NHS 2011: Privatise? Never!!!

As the NHS plans pass the first Commons hurdle (BBC) the fear is that the NHS is being privatised.

This is not the view of The Cockroach Catcher.

That would be an underestimation of politicians. History taught us that many former politicians including Health Secretaries swiftly joined the private health sector after their remarkably short terms in office.

It remained true in all countries (first to third world ones) that the best money to be made is government money and in the third world countries money from other people’s government.

So the NHS will be free at the point of delivery.

Lets hope so but the money must come from somewhere.


And some of us pay taxes!!!


What about private providers:

Private providers will not be hovering around if there is no money to be made.

Just look at one of the biggest private provider:

General Healthcare Group has produced strong revenue and profit growth during a challenging year. Stripping out discontinued ISTC contracts and the Transform and Abbey acquisitions, revenue has increased 2.6% from 2009 levels which, slightly offset by more NHS cases, has seen its EBITDA margin increase from 26.2% to 26.3%. This generated EBITDA of £222.1m, up from £220.6m in 2009.

During 2010 General Healthcare Group has strengthened its position as the leading private healthcare provider in the UK. The group has broadened its geographical coverage and improved its performance through a strategic investment in the Transform group and acquisitions of Phoenix Hospital Group in central London, Southend Private Hospital in Essex and Abbey Hospitals. In addition to these acquisitions, two new ventures were started in the form of Syon Clinic in Brentford and Coombe Wing in Kingston.

In addition, the group acquired SterilPlus, which comprises three decontamination units in Glasgow, Manchester and Radlett. GHG acquired SterilPlus on the back of a decision by Vanguard AG to divest itself of its UK interests. SterilPlus will deliver the ‘gold standard’ service for instrument decontamination.

Pheonix Hospital Group has two hospitals. The consulting and diagnostic centre at 9 Harley Street has eight consulting rooms, four treatments rooms and a complete diagnostic imaging suite. The Weymouth Hospital has 17 beds and four theatres. Phoenix Hospital Group brings a unique, modern approach to providing private hospital healthcare in London.

Southend Private Hospital is a purpose-built specialist day case facility with two full theatres and a range of consulting and treatment rooms.

Transform Group is the UK’s number one cosmetic surgery group with 24 clinics operating out of the London, Manchester and Scotland regions.

The Abbey Hospitals are made up of Gisburn Park Hospital in Lancashire, Sefton Hospital in Liverpool and King’s Park Hospital in Stirling. They offer a range of specialist and general surgery together with physiotherapy departments. They also undertake a range of contracts for a number of NHS Trusts and PCTs.

General Healthcare Group Limited ('GHG') is the largest operator of private hospitals in the UK in revenue terms, trading through its wholly-owned subsidiary BMI. GHG turnover was £435.6 million for the year to 31 December 1999.

GHG is controlled by funds advised by B C Partners ('BCP') a venture capital firm which provides funds for management buy-outs in return for equity stakes. BCP's equity is divided among a number of its investment funds. BCP's funds' principal investors are financial institutions and pension funds. BCP does not have any interests in competing healthcare companies. Around 10% of GHG equity is owned by the GHG management. For the sake of clarity I will refer to GHG as BMI in the rest of the submission except where it is necessary to refer to the group as a whole.

Community Hospitals Group plc ('CHG') owns and operates 22 private hospitals. The gross assets of CHG were £270 million at 30 June 2000. The Group turnover in the year to 30 June 2000 was £123.9 m with a profit before tax of £19.4 million.

GHG proposes to acquire the entire share capital of CHG and would re-brand the hospitals under a common name. GHG would close CHG's Head Office, transferring some of the staff to BMI's corporate and regional management teams.

So nobody in their right mind would want to privatise the NHS. There is certainly more money to be made if it remained in the public domain.

Dave Cameron’s brother-in-law should not worry either as his income would go up at least 300% as long as he works for one of the private providers.

For a long time, private providers only have consultants working for them to provide the specialist care. They are now moving into primary care to basically corner the market.

Business is business!!!

But the sums are somehow wrong: if the private providers are making money and the GP commissioning teams have a limited pot and that Consultants working for the likes of BMI hospitals have a 300% increase in pay compared to old NHS Hospital pay scale, either tax payers are going to be forking out more and more money or someone is not going to get their treatment.

Is some politician heading for a top job with the likes of GHG or Bupa? Only time will tell and history told us it won’t be long: less than 2 years.

NHS: Scotland, Wales & Northern Ireland

Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Simon Stevens: now with UnitedHealth

Enemy Of The People: NHS, Internal Market & Safety Net

NHS: Market Forces, Genuine Medicine & BMA

NHS: Changes Or A Conspiracy Against The Public Interest

NHS: Best Health Care. Still!

The Jobbing Doctor had a post on :

Why the NHS works.

“I saw a patient last week, who has recovered from major surgery. He has had brain surgery and is now likely to do very well. I am pleased. He is well.

.......His care, I reckon, would have cost around £200,000. He knows that. We, the healthy, paid for him to have his treatment.

This is the NHS that I joined as a Junior Doctor 36 years ago.

I get a bit fed up of politicians and journalists telling me that the NHS needs reform.

It blinking well doesn't. What it needs is aforesaid politicians to go away and do something else with their time. I'd rather they dredged their moats, or tended to their duck houses.

Leave us alone."

I will reprint one of my previous posts.

Best Health Care: Private Medicine, Porsche & The NHS

Do we judge how good a doctor is by the car he drives? I remember medical school friends preferred to seek advice from Ferrari driving surgeons than from Rover driving psychiatrists.

My friend was amazed that I gave up Private Health Care when my wife retired.

“I know you worked for the NHS but there is no guarantee, is there?”

Well, in life you do have to believe in something. The truth is simpler in that after five years from her retirement, the co-payment is 90%.

He worked for one of the major utility companies and had the top-notch coverage.

“The laser treatment for my cataract was amazing and the surgeon drives a Porsche 911.”

Porsche official Website

He was very happy with the results.

“He has to be good, he drives a Porsche.”

Then he started feeling dizzy and having some strange noise problems in one of his ears.

“I saw a wonderful ENT specialist within a week at the same private hospital whereas I would have to wait much longer in the NHS.”

What could one say! We are losing the funny game.

What does he drive?

A Carrera.

Another Porsche.

We are OK then.

Or are we.

He was not any better. And after eight months of fortnightly appointments, the Carrera doctor suggested a mastoidectomy.

Perhaps you should get a second opinion from an NHS consultant. Perhaps see a neurologist.

“I could not believe you said that, his two children are doctors. And he has private health care!” I was told off by my wife.

He took my advice though and he got an appointment within two weeks at one of the famous neurological units at a teaching hospital.

To cut the long story short, he has DAVF.

I asked my ENT colleague if it was difficult to diagnose DAVF.

“Not these days!”

He had a range of treatments and is now much better.

All in the NHS hospital.

“I don’t know what car he drives, but he is good. One of the procedures took 6 hours.”

Best health care.

I always knew: Porsche or otherwise.

Related:

Best Health Care: France & The NHS

Best Health Care: NHS GP & NHS Specialist

Others:

NHS-Kaiser Permanente: Integration?

NHS-Kaiser Permanente: The Good Bits!!!

NHS-Kaiser Permanente: Integration or Fragmentation?

NHS-Kaiser Permanente: Which Bits?

NHS 2011: Ownership & Integration or A New Brand?

Cherry picking soon?

©2010 Am An Zhang

In a previous blog post I stated:

When all the talk is about trying to emulate Kaiser Permanente in the NHS reform up and down the country, my observation is that unless there is some radical rethink, the new NHS may end up as removed from Kaiser Permanente as imaginable.

Ownership and integration

Ownership and integration has undoubtedly been the hallmark of Kaiser Permanente and many observers believe that this is the main reason for its success, not so much the offering of choice to its members. Yes, members, as Kaiser Permanente is very much a Health Club, rather than an Insurer.  Also, a not so well known fact is that Kaiser Doctors are not allowed to practise outside the system.

Sacrifice choice:

It is evident that the drive to offer so called choice in the NHS, and the ensuing cross-billing, has pushed up cost.  The setting up of poor quality ISTC (Independent Sector Treatment Centres) that are hardly used is a sheer wastage of resources.  When Hospital Trusts are squeezed, true choice is no longer there.  Kaiser Permanente members in fact sacrifice choice for a better value health (and life style) programme.

Covert Rationing:

The push for near 80% of GP commissioning is to lure the public into thinking that they are going to be better served.  In fact this is a very clever way to limit health spending and at the same time leave the rationing to the primary care doctors in a very un-integrated system.

Consultants:

So what about the specialist doctors that we call consultants in England?  Well, some are already offering their services in a private capacity to the GPs via PCTs, who are at liberty to buy those services. The NHS pay for hospital Consultants has now lagged behind that of GPs, and many consultants supplement their income by private work. Once you have had a taste of Porsche and Ferrari, are you going to go back to Rover?  A few major insurers are poised to buy up Foundation Hospitals and offer consultants a deal they cannot refuse.  This will lead us further away from the Kaiser Permanente ideal of an integrated system.

£££££££££:

The most conservative estimate is that Consultant income will increase by 300% in the new private provider dominated specialist service. Has anyone not noticed that you buy private insurance to get your Specialist treatment? The gatekeeper is still your friendly GP.

The total income for all Private Health Insurers is currently estimated at around £6.5 billion, a quarter of which goes to the Specialists.

The NHS is already funding 20 to 25% of the Private sector.

Internal Market

By contrast, Kaiser Permanente is in part successful by doing away with the internal market and fees for service.

The New Brand:

"In reality, Lansley's health white paper opens the door to the comprehensive privatisation of healthcare and the end of the NHS as a national service. If the plans are taken to their logical conclusion, by 2015 the NHS will be little more than a brand. From a major public service with a million employees, it will have become a central fund with a minimal workforce, commissioning services from a string of private companies in a fully-fledged healthcare market.

"'The bottom line of this is the abolition of the NHS,' Dr David Price of Edinburgh University argues. "It will remove the government's duty to provide a universal healthcare service." His colleague, Professor Allyson Pollock, believes it will lead to "full privatisation".

"Meanwhile, all hospital trusts are to be turned into freestanding businesses outside the NHS. They will be allowed to go bust or taken over, encouraged to form "partnerships" with profit-making private companies and obliged to remove all limits on private provision. These new, independent trusts are supposed to be not-for-profit "social enterprises", but health policy experts scoff at the distinction when profits can be distributed as "surpluses" or extravagant salaries to directors.

"Why should anyone worry who provides healthcare? Because the weight of evidence is that private markets in health bring exorbitant administrative costs, lead to cherry picking of more profitable patients, increase inequity and the postcode lottery gap, generate conflicts of interest, are unaccountable, and increase pressure for top-up payments and "care package" limits.

"The scandalous costs of creeping privatisation are already clear enough, from PFI projects to independent treatment centres. This year the Commons health select committee found administration costs had risen from 6% to 14% by 2005 as a result. They're certainly higher now – and are double that in the US, by some estimates. But now the coalition wants to put the NHS in the hands of the very health corporations that fought Barack Obama to a standstill over his attempt to bring universal health coverage to the US."

Related:

A BETTER NHS

Campaigning For Health

NY Times: 

A Breath of Fresh Air for Health Care

Is Kaiser the Future of American Health Care?

NHS-Kaiser Permanente: Integration?

NHS-Kaiser Permanente: Which Bits?

NHS-Kaiser Permanente: Integration or Fragmentation?

Animal Farm: Democracy!!!

Animal Farm

©2010 Am An Zhang

I think there is something fundamentally scary about our democracy…. Because I think people have a sense that the system is rigged, and it’s hard to argue that it isn’t.

Michael Lewis: The Big Short

MP Expenses:

“Baroness Uddin claimed £100,000 in public money by naming an allegedly empty flat in Kent as her main home, while living in a flat just four miles from Parliament.

She was investigated by police over allegations that she had misused the £174-a-night allowance intended for peers who have to stay overnight in London while living elsewhere in the country.

But in an unprecedented intervention, Keir Starmer said that she had not been charged because the Lords’ rules were so lax.”

If they are not in government, where are they?

The Guardian

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn

Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

 Alan Milburn now also holds a place on the board of PepsiCo as an advisor.        Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4billion for Bupa's UK hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.

[edit]Stepping down

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat in Leicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family.   Wikipedia

 

"Somehow it seemed as though the farm had grown richer without making the animals themselves any richer- except, of course, for the pigs and the dogs." 

Animal Farm        George Orwell

A culture of corruption pervades the links between government and business, fuelled by and fuelling privatisation. These relationships are – as Adam Smith put it – a conspiracy against the public interest.

Glass-Steagall Act

 

Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Simon Stevens: now with UnitedHealth

NHS & Market Forces: Unnecessary Rx & Fraud

Do we ever learn?

Winter’s Tale/Tristram Kenton Guardian

In the current push for applying market principles, the NHS is in serious danger of paying dearly for unnecessary treatment and worse, fraudulent claims by the new “suppliers” in the market place.

I have highlighted the problems in the US before. Fraud is seen as more profitable than drug dealing.

The US Medicare and Medicaid systems are in a way very similar to what the new market style NHS will be like. Tax-payers pay for them! The much hyped saving, if there is going to be any, will be swallowed up by paying for unnecessary treatment and fraud.

By how much? In the US:

WASTE IN THE U.S. HEALTHCARE SYSTEM PEGGED AT $700 BILLION IN REPORT FROM THOMSON REUTERS

26 OCT 2009

Reuters pdf

The U.S. healthcare system wastes between $600 billion and $850 billion annually, according to a white paper published by Thomson Reuters.

The report identifies the most significant drivers of wasteful spending - including administrative inefficiency, unnecessary treatment, medical errors, and fraud - and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.

Unnecessary Care (40% of healthcare waste): Unwarranted treatment, such as the over-use of antibiotics and the use of diagnostic lab tests to protect against malpractice exposure, accounts for $250 billion to $325 billion in annual healthcare spending.

Fraud (19% of healthcare waste): Healthcare fraud costs $125 billion to $175 billion each year, manifesting itself in everything from fraudulent Medicare claims to kickbacks for referrals for unnecessary services.

“The Federal Bureau of Investigation (FBI) estimates that fraudulent billings to public

and private healthcare programs are 3-10 percent of total health spending, or $75–$250

billion in fiscal year 2009.”

“Fraud and abuse” occupies the extreme end of the continuum of appropriateness of use and potential waste. While arguments can be made about the appropriateness of some of the care described in the previous section, and, therefore, its classification as waste, no reasonable argument can be made for the contribution of fraud and abuse to quality of care or outcomes. They are cases of intentional misrepresentation resulting in excess payment, including billing for services never rendered and the knowing provision of unnecessary care. Most fraudulent and abusive practices simply add cost with no value, but others actually expose patients to the risk associated with unnecessary procedures.

Practices leading to waste include:

• The intentional provision of unnecessary or inappropriate services

• Billing for services never provided, often with patients’ participation in the fraud, often for

deceased patients

• Misrepresentation of the cost of care by insurers to group plan sponsors

• Kickbacks for referrals for unnecessary services

• Misbranding of a drug by a pharmaceutical company

• Abuse of the healthcare system by patients to receive harmful services, such as Medicaid  recipients with drug addictions enrolling in multiple states.

Administrative Inefficiency (17% of healthcare waste): The large volume of redundant paperwork in the U.S healthcare system accounts for $100 billion to $150 billion in spending annually.

Healthcare Provider Errors (12% of healthcare waste): Medical mistakes account for $75 billion to $100 billion in unnecessary spending each year.

Preventable Conditions (6% of healthcare waste): Approximately $25 billion to $50 billion is spent annually on hospitalizations to address conditions such as uncontrolled diabetes, which are much less costly to treat when individuals receive timely access to outpatient care.

Lack of Care Coordination (6% of healthcare waste): Inefficient communication between providers, including lack of access to medical records when specialists intervene, leads to duplication of tests and inappropriate treatments that cost $25 billion to $50 billion annually.

Full Report: Reuters

Hermione: "You pay a great deal too dear for what's given freely". -

(Act I, Scene I). The Winter’s Tale.

Health Care Fraud: US Medicare & NHS Reform

Enemy Of The People: NHS, Internal Market & Safety Net

NHS: Market Forces, Genuine Medicine & BMA

NHS: Changes Or A Conspiracy Against The Public Interest

NHS: Radical Options

A reprint from an earlier post:

New Zealand, Wales & England: NHS    Saturday, April 3, 2010

“Do not adjust your TV, there is a fault in the broadcast” was an approach my Guru taught me about some of the symptoms psychiatric patients think they might have. Just as Dr House thought in one of the recent episodes that he might be hearing voices. (Yes, The Cockroach Catcher watches House M.D., the best antidote to top heavy management).

In Hooray for the Health Committee, Dr Grumble was worried:

“At times it seems that nobody else is aware of these home truths about our health service to the extent that, just occasionally, Dr Grumble begins to just wonder if it might be him that is mad and not the rest of the world.”

©2010 Am Ang Zhang

Following his suggestion I read: House of Commons Health Committee Fourth Report of Session 2009–10:

“The most radical option would be to abolish the purchaser-provider split, as Wales and New Zealand have. The BMA argued that the split between purchaser and provider had been expensive, inhibited clinician involvement in planning services, and fostered a system which is dominated by cost containment by PCTs and income generation by providers.”

New Zealand? Where is it? Was it part of the original NHS?

Should I like Dr House check into an asylum?

On Darzi:

However, the Committee received evidence of concerns. Professors Bloor and Maynard have argued that it is not yet clear whether incentive schemes will result in improved patient outcomes and justify the cost of implementing them. Evidence for US incentive schemes is weak and the impact of the new scheme in the English NHS is not predictable:

Experience from the US suggests that a balance needs to be struck between the motivational effects of potential penalties and the possible costs of destabilizing organisations. In addition, if penalties are a real possibility and are on occasion levied, their motivational effects are likely to be short lived.

Is Pavlov still alive? Who are these MPs?

20 years of costly failure: MPs verdict on NHS commissioning

                                                             
                                                               Key issues

NHS Scotland

Current provision of healthcare is the responsibility of 14 geographically-based local NHS Boards and a number of National Special Health Boards. In April 2004 the NHS became an integrated service under the management of NHS Boards.

NHS Wales

• Abolishing the internal market in Wales by providing funding from the Welsh Assembly Government or an NHS Board for Wales directly to NHS Trusts and Local Health Boards (LHBs);
• Three options for establishing a Board for Wales - a Special Health Authority, a Civil Service Board, or an Advisory Board supporting an Assembly Government NHS Chief Executive; and,
• LHBs reduced from 22 to eight, including Powys LHB. Health of Wales NHS Reconfiguration

Dr Tony Jewell, Chief Medical Officer for Wales:

“The end of the internal market in health is part of the wider Welsh Assembly Government determination to make co-operation, rather than competition, the bedrock of public service delivery in Wales."

Northern Ireland: Free Rx

FT: they know about money!

Having a purchaser-provider split, rather than more integration between health authorities and hospitals, involved a degree of tension between commissioners and providers, the committee said. But at present the NHS in England might “have the disadvantages of an adversarial system without as yet seeing many benefits”.

New Zealand

Other Posts:

NHS Wales-Why? Why? Why?

House M.D. : 95% vs 5%

House M.D.: Modern Tyranny

Enemy Of The People: NHS, Internal Market & Safety Net

NHS: Market Forces, Genuine Medicine & BMA

NHS: Changes Or A Conspiracy Against The Public Interest


RBS, Lord Ashcroft, Priory & The NHS Reform