Wednesday, April 3, 2013

News: James gives stark warning to NHS


As major government reforms of the NHS come into force, Brian James, the former chief executive of the Rotherham NHS Foundation Trust, has warned that smaller hospitals like Rotherham will be considered non-viable and forced into bankruptcy if payments are put before patients.

The Health and Social Care Act 2012 puts commissioning groups of local GPs and other clinicians in charge of budgets and tasks them to plan and buy most of the health care for the people in their area.

Interviewed for a new report by health think tank, the Nuffield Trust, Brian James said that he was not optimistic about the reforms. He said: "There has been, and there still is, huge uncertainty and lack of clarity about the new system on a scale that I've never seen in my 37 years in the service. There are still many people out there who don't know what, if anything, they will be doing a month from now. It's chaos, really."

James retired from Rotherham NHS Foundation Trust in November 2012 after overseeing a time of transformational change from 2004.

In February, the Trust was formally notified by Monitor, the independent regulator for Foundation Trusts, that they found the Trust to be in significant breach of the terms of its authorisation, due to the failure to address certain financial problems promptly and effectively. The trust has brought in the specialist healthcare management firm, Bolt Partners LLP, to lead the recovery and restructure.

According to James, the hospital will effectively need to operate on £50m less than they had two years ago.

In the interview, James says that being an NHS chief executive is the "most satisfying job that you could ever aspire to" but admitted that he sometimes found it lonely and often found it frustrating.

He discussed major achievements such as eliminating waiting and "pretty much" eradicating MRSA as an issue. The hospital went for three years without a single case.

The frustrations came from the constant government reforms and reorganisation and the inability to be innovative. He also admitted that it would have been better to wait than to plan ahead and discuss the fact that the Trust would need to operate with 750 fewer posts in 2015.

He said that the issue was "hijacked" by the union and the local press but in the end a national agreement was reached about changes to the terms and conditions with the majority of losses expected to be manageable through natural turnover.

Looking to the future for an NHS led by the markets, James is worried that small and medium sized hospitals will be put at risk by the reforms: "I am not a believer in them. I think they have done a lot of damage." he added. "And I worry about where they are leading us. Payment by results and all of that is taking us to a point where small and medium hospitals will be seen as non-viable.

"They will be bankrupted by the market and more and more will be pulled into the big teaching hospitals. But for people in Rotherham or Doncaster, that will mean Sheffield and that is going to mean a huge amount of travelling for poor people – and Rotherham is full of poor people – who will need to get three buses and a taxi to go and see their loved ones in hospital.

"I think it is very questionable where it is all leading us."

Nuffield Trust website
Rotherham NHS Foundation Trust website



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