"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Friday, 25 June 2010

Lansley's plans stalled... just

I warned about this before the election and yet no one in the Press seemed interested in the significance. More concerning, the Labour Party (and that pathetic excuse of a Health Secretary, Andy Burnham) who knew that the Tories were planning this, chose not to make it a central part of their election campaign. The break up and privatisation of the NHS has started by Andrew Lansley. This process has been stalled, but this is only temporary.

Let me give a little background (simplified, but just to give you the gist). Currently, the Department of Health (DoH) hands money to Primary Care Trusts (PCTs) to pay for the healthcare in the region. The PCT commissions services, which means that they decide how much healthcare will be required in the coming year, and then contracts providers to provide it. Usually this means NHS hospitals. When you need treatment your GP has to give you a choice of where you get that treatment and this choice is taken from providers that are commissioned to do the work. The treatment is paid by the PCT and each treatment is paid at the "national tariff" which is essentially the average cost of the treatment across the NHS in England.

From a hospital's point of view, they get paid per patient, the more patients they treat, the more money they get. If the hospital can perform the treatment for less than the national tariff they can keep the surplus. This surplus goes to provide new facilities or (frequently) to subsidise the treatments that they perform for more than the national tariff.

PCTs are public bodies and any member of the public can attend their meetings and ask questions. You can make them accountable for their commissioning decisions. Andrew Lansley intends to hand over all NHS commissioning to GPs. GPs are private businesses and there will be no democratic control over their governance. There will be no mechanism for you to challenge their commissioning decisions. There will be no way for you to choose to be treated in the hospital of your choice.

Luckily the Treasury have blocked this initial plan.

"The white paper got bounced back because there was no way the Treasury could sign up to a proposal which handed £80bn of public money to 35,000 GPs who are basically unaccountable private businesses," said one official.

This is a serious charge. But I would say that there is a far more important issue. GPs will be given powers to commission healthcare including services provided by themselves. Can you imagine the effect of this? Your GP will be handed a huge wad of money (£80bn given to 35,000 GPs means on average £2.3m each) and they will be allowed to spend some or all of that money on themselves. Do you really think they will send you to a specialist in a hospital when they think they could have a go themselves? The GP fundholding scheme (1991-1997) allowed some GPs to do this and the result was that fewer patients received specialist care at practices that had GP fundholding. Lansley wants to apply this over the entire NHS. You will not get the choice, if your GP has not commissioned your local hospital specialist to provide the service they will not be able to send you to the specialist.

The effect of this will be to reduce the number of patients seen by each NHS hospital, and this means that their income will reduce. This will result in a cut to the income of NHS hospitals. GPs, as businesses, will commission themselves to do the work which they think will be the most profitable. As I mentuioned above in your local hospital some treatements generate a surplus which subsidises other services. If GPs take the services that generate surpluses there will not be the subsidy. Those other services will suffer, and patients will suffer.

There is also evidence that GP services will suffer.

"Another issue is that to commission healthcare effectively, the new GP surgeries will need to oversee a large number of patients – with estimates of between 30,000 to 100,000."

In England each GP practice currently covers about 15,000 people. This means that the plans will involve the merging of two or even four practices. My town is 22,000 and there are two GP practices. I have the right to choose to register with one of two GP practices. Lansley's plan will mean that my town can only sustain one GP practice, and even then there may not be enough patients. It may mean that there will be one super GP practice covering my town and the neighbouring town. What has happened to the idea of a "family doctor"?

This is one of many truly terrible changes that Lansley plans for the NHS. The Treasury have blocked this temporarily, but the plan will return soon.

Friday, 11 June 2010

Longer NHS Waiting Lists next year

At the moment every NHS hospital has to meet the 18 week Referral to Treatment Target, that is the maximum amount of time between being referred by a GP to the NHS hospital providing the treatment must be less than 18 weeks, or 4.5 months. In my opinion 18 weeks is too long, it should be brought down to (initially) 8 weeks, and ultimately down to 2 weeks.

The problem is that restricting the length of waiting lists is expensive. For example, imagine you are a patient and you are referred to a hospital clinic that is only run every 10 weeks and the next two clinics are full, that will inevitably mean that your clinic appointment will be more than 20 weeks away and the hospital will fail the 18 week RTT. Hospitals must reach 98% of the 18 week target, so typically they monitor the situation until there are several people who have to wait more than 18 weeks and then put on a new clinic. This is often a good thing for patients because to justify a clinic the hospital will have to make sure there are enough patients and hence they may re-schedule other patients to have an appointment in this earlier clinic. Of course, the hospital wants to avoid this approach and so usually they make sure that there is sufficient capacity.

Because cutting waiting lists is expensive, the easiest way to make savings in the NHS is to allow waiting lists to grow. We saw how this cut price NHS worked in the 90s when typically you had to wait a year to have a cataract operation. During that time you would live with failing eyesight and so become economically inactive, but such things do not matter to Tories because their approach is that if you want the operation quicker you should pay for it privately (which I have shown in another post, means using out vastly over expensive private healthcare).

So now I see this tweet from Sally Gainsbury.

The reason for these changes are clear: it will save money. The effects are even more clear: we will return to 90s levels of waiting lists and long stays in A&E.

It is important that everyone contacts their MP to pressure Andrew Lansley to prevent waiting lists from growing. A key measure of this government should be how long waiting lists are, and by removing the targets waiting lists will inevitably increase.

Thursday, 10 June 2010

Tory in Labour's clothing

I know that this blog is about the Tories, but I had to comment on this blog by Pat McFadden, the MP for Wolverhampton South East (it is posted on the home page under "10 points for the new Labour leader" and there is no permalink, <sigh> ).

1. Understand that what much of the public means by fairness and what Labour politicians mean are often different things. For many people, fairness in public services is about the concept of exchange – people feel they have paid in and on that basis can draw down, be it in health treatment, social housing, pensions and so on. Yet often, public goods are not allocated on the basis of exchange but purely on the basis of need. It may be argued this is the fairest way yet the absence of an inbuilt concept of reciprocity lies at the root of much anger about issues as varied as the banks, housing allocation, welfare benefits and immigration. Those who raise concerns on these issues are not bigots. They are asserting that fairness should be about what you put in, as well as what you take out.

Oh dear Pat, you really do not get it do you? The public do not think that they have paid-in to the NHS. In fact it is often difficult to get most people to recognise that the NHS is paid out of their taxes. To most people the NHS is just there, and you get NHS healthcare because you need it. In fact the fairness of the NHS model is that regardless of how rich you are, or how much tax you have paid, you will get the ebst healthcare available on a principle of need. If you dare to suggest that people should have an entitlement according to what they have paid in, then you have started the slippery slope down the road of healthcare insurance and private health.

Please, remove this offensive statement.

Wednesday, 9 June 2010

Cameron's Claims on Economy are False

On Monday Cameron claimed that the state of the economy was worse than the previous government had told us. He tried to paint the picture that the Labour government had lied to us. In fact the absolute opposite was true, and Cameron was lying himself to suggest so.

On Radio 4 the Today programme, economist and journalist, Tim Harford says that Cameron was quoting figures that Labour had already published:

"That's false. Things are bad but the numbers David Cameron was using in his speech - that he seems to claim just came from nowhere, from secret government numbers - they're absolutely the same numbers that we were using during the election campaign, that the politicians weren't talking about but everyone else was. Especially the big numbers: the national debt £770bn, the projected debt in five years £1400bn, they haven't changed. Cameron also pointed to lots of little numbers throughout his speech and we have tracked down all but one of them and every single one of the ones that we tracked down was available in a published document often an official document before the election."

The one figure that Harford could not find was the figure of £70bn in interest on the debt in five years time. He says:

"Now, this is something we have discussed with George Osborne's office. They were quoting this number at us before the election campaign even started. It's true that before the election this was a figure published by the Institute of Fiscal Studies ... but George Osborne's own office was quoting this figure to us by email three months ago."

So there you have it, Cameron lying to the nation. The reason, of course, is that the speech was purely political - he wanted to blame everything on Labour. As Alistair darling pointed out, before 2008 when the structural deficit was building the Tories agreed with the Labour spending plans and said that they would continue them for several years if they were elected. So the Tories are just as to blame for the structural deficit as Labour. And of course, the vast bulk of the deficit (and the debt) is due to the recession - one that was created by the bankers.

The Cameron plan is to soften the public for the huge and unnecessary cuts that Osborne will introduce over the next few months. It will be messy and, as history (both past, in 1977 in the UK, and recent, in Spain) has shown us, the effects of these cuts will be civil unrest.

More evidence that the ConDems are Wrong

In the Financial Times yesterday, Martin Wolf argues that cutting too early will lead to the recession getting worse. (You'll need to register to read this article.)

Wolf quotes Adam Posen, (outside member of the Bank of England’s monetary policy committee) who points out that the danger is not that Britain will become a Greece, but that Britain would become a Japan. The Osborne plans to cut at a time when cuts will be the most damaging will lead us to the deflationary limbo that Japan is suffering now, and that the US suffered in 1937.

As to whether the UK is in as bad a shape as Cameron makes it out to be, Wolf says:

US government 10-year bond rates are a mere 3.2 per cent, down from 3.9 per cent on June 10 2009, Germany’s are 2.6 per cent, France’s 3 per cent and even the UK’s only 3.4 per cent.

This is saying that the bond market see the UK debt as manageable and not the huge risk that Cameron claims it is. Wolf then says:

What about default risk? Markets seem to view that as close to zero: interest rates on index-linked bonds in the France, Germany, the UK and US are about 1 per cent. What, for that matter, does the spread between conventional and index-linked bonds tell us about inflation expectations? We can say that these are, happily, still well anchored, at about 2 per cent in the US, Germany and France. In the UK, they are somewhat higher.

So the markets say that the chance of default is close to zero and the chance of high inflation is very small too. The markets like the economy that Labour left the ConDems.

Wolf finishes by saying:

Premature fiscal tightening is, warns experience, as big a danger as delayed tightening would be. There are no certainties here. The world economy – or at least that of the advanced countries – remains disturbingly fragile. Only those who believe the economy is a morality play, in which those they deem wicked should suffer punishment, would enjoy that painful result.

Sunday, 6 June 2010

Get Ready For the Privatisation of the NHS

Of course it had been planned for years. In fact, right from when Cameron was elected leader of the Conservatives: the NHS will be privatised.

Cameron declared when he was first elected as leader of the Conservatives that he wanted to cut the size of the state and bring in private involvement into public services. Then, before the public could recognise the full consequences, Cameron turned all "hug-a-hoodie" and "hug-a-husky" and the Press got deflected away from scrutinising his plans.

Now we will see what those plans will be, and a lot of people will feel cheated after the last election. You can see him building up to the worse. At the moment Cameron's team are telling the Press that "it is all Labour's fault" and saying that the economic situation is more worse than it is. (Remember that the independent ONS have already said that the economy is growing faster than they estimated before; remember that we borrowed far less in April than was planned; remember that the OECD says that the UK will have the highest growth in the EU?) Cameron will use this made up economic excuse to justify doing something that he has always wanted to do, but knew that the public would never allow. That is privatise what currently takes one sixth of the government's spending: the NHS.

Look at this coded message that he will give tomorrow (as reported by The Guardian):

Cameron will say: "How we deal with these things will affect our economy, our society – indeed our whole way of life. The decisions we make will effect every single person in our country. And the effects of those decisions will stay with us for years, perhaps decades to come."

The one service that affects all of us sometime in our lives is the NHS.

Ministers will be expected to ask searching questions about which services the government should provide and to find new ways of making services more efficient.

Searching questions? Oh really? Lansley has already decided what he wants to do, and his close ties with the private healthcare companies have given him the solution that he wants to apply.

The former BP boss Lord Browne is being lined up to be a "super director" with the job of inserting private sector business practices into the heart of government.

So there is the main clue thrown out by Cameron: Lord Browse will be the Privatisation Czar.