Roy Lilley and the Commissioning (and Service) Crisis in the NHS

We’ve mentioned Roy Lilley many times. Having worked in some very senior roles within the NHS, he is now one of – perhaps the – most influential commentator on the system with his daily newsletter, as well as conference appearances and public interview sessions with current NHS leaders.

He also lives very close to the nerve centre of Spend Matters Europe (my house) and indeed has been Mayor of Surrey Heath, the borough in which we live. Last week he wrote a particularly powerful article that resonated with me both because of the locality and given my father’s recent demise.

Lilley found an elderly neighbour very ill, and (to cut a long story short) found himself very frustrated – by the inability to get a district nurse or out of hours doctor to come and see her, by the user-unfriendliness of the ambulance telephone service, and the general lack of joined up or patient-focused attitude or care within the system. Eventually the lady was taken into our excellent local Frimley Park Hospital, but as Lilley says, she did not really need to be in there and a better process would have enabled her to be treated at home.

He then rails against the local clinical commissioning group, who buy the services on behalf of the local patient community.  When I checked out the CCG details, I found that the Chair is John Guy, who was Principal of Farnborough Sixth Form College when my daughter attended it in 2006-08. He made it into probably the best sixth form college in the country – a truly non-selective school, it had results that were astonishing under his leadership. Yet perhaps even he can’t overcome the inherent issues of the CCG. What are those issues? Well, a lack of funding to provide the services needed must be an issue, with immigration, people living longer and getting fatter amongst the key drivers of cost pressure.

But Lilley also picks up on the point that the CCG is too small to be effective, saying “they have a budget of £110 million and a population of 90,000 – I’ve seen bigger bridge clubs”!  We said that way back when the new CCG structure was first launched. 500 CCGs across the country meant they were too small to have any “market power” or real influence on the provider market, and too small to have the real process design, medical and commissioning expertise needed. They are heavily populated with GPs – another issue we have highlighted previously, and one that brings inevitable conflicts of interest and perhaps a bias against radical change.

We have to hope that technology eventually helps – again, Lilley mentions this, and whilst my Father received very good care from virtually everyone involved (I think because there is more of a local community feeling in the north-east than in Surrey, and the salaries go further, the attitude is perhaps generally more ‘caring’ to be honest), the lack of technology to support joined up thinking, data and processes was striking. No-one seemed to know anything that was going on with other parts of the system, with hospitals, GPs, social services and district nurses sometimes seeming to be operating in parallel universes.

Back to Lilley – he calls what he experienced “avoidance of service” – a whole new process, perhaps driven by inadequate funding, which means it is not even a case of providing poor or limited service but an aim to avoid providing anything at all.

As he says, “The ambulance service is geared-up to doing everything to avoid sending an ambulance and doing it on bits of paper. The OOH (out of hours service) is organised to do everything but send a doctor. The district nurses are organised to be everything but accessible”.

Nobody wants another wholesale re-organisation of the NHS, but at some point something will have to change. When someone as passionately positive about the NHS as Lilley talks like this, then we have a problem. Do read his article here.

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First Voice

  1. Sam Unkim:

    How about MORE MONEY…

    Where’s the NHS’s share of the wealth created by immigration.
    Population goes up by 10%, NHS funding flat-lined, hardly seems fair !!

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