Sunday, November 17, 2013

NHS Reform: Plan B or Plan 1957



Dr No has a Plan B.


But it is not Plan B! It is NHS circa 1957. Brilliant piece.


• The NHS Annual Budget should be decided by a single vote in Parliament, and then distributed pro-rata on a capitation weighted by deprivation basis by the treasury to hospitals and GPs, who would then spend the money as they see fit in the best interests of their patients. Political interference in allocations and how the money is spent should be expressly banned by primary legislation.
• Hospitals (all publicly owned) and general practices should be administered (not managed) by boards and partnerships who should include amongst their responsibilities a requirement to foster a sense of spirit and belonging in the institutions in which they serve. Matrons should be found on wards not in offices, and staff identifiable by uniform: white coats for doctors, and starch for nurses. Succour for patients should be provided by chintzy ladies pushing WRVS tea-trolleys, and porters become once again the oil that keeps the hospital wheels turning…


There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.


Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.





Great Barracuda waiting / ©2009 Am Ang Zhang

Is it really that difficult to grasp! I wrote a little while back:


Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals. 

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job. 

My friend just did in some other country: a bargain at US$ 50,000. The cardiologist is easily earning $ 10 million per annum.

What about your painful hips, the Consortia decided to impose a wait time to limit cost. So you too paid for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.


So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in consortia arguing about the price of Stents or Hips. 

Private patients will now have priority and NHS patients will fill in the slack. Very clever indeed. 
Reform will not save any money but it will make a few City people very rich, very rich indeed.

Ever since Barbara Castle took on Junior Doctors in 1974, there has been only losers in the battle between doctors and the government. Indemnity, OOH would be nothing compared with what is going on now. 

The losers:

Not doctors, not government.

But patients.

Because if I am a good cardiologist, I am not going to waste time with all these matters as every stent is money and a life saved. I feel good either way.

Doctors stand to gain from all these reforms and so it is very noble that many of us object to it. 

Prime Minister, you are on the verge of losing some of the cheapest doctors in the world.


1 comment:

Fenella Lemonsky said...

Many consultants do private work and less NHS work as they are treated badly by NHS, bullied by managers so want freedom to work as clinician as they choose not by management dictates. BTW CSection and IVF not available on PHI. Csection only paid for on PHI if high medical risk and complication .