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.

Given the perilous times that we live in with the current economic climate, so ably discussed in this new Institute of Economic Affairs publication, there was a fantastic opportunity for the Royal Collect of Nursing at their congress this week to lead the way in setting the agenda for healthcare during the recovery period given that it is generally accepted that there will have to be sweeping public sector cuts.

However, it seems to me that this was barely mentioned at congress.  There were a couple of debates that seemed to conclude that financial considerations should not sully the waters of patient care, but the RCN once again demonstrated that they have no teeth!

Now is the time for them to lead the way, to recognise that the NHS has never worked, with billions of pounds pumped in to it in recent years patient care and outcomes have got worse and the system is in demise.

Come on RCN ‘smell the coffee’ as they say, embrace the market and lead the way in demanding a better way of providing health care in the UK.

The Royal College of Nursing (RCN) Congress is underway this week and Dr. Peter Carter, the General Secretary, has announced the publication of some research on nurse recruitment and how this will affect the NHS.  Apparently, young people do not want to come in to nursing for reasons such as not liking blood.

I am afraid that to me this research is not addressing the real problems.  The RCN claims that nursing needs to be promoted in a better light by government to encourage school leavers to consider it as a profession.  This will make no difference what so ever.  NHS nursing is facing a crisis because the NHS is a failing system, nurses are being turned into administrators and the allocators of scarce resources.  While they are busy at their computers, unqualified assistants are being left to attempt patient care, 10% of patients are getting health care acquired infections and between 40% and 60% of NHS inpatients are suffering from some degree of malnutrition.  Add this to working in a system where you have to care for patients who are dying because NICE has decided that the drugs that would save them are too expensive.  Why would anyone consider going in to nursing to have to put up with this?

During my recent stay in a private hospital in london I met with a number of nurses who had left the NHS to work in the private sector.  Interestingly, many of them had not been lured by the mythical higher salaries. Most of the nurses that I spoke to had moved to more junior positions, voluntarily taking pay cuts because in the private sector they were able to nurse.  They were able to do what they trained for, to spend time caring for their patients.

So I call on Dr Carter to stop tinkering around the edges.  Asking politicians to tell people how nice it is to be a nurse when most of the public know that NHS nursing is a nightmare, will do no good at all.  Work with nurses who want real reform.  Call on government to set hospitals free from NHS ownership and let the market promote nursing to the next generation!