Friday, June 17, 2011

NHS & Andrew Lansley: Sharp Doctor

It must be reassuring to the Secretary of State for Health that there are still sharp eyed doctors in the NHS. He might one day save him from the Bevan Curse.

The Curse of Nye Bevan usually strikes down anyone who badmouths the NHS.

Alan Milburn had an outburst; some GPs are up in arms about Consultants on the consortia but there are still sharp eyed Consultants in the soon to be re-branded NHS.

 He told a conference of GPs in London: "So for those of you concerned that the listening exercise represents a tearing up of our plans to modernise the NHS, don't be. For those of you worried that in places the detail of the bill was at odds with the principles of reform, be reassured."
He also maintained the forum's approach to the bill was "not to tear it up, not to start from scratch [and] not to reject or undermine the fundamental principles of the reforms and the bill." His comments prompted claims that the experts' work, under professor Steve Field, was mainly about public relations and had produced changes to Lansley's original plans that are "totally cosmetic".
Doctors especially those brought up in the traditional great medical schools can naturally detect minor things that will make a difference to the management of patients. The Secretary of State should be proud that not all have moved to New Zealand or Australia and dare we say, the US of A.

One such doctor is Clive Peedell!

10.32am: Dr Clive Peedell, an influential and unashamedly pro state-run NHS member of the British Medical Council, has emailed with a statement as co-chair NHS Consultants Association. Dr Peedell, a consultant oncologist, says that the government is being disingenuous in its response to the Future Forum:

The government says
We will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers – or vice versa. What matters is the quality of care, not the ownership model.

This statement is disguised as a control on privatisation, but note "or vice versa". This means the revised bill will outlaw the Government now, or in the future, from naming the NHS as preferred provider.

The terminology of the NHS as preferred provider implies a deliberate attempt to encourage NHS public provision, so this policy will be outlawed (by legislation if the bill passes). However, the key point is that the policy of "Any qualified/willing provider" does not explicitly encourage private sector provision per se (although it is obvious that this is what it is designed to do.)

As long as Government policy is not seen to deliberately and directly encourage private sector provision, the market share will be allowed to change. In fact, the decisions to involve private companies will actually be made locally by the clinical commissioning groups. This is therefore local decision making and not Government policy itself. So increasing NHS privatisation is still clearly on the agenda and the idea of the NHS being the preferred provider with be confined to the dustbin of history.
You really have to hand it to the politicians and policy makers. They have managed to produce of paragraph that looks as though they are preventing further NHS privatisation, but it actually means that they are legislating against the NHS being the preferred provider!

This is in effect accusing the coalition of doublespeak. Dr Peedell has been effective of both Labour and the coalition when policies undermine the BMA's favoured NHS system. You can read his prescient attacks on all parties here when in 2009 he said:

It is clear that the current Labour government and — judging by the polls — likely next Conservative government want the English NHS to become a market-based healthcare system. In fact, the main levers for a market-based system are already in place, including the purchaser-provider split, patient choice, payment by results and a plurality of providers. Those in favour of the market-based approach believe that competition and contestability between healthcare providers will increase the efficiency, quality, responsiveness, accountability and equity of healthcare, by creating an environment where only the best organisations survive. However, there is a lack of evidence to substantiate these claims. Most of the available evidence suggests that market-based healthcare systems are poor value for money and deliver worse care to the populations they serve.

No comments: