13th October 2015

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One out of ten
News and Comment from Roy Lilley
It looks to me like the King's Fund has blown a raspberry at the Department of Health.
The Tinker-Man wants 'aggregate scores' to assess the performance of CCGs. It's Mark Britnell's World Class Commissioning Scores for PCTs, in drag... except that you mustn't' mention World Class Commissioning or PCTs.
Why bother Vanguards will soon show CCGs and commissioning the door.
To confuse an already bewildered public, he proposes a series of 'quality indicators' across population groups; the elderly, kids and mental health and what-not for 'every health economy'.
So, if I have it right, +200 CCGs will capture and publish data across five 'domains'; +1,000 publications of probably 200 pages each. That's +200,000 pages of more stuff that no one will take a blind bit of notice of and will occupy six months of the time of at least two people per CCG, working a 48 hr week... say over two thousand hours.
Plus the obligatory web-site. Millions, to achieve what? A line in a speech for the Tinker-Man to say how the NHS is the most transparent and lovely in the world. What a bargain!
This is management by politics not management by management.
The King's Fund are having none of it. However, instead of just saying 'no thanks' and walking, they are having a tinker themselves; a report, 102 pages 'Measuring the performance of local health systems; a report for the Department of Health'.
They have given the Tinker-Man's idea the elbow. They point out present indicators refer to whole populations and map to more than one population group. Also, the no little matter... no one seems to know where cancer and end of life care would fit in.
Stay with me on this, please!
They should have stopped there and asked themselves don't we have enough bureaucracy, administration and officialdom around quality and outcomes? All the stuff we have now, we've been doing for years; if it was going to work, wouldn't it have worked by now?
Undeterred the KF bash-on, so I'll have to!  Please, don't go to sleep on me!
They want to crunch together Outcomes Frameworks for the NHS, public health and adult social care and the CCG Outcomes Indicator Set. In fairness, they point out what a mess it all is:
" [they]... were struck by the number of different bodies involved in assessing performance... the DH, NHSE... the CQC... duplication in some of the work that has been done... competing frameworks... early on it became clear that there is a need for radical simplification and better alignment of this work... especially important at a time when the DH is proposing [to add] a new framework... "
They are dead right. But, instead of saying to the Tinker-Man 'Listen mate, your job begins and ends with the annual Mandate... so clear off and leave it to the Carbuncle', they've played his game.
This is a truly horrible, impenetrable document, dense paragraphs, the electronic version has no 'live index' so finding your way around it is a pain. This is a document written, not to be read.
The document has a whiff of snooty and says; 'I'm only for the clever people, with nothing to do all day but read opaque stuff'.  This is way below the KF's usual exemplary presentation standards. It has all the page grabbing qualities of an engineer's report on a leak at the Pauzhetsky Power Station.
If you can be bothered the international comparisons are interesting; page 49 onwards. The conclusions start on page 40.
Let's start again; with the exception of the exceptional NHS Choices website, by and large, the public don't sit in front of a computer, pouring over arcane NHS stuff.
If, where you live, your CCG is crap, what can you do? Move? If it's about outcomes it might take years to know they bought the wrong thing for you.
Don't most of us want to; get in, get diagnosed, get fixed up, get out and get on with our lives.
Five 'gets' that I have no idea if I can get. Decent commissioning might get it for me? A labyrinthine report, a year out of date by the time it's published, ain't gonna tell me anything.
If I could see, in real time, on my NHS in my Pocket App, Facebook, or Twitter, where I live; nine out of ten people get an appointment when they want it, treatment that worked, when they needed it, went home safely and were happy, I might be interested.
But I'd still be left wondering what if I might be the one out of ten?
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