DECEMBER 2015 Page 1 Editorial: Handcarts in Convoy
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NEWSLETTER Editorial – 2 General practice on the brink – 4 Junior doctors: the wider view– 5 Barts merger nightmare – 7 Manslaughter and beyond – 8 AGM and Conference 2015 – 11-21 AGM: Reports – 12 AGM: General practice – 14 AGM: New politics – 16 AGM: Devo-Manc – 17 Git et qui nonAGM: et ommollesFYFV – 18 corempo AGM: Devolution – 19 AGM: Paul Noone Memorial Lecture – 20 Mental health: What lies ahead – 22 Executive Committee 2015-16 – 24 Page 1 DECEMBER 2015 Page 1 Editorial: Handcarts in convoy Despite 70 years of continual old- and (as someone else pointed out testament-worthy predictions of when they highlighted the high-risk terminal melt-down, the NHS government strategy of targeting the arrives, join our happy team” – the won’t do that, just as it hasn’t juniors) very definitely neither on usual depressing PR-speak. since 1948. We’d do well not to the golf course nor seeing private Interestingly, many of the trusts were proclaim its demise – a ritual patients. I spoke to a couple of – though you’d never know it looking pronouncement every winter. foundation year doctors. They told at the pictures of happy-clappy But its foundations continue me of their concerns for patient healthcare professionals – in special to be eroded in ways that safety, their insecurity about their measures or otherwise engaged only intermittently make the long-term futures, and the instability with the CQC, so were obeying the headlines. Without seeking out of their organisations. By the time management-consultant mantra of trouble – or even information, for this is in print, they will either have smiling especially broadly when you’re that matter – in the past couple become the 2015 equivalents of in your death throes, and hoping of weeks several of the demons the miners under Mrs Thatcher, or that some people might not notice gave me a good nip. preferably will have ensured that (actually, I’d be interested to know the race to demean professionals how many prospective consultant Juniors on the streets to the status of the lowest currency candidates are properly informed of human capital may have slowed a of the real significance of the CQC On Sunday 15 November, we were little. status of the dying organisation they in a warm and relaxed Birmingham, may be joining for the next 40 years). and spent a few hours in the splendid PFI, PF2 – and counting I spoke to two nicely presented German Market that spills down young people, presumably managers, from Victoria Square all the way Though I no longer do acute or possibly press and comms people, along New Street, and which has medicine, we all need our CPD in front of a lavish scale model become a traditional pre-Christmas notches, and the Acute and General of a new hospital called Midland event. At the station end of New medicine conference at ExCel is Metropolitan. We are encouraged on Street (the station itself has become usually a good two-day update the hospital website (definitely virtual, yet another dreary white shopping for physicians of all generations. as it doesn’t open until 2018) to call centre with a few train platforms The adjoining exhibition is nearly it much more coolly “Midland Met”, attached) in the middle of a very as interesting as the lectures. There which has a laid-back, slightly North large crowd of good-natured beer- were at least 20 trusts displaying American twang to it, presumably drinking and frankfurter-chomping their wares in very smartly appointed fully intended, and of course it will Brummies was a large rally of about stands, all adorned with rural lifestyle be a hospital “Where EVERYONE 200 juniors demonstrating, quite photos. The reasons for these matters”. It will replace a handful undemonstratively, their feelings conspicuous displays of ostentation of large hospitals near Birmingham about the new contract, that nice Mr were frequently less clear than the including Dudley Road, Smethwick Hunt, and other related matters. dreary slogans they displayed, usually and Sandwell. I didn’t spy too many obvious a random mixture of “opportunity, So PFI is alive and well, I suggested. Trots or anarchists. They were nicely innovation, exciting, nice schools, only But this, the young lady told me, is scrubbed and rather well turned out 2 hours from London when HS2 PF2. In what ways does that differ Page 2 from PF1? Wasn’t quite sure. I over 100 years old in some cases, Commission omission prompted this eager young person and the cost of bringing them with tangential questions like how consistently to basic statutory Finally, the shadowy world of conflicts much the glass-covered cockroachy- standards is over £100m.” of interest in CCGs, widely suspected, looking thing would cost to build and now exposed in the BMJ. Twenty (I suggested the usual “DGH” cost (£100 m for a full refurbishment years of false reassurance about of £350m or thereabouts – they seems like good value, compared the watertight supremacy of the demurred), and more importantly, with the total PF2 cost. The neoliberal quartet of “governance”, the interest rate on the loan (and refurbishment option must always be guidelines, audit and compliance has indeed the term of the loan). Didn’t considered, and is ritually dismissed, led to a morass of just-about-legal know really. But they were up front so presumably the need for clever arrangements that any non-expert that because of new ways of working accountancy is another thing that would immediately spot as fairly stinky and transformative innovation hasn’t changed in PF2.) if they were exposed in banking, but (or it may have been innovatory a few hundred million here or there transformation) they needed fewer Failing the final duty in the NHS doesn’t seem to be the acute beds than the hospitals it was same. replacing. Ah, yes, I said, that was Then, a personal and poignant Actually it’s much worse. The side-bar one of the characteristics of PFI piece in the current 19 November quotes from leading doctors miss the that seems to have been translated issue of the London Review of Books. herd of elephants with their howitzers. unchanged into PF2. Casual question, The novelist Jenni Diski is dying Clare Gerada: “We’ve got to be careful then, by how much would the bed- of lung cancer superimposed on that it’s the patient’s pulse we’re feeling, base be reduced? 10%, 20%? They longstanding pulmonary fibrosis, not the patient’s purse”. were coyly ignorant of all these and is writing a series of articles. She Clare, unusually, seems to have been matters. has been introduced to the hospice. misquoted: we’re ignoring the bulging The Midland Met website has a She felt that she would benefit from purses of some commissioners. Sarah jaunty Q&A section, and the PFI a week’s respite in the hospice, but Wollaston MP, a GP new chair of the question is handled with consummate because of her severe depressive health select committee, and someone mendacity, using exactly the state would have preferred a room who should know better, still seems to arguments DFNHS members have to herself. Promises to fulfil both think that world-class commissioning been hearing for nearly 20 years: these requests were twice given (remember that?) is intrinsically right her, but when she pitched up there and even more strangely, good for “Q. The new hospital will be built was no single room, and she was patients. A little financial irregularity is under PFI – should I be worried? reminded that the hospice doesn’t a price well worth paying for world- do respite. They couldn’t even class care: “The trouble is if you have a A. No. The new hospital will guarantee that she would have a blanket ban on CCGs commissioning be built under Private Finance single room when it came to her from organisations where GPs have an 2. Crucially that means that final admission. interest then you might lose something key services like portering and No clinical negligence, no lack of that gives patients the best care.” cleaning will remain within the communication, nothing that would NHS. The financial model for the register with the CQC. Just non- Four events that I didn’t seek out: new build has been assessed by decent care that is increasingly at commissioning to palliative care, PFI to the trust, the Treasury and the variance with the sloganizing mantras rotting “human resources”. All different Department of Health, as well as of holistic care, mission statements, Rorschach blots. The pendulums have other NHS bodies. It is affordable, and repeated and empty promises swung a long way from unconflicted and the cost proportionate to the to keep the customers happy and care. turnover of the hospital trust is scoring us highly on the Friends and far lower than some PFI schemes Family Test. Many, but sadly not all from the early part of the century. of us, have honourable intentions of David Leavy Of course, new facilities cost. keeping those promises. Editor The existing hospital facilities are [email protected] Page 2 Page 3 General Practice: On the Brink? Things are not good in general the funding clearly will have dramatic Workload has rocketed with many practice at the moment. Over effects on the service offered. GPs working 13-14 hour days and recent years we have seen year- Those of us working every day in our dealing with upwards of 60-70 patients on-year systematic reductions in surgeries see the effects of this. GPs a day. This is neither safe nor desirable overall funding to general practice.