Transparency is a terrific buzz word, isn’t it?
It is very much a buzz word in the politics of health care and provision. Everyone claims that they want to be transparent these days. It is almost as fashionable as kale crisps, and about as palatable.
Transparency, it appears, is very good for all of us.
What transparency is supposed to mean in real terms is that when a body is acting on behalf of their community for their welfare, that that community should be able to see exactly what is being done on their behalf. They should be able to understand why these things are being done. They should be able to ask questions about the process from beginning to end and they should be provided with answers that make sense and which are clear.
Clarity is important.
This all seems absolutely splendid. I am all for it.
Apparently the NHS is as well, in principle. In practice and in certain areas of its administration, not so much, it transpires.
Now I’m going to talk about my new, best friends, the CCG.
You have been warned.
We have, in the last few weeks, received a fair amount of communication from the CCG. Much of it is written in terms very similar to those I describe on yesterday’s blog post about spin.
Spin is another buzz word. It’s a posh phrase for hiding the truth by either lying, omission, or saying ‘Hey! Look at that ruddy great elephant over there! He’s stealing your pies!’ then using the moment you are looking at the elephant to steal all your pies.
Spin pretends that it is transparent. It isn’t. It provides just enough truth to throw most people off the scent.
This kind of transparency allows them to say: ‘We told you to look. It was there in plain sight. It’s your fault you didn’t see it.’
In the interests of further transparency, the CCG are required to divulge any and all care providers they have business interests in, so that we can see that they have nothing to hide and no shady dealing is going on.
They also have a duty of care to state when one of their members has a conflict of interest with any issue they have to deal with.
They are required to provide assurance that these people are not directly involved in decisions by which they may benefit.
This all sounds brilliant. It’s all so transparent you can see right through it.
To the other side.
On the other side of this you realise that knowing which care providers your CCG members are involved in, in no way stops them from awarding those care providers contracts which they pay for with tax payer funds.
This means that as long as they tell you that they are lining their own pockets, they can keep lining their own pockets.
On the other side they can and will tell you about a member of their board who has a conflict of interest in a matter that you might want to understand better because it affects you.
It does not stop that member having influence outside of the one decision making meeting they have to step out of, which might affect how the people inside that meeting are voting.
On the other side, they are free to set up whatever regulations regarding conflict of interest they like, no matter how flimsy or spurious they may seem, because they set their own rules and largely regulate themselves unless someone turns whistle blower and has enough evidence to over-reach them into the heady heights of NHS England.
Who would be brave enough to do that, when the livelihoods of those inside the system depends on whatever meagre crumbs that CCG choose to throw them in terms of their career and funding?
Neat isn’t it?
What transparency means here is performing a magic trick, and showing you how it’s done at the same time.
It’s Find the Lady, and every time they win, and every time they take your money, and they show you that they are doing it, and what they are doing is not illegal.
It’s just unethical and immoral, and greedy.
And it’s being done with our money, and eroding our health service and helping to break it, not heal it.
And they’re asking us to support it.
Transparency means me being able to go to a public board meeting of the CCG, which I did yesterday.
It’s like the circus.
The members sit round the largest board room table I’ve ever seen and perform tricks, and we, as the audience, sit in the cheap seats, tossing peanuts and occasionally being allowed to ask questions, most of which are answered with more spin.
Occasionally they throw you a bone, sacrifice something that doesn’t mean much to them or to you, but does make it look like they are trying to help you, so that they can still be seen to be complying with their mandate.
And all of this is transparency.
Yesterday some things became very clear, despite their attempts to hide in plain sight.
We all know that the priority of the CCG is patient welfare through the successful administration of first and second line services to the community.
Yesterday as I listened to a litany of failures across the city at the hands of the CCG, what is as plain as a pikestaff is their inability to do this job.
Here’s what they would admit to:
The failure of their transport contract with Arriva to hit targets for the third year running. The service is admitted by all to be shocking, but the CCG are finding it hard to get out of because of contractual issues. It means that this will continue to fail for months to come. There was the admission that interim measures put in place to force Arriva to up their game had only temporary success and the situation is now as bad as it was before.
The failure to deal with escalating crisis with regard to Leicester Royal Infirmary A&E and the ambulance service, as 17 more ambulances were stuck in bays with patients waiting for beds on Monday of this week. You will recall I mentioned this also happened last week.
The failure of the four hub surgeries that the CCG funded with millions of pounds to take the pressure off the A&E department. These hub surgeries are supposed to operate as emergency walk in centres. They are underperforming across the board. They are operating at an average 70% capacity.
The CCG admitted that there was an issue here, citing the fact that there was no motivation for the hubs to advertise for new customers as the surgeries had reached a cap point in the amount of money they get for patients. This basically means that the extra work involved in treating patients is not worth the money the surgeries are awarded for taking those patients on. The CCG admitted that this was a problem enshrined in the contracts they had with the hub surgeries and that it could not be addressed until autumn 2016.
They will tell you that the problem with Arriva is one they inherited, they’re doing the best they can.
They set up the hub contracts themselves. There is nobody else to blame.
They also admitted that there is a chance at least one of the hub surgeries will have to close by April 2016.
This is a disaster given how much of our money they cost.
It would be interesting to see how many of the service providers at these failing hub surgeries are providers in which CCG members have a share, wouldn’t it?
They touched on their failure to address the GP exodus. This includes Dr. Lenten, but also the poor take up of the Golden Hello scheme, and the rate at which GPs are being shed across the city.
It did cross my mind to ask whether the closure of GP surgeries in the city might help push patients into the failing hub surgeries and save them from a stay of execution. It is, of course, merely a thought, but an interesting one, don’t you think?
They did say, in fairness, that this year will be the year they work on more attractive packages to entice GPs into the city. We know how well those schemes worked last year, so I will reserve judgement.
Far be it from me to question whether the questionable behaviour of our CCG itself has something to do with the fact that we cannot attract GPs to the city.
These are the things that are transparent. These are the things they have to tell us about. Spin notwithstanding, it doesn’t look good.
I wonder what we’re not seeing.
What is utterly clear is that their greatest success is just how much of a mess they have been able to achieve in the less than 12 months that the CCG has had control over their budget.