Wednesday, October 17, 2012

NHS & Hospitals: Dr Grumble & Frosty View!

Readers might have noticed the return of Dr Grumble:

The really surprising thing was the illusion these GPs had about the power of the consultants in the hospital. I have picked up this misunderstanding before from online comments from GPs. They really don't understand. GPs, you see, have very great influence over their own surgery. As many politicians like to point out, they are independent contractors.

If you are a senior GP you remember hospitals as they used to be. There was an illusion then that the consultants were in charge and ran the hospital. Perhaps there was a time when they did or, at the very least, they were listened to. But that was way back in history.  They don't now. Not at all. They are scarcely listened to.”

Yet the government wants the rest of the world to believe in our hospitals and that is not about managers but about the skill of their consultants.  Ill people in Qatar & other Arab countries seem to know what they want: fly in their private jet and get admitted to an NHS Hospital.

More from Dr Grumble:

"It was an eyeopener for them to discover otherwise. One of Grumble's colleagues pointed out that our Chief Executive, when announcing some plan nobody much liked, announced that the hospital was not a democracy. It's not. It never has been and it never will.

Like most meetings nothing much came out of it though the GPs certainly learnt just how impotent today's consultants are. The interesting point for the consultants, though it may not have been a surprise, was that the local GPs had also not been consulted by their masters on the hospital closure. They had taken part in a formal public consultation process but, as was pointed out to them, formal consultation processes are more about telling the populace what is going to happen than listening to their concerns."

Are we really that stupid?

A frosty view:

© 2012 Am Ang Zhang

Why are privateers buying into GP practices. The answer may lie with the way the NHS internal market is going: all for the benefit of privateers. Like supermarkets, the only way to make money is through: OWN BRAND. So channelling patients to profit making part of OWN BRAND hospital services will be the only way.

It may soon dawn on the average citizen of this country that they have lost what they thought was their birth right: free access to Health Care.

The Plotters had been working for the better part of 20 years to dismantle the NHS and in these difficult financial times, the most money to be made apart from coffee is government money: AKA taxpayer's money.

Unless we act fast, we stand to lose the hospital consultants to the private sector and the hospitals too will go that way. Consultants had been side lined for too long!

In the case of the consultants, a show was made of trying to make them accept much closer supervision by hospital managers, and cut back on their private work. But it soon came to seem that the real aim of doing this was to make them feel more disenchanted with working as salaried NHS employees and readier to go into business – to form doctors chambers, on the model of barristers, or other kinds of business, and sell their services to any employer, public or private, that offered them the best terms. A significant number began to plan to do so and some have begun to. And as the cuts begin to bite there will be unemployment among hospital doctors. As you will have read, consultants are among those scheduled to be laid off by St George’s hospital in Tooting, and elsewhere. Working for private providers will become normal again in a way it hasn’t been since 1948.                  The Plot Against the NHS

So do you really think that hospitals are not necessary, or not necessary for the average citizen of England. Soon they will be sold and it will be costly to buy them back.

What about medical training? If these hospitals are sold, who pays?

And watch out, someone, your parent, your spouse, your child and even your MP may need a Hospital Consultant one day. 

It is of course likely that after plotters plotted for nearly 20 years to have the money making part of the NHS privatised, they are unlikely to give up quietly.

Democracy is a peculiar business and there is truth that some of us know who the enemies of the people really were.

Some politician may regret too late for not taking the opportunity and grasp the three hairs on the god of opportunity. The Cockroach Catcher did spell it out not many weeks ago.

That many of the plotters in the Labour camp are now unashamedly working for private health care insurer or provider in one form or another that they did not get the votes from the PEOPLE.

I have previously suggested that the new CCGs should buy up Hospitals as the current internal market system is having a very serious unhealthy load on the total cost of Health Care in this country.

Why not do the opposite, let the hospitals employ the GPs. In other words: integrate primary and secondary health care and be done with the internal market that is grossly skewing the way health care is funded.

With some of the “best” advisers available (costly as well), the only reason for recent governments to pursue the market driven idea can only mean one thing: the eventual privatisation of most providers of health care! 

But wait for this: only the profitable ones.

US Model:

One can assume that for a range of basic medical conditions, the NHS (by now a brand) will be free at the point of delivery. Private providers to the NHS will provide on a per case basis and we already have the best example of this is the US in the form of Medicare:

An estimated 77 million people born between 1946 and 1964, turn 65. This year, the first 3 million will reach that milestone, adding significantly to the 47.5 million patients covered by Medicare in 2010. That explosive growth will jeopardize the federal program’s ability to meet its obligations at the same time that it inundates physician practices and hospitals.

Largely left to their own devices in finding help with these problems, these patients have a habit of seeing several physicians, including specialists. No referrals are needed, and Medicare pays a fee to each doctor for every visit. That adds up to a situation in which not only are there no limits on how much is spent, but often there’s no one in charge to make sure patients don’t receive unnecessary or counterproductive treatments.


It also is  important to keep in mind that, “contrary to popular assumptions, it’s the volume of services, not the price per service, that accounts for most of the variation in Medicare spending” observes Dr. Jack Wennberg, the founder of what is now known simply as “the Dartmouth research.” And as more than two decades of
 Dartmouth research have shown, it is the supply of hospital beds and doctors that drives volume—not patient demand. When more resources are available, as they are at UCLA, patients spend more time in the hospital and undergo more procedures. Yet outcomes are no better; often they are worse.

“UCLA knows it has a problem,” Wennberg confided in an interview last year. “But what are they going to do—close down beds and fire doctors? They need that stream of revenue that comes from the beds and doctors to service their debt.”  So Medicare spends more at UCLA—and some patients are over-treated. 

US Health Insurers had a good deal, they do not need to deal with this group.

If one look closely at Hinchingbrooke: they will only have so called 48 hour in-patients, no neonatal, mental health (illness more like) and certainly no dialysis. So if all hospitals are to be run by Circle what will happen to the other patients.

The answer is simple: it will never happen and there is little doubt in my mind that Circle will provide good profit for its investors. These smart people do not throw away money unless they belong to others.

A Hospital based health service:

The Cockroach Catcher has many medical friends working in different health care systems and most of my friends find our GP system ‘unique’. They see that progress in medical science has meant that it is difficult for a generalist to be able to do everything. Many medical procedures require specialist training.

Growth in most other countries has been in the area of specialist doctors.

The UK is the only country in the Western Word that is defying the trend. The serious side effect is that soon we might be running out of specialists in this country: well trained specialists.

So, what would be so wrong with a Hospital based integrated NHS.

My suspicion is that it will happen but it would be the privateers that will be doing it to have full control of cost that would be escalating. 

It is already happening in the US and believe you me, it will here. By then it will be too late as the specialists would have left the state run NHS.

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