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| NHS chief admits to anger at Jeremy Hunt's meddling | |
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| Sir Malcolm Grant, chairman of NHS England, has revealed his frustration at attempts by the health secretary, Jeremy Hunt, to micro-manage Britain's health service. | Sir Malcolm Grant, chairman of NHS England, has revealed his frustration at attempts by the health secretary, Jeremy Hunt, to micro-manage Britain's health service. |
| Grant said politicians should stop meddling in the NHS at a time when clinicians were supposed to have been put in charge under recent reforms, and admitted fighting with Hunt over attempts to interfere through a detailed blueprint called the NHS mandate, which was published this year. Grant also revealed that he had been forced to block ministers' attempts to punish clinicians who failed to meet certain care standards by reducing their budgets. | Grant said politicians should stop meddling in the NHS at a time when clinicians were supposed to have been put in charge under recent reforms, and admitted fighting with Hunt over attempts to interfere through a detailed blueprint called the NHS mandate, which was published this year. Grant also revealed that he had been forced to block ministers' attempts to punish clinicians who failed to meet certain care standards by reducing their budgets. |
| Grant, a former provost at University College London, said: "I am a staunch believer that the NHS is one of the finest social institutions in the world and the people who make it that are the frontline staff. I think the way we design the structure to incentivise people is right, and to take money away and penalise poor performance is not the best way to get the best out of people." | Grant, a former provost at University College London, said: "I am a staunch believer that the NHS is one of the finest social institutions in the world and the people who make it that are the frontline staff. I think the way we design the structure to incentivise people is right, and to take money away and penalise poor performance is not the best way to get the best out of people." |
| He denied rumours he had considered quitting his role over his battles with Hunt, in particular over the NHS mandate, saying: "That would have been an abdication of responsibility. We had, shall we say, some really difficult discussions, which is absolutely right, it is what you would expect." | He denied rumours he had considered quitting his role over his battles with Hunt, in particular over the NHS mandate, saying: "That would have been an abdication of responsibility. We had, shall we say, some really difficult discussions, which is absolutely right, it is what you would expect." |
| In a wide-ranging interview with the Observer to launch a new era for the NHS, Grant also claimed to be "quietly confident" that the service would cope with what is expected to be its busiest winter. He admitted to being surprised by the record number of people attending A&E departments in recent weeks. The "big uncertainty"would arise if there was a major change in the weather, but he said the system "will cope". | In a wide-ranging interview with the Observer to launch a new era for the NHS, Grant also claimed to be "quietly confident" that the service would cope with what is expected to be its busiest winter. He admitted to being surprised by the record number of people attending A&E departments in recent weeks. The "big uncertainty"would arise if there was a major change in the weather, but he said the system "will cope". |
| However, he said a whole new era was being ushered in for the service. Major changes – including encouraging feedback through a new "friends and family" survey – were being established in the wake of last year's revelations about Mid Staffordshire NHS trust and abuse of residents at the public-funded Winterbourne View hospital near Bristol. | However, he said a whole new era was being ushered in for the service. Major changes – including encouraging feedback through a new "friends and family" survey – were being established in the wake of last year's revelations about Mid Staffordshire NHS trust and abuse of residents at the public-funded Winterbourne View hospital near Bristol. |
| "I think it has been a big wake-up call," he said. "Everybody knows the NHS is not divided into institutions that provide world-class care and those that are appalling. There is a distribution of quality across the whole system. | "I think it has been a big wake-up call," he said. "Everybody knows the NHS is not divided into institutions that provide world-class care and those that are appalling. There is a distribution of quality across the whole system. |
| "What I think is shocking about Winterbourne View and Mid Staffs is that these were the most vulnerable patients, who couldn't speak up for themselves." | "What I think is shocking about Winterbourne View and Mid Staffs is that these were the most vulnerable patients, who couldn't speak up for themselves." |
| However Grant said that difficult decisions would need to be made to avoid a £30bn black hole in the budget by 2021. Among the changes, he said, was a need for a significant reduction in the number of NHS hospitals offering specialist services, such as treatment for cancer or ear, nose and throat conditions among children. The current 200 providers of specialist services, often based in trusts in major towns and cities, would be cut to between 15 and 30, he said. While aware that the move would be controversial, Grant said the NHS could not afford "geographical pride" to get in the way of reform. | However Grant said that difficult decisions would need to be made to avoid a £30bn black hole in the budget by 2021. Among the changes, he said, was a need for a significant reduction in the number of NHS hospitals offering specialist services, such as treatment for cancer or ear, nose and throat conditions among children. The current 200 providers of specialist services, often based in trusts in major towns and cities, would be cut to between 15 and 30, he said. While aware that the move would be controversial, Grant said the NHS could not afford "geographical pride" to get in the way of reform. |
| "We have to rationalise, and that means grouping specialised services in a smaller number of places. We are not doing this for fun," he said. "But there have to be very good clinical reasons for having a smaller number of institutions with better staffing levels and the technology that allows us to get there. | "We have to rationalise, and that means grouping specialised services in a smaller number of places. We are not doing this for fun," he said. "But there have to be very good clinical reasons for having a smaller number of institutions with better staffing levels and the technology that allows us to get there. |
| "The cost is rising all the time with new technologies on board, new drugs coming in. Second, we have to keep an eye on geographical spread. I think access is really important on all of this." | "The cost is rising all the time with new technologies on board, new drugs coming in. Second, we have to keep an eye on geographical spread. I think access is really important on all of this." |
| He also expressed enthusiasm for the "industrial scale" of operating centres in India. Under its system, more than 300,000 cataract operations a year are carried out using a production-line method in which qualified surgeons only perform the most complex part of the procedure, with simpler tasks given to less expensive staff. | He also expressed enthusiasm for the "industrial scale" of operating centres in India. Under its system, more than 300,000 cataract operations a year are carried out using a production-line method in which qualified surgeons only perform the most complex part of the procedure, with simpler tasks given to less expensive staff. |
| Grant said that the NHS should also treat more people in their homes, claiming that admission to hospital should often be seen as a failure. "We spend the same amount on one attendance at A&E as we give to a GP for a whole year of care for a person, about £200 to £220. We have to regard admission to hospital as a failure. | Grant said that the NHS should also treat more people in their homes, claiming that admission to hospital should often be seen as a failure. "We spend the same amount on one attendance at A&E as we give to a GP for a whole year of care for a person, about £200 to £220. We have to regard admission to hospital as a failure. |
| "The worst thing would be to be admitted to hospital. It is a disorienting environment; it is noisy, it is unfriendly, it is unsafe. Your identification, your identity is taken away. Your money, your wallet, your clothes. | "The worst thing would be to be admitted to hospital. It is a disorienting environment; it is noisy, it is unfriendly, it is unsafe. Your identification, your identity is taken away. Your money, your wallet, your clothes. |
| "For a patient with early-stage dementia, that is a pretty unpleasant outcome when, had it been possible to have that diagnosis early, adapting the home environment to ensure there was good community support could have reduced the risk of admission." | "For a patient with early-stage dementia, that is a pretty unpleasant outcome when, had it been possible to have that diagnosis early, adapting the home environment to ensure there was good community support could have reduced the risk of admission." |
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