Thursday, 29 December 2011

Another man with his head up his arse.

This is Mike Farrer, who is chief executive of the NHS confederation. He it is who thinks that 25% of hospital in patients don’t need to be in a hospital bed. It is true that many patients, particularly the elderly and chronic sick can prove difficult to move out due to lack of community facilities, but the proportion is nowhere near that percentage, and it is also true that, even if this were addressed there would still be plenty of patients queuing up to take those vacated beds.

The fact is that there is chronic under provision of acute beds, and the frantic drive to discharge patients as quickly as possible inevitably results in the high readmission rate we currently see.

Despite Mr Farrer’s years in the NHS he seems blind to the fact that both NHS consultants and GPs are increasingly finding it difficult to find beds to admit patients to. 

Medical admission and discharge are clinical decisions, and NHS clinicians have no incentive to keep patients in hospital unnecessarily. So by and large if a doctor thinks a patient should be in hospital he is the one best qualified to make that decision. 

Mr Farrer thinks that we should be moving more towards care in the community, rather as was done with psychiatry, and patient self care, otherwise known as “you’re on your own mate”.

So what qualifications and experience does Mr Farrer have that makes him feel he can pontificate on clinical matters to clinical professionals? Well his first NHS job was as a gardener. Before that he worked for Grand Metropolitan, and was a semi professional footballer. Not a doctor then. His numerous roles in NHS management do not qualify him to venture any opinion on a single hospital patient’s requirement for admission, or readiness for discharge. Perhaps instead of hectoring doctors in both primary and secondary care, and telling them how to do their jobs, he should shut his ignorant mouth and listen.


  1. Well, Zorro. That's your knighthood gone for ever.

    You know he wants to discharge everyone so the hospitals can admit lots of lovely private patients to have their facelifts.

  2. why dont they tell the truth you can't possibly have hospitals full of the old, sick and infirm because who want's to be a customer in a place like that
    damn why don't the poor,the disabled and the elderly do the decent thing and die ! would help save the country from bankruptcy

    yours kindly

    Sir Cameron Clegg

  3. I wonder if this was one of Farrar's brainchildren while he was running NHS North West:

  4. I think the answer lies somewhere in the middle. It is not possible to say that 25% of pastients do not need to be in hosiptal at any one time; we just don't know. However, it is surely the case that the NHS is not 100% efficient. As a retired NHS manager (sorry!) i know perfectly well that patients are delayed in hospital because of delays in diagnostic tests, insufficently organised co-ordination between departments, inadequate discharge planning, weekends, and a host of other things. These have been around for years and the difficult bit is doing something about them. The main problem is that politicians/managers select an arbitrary target, close beds and then run around trying to find the means of doing it, rather than the other way round.

  5. My experience of old age psychiatry is that you end up with wards filled with social admissions (dementia, can't be looked after at home anymore, needs placement in a care home) while the few risky mentally ill patients who make it in are discharged in double quick time to make way for more social admissions who will then languish on the ward needing no acute input other than management of the occasional UTI while social services and the family drag out finding a placement over months and months.

    And who determines admissions in psychiatry? Nowadays it is usually managers and 'modern matrons', not medics, because they are such scarce resources that medics can't be trusted to ration them because it conflicts with their duty of care. And who will get to the front of the cue? Those whose relatives make the most noise, not those with most clinical need, because that'd what management pay attention to - after all, they don't have any clinical responsibility or professional liability.

    Until NHS and social services are integrated acute beds will always be used as a convenient place to park problems from the community.

    And if we're serious about using NHS acute beds efficiently then we need to move to a 24hrs, or at least 7-days a week service where staffing levels are more than the skeleton crews we see at night and weekends at the moment. It is frankly miraculous that there aren't more deaths and SUIs than we currently see given how few (and inexperienced) clinicians are working out of hours.

  6. It's a very simple moneysaving device.

    Shunt people out of hospital into the community. Tell them most/all of their care needs are social care needs not health care needs.

    Social care via local authorities is (a) rationed according to levels of need (to an absurd point) and (b) means-tested.

    This has been going on more and more with dementia for some time now.