Local politicians are obstacle to better health care – troubleshooter Robinson

Why has more attention not been given to a great expose of the NI health service shown on BBCNI last week? I’ve just been watching the programme on BBC iPlayer that’s taught me a lot about the strengths and weaknesses about how Northern Ireland is run today. Multimillionaire Raphoe resident and NHS troubleshooter Sir Gerry Robinson has homed in on the new Belfast Health Trust, employer of 22,000 with an annual budget of over £1 billion a year and  the UK’s biggest. He came to conclusions even more critical than reported in the accompanying BBC website news story, viz:

  • Politicians treating the Royal, City and Mater hospitals as personal fiefdoms were standing in the way of the Trust from planning effectively; all three operated wastefully as general hospitals when they should be specialising  as ” more logical operating units”.

 

  • Target setting by Michael McGimpsey and the Health Department were sometimes evasion strategies for proper planning, were rushed in too quickly and were oppressing staff.

 This super manager was firmly on the side of the staff. Disarmingly frank at times : “Sounds like waffle ” he murmured at one hapless manager. ” You need to ease back on the sense of punishment and set about a feeling of achieving together.. The management has been heavy handed”

A brave management witness spelt out the problems caused by the politicians. “With a fresh sheet would you really have 5 A&Es in a 15 mile radius? Bear in mind that there are local politicians associated with each of them. Our minister says we won’t be doing anything with the City. Then there’s the Mater and the Royal is the trauma centre..

Big achievements were indeed credited.

  • Waiting times had dropped form 13 hours to 4 hours by March last year for 95% of patents.
  • Ambulance picked-up 66% of patients within 8 minutes but missed the 70% target.
  • They had 600 patients waiting on trolleys a year ago and now there are none.
  • 5 year waits for cardiac and six for hip operations had gone down to 34 weeks from first seen to treatment or discharge.
  • The star area is orthopaedics at Musgrave Park, the UK’s best treatment centre, dealing with 1500 procedures a year compared to 200 p.a.  UK average, by developing their specialisation to a very high level.

But where does  patient care figure in all these stats? Quite prominently I reckon, although the clinicians and managers are worried that patient satisfaction isn’t being monitored properly.  The service needs to concentrate more on outcomes, said one manager who could be forgiven the terrible jargon that infects the whole system.

And if they don’t reform? Andrew McCormick the permanent sec admitted that ” on the demographics, we’ll have a serious financial problem if we don’t secure good health prevention.”

And good political prevention too Andrew?

 Do watch Life Matters before they drop it.

  • Pete Baker

    The drops in waiting times came about as a result of significant, targeted, expenditure. Contested expenditure it should be noted.

    That is no longer available.

    I’d expect those waiting time to rise again accordingly. But it’s already been pocketed by the NIO ministers involved.

    And on the A&E provision.

    “With a fresh sheet would you really have 5 A&Es in a 15 mile radius?”

    No. But look west of the Bann…

  • fitzjameshorse1745

    “Local politicians are obstacle to better health care”
    He would say that wouldnt he?
    Thats what people say about our local politicians…who have rather inconveniently for their detractors been elected.

    But for years BBC Health Correspondents in Norn Iron (formerly Dot Kirby and currently Marie Louise Connolly) have been running well sourced “exposes” on the quality of health care in Norn Iron.
    Frankly it did not take an outsider to point up what we already know.

    I dunno how many contributors and watchers that Slugger has in Norn Iron…..50…100……200?
    But Id hazard a small wager that some actually wrk for the Health Service.
    If not, Im sure they have family members and/or friends who work for the Health Service.
    And we have all certainly had dealings with the Health Service.
    So when is an expose NOT an expose?
    When we already know.

  • Cynic

    I think Gerry missed a point. Its not just local political considerations – its local SECTARIAN political considerations

  • Framer

    Exceptionally well made programme particularly in the direction and camera work which held your attention visually.

  • fitzjameshorse1745

    The Conclusion….that local politicians are wasteful backwoodsmen lacking the sophistication of dazzling London urbanites like ……er David Laws is of course the conclusion that the Great and the Good at the BBC want.

    But theres another story. The wasteful nonsense of our local Beeb importing any London “face” to show us how things can be done.
    Robinson follows a long and undistinguished line of London C list celebs imported at what cost exactly
    Laurence Llewellyn Bowen and his wife….some show about Norn Irons best house? And Gary Lineker and his wife imported to taste our hospitality. More suited to the Ulster Tatler that a Beeb feature. What lunacy was this except to show that our local BBC has such an acute inferiority complex (as a result of its acute inferiority probably) that it needs a network face to make it look good.
    Presumably Robinson, Llewelyn Bowen and Lineker only got these gigs in Belfast as Alan Partridge was doing something similar in Norwich.
    BBC IPlayer does indeed hold a lot of home truths about Ormeau Avenue. The Blame Game……try that ……where four local “comedians” fawn over a C-list name from the English Comedy circuit (Reginald D Hunter, John bishop, Lucy Porter etc) as they tell us that “I just dont get your politics and you all talk funny”.
    Brilliant Stuff.
    Gin and Tonics all round in the BBC.

  • SDLP Man

    Programmes featuring Robinson are always watchable. However, I have two reservations about him, not bearing directly on the programme.

    1. He is very “anti-politics” and anti politician. The truth is that if it was not for political will and principally the actions of one poitician, namely Aneurin Bevan, there never would have been a National Health Service. That said, it is daft to have four A&E departments within a 15 miles radius. McGimpsey moved to protect the City Hospital (own constituency), Mater casualty is superfluous and listening to some of the trades union people I sometimes get the feeling they see that RVH as some sort of job creation scheme. The uncomfortable truth for everyone here is that productivity in the NHS here, at all levels, is 15% lower than across the water (Appleby Report).
    2. I went off Robinson last year when he came out against the idea of a Minimum Wage. The idea of a multi-millionaire being against the MW makes me puke.

  • fitzjameshorse1745

    SDLP Man,
    But surely his “anti-politics” stance goes down well with our local BBC where for example the Mark Carruthers led Questions and Answers thing is really nothing more than an exercise in holdiing our politicians to ridicule.
    Likewise the cynical Blame Game……laugh I thought Id never start..second rate Have I Got News For You format.

    As ive said…..nobody elects Mark Carruthers. Or Tim McGarry.
    And of course our fearless local Journalists are anti-politician.
    The sheer nerve of the local Beeb bringing over an English millionaire to pontificate on waste of money is breath-taking.
    I dont suppose theres any chance of them putting on a programme about BBC waste.
    I guess not.

  • Droagh

    I work in the health service and have observed ministers and managers mess it up for 30 years. McGimpsey thinks that sitting in Stormont issuing edicts will work – it won’t. The service is overpopulated with managers who wouldn’t survive a week in private industry whose main job is to talk the goobledegook we heard on TV. Number one rule, make no decisions and call as many meetings as possible and appoint a new tier of management.

    NI probably needs 3 – 4 high tech acute hospitals with supporting local community hospitals. 90% of care – outpatients, x-ray, physio and rehabilitation could be provided locally and when you are really ill, you end up in an adequately staffed and equipped acute hospital.

    We also have the legacy of hospitals built in the wrong place. Because Antrim Hospital was not built in Ballymena, we have a hospital in Coleraine that has not got the catchment population to ensure a long term future. The new hospital in Enniskillen is being built in the wrong place – based on being a Western Board hospital even though the Western Board was about to be abolished.

    We need politicians who have the courage to rationalise our hospitals and save the duplication of services and the money wasted on the fixed costs of too many units. We need politicians to set sensible strategy and we need managers of ability to manage the service.

    In other words – we’re doomed.

  • Cynic

    ” 3 – 4 high tech acute hospitals ”

    Or perhaps one or two. The massage that needs to get across is that this is a small place. In acute care the option is that:

    1 your granny goes to a local hospital which is easy for the family to get to but there’s a higher chance she will die or

    2 she goes to a Regional Centre of excellence that gives her the best care and highest chance of survival

    Live Granny vs Dead Granny

  • Brian Walker

    The interesting question which the programme didn’t probe is how exactly politicians exercise influence and why Trusts put up with it. Even if you are the Health Minister – and McNarrry is not alone – under what authority do you prevent a department or Trust taking action? It must be an unholy alliance among all sides. You keep my A&E open and I’ll keep yours. Baibre de Brun denied she was behaving poltically when the Regional maternity unit was based at the Royal and the Jubileee in the City was closed. I’ve no idea if the accusation was fair or not.

    Of course it can happen in England too.
    http://www.guardian.co.uk/uk/2010/may/26/nhs-london-richard-sykes-resigns

    “Sir Richard Sykes, chairman of NHS London since 2008, is said to be furious at the scrapping by the health secretary, Andrew Lansley, of the review of healthcare in the capital. The review included possible A&E closures and the possible closure of some maternity units.”

    Hospitals are always a poltical minefield.Officials, clinicians and board members always have the power of publicity – maybe used cannily in this film? – and resignation as a last resort. Clsures are inevitable and desirable to improve health care, not just in response to cuts, is a tough message to get across. But someone has to start doing it..

  • Droagh

    Aneurin Bevan apparently said (saw it in the Science Museum in London) “I would rather be treated in an efficient large hospital and survive than treated lovingly in a local hospital and die” or words to that effect.

  • fitzjameshorse1745

    Im not actually sure that repeating an accusation against a politician that you have no idea is fair or not ..is itself fair.
    But certainly theres an element of “in my back yard please” or “not in my back yard please” in all politics.
    Ms de Brun was a MLA for West Belfast and the suggestion that as Health Minister she leaned towards her own constituency would be serious if true.
    Best I think to assume that its not true.
    Aside from a MLA, MP or TD being a Minister….
    As in County Roscommon or Wyre Forest, people might reasonably expect their representatives (although clearly not delegates) to fight for local jobs and interests …including Hospital Services.
    Whether or not a decision is finacially justified we would expect public representatives to suffer if it impacts negatively.
    Reasonable enough I think for (say) Barry McElduff or Tom Buchanan to argue for Omagh hospital. Reasonable enough for Michelle Gildernew or Arlene Foster to champion Erne Hospital.
    Any A&E closure WILL cost lives.
    How many deaths have happened on the Belfast-Newry Road since Banbridge Hospital ceased…..the journey to Lagan Valley or Daisy Hill might be five minutes too long.
    More so if and when Lagan Valley downgrades.

    Its that simple.
    Jobs yes.
    Lives yes.

  • Cynic

    Well the High Court judge who upheld the initial JR against her certainly took a view on it. As I recall he said that after receiving an options paper with detailed analyses two feet thick, the Minister opted for the Royal Site before she could even have read the papers. That was why he overturned her initial decision and sent it back to her to do again.

  • Cynic

    “Any A&E closure WILL cost lives.”

    Nonsense. Having a number of sub-optimal A&Es costs lives. The data clearly shows it

  • ForkHandles

    Just watched it on iplayer. I agree with Framer, it was a well put together documentary and held my attention throughout. I think all the staff involved should get a “well done” for the success they have achieved.

    There did seem to be quite a lot of David Brent style management speak at those round table meetings though. Perhaps we were seeing the layers of excess management that we know exists in NI. As far as I could see all they were discussing was setting targets. Does this really need that many people?

    Im one of those people that thinks politicians are the wrong type of people for the jobs they are doing. Its basically administration and running a service as best as possible, health, education etc. What do any of the MLAs bring to the jobs they have? What experience and skills do they have for running the department they have got? Having said that, the improvements in the NHS have happened under a local MLA Michael McGimpsey so some credit should go to him I suppose. But I would like to know what all the top level of management have actually done apart from set targets?
    In my own job I know that it is the people in the middle that actually come up with the good ideas. People with hands on experience that have a practical effect ‘at the coal face’. Higher management tend to talk a lot of ballicks and then turn to people below them to translate their ballicks into something practical.

  • fitzjameshorse1745

    Then why not close ALL hospitals so that we can all live forever.

  • kevin talor

    We need to look furhtur afield before we play the blame game
    one oint eight million people in N.I the Royal Collages(set standerd for training ) say a population base off 500.000 to have a full acute hospital allowing the cliniciands to keep a high standerd off quality care
    taken to a logical conclusion that would mean one hospital in Belfast Certintly none in Antrim nor Craigavon and we lose two area hospitals A&E can be kept open by five dr two at consultant level and three trainess overseen by on call consultant and everyone is happy
    However Royal Collages then decide to remove training accredation from small rural hospital So trust has option off employing five consultants whom are unwilling to work in small rural hospital So locumn whom are well aware off the supply and demand situation and that demand far outstrips supply can then charge trust anything they like per day and you see the trust then goes into deficit
    Finally how do we solve the problemn Ask the royal Collages for a special dispensation to reduce the training numbers and allow traing to be part and arcel off eve hospital small rural and alrge city teaching units
    I have all the evidence and am still waiting fro the MId Ulster Campaingers to get in touch

  • kevin talor

    Well said let local people decide what they want and work with the trusts Foundation hospitals are the ideal model to bring in here as everybody gets a say

  • kevin

    I can spell but my keyboard is done

  • kevin

    Can you imagine the fire service or police service run along the same lines as our hospital system Where the Royal Collage off police or fire continue to close down small rural police stations or fire stations due to lack off fires or criminal activity
    It is the royal collages and them alone whom close the smaller rural units by have completly ludicrousely high training numbers Thought i do agree with the poster that for a population off less than 2 million we do not need as many hospitals i pose this question off the six area hospitals in N.I why do four have to be in Belfast ? Answers please