It Seems Fair Trading Only Applies to the Private Sector

 

Vivienne Dews from Office of Fair Trading
Image by bisgovuk via Flickr

Vivienne Drews of the Government’s Office of Fair Trading – Maybe It’s Time They Turned Their Attention to the Government Itself?

The Office of Fair Trading has said it is thinking of referring the private healthcare market to the Competition Commission.

Why?

In a statement, the OFT said it found three key issues that needed further investigation:

There is a lack of easily comparable information available to patients, GPs or health insurance providers on the quality and costs of private healthcare services;

Whilst in the National health Service there is of course an absolute wealth of information to help people choose which provider.

Except that there isn’t. There is only one provider and no choice at all.

There are only a limited number of significant private healthcare providers and of larger health insurance providers at a national level;

Whereas in the National Health Service there are lots of providers.

Except that there aren’t. The Left go into apoplexy if a private company does anything in the NHS, and as to any concept that there might be multiple privately-run providers from whom people could choose, well, let’s just say that even the most rabid Tories never suggest that.

A number of features of the private healthcare market combine to create significant barriers to new competitors entering and being able to offer private patients greater choice.

Whereas in the National Health Service there are hardly any barriers to new competitors offering greater choice.

Except that there are. Like the fact that there isn’t any choice at all.

The private providers are welcoming the review in public, of course.

“We need much more upfront pricing transparency on what patients are required to pay when they sign up to a private medical insurance policy,” said Dr Andy Jones, of Nuffield Health.

After all, inn the National Health Service, everyone knows what they have to pay. It’s all free!

Except that it’s not. It is funded out of people’s taxes, and nobody has any idea how much they are really paying for the NHS.

“This [report] calls into question some of the agreements between insurers and providers. It calls into question some of the cosy deals.”

Whereas in the National Health Service, there are no cosy deals at all. All those drug companies have completely transparent deals with the NHS that are completely visible to taxpayers. And Hospital Trusts are a model of openness.

Except that they’re not. The NHS is basically chock full of cosy deals done for the benefit of providers.

Meanwhile Dr Natalie-Jane Macdonald, managing director of Bupa Health and Wellbeing, said: “The OFT has recognised that private patients are not always aware of the full costs of their treatment and may need to pay additional unexpected charges over and above their health insurance premiums.

“This shortfall happens when a consultant charges more than health insurers’ monetary limits and is, understandably, of great concern to our customers.”

Whereas when consultants charge lots of money to the NHS, it is of no concern to taxpayers at all. Why should they worry? The NHS is free!

Except that it’s not. We just all have no real idea how much we’re paying for it.

How many people, given the choice between private healthcare or the NHS, would choose the NHS? Even Trades Unions often negotiate private medical insurance deals for their members.

How much choice is there for patients within the NHS? There is a level of choice of GP, although many people don’t even get that choice.

Going beyond that, the choice is limited to whatever hospitals their local PCT (or soon their local GP Consortium) has a deal with. That would be one of those completely transparent deals in the NHS presumably, completely unlike those frightful “cosy deals” in the private sector.

The real scandal in this country is the lack of choice in publically funded healthcare, not the level of choice in the small private healthcare market. Especially when its customers are also forced to pay for the NHS whether they use it or not.

The NHS Generation

NHS Hospital Corridor
Image by Laura Mary via Flickr

 

The Patients’ Association has published a dossier outlining what they call “shameful attitudes” to the care of elderly patients.

Katherine Murphy, the Association’s Director, did not mince her words:

We cannot ignore the fact that some trusts are not even paying lip service to the fundamentals of care.

The issues we continue to highlight are human rights issues. They show a lack of compassion and care and a shameful attitude to treatment of the elderly.

The government, however, was brushing it all off with platitudes:

The government said it was determined to “root out poor performance”…

A programme of unannounced inspections would continue, the Department of Health added…

A spokesman for the Department of Health said: “The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out.”

Angela Rippon was on the Today programme this morning for the Patients’ Association, talking about the report. She specifically made the point that the issues are not confined to care of the elderly, but are widespread across the NHS. After going through the appalling neglect that was highlighted in the report, however, she went off at a tangent.

She started talking about how most nurses in the NHS are “superb” and provide “wonderful care”, and the problems are all the fault of “a few rotten apples in the barrel”.

She has completely missed the point. The problem is not a few rotten nurses, but an entirely rotten system. That system drives even good nurses to behave badly. It cripples them with red tape. It takes control away from them, and gives it to bureaucrats. It demoralises and demotivates them. They are victims of that NHS system, just as much as the patients are.

And the same goes for those overworked doctors, rushing from patient to patient with never enough time, and for the ancillary workers too, paid a pittance and held in contempt by the system because they are doing menial but vital tasks like cleaning the floor or serving dinner.

The nurses are just human beings, doing a job. The system is what is wrong, not “a few rotten apples in the barrel” that simply need to be rooted out.

The NHS is driven by top-down centralised management and that is the cause of the widespread – and they really are widespread – failings of the NHS.

As I blogged before, Andrew Lansley, the Health Secretary, is trying to push through reforms to put the service in the hands of groups of GPs, called GP Consortia. And the response of the bureaucrats? They have set up a new body to “oversee” the Consortia, headed up by the guy who is currently NHS Chief Executive. In other words, they are turning the GP Consortia into clones of the old Primary Care Trusts, and keeping an iron grip on the central control of the service.

Like so many of her generation, Ms Rippon just can’t quite grasp that the NHS is utterly broken, that its problems are inherent in the way it is set up. They cling on for dear life to that comfortable fantasy, that the NHS will always look after them, and make sure they never suffer. They see it as a great big much-loved teddy bear, a bit threadbare but always there for a hug.

It is time we grew up, and saw the NHS for what it is. Our hospitals are characterised by sloppy care, bureaucratic waste, filthy wards and demoralised staff. The care they provide is too often scandalous. People are dying – literally – because of its failings.

For decades the Left have peddled the lie that the only alternative to today’s monolithic NHS is a free market free for all, and held up the spectre of health services “like the ones in America”. And Ms Rippon’s generation have – almost to a man and woman – been suckered by that lie.

But that is what it is. A lie. Other countries do better.

I have visited a hospital in Ukraine. As you would expect with a relatively poor country that was part of the Soviet Union, there are many problems. Drugs are in short supply, for example, and corruption rife. But I’ll tell you this. That hospital was spotless. The floor, from wall to wall and in the corners as well, gleamed. The window sills were shiny. The whole building smelled strongly of disinfectant, just as NHS hospitals used to when I grew up in the 1960s. Basically, despite all the problems, the people running that hospital knew what they were doing, and had discipline and the right priorities.

By contrast, the large NHS hospital I visited frequently while my first wife was ill with cancer in 2000 was drab and run down, with grubby floors and an air of aimless chaos. Until one day I pressed the wrong button in the lift and went up to the administrative levels by mistake. Those levels were well decorated, with a nice and spotless carpet on the floor and row upon row of offices with computers on the desks. It was clear to me where the priorities of that hospital lay. OK, that was a decade ago. Have things really changed for the better since then? I doubt it.

The problems of the NHS cannot be eliminated without entirely reforming the system. Until then, the poor performance won’t be rooted out. The problems won’t be sorted out, and the unannounced inspections will achieve nothing except to tell us what we already know – that the NHS is failing.

Perhaps once the NHS Generation of Angela Rippon are gone, we can start a grown up debate about the future of Britain’s health services. Until then, people will go on suffering and dying.

This is How Bureaucrats in the NHS Prevent Change

Sir David Nicholson
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Sir David Nicholson – Bureaucrat in Chief in the NHS

 

The BBC reports on the setting up of a new NHS Commissioning Board.

The board, which will at first operate in a shadow form, will aim to help patients “shop around” and compare GPs.

It will take on the day-to-day running of the NHS, with a staff of around 3,500 and overall responsibility for NHS care worth £80bn…

Its role includes overseeing the new clinical commissioning groups led by GPs and other clinicians who will “buy” care within the NHS, and organising the treatment of complicated conditions such as heart transplants.

3,500 staff! Now we know where all those redundant Area Health Authority employees are going.

And its Chief Executive will be Sir David Nicholson, who has been Chief Executive of the NHS in England since 2006.

Andrew Lansley’s NHS reforms are designed to decentralise, to create competition within the NHS, and to put the NHS budget in the hands of groups of GPs.

This new Commissioning Board is going to “oversee” the GP groups. In other words, it is the bureaucrats making sure they maintain central control.

What all this means is that nothing will really change in the NHS. The GP groups will be accountable to the Commissioning Board, when the whole point of Andrew Lansley’s reforms is that they should be accountable to GPs.

The bureaucrats are, as usual, waging war on the democratic decisions of the elected politicians. In the short term, they can certainly do this. In a war between Mr Lansley and the Civil Service, I wouldn’t put money on Mr Lansley’s chances of victory.

But in the longer run, this move increases the chances that the NHS will, ultimately, face collapse and dismantling. We are already seeing a great deal of anger from ordinary people at the performance and care provided by today’s NHS. The depth of support for the very existence of the NHS is much shallower now than it was 30 or 40 years ago.

Mr Lansley’s reforms were the last chance to save the NHS. If the bureaucrats like Sir David succeed in neutering them, the NHS simply does not have a future.

Those bureaucrats are playing right into the hands of the enemies of the NHS.

Our Failing Nationalised Health Service

British Railways Board
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Nationalised British Railways – Not So Different from the NHS

A new report by the Care Quality Commission on the NHS has highlighted serious failings in the care being provided to elderly patients.

The report is pretty damning, and itself calls its findings “alarming”:

[Problems] included call bells being placed out of the reach of patients, staff speaking in a condescending or dismissive way and curtains not being closed properly.

In terms of nutrition, some people who were judged to need help eating were not getting it, while interruptions meant that not all meals were being finished by patients.

The regulator also said that in too many cases patients were not able to clean their hands before meals.

The report identified three main reasons for the failures – a lack of leadership, poor attitude among staff and a lack of resources.

A lack of leadership, poor staff attitudes and a lack of resources. Those are pretty fundamental failings. Obviously the Royal College of Nursing was highlighting the lack of resources. But the Labour government provided an absolute tidal wave of additional resources for the NHS! In fact, under Labour, NHS spending more than doubled. And this government, even during its “austerity” programme, has continued giving the NHS inflation-busting increases.

If there is a lack of resources, it is because the resources being provided are being misused. If there are poor staff attitudes, it is because they are not being managed properly.

It all comes back to that first issue – “a lack of leadership”.

So what is going to be done about it?

Health Secretary Andrew Lansley said he would encourage whistle-blowers to highlight any concerns they had about the standard of hospital care for the elderly.

He said: “We expect that staff across the NHS, if they see examples of poor care they blow the whistle on that, which is precisely why we have introduced changes to the staff contract.”

Both the government and the NHS Confederation, which represents managers, said examples of poor care were “unacceptable”.

Great. Their big plan for dealing with these serious failings is to encourage people to report the issues.

What will they really do about the issues? The real, true answer is NOTHING. Because they cannot do anything. These failings are INHERENT in a health service model that involves a centrally run nationalised industry delivering the services.

It happened in every nationalised industry. From the old Gas Board through the GPO Telephones to British Rail, those same failings were evident. They are inherent in that model for service delivery.

The failings of the NHS are built into the NHS itself.

Daniel Hannan criticised the NHS in America last year, and Tory politicians including David Cameron fell over themselves to condemn what he said. But what he said was true.

The National(ised) Health Service experiment is a failure. There is a reason why no other major country runs its health services like this. No, it is not because they are all envying our amazing NHS and cannot match it. It is, in fact, because it doesn’t work.

That does not mean you cannot have tax-funded healthcare available to all, of course.

The Socialists in the Labour Party and elsewhere always pretend that is the choice. It is not. We have, for example, privatised refuse collection in most local authorities. That does not mean households have to pay the contractor to have their rubbish removed. It just means that private companies are running the service, and competing for the contract.

The NHS needs real, fundamental, serious reform. Even Andrew Lansley’s reforms do not go nearly far enough, though they are a step in the right direction.

Nationalisation is a failed 20th Century solution. And the National Health Service right now is a nationalised industry.

Is Mr Lansley About to be Toast?

LONDON, ENGLAND - APRIL 13:  Secretary of Stat...
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Andrew Lansley – Is He About to be Hung Out to Dry?

Labour have been attacking the government’s NHS reforms.

As the BBC puts it:

Labour said the reforms in England would introduce a “full-blown” market into the NHS and put hospitals at risk.

The Royal College of GPs say the proposals are “unravelling and dismantling” the NHS.

The Liberal Democrats, as ever, are stuck in the middle, vowing to be a “moderating influence” on the Conservatives in the Coalition – whatever that means.

I watched a little of the pointless debate by accident on the BBC News channel.

John Healey, for Labour, bemoaned the fact that under the Conservative proposals, NHS hospitals might actually go bust.

He did not dwell on what might cause an NHS hospital to go bust. That would only happen if it was run so badly that it did not attract any patients, and the patients were all choosing to be treated by rival hospitals. Mr Healey wants to keep open even failing NHS hospitals, because, you see, they are part of the sacred National(ised) Health Service.

Andrew Lansley, the Health Secretary, responded by saying

What matters is the views of NHS staff.

Yes, really he did say that. And by that little phrase, ladies and gentlemen, Mr Lansley laid bare everything that is wrong with the NHS. Here was a Conservative letting slip that what is important to him is not the views or interests of patients, but the views and interests of NHS staff.

There seems to be a wall of misunderstanding over health services. Tony Blair once said “The NHS is not a supermarket, for goodness’ sake!” And yet, without food distribution, we would all starve. Our food distribution network is every bit as essential as our health services – arguably even more so.

People seem to be able to understand that competition in food supply is a good thing. They understand that the interests of food consumers are best served by a free market in food distribution. Nobody, not even Labour, suggests that we should nationalise all Britain’s food shops otherwise some of them might – shock horror – go bust.

And yet, over health care, people come over all misty eyed. That dream of Socialist Utopia that the Labour government of 1945 created seems to be alive and well in people’s attitudes to the NHS.

We ought to be a bit more grown up.

NHS nurses are not “angels”. They are human beings doing a job. They deserve to be properly paid for it, and they deserve to be respected. They need to be managed and they need to be motivated. It is simply not enough to claim that their devotion to public service is enough to motivate them.

And the same goes for doctors, ancillary workers and everyone else working in British health care. They all need the discipline of the market and competition to motivate them to serve patients. Tesco only serves customers well because otherwise the customers go off to Sainsburys – not because its staff have a vision that they are stopping starvation on our streets.

Patients are the ones who matter – or who should matter. Mr Lansley’s NHS reforms go in the right direction. And as Labour seem not to understand, the reason they are right is, ultimately, because under his proposals, NHS hospitals might go bust.

In the 1980s, contracting out of refuse collection was highly controversial. People were shocked at the idea that private companies might make money by collecting our rubbish. Now, privately run refuse collection is commonplace. The ideologically driven debate of those times seems an anachronism. One day, the same will be true of this government’s timid attempts to introduce market disciplines into health care. One day, people will wonder what all the fuss was about.

The government either gets on with these reforms and defies its critics, or it backs down. Sadly, I fear that David Cameron may well end up hanging Mr Lansley out to dry as Mr Cameron runs for cover. After all, he can always blame a climb-down on Nick Clegg.

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What If Food Supply Were Organised Like the NHS?

First self service Tesco, St Albans, England
Image via
Wikipedia

Would You Rather Have This or State Food Shop Number 1?

There has been lots of controversy about the NHS reforms, which are published today. Watching the debate has been like peering through a window into another gloomy world, in which nothing can work unless it is centrally planned and managed, and free enterprise is anathema verging on evil.

Just to bring home how unreal the whole thing is, let me take today’s article by the BBC on this and change it slightly. (This is no criticism of the BBC, by the way, who simply reported the comments of the parties involved.)

Imagine a world where the government ran all the food shops and food distribution, under a nationalised “Food Supply Service”. Everyone could get whatever food they needed free, provided their family cook wrote to the food shop asking them to provide it. Food shops would not deal with anyone unless they had a family cook’s referral.

Imagine people had died due to food poisoning in large numbers, and shortages of particular foodstuffs were commonplace. Imagine food shops were notorious for being filthy. Imagine the government was spending as much on food supply as other countries, but many people were still going hungry, and some starving.

And now, here’s that doctored BBC article:

Ministers seek to answer critics as Food Supply Service bill published

Ministers have taken the first step towards an overhaul of the National Food Service in England with the publication of controversial draft legislation.

The Food Supply Bill paves the way for family cooks to get control of most of the Food Supply budget from 2013.

Unions warn the plans could undermine the food supply service, while MPs say they have taken the Food Supply Service by “surprise”.

But the government argues the changes will improve the provision of food and accountability.

Speaking as the legislation was unveiled, Food Supply Secretary Andrew Lansley said modernising the Food Supply Service was “a necessity not an option”.

He said: “In order to meet rising need in the future, we need to make changes. We need to take steps to improve nutritional outcomes, bringing them up to the standards of the best international food supply systems, and to bring down the food money spent on bureaucracy.

“This legislation will deliver changes that will improve the supply of food and save the Food Supply Service £1.7 billion every year – money that will be reinvested into supplying food for hungry people.”

Pace of Change

The plans will led to more than 150 Food Supply Service organisations being scrapped and sweeping changes to the way food is supplied.

Family cooks will take on responsibility for “buying in” the bulk of food for hungry people.

In the process, all of England’s primary food supply trusts (PFSTs) and strategic food authorities will be disbanded.

Commenting on the bill, Dr Laurence Mynors-Wallis, Registrar of the Royal College of Food Delivery Experts, said the college was concerned about the pace of change.

“We are particularly concerned that in some areas the new structures will not have the skills or expertise to support bread buying,” he said.

“There is a danger that, in the new system, bread will be bought from the cheapest provider at the expense of quality.”

Betty McBride, Policy & Communications Director at the British Milk Research Foundation, said hungry people at “the sharp end of these reforms” must not be forgotten.

She said: “If the Government wants to make reducing hunger the measure of success, then these are exactly the issues they have to address.”

‘Disastrous’

Earlier, during exchanges at Prime Minister’s questions, David Cameron was accused of being “arrogant” for going ahead with the moves despite warnings from unions and food experts.

Labour leader Ed Miliband said food shop staff had warned of “potentially disastrous” consequences for food supply.

But the Prime Minister said the Government was “reforming the Food Supply Service so that we have got the best in Europe”.

The changes were first set out in a white paper published last summer. They apply solely to England – Scotland, Wales and Northern Ireland have different systems.

Managers working for PFSTs are currently responsible for planning and buying local food from bread to coffee, but under the changes consortia of family cooks will take on responsibility for this from 2013.

Pilots are already starting and once the process is complete, two tiers of management – PFSTs and the 10 regional food supply
authorities – will be scrapped.

The bill has been eagerly awaited by those in the Food Supply Service to see just how much power will be devolved to family cooks, how they will be held accountable and what safeguards will be put in place.

‘Extreme concerns’

In the lead up to its publication, fears were voiced by the
Confederation of State Food Shops that food shops could go bust as the plans include opening up the Food Supply Service to “any willing provider”.

Critics have also questioned whether family cooks have the experience and skills to handle such huge budgets – they will have control of about 80% of the budget.

On Tuesday, the Commons food supply committee criticised the scale and speed of the reforms, saying the Food Supply Service had not been able to plan properly.

A host of unions, including the British Association of Cooks and the Royal College of Washers Up, have expressed their “extreme concerns” that greater commercial competition in the Food Supply Service would end up undermining the supply of food.

The government has responded by saying it is all part of a managed transition to devolve decision-marking closer to the eater so services are designed in a better way.

The timing of the reforms has also been questioned. While the Food Supply Service will be getting small funding rises in the next four years, it is still being asked to making savings – £20bn by 2014.

Peter Carter, of the Royal College of Washers Up, said: “This reform programme could come off the rails, as people concentrate on saving money rather than delivering quality food.”

Meanwhile, back in the real world, Tesco, Sainsbury’s, Asda, Morrison’s, the Co-Op, Waitrose and a host of others are competing ferociously to supply food, there are no shortages, food quality is excellent and improving and prices are under control.

But there is no central planning, so obviously we are all heading for a disastrous future of starvation.

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High Stakes in the NHS

NHS logo
Image via Wikipedia

The Stakes Are High for the NHS – The Government Reforms or Abolition

David Cameron has been defending the government’s plans for NHS reform.

The BBC comments that the stakes are high for the government.

The plans centre around abolishing Primary Care Trusts and giving GPs (mostly organised into GP Consortia) control over the NHS budget.

Vested interests in the NHS are, as you would expect, complaining. The Royal College of GPs, the British Medical Association and Trades Unions that represent NHS staff are all against.

Some GPs, though, have been supporting the reforms – in fact, some already operate in such a way.

It would be good to take some of the heat out of this debate, and look at what is really being proposed. At the moment, we have Primary Care Trusts buying services from hospitals and other parts of the NHS. Those Primary Care Trusts are answerable to the local Health Authorities, who are in turn answerable to Whitehall.

And what is the difference between a Primary Care Trust and a GP Consortium? They will operate in a similar way, and be buying similar services from the same providers. It is highly likely that most of the employees of the Primary Care Trusts will end up moving to the new GP Consortia.

There is one crucial difference: instead of being responsible to the Health Authorities, the GP Consortia will be responsible to GPs.

A little history is also in order: the last Conservative government introduced the “NHS Internal Market”, in which GPs controlled the budgets and bought care from Hospital Trusts and others. The incoming Labour government of Tony Blair didn’t abolish the internal market – they just seized control of the buying of services, creating the Primary Care Trusts, answerable to Whitehall. Tony Blair and his government believed that the Man in Whitehall knew better than the doctors who are treating patients.

Is all this reform really necessary? Mr Cameron defended it thus today:

I think if we just carried on as we are, because there is so little incentive in the NHS to actually improve the health of the nation, I think we would face a very big crunch in two or three years’ time.

It is necessary because we’ve fallen behind the rest of Europe, we spend similar amounts of money but we are more likely to die of cancer or heart disease – I don’t think we should put up with… coming second best, we should aim to be the best.

I don’t think there is an option of just quietly standing still, staying where we are and putting a bit more money into the NHS. I think we do need to make more fundamental changes.

Here is a little example of why the change is needed.

It is a job advertisement for two “Non-Executive Directors (Designate)” by Coventry and Warwickshire Partnership NHS Trust, which provides mental healthcare in those areas:

The Trust is currently seeking to strengthen its Board of Directors in preparation of acquiring a range of community health services and achieving Foundation Trust status, by appointing two Non-executive Directors (Designate).

Foundation Trusts are NHS Trusts that have a degree of independence from Whitehall, and are supposedly responsive to the wishes of local people. In practice, they end up with their own momentum and priorities, and take little notice of the wishes of local people. Ordinary NHS Trusts are accountable to Whitehall. Foundation NHS Trusts are accountable to nobody. The new GP Consortia will, for the first time, hold these Trusts to account, on behalf of patients.

The two Directors (Designate) for Coventry and Warwickshire will receive £6,096 per year for an average 2.5 days’ work per month. You can see that this NHS Trust is trying to copy the operation of a Public Limited Company, with its Board of Directors overseeing the executives who run the organisation.

This is a typical example of the mimicry of the private sector that goes on in the public sector. They think that having a Board of Directors, complete with non-Executives, will give them the efficiency of a private company. It will not. They have only half understood how private companies work – they have understood the process, and are mimicking it, but have not understood what really counts.

What they have not grasped is the motivation that drives private companies. The motivation is competition, pressure of potential bankruptcy, and accountability to shareholders who own the company.

The processes, and the “Board of Directors”, are only the mechanisms by which private companies respond to that pressure. It is the pressure that matters – and at the moment, that pressure is lacking in the NHS. In fact, an independent NHS Foundation Trust is even more likely than a normal NHS Trust to fail to deliver services – at least a normal NHS Trust has some kind of accountability, to the man in Whitehall.

For the first time, the new GP Consortia will be there to start exerting some real pressure on behalf of patients, whose care they will be buying. And the Trusts will be competing with each other, and potentially with private sector providers, to deliver that care. If the GPs decide a particular hospital is rubbish, they will be able to send their patients elsewhere. That doesn’t happen now – the Primary Care Trusts, who buy the services, work for the same Health Authorities as the NHS Trust Hospitals do, and the PCTs do as they are told.

You will also note that this job advertisement was not placed by Coventry and Warwickshire Partnership NHS Trust. It was placed by the Appointments Commission – “Adding Value to Public Appointments”. What value they are adding is unclear. Does the NHS Trust really not have an HR department that can place job adverts?

This job advert is a tiny illustration of the bureaucracy that has grown up in the NHS, and which is gobbling money that should be going on patient care. The government’s reforms are the only chance to tackle this issue short of complete privatisation.

The stakes are high here – that much is true. The stakes are high not only for the government, but for all of us. If these reforms fail, the only alternative left will be the dismantling of the entire NHS, outright privatisation, and an insurance-backed healthcare system.

Anyone who works in the NHS, and truly believes in it, therefore better do their bit do make damn sure the reforms do work. The Right is waiting to take the NHS apart if they fail.

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