Friday, December 29, 2006


To whom is the NHS accountable? It is not accountable to local people, it is not accountable to MPs and certainly there is no accounability with local government. It now appears that the NHS is not accountable to ministers either.

Perhaps I am missing something but shouldn't an organisation that has £90 billion of tax payer's money be accountable to somebody?

Sunday, December 17, 2006

Legal challenge to ISTC

Interesting development in the murky private world of Hewitt and Co. A legal challenge to ISTC has started in Bristol, thought to be the first legal challenge against these.

Bristol Evening Post

Saturday, December 16, 2006

Obesity - is a Staple Diet Needed?

The news that NICE has recomended surgical intervention for extreme cases of childhood obesity shows the complete failure of government policy in stemming the obesity epidemic and it represents the increasing medicalisation of life with medical and surgical interventions being used to correct a failure of social policy.

The government has clearly failed to address the causes of obesity. Suggestions that people should go to the gym in their lunch hour or giving them free passes to gyms are simply sticking plaster ideas - what is needed is reengineering of the way we get around. Exercise has to be useful in order for it to be engaged in over a long period, yet transport policies encourage car use and discourage walking and cycling.

The government's failure to address the fast food culture is the other side of the obesity failure. While recent improvements in school food were welcome, they fail to address the widening cultural and health divide that requires are rethink of the way we supply food.

Thursday, December 7, 2006

Cooperative Health and Social Enterprise

Social enterprise, mutual health, cooperative health - all flavours of health care with a socially responsible theme, usually a health care service owned by its workers providing care for local people.

Pre-NHS there were many disparate healthcare services paid for out of, often, locally arrange social insurance or worker insurance - for example a community might fund a GP with a set amount each week charged to individuals.

I have been thinking a lot about these over the past few weeks as there is a great feeling that the model of health care is a useful one - but three things worry me: accountability, ownership and accessibility.

Accountability: This applies equally to the big boys, the private / corporate sector / foundation trusts etc. To whom are they accountable and how are they held to account? What happens when things go wrong (as they inevitably will from time to time)? Is professional liability enough?

Ownership: Most recent models talk of worker ownership and profits rather that ownership by a community and the mutual interest of a community. The organisation should be there to serve the community as its primary goal, rather than its owners.

Accessibility: Pre-NHS accessibility was often assured by community ownership, i.e. if you were part of the community and had paid your duty then you had access. The NHS is a nation wide version of this. If the organisation is funded through the NHS, then there is an assumption of universal access. If the organisation is not paid for by the community as a whole then universal access is unlikely.

I think there can be a role for mutual / cooperative health care in stable communities, but that ownership should be with the community, accountability should be to the community and the whole community should have access. But then we already have this don't we?


Wednesday, December 6, 2006

Foxtrot and tango

This is akin to driving to the gym... prescriptions for dance classes. I can't get my head around people that drive to the gym for a workout.. why don't the choose a gym a couple of miles away and run there an back (without going in) and save themselves pounds? I'm told it helps with motivation...

Anyway dance classes??? This was tried a few years ago with gym classes on prescription and is a prime example of a sticking plaster public health measure. If someone urgently needs support and motivation to lose weight then this should be available. If we want the popoulation as a whole to slim down, we have to address the way people want to live their lives.

Getting more people to walk and cycle will do a lot more good than a few people learning the quick step. That said, dancing is excellent fun and recommended to all (just not on prescription).


Saturday, December 2, 2006

Private costs revealed

The document published this week by the House of Commons Health Select Committee makes for fascinating reading, even though it will take you a few weeks to wade through the detail.

Snippets so far....

1. NHS spending on private healthcare companies (NHS expenditure on the purchase of healthcare from non-NHS bodies) has increased from £1.1 billion in 1997/98 to £3.7 billion in 2004/05 (page 99). This figure will far higher this year as with the exponential rise in ISTCs over the past 2 years. Surrey and Sussex Strategic Health Authority topped the table for spending the most on private healthcare companies (£238 million) and Leistershire spent the least (only £69 million).

2. The 'Wave 1' ISTCs (the first set of private treatment centres to be set up to provide NHS funded operations) cost 11% more than if the care has been provided by the NHS (p101).

3. Page 54 sets out the payments made each year to PFI companies as the 'unitary charge'. This charge includes the cost of the lease of the hospital plus any services that PFI company provides, e.g. cleaning / portering etc. Norfolk and Norwich are at the top with £43m being paid each year to their PFI company.

More to follow!