Tuesday, August 2, 2011

These Doctors: So Annoying

Elephant: I have listened. So now go away! So Annoying!

©Am Ang Zhang 2005


Jobbing Doctor: Pop-ups

I have had this document pop up in my inbox. It is from the Government.

A simple guide to Payment by Results.

It is a complex tariff-based system where one part of the NHS (Primary Care Trusts) pays another part of the NHS (Hospital Trusts) for looking after the sick.

This is the bare bones of how transactions occur and the relative costs.
You can see from the "History of PbR" on p.46 onwards that this process has been slowly and steadily marching towards a marketised health care system that is the precursor to the break up of the NHS into fragmented, part-privatised parts.

The one part of the NHS employs considerable number of administrators, coding clerks, validators, finance directors and accountants to work out bills to send to another group of administrators, coding clerks, validators, finance directors and accountants. Then they work assiduously at arguing about the bills. Meantime there are doctors and clinicians who will spend their time poring over the details to say "we should charge more for this" or "we shouldn't be paying for that".

This has been going on slowly and consistently under successive Governments (Labour-Blair, Labour-Brown and Conservative-Lib Dem).

If anyone really wanted to check if the neoconservative agenda for break up of the NHS is on the horizon, then just study this. It is a simple guide.

All this activity and the resultant costs (?now 20% of the whole budget) will not treat a single extra patient.

Why, then, have all recent Westminster governments been obsessed with, and enforced, a market system on NHS England? Why is the current Westminster government determined to force through, on top of these existing pro-market changes, a radical bill that will expand existing market molehills into mountainous commerce?
The stock answers are that it is all about choice, no change is not an option, and efficiency. Yet each of these answers is baloney. The ‘choice’ is of the ‘any colour you like, so long as it is black’ variety. NCINAO makes about as much real world sense as its acronym. And efficiency – well, we only have to look at America to see market ‘efficiencies’ in full force.
So it is all a bit odd. There is no need for the reforms, compelling or otherwise. The majority of professional opinion, and much public opinion, are against the reforms. Yet the Tories are determined to force them through. Why?

Mark Porter: Chairman of the British Medical Association's consultants committee.

NHS services in some parts of England could be "destabilised" by private firms taking advantage ……….to win contracts for patients with easy-to-treat conditions. This could lead to some hospitals no longer offering a full range of services and ultimately having to close.

The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.

The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.

The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porter. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.

The NHS, he told us, is simply not sustainable in its present form and its commitments can no longer be met from taxes. This controversial claim is far from true.

Cameron's twin strategy is to continue with market competition on the assumption that it improves cost-efficiency, and raise new forms of funding by facilitating the introduction of private insurance and patient top-up fees. While competition is now proclaimed by government as an unqualified good, the second prong of the strategy – moving to user charges and insurance funds – dare not speak its name. But key to both are the consequences for redistribution or fairness.

…….The bill, as designed, will allow commissioners (purchasers of healthcare or insurers) to pick and choose patients and services. It abolishes the duty to secure or provide comprehensive care, and permits GP consortiums to recruit members, and introduce charges and private health insurance, as well as enter into joint ventures with private companies.

In a market, insurers and commercial providers must be able to limit their risks by carefully selecting members on the basis of ability to pay and predictable costs.

Across the country primary care trusts, in advance of their own abolition, are closing NHS hospitals.

It heralds a return to pre-1948 arrangements
 of inequitable charitable and private provision,
mixed funding –
and a return to fear.

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