Mr Nanny State: Stephen Dorrell – image by NHS Confederation via Flickr
Health Secretary Andrew Lansley has been trying to implement an NHS under control of GPs. The idea is that GPs band together into “GP Consortia”, which will commission healthcare services for their patients.
The Consortia therefore take the place of the old Primary Care Trusts – the difference being that they are run by GPs rather than bureaucrats.
So far so good.
Except that it seems the bureaucrats have got their teeth well into this.
The House of Commons Health Committee have been banging on again about how the government needs to consider tougher rules on alcohol marketing.
The “chair” of the Committee, and former Health Secretary, Conservative Stephen Dorrell, said:
We don’t think the industry has a sufficiently well-developed sense of what it takes to trade responsibly.
Some of us are wondering whether MPs have a sufficiently well-developed sense of what it takes to represent us responsibly, but let that pass.
Mr Dorrell’s committee has produced a report. They want a “crackdown”.
The report called on Public Health England, a new body within the Department of Health, to look at the regulation system used in France.
Loi Evin was introduced in 1991 and bans alcohol advertising targeted at young people and being aired in cinemas as well as stopping the sponsorship of cultural or sporting events.
Yet more interference and messing around with people’s lives from the great and the good, then. Men like Mr Dorrell, who understands so well how we ought to be living our lives.
Chief Executive Designate Duncan Selbie took up his role this week and has set out his ambition for Public Health England to begin the conversation about how the agency will work, the ambitions it will have and the style it will adopt.
Sounds like it’s not clear what the body is for then…but we definitely need it….
‘The Secretary of State for Health has made clear his expectation that Public Health England will provide strategic leadership and vision for the protection and improvement of the nation’s health.
‘Through the application of research, knowledge and skills we will lead nationally and enable locally a transformation in the health expectations and, in time, outcomes of all people in England regardless of where they live and the circumstance of their birth.’
Further information, including modules of the Public Health England People Transition Policy, will be published in the next few weeks.
And so on through reams of meaningless bureaucratic twaddle.
The whole ghastly mess is helpfully set out in this graphic.
It’s nearly as bad as Obamacare. Make no mistake, this is the last chance to reform the NHS, as I’ve said before on this blog. If these reforms fail, the service will collapse.
And fail they will. The NHS is just re-arranging the deckchairs on their Titanic.
I am now more convinced than ever that the National(ised) Health Service can never work. Its whole philosophy and culture is poisonous. The people who run it just cannot conceive of anything being run without a centralised strategy. They don’t understand markets; they don’t understand decentralised decision-making; they absolutely don’t understand, or don’t want to understand, the concept of an NHS that answers to patients as opposed to answering to themselves.
And perish the thought that they should ever just let people get on with their lives in their own way without interference.
They are arrogant, pompous and out of touch. And they are grabbing billions of our money every year. A plague on all of them.
Who is being punished here? If that hospital loses £325,000 then that money can only in the end come out of the hospital’s budget – unless the government simply gives them extra budget to pay the fine.
This goes to the heart of the problem with State-run industries like the NHS. What happens when those industries don’t deliver?
In the normal private sector, companies that do things like this lose customers, and may ultimately go bust.
Even where there is a private sector monopoly, as in the water industry for example, the outputs of the industry concerned are ensured by regulation. In theory at least, fines like this one would come out of the dividends that would otherwise be paid to the company’s owners.
But in a government monopoly like the NHS, fines are being paid, in short, by the government to itself. (The costs of the legal action, of course, aren’t paid to the government itself. They go to lawyers and have to be paid for by taxpayers.)
This is just one isolated case – but it is a reminder to us all of just how lacking in accountability is the NHS. Socialists always tell us it is accountable to the people through their elected government.
The truth is that the NHS is accountable to nobody and makes up its own rules.
Unless the NHS trusts are brought into real competition with each other, the people have no sanction when they don’t deliver.
We all know there has been a lot of controversy over student finance.
We’ve had the tuition fees debate, with tuition fees of £9,000 now the norm.
The government has overhauled the student support scheme. There seems to be a lot of confusion about this, but basically, you get a loan to cover the tuition fees, and a further loan that is mildy means tested to help with maintenance. Despite the confusion, those who look can find out the exact details.
If you want to go to university in September, you can find out what your financial position will be.
But what about people who want to be nurses? The normal student support arrangements do not apply for them. They have different arrangements.
How much will they get?
I wish I knew. Nobody does.
We do know they will get a £1,000 grant from the NHS. We do know they will get their tuition fees paid by the NHS. We do know they will get a maintenance loan from Student Finance. That loan is smaller than the one other students get, but again is not means tested.
They will also get a means-tested loan from the NHS. The maximums have been published, but astonishingly, the NHS has still not published the thresholds for the means testing for 2012/13.
Would be students are already in the application process for “uni”. They are advised by Student Finance to apply for their loans by 31st May.
Meanwhile the NHS says it will make application forms available in June. For students who will actually go to university in September! When the thresholds will be publshed, nobody knows.
The “NHS Business Services Agency” (sic), which pays the NHS support, is apparently still mired in processing applications for last year’s students. Shades of the early days of the Tax Credits Office.
They are expecting people to apply for nursing courses with no idea of how much financial support they will get. Would-be students can’t even look at last year’s rates and assume they will be fairly similar, because the system has changed completely.
This is no small deal. For a student studying outside London, the non-means-tested loan from Student Finance is £2,324. That non-means-tested grant from the NHS is £1,000.
And the means-tested grant will be up to £4,395. But if their parents earn a lot, it will be less. Possibly a lot less, or even zero. But the NHS hasn’t decided how much yet.
That student will get between £3,324 and £7,719. And that’s all they know.
More than half of that student’s financial support is completely unknown, and they are applying blind from a financial point of view.
Meanwhile, although they can’t tell you how much money you’ll get, and have a pathetic website with hardly any information, they do, it seems, have time to maintain a Facebook page containing repeats of the same vague answers.
What an unprofessional, sloppy, dysfunctional mess the NHS is. It seems it has no more concern for its staff, or would be staff, than it does for those unfortunate enough to be its patients.
The irony is that if it were a private sector company acting in this way, it would be taken to the cleaners.
NHS figures for the past year show 19% of children in their final year of primary school were classed as obese, compared with 18.7% the previous year.
But obesity fell to 9.4% in children going into reception, down from 9.8% the previous year.
Apart from producing a great source of copy for the media, what is the use of these statistics?
They are produced by The National Child Measurement Programme (copyright: Tony Blair 1995). This measures all schoolkids when they start primary school and again as they get to the end of primary school.
The purpose, according to their website, is:
The information collected helps your local NHS provider to plan and provide better health services for the children in your area.
In other words, they serve no purpose – unless “health services” includes putting pressure on parents to turn their kids into anorexics.
We all know that cakes and chips are bad for our kids, don’t we? And we all know that feeding our kids healthy food is a good idea. The statistics prove that … wait for it … people feed their kids cake and chips anyway.
Obviously no figures are published for the cost of all this, as NHS finances are completely opaque to the public. But the cost of this measurement programme must be quite high. The survey is after all measuring a million pupils every year. The survey – even without the pseudo “actions” that are taken as a result of it – must run into many millions of pounds of our taxes.
One can only hope that not too many children (and their parents) are made miserable by being branded “obese” when a fifth of kids are heavier than they are.
But mostly, really, the jobsworths who waste their lives running this programme just need to be told to p*** off. We don’t need their useless information, and we don’t want our taxes wasted on their salaries.
They are a great example of why the NHS is crumbling.
In case you are indeed one of those jobsworths yourself reading this, and ask whether I am embittered by myself being a victim of this 1984-style programme, the answer is that no, I have not fallen foul of it myself.
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.
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.