Amid a snowy backdrop, moves afoot to whiten rules and procedures: Health Policy Today 2nd February 2009

This summary of health stories today reflects a subtle social and political shift in favour of greater clarity, transparency and thrift. After heavy snowfall, we now have the perfect backdrop for a renewed push on whiteness. Greater transparency is becoming a key political theme for the NHS.

How much?

We are still seeing stories exposing the large staff costs of institutions that are not very well understood. The Mail On Sunday yesterday featured the following headline: 'NHS quango set up to cut nursing costs spent £1m on bosses'.  It is the story that NHS Professionals has been paying some pretty serious wonga on senior executives to guide its strategy.

As you'd expect, the Tories are outraged and have 'demanded an inquiry after it emerged that NHS Professionals paid a private company £1,700 a day for chief executive John Faraguna and £1,150 a day for director of operations Stephen Dangerfield.'

You won't believe how angry Matthew Elliott, chief executive of the Taxypayer's Alliance, is about it. He says it is "ludicrous"' that such large sums were paid to an outside agency whose aim was to restrict the amount of money the NHS spends on agencies.”

“To squander such vast sums of money on outsourced quangocrats when this body was supposed to reduce the cost of agency staff is tragically ironic," he said. "This is a prime example of the public sector culture of throwing money at a problem instead of addressing root causes such as lack of planning or poor management. Serious questions need to be asked about the spending priorities and hiring practices of the Department of Health, and this sort of ludicrous waste must not be allowed to happen again.”

And there's more
And that's not the only scandal along these lines reported today. The Times leads with '£18 billion scandal as Whitehall's IT plans spin out of control'.  A lot of that is due to the NHS.

As the paper explains, 'plans for new computer systems are years behind schedule and have ballooned in cost; others have been scaled back or even scrapped. Yet companies continue to make hundreds of millions of pounds in profit, with £102.3 billion forecast to be spent on government IT projects over the next five years.'

Lords a-lobbying
Health has been drawn into the Lords lobbying row.  The FT last week reported that a legislative attempt to govern the promotion of unhealthy children's food was stymied in the Lords 'after “vociferous” opposition from a peer who speaks for the advertising industry'.

The FT say, 'Baroness Buscombe, a former vice-chairwoman of the Conservative party, was described by one fellow peer as leader of the “kill-the-bill brigade” which stymied the television advertising (food) bill. The proposed legislation sought to limit the advertising of unhealthy snacks until after 9pm.'

The role of lobbyists is attracting more attention, not just in terms of influencing legislation on health, but influence within the NHS - on the drugs it dispenses and the equipement it procures.

The emphasis  on transparency is not linked solely to money.  There is growing emphasis on observing procedure.  The potential for the influence row to hit health is large because of its complex activity.

Greater clarity from doctors
The financial stories will continue, but an emphasis on transparency extends into other areas in today's press, but before illustrating further, let's begin with a light-hearted example of another area in which clarity is becoming important.

It comes from today's Western Mail, Wales' main paper.  It reveals that because it is difficult to decipher doctors' handwriting, a scheme will issue doctors with name stamps as part of a pilot scheme in Conwy and Denbighshire'.   As well as their name, 'the stamps will also include the doctor’s General Medical Council registration number, making it easier to identify them'. The pilot has a serious aim. It is just as much to let fellow professionals know who has directed treatments.  Pharmacists for example find it hard to decipher 'just a squiggle'.

The BMA in Wales doesn't mind the scheme.  It's chief executive, Richard Lewis (himself a GP) said : “Even if notes are legible, unless someone has a clear signature it is not always easy to tell who made those notes. It is extremely important for any health professional writing in a patient’s records, or making electronic entries, that their actions and comments can be traced back to them".

No pens for doctors
It is just as well that doctors will have to stamp their name because if a heavily-previewed report gets its way, there will soon by no (free pharma) pens for doctors to sign with.

A lot of space was given to report on the relationship between doctors and the pharmaceutical industry, ahead of a report not due until Wednesday.  A working group at the Royal College of Physicians have been looking into the issue, led by Lancet editor, Richard Horton.

The aim is to stop the gift culture between doctors and the pharmaceutical industry, though it will have uch broader implications for the 'gift relationship' between the NHS and the industry.

As Nick Timmins says in the FT, 'The industry's code of conduct limits gifts to small promotional items such as pens or smaller items of medical equipment. But it also holds or subsidises many educational meetings and conferences, in some cases paying travel and accommodation expenses'.

The press reports tend to focus on the small stuff of the RCP report, such as drug companies giving pens to doctors.  Yet the issues are much bigger than that: the use of doctors to promote experimental drugs, to fund trials and large amounts of money spent by pharmacological companies on supporting educational meetings and initiatives.  

The most interesting parts of the report contrast the relationships that pharma builds with doctors compared with a perceived lack of support from NHS management.

It said: 'It is partly because the NHS fails to value doctors, while the pharmaceutical industry is good at expressing this value, that practitioners turn to industry and become dependent on its gift culture.

In fact, pharmaceutical firms play an important role in supporting a lot of activity that should be the core responsibility of the NHS – medical education, clinical research and so on.

Public anger about evading responsibilities
The Guardian today leads with the story of large firms who are placing leading brands in the hands of foreign owned vehicles so as to avoid UK tax.  There is nothing likely to irk a Guardian reader more than tax avoidance.  And, to be honest, in these current times, when we are all pledged to pay of banks noughties debt for the rest of our days, nobody likes a tax dodger.

Metro-politician Frank Field told today's Daily Politics , “People who don't pay taxes shouldn't be making laws for the rest of us”.

He was responding to a story in the Sunday Times which reported that justice minister Jack Straw intends to legislate so that members of the House of Lords who break laws or don't pay tax can be removed from their seats.  Interesting connection.  In these current times, tax dodgers and criminals are in the same bracket.

Hassle for Daschle on unpaid tax
Not everything is running smoothly for Barack Obama in the States. His pick for health secretary has run into a few problems during the vetting process. He has underpaid on his tax return. After being forced to replace his business secretary for similar reasons, is the appointment of Daschle in doubt?

We will know more tomorrow as today Tom Daschle is appearing in front of the Senate's finance committee to explain himself.  The critical issue, the Washington Post explains, is the 'gift' of a chauffer and  driver paid for by the head of a private equity firm.  It is also reported that Daschle hasn't declared all of the income he receives for speeches and consultancy.

In a letter written to the chair of the finance committee, and released to CNN today, Mr Daschle says he is "deeply embarrassed and disappointed by the errors that required me to amend my tax returns".  “I apologize for the errors and profoundly regret that you have had to devote time to them".

Mr Daschle has some high-profile supporters who thinks he will survive the process and be appointed.  John Kerry considers the matter resolved. "Months ago, Tom personally and proactively addressed the taxes issue and took all necessary steps to correct his innocent error," Kerry said. "I've known Tom Daschle for years and he is a man of great character and integrity who will do a superb job in helping us fix our healthcare system. I look forward to his speedy confirmation."

We will see.  Financial transparency is becoming much more important as the recession sets in.