Tuesday, 19 October 2010

Whats ailing Betsi?

The Welsh Florence
Nightingale is ill...
Another day, another Daily Post headline about possible cuts by the Betsi Cadawaladr University Health Board -- today it is about the possible closures of maternity services and children's wards. What are the causes of the need for cuts?

Do they lie with Parliament? Well, as the coalition government has pledged to ring-fence NHS spending and increase it with inflation, its hard to see that Westminster is immediately responsible.

The recently leaked McKinsey report (which WAG Health Minister Edwina Hart attempted to suppress) could provide some clues. It identified the following failures within the Welsh NHS, including that revelation that many initiatives were 'financially unaffordable':

  • Strategic objectives in the NHS were too numerous and not prioritised so "none or the wrong ones were implemented";
  • objectives were "politically unviable";
  • clinical staff did not "own the strategy";
  • implementation lacked accountability; and
  • initiatives were "financially unaffordable".

Another possibility was suggested by a member of the Druid family who works at Ysbyty Gwynedd, who said that many of the current financial problems are a consequence of large amounts of red ink at the Glan Clwyd Hospital. In the past these budget deficits would have been localised in each Local Health Board, but now that the whole of North Wales has been combined to create Betsi Cadawaladr, all of the North Wales Hospitals are having to be pared back to balance the books.

I wonder if any readers with knowledge of these matters can give us some greater insight?


Prometheuswrites said...

This is not a direct answer to your question Druid, more of a musing on where some of the money goes:

Listening today to politicians and pundits talking about how private companies are going deliver services to cover the anticipated staff cuts in some departments I find myself wondering who is going to be paying the private companies?

Presumably the government will be paying through its departmental budgets if we are not going to be paying for it ourselves at point of delivery.

I've always puzzled about private sector service support for public bodies, as it seems to me that the private company will be driven by the profit motive and the temptation to maximise the profit, which is money that could be spent on providing more of the actual services.

The argument in favour of privatisation is that the larger private companies, (larger companies have the resources to make competitive tenders and cut costs by servicing multiple contracts in the same sector), tend to be more efficient and the amount of efficiency savings outweighs the profit margin costs.

However in my experience other factors come into play with profit driven companies in the public sector. For example, there is a tendency to pay cheap wages and to further outsource support services.

Take for instance elderly care homes. The basic wages for the carers are at or just above minimum wage levels. Maintenance is sub-contracted out to other private companies, thus propagating the profit ‘take’. Managers are put under pressure to serve the interests of the company, (making a profit and not getting sued), and not the interests of the patients /residents. Basic non profit services and functions (health and safety, staff training, resident leisure services, etc) are of secondary importance and can disappear from the services provided, (see my earlier comment on the dangers of complacency and the adoption of incautious ‘tacit policies’).

Often care workers from outside the UK provide the labour as the wages are better than their country of origin, (or so it seems at first), and they can send money home (and therefore out of the UK money supply). However the low wages, (and for overseas workers this is where the relatively high cost of UK living comes in), aren’t conducive to worker motivation, something particularly important in the public care services.

Prometheuswrites said...


Personally I don’t see what ‘added value’ there is of using a private profit companies to deliver public services. (Especially in the case of PFI funded capital projects - schools, hospitals, prisons, etc)

On the other hand one would have a reasonable expectation that managers of sufficient calibre could be recruited to run public services just as well as managers in the private sector. They certainly get wages that are comparable to private sector wages and executive level civil servants have been receiving bonus payments for achieving performance targets.

What’s more their jobs and wages are protected. When the WAG re-arranged the health trusts in Wales recently most of the executive members were given guaranteed wages (cica £50K) for ten years.

I attended a public meeting some years back where representations were made to IWJ about the problems for rural Wales health funding within the Townsend formula and the difficulties having our contributions listened to in the ‘consultation’ that was taking place at the time. Part of IWJ's reply was that it was difficult to find and employ managers of the quality needed when the health service had just expanded from 7 (or so) trusts to 22 and needed a matching increase in health board executives.

Presumably these are the same people with the 10 year guaranteed income salaries.

PrometheusW said...

Intrestingly, just minutes after I posted this, Peter Day on Business Today (Radio 4) investigates and reports on exactly the same issue, (the recent caliber of executive competence and quality) and gives it a thumbs down.

TGC said...

I agree with Prometheus on most aspects. The answer to most points is 'political hot potato'. The NHS is probably one of the last things that has the ability to get Brits out on the streets and, boy, do the politicians know it.

What is a typical upper management path in the public sector? You fly in from some other management job, promising the earth. You're probably early middle-age, already having pocketed enough money for comfort. Things start to go pear-shaped in a couple of years, and the organisation's in trouble. It's suggested to you by the board that you might want to leave on a 'stay quiet, keep our faces egg-free' deal. They'll see you right, or at least the tax-payer will. You wave ta-ta and take the big fat cheque and pension.

Can anyone explain to me why, knowing this well-worn route, any senior manager would find a true incentive to produce good, long-term management? Failure should be rewarded by dismissal, not golden goodbyes.

Prometheuswrites said...

Pensions ... yes I'd forgotten about those.
Not sure how pensions in the NHS work. Does it come out of NHS budgets, NHS pension funds, or are they of the 'private' pension variety.

It would useful to know how much (if any) health funding gets used to pay pensions.

I'd add to your comments by observing that once someone has managed to get on the 'senior management' ladder they are able to join agencies like 'Solace' (which I believe is the name of the engine that pulls the gravy train).

Anyway, see below, Edwina Hart is coming to North Wales to explain why she's getting rid of the dead weight that's clogging up the North Wales NHS payroll system. (We should be so lucky)

"Minister to meet NHS staff over health review concerns"


Groundhog Day said...

The NHS in Wales is an absolute disgrace. More is spent per head of population than in England yet we have a far inferior service with less choice and, particulalry in the north, our large hospitals haven't the capacity or capability to handle complex surgery. Most of the intricate stuff is done over the border in Liverpool and Manchester, in my case I thank heaven for the Christie in Manchester which proved to be my life-saver. I had to fight tooth and nail to be given the funding to attend the Christie.

My wife is a nurse in the BCULHB and she is appalled at some of the things that go on in ther BCULHB. At the moment, when a nurse leaves her job she is replaced by a health care assistant. My wife has two nursing degrees and it took her years of training to become the efficient professionaly she is today. HCAs have the minimum of on-the-job training and are really not answerable to any professional body. My wife has to meet the high standards set by the Nursing and Midwifery Council and pays professional fees for the privilege. If she makes a serious mistake she is answerable to the NMC who can strike her off the nursing roll. HCASs answer to nobody.
When the three Trusts in the north amalgamated into the BCULHB there were three chief executives, only one was chosed to run the new Trust, namely the chief exec of the Maelor Trust in Wrexham. You may ask what happened to the other two, well they are still employed in their respective areas with a retention of their salary protected for 10 years - and lets face it we are not talking peanuts here, three-figure salaries is what we pay them. So, what was the reason for the amalgamation, it certainly was not to save money. In fact from what I gather the YG Trust was well run and had very little debt whereas the other two trusts were deep in the financial mire and therefore has dragged YG down to their levels of debt. Meanwhile the badger headed ex-TSB bank cashier Edwinda Hart lies to the Assembly Govt about the McKinsey report which blows holes in how our NHS in Wales is run. I have said it before and I repeat that it was a sad day when the Welsh turkeys voted for Christmas by voting for devolution. I shudder to think that the same turkeys will soon be voting in the next referendum to give these tossers even more powers to destroy our country.

Anonymous said...

Edwina Hart,she worked her way through NUBE (National Union of Bank Employees) and BIFU, she sat on the South Wales Area Council and was very active in the Broad Left section of that union, eventualy it was banned...

Edwina Hart, a lowly bank clerk from Wind Street, Swansea, Lloyds Bank... Never going to get anywhere in banking!! Just look at her now...

Anglesey Flame.

Prometheuswrites said...

Re: Emergency Budget:

Initial analysis by pundits says that hardest hit will be women and the lowest paid.

And where are wages lowest in the UK? That's right ... here.

Following Mr Osbourne's announcements today, I don't hold out much hope for any Conservative candidates on Ynys Mon in the coming Assembly elections.

As the pundit's said, it won't be the reaction in the next few days that will count, but the longer term reaction when individual stories of hardship start making the press. I wouldn't like to be one of the 1/2 million civil servants being made redundant and finding out out how Reiley really lives on dole.

A shame, because much else in the E.B. was OK.

Anonymous said...

Prometheus says "Following Mr Osbourne's announcements today, I don't hold out much hope for any Conservative candidates on Ynys Mon in the coming Assembly elections."

Why? Labour left a mess, everyone agrees deficit should be cut. Why punish Tories for trying to solve the problem, while presumably rewarding Labour for creating the problem?

Anonymous said...

Hear hear !!! It was the labour party that left us in this mess. It's true a fool and his money is easily parted. This what the Labour government has always been since time in memorial. They have always left us in a mess, and the Conservatives have had to sort the mess. God help if ever see another Labour Goverment !!!
The same applies to Heath service in Wales run by the lost mountain sheep party.

Un o Fon

Anonymous said...

Lost Mountain Sheep you say, fancy that now. You've just described Anglesey County Council's Executive to a tee.

Prometheuswrites said...

It wasn't the Labour Party (or even 'New Labour') who created the current situation.

True they didn't help matters by turning a blind eye to regulation and spending during the good times instead of saving. (Aesop has something to say about ants and grasshoppers on this matter).

Many seem to forget that what has caused the economic crisis and brought about the huge leap in deficits was the global collapse of the sub-prime bundling, the bail-out of the banks and the Quantative Easing that followed; and which has yet to bite in the form of increasing inflation.

Something I noticed in Osbourne's speech was a reference to selling off more of the government's (nation's) assets.

I always agreed with Thatcher when she said that running the country was like running a grocers shop. What I couldn't understand was why that government, ('New Tory' they would be called now), was buying more than it was selling and was keeping the books balanced by selling-off the shelves, the delivery vans, the till and the boiler. Not that 'New Labour' did much different when they got in; and the 'off-balance' PFI contracts they created are going to keep on increasing in cost for years to come. (See umpteen editions of Private Eye regarding the PFI scandal).

As I said, time will tell, I've had to eat my words before, (Yes - I was an optimist in 1998).

The Red Flag said...

I think part of the problem Prometheus is that there have been to many re-rganisations to close together/

My sister is a senior manager in North West England and she complains bitterly about it all the time. Each major change actually takes several years to carry-out and she reckons the last 3 have overlapped with each one based on 'data' taken from incomplete changes to start with - ie based on corrupted and incomplete data.

She reckons at amnagerial level it's no better now than it was a decade ago and they are still re-organising from the last set of changes. She also reckons that there should be 5 years between structural changes so that they can actually carry them out and have a couple of years to actually see if it works.

TGC said...

"Most of the intricate stuff is done over the border in Liverpool and Manchester"

The problem with devolution is that yet more boundaries are created. In the past, this was the United Kingdom, so if Manchester had the facilities, you go there. A headache to travel back and forth, but you get the service without having also to become a personal campaigner for access to those services.

It seems to me that there is an underlying rationale for pushing-out devolution. It has little to do with giving local people more say. Rather, it is a very convenient way for Westminster to say 'sorry, not our problem, please refer to the Assembly', whilst ensuring Middle England doesn't go too short for fear or loss of votes.

As for Wales under the Tories, well, we don't vote for Tories as a population, so we're hardly going to get much attention, are we?

If Mr. Osborne wants fairness, why isn't he addressing the unfairness in funding to various constituent parts of the United Kingdom? Or have we become now the Disunited Kingdom?

Groundhog Day said...

"It wasn't the Labour Party (or even 'New Labour') who created the current situation."

So it wasn't Gordon Brown who, long before any banking crisis, sold our gold reserves quietly at carboot sale prices? And it wasn't Gordon Brown who as chancellor robbed many people of their pensions by his actions. These are just two examples of financial messes left by the Labour Party (New or Old)Sorry Prometheus, my old mate, the blame lies squarely at the door of the last governement. What we all have to suffer now, as always, is the Tories yet again having to get this country out of the mess left us by the Labour Party. We are paying £120m a day in interest on the debt left by Blair, Brown and Darling to name but three. It is, as the Chancellor stated, like having a credit card and ignoring to pay it off thereby incurring interest on the iterest on the interest on the interest ad infinitum. In the meantime, as expected, the trade union neanderthals who are Ed Millipede's paymasters, are coming out looking for action on the streets. Bob Crow is jumping up and down, Mark Serwotka is urging everyone including students to copy what the French are doing across the chanel and bring the country to a standstill. I have voted Labour, new and old in my lifetime but nevere ever again.

The Red Flag said...
This comment has been removed by the author.
The Red Flag said...

Health spending comes as part of the total government spend. The per capita total government spend for the UK does not support your argument TGC. Across the nations the last set of figures reveal total government per capita spending to be as follows:-

England £7121
Wales £8139
Scotland £8623
N. Ireland £9385

England sub divided to it's constituent regions spans from the South East @ £6304 through to London @ £8404. In England only London and the North East (on £8177) get more per capita than Wales.

And it is from these 'spends that the Health budget is funded.

Perhaps the argument is not how much money is spent, but how it is spent (for example doctors in Wales are far more likely to prescribe than in England where they are more likely to tell you to bugger off to Boots and get some paracetomol).

Figures show that health spending per capita from that budget is roughly equal in England & Wales (Wales is very slightly more than England) both of which in turn are 10-12% below Scotland and NI.)

You could argue Wales is more rural than England and should be spending on a level comparable with NI and Scotland. However their overall per capita budget is higher than ours so perhaps it's the good old Barnett formula that needs adjusting and no UK government is going to do that except in England's favour - the electoral implications are to great.

TGC said...

"The per capita total government spend for the UK does not support your argument TGC."

Not sure the argument is that simple. Firstly, I think my comment was about access and the division of the supposedly United Kingdom. I don't think I was arguing about relative health spends as such.

One thing that comes to mind: you usefully give the per capita spend per region, but there doesn't seem to be any way we can compare this against need. Deprived areas (which Wales and, arguably, the other regions in question are), tend to have less healthy populations. That might well apply to poorer regions of London. So the per capita spend value is interesting, but perhaps not as useful as it might first appear.

But there are far better economic experts out there than me...

The Red Flag said...

Oh you're quite right. There are things on the ground which distort the 'cash worth' of the figures. The general poor health of the Scots (they tend to smoke and drink more and eat a saturated fats heavy diet) is a class example. They have a far lower life expectancy but that then reflects in other areas as a 'plus' in that their aging population dies quicker than say South East England's. Strangely, their infant mortality rate is lower than any other area of the UK.

You could argue that in North Wales the 'Costa Geriatrica' of Prestatyn, Rhyl etc (and also Anglesey) where a lot of retirees from England - particularly Greater Manchester, Merseyside and Cheshire - settle to while away their golden years skew the figures by 'artificially' increasing the average age in those areas and the need for more health spending, whilst at the same time it is lowering the average age in the areas they came from and thus reducing their health needs slightly - ie a pound on health goes further in NW England than it does in North Wales because of that distortion.

The problems and inequalities Wales has would in fact have replicated in England but for their rejection of Regional Assemblies. Under the Regional Assembly scheme for England their Health Regions would have faced equally annoying 'quirks'.

Prometheuswrites said...

Groundhog Day:

"Sorry Prometheus, my old mate" -
No need to apologise, we are after all in agreement.

"the blame lies squarely at the door of the last governement." - Same as it ever was.

What's that old saying? -
"No matter who you vote for you always get the government".


Prometheuswrites said...

"Assembly inquiry into north Wales health reviews"


"There looks as though there has been cherry picking of those invited to those consultations,"

This is how consultation works in Wales.

I remember standing up at a 'public consultation' on the Anglesey Health and Social Well-Being Plan and asking why I was the only member of the public there and the only person in the room who wasn't a member of some charity, trust, quango, LA Dept, etc.

Anonymous said...

I here that the Board of Directors of the Betsi LHB have now re named their Board meetings to 'Star Chamber' I assume that nobody has bothered to check the history of 'Star Chamber'. Maybe they should!!