Thursday, October 6, 2011

NHS Reform: Doubts & Fears

Is it beginning to dawn on some people?

                                                   ©Am Ang Zhang 2011

Gerry Robinson:
Businessman Sir Gerry Robinson fears 'end of the NHS'

Some PCTs have already begun to close.

As the coalition government plans the biggest shake up in the 63-year history of the NHS, businessman and corporate troubleshooter Sir Gerry Robinson offers his viewpoint after spending six months taking the NHS's pulse.

Are the government's health reforms a step forward - or a step towards the eventual dismantling of the NHS?

Two sides of a story:
The changes are better for patients and better for NHS finances according to Dr Kosta Manis, a GP in Bexley. And key to that is the central reform - giving GPs substantial control over budgets instead of the current PCTs.

And that means control over how much they pay for services from the NHS and how much they buy in from the private sector.

In the past, Dr Manis referred patients with heart complaints to a local hospital where consultants usually ordered an often painful and expensive angiogram, using a catheter to probe inside the coronary arteries.

Dr Manis has found a more effective and cheaper alternative, which makes invasive angiograms unnecessary.

Patients at Dr Manis's surgery are examined on the spot to decide whether tests are needed by a top cardiologist, Dr David Brennand-Roper, brought in from a London teaching hospital.

If Dr Manis's patients require further tests, they are sent to a private Harley Street clinic equipped with a high-tech CT scan. They showed a healthy looking lady having the procedure.

This is an example where NHS money is being spent on a private provider - simply because they have got better kit.

I agree with saving the money where possible, but I really do wonder why we cannot have similar facilities to that Harley Street clinic within the NHS - especially if it presents cost savings.

Surprise! Surprise!

But wait: from the Mayo website
If blockages are found with a traditional coronary angiogram, the doctor can perform a procedure called angioplasty to open the blockages straight away.

However, because no catheter is used with the CT angiogram, if a blockage in one’s heart's arteries is found, a separate procedure (a traditional coronary angiogram) is needed.

So it may not be as straight forward as it first appeared.

Oh and the young healthy looking Angela has a normal CT angiogram! But the decision was made by a top cardiologist. The PCT had to pay for that “normal” CT angiogram. Panorama did not raise any question there.

Dr Manis was also concerned that angiograms were often routinely ordered at the local hospital because they were a source of income for the NHS hospital, not because they were absolutely necessary. Wow!

Remember Mayo again?
Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. One surgeon refers to this tradition as a ‘‘disincentive system that works.’’ Adds another surgeon: “By not having our economics tied to our cases, we are free to do what comes naturally, and that is to help one another out. .  .. Our system removes a set of perverse incentives and permits us to make all clinical decisions on the basis of what is best for the patient.”

That was how it used to be in our NHS!!!

It may be simpler to do away with Internal Market and incentive system.

I quoted Prof Waxman in an earlier post:

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

……..Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.
Panorama again:

Andrew Lansley Knew:
The health secretary agreed that the current system can encourage waste.

"It happens because of the way the payment system in the NHS works at the moment - because it pays for activity. So of course if you incentivise somebody just to do more work, they will do more work," Mr Lansley said.

This naturally provides great potential for waste if hospitals are not vigorous in weeding out unnecessary procedures.

I also have concerns that GP reforms would affect other elements of the NHS, possibly even leading to hospital closures if hospital incomes are significantly reduced as money is spent instead on private health care.

Gerry Robinson again:

Still, I am left with serious doubts about key elements of the plans as they stand.

I think the stakes here are huge. Who is going to be managing that big picture?

Unless somebody really does grab this thing at the centre and has the courage to make unpopular but right decisions then I fear this could spell the end of the NHS.

You can catch Margaret McCartney on the show!

Jobbing Doctor: This is important

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