Dawning?©2010 Am Ang Zhang
Allowing private providers into a relaxed competitive market funded by the tax-payers is likely to lead to escalating costs and “dis-genuine medicine” being practised. Private companies need to make profits, and if set up as non profit making, need to pay their CEOs huge salaries. Where is all that money going to come from?
Some years ago (in fact nearly 30 years ago) I was faced with caring for a highly disruptive manic adolescent at home, as none of our psychiatric units (adolescent or adult) had room for such a patient. With only a very junior social worker in attendance, I had to sedate the boy at home with injections of major tranquillizers. Our hospital secretary, having heard of my heroic attempt to manage the patient at home, decided that he should be admitted into a private psychiatric hospital. The hospital concerned was agreeable as long as I remained his consultant. They would provide the nursing and junior doctor support.
My daily visits took the better part of half a day in those days. Before then, I had never set foot in a private psychiatric hospital. When we had some spare time, the junior doctor took me round the complex. I was suitably impressed with the buildings, the décor and the apparent pleasantness of the whole milieu. Then I passed a ward where quite a number of patients were on drips and each with a nurse in attendance.
"ECT?"
"No, modified narcosis! They came from all over the world, 30 days at a time."
What, this was the late 70s and I have only read about this treatment method in ancient text books!
"What do you use?"
"Barbiturates mainly!!!"
This was well before Michael Jackson’s era.
“You can join us if you like. We are short on Child Psychiatrists and there is a huge demand in areas of anorexia nervosa. You will earn three times, if not more, than what you do now!”
Soon after, I talked to a friend and my patient was transferred to the Maudsley, where he stayed for another 9 months.
I preferred to practise “genuine medicine” in the NHS.
News came of a doctor in America
Abbott Laboratories hired a Baltimore-area cardiologist as a sales consultant after he was barred from practicing at a local hospital last year for allegedly putting heart stents in hundreds of patients who didn't need them, say Senate investigators probing the medical-device industry.
Their report, to be released Monday, shines a light on one of the most lucrative procedures for hospitals and medical-device makers, at a time of spiraling health-care costs. Medicare paid some $25.7 billion for stent surgery in the six years through 2009, according to the report.
This is the danger. When doctors are paid for on a case by case basis by private health providers, they will find it hard to practise “genuine medicine”.
No wonder doctors are paid salaries at Mayo Clinic, Cleveland Clinic and Johns Hopkins Hospital
Christmas came and went: 50% discount at the stores is now followed by 75% discount.
Would one of the private providers be offering: have one hip replacement, get the other one free! Two cataracts for the price of one etc.
Or:
We check the prices of other insurers and we will match them!
Is that what the government think will keep health care cost down?
Some doctors that probably prefer to practise “genuine medicine” wrote to the BMA: over 100 doctors and 20 professors.
Denis Campbell, health correspondent
The Guardian, Thursday 6 January 2011
Doctors' leaders are facing a challenge from senior medics who claim they have been too quick to accept the government's NHS shakeup and should instead "mobilise" to thwart it.
More than 100 doctors, including 20 professors, have signed an open letter in the British Medical Journal, criticising the leadership of the British Medical Association, the doctors' union.
They claim the BMA should abandon its "failed" policy of "critical engagement" with ministers over plans that will "destroy" the NHS, and instead withdraw from discussions with health secretary Andrew Lansley to fight his reforms.
They write: "The NHS really is in your hands. We understand the pressures you are under, but now is the time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation."
+Author Affiliations
1. 1NHS Consultants’ Association, Correspondence to: C Peedell clive.peedell@stees.nhs.uk
Clive Peedell and more than 100 co-signatories ask why the BMA is not representing its membership and has acted as though the proposed health reforms are a done deal
Dear Hamish Meldrum, Laurence Buckman, and all members of the BMA General Practitioners Committee,
After the publication of the health white paper earlier this year, Hamish Meldrum wrote to the profession to explain that the BMA was going to “critically engage with the consultation process” to defend the founding principles of the National Health Service and the principles underpinning the BMA’s Look after our NHS campaign.
The consultation period is now over, and it is clear from the Department of Health’s response to the consultation that the BMA’s policy of “critical engagement” has failed to persuade the government to alter its approach. The BMA responded with a damning press statement: “There is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS. Most of the major concerns that doctors and many others have raised about the white paper seem, for the most part, to have been disregarded.”
In fact, Andrew Lansley’s plans are now even more market based. Within the new operational framework for the NHS in England
The NHS Confederation shares this view : “Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the US [United States
Moreover, the BMA has stated that it has “concerns over the use of ‘best practice’ or deregulated tariffs in the NHS, because this system brings with it price competition, which can risk basing decisions on price rather than on clinical need.”
The white paper is still awaiting publication as the Health Bill, which will then need to be subjected to the legislative process before being enacted by parliament. We are therefore very concerned that the BMA and more specifically the BMA General Practitioners Committee is treating proposed policy (that is, a white paper) as if it is policy. For example, on 17 December 2010, the chairman of the General Practitioners Committee Laurence Buckman stated in a letter to all general practitioners8: “Practices should now be working with other practices to make progress in setting up their embryonic consortia and electing and appointing a transitional leadership.”
In addition, on the topic of general practice consortiums and commissioning, a recent BMA briefing paper stated: “The pace of change in developing commissioning must allow the vanguard to develop swiftly.”
The fact that market based policies have actually been strengthened by Mr Lansley goes against BMA policy from numerous BMA annual representative meetings and the stated principles of the BMA’s Look after our NHS campaign. The BMA should therefore withdraw its policy of “critical engagement” with the government and engage more with its own membership. It is remarkable that despite “the most radical restructuring of the NHS since its inception,”9 BMA Council recently voted against holding a special representative meeting of the BMA to allow its membership to debate the current proposals. This is in contrast with the BMA’s stance against the other most significant NHS white paper reforms, Working for Patients in 1989, when two special representative meetings were called.
Although the BMA hasn’t formally surveyed the profession about the white paper, surveys conducted by the King’s Fund and the Royal College of General Practitioners have both highlighted the high level of concern among healthcare professionals, with fewer than one in four doctors believing that the proposed reforms will improve the quality of patient care provided by their organisation or practice.
We believe that the BMA has no mandate from the BMA membership to continue with the “critical engagement” policy. Mr Lansley’s reform agenda has been widely criticised across the health policy and political spectrum as moving too fast, yet the current approach from the BMA could actually hasten the pace of reform because the association has effectively sent a message to the profession that the white paper is a done deal.
We have serious concerns that the proposed reforms will fundamentally undermine the founding principles of the NHS by creating a much more expensive and inequitable market based system. However, we also believe that the BMA could play a crucial role in saving the NHS from this fate, because, according to the Health Service Journal, “From an influence point of view the BMA is critical because it could derail the coalition’s white paper reforms, which propose a clinically led system. If the BMA were to say no, then the whole initiative could grind to a halt.”
Thus the NHS really is in your hands. We understand the pressures you are under, but it is now time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation.
This is a great opportunity for the BMA to achieve redemption for its opposition to the inception of the NHS in 1948. We urge you to take it and will support you 100% of the way.
It is best perhaps to leave the financial people at the banks and let the doctors practice “genuine medicine”. Market forces can only distort. We can save a lot of unnecessary stents, modified narcosis and in fact money: tax payer’s money!
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