I don't often read the local paper and I don't know why I did tonight, especially as the front page headline was about some common land being fenced off for the grazing of cattle. It sounded like something from the beginning of the Nineteenth Century. But there were two articles that caught my eye. One was about the report of the Police and Crime Standards Directorate, which apparently ranks the local police force as third best in the country.
The second was about the Health Commission’s report in the local hospital. On use of resources it ranked excellent but on quality of services it ranked only fair. This was despite meeting all 24 core standards and gaining an 'excellent' for diagnostic services (my old department). Apparently it fell down in three areas. The first was in meeting targets for reducing smoking. What exactly a hospital can do about this, I'm not sure - surely it is a task for the community and general practitioners? However, the failing was that junior doctors were not sufficiently rigorous in writing in the patients' notes whether they were smokers or not.
The second area of concern was tardiness in transferring patients out of hospital. In Bournemouth this generally means transferring old people from hospital to rest home. Unfortunately, there is not much they can do about this. Compared to a few years ago, the number of beds for residential care has diminished. This is almost entirely because of government regulation. The economics of running a care home have changed. First, costs have increased. The national minimum wage has meant that staff costs have risen, and the European Working Time Directive has limited the amount of overtime staff can do. Health and safety regulations have added costs - fire doors wheelchair ramps, stair lifts etc have all become necessary. Second, reimbursement from the public sector has not kept up with inflation. This is because the government measure of inflation gives a falsely low rate, by weighting it with things that are reducing in price, like DVDs and electrical goods rather than things that increasing in price rapidly, like fuel, food and staff costs. Third, reorganization of local authorities has meant that rather than having dedicated social workers specializing in patient transfer, achieved by having larger local authorities, the smaller local authorities have to employ 'Jack-of-all-trades'. One physician for the elderly told me that whereas he had a specialized team of social workers to move patients into residential care, he was now dealing with 19 different social workers who were trying to transfer 29 different patients. Fourth, there are now perverse incentives for owners of property formerly used for residential care.
Recently, a house a few doors along the road from us sold for £417,000. It was not in very good condition, and I thought it a good price. It was demolished and a block of 8 apartments assembled on the site of the house and garden. Each will have 2 bedrooms and sell for £200,000. The whole build took 4 months and cost about £100,000. The developer makes a cool million pounds. The government is encouraging high density housing. Why? Because they admitted between half and three-quarters of a million immigrants from Eastern Europe last year and they have to live somewhere. No wonder we have too few places for residential care. it is not a sensible place to put your money.
The third area where the hospital fell down was a failure to make a 50% reduction in the number of cases of MRSA. The difficulty was that there were so few cases to start with. If you are overrun by MRSA like some big London teaching hospitals with Victorian buildings, it is quite easy with simple measures to make a big reduction in cases. However, if you have a modern hospital with clean customers and very low incidence, making a 50% reduction is next to impossible. The pips are already squeaking.
This is the problem with targets. They are never sufficiently tailored to the individual organization. It's like setting the same target for a child in his first year at school as one in his sixth year. It comes from central direction of health care. There are only few hundred hospitals. Why doesn't somebody have the bright idea of setting them individual targets? Imagine if HR departments set every employee the same target. If anybody reading this knows anybody in the Health Commission, perhaps they will suggest it.