that is growing over these crass and ill- judged changes.
The Government needs to get off the back foot and that means ceasing to dig itself into a bigger hole. It is seriously detached now from mainstream opinion on the NHS and should draw a line under the fiasco, which is all of its own making. Even if the Bill is passed and the changes proceed, they will never get implemented in the teeth of such overwhelming opposition. Cameron, Lansley and co are either stupid or just dogmatically determined to break the public service ethos of the NHS. Probably it’s a mix of the two. Whatever happens they are losers on this issue and should admit defeat however difficult that is.
We are, after all, supposed to be a democracy and the degree of opposition to these changes is such that it beggars belief how any government can proceed with them. The massive support for the e-petition is surely indicative of this. A failure to read these signals correctly will be the government’s nemesis and rightly so. No government deserves support when it fails to take account of such public outrage.
Subject: Risk register From: Phil Barber, consultant respiratory physician
I think it is understandable that the DH doesn’t wish to share its risk register with the public, though I can also sympathise with the exasperation this causes. The fact is that making a ‘negative’
national health executive Mar/Apr 12 | 15
feature of any service explicit invites irresponsible broadsides from the press and others about why things are the way they are.
Thus, risk is essentially an internal concept, to be addressed as resources allow.
Look at analogous areas and events in healthcare and other areas of public life – if we have a vigorous campaign against theft or prostitution, for example, the apparent crime-rate goes up and things look worse although they are in fact better.
In healthcare, the more we look for and identify serious risks of failure to rescue or to care properly for patients, the worse we will look in the public domain, so externalisation has a ‘risk’ itself - of dumbing down the process of making our service safer and better, reducing it to the usual box-ticking front-of- house process which is, in the end, actually counter-productive and probably the worst single feature of modern health-service management.
These things are more complex than they may at first sight appear.
Subject: Diabetes From: John Sanderson, Hicom
The National Diabetes Audit figures highlight the plight of more than 1.3 million diabetes patients not being offered vital tests for their condition. This, combined with the shocking statistics that around 70-75,000 diabetic patients die every year, with an estimated third of those deaths avoidable if their condition were better managed, points to a systemic failing in the treatment of diabetes in the UK. Surely the time is right for an interactive system to be implemented to encourage regular GP and patient interaction. Andrew Lansley’s implementation of mobile apps to help patients self-manage ongoing illnesses such as diabetes is a welcome initiative to the market. These apps will play a significant part in managing long-term conditions and leading to savings within the NHS.
The costs associated with the management of diabetes and the seemingly high death toll from its mis-management are escalating at a dramatic rate and continue to put enormous pressure on an already squeezed NHS and
struggling diabetes services. Now is the time to focus on better management of the condition and raise simple education and prevention up the healthcare agenda. Basic health checks from clinicians, functionality that facilitates reminders for patients taking medication, and support in keeping to a healthy diet, all go some way in combatting this deadly illness.
What is now required are joint pilots between the NHS and specialist software vendors that can demonstrate the clinical and financial value associated with improved patient empowerment.
Subject: Hinchingbrooke / Circle From: Nigel Padgham, East Kent Hospitals University NHS FT
I am dismayed by the union attitude – it seems they think the previous failed regime was satisfactory or better than what is proposed by Circle. If Circle can be given a chance – and succeed – there will be much to learn for the wider NHS, and perhaps a better reform of health service management will emerge, rather than the turmoil being created at present with GPC!
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