NHS Reforms


Two stories here and here hit the press yesterday on how the NHS is continuing to fail patients.  The first details how Doctors, though uniform lack of knowledge, are failing to treat patients with kidney disease effectively.  The second is about how NICE is, yet again, denying patients in the early stages of Altzheimer’s disease effective treatment that can prolong a reasonable quality of life for a significant amount of time.

I am sure that with the expected cuts in NHS spending we are going to hear many more stories like this.  How many will it take before the Government starts to make some real reforms that will stop the obsession with the out-dated model that is the NHS and start to think about how they can really help to assure – rather than provide – improved health care for all.

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The NHS Confederation will announce today that by 2011 there will be a major shortfall in NHS funding leading to a crisis in the provision of care.  The Confederation are concerned that the NHS will not survive unchanged.

Well I hope they are right!   As I have blogged before here and here, the NHS is not doing the best for its patients now with the historically high amount of funding received since Labour came to power in 1997.

The unions are apparently up in arms as they fear more use of the private sector in health care provision.  The time has come for the unions, such as the Royal College of Nursing, the British Medical Association and Unison, to wake up.  For more than sixty years the NHS has tried and failed to provide uniform health care for all, and it has failed.  Now is the time for the independent sector to increase its involvement in health care provision.

Andy Burnham must not give in to pressure from the unions.  He must push through vital reforms that will be good for health care.  It must also be recognised that that will not necessarily be good for the NHS.  The NHS is an out-dated institution that has had its chance and failed, it is now crying out for reform.  The next few years might just be the right opportunity for a determined and right thinking Secretary of State for Health to push these reforms through.

As far as the main stream media have been concerned, things have been very quiet at the Department of Health recently, so this prompted me to have a dig around to find out what our erstwhile health team have been up to.

Interestingly, Lord Darzi, one of the Health Ministers, is initiating a little publicised project called Personal Health Budgets (PHB), a new way of funding NHS care for chronically ill patients.  I first wrote about this here in January, but this week the Trusts undertaking the pilot schemes have been announced.

My criticisms of this project remain the same, while I applaud this initiative, I do not think that it goes far enough.  My view is that if projects like this are to really work, patients must be able to purchase care from the private sector as well as the NHS.

As part of my digging around I telephoned the PHB office.  Here while asking one question, “Will patients be able to purchase care from the private sector?”, I was passed around to speak to a number of people within the department.  The general gist of the replies I got was that the guidelines have not been developed yet, most of their experience is in social care not health so they are not sure what will be decided for health care and finally, they are not sure what will happen if patients become acutely ill because patients do not have the experience or knowledge to make such ‘difficult’ decisions! (or to put it bluntly, patients are not trusted to make decisions because the bureaucrats might not like the outcomes!).

This leads me to suspect that yet again an enlightened project will be derailed a bureaucracy that really doesn’t want patients to behave like customers.

This story from the Daily Mail, is evidence that Government and Politicians never learn from their mistakes and should not be left in charge of health care. It is a report that despite a lovely new contract and a bonus filled salary scheme for the doctors, patient care is no better.  Apparently, once General Practitioners have met their targets of signing up enough patients to be paid the full bonus amount they do nothing further to enhance or improve their patient’s health.

This Government obviously does not remember that in 1948, following a long stand off with the British Medical Association, Nye Bevan was forced, at the last moment, to “stuff their [the doctors] mouths with gold” to ensure that the plans for the new NHS became reality.  The medical profession had put the Government in position where improved patient care was not guaranteed  but the medical profession was financially better off what ever the outcomes.

Surely, it is time for the Government to realise that it cannot continue in this vein?  It has failed time and time again in trying to improve health systems.  It is now time to try something different, and surely it is the turn of the free market?

More reports are appearing in the press about the need to improve NHS dentistry, including one from a new think tank saying that dentists should be forced to spend half their time working in the NHS.  As I wrote here earlier this week this is not the way forward.

The NHS is a broken system and NHS dentistry is no exception.  It cannot be mended by forcing staff to work in it or allowing dentists to fine people for not turning up to appointments.  The time has come to “think out of the box” as all of these management consultants say, and rather than trying to mend the un-mendable look for new ways of ensuring provision of the service.

Surely, it is time for politicians to accept that the state has failed in trying to provide this service and give the market a chance?  I don’t know what the market solutions would be anymore than I could not have predicted the plethora of mobile phone devices that we have now when Margaret Thatcher privatised British Telecom in the 1980s.  What I do know is that the market is a discovery process and that we know have an historic opportunity to discover the wonderful tapestry of services that it can provide.  And, while I know that no service will ever be 100% perfect I do know that the market can be no worse than the NHS!

This story from the times is titled “The real cost of going private”. However, although the few areas of the private sector involved did not shine, the real villian here is, yet again, the NHS.

By sheer incompetence the NHS is delaying and in some cases probably prohibiting, people taking advantage of the Health Secretary’s ruling that  through either insurance or self-funding they can buy cancer treatments/drugs that are not available on the NHS.

In this story NHS jobs-worths are shortening a young man’s last few months by prohibiting access to drugs “because the policy isn’t written yet” or because they claim not to know about the change in the law.  The authors of this report generously say that the delays by the NHS staff are not for ideological reasons.  I would beg to differ, I have been working in and around the NHS since the mid 1980s and have lost count of the times that I have listened to the private sector being derided.  I know that there are NHS staff who would go out of their way to make it appear that the private sector is failing whatever the cost to the patient.

It is time for NHS to wake up and realise that the future is working with the Independent Sector.  The NHS cannot, and never has been able to do it all.  With the cuts in public spending that are coming our way independent sector health care providers will be features in all our lives providing care for NHS funded patients.  NHS staff will have to grow-up very quickly, put their houses, policies and relationships with the independent sector in order and get ready for these changes, because patients are quite rightly becoming ever more vocal when the NHS does not live up to its promises.

We have seen this week heads rolling in NHS trusts where appalling care has been given.  Maybe this has to happen a few more times before NHS staff start treating their patients as the customers they really are.

The media are today reporting that the Conservative Party’s next great idea for health is to ensure that all children under 5 years old have free dental checks at a cost of £17 million.

My first thought is where is this money going to come from?  It is muted that it will be covered by existing NHS spending, I can’t see this working without other services for less vocal groups being cut, given the financial mess of the NHS.

Secondly, the next Conservative government must move away from such prescriptive measures.  It is time that people are encouraged to take some personal responsibility.  

Surely, the conservatives can see that over the past sixty years the top down rationale of the NHS has not worked.  We have some of the worst health statistics for obesity, teenage pregnancy, cancer cure rates, MMR take up, heart disease and so on, all s0-called public health campaigns that governments have previously embraced.  So why is it still assumed that this model will improve the state of our children’s teeth?

Rather than promoting the continuance of the Nanny State it is time that the conservatives look at options such as Health Savings Accounts, as described here by the Adam Smith Institute, to give people responsibility for their own health and health care.

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