Thursday, 24 March 2011

Lansley and his lies: a tired corrupt joke

I recently took the time out to listen to a certain Andrew Lansley interviewed on, unfortunately nothing surprised me. Lansley comes across as a slightly unpleasant and aggressive individual, he doesn't like having to answer questions, he seems to just assume that 'his change' is good change.

I was not impressed by several of Lansely's naive assumptions. He frequently talked of 'decreasing bureaucracy' but he was never adequately questioned on this. The reform is costing several billion in itself, while the reorganisation of PCTs into GP consortia hardly promised to do much to the size of the administrative layer. Lansley should have been asked why introducing a marketised system with a central regulator 'Monitor' will drive down the bureaucratic costs, all the evidence suggests that markets like this lead to more bureaucracy, not less.

One thing Lansley was also not adequately questioned on was emergency care at NHS hospitals. The current white paper is the thin end of the wedge, it's one thing for certain elective work to be farmed out to alternate providers, but the problem comes when hospitals start to lost bits of their services and are still expected to provide the unprofitable emergency services in areas such as surgery/medicine/obstetrics etc.

Lansley talks of commissioning leading to 'more integrated services'. Relating to emergency services as explained above, certain hospitals will start to lose various bits of their axial skeleton while still being expected to run at the same speed in providing decent emergency services. Lansley needed to be grilled and taken down on emergency services, 'the fragmentation' will destroy decent DGH emergency care, it is an inevitability. Emergency care is unprofitable and the private firms will not bid for this, the NHS will be left to pick up the pieces but they will have lost essential parts of themselves, it is a disaster waiting to happen.

'Not allowing cherry picking', ignoring the improving outcomes and patient satisfaction levels, there were just so many cases in the interview where Lansley ignored the point and just repeated the same old claptrap. Lansley got far too easy a ride, he was very rarely grilled, hardly ever picked up on his errors, barely interrupted. interesting how is links to Care UK were not questioned at all in this interview. Not impressive in my eyes.

For anyone else worried about the government's 'reform', have a look at this, the rewording of Clause 2 looks rather key:

"Clause (2) is the crucial one. Where the wording used to be ‘must’ (provide services etc…), with its attached duties, it is now ‘must act with a view’ (to provide services etc…).

Now, note the syntax. In the previous wordings, the compulsion created by the must was to ‘provide (services etc)’. In the proposed amendment, the compulsion created by the must is to ‘act (with a view etc)’. At a stroke, the Secretary of State’s duty to provide services has been transformed into a duty to ‘act with a view’ – and ‘acting with a view’ is most certainly not the same thing as providing a service. The ministerial duty has been removed."

Neither Lansley or his words impress me, he's like a tired broken record, his expensive creation of yet more bureaucracy in yet another corrupt politically motivated deckchair reorganisation is bound to fail patients.

Thursday, 17 March 2011

The 'principles' and the lies

It is quite astonishing what lies are being told as the government tries to railroad through it's destructive health white paper. As always with rubbish corrupt policy, the 'principles' behind it are the common defence used, irrelevant of the fact that the actual reforms will do nothing to to respect or even live up to the so called sham of the 'principles'.

We saw the same with MMC (Modernising Medical Careers), it was a useless load of policy designed to dumb down medical training, but who could argue with the principles? The principles of 'making training better for everyone' were fine, but the problem was that the policy behind these principles was only going to make things worse, the 'principles' were just a sham, a pretence that the government wasn't going to screw everything up in a royal fashion. In the end the principles turned out to be fine, it's just a shame that they were a smokescreen for the carnage and damage that resulted from MMC.

The same smokescreen of 'principles' is being used with the government's destructive current reforms, who could argue with making every one's health better? It's just a shame that the white paper will do nothing to live up to the noble 'principles' that the dishonourable Andrew Lansley keeps rambling on about.

Dr Grumble's excellent recent talk of the 'health tsunami' is spot on. It is quite clear that the Conservative and the Lib Dems are lying through their teeth in betraying those who voted for them. Both parties have completely ignored their manifesto promised to shaft the public with this program of enforced privatisation of the NHS. The BMA are quite rightly trying to stand up to this wave of propaganda and doublespeak, the problem is that the media do not appear to understand the issue and don't give the government's lies nearly enough critical analysis.

Monday, 7 March 2011

BMJ bias: the sorry Needham saga

The following letter has been signed by a number of doctors and sent to the BMJ, the author has sent it on to me to publish here just in case the BMJ decide not to stick it up on their website. It focuses on the BMJ's strange decision to give Gillian Needham a free shot of self justification the other week. The BMA has subsequently published only a small percentage of the rapid responses on their website, they have also only published by far the least critical letters in print form. BMJ bias, you work it out:

"We, the undersigned, believe that we represent a broad cross section of the medical profession from UK shores and as such, we believe that the BMJ's decision to publish Gillian Needham's 'personal view' was a massive editorial error (1) for which the BMJ should apologise. The BMJ's consequent editorial decision to publish only two of the least critical responses to Gillian Needham's twisted and one-sided tale of self-justification in print is both disappointing and unrepresentative of the general feeling of the medical profession. Perhaps the BMJ is hoping that the focus on their initial editorial error will shift and that by failing to publish the other side of the story fairly this process will be catalysed. Whatever the motivations were behind these editorial decisions, I would like to register my disapproval of the BMJ's coverage of this whole affair. Would the BMJ care to apologise or at least attempt to justify its biased coverage of Needham’s flagrant abuse of her position of medical power?

1. Needham, G. Free speech and professional duty: why I couldn’t fight tabloid rumours. BMJ 2011; 342:d752 "

I wonder if the BMJ will respond on this, I cannot imagine they will apologise, even though it is clear they should do, the editorial decision that allowed Needham's personal view to be printed was a massive error of judgement.

Wednesday, 2 March 2011

Bravo Baroness!

I must apologise for being so lazy with this little blogging effort. I stumbled upon this blogging piece which links in two excellent pieces of opinion the government's disastrous White Paper. The Baroness's excellent piece has been repeated here:

"I can’t support the coalition plan for the NHS
by Liberal Democrat Peer, Baroness Williams of Crosby

Some of the health service reforms are valuable but the scale is too great and too many questions are unanswered. Being in a coalition government produces difficult dilemmas. I support the coalition agreement. I believe the coalition is necessary to tackle our immense financial crisis. But every now and then, a dilemma emerges that cannot easily be resolved. Such a dilemma for me is Andrew Lansley’s health policy.

I campaigned nationwide in the last general election on the basis of the Liberal Democrat manifesto, reiterating our strong commitment to the National Health Service. The coalition agreement, which promised “to stop top-down reorganisations of the NHS” and made no mention of insisting on competition, posed no problems. On reading it I felt the NHS was safe in David Cameron’s hands.

But a recent report by the candid and incisive Commons Health Select Committee pointed out big differences between the agreement and the subsequent White Paper, Equity and Excellence: Liberating the NHS: “The coalition programme anticipated an evolution of existing institutions, the White Paper announced significant institutional upheaval.”

As a Liberal Democrat parliamentarian, I am under no obligation to support policies outside the agreement. Indeed, I have a moral duty to the voters I asked to support us to find out exactly what Mr Lansley intends and its implications for the NHS. So I have a few questions.

But first let me say what is valuable in his proposals: the recognition that the NHS must become more efficient if an ageing population is to have good care; the joining-up of healthcare and social care vital to the wellbeing of sadly neglected elderly people; reducing bureaucracy, though it will be easier said than done; ending Labour’s often niggling interventions in professional judgments, which left a legacy of resentment. There is, however, an unresolved tension between an emphasis on good management for obtaining efficiency savings, and the plans for radically reducing NHS staff.

I have four questions: the cost of the reorganisation, the accountability of the new GP consortiums, the role of the private sector and patient choice.
The cost
What is the cost? The Government must reduce public spending from 2011- 2015 by £80 billion. If it can’t, its strategy will have failed. The NHS accounts for a third of England’s revenue budget and 11 per cent of its capital budget. It faces relentlessly growing demand.
David Nicholson, the chief executive of the NHS and now of the National Commissioning Board, noted in 2009 that the NHS must find £15-£20 billion in efficiency savings in the next four years. But he himself believes that “to do so will require clear and effective management every step of the way”.

Key to this is a 40 per cent cut in management costs. Already hundreds of managers have left Primary Care Trusts at a cost of about £1 billion. The impact of this is not yet known, but GP commissioning consortiums are bound to look for good managers, some of whom will be hired from outside the NHS. They are likely to cost more. Some 20 per cent of the savings will come from moving patients from specialised hospital care to treatment by GPs or nurses in the community.

The final 40 per cent will have to come from clinicians and hospitals, an estimated £2 billion a year. Such huge savings will almost certainly entail an element of rationing. Waiting lists for routine operations are lengthening, and in some cases they are being postponed or cancelled. As the National Audit Office observed: “Government reorganisations … frequently entail higher costs than anticipated”.
What arrangements are there to hold GP consortia accountable for quality of care? Primary care trusts (PCTs) were accountable to Strategic Health Authorities and, ultimately, to the Secretary of State. They were overseen by local authority committees. Meetings were held in public and the minutes made available. The new consortia, responsible for about £80 billion, are not obliged to meet in public. Local health-watch groups may scrutinise them but have no power to hold them accountable. Suggestions for adding knowledgeable lay people, members of other medical professions such as clinicians or nurses and elected local representatives have come from many quarters, but it will be up to each consortium to decide for itself.
Accountability upwards will be to the Secretary of State via the NHS Commissioning Board, but the board has no powers of oversight.
The private sector
What are the Government’s intentions here? Private medical practices work closely with NHS colleagues and were encouraged by Labour to bid for contracts at a price determined by the NHS tariff. Competition for these contracts depended on the quality and effectiveness of service. There is a cap on the proportion of private beds in Foundation Trust hospitals, which varies according to earnings from private patients and is much higher in London. Last year the private sector treated 220,000 patients.

The Government is now preparing to remove the cap, renegotiate the tariff and require the National Commissioning Board to promote competition. This will open the door to competition on price, not just quality. Many clinicians fear that the private sector will skim off profitable routine operations, leaving expensive, complicated treatment to the NHS.

The body that will license health providers is Monitor, which oversees foundation trusts. Its chairman, David Bennett, wants healthcare exposed to competition like gas and rail. British Gas raised energy prices by 7 per cent last year, while making £700 million in profits. Since rail privatisation, the UK had paid the highest fares in Europe. Should this inspire confidence?
Patient choice
How does the Secretary of State reconcile this with the need for large savings? Mr Lansley puts great emphasis on the involvement of patients in their own treatment. That’s good but achieving it in practice is hard. Articulate and self-confident people are likely to benefit, but elderly or busy patients will have little basis for their choices beyond rumour or GPs’ advice. Choice must be balanced against the realities of a publicly funded service.

Underlying the debate about health is another about values. For some of us, health care is a public service, strengthened by partnership and co-operation, the model in most Western European countries. For others, it is a market in which price determines quality, the US pattern. A June 2010 study of 11 health systems by the US-based Commonwealth Fund said of the US system: “Compared with … Australia, Canada, Germany, the Netherlands and the UK, the US system ranks last or next to last on five dimensions … quality, access, efficiency, equity and healthy lives.” The NHS was the second least expensive per person after New Zealand, and came first on effective care, efficiency and cost-related access, and second on equity and in the overall ranking. Why we should dismember this remarkably successful public service for an untried and disruptive reorganisation amazes me. I remain unconvinced."

This is all absolutely spot on. The Liberal Democrat MPs who are supporting the White Paper should hang their heads in deep shame, they can have no excuses at all, they are selling their souls. There was also an excellent bit of journalism on the Channel 4 news tonight exposing some other problems with the proposed system, huge conflicts of interest indeed.