Sunday, 31 March 2013

So, which A and E would you shut?



                IS BUST!

My ‘Merger Mania’ series drove all my readers away, well, nearly all of them. I still want the world to read it though, it’s a review of an academic study into the effects of merging hospitals. It looks at the costs savings, efficiencies, improvements in patient outcomes that result from them – there aren’t any.

If that was theory, here’s the practise of it all;

In the ‘bad’ old days the ‘National health service’ was just that – a service. There was a great big plan. It aimed to match supply and demand, within the constraints of how much money was available. Human beings and plans don’t always work out too well, that’s being ‘human’. But they try to get it right.

Then we had Reagonomics/Thatcherism. The market was the new big thing. A free market would ensure that supply met demand, and as a result the fittest hospitals would survive, the inefficient would go bust. The problem is, there is no free market in healthcare. There are just sick people. It isn’t a business.

Now the “Big Plan”, is for hospitals to go bankrupt. That’s not a very good plan.

Hospital “A” is really efficient, gets all the work and “makes” money like a business does.

Hospital “B”, loses work to “A”, loses money, goes downhill and then goes “bust”.

Hospital “A” takes over Hospital “B” and a new regime of efficiency is brought in, like a business takeover.

Over the last 2 years, Ashford and St. Peter’s Foundation Trust has been negotiating to take over Epsom Hospital. Epsom is miles and miles away from either Ashford or St. Peters, unless you are in a Mercedes and the M25 is empty. It never is. It’s a journey no one would ever make by car, if they could avoid it. Public transport just does not connect any of these places. Helicopter maybe.

Luckily the negotiations broke down.

Suppose it had gone through?

The only “asset” any hospital has that could make money is Land. People cost money.

So to save money, you would close departments, sack people, cut the wage bill to get fewer people to do more work. Can you guess I’m thinking ankles here?

You then sell off the land.

Ashford Hospital had a great Accident and Emergency department serving a local community. It’s been shut down (now you go to St. Peters) and most of the land around the Hospital has been sold off; first to Tesco’s for the supermarket and car park, now more has gone for housing.

So now you travel to Woking/Chertsey. When I was discharged the first time on a bank holiday, a taxi cost me over £30.

If the Trust had taken over Epsom; what would they have shut? There are no public transport links between the different areas.

Epsom has a big and well respected psychiatric unit as does St. Peters – which would you close? One area doesn’t need two.

Except this isn’t one area, the hospitals have no community connection, are many miles apart and no public transport. For patients with mental health problems, on medication and distressed, the journey is impossible. What about relatives visiting?

Which A and E would you have shut? You don’t need two in an area, that’s why they shut Ashford A and E already.

If you don’t believe this particular madness, my next post will cover the bizarre proposals coming from Slough.

Neil Harris

(a don’t stop till you drop production)

Saturday, 30 March 2013

Shout a little louder.

Now I’ve remembered why I don’t tweet. 140 characters are just enough to get you into trouble and not enough to sort anything out.

I wrote a Blog last night about the  growing scandal surrounding the closure of the children’s heart surgery unit at Leeds General Infirmary – I picked sides, I knew I was right. A tweet would have flashed that out, late last night.

Then I did what I often do – I slept on it. In the morning it all looked different and so did the morning papers. Now I’ve heard the other side. I’m still none the wiser and a little more suspicious about the real motives behind all this.

Now, I want to see the figures, and then I’ll decide. Meanwhile I binned the blog.

What I do know is that in all the arguments, patients aren’t necessarily being put first.

I also noticed that in the proposed new NHS constitution, they aren’t going to ‘put patients first’, as the principal aim of the service, either.

If we are going to get heard, we’ll have to shout a little louder.

Neil Harris
(a don't stop till you drop production)

Friday, 29 March 2013

Shallow people.

Everybody seems to love David Bowie these days. He has an exhibition on at the Victoria and Albert Museum which is sold out until summer and a number one album. He’s celebrating 1977 and his return to Britain from a long spell in Berlin, making ‘Low’.I like the album ‘Low’ probably because of the other people who contributed to it. It’s worth listening to again, very stark. I can’t deny the influence he had but…

Actually, I think he is shallow and empty and always was, soaking up other peoples work and style. A chameleon mimicking what was around him. His use of image and fashion is as deep and original as an advertising executive’s theft of popular/street culture to sell things.

And now I think of it, Bowie worked in advertising, so perhaps that is what it was.

Very few remember his arrival in Britain, back from Berlin in 1977, coming out of the airport in a large open top limousine surrounded by the press and TV, dressed in nazi uniform, making nazi salutes.

It was meant to shock for publicity, luckily most people ignored it, because it was a really dangerous time in Britain. It seems bizarre to me even now – I don’t think Berlin in those days would have inspired such a display, neither would the kind of people who had worked with him on the album.

In Britain it prompted the creation of Rock Against Racism as a protest, and I am really, really proud to have played an active part in all that. RAR actually did change the world. It was when people like me fought back against ‘life on Mars’. Maybe I should post a few stories from my street fighting days, some day.


So I suppose looking back, it ended up doing some good by accident and I have never forgotten just how dangerous a shallow person can be.

Neil Harris

(a don’t stop till you drop production)

Thursday, 28 March 2013

I found a really interesting graph, don't yawn.

I’ve stolen a really interesting graph from this weeks ‘Private Eye’, (don’t you dare yawn).

Their medical correspondent calls it the ‘death graph’, and I’ve posted it because it illustrates very well the effects of ‘coding’ in the NHS, or as big Phil from customer relations puts it;



It’s Ok, Boss -

I’ll Cooka Da books

You can take a look at my various postings about coding by going through the archive.


This graph shows the number of deaths from ‘palliative care’ – that’s where people come into hospital with a terminal illness, so that their death is predictable. If that code is used, the death isn’t a problem; it was likely to happen anyway.

But, for example, if someone is coded as breaking a femur, emergency heart attack or stroke, if that patient dies it is unexpected and it makes the hospitals statistics look worse – it’s an indication that something is going wrong. Patients should survive those problems. Then alarm bells ring.

So, if someone comes in with a broken femur, dies, but also happens to have a terminal illness - alter the codes to palliative care…. and you are in the clear!

The dark blue line is the average for England – it goes from about 3 or 4 % in 2004 to about 17% in 2010. That’s pretty disturbing, because there is no reason for that to happen – unless the books are being cooked. It also means that this is happening everywhere, to some extent.

What’s worse are the lines for George Elliot, Mid Staffs, Walsall, and the average of all three. They all show a massive jump in the percentage of ‘Palliative care’ deaths for each hospital, something that just couldn’t happen. It happened when they discovered the advantages of changing the way their coding is done.

Walsall went from the national average of a few per cent to nearly 80% - so nearly everyone who died would have died anyway – pretty convenient.

It’s what Professor Jarman of ‘Dr Foster’ described as only possible if the hospitals had become ‘giant hospices’.

Being angry isn’t really enough for this because it means they covered up the figures instead of doing something about the problem. They also made money doing it.

Neil Harris

(a don’t stop till you drop production)

Wednesday, 27 March 2013

Washing hands.




I am a big fan of Dr John Snow (a previous Hall of fame entry) but Dr Ignaz Semmelweis (1818 – 1865) has to be my all-time medical hero (tomorrow who knows).

Dr Semmelweis was a Hungarian Doctor who came to work in Vienna for a charity hospital for the poor. In particular, it provided medical help, money and adoption facilities for poverty stricken mothers.

There were two maternity clinics; one to train midwives and another which was used to train Doctors. The two clinics admitted patients on alternate days but the outcomes were dramatically different.

The Doctors ward was plagued by puerperal fever, an infection of the womb. Often over a third of the mothers died after childbirth.

By contrast the midwives ward had a very low rate of infection. It was so obvious that word had reached the street; on days when admissions were to the Doctors ward, expectant mums did anything they could to avoid being taken in. They would give birth at home or in the street outside and then attend on foot for the financial benefits. Meanwhile on midwives day, the new patients poured in to have their babies.

Semmelweis took it upon himself to try to find the reason, in a time before there was any understanding of ‘germs’.

In the end he came to the conclusion that the trainee Doctors were attending dissection before going around the ward. Something they were doing was causing the fever.

Semmelweis decided that everyone had to wash their hands before they entered the ward. After a huge battle to win the junior Doctors over, he was able to show a dramatic fall in infections and deaths. He didn’t stop it all together because he didn’t realise that hands needed to be washed between patients too; it was for Louis Pasteur to make the discovery of ‘germs’ many years later.

Instead of praise, poor Semmelweis got a barrage of criticism; senior Doctors took it as a personal insult and refused to wash their hands, considering it an attack on their social status.

Unfortunately problems at work and in the scientific community took its toll and eventually resulted in his admittance to a psychiatric hospital, where he was so badly mistreated and beaten that he died shortly after.

It’s a very sad story; the happy ending came with Pasteur and Lister who were to change the world from the starting point of Semmelweis’s research.

As Isaak Newton said; “we stand on the shoulders of giants”


Neil Harris

(a don’t stop till you drop production)


Tuesday, 26 March 2013

Upspring monday?

Last night I was at the Red Lion, Isleworth, having my taste in jazz challenged again by being forced to listen to stuff I wouldn’t have chosen to hear – that’s what it’s all about.

This time, Kelvin Christian was on sax and flute, Roger Beaujolais on vibraphone, Alec Dankworth was bass, Alex Hutton on keyboards and Trevor Tomkins on drums.

They even made me listen to Chick Corea, (70’s fusion is definitely not on my list) but doing it by mixing Flute and vibes really worked. It worked on ‘Jobim’ too, composed by Roger Beaujolais – that latin sound.

I really enjoyed a fast and lively ‘Eternal triangle’ by Sonny Stitt while ‘Round Midnight’ was a showcase for a slow, throaty sax, my kind of stuff. Stitt and Monk – did they ever play together?

I wish I could say that spring was in the air outside – despite playing a sprightly ‘Upspring Friday’ by Freddie Hubbard as well as ‘Joyspring’, it wasn’t. It was freezing. Spring has been cancelled, indefinitely.

It’s been a long, cold hard week.


Still it was a nice night, chatting with a teacher from Brittany, and another group of East Europeans drawn in – jazz was always big there. It was a good mixture of people and backgrounds, accents and languages, which is what jazz is all about.

I’ve been feeling grim lately and last week dealt with all the bad stuff and not being able to do physical things much by laying into writing something I’d put off since the summer when I did all the research for it. I’d put it off because it was really complicated, boringly detailed numbers and routes, which means its tough trying to tell a story interestingly while keeping it accurate. Not easy and after about four days of it, late nights and all, I got it finished but it left my brain as aching and scrambled as the rest of my body.

So the music helped. And when it finished I realised I’d been standing most of the night, so still some mileage left.

Neil Harris

(a don’t stop until you drop production)

Oh and by the way (don't know if I can make it) 6/4/4 is looking preety good;

'Hillbilly in the UK'
The Wessex Pistols.
All the punk hits and more - Hillbilly style.
Features Johnny Forgotten and Joe Bummer.

I guess you'd have to be of a certain age....

Monday, 25 March 2013

You get what you pay for, you don't always get what you need.



                IS BUST!

This is from ‘Get Surrey’ – basically Epsom Hospital is rated higher than next door Ashford and St. Peters. However, Epsom has a £13 million pound deficit, while Ashford and St. Peter’s has a small surplus. Ashford spent the last year trying to take over Epsom; it fell through over the deficit.

Ashford/St.Peter’s must be very efficient.

In fact, Epsom now turns out to be better in most ways except finances – you get what you pay for, but you don’t necessarily get what you deserve.


Under-threat hospitals 'best in area', report says

By Amy De-Keyzer      

        March 15, 2013

A REPORT has hailed Epsom Hospital for providing some of the highest quality of care in the area despite several departments facing an uncertain future.

Independent health consultancy MHP Health Mandate's report assessed NHS trusts across the country and showed Epsom and St Helier, its sister hospital in Carshalton, were providing the highest quality of care in south-west London and north Surrey.

It comes as the Better Services Better Value (BSBV) review panel considers shutting down the A&E and maternity departments at both hospitals as part of a review of healthcare provision in the area.

The review team has already recommended that two out of five hospitals - Epsom, St Helier, St George's in Tooting, Kingston and Croydon - should be downgraded.

The MHP report is based on 10 standards - the number of formal complaints, whether patients felt they experienced good care, risk of getting an infection, chance of an operation being cancelled at short notice, the number of patients who said they got better after treatment, whether a patient had to share a sleeping area or bathroom with someone of the opposite sex, operation waiting times, risk of being harmed during treatment, being involved with decisions about care, and the number of staff at the hospital who would recommend it to their friends and family.

Data from 2011-12 was used including staff and patient surveys by health watchdog the Care Quality Commission, information from the Office for National Statistics and records from the Department of Health.

Epsom & St Helier University Hospitals NHS Trust measured in the top quarter nationally for operation waiting times and for protecting patients against the risk of harm.

But overall scores placed the trust in 91st place out of a total of 146 hospitals - the highest position for any hospital in south-west London and north Surrey.

Chief executive Matthew Hopkins said: "These findings contain some fantastic results for our hospitals, but we recognise that at 91st in the country, there are many aspects of our service we need to improve.

"But what the report does do is highlight our performance in both national and local terms.

"We recognise that there is work to do on a national scale but we are very pleased that we are also recognised as providing the best patient care of any trust in south-west London and north Surrey.

"And of course, we are delighted that local people can now compare the strengths and weaknesses of their local hospital more easily than before."

In comparison, Ashford and St Peter's hospitals came in 115th place, Croydon was at 140, Kingston Hospital was 97th, St George's came 141st and Surrey and Sussex Healthcare NHS Trust (incorporating East Surrey Hospital in Redhill) was 124th.

The Royal Surrey County Hospital in Guildford came in 86th position while Frimley Park Hospital was the fifth best in the country.

The scores showed Epsom and St Helier were performing better than the three other hospitals being considered for downgrading as part of the BSBV review. The programme aims to shake-up healthcare provision, in a bid to improve clinical quality and the care and health of patients, as part of national NHS reforms.

Neil Harris

(a don’t stop till you drop production)


Sunday, 24 March 2013

Being Horrid

This was posted by ‘Kathy’ last week, taken from Patient Opinion March 2013, describing her experience of St. Peter’s Accident and Emergency.
I was kicked out in much the same way - left in reception in a wheelchair,waiting for a cab. In fairness, the nurse who put my ankle in plaster didn't know it was a dislocated fracture so it wasn't her fault.


“When I was taken to A&E by ambulance I was seen very quickly. The nurses and consultant were first rate as were the ambulance team. I was diagnosed and treated very well.

I was discharged, but on getting up I could not stand and collapsed, the discharge process continued uninterrupted. Two nurses helped me into a chair. I was left in in that chair in the main waiting area in a state of undress.

My husband was called to say I was ready to go home. On arrival he was shocked to see me in that state and tried to get me dressed in the disabled toilet but because I could not stand I collapsed again and hit my head.

My husband went to reception for help to lift me and was advised that he would have to wait for triage! Eventually two nurses saw my plight; they and my husband helped me up. I then had to go back through triage which took over eight, yes eight hours only to be told there was nothing they could do as there were no beds and my husband should collect me and I would be helped into the car.

Quite how they expected him to get me into our house was beyond me. He had no option but collect me and in the process of transferring me to the house he hurt himself as he practically carried me from the car to the house and upstairs.

To say my treatment was mixed is somewhat of an understatement. As Henry Wadsworth Longfellow once wrote: "And when she was good, she was very, very good, But when she was bad she was horrid". “


Neil Harris

(a don’t stop till you drop production)

Saturday, 23 March 2013

Lousy week, lousy month.

A lousy week – am I down-hearted? Perhaps a little.

As I said yesterday, last week I put up some serious, important stuff for a change and drove away (nearly) all my readers as a result. It was an important report, it needed to be seen by people. Cutting it down to a few paragraphs disrespects the report, it also disrespects the people reading it.

Funnily enough, at the beginning I wondered why it had gone over a year and no publicity. Now I begin to understand why.

What I mean is no apologies, no compromise.

Last Saturday night, after hearing a noise I went out and disturbed a group of youths outside my poor old mum’s house. They disappeared quick at the sight of me, it was only the next day I discovered why they ran off; they’d kicked in a couple of fence panels which I now have to try to repair, when it warms up a bit.

I wrote up a page to celebrate the spring solstice on the 21st – the weather’s been so cold and miserable I didn’t bother to post it. Spring is going to have to wait this year.

I’ve learnt that Blogging is serious stuff to take on. Fighting big and powerful organisations alone is tough and this March has been a personal struggle too.

To be or not to be (blah, blah, blah), whether ‘tis nobler (yadda, yadda, yadda), sea of troubles (…….. yawn).

And then I read claims that Basildon Hospital has been altering mortality codings, just like Mid-Staffs, Bolton, Wolverhampton. Where else? (Check out my ‘cooka da books’ postings if you don’t understand what I mean). Now, it’s not even being reported properly – the press are bored with the story.

It is really depressing me.

On the other hand, this last fortnight I’ve been able to write some articles I’m proud of, which I needed to get done before…and I still have a few more in me, I think, (I do other things too, y’know) and got through some hurdles.

Also, I must still be just a bit scary if I can scare people off, while wearing comfy slippers, which is good I think.

We’ll see.


Neil Harris

(a don’t stop till you drop production)
contact:  neilwithpromisestokeep@gmail.

Friday, 22 March 2013

Merger Mania 8 - that's all folks.


I’m printing the report’s final conclusions in full because they are important. Every local campaign to prevent closures and mergers needs to have this in mind when they take on those pesky experts who ‘always know best’;


The literature on mergers between private hospitals suggests that such mergers often produce little benefit. Despite this, the UK government has pursued an active policy of hospital merger. These consolidations are initiated by a regulator, acting on behalf of the public, and justified on the grounds that they will improve financial performance, productivity or patient care. We examine whether this promise is met by exploiting the fact that between 1997 and 2004 in England around half the acute general hospitals were involved in a merger.

We examine the impact of mergers on a large set of outcomes including financial performance, productivity, waiting times and clinical quality and find little evidence that mergers achieved gains. While admissions and staff numbers fell relative to the pre-merger position, which is desirable if the regulator wanted to remove spare capacity, labour productivity did not rise and financial deficits increased. And while most measures of quality were unchanged, there is no indication of an improvement in quality to offset this poorer financial performance. Further, in already concentrated markets, mergers brought about lower reductions in capacity. This suggests smaller gains in these markets.

We therefore conclude that there seems to be little hard evidence that this attempt at government planning of hospital care has achieved much more than simply reducing hospital admissions. This removal of capacity may reduce patient welfare. We show that waiting times rose post merger; travel distances may also rise when hospitals are closed. Consolidation also downstream reduces potential competition, which has been shown in the UK market to have some beneficial effects on patient outcomes and length of stay (Gaynor et al 2010, Cooper et al 2011, Bloom et al 2010). Given this, it seems the English government should carefully consider potential losses before allowing more mergers between short term general hospitals.”

Worse for patients, worse for staff, cost more, did less but better for managers.

‘May reduce patient welfare” – kinda says it all, really.


I’m going to give us all a break (you can put the soggy ice pack back in the fridge for now) because whenever I do serious stuff, I lose nearly all my readers. 8 days ago I was getting over 30 hits a day – all gone now (nearly but not quite all gone – thank you for staying with me)

A good friend has suggested to me that my Blog would do much better if I just put up a video of myself doing a silly dance. Trouble is, he is probably right. Mind you, he has problems e-mailing, so what does he know?


But I am going to go on going on. Later on I’ll take a look at the ‘new’ policy of setting up independent ‘trusts’, and then letting them go ‘bust’.

It’s a ‘Free Market capitalist’ way of bringing about mergers. Except nothing is free and there is no market. Mind you it is the people’s capital, until we let them squander it all away.



At the start of this series, I sent an e-mail to Bristol University, warning them I’d been using their research, which seemed only fair. In fact, it’s just the Centre for Market and Public Organisation that’s in Bristol, the authors are based elsewhere.

One of the authors kindly sent me over a direct link to their article, which is well worth a look;

(Luckily, between you and me, I think I managed to get away with the whole ‘st#t-g#ek’ thing, phew!)



Neil Harris

(a don’t stop till you drop production)

Oh and I’ve got a new graphic:




                IS BUST!

I fear its going to get some use.

Thursday, 21 March 2013

Merger mania Seven



Now we know that all those closures cost a lot of money and then after a while it got worse, they lost even more money.

Surely, quality must have gone up – that’s what it was all about. The italics are mine, the rest are quotes from the report;


“ Waiting times, length of stay and quality indicators

Table 3 presents results for a large set of measures that have been used as indicators of quality of patient care. We begin by examining waiting time and length of stay. We then examine measures of quality of clinical care published by the national agency which constructs measures of clinical quality of care.

In the main, none of these measures show an improvement and there are some signs of a decrease in quality of care. Column (1) shows no effect of merger on length of stay. Columns (2) and (3) present some evidence of an increase in both mean waiting times and of the share of patients waiting more than 180 days for an elective admission four years post merger.”

Wait a minute, length of hospital stay was the same and waiting times got worse?

“In terms of the clinical measures, we examine death rates from emergency heart attack (AMI) admissions, a widely used measure in the literature on the impact of market configuration on outcomes (e.g. Kessler and McClellan, 2000), measures of care for patients with stroke and measures of care for patients with fractured proximal femur. For AMI (column 4) and fractured proximal femur (columns 8 - 10) the quality indicators remain relatively stable post merger. However, columns (5) and (6) show poorer outcomes for patients admitted following a stroke. Column (5) shows higher death rates post discharge after merger. Column (6) shows higher readmission rates to hospital within 28 days of discharge, both immediately before the merger and post-merger. Column (7) shows an improvement in one measure – the 56 day return rate to usual place of residence - but this is for only one of the years post-merger and is only significant at 10%.”

Now this is bad;

Heart attacks and broken femurs no change.

Strokes – death rates get worse after merger – probably because there is more delay in getting treated because the nearest Hospital is now further away.

Higher death rates after being discharged.

Higher readmission rates within 28 days.

The only thing that got better was the Hospitals ability to kick patients out early, often too early, and that only got better in only one of the years examined.


“In summary, we find that whilst the effect of mergers was to shrink the combined size of the merged hospitals, other than this reduction in size and associated fall in activity, the merger does not appear to have brought benefits. Labour productivity does not appear to have risen, the merger has not stemmed the increases in size of deficits and there are no indications of an increase in quality (in fact there is one indicator of a fall in measures of clinical care.”

That means it was all a waste of time as well as money? And then things got worse.

That can’t be right. I’ll wrap it up tomorrow.



Neil Harris

(a don’t stop till you drop production)

Wednesday, 20 March 2013

Merger Mania six.


In six years the NHS cut 112 acute Hospitals; think how much that would have cost in redundancy payments, management time, wasted equipment and stock, redundant buildings, cancelled operations, disruption, unhappiness and stress to staff and patients. And then we ended up with fewer Hospitals.

It must have produced a heck of a lot of efficiency savings to make that all worthwhile? The italics are mine throughout, the rest are quotes from the report.


“Activity, Staffing and Financial Performance

The first four columns of Table 2 show measures of activity – total admissions, total staff, beds and total operating expenditure. These show a general fall in hospital activity post-merger. Columns (1) – (3) show that post-merger, admissions, staff and beds have fallen by around 11-12 per cent each year.”

So, the merged Hospitals shrunk by almost 12% -less staff, less beds and less patients.

“Column (4) shows the fall in activity is not matched by a fall of the same size in total operating expenditure. In the first year post merger the fall in the growth rate of expenditure was similar to that of admissions, but thereafter was less than the fall in admission, staff or beds.”

But expenditure did not fall as much as the fall in the work done.

“Column (5) examines the number of staff and shows little change in the share of staff that is medically qualified, implying that mergers lead to little change in hospital spending on staff who might bring about higher clinical quality. Columns (6) and (7) examine expenditure on managers and agency staff as a share of total hospital expenditure. The share of expenditure on managers rises a little in the year of merger: the point estimate of 0.35 percentage points represents around an 8 per cent increase on a mean of around 4.4 per cent.”

Wait a minute, after mergers the expenditure on managers goes up by 8% while there is no change in the share of staff that is medically qualified – no more Nurses or Doctors but more managers?

But there was less to manage.

Or maybe they just awarded themselves a big, fat pay rise to celebrate the merger?

“What is more dramatic is the increase in the share of staff who are not permanent employees of the hospital. The share of expenditure on agency staff rises significantly post-merger and by year 4 post-merger is about 1.15 percentage points higher. At the sample mean of around 3.5 per cent this is an increase of around 33 per cent. This provides a possible answer to how merger can lead to a larger decrease in (permanent) staff than in hospital spending. Merging hospitals appear to be offsetting decreases in permanent staff with temporary hires.”

So the effect of the merger is to make experienced staff redundant to ‘save’ money (‘we’re making savings through merging’) but then the expensive managers find they got it wrong, so the cost of expensive, temporary agency staff goes up by 33%, because they got rid of too many medical people.

Agency staff are far more expensive than permanent staff, and they don’t have a commitment to the Hospital (as in “ do I give-a-damn?, I’m outa here”).

DOH! and I thought I was stoopid.

“The last two columns of Table 2 shows a key measure of performance for the government – the surplus of the hospital (in levels) - and a crude measure of labour productivity: the (log of the) volume of admissions per NHS employee in the hospital. The surplus is shown in column (8). It is clear that mergers are costly: any surplus falls in the year immediately before operation as a merged unit and falls thereafter, such that by four years after the year of first operation as a merged entity, the deficit is nearly £3m. This result suggests that mergers are expensive to carry out and result in the increasing deterioration of the financial position of the hospitals involved both in the short and in the long run. Column (9) shows no significant productivity gain following the merger.”

Do my eyes deceive me?

Mergers are expensive.

Managers are expensive.

We end up with fewer Hospitals, which cost more and are less efficient. And more managers.

The result of mergers is worsening financial deficits and no improvement in productivity. That’s a tough one to swallow; I thought it was supposed to be the other way round.

Surely quality must have gone up?

Tomorrow will tell.

 Neil Harris

(a don’t stop till you drop production)


Tuesday, 19 March 2013

Merger Mania five.


One of the findings of the report came out of their study into the effects of competition on the provision of State Health services; this is the creating of an artificial ‘market’, where none really exists.

So in the NHS, the State buys all the services for the patients. Once upon a time there was a great big plan, attempting to match need against resources. It didn’t always work out – that’s the thing with fallible human beings and plans – but they were trying.

Now plans are out and the ‘free’ market is in.

All recent governments have tried to create some kind of market in the belief that ‘competition’ would be more efficient than planning for health needs (that is putting services just where they are needed).

The thing is, a free market is a pretty unfeeling thing, at least where healthcare provision is concerned.

I quote from the report;


“Third, we contribute to research on whether planned systems in welfare provision achieve better outcomes than the private market. There has been a great deal of interest in recent years in competition in education, both theoretically and empirically (e.g., Epple and Romano 1998; Hoxby 2000; Epple, Figlio, and Romano 2004). Initial positive findings on the impact of competition in education (e.g. Hoxby 2000) gave impetus to attempts to promote competition. These findings, however, have been challenged by later research which suggests that the benefits from competition are less easy to achieve (e.g. Rothstein 2007; Bayer and McMillan 2005). Our findings suggest that, in the case of UK hospitals, configuration of the market by government does not result in the promised gains either.”


It looks that trying to create a market where there isn’t a market, doesn’t work. Not least because merging hospitals means reducing competition . That goes back to the ‘median hospital market’ – which is about how many choices you actually get in the real world – which actually fell from 7 to 5, after the mergers. There are some other studies on this and (yawn) I’ll be taking a look at them in the weeks to come.

Foundation Hospitals and G.P.’s commissioning groups are the latest attempt to create a ‘market’ where it doesn’t exist, it’s all about to start next month and it’s going to be run by Sir David Nicholson (Mid-staffs hospital).

That’s not so good.

Meanwhile, there are three more chunks of this – I never said it would be easy.



Neil Harris

(a don’t stop till you drop production)