Private firm awarded 1/4 of new NHS outsourcing "dangerous" and "unsafe"

Impressive, most impressive; the Tory government's semi-privatisation of the NHS is not even halfway through implementation, and already we discover that "Harmoni", a medical service owned and run by private equity, is putting patients' lives at risk.

The Guardian reports on the resignation of their former lead-clinician over safety concerns, his letter at the time describing his reasons for leaving states(among many others);

"One newborn with diarrhoea and vomiting and almost zero oral intake for three days waiting 90 minutes to be seen as 'urgent' at St Pancras ..."

"A 13-year-old with shortness of breath and wheeze wrongly classified as 'routine', mother rang at 11.47, was rung back at 15.23, next appointment available at 18.00 at Whittington, child then waiting over an hour to be seen by which time he was taken straight into A&E due to extreme difficulty breathing."

He warned that he had received reports from GPs working for the service that the levels of understaffing and cost-cutting in service of profits were dangerous, and that a major incident would not be long coming.

His comments are supported by interviews conducted by the Guardian with several other local GPs, who also claimed records of patient contact received from Harmoni were inadequate; that decisions about treatment appeared to them to be made on the grounds of cost and payment rather than clinical need; that their patients were regularly told inappropriately to go to A&E or to clinics; and that home visits that should have been made were not.

They were ignored, and despite the other candidates scoring higher on quality of care standards, Harmoni was awarded more out-of-hours-service contracts because they were cheapest. They've also been awarded one quarter of the new "111" contracts, the "new" nationwide service the government is rolling out in an attempt to drive-down costs in A&E departments by essentially triaging patients over the phone.

And in November, this industrial-scale incompetence and greed resulted in the death of a seven-week-old baby.

That case has prompted more revelations about Harmoni's service;

Documents seen by the Guardian, and sources close to the service, indicate that Harmoni has frequently operated in the capital with shifts unfilled, both recently and over an extended period.

A Norfolk family is suing Harmoni's out-of-hours service and one of its nurses after the death of a 19-year-old woman. Although the nurse has admitted being in breach of her duty, she claims the company should have indemnified her. Harmoni says its insurance excludes responsibility for negligence by nurses.

In the Whittington case, crucial checks are said to be missing from the notes of the doctor who first saw the baby. A second doctor, who assessed the case by phone from another site a couple of days later and downgraded it from urgent, failed to record his call, as is required.

Local doctors were receiving frantic texts from a Harmoni rota co-ordinator for north central London on the Friday and Saturday in question, asking for help with unfilled shifts that weekend, one recipient told the Guardian. Sources say the baby died shortly after arriving at the clinic, which has been regularly overbooked or closed because of staff shortages.

Sources described Harmoni data being "cleaned up" by blaming delays on patients not wanting to take appointments many miles from home, or by recategorising them. Local GPs have reported being puzzled by repeated evidence that targets were regularly missed, despite reports suggesting all was well.

The Guardian was told of the routine overnight report prepared for management each morning, which says that on the night of Saturday/Sunday 10/11 November, owing to staff shortages, for most of the night only one advanced nurse practitioner was exclusively designated to assess the seriousness of calls from patients to the out of hours service for the whole of Harmoni's London contract area. This covers Brent, Barnet, Camden, City and Hackney, Ealing, Haringey, Harrow, Hillingdon, Hounslow, Islington, Kingston, Richmond, Twickenham, and Wandsworth, a population of more than 3 million. In response, Harmoni said four GPs assigned to cars for home visits for the London area were able to cover some of the triage work, taking half of the calls from their vehicles in between home visits to assess the urgency of cases.

In another example, sources say on 26, 27, 28, 29 and 30 November shifts were unfilled overnight at a Harmoni clinic in St Pancras, with no qualified medic or nurse to see patients. They also allege that clinics the Harmoni service is expected to run at the Whittington hospital for patients who need an urgent out-of-hours appointment have been closed repeatedly for several hours, including on 30 November and 1 and 2 December. Harmoni did not dispute the allegations but said it did not believe safety had been compromised.

Concerns about the safety of the service, the number of complaints about its quality, and allegations that its performance data were being "cleaned up" have also been made by the local GPs' representative body, the Local Medical Committee (LMC). Dr Paddy Glackin, who was secretary of the LMC until this summer, said concerns about each of these three issues had been brought to him by several local GPs and staff. Dr Tom McAnea, a GP in Islington who works home-visiting shifts for the service, wrote to Harmoni's regional director in autumn 2010 saying he feared the service had become unsafe because of an aggressive cost-cutting agenda. He decided not to work shifts at Harmoni clinics after it cut the time available for appointments, because he felt it put patients at risk.

Harmoni told the Guardian none of these concerns had been raised with it by the primary care trust or the LMC.

There you have it ladies and gents, "private sector efficiency" at work; long waiting times, understaffing, poor quality of care, overworked staff, manipulating data to hide their incompetence, and ignoring legitimate concerns raised by their own employees.

Not surprised in the slightest. The profit motive works perfectly fine for all sorts of services, but essentials like healthcare really don't fall under that. Far less problematic but still an annoyance is the privatization of the German rail service in my view. Lots of service cutting measures, lots of problems with trains (especially the ICEs) not being up to snuff and so on. But at least those issues are less immediately harmful than doing it to an NHS.

You heard similar predictions of impending doom when Dutch healthcare was privatised, but in the end, none of it turned out to be true and quality increased steadily.

As for those two cases they quote, you can probably find a thousand similar too long waits or medical mistakes in a fully state-run system. Does that mean that those cases are proof that the NHS sucks worse than, say, US private healthcare? of course not, that's not related to the quality of any service, it's just how the medical branch works. If perfectly normal mistakes are made, shit happens. Unfortunately mistakes are always made, even when every effort is made to avoid them.

Plus that of course the Guardian's political side would always lead it to bash any form of privatised healthcare. The article is unbalanced and appears to be cherrypicked.


In short: biased article, no discussion value, non-topic


But can we get Harmoni in the Netherlands please? Out-of-hours care? If you break a bone here outside of office hours they tan your hide at the local out-of-hours GP post. Here in Utrecht, you're only supposed to be injured during office hours and they let you know that in none too subtle terms, or walk around with a broken foot or collapsed lung for a few days untill your regular GP has time. All because the GPs on duty there, and not the health insurers or the customer through the free market determines the services offered there. If only we had a private service specialising in out-of-hours treatment, wow...

...this doesn't really say anything without knowing how prevalent errors were in the 100 % public health care system. That one subcontractor has instances of medical errors up its belt doesn't automatically mean the public system was any better (unless there are credible statistics saying so). And with private contractors, you'll have the opportunity to renegotiate contracts, switching them to the subcontractors which perform best.

There's of course no guarantee that even the best of those will "perform" better than did a wholly public health care system (at least theoretically, they'll always be more expensive, as there's a profit mark up which didn't exist before: The question is whether this is in reality offset by other efficiency gains). But what even constitutes "perform" - lower price or lower error rate - is ultimately a political call, to be made by those in whom democratic legitimacy have been vested. It's not economically feasible for any nation to offer up the latest cutting edge "best practise" in every medical field to all groups of patients with a 0 % error rate, leaving the gap between "best medical practise the nation can afford" and "what's by and large above the minimum professional medical standard" to choose from.

Blablahb:
You heard similar predictions of impending doom when Dutch healthcare was privatised, but in the end, none of it turned out to be true and quality increased steadily.

Documented cases of misconduct turned up by the head of the company's clinical division and the investigative journalism of a national newspaper are not "predictions of impending doom".

As for those two cases they quote, you can probably find a thousand similar too long waits or medical mistakes in a fully state-run system.

Two cases I posted, the article has several others. And if you can "probably" find thousands of similar cases in the NHS, why did you fail to post any?

Does that mean that those cases are proof that the NHS sucks worse than, say, US private healthcare? of course not, that's not related to the quality of any service, it's just how the medical branch works. If perfectly normal mistakes are made, shit happens. Unfortunately mistakes are always made, even when every effort is made to avoid them.

And this simply proves you didn't bother to actually read the articles before regurgitating your standard pro-business bullshit line, because the point of the article is not that the company makes "mistakes", it's that chronic underfunding has led to systemic failures which they have attempted to cover up.

Plus that of course the Guardian's political side would always lead it to bash any form of privatised healthcare. The article is unbalanced and appears to be cherrypicked.


In short: biased article, no discussion value, non-topic

Oh please. The first article is a series of quotes from, paraphrases of, and comments upon(from third parties not the reporter) the letter of resignation from the company's former head clinician, who resigned specifically over concerns that cost cutting and failure to acknowledge problems with the service was putting lives at risk, so the idea that it's "biased" is patently moronic, unless you're saying that reporting the existence of a thing and information from and about that thing is "bias". The second article is only "unbalanced" because it says something you dislike; how the fuck can it be "unbalanced" when they allow the company to respond to the allegations right there within it?

But can we get Harmoni in the Netherlands please? Out-of-hours care? If you break a bone here outside of office hours they tan your hide at the local out-of-hours GP post. Here in Utrecht, you're only supposed to be injured during office hours and they let you know that in none too subtle terms, or walk around with a broken foot or collapsed lung for a few days untill your regular GP has time. All because the GPs on duty there, and not the health insurers or the customer through the free market determines the services offered there. If only we had a private service specialising in out-of-hours treatment, wow...

Hold on, according to your first nonsense statement, Dutch healthcare is privatised. How the fuck do you managed to twist the failure of the private sector to offer you a service into the private sector being the victim?

Facepalms all round. The UK government are all too free and easy pissing our money away on the private sector (I'm thinking transport, but also medical services, and worryingly, policing has been suggested). The result? Zero improvement in service, raised prices, the marketplace is still effectively a monopoly, but this way there's more wriggle-room for passing the buck when something goes tits up - "Incompetent new management!" "Inadequate existing infrastructure!" (See: Railtrack.)

Things will change when I'm dictator for life, believe you me.

Batou667:
Facepalms all round. The UK government are all too free and easy pissing our money away on the private sector (I'm thinking transport, but also medical services, and worryingly, policing has been suggested). The result? Zero improvement in service, raised prices, the marketplace is still effectively a monopoly, but this way there's more wriggle-room for passing the buck when something goes tits up - "Incompetent new management!" "Inadequate existing infrastructure!" (See: Railtrack.)

Things will change when I'm dictator for life, believe you me.

Funny thing - I am fairly convinced many of the Tories' reforms are at least in part about removing accountability from the government. There is often talk about choice and decentralisation from them, but I'm not sure that these things are truly occurring at all. I wonder if the government is centralising the real stuff of power and money, and merely decentralising blame by creating public and private sector middlemen to cop the flak instead.

Magichead:
Documented cases of misconduct turned up by the head of the company's clinical division and the investigative journalism of a national newspaper are not "predictions of impending doom".

It becomes one when a forum member with questionable skills regarding drawing conclusions from data hijacks the numbers and uses them to claim any form of privatisation is the anti-christ.

Anecdotes aren't evidence.

You may believe that any form of market forces is teh evilz, but finding one or two examples of normal medical mistakes made everywhere doesn't endorse that political idea of yours. You'd need to prove there's a significant difference in the percentage of mistakes made between fully government-run and customer-centered private healthcare, and you haven't done that.

In fact, even a thousand anecdotes wouldn't say anything, because we have no baseline to compare it with. For all we know Harmoni is doing better than the previous similar government-run service. Or did any such out-of-hours service even exist at all? Or is their service marginally worse, but lots cheaper, meaning that it's still better?

Magichead:
Hold on, according to your first nonsense statement, Dutch healthcare is privatised. How the fuck do you managed to twist the failure of the private sector to offer you a service into the private sector being the victim?

Because there is no market input on that specific phenomenon of the GP's post, other than that you don't get coverage for brand-specific expensive drugs without any additional health benefits, when a normal alternative is available in their pharmacy. Local governments (municipality level) arrange this, rather than market parties, and local GPs are compelled to spend a number of shifts a month there.

Quality suffers as a result, because the government-run compulsory character of the service gives the GP's post no incentive to improve their work. They deal with nobody except an incompetent city council that's doesn't give a shit unless there's a storm of complaints and merely signs off on the inadequate quality reports every year.

A regular GP's practise on the other hand has to negotiate with the private health insurers about service level and fees, as do hospitals. This gave rise to for instance waiting list negotiation services, where a health insurer scours the country looking for a shorter waiting elsewhere if you have to wait long. Quite usefull for instance if a hospital is being an idiot by trying tests one by one with months worth of waiting between the examinations because they're only using their own resources. In a goverment-run system that means the hospital and their resources determine the quality and speed of treatment, in this system, you yourself determine that. To name an example, if you have an unknown infection, you can either wait a full year while test after test is tried, or you can set the market forces at work, use the insurer's service and have them arrange a treatment plan by several hospitals, meaning that the waiting time between the outcome of one test and the next test is much shorter.

To give a rough idea: Zorgkaart is a non-profit site which collects quality data from feedback. My GP's office scores 8,4/10 from 24 reviews, the GP's Post for my city scores 2,4/10 from 56 reviews, with people quoting rude staff, incorrect diagnoses and even outright refusal of treatment (of actual injuries that were later diagnosed). Let's just say that if you pull that stuff as a private practise, one can be prepared to not last very long.

 

Reply to Thread

This thread is locked