Cameron’s right on the NHS

Baroness Murphy

I listened with some trepidation to the Prime Minister’s speech this morning, which you can read here  at http://www.politics.co.uk/features/health/david-cameron-nhs-speech-in-full-$21388842.htm. Was he going to subtly shift from the crucial parts of the Health Bill that are likely to make the difference in the long term to the cost effectiveness, responsiveness and sustainability of the public service most of us rely on? Hard to tell of course what subtle shifts will appear when the Bill resurfaces but I was pretty reassured that he will do his utmost to take on the vested interests opposing it in the shape of a heavily unionised workforce dominated by professional self-interest.

We have a curious alliance between those who oppose the Bill on political, ideological grounds, the internal vested interests who naturally don’t want any change which might affect their working practices and a more puzzled group who oppose it because they have been repeatedly told it is bad.  My conversations in parliament are bizarre; the vast majority of my colleagues have been inundated by anxious briefings from organisations who assume the changes will be bad for them even though there’s no evidence that it will have any impact at all on their area. Many colleagues assume that because I worked in the NHS for 30 years that I must also be opposed to change. When professionals threaten that services will be ‘more fragmented’, more ‘variable in quality’, ‘cinderella services will be ignored’, it’s the same old shroud-waving that professionals learn to do very early in their career. No wonder the public is worried and no wonder they feel safer with the second rate NHS we’ve got rather than risk any change.

9 comments for “Cameron’s right on the NHS

  1. 16/05/2011 at 2:31 pm

    The creation of the NHS was also opposed by the same sorts of vested interests who seem to be opposing any attempt to change how it works today.

    People just don’t like change, even when it is good for them – and in healthcare, people especially dislike change when it is good for them (you want me to give up smoking, drinking, junk food?).

    I do find depressing that anti-change lobby talk about cuts to the budget, when none is planned (increasing at the rate of inflation is not a cut) or privatisation, when about half the NHGS budget already goes to private suppliers of drugs/food/bandages etc.

    What’s wrong to sticking to the facts instead of scaremongering?

    Ultimately, I think we have to decide what the NHS is supposed to be. Is it a job creation scheme for the medical industry, or is it a provider of healthcare to the those who need it?

    If it is there to provide healthcare, then it should be required – nay forced, screaming if necessary – to do that, and as effectively as possible.

    The changes to the NHS will in part be driven by politics, but the creation of the NHS was also a political decision – and occasionally, politicians can get it right.

    • MilesJSD
      milesjsd
      17/05/2011 at 8:20 am

      Ian has it right;
      you, and I,
      and every third party (not able or willing to be present at this or other democratic meetings)
      have to tackle (rather than attack) both each collective-hostility, and every individual-resistance, to
      change-for-the-better-of-all-parties.

      This immediately involves us in being cooperatively clear about intentions, terminologies, and methodologies.

      A few years back the BBC ran an ‘enquiry’ about the NHS-problem, at the close of which the senior civil-servant in the ‘hot-seat’ was asked whether any of the many proposed, or publicly-chanted reforms and “best-systems” would work ?
      He answered that

      (“)In some real sense, any system will ‘work’;

      provided we are all using the same one (“).
      —————–

      Introductory skilling-textbooks will tell you, also, that
      “Any new skill you attempt will at first feel awkward, even outrightly ‘wrong'”.

      During a recent Scrutiny committee a top civil-servant witness was asked
      (“) If we ask a civil-servant what civil-service System will be best for the immediate and longer-term future, the answer will always be “The one we are now using” –

      and the reason for this kind of ‘group-think’ answer is simply that these civil-servants have no experience of any other System (“).
      ============
      For me (and for any one practically able to follow printed instructions) self-help publications are both remediation-&-improvement manuals and supportive-quotations texts:

      ‘Health Care Together’ (Johnston & Rifkin, 1987, MacMillan; helped by YIS, ACHAN, Prof David Morley, and Fred Abbatt):
      “In 1978 over 150 governments, members of the World Health Organisation, became signatories to the Declaration to support Primary Health Care as national policy,
      In doing so, they pledged to pursue the development of a healthcare system which

      (NB please)
      “shifted priorities from curative, institution-based, professionally-dominated care, to a new approach.

      This approach emphasised preventive, community-based care designed to meet the needs of the majority of the majority of the world’s people living in poverty…”
      (jsdmNB: in some real sense we in the West are slowly waking up to the fact that we too are possessed by a ‘poverty’, but of ‘exemplary-ability, leadership, education, and governance’, rather than of meals-in-stomach and roofs-over-heads)
      “These noble intentions have been difficult to realise… In addition to political and social problems, a major reason has also been the lack of training and experience of health-care providers in community work …
      After all these years we have no hesitation in recommending participatory training as an excellent tool for attaining human development”.
      ————-
      Currently I (jsdm) am using, and trying to get support for, quite a long list of self- (and mutual-) help ‘manuals’, some of which are

      ‘Natural Vision Improvement’ (Janet Goodrich).

      ‘The Moving Center’ (Hendricks G. & Hendricks K.).

      ‘Somatics’ (Thomas Hanna).

      ‘Six Thinking Hats’ (Edward de Bono).

      ‘Dynamic Alignment Through Imagery’ (Eric Franklin) …

      all of which point out the absolute essential of practising it right, choosing the right learning-games, and allotting plenty of time for yourself to get used to the good-changes you can discover and implement in yourself;

      one ‘keynote’ being to face-into
      “Wrong Habits That Feel Right” (Franklin).
      ——–
      … all of such, should be continued…
      ===============
      0819T17May2011.JSDM.

      • MilesJSD
        milesjsd
        17/05/2011 at 12:05 pm

        ..there are yet other sticky-points:

        “What’s wrong with sticking to the facts instead of scaremongering ?”

        OK, Ian – but entangled therein is the opposite “substituting-in for the Fact a Sugar-Coated-Title”

        We have to call neighbour-and-ethnic- PERSECUTION
        (I do beg pardon, but my capitals indicate title- or key-wordings, or emphasis, NOT (please) to be taken as “shouting”)

        “ethnic-cleansing”.
        ——————–
        “Shot-in-back-by-own-troops” has to be called

        “friendly-fire”.
        ——————–

        and herein, for our Wellbeing-building, and for the NHS-Role & -Problem, calling fundamental-health-education “preventive-medicine” is surely and oxford-moron, as well as being cart-before-horse ?

        1205T170511.jsdm.

  2. MilesJSD
    milesjsd
    16/05/2011 at 4:02 pm

    My non-pharmacological, non-psychiatric, “psycholgical support for older people” agreement with the NHS has not yet been positively-constructive, merely acceptably neutral and low-key;

    but suddenly I am told

    (“) you have always been a psychiatric-case”;

    we are having to cut back on the minimum we have been providing you;

    and the Media front-page news that we (the NHS)will be providing much more preventive-care is actually not affordable and we won’t be doing it. (“)

    ====== 1601M160511.JSDM.

  3. Dave H
    16/05/2011 at 7:35 pm

    I’d probably start with the beancounters. To me, it seems that every time extra funding was announced for the NHS, extra staff were taken on to make sure it was spent properly, thus burning up a significant portion of the extra funds.

    I’ll stick in a disclaimer that I’ve never seen hard figures for breakdown of staff in a typical hospital so it might just be a media-inspired perception.

  4. Jon
    16/05/2011 at 11:32 pm

    Of course people are worried. The Conservatives have made the case for change, but not for their proposals to deliver it. In the absence of substance, fears naturally fill the vacuum.

    The proposal that the government washes its hands of the responsibility to, as the NHS Act (2006) puts it, “provide or secure the provision” of health care is a plan to avoid accountability. I prefer my government with a bit more spine.

    Lansley’s Bill is based on a naïve faith in markets and competition. The only other country that does so in health care is the US. They spend twice as much of their GDP on health, and yet have the worst infant mortality record of the advanced nations. Mine is not an ideological concern; I am not a vested interest. But more money for worse outcomes gets my attention.

    In the UK, it would prove impossible to retain the commitment to free-at-the-point-of-care, yet introduce private commissioning of care and competing private providers. There would be a strong incentive to demand more funding year-on-year, with the political fear of bad health statistics as a hefty stick indeed to beat the Chancellor with.

    That’s a recipe for financial incontinence without necessarily improving health outcomes. There is not a single comparable health care system on the planet. This is not responsible governance.

    Rather than sneering at the shroud wavers, our legislators should be examining these major factors. They won’t go away just by chanting “we need to reform”. Looming demographic trends do not go well with misaligned incentives.

    Rather than US-style market failure, Europe provides a wide variety of systems. Sweden’s is government funded but locally structured. France’s includes GP commissioning and a significant proportion of privately provisioned care. There is a possibility of a debate based on what has been proven to work. One based on real world comparisons, not pie-in-the-sky ideological fantasies.

    Let’s hope the Conservatives put Euroscepticism aside and put nation before party.

  5. Baroness Murphy
    Baroness Murphy
    17/05/2011 at 7:27 pm

    Jon, let me respond to some of your points.
    First, under the current proposals the NHS Act 2006 is maintained. The Secretary of State remains responsible for the provision of healthcare and the NHS constitution remains. The NHS Commissioning board will remain a national focus for ensuring procurement of services.

    Second, it is not ‘Lansley’s Bill, it is a Lansley version near identical to the Labour party proposals under Alan Milburn and accepted broadly by all political parties until recently.

    Third, it is not based on the American market model; the injection of competition will be closely regulated as it is now. It will not be based on price but quality. There is existing good evidence of its efficacy in driving up standards.

    Fourth, you are simply scare mongering when you say it would ‘prove impossible to retain the commitment of free at point of care’. Rubbish, that’s the whole point of the exercise, to make sure we can maintain it in the face of the demographic pressures. Where did you get such a wildly misinformed point of view? Give me one piece of evidence to support that notion. Socialist Workers Party perhaps? Private sector organisations have been involved in free at point of care commissioning for some time. Why shouldn’t they make a contribution to improving commissioning techniques in the NHS?

    Finally, yes you are right there are many good things we can learn from European healthcare systems and indeed many of the proposals include some of the elements of other countries’ systems.

    • Jon
      18/05/2011 at 6:19 pm

      Baroness Murphy,

      Thank you for your response.

      I have no fixation with the vested interests and socialists. As a private sector, corporate, Ivy League MBA professional with good experience of commercial realities, I have no instinctive aversion to private sector involvement. For the same reasons, however, I prefer a more hard headed analysis than you appear to have performed.

      According to the Office of National Statistics, NHS productivity has been flat for a decade. The introduction to date of private commissioning and higher quality standards have, it would seem, not contributed to improved cost containment. Rising demand combined with level productivity is an expensive combination.

      As a point of comparison, Canada also provides free at point of care, privately provisioned health care. They face the same demographic trends, and Quebec recently considered introducing fees for GP visits. They settled on an additional tax, with exemptions for low incomes. That is the first step to a health insurance model rather than giving commissioners direct access to general funds.

      Free at point of care encourages demand, private commissioning and provisioning provide incentives to encourage demand, and the inevitability of ageing and health care guarantees demand. Conversely, high standards limit supply. Health care markets have high barriers to entry, limited substitutes, and wide asymmetries of information. Regulatory bodies have a natural tendency to focus on abuse, not prevent incremental increases over time.

      This is little reason to believe the NHS Commissioning Board will prove capable of controlling the aggregate costs of such a system.

      To correct you on its substance, the current not only maintains but also amends the NHS Act 2006. Government would no longer be responsible for providing or directly securing the provision of care. I believe this introduces a risk of weak cost controls, based on the personal experience of working for a corporation with a budget comparable to that of the NHS. When executives control over their P&L is weak, cost controls are weak.

      In my view, it is irresponsible for a Cabinet Secretary to pre-emptively wash his hands of responsibility for the cost outcomes of a major reform of a large, complex service.

      Perhaps in the future, there will be evidence of the success of these reforms. I would be delighted to be proven wrong. In the meantime, I ask that you take your duty to consider the nation’s best interests more seriously.

  6. maude elwes
    18/05/2011 at 10:22 am

    If you want genuine reform to the NHS and are honest in the desire to have it ‘free’ at the point of use, then you must begin as you do with the refurbishment of a house.

    What needs fixing and what is perfect as it is? The roof is always the optimum way to proceed. What is wrong at the top? Then you go to the basement, and refit the plumbing and wiring whilst you tackle the damp. The rest follows along in order after that.

    Stop looking at the USA, that is a system on its way out as a viable route to health for that population as a whole. The carpet baggers are far too well entrenched for it to survive in any realistic form.

    Look to countries that have what we want and base the changes on their practice. How do they do it? What makes it work so well? Are the people of that country content and with justification?

    There is the Dutch.

    http://www.expatica.com/nl/news/dutch-news/Netherlands-has-best-healthcare-system-in-Europe_56753.html

    This is an American viewpoint and even they admit their system stinks. The optimum from this study indicates France as the top dog on health care.

    http://www.businessweek.com/globalbiz/content/jun2007/gb20070613_921562.htm

    This is the Belgian view.

    http://www.expatica.com/be/health_fitness/healthcare/belgian-healthcare-system-1493_8299.html

    And on.

    http://hospitals.webometrics.info/top500_europe.asp

    I am sure the brilliant people in our government have taken the initiative to look at what is available elsewhere and what would be the most suitable for the British people. But you cannot fiddle with the facade and expect a complete overhaul to materialize with a bewitched twitch of a nose.

    This GP backed idea is a nonsense. They are not up to it.

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