Thursday, 15 July 2010

Oh Doctor - I'm in trouble

A programme of dramatic change, promising to free the English health service from bureaucracy, put family doctors in the driving seat and hand power to patients was disclosed by Andrew Lansley, the Health Secretary

The health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service. If the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand. From a major public service with a million employees, it will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market.

I was involved in outsourcing facilities and services for a couple of the large London Health Trusts. It was a very easy way for my employer to make considerable profit. The specifications of the work and services to be undertaken were extremely loosely drafted; it seemed as if the drafter had no idea of what was being done by the directly employed personnel. Those who tendered were able to meet the demands by doing little more than reducing the levels of service. Just what is this driving seat that doctors will occupy? If what they want to prescribe is not included in the outsource documentation it will be charged as a one-off extra. That is where already juicy profit becomes exorbitant blackmail.

What power will be handed to patients? They cannot know what they actually require and will make choices on recommendations made to them. The best presenter gets the work so all the tricks of salesmanship will come into play. What if the desired treatment or drug is not available in this country? The existing organisation NICE is castigated for some of its decisions but it does ensure that there is some sense in drug procurement and dispensing. Just what will it take to convince the patient with his new found driving opportunities to accept 'Sorry. This bus not in Service' They will soon find out that cheaper equals inferior.

Why should anyone worry who provides healthcare? Because the weight of evidence is that private markets in health bring exorbitant administrative costs, lead to cherry-picking of the more profitable patients, increase inequity and the postcode lottery gap, generate conflicts of interest, are unaccountable, and increase pressure for top-up payments and "care package" limits.

No wonder the government is already ditching patient rights over GP and hospital appointments, and David Cameron was dithering yesterday about whether to maintain the right for cancer patients to see a specialist within a fortnight. The prime minister also struggled to explain why this upheaval in the NHS would avoid the increased costs that has attended every other reform.

He may think that costs will be reduced where NHS staff who end up being employed by the new foundation trusts or private companies have their pay slashed. There used to be protection for such employees who were guaranteed the offer of employment by the contractor at rates no lower than they were paid by NHS. I have seen nothing about this transfer of undertakings legislation being abandoned.

When it comes to spin and honeyed words, the Cameron-Clegg show is already putting Tony Blair and Peter Mandelson in the shade. However extreme or cock-eyed the policy, from savage benefit cuts for the poorest to the chaotic scrapping of school building projects, a gentle gloss or a winning apology from a coalition front-man and critics go weak at the knees.

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