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www.amicustheunion.org | November 2005 | AMICUS HEALTH WORLD

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Taking the NHS to new heights?

What are the government's plans for health and how will they affect those who work in the NHS? Charlotte Waterworth asks the Secretary of State for Health, Patricia Hewitt, about her new vision of the health service

We need to make sure we don't fragment services, since the goal is to integrate Body and soul CW: MRSA in hospitals is constantly in the headlines. Is this them a problem that will ever go away? better PH: Given the current position of medical and scientific

CW: The government is pressing ahead with a radical reform agenda, which means constant change for NHS staff. What do you believe this is doing for morale and how can it be addressed? PH: Change is always difficult, but it is essential otherwise we wouldnt be doing it.A lot of people have said to me, Just stop the changes and let us get on with our jobs. I sympathise with that but Im afraid we cant do it.Weve seen some really big improvements over the last five years but we have to go on because were still a long way from where we need to be. We need to keep making changes for better health and to get better value for money but its hard for staff.This is why we have put a lot of effort and money into Agenda for Change and into improving working lives to enable staff to have more opportunity to fulfil their potential.

knowledge, MRSA cannot be completely eliminated but there is no doubt that it can be very dramatically cut. Guys and St Thomass, which had one of the worst MRSA incidences three years ago, has halved MRSA rates in 12 months, so it can be done. Its about systematically screening incoming patients, taking scrupulous precautions on the wards, using alcoholic gel everywhere, making sure visitors play their part as well as the staff and trying to ensure there isnt any spread of the infection. All these measures work when they are put into effect, but we cant leave everything to the infection control teams. CW: Some of the most effective treatments, as recommended by the National Institute for Clinical Excellence (NICE), are not reaching a sizeable proportion of NHS patients because of poor financial management by hospital trusts. What is your response to this? PH: There is still poor financial management and inefficient ways of working in too many parts of the NHS. This is never

acceptable but its particularly unacceptable when there is more money going into the service than ever before. Weve made it clear to trusts that are in deficit that theyve got to get a grip on their finances. Trusts in deficit are putting in place deficit recovery plans and the reason for that is not because we are bean counters who are obsessed with finance, its because every pound that is wasted in unnecessary administration, for example, is a pound that cant be spent on essential patient treatment. It is very noticeable that the trusts that are the best in terms of their clinical quality are very often those that are also the best in their financial performance.
Theres a huge task CW: While healthcare ahead, of you course how so do think

way in implementing a new strategy called Caring for the Spirit, which will give us a chance to learn from a new approach to spiritual care, which takes into account the needs of different faiths and beliefs that are more suited to the modern world. The role that the chaplains and priests from other faiths play is very important. I was very struck when I went to the new west wing at Barts recently, where theyd set out to create an environment that was soothing to the spirit. It has been designed as a healing environment for breast cancer patients where the quality of the environment and people working there is healing to the spirit as well as to the body. CW: The Chairman of the BMAs Junior Doctors Committee has expressed concerns that increased competition in the NHS could jeopardise the quality of doctors training, saying that private companies who are running treatment centres will have no incentive to provide doctors with high quality training. How can it be assured that private companies

continues to enjoy technical progress we can retain and further the kind of I human will carry on and spiritual care that we know makes such a difference to the patients experience? PH: This is a really important question, particularly for patients who are nearing the end of life. South Yorkshire are leading the

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running treatment centres will provide the same standards of training for doctors and other health professionals as the NHS? PH: Weve been talking to the BMA about it because of course we need to use the independent treatment centres for training. That will now be a compulsory part of wave two of the independent sector treatment centres. CW: There are persistent rumours about privatising the blood product services and NHS Direct. How do you respond to this? PH: We are moving NHS Direct outside the Department of Health (DoH) so that it becomes a freestanding body. There is no question of privatisation the move is simply a change in its structure to give it a bit more independence as opposed to being buried within the DoH. As far as the blood product and transfusion services go, the DoH is looking at a whole variety of options because the current service not only provides to the NHS but also sells blood products on a commercial and international market, so theres an issue there around whether the present arrangement is giving the best value for money. Hence were looking at whether different arrangements will give us better value for money, and while a variety of possibilities are being looked into, no decisions have been made. CW: There have been suggestions that a new board will be set up under the auspices of Lord Carter, to deal with modernising pathology services. What will this add to the health service, and is this an example of outsourcing science to the private sector? PH: Lord Carter has been asked to advise on continuing improvements to pathology services and hell come back to us with his recommendations next spring. The view we take is that weve seen some real improvements in the NHS pathology services but we now want to speed up the rate of improvements. Again, everything comes back to better faster safer patient care.

absolutely not the case. However, I completely understand the anxiety that this is raising for staff who fear they wont know who their employer is going to be. Were looking at the whole issue in the context of the White Paper on community health and care services.We will listen to the views of the public, patients and users, but also the staff through their unions and professional organisations. We will set out the vision and direction we want to go in and the policy framework in the White Paper, but it will then be up to PCTs to take this development forward and where there are changes to be made, this will all be done in full consultation with staff and their unions. CW: How can you reassure community nurses and allied health professionals that the proposals wont lead to fragmentation of service delivery? PH: When I look at health and care services in local communities at the moment, there is a whole range of providers, so there are already some problems simply because of who is doing the employment. A GP was telling me the other day that nurses employed by the PCT to work in his surgery arent allowed to give vaccinations to patients he can only use the nurses he employs. Now that doesnt necessarily make sense. However, people are already co-operating across different organisations and theyre going to need to do even more of that in future to get the kind of integrated care that patients want. Of course we need to make sure that we dont fragment services, since the goal is actually to integrate them better. CW:What are the next steps following the publication of the White Paper at the end of the year? PH: At this point we are in the throes of engaging the public and partners, staff and other stakeholders through the Your Health, Your Care, Your Say initiative, which is a major public consultation exercise. Its the first time the government has done this on such a large scale and all of this listening to the public and putting different possibilities to them will then feed into the White Paper. CW: If the government goes through the process of commissioning a patient-led NHS and professionals in healthcare express strong objections or concerns, how will you address this? PH: It is quite interesting that Ive had a number of people say to me: Were really unhappy about this, but mind you in my town I always said it was complete nonsense to have two or three PCTs when really there should be one, but still I am really unhappy about this policy direction So the first thing well do is look at the proposals from the strategic health authorities (SHAs) and the PCTs, because we need to get them right. We need PCTs that are able to understand the needs of local populations and support GPs in the move to practice-based commissioning, as well as challenge and hold to account their acute hospitals so that you dont end up with all the patients and all the money being sucked into the big acute hospitals. Acute hospitals have always dominated healthcare and it is important that we counter that. We will make decisions on initial proposals very quickly and, where changes are proposed, these will go out to public consultation. Were doing the White Paper and well have that out by the end of the year and then well move forward on that. There is a great deal more for discussion.

Patient power and beyond

CW: Are you surprised by the strong reactions to the proposals regarding Commissioning a Patient-led NHS? PH: I was surprised although what became clear over the summer was that there were some misunderstandings about what we are proposing. I think people thought we were trying to dictate mergers of primary care trusts (PCTs) all over the country. Were not: were simply saying that with every move forward we make with the NHS, the PCTs need to be even stronger at commissioning services for their local population and they also need to support GPs in practice-based commissioning. There are undoubtedly several PCTs that will merge because they have been talking about it for quite some time but Im waiting to see the proposals from the health authorities concerned. Were doing that very fast the proposals will be in by the end of October and where theres a merger there will be a proper threemonth consultation. Another misunderstanding that arose was because we believe that where a PCT is really concentrating on its commissioning function, it will find it difficult to also be a good employer and provider of a very large number of services. This is why we said in Commissioning a Patient-led NHS that we would expect most PCTs to no longer be providers by the end of 2008. But some people clearly took that to mean that they had to decide what they were going to do by 15 October this year. This was

Amicus is organising a Parliamentary lobby to enable members in primary care, England, the opportunity to express their concerns about the proposals set out in Commissioning a Patient-led NHS. The lobby will be time to coincide with the publication of the new White Paper early January 2006.