Saturday, May 28, 2011

NHS Reform: Space, Snorkel & Scotland

Sometimes in life the solution to a big problem could be so simple.

Now that David Cameron and Andrew Lansley are faced with major delays in the proposed NHS reform, the Cockroach Catcher may have a simple solution for them.

Remember the very old Urban Myth about NASA spending millions on developing a zero gravity pen:

The Myth did get into one episode of The West Wing: We Killed Yamamoto

Leo: We spent millions of dollars developing a pen for the astronauts that would work in zero gravity. Know what the Russians did?
Toby: Used a pencil?
Leo: They used a pencil.

Well it was not exactly true but it illustrated a very important point: solutions could sometimes be very simple and cheap.
Now most readers know that I love snorkeling and when I started my wife on it she, being a scientist, wanted to know the names of things she saw whilst snorkeling. The West Wing came to mind.

We used a polypropylene chopping board (the smaller one), drill a hole in the corner to tie a strap so that the hand could sometimes be free to operate the camera. We then use a golf pencil tied to the board with a fishing line to write.

Blue Brittle Star ©Am Ang Zhang 2010

So what about The NHS:  A pencil solution?

Just copy Scotland; that “country” north of the border.

As much of the opposition to the new Bill is to do with the simple fact that it was a back handed way to privatise a major part of the NHS, the profitable part. Ordinary citizens without insurance will be left with a much depleted hospital service and those with insurance may find that over time they too might be dumped by their Private Health Insurers.

The Herald
25 Feb 2009
Radical new legislation stopping private companies from running GP surgeries in Scotland is to be unveiled by ministers - further widening the divide between how the health service is run north and south of the border.

Explaining the purpose of the new legislation, which won near "unanimous" support from Scottish doctors during a recent consultation, Ms Sturgeon told The Herald: "We have decided to go ahead and legislate to effectively remove the possibility of commercial companies running GP practices.

"We want people providing GP services to be committed to the NHS and not to see it as a way of making a profit. I would hope that we would get considerable support for the bill from opposition MSPs."

The legislation, which ministers also expect to garner cross-party support, was sparked by concerns over a legal loophole which could allow into Scotland the kind of "creeping" privatisation of the NHS which is supported by the UK Government south of the border.

Trust in the government will return. There will not be any privatisation of primary or secondary care and that it would not go the way of the dental services.

Then those of us who could not afford private health care might be able to accept genuine and well thought out changes to the way the NHS will be run.

No more internal market, no more cherry picking and back to an integrated service.

By the way why not use the Scottish model that has now survived 10 years.

Nottingham University: NHS Scotland a role model for reform

After devolution the NHS in England increased its reliance on a market-based approach – now one of the various controversies surrounding its future direction.

By contrast, NHS Scotland set about developing partnership agreements at national and board level as part of a strategy to engage staff in improving services.

The result, according to a study funded by the Economic and Social Research Council, is an “incredible common agenda” among interested parties from all quarters.

Research co-author Dr Peter Samuel said: “Although partnerships are found elsewhere in the public sector, NHS Scotland’s stands out as distinct and novel. It has survived for over a decade, defying reorganisation and changes in administrations, and it can offer valuable lessons in how to improve industrial relations.

………Dr Samuel said: “The policymakers of NHS Scotland clearly concluded the only way to deliver better healthcare was to improve the way staff were engaged. This led to the establishment of various structures at national and local levels to give staff more say in decisions affecting their working lives and healthcare provision.

“NHS Scotland has even passed into law a ‘staff governance code’ that compels all its health boards to engage and involve staff and their representatives.

“This innovation in industrial relations is arguably one of the biggest examples of industrial democracy to be found anywhere in the world – and they have made it work.”

……….. We need to get back to using clinically relevant measures of performance that tell us how we are doing in comparison with our peers.

This has been repeatedly shown to be one of the most potent ways of modifying GP behaviour, and we should go back to it as a way of influencing clinical practice.

Scotland has no real truck with private medicine; APMS (Alternative Provider Medical Services) is not allowed. There is no market in healthcare as health boards keep primary and secondary care working together, and we actually speak to each other. Some of my best friends are consultants.

………… that trusting us to do our job is more effective than micromanagement.

Scotland: Serco NOT allowed to run GP practice


Julie said...

Yep, the Scottish Health Campaign Network was one of the major backers of that legislation on GP practices and it was in my area (Lanarkshire) that Serco tried to take over Harthill GP practice. We kicked up a hell of a fuss and as it was close to the elections it was dropped; there was already enough fuss going on about Monklands Hospital. Devolution has allowed us to take a different direction on health and it's the same in Wales, where PFI projects were banned long before the rest of us realised how toxic they were.

Cockroach Catcher said...

Thanks Julie. It is not as if no one is alerting the government.

It is very suspect. Bringing in private providers is going to disadvantage a section of the community. Those working for big corporations and the GMC have private cover and jump the queue. People think that having Private Providers will improve the access time. There are just the same number of specialists and if they can make more money in the Private Sector, they will as they will have more say and treated with more respect.

How is NHS England going to save money?

Anonymous said...


Do you think it would work if England followed Scotland? Not that I think it will happen in a million years!

Julie said...

Hi Anon,

Yes, it would work. You would have to get rid of the purchaser/provider split and basically remove the internal market, but it would work. Your biggest problem is that every single procedure has a paper trail of tariffs attached to it for market purposes and Allyson Pollock estimated that this doubled your admin costs from 6 -12%. Admin here is 6% of our costs, so assuming a budget of £100 billion for England, you could save £6 billion a year.

Cockroach Catcher said...

I totally agree with you. If simple folks like us can see it why can't they?

If Mayo can do you, why not the NHS.

Part privatisation is the reason, has to be and in the end we will be paying out more. Just like Southern Cross, just like PFIs!!!

Panic Attacks said...

This statement - We need to get back to using clinically relevant measures of performance that tell us how we are doing in comparison with our peers - says it all. Though those who are dedicated to patient care far exceeds the ones who are only after money, it is good to always keep the primary concern in mind.