Scrutiny is no more than whistling in the wind


Nearly every other day now, councillors are being told that they are, ‘key to driving forward the innovations needed to transform local government, so that it can weather the current financial storm being visited upon it by Westminster’.
Along with this often junior government minister uttered blurb, which is actually code for we’re passing the buck – they wouldn’t describe it as a ‘financial storm’, but rather, local government doing its bit – comes advice that the scrutiny process is an integral element in any transformation strategy.
It’s somewhat disingenuous to identify scrutiny as the way forward, given the abysmal record it has even when richly resourced and supported, as in the case of the Parliamentary scrutiny system.
Almost every other week we hear and read statements from various Parliamentary committees, with Keith Vaz and Margaret Hodge having a seemingly insatiable appetite for appearing on our TV screens, with the opening words, “The government needs to….”, yet what difference does it make to what the government actually does?
Translate this to the amateur, volunteer ‘scout master’ world of the local government councillor, where officer support is always at a premium and constantly under threat from the slash and burn economics of deficit reduction, and scrutiny looks more like whistling in the wind, than an insightful process, that can beat a path to innovative service delivery.

By way of a footnote, I would point to the recent revelations regarding the Lincolnshire Hospitals Trust. Lincolnshire County Council has a health scrutiny committee, with South Holland District Council represented by an independent councillor, who takes every opportunity to tell us what the committee is, or more accurately, isn’t doing. I say isn’t doing, because, in theory, if LCC’s scrutiny of our local hospitals was in any way effective, Lincolnshire hospitals wouldn’t have one of the highest abnormal death rates in England would it? Unfortunately, they seem to have gotten themselves completely hung up on the proposed changes to our local ambulance service instead.

Local Government and Public Health

Some of my councillor colleagues told me that they weren’t interested in attending yesterday’s workshop on public health, because ‘it was a county council problem’. The county council are the ones with all the resources and have been involved with public health for the last few years, but that doesn’t mean districts will be able to leave them to it – the game has changed it seems.

The first speaker at Tuesday’s event was from the Strategic Health Authority. According to the programme, after this presentation, ‘Members will better understand the government objectives through the health reform policy…’. Well, I must of missed the bit where that became clear. I now now know how my fellow councillors feel, when I’m trying to explain the technicalities of our planning policy!

What I did understand, was that the current system is fiendishly complicated. It has lots of people with wonderful job titles like, Clinical Commissioning Group Chairman and enough acronyms to fill a a decent sized book. Some of these acronyms describe the various boards, panels, groups, herds, gaggles and flocks, these people attend to wring their hands over issues such as, how fat we are all becoming.

Britain used to be the sick man of Europe, now, apparently, we are the obese man of Europe. Well if the footballers and tennis players can’t do it, at least us fatties are stepping up to the mark to claim first place in something.

The new system, that local government will be wrestling with, appears to be as equally fiendish in its complexity and bewildering terminology. The only difference will be, that instead of the NHS being the ones getting the blame for us all eating, drinking and smoking too much, it will be local government.

A spokeswoman from the Local Government Association then gave us a presentation, promoting the opportunities the new responsibilities will offer local government – opportunites? She told the audience, that local government was extremely keen to take on these new responsibilities, offering confirmation by telling us that, ‘no council had said no thanks, we’ve already got too much on our plates’. Cynic that I am, I suggested that saying no, at a time when local government was being subjected to a form of genocide by central government, would be like turkeys voting for Christmas.

Of course unitary and upper tier (county) councils would say yes please, we can do that. It will help them justify their continued existence. It also gives them a further opportunity to claim that they are essential, whilst district councils are an unneccesary expense that should be scrapped. Maybe they’re right, time will tell and that time could be sooner than many of us think.

Myth that Britain cannot ban EU doctors, says commisioner

From an item in today’s Daily Telegraph, it would appear that somebody has, at last, called the bluff of those who love to trot out EU rules as being to blame for their own failings. The EU is big enough pain in the backside to us, without making things up.

“Britain is free to ban foreign doctors from working in this country if they do not speak adequate English or there are concerns over their medical ability, an EU Commissioner insists today.
It is a myth, he says, that Brussels rules are putting Britons at risk and the authorities in this country should be scrutinising potential employees to ensure they are suitable to work in the NHS.”

A small victory for the pedestrians

Almost 12 months ago now, I wrote to Boston’s Pilgrim Hospital management, raising my concerns regarding pedestrian safety.  As often happens with these large faceless organisations, I received no response.  Never deterred by stonewalling I wrote again, just in case the first letter didn’t get there, however this time I hand delivered it.  Yet again, no response, so then I wrote to the hospital trust HQ in Lincoln.  This time, albeit after a period of some 8 months, I received a letter stating that, having consider my points, they would indeed be taking steps to improve the situation.

Although it may sound like it, I’m not actually out to blow my own trumpet, but simply to point out that it sometimes takes more than one go to get an answer, let alone to get something fixed.  If at first you don’t succeed and all that.

What was I complaining about?  Next time you go to the Pilgrim Hospital and park in the main car park, take note of the bit where you have to cross the road to get to the main entrance.  Assuming the new signage hasn’t been installed, take note of the care, or more accurately, lack of it, taken by some drivers as you attempt to walk across the raised road section between the car park and the approach to the hospital’s main entrance.

About 2 years ago it was necessary for us to visit the hospital every week for nearly 6 months, so we became very familiar with the selfish attitude of some drivers when using this piece of road.  The raised road surface and some signs, were supposed to alert drivers to pedestrians crossing and that they (the drivers) should therefore give them priority – this was often not the case.  Having witnessed at least two near misses, one involving my wife, I decided enough was enough, hence my letters to the hospital management.

Although I didn’t get the type of signs I wanted, ‘STOP – Give way to pedestrians at all times’, I did convince them to change the existing signs for something more prominent.  A red square with white lettering.  I just hope it doesn’t take them another 12 months to put them in place!

Health reforms – quality measurement?

As a recent cancer suffer myself, I’ve been listening to the Health Secretary Andrew Lansley on Radio 4 this week, with great interest.  Unfortunately, I’m a hopeless patient and consistently fail to remember most of the details regarding my treatment, so I make no claim to any expertise on the subject of the NHS, apart from the fact that they appear to have helped me to live a bit longer!

The reason for my self confessed poorly informed comment today, is to do with Mr Lansley’s repeated use of the words ‘quality’ and ‘outcomes’.  This is in relation to the scrapping of the previous government’s target driven performance indicators and the new government’s belief that it should be all about the two words previous mentioned – quality and outcomes.

The problem I have with this approach, as somebody who has more than a passing interest in both, is what happens when they don’t hit these targets?  Also, what does it actually mean when the targets are not met?  The merit of measuring the numbers of patients seen within a particular time frame, was that the patient was seen by an expert within a certain deadline (unfortunate inclusion of the word dead there!) and could then hopefully start treatment post haste if required.  However, now that we are going to measure ‘quality’ and ‘outcomes’, it would seem that we are going from one end of the telescope to the other.   Whereas before the target was hit by getting you to see the right doctor as quickly as possible, that no longer matters.  Now you will have to survive long enough to get to the doctor, before they start to measure the quality and outcome of your treatment.

If you don’t measure things until the end of the process, as opposed to at the beginning, does that mean that if you drop off the perch before you actually get in to the new health care system, it isn’t actually a quality failure?  And, from their point of view at least, it might not even be a bad outcome!

If I have a quality failure at work, somebody gets their a**e kicked and the job gets redone.  If I have a quality failure in my health care, it may well kill me, or at least cause me to die sooner than I might of.  Which then of course will indeed give Mr Lansley a poor outcome to measure.

As I said, I’m no expert in these things, but measuring quality and outcomes in health care, in the same way you inspect widgets in a factory, doesn’t seem like a step in the right direction to me!  Trouble is, if I’m right (and I am very occasionally) I probably won’t be around to say I told you so!