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 West Dorset / Comment/ NHS, And Clinical Commissioning Groups.
 
This is part of a article I put online back in March of 2015 while my Wife bless her had been waiting for treatment for breast cancer, it was only as a result of that I started to take along hard look at our NHS which I have the most respect for saying that, the people I respect the most are the front line staff, the ones who truly look after us, who are underpaid and it seems undervalued by our government who in my mind are doing nothing but abusing there outstanding work and good will for which the Government should hang there heads in shame.
 
NHS, And Clinical Commissioning Groups.
 

Do you know what a Clinical Commissioning Group is or what they supposedly do on your behalf? I doubt many do. There was, in fact a huge debate over them and many thought it was not a good idea at all. We all have to rely on them now for a majority of our health care this at a time when news reports seem to suggest that the NHS is near on the verge of total melt down.

 

The responsibility of any Clinical Commissioning Group  is in fact to purchase health services on behalf of the public. Knowing that they have to purchase such services, will the cost of the health services go up as a direct result and we will get the same services we have had in the past? Do you trust them to purchase you the best health care available?

 

In Cornwall, only last week in a survey took place to gather the opinions of internal staff. The results certainly make for unpleasant reading among bosses at the Royal Cornwall Hospital Trust which runs the hospital at Truro, its main base, as well as St Michael's in Hayle and West Cornwall Hospital in Penzance. In terms of overall staff engagement, the trust is rated as the worst in the country by the people who work there. 

 

So where do the NHS Dorset Clinical Commissioning Group stand in all this? They state the following:

 

 "Using our clinical understanding, we strive to lead continuous improvements to health and care services in Dorset."

 

On the face of it, this sounds ok but what it means is that NHS Dorset Clinical Commissioning Group is responsible for outpatient, inpatient and urgent care received by patients in their local hospitals here in Dorset and other Hospitals. So if your living in Dorset or even visiting Dorset your health care is now there responsibility? As for the "Using our clinical understanding, we strive to lead continuous improvements to health and care services in Dorset." with all the cuts to come in our public services I have doubts, many in fact.

NHS Dorset Clinical Commissioning Group also have a Mission statement, a Aims statement and a Value statement, it's seems the way to go nowadays, if you wish you can read them all here 

  

So, are the Clinical Commissioning Groups just another layer of bureaucracy within our NHS system that is already astonishingly complex with layer upon layer, upon layer of bureaucracy within it? Let us take into account that bureaucracies have been criticized as being far too complex, inefficient and inflexible, not counting the dehumanizing effects that excessive bureaucracy can have on us as all as individuals.

 

We all know what it is like to be treated more like a number than a human being by someone at some stage. Well, you’re not alone.

 

Scandals within the NHS again have resulted in a huge number of deaths, poor care and mistreatment. Due to its bureaucracy it has taken years in most cases to get to the bottom of the problems and the reasons why. In a huge number of cases both patients and their relatives concerns have been totally ignored (this is not counting the numbers of patients and their relatives who have not been able to cope with the pain and distress of trying to address such issues) no surprise then that many people give up in such cases. 

 

Just today, the 6th of March 2015, in our national newspapers there is a story about the problems at Furness General Hospital, Cumbria, England which resulted in the deaths of eleven babies and one mother over a five year period; yes, over five year period. Why did this continue for so long? Why did it take twelve deaths to realise there was a problem? Watching and listening to the news, one of the young mothers who had lost her child gave a short statement, she said with tears in her eyes  "Yes, we hope lessons have been learnt. Yet no one has been held accountable, have they?"

 

As always and point in case at Furness General Hospital, no one is held accountable. It seems the hierarchy within such huge organizations including the NHS are totally untouchable and run them as they see fit regardless.

 

One of the great things about bureaucracy is that it creates employment, most of it from what I can see at the top end of whatever organisation it’s in. The NHS for instance has near on 45,000 mangers working with it. Yes near on 45,000 mangers working with it.

 

You have managers managing the managers of the managers. There are Groups, Boards, Committees, Teams, Members, Executives, Directors, Chiefs - the list of titles that run and administer the NHS is near on endless, a number I never even heard of in fact.

 

In my view the “hierarchy” ensure that this system remains in place, so are they just writing out their own meal ticket at the expense of patients? The more I look at it, the more it seems like it to me.

 

My view of running any business or any organization is that it's kept as simple as possible, simple works. However, we are told again by our the called “hierarchy” within the NHS that this is not possible - I don't believe that.

 

An example of the failure of bureaucracy, complacency and greed is Tesco. They were and have been the most successful supermarket in the UK for as long as I can remember. So what did Tesco do? They changed their basic business strategy by expanding into larger and larger supermarkets and then continued into smaller local supermarkets. They proceeded with other services such as banking, insurance, even an expansion outside the UK to the USA. As a result they were unable to deal with the bureaucracy of it, or the costs, which ended up killing what was once there huge profits.

 

Apparently, now Tesco are going back to basics, lesson learnt it seems! Another lesson that the “hierarchy” will be not be held accountable for. In this case the first thing Tesco did as a result of "going back to basics" was to also announce their intentions of withdrawing the company pension scheme for its workers.

 

The costs to run such a bureaucracy like the NHS is totally incredible and ludicrous to the extreme of billions of pounds per week in fact. It is even more ludicrous considering that if you become seriously ill or even near death, currently you stand as much chance of dying in a car park at A & E or on a trolley in a passage way; like it or not it's the truth.

 

So back to our Clinical Commissioning Group, the costs financially of setting up the DCCG I have have not a clue, but no doubt it was not cheap. In fact if you enter the following text into an online search engine "Clinical Commissioning Group jobs" you will see a number of vacancies for people who are being offered salaries in the order of between on average £300 to £600 or more per day, yes I said per day. With yearly salaries starting at around £100,000pa. It is estimated that the cost of the tax payer to setup the so called Clinical Commissioning Groups in England was billions. Think of that while if you’re on a waiting list for an operation.

 

Furthermore, the National Audit Office catalogued a series of failures in managing the transition to the new NHS structure, including a lack of staffing and uncertainty around CCG budgets and has also expressed doubt whether the CCGs will be able to make necessary efficiency savings.

 

The independent Watchdog’s report “Managing the transition to the reformed health system” of June 2013, found that NHS England had failed to fill more than one in ten positions by 1st April 2013 when it took charge of overseeing the health system in England.

 

This was, despite the NHS having made just over ten thousand full-time equivalent staff redundant, at a total estimated cost of £435,000,000 in the three years leading up to 31st March 2013.

 

The Department of Health estimates over two thousand of the redundant staff were then re-employed by the NHS, with the NHS only able to reclaim redundancy payments if a member of staff had re-joined within four weeks of redundancy.

 

To give you an example of what that means a large number of board level managers were made redundant and then given on average of £277,273 redundancy pay; this is over a quarter of a million pounds to you and I. So after spending four weeks laying on a sun lounger on some exotic beach (I presume), they came back to work in the NHS receiving an even higher salary than they had previously. Further details on this can be found here

 

In fact only a couple of weeks ago the evaluation by the King's Fund think tank says the coalition government's changes had wasted three years, failed patients, caused financial distress and left a strategic vacuum. Chris Ham, chief executive of the King's Fund: "If the government hadn't pursued misguided reforms... we believe the NHS would be in better shape"

 

The aim was to shift the balance of power in the NHS to give GPs more say over the way budgets were spent. It provoked uproar in sections of the medical profession, in part over the role of potential privatisation of some services.

 

King's Fund chief executive Chris Ham stated: "People in the NHS focused on rearranging the deckchairs rather than the core business of improving patient care. "That's contributed to the increasing waiting times and declining performance that patients are experiencing, including growing problems in trying to treat patients in A&E or those waiting for cancer care or a planned operation within set targets"

 

They also stated the structure of the NHS so “complex, confusing and bureaucratic” that the organisation of the service “is not fit for purpose” (I can agree with that all day long)

 

Dr Mark Porter, head of the British Medical Association (BMA) said the changes were "opposed by patients, the public and NHS staff, but politicians pushed through the changes regardless".

 

He added: "This report highlights the damage that has been done to the health service and the major shortcomings of the Act, which distracted attention from rising pressure on services and cost billions to introduce.

 

"The damage done to the NHS has been profound and intense, but what is needed now is an honest and frank debate over how we can put right what has gone wrong without the need for another unnecessary and costly top-down reorganisation."

 

Returning once again to the Dorset Clinical Commissioning Group, are your now thinking “Oh no, not another load of people on six figure salaries attending meetings and whatever” considering you are still going to see the same Doctor in the same surgery and if you wind up in hospital you are still going to end up in the same hospital bed. So what's in it for you then, you may ask? It was a question many asked, the answer is not a lot in my mind.

 

No doubt your next question is going to be “How on earth did I end up getting involved with a Clinical Commissioning Group?” The fact is, I made a simple complaint to them concerning one of the hospitals with whom they have a contract with.

 

The complaint was, in my view, quite a simple complaint concerning how long my wife had been waiting for treatment of her breast cancer. The results upon contacting the Clinical Commissioning Group resulted in a number of emails and phone calls back and forth, which carried on with a number of individuals over a number of weeks. The end result of these communications is below:

 

Just to clarify, I have not opened your enquiry as a complaint as I believe we have been discussing the issues in general/in principle at this stage. I have offered to do some research for you in relation to the hospitals performance.  If I have misunderstood this situation, please let me know. (This Is up there with Bill Clintons "I did not have sexual relations with that woman." comment)

 

As part of my offer to research the population performance information (I had no such offer, it is a complete lie. I don't even know what the so called “population performance information” is, no doubt it's more bureaucracy, do we really need all this, do we? you tell me?) that we monitor, I spoke with one of our analysts. We monitor the national performance indicators – eg. % of service users waiting no more than one month from diagnosis to first definitive treatment for all cancers; % of service users waiting no more than 62 days from referral from an NHS screening service to first definitive treatment for all cancers; % of service users waiting no more than 31 days for subsequent treatment where the treatment is a course of radiotherapy.

 

I wanted to look to see if some of the issues you have reported have been repeated across the population. From the information that we reviewed, currently the performance overall is compliant. There have been minimal breaches of the national standards (Standards are there for a reason, any breach no matter how large or small is of concern that's why they are put in place) but please be aware that the % targets vary according to the target – some are 85% compliance, others are higher. We looked at each standard during the time that your wife would have been experiencing care and found that in the majority of cases the targets were met (Not all cases but in a “majority of cases” I asked in writing what targets were not met? I had no reply what so ever? they do as they please?) As a consequence of this, I do not plan to investigate further.

 

 (Investigate? Yet they stated they were doing some research? it seems to me they don't have a clue as to what they are doing? and being paid an awful lot of money for it)

 

What the hell this has that to do with my Wife who was waiting for month after month after month for treatment of her breast cancer,  you tell me? You don't treat women with breast cancer like this!

 

So to conclude, does this sound like a good deal to you? As for Clinical Commissioning Groups, while no doubt they are all enjoying the fruits of their so called labour, the rest of us will just have to suffer as a result it seems even if it means some people may lose there life as a result - nothing new here then.

 

I wonder what would happen with in the NHS if we got rid of all these so called people and put the money into front line staff (And paid them more) the ones who diagnose our illnesses and treat us and look after us ? I wonder what would happen if we got rid of the bureaucracy and got rid of the bureaucrats? No doubt it would improve waiting and treatment times that's for sure, in fact waiting times could even become a thing of the past?

 
6th March 2018  In the BBC news today: Dorset Clinical Commissioning Group (CCG) proposed changes, including the closure of Poole's A&E, and other changes through out Dorset that no doubt will in the long term effect everyone of us, the pressure group Defend Dorset NHS applied for a judicial review and has been granted a full hearing. See the story here and here and here. Please support the  Defend Dorset NHS group.
 
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