Friday, June 27, 2008

Nurses, the new capitalists

Lord Darzi has announced that nurses are to run the NHS, but not in the traditional matron fashion, but as businesses.

While nurses often make reasonable managers (I include myself in this...), as I have repeatedly said the NHS should be a public service not a private company. Darzi seems as intent on privatisation as the ultra right-wing Doctors for Reform. These people are supposed to be in a caring profession, yet they are championing private profit over public service.

What is more, without democratic control of local services, the NHS is rudderless and providers will gravitate to the easy pickings in the market of healthcare, cherrypicking easy, profitable work at the expense of people in need.

And what really hacks me off is that crap that the right-wingers come out with. They can spout anti-tax and privatisation of health care, but to be paid for out of taxpayers money. THEY DON'T EQUATE!!! Either you have a for-profit system based on insurance, such as the US and leave millions to suffer and die or you have state provision through taxation and universal coverage, such as Cuba and er... the UK until 20 years ago.

Sunday, June 22, 2008


The debate on co-payments has increased again over the part couple of weeks and it seems to need exploring further.

The current debate seems to focus upon the Tory policy of top up health care, i.e. creating a two tier health care system that effective excludes people who can't afford to pay from receiving clinically effective treatment - breaking the founding policy of the NHS: health care based on clinical need not ability to pay.

Clearly the Tory policy is barking mad and should be opposed at every turn, however the current Labour policy appears to deny patients NHS care when they opt to have additional care on top of their NHS treatment. Desperate patients are therefore banned from seeking desperate alternative measures.This too seems wrong, but we need to understand why.

The top up rule was alledgely put in place top prevent doctors misusing the system to benefit their private practice and the Department of Health document: "A code of conduct for private practice: recommended standards of practice for NHS consultants"

The relevant section says:

2.13 Where a patient wishes to change from private to NHS status, consultants should help ensure that the following principles apply:
• a patient cannot be both a private and a NHS patient for the treatment of one condition during a single visit to a NHS organisation;

Interestingly this doesn't actually ban patients having top up treatments... although some trusts seem to treat it as such.

The key to the debate is whether or not the NHS can provide the full range of clinically effective treatments that patients need. Clearly the founding principle of the NHS states that it should and it seems that at present this principle is adhered to. The formation of NICE aids this principle (although I have some reservations about the processes behind NICE) providing a clear indication of what treatments are clinically effective and reasonable to be provided by the NHS.

The present system means that the founding principle is adhered to and ignoring that NICE could make mistakes, that BigPharma are great at publication bias, that alternative treatments not backed by BigPharma get little research funding, etc., this should make top-up treatments a complete waste of time and money.

However is people want to waste their time and money on extra treatments, should they be allowed to do this without being expelled from the NHS. I think the answer has to be yes.

Monday, June 16, 2008

How David Cameron can't deliver for the NHS

This is from the Torygraph today: How David Cameron can deliver for the NHS.

Toryboy describes how his party will:
  • increase spending on the NHS
  • to stop it being a political football, by creating an independent NHS board
  • anyone - a company, charity or NHS hospital - who can supply a service at the tariff set by the new NHS board should be free to supply it
Apparently: "The Conservatives can now afford to be radical on the NHS because the charge that they want to dismantle it just won't stick - all they are doing is following through Blair's revolution."

To take the last point first... how is radical simply following the current direction??? How can the Torygraph claim they won't dismantle the NHS when they are following Labour's policy of dismantling the NHS?

I'm sure spending on the NHS will increase, not matter which party is in government. The population is aging, inflation is rising. I doubt the Tories will increase spending in real terms - I'm sure that will decrease. Labour claim to have tripled spending on the NHS in the past 10 years, but it really just amounts to a 40% increase in real terms (not that I'm knocking that!).

The Tories are also backing Brown when it comes to independence for the NHS. For independence, read unaccountable. We need more accountability, not less! We need an NHS accountable to local people through local government.

Cameron's final policy is the continuation of Labour's market in healthcare providers.

These are the same policies as New Labour's. Now that's radical...

International Journal of Cuban Studies

The International Journal of Cuban Studies has been launched this evening:

Useful insights into Cuban society and how it could benefit the West. There is a particularly useful and well written piece on health care in Cuba...

Thursday, June 12, 2008

A week in the NHS

What a week.

Firstly, the government is against the wall on polyclinics with a million people signing the BMA's petition. Polyclinics, per se, are a good thing, the UK has had a form of them for some time (many community hospitals are in fact polyclinics). The problem comes when you attempt to build polyclinics to be run by 'for-profit' commercial BigHealth companies which replace and centralise local GP surgeries. (Not that there isn't a problem with GP surgeries being independent businesses anyway, but this is not the way to tackle it).

The pay ballots have been interesting to watch. The government has offered 8% over 3 years (pay increase of 2.75% from April, followed by further increases of 2.4% in 2009/10 and 2.25% in 2010/11), i.e three years of pay cuts to NHS staff. Unison and the RCN have accepted the deal but UNITE have rejected it. The RCN and Unison say that the deal is the best in the public sector! Doesn't say much for the public sector.

The RPI is running above 4% and you only have to look at energy and food prices to know that the real cost of living is going through the roof. Gordo's view is that public sector pay rises should be kept low to control inflation... i.e. stuff the nurses.

Sunday, June 8, 2008

Support your surgery!

This petition is from the BMA who seem to be up for a fight with Labour. Today's Observer spells out some of the rhetoric... I bet the Tories are rubbing their hands with trouble being caused while secretly being envious that they didn't think of it first.

Of course we don't want to see the closure of GP surgeries but remember they are currently run as small businesses anyway, but the petition below calls for them not to be sold to BigHealth - so please sign it!

Petition is here:

In the 60th year of the NHS, we, the undersigned, petition the Prime Minister to:

• Continue to support our existing NHS GP surgeries
• Improve services to patients by further investment in existing GP surgeries

We also urge the Government to halt its plans to promote the use of commercial companies in general practice because this risks destabilising our local surgeries and threatens the comprehensive, high quality care we receive from our GPs. We don't want public funding to move from GP practices to commercial companies who are accountable primarily to shareholders rather than patients. We want to be treated by GPs who see us as patients, not as customers.

Tuesday, June 3, 2008

Failing hospitals

Yesterday we heard how the majority of consultants were against the privatisation of the NHS. Today we are to learn that 'failing' hospitals are to be handed over to private companies...

Of course the government listens to clinicians: it listens and then heads off in the opposite direction.

So what is a failing hospital, why has it failed and what should be done about them? Answers on a postcard - or better still post a comment below!