NHS REFORM: WHY AND HOW THE POLITICAL FOOTBALL TURNED INTO A SCRUM….

….and how honest politics could deliver a simple solution

The Coalition’s NHS Bill has undergone just over a thousand amendments since it first began to germinate in that small space occasionally referred to as Andrew Lansley’s brain. The majority of them, it seems, have been pasted in and patched not by the Opposition (which has little constructive to offer on the issue) but by Liberal Democrats who don’t know what they’re talking about, yet do realise that they must have some effect on something pretty soon, or they’ll be wiped from the map of UK national politics in 2015.

Now, a group of 240 doctors (see today’s IoS) have grouped together and are vowing to stand against MPs who vote for the bill. Single-issue candidates rarely win at General elections, so it feels like all they’ll get for their trouble is a lost deposits bill for £120,000. My own view is that the money would be better spent trying to get some media quid pro quos and sympathisers to turn the sum into some full page ads (or free website editorial) in the press and online, on a trailed day just before the election. These would do two vital things: first, name the guilty lobby-fodder who voted for it; and second, explain to the confused of Britain WTF they’re on about.

Apart from saddos like me (I’ve been on Lansley’s case since mid 2010) I don’t know a single person outside the NHS who has even the remotest idea what the argument is about, or where the real truth of the debate lies. It is a tribute to David Cameron’s ‘style’ of government – and Andrew Lansley’s capacity for tramline political theology – that between them they have made the public health debate even more dense and opaque, in fifteen months flat, than the ongoing pie-throwing contest between climate warmists and deniers. But to be a little more fair, the failure here is also one of a media set driven almost entirely by a fierce readership/hits battle, and other commercial concerns such as bankruptcy, as a result of its own technological and policy myopia. As well as a bit of criminality here and there.

Not since June 2011 has any major national press title given us an idiot’s guide to the Lansley Bill. Since then, the amendments have changed it into something for which we would need a Galactic Hitchhiker’s guide. But the fundamentals remain the same, so if I may I will point them out again, and my objections to them in red italics.

1. Lansley’s basic idea is to give 80% of the health budget to the primary care sector (GPs) and ‘give hospitals more control over their destiny by reducing Government control’. The Bill’s starting point is wrong, full stop. To give GPs even more money is patently daft, when the real need for infrastructural and techno-investment is at the hospital level. You don’t give hospitals more control over their destiny by starving them of funds. You do that because you want private health companies to buy them all at a knock-down price, and thus remove a persistent headache Whitehall has in terms of how to fund them.

2. These lucky GPs  will then form themselves into buying and commissioning groups. To further confuse what the point of these might be, Lansley proposes an NHS commissioning board to ‘oversee’ their activities (oh dear) and an organisation – working title HealthWatch – which will give nosey and ignorant patients a say in what’s happening. This is such an obvious, tangled mess waiting to happen, it is not even worth deconstructing.

3. The admin of the groups will be handled by ‘people currently working at primary care trusts (PCTs) and strategic health authorities (SHAs), which will be scrapped under the plans’. This part is Whitehall’s ‘contribution’ to the ‘reforms’, and consists  of a naked attempt to ensure that all the pen-pushers retain their jobs in one way or another. Thus the NHS’s second biggest problem – far too many admin folks – has been fudged completely, and little or no money will be saved.

That’s it, actually. That’s all there is to the Bill. Read the amendments, and you will quickly grasp that the LibDems have basically turned a schizoid Bill into an obsessive compulsive disorder. But the basic and core daftness of it remains exactly the same.

The point 1 above is for the greedy GPs who don’t do weekends or visits any more, the Tory Right who are having privatisation withdrawal symptoms, and the private health combines just gagging to get their hands on those hospitals. So for once, when the Left calls it creeping privatisation, they are right. It is a symptom of the sterility of our politics, however, that 67 years after the end of the Second World War, we have not progressed beyond nationalisation and privatisation. That is especially astonishing given that neither solution would be to the long-term benefit of patients in particular or Great Britain’s finances in total.

The fundamental problem that we as citizen voters face is that both the major Parties are working to a busted agenda rather than real needs. The Labour Party has never, and will never, learn that nationalised industries are wasteful and a drain on resources; while the Conservative Party – despite myriad examples since 1979 – will never learn that you simply cannot hand over vital services to a commercial culture that mislaid its moral compass some time around 1982.

My plan for the NHS is extremely simple and would, I venture, get the support of most electors if put forward. I’m calling it Slogplan A.

That is, to fire every civil servant from the health service by simply removing it from any relationship to government: but giving the entire thing mutual trust status so that it can never be taken over by profit-motivated business…and ensuring that every patient has a stake in the enterprise. And finally – there is more to this than brand-wank – dropping the ‘National’ part from the name. It should be called the Community Health Service. I mentioned earlier the NHS’s second biggest problem. Its first one by miles is the sheer size and complexity of the thing: responsibility must be devolved to community level. Then, in the end, communities will get the public health services they deserve….not a costly privilege they take for granted as one of their many assumed ‘human rights’.

All non-plc building societies, Waitrose, John Lewis and the Coop work on this basis, and work perfectly well. They also, on the whole, produce organisations with higher ethical standards and more honesty in their dealings with the public…and generate lots of profit for investment in the business.

Although the mutual commercial solution has made some ground in the years I’ve been banging on about it (and has a growing number of enthusiastic supporters in the media) it won’t be enacted by any of the Establishment Parties: because one or another of their grubby, tattered wings wouldn’t approve – and any attempt to would anyway be sabotaged by the Mandarins, who will never allow Whitehall to shrink. Not even the Mad Handbag managed to achieve that, and she was as determined as we’re ever likely to get.

Far more likely is that this Bill will pass, and within ten years a large proportion of the population will not be able to afford hospitalised health care. The market will be handed to US companies and general insurers, all of whom will under-cover and over-charge. Labour and the Unions will demonstrate, but get nowhere, because their idea of a solution is simply more jobs for the boys: and that one got found out years ago.

So my final plea would be this: Slogplan B. Drop all the LibDem amenditure bollocks, and add one big one: there will be an open auction of certain hospitals and their Trusts to the highest private-sector bidder, but the downside is that a mutual company rakes off 6% of all pretax GP and Hospital profits every year. (It has to be pretax, otherwise most of the money will go straight to the tax accountants and offshore banks).

That company – again, with no connection whatsoever to Westminster or Whitehall – will then sell low-cost, fully comprehensive health insurance to the less well off, and other people with more sense than money. With a bit of luck, within a generation the open market insurers will go bankrupt, following which we can revert to the  Slogplan A we should’ve had in the first place.

You see, if you don’t have lobbyists, extremists, dinosaurs, Party contributions and trade unions to worry about, there is a relatively simple, realistic and radical solution to most of the UK’s festering problems. Just don’t hold your breath waiting for that long-hoped-for New Dawn.

The full Slog view of mutuality can be found here

Related: A prediction of  the Lansley dog’s dinner

How monied politics leave out the citizen

33 thoughts on “NHS REFORM: WHY AND HOW THE POLITICAL FOOTBALL TURNED INTO A SCRUM….

  1. My plan is much simpler make it mandatory for every public servant, local government employee,quango employee members of the armed services, fire brigade health service, police etc. anybody funded by tax payers money and their immediate families banned from using the private system. Doctors and health workers make a choice one or the other. There would of course be queue jumping by the powerful within the system but overall improvements would begin to show

  2. The really ludicrous point about the Health Bill is that by the time any of this is implemented (assuming it goes through), there will be a new government in power which will certainly not be a ConDem coalition (more than that I’m not willing to speculate) and they will start re-organising the health service all over again.

    I cannot understand what on earth Lansley is playing at – or why Cameron is so averse to canning this entire shambles. It’s tempting to assume there is some kind of hidden agenda to privatise the health service, but I suspect there isn’t and that it’s part of a new dogma in Whitehall to put purchasing power in the hands of a ‘purchaser’. Except, of course, that GPs are not really purchasers of anything except holiday villas and 4 x 4’s these days. Far from giving them more power, their existing role as compulsory ‘gatekeepers’ should just be scrapped – an instant saving.

    In support of my ‘new dogma’ proposition, take a look at the latest skills and training proposals that purport to put some of the skills budget in the hands of employers. Except that, rather like the health service problems set out in 1 ,2 & 3 above, they don’t really do that, because bids for funding are expected to be made in partnership with the existing ‘providers’ (like A4e, for example) who will received the money that the employers in theory have control over, so that the quangos and Common Purpose infrastructure can continue to receive their taxpayer millions (your bullet point 3 above, John).

    It’s all rather reminiscent of the last Tory era, with Railtrack, Tell Sid, and a host of other privatisations. They worked out well, didn’t they? (Not for the consumer, of course, but who cares about him?). Worth bearing in mind though that railways, utilities and more recently the mail service privatisations were / are all driven by the EU.

    What we seem to be completely unable to do in this country is identify and run essential services for the benefit of all but free from political interference and profiteering by private companies. Toothless regulators have already been thoroughly discredited, from the Press Complaints Commission to the FSA. Your ‘mutual’ system might work, John, but above all what is needed is a framework that prevents taxpayers money passing straight through the system into the wallets of private corporations and ‘professionals’ quicker than a dose of Picolax..

  3. Mutual hey, just like John Lewis, the dearest shop on the high street (not many offers on HUKD, and the never knowing undersold shit is a sham to make you believe they are cheapest in the first place) and to boot one of the worst pay rates, yup the bonus makes up for it but only just.

    The problem with the NHS is too big, just like the banks is not a problem of capitalism or in the NHS case socialised care, it is one of scale.
    The best model imo is the German model, you buy your insurance and if you cant afford it the state buys one for you. But when you roll up an the local benefits office in German the first thing they ask you for is the addresses of your relatives who they contact to see if you can help you out first.

    The major advantage of this is that if you get pissed and out cold on the high street is that you pay higher premiums.

    Not sure how this personal responsibility stuff will go down with the Left, the NHS is one of the UKs two religions the other being Football but i noted that Billy Bragg was a big fan of the German social model yesterday on R4s any questions yesterday, so there might be hope I suppose before he realised what he was supporting I guess.

    As for who should one the Medical bit of the health system, I really dont care. I image like Gemany some will be state, a lot mutual and a chunk private. Its that the system is diffused is the main thing not interconnected with endless levels of pretend management, thus less prone to failure and quick to copy good practice.

    As Nassim Taleb said this week ” a system has not just to be robust to survive a crisis, its has to get stronger for it”

    Lets apply it to banks and to government too.

    • In answer to Sean: You seem very disparaging of John Lewis, but nobody forces people to shop there – and their business model seems to work: how many of their stores have closed during the current recession? They pay low wages, allegedly – less than Asda or Tesco? The retail sector has never paid “grunts” high wages, so perhaps better to work for a mutual where your collective efforts are rewarded with an annual bonus well into double figures (in effect, getting the dividend that would otherwise go to shareholders, or parasitic directors), than being treated as dirt just to generate profit for other people.

      • Think John?

        My daughter was on the graduate trainee course and is now selling nuclear reactor parts to the Chinese. Maybe I will tell you how they target local SME retailers in the stores areas, you know the ones that come up with new products and ideas and do generate new jobs. Or you might go and speak to some of them yourselves ask them what they think of” never knowingly undersold”

        Or are we talking prices? apart from the zest chair which is an exclusive there is nothing in there stores you cant pick up cheaper elsewhere.

        In 12 years apart from bedding in the sales we/I have only bought two Liebherr fridges which I dont seem to be able to buy from any where else. As for food we are a big clan and spend around 500 a week on food. I go to all the main supermarkets once a week and generally buy the offers. I go passed Waitrose everyday and have never been in the store.

        Ask yourself a simple question, If you rung me up for a quote and I then put some effort putting together the best price I could for you. You then used that quote to get yourself a better deal with your preferred deal would that be ethical?

        JL are just like all other businesses that wish to rig the market in their own image, they use a nice tie and suit and pretend they know something you dont. They are the most anti-competitive business on the high street and that’s why they are successful. As a model for the health services. I dont think so.

        Roll on the day I can get word of a good hip replacement deal on UK Hot Deals. But I imagine the guilds of Doctors will put paid to that.

      • ..And as for that other “mutual” the co-op,they are even worse at least JL target middle class people with too much time and money on their hands. The Co-op screws old people over instead.

      • @Sean: “there is nothing in there [sic] stores you cant pick up cheaper elsewhere.”

        If you find the *same product* available elsewhere, JL will refund the difference. That is their promise and AFAIK they stick to it. They certainly refunded several £100s to me a while back when I bought some carpet. I grant you that’s a bit of hassle but how else can they operate such a scheme? Or do you expect them to have 24×7 surveillance on all other retailers in the country selling the same products? That would take a small army of partners!

      • If you find the product cheaper elsewhere you should take the ethical route and buy it elsewhere. That is my point. They kill small and medium business with this practice.

      • @Sean: I’ve usually gone ahead and bought at JL because of the standard of service, free delivery of large goods *on the day arranged* and for carpets etc, top quality fitters. I note the DM article that JL have refined their price promise and it doesn’t really surprise me. To do otherwise means you are not comparing apples with apples. All that said, I’m sure there are flaws with JL if one looks hard enough, but overall they are the tops, except nowadays I do a lot of shopping on the Internet.

  4. If its not broke dont fix it…..the trouble is it is broke and cant be fixed……on that basis structural reform of some sort has to be an improvement………people dont seem to realise that tax rates would be drastically slashed……that saving could easily pay for some sort of insurance scheme probably subsidised for the needy……..The other big issue that has not been discussed as far as i can see is that with publicly funded cradle to the grave health service there is no incentive to stay healthy……..maybe no everyone wants to pay an additional 10% on their tax for an inefficient out of control health service?

  5. And the reported scrapping of National Pay Awards will only play to the private sector which will, in the end, take over our NHS. Local NHS managment teams are already, (in my area), planning to have non-nurses (Band 4’s) look after patients in intensive care and in the neo-natal unit, (premature babies).
    99% of GP’s in any given city have no idea how the NHS works, (specialty by specialty), hour-to-hour with regard to the myriad policies, procedures and best practice changes that have occured since they worked there.
    Neither do they see the wear and tear to the fabric of the buildings, nor do they understand the requiremnts for changin of materils and supplies given

  6. And the reported scrapping of National Pay Awards will only play to the private sector which will, in the end, take over our NHS. Local NHS management teams are already, (in my area), planning to have non-nurses (Band 4’s) look after patients in intensive care and in the neo-natal unit, (premature babies).
    99% of GP’s in any given city have no idea how the NHS works, (specialty by specialty), hour-to-hour with regard to the myriad policies, procedures and best practice changes that have occurred since they worked there.
    Neither do they see the wear and tear to the fabric of the buildings, nor do they understand the requirements for the changing of materials and supplies given the various dynamic processes that occur within departments.
    For any group of GP’s to truly start managing NHS hospitals in an efficient manner, they would first have to stop being GP’s and start being administrators. The learning curve for that would be beyond them, both in terms of energy expenditure and time required.

  7. No blog-page is big enough to list all the problems manifest in the NHS – 65 years of gross mis-management, vested interests and political football have left us with something which isn’t National, isn’t about Health and certainly isn’t a Service.

    The vested interests will ensure that any plan for progressive change will be defeated, either politically or practically so, although Lansley is a lightweight failure, chances are anyone else would suffer the same knee-jerk reactions he has.

    The only way to address it is to start again with a zero-base plan. Work out what sort of health services are needed in the 21st century, how to deliver them and what they will cost to deliver, then work out ways to structure and manage those necessary services, along with ways to acquire the ongoing funding to meet the costs. That’s all that’s needed.

    Trouble is, when you’re dealing with scared cows, of which the NHS is the biggie, all hope of logic goes out of the window and the familiar dog’s breakfast ensues. Can you think of any politician or party with the balls to do the job right ? I can’t, so it will never be done.

      • I fear the only sacred cows are now bullshitting administrators. Having just had lunch with my brother, who having been merit awarded last year after 30 years of total dedication to the NHS, has been informed that he and several dozen of his ilk, the best of the best, are to be made redundant. As a colorectal surgeon he is used to dealing with malignant arseholes, however it has become obvious that these particular pen-pushing arseholes are incurable. My brother is devastated, not for selfish reasons, but because of his desire to heal and to educate fellow clinicians.
        To the Slog, I raise a glass. Your breadth of insight is remarkable, not to mention your fluidity of thought and reason.

  8. We ought not be too surprised that the great and the good seem incapable of formulating workable proposals to address the myriad problems of the “National Health Service,” which has clearly become a sick joke, in need of radical surgery, if it is ever again to be fit for purpose. All we are seeing is an unprincipled battle, by the various vested interests keen to feast on the NHS carcass. To the victors, the spoils; but the only losers will be taxpayers and patients.

    Rebranding our health care to the Community Health Service is an excellent idea, because NHS has been debased as a title, and has, for me, lost any meaningful connection with it’s founding principles. Mutuality seems like a great way forward in the provision of services generally, and healthcare in particular, but I’m not holding my breath for it’s adoption by anybody with power or influence, as such people have consistently demonstrated themselves to be self-serving shysters, who too are no longer fit for purpose.

  9. I agree with most of the other sloggers here…..

    Placing the Labour Party on an equal pedestal as others in finding solutions to the NHS is wrong IMV. The NHS was created by Labour and it will not allow meaningful change. They have turned the NHS into a sacred cow, cared for and funded by socialist dogma. Allowing change would be an admission that socialism doesn’t work.

    There is no solution to the NHS in its current form. The only solution is to create a new parallel NHS & transfer responsibilities across, over time.
    But the country’s bankrupt, so we’ll carry on until the NHS implodes.

  10. If you can afford private health insurance, good luck to you, for the rest keep your fingers and everything else crossed.

    • That’s about right .The NHS is used as a ‘Political Football’ because it has the largest budget in govt of around £100 billion and the ~3rd largest workforce in the world .(Chinese Army #1, Indian Railways #2, NHS #3)

      Time to rebuild from the beggining upward

  11. Calm down, guys. My financial advisor (financial advisor!!! – actually I inherited him from my mum, who actually had some finances to advise upon..) once said to me “If you didnt read a newspaper, or go on line, or whatever, life goes on…. things are bought and sold, the sun shines or not. There are no outward signs of trouble. Lighten up” or words to that effect. And he is right. People just go on with their lives, giving and being given in marriage etc.
    I often think of this when I fear that the whole world order is about to implode, or worry about the idiots ‘running’ things.
    He does have a point. Take a bow, Michael Kent.
    (am I allowed to name him?)

  12. Trouble is the NHS doesn’t work and never has. It was the wrong solution to the wrong problem. And why is it so many are so obsessed with this Stalinist creation ?

    What the NHS replaced was probably a better system and what we should do is gradually break up the NHS and encourage much more private provision. Many of the great hospitals were built not by the State but by private philanthropy. And perhaps we need to ask a question: why does the State need to own and run a Hospital ?? Why can’t they be fun by Charitable Foundations for example ? Or private companies ? None of you are advocating we have such a system for growing cabbages so why with Healthcare ? Much more diversity in provision is what we need and that can only be of benefit.

  13. I prefer plan A ,all the NHS’s faults are consequential to scale and inertia, but 6% of turnover on plan B would improve it.

  14. When the Labour Party increased National Insurance contributions , substanisally , a few years ago must of the money went on huge increases
    to medical practitioners, not patient care. I expect the same thing will happen again. Investing in new equipment is always way down the list of priorities.

  15. I fail to see an logic in GPs being given a larger share of the health budget when, from my experience, they have become very adept at passing the parcel to the local specialists.

    For chronic cases GPs appear to be only semi-capable of diagnosis and not very good at long term management. It seems to be very much patient manage yourself with problems being referred to specialised clinics. In many cases the role being to do little more than issue the prescriptions.

  16. @John Ward
    Now, a group of 240 doctors (see today’s IoS) have grouped together and are vowing to stand against MPs who vote for the bill. Single-issue candidates rarely win at General elections, so it feels like all they’ll get for their trouble is a lost deposits bill for £120,000.

    John,
    don’t underestimate the power of this. It may be a protest vote and a single issue campaign but there’s nothing wrong with that. In the absence of a “Slog Party” or “Slog Candidates”, these people (the majority of whom are of good standing in their community) may be the ones who start the ball rolling against the cricket-match politics we have had for the last 80 years.
    The message from the three parties has always been that if you aren’t a party member and thus a potential candidate, you don’t stand a chance of being elected.
    That’s what they want you to believe.
    The reality is that their grip is far more tenuous that they’d have you know.
    Cast your mind back to 1997. Martin Bell (the man in the white suit) gave up his job as a BBC reporter and stood for election on a platform campaigning against sleaze in politics. Twenty-four days later, Bell overturned Neil Hamilton’s majority of 22,000, and Bell passed the finishing post with a majority of 11,000.
    That was ONE man who started a single-issue campaign just 24 days before the general election.
    I think that the good doctors could do at least as well.
    And just the threat of their campaign would most likely get Lansley spending more time with his family.
    Very soon.
    Kennyboy

  17. Sean: re John Lewis – they are a business, not a charity, and they exploit their niche well. Surely the NHS (or its future replacement) would be better run along Mutual lines, as JW espouses – accountable to local stakeholders, but able to pursue long term goals without pressure either from remote shareholders for short term profits, or national politicians looking to use it as a political football.

  18. John – Thank you for being able to articulate my thoughts much better than I ever could.
    There are so many of us who, whilst not always agreeing with you 100%, are on your wavelength. The frustration is that there is no political party representing our views, hence we appear to have no voice and no power.
    I had hoped that the Con/Lib-Dem coalition would demonstrate that the two-party stranglehold on UK politics could be broken, so that minority parties could sit at the table and have a say, but this dogs dinner of a government is not exactly a good model for that idea.
    Perhaps, as you say above, a well-orchestrated media campaign would be more effective. How to break the two-party / lobbyist / financial backers stranglehold?

  19. Pingback: HANDS OFF OUR NHS…. | The Slog

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