Saturday, 11 February 2012


Much in the news these days is the latest plan by the Coalition to operate on the NHS with the aim of providing a better service, as has just about every government since it was created by the National Health Service Act 1946. Also in the news of late has been the question of care of the elderly.

Douglas Carswell has entered the fray with this post, announcing that he intends to support the coalition plans. In this post he writes:
"Of course there are various vested interests opposed to change. They should be listened to carefully and with respect. But at the same time, we should remember that the British Medical Association, for example, has pretty much opposed every single reform ever since the NHS was founded. We should no more run a health service for the benefit of the BMA than we might run a political system for the benefit of MPs." (my emphasis)
Out of the mouths of babes and sucklings........ Mr. Carswell, we do run a political system for the benefit of MPs and it is called representative democracy - but I digress.

Of course Douglas Carswell is correct when he says 'we', as in 'government and politicians' should not run a health service and it is a great pity that government and politicians cannot accept and understand that they should not run anything - but again, I digress.

I would venture that most people believe the NHS, in it's current format, has existed well beyond its sell-by-date and that change is needed cannot be denied. The main problem, in enacting change through the years, is that that change has been driven by political dogma to the detriment of the people. Radical reform is necessary, reform that puts the people in charge of their healthcare and in this respect perhaps a system based on that operated in Switzerland would be the way forward. On the two matters mentioned in the first paragraph of this post, do read this and  this - while bearing in mind the content of the preceding post. That change would, no doubt, present problems in implementation and may necessitate two systems being operated for a number of years, but then radical change never is easy.

Just saying..................


Dave H said...

The NHS has a lot in common with the benefits system - we're here in the middle of the mire slowly sinking, and we need to be over there on firmer ground, but the path between is treacherous and many will suffer along the way.

One lot of politicians would have us tramp deeper into the mire, the other lot would have us take a narrow and unstable path, none of them seem capable of the thought needed to pick the best path, always assuming there is such a thing.

Edward Spalton said...

I have often thought that it is in the party interests of both Labour and the Conservatives, but especially Labour, to keep bickering about the NHS.

It is certainly a "dog whistle" issue for Labour supporters - the wicked Tories will close down the NHS and put the sick and poor on the streets.

For Tories, there is a genuine sentiment of wanting to cut down bureaucracy and, perhaps, introduce some efficiencies which might result from using "business methods".

Yet is was Labour which was by far the most active in office to introduce the disgracefully expensive "Private Finance Initiative" projects which combine the worst effects of business and bureaucracy with the corruption of the "revolving door". Ministers and senior officials who awarded contracts for billions draw their inflation-proofed pensions on retirement and re-emerge a year later as handsomely paid directors and consultants of the firms to which they awarded the contracts.

I haven't looked into it in depth but understand that, in mainland Europe, the political parties co-operate on the agreed general framework under which the health service is provided on an insurance-based model, so that huge amounts of money and staff time are not wasted in convulsive, self-cancelling reorganisations every five years or so.

Back in the early Seventies, I remember my aunt, a deputy matron, puzzling over masses of huge glossy brochures about the then current re-organisation. "I've looked everywhere" she said "and can't find a mention of the patients anywhere".

TomTom said...

The NHS today is not what was founded. It has lost its local aspect, I am a Member of a Foundation Trust, it means zilch. I asked Monitor to remove the Board appointed by Milburn. I have no real say or information and I am better educated than anyone on the Board.

The fact that I must self-diagnose because GPs have become attuned to prescribing long-term medication without review or withdrawal, shows how poor patient review really is.

I have seen German and Us medical systems in depth and do not think one better than the other, or than the NHS. I simply think the NHS is monolithic and run by political stooges and has lots of low-paid jobs that probably should not exist.

I do see how every Government rewards McKinsey, Bain, BCG, Booz etc with huge contracts, and I know these firms from the inside and it is no answer.

The Treasury wants to offload hospitals and care and keep the revenues; it was NHS to be an Insurance Company feeding revenues to the Treasury and make patients pay up front for care and claim reimbursement.

It is so obvious politicians cannot be trusted on the NHs but that change is necessary

Edward Spalton said...

Not forgetting, Tom Tom, that the Staffordshire hospital which probably killed some 1200 patients in conditions of appalling neglect and degradation, was meeting all its targets for Foundation Trust status. A few nurses may eventually face some disciplinary action for this. The responsible managers will have long moved on to promoted posts. Doctors and nurses said they were afraid for their jobs to speak out.

Here in Derby, we are very fortunate. The Derby Royal is excellent - so proper leadership can make the system work. One has the feeling there that things are under control. Whilst there are lots of boxes to tick, I never felt I was one of them and others who have had longer stays for serious conditions say the same. So I think the NHS is probably like the curate's egg.

TomTom said...

Doctors and nurses said they were afraid for their jobs to speak out.

During the Thatcher Era Gagging Orders were imposed on Medical Staff - they have never been rescinded. It is a Disciplinary Offence to speak to the Media without Management Permission.

As for Northl Staffordshire, you might want to read The North Staffordshire Whistleblower - The Executive Summary

about Dr Rita Pal who was persecuted by the GMC for exposing matters


WitteringsfromWitney said...

DH: Of course there is a path and it is one that should be taken so that health care is localised as it is in Switzerland.

ES: The Tories may want to cut bureaucracy but they still want to retain the central control. I have to return to my central theme - Government shouldn't 'run' anything.

TT: As I said the NHS has outgrown its sell by date. As ES says in his comment following yours, meet targets and all is well - well all is not well.

JVB said...

Here's a proposed path for NHS reform: would love to have it critiqued.

Let anyone who wants to opt out of the NHS opt out (except for A&E - I'd want to keep a nationalised A&E for now: not sure what I'd do long term).

Those who opt out would receive a tax deduction worth 50% of the current average cost of NHS care minus the cost of A&E. This would give people c. £1000 which would buy private health insurance (though there would be no compulsion to do so). Deregulate all private health care, but keep the NHS the same. (Keeping the NHS unchanged could be sold as keeping it stable, so they don't need to go through expensive reforms again. In reality we would be keeping the same poor service in place, so encouraging people to opt out).

Those opting out of the NHS will still contribute to the cost of the NHS (i.e. the remaining 50% of the average cost. This is politically important, and ensures some stability. Over time the rebate could increase to 100% of the average care cost - but change needs to be relatively slow)

Those on very low incomes, and therefore not paying tax wouldn't get a rebate, but they would still have access to NHS care: their care would be essentially unchanged (politically it could be argued to be better: there is more money per patient available, with many people no longer using the NHS services)

The rebate should slowly increase to 100% and an individual should be able to sponsor others to opt out (i.e. families, but also friends and even strangers: a market could develop where someone's tax is reduced by £2000 in exchange of giving someone £1800 worth of medical insurance).

Eventually most people will be on a private scheme, with only those who are poor or very ill staying with the NHS. At that point the NHS will no longer been seen as absolutely essential, and we will be in a position of re-evaluating what is needed for healthcare in this country.

(During this process we'd expect private healthcare to increase and the NHS to decrease. Private practices should be able to hire/buy/use NHS properties/equipment/personel so that we don't have too many politically difficult hospital closurs)

The plan is very simple - it only require a government who doesn't want to control everything to come to power. (Which is hard to imagine).

Would appreciate critical thoughts

WitteringsfromWitney said...

JVB: Sounds feasible, however it needs a better mind than mine to work out how this could be implemented.

Alternatively, how about those starting work and those up to the age of say 25 who probably have had little or no reason to use the NHS began to pay medical insurance - over two decades things would begin to level out and after that medical insurance would start to become the norm and the NHS would 'die'. All their buildings and equipment can be taken over by the private sector?

JVB said...

The new centralised NHS database (if it is working) should be a help towards implementation. Anyone opting out would need to inform their GP and the tax authority and some cross check could be done.

Alternatively, the first time someone uses their GP in the new tax year they would show a certificate from the tax office that they have not opted out of the NHS.

Must admit though, given how good large governments are with computerised systems, implementation might be hard.

The advantage of the idea in my mind is that it could also apply very easily to education as well and (though a bit more difficult) to pensions.