Thursday, August 2, 2012

Greece & NHS: Bells Toll!

Roy Lilley has no fear: despite our libel laws.

How difficult do you think it would be to hack off most of the NHS and make the BBC look really stupid - all before lunchtime?  Ali Parsa, at Circle, made it look easy.

On Tuesday they 'celebrated' their first few months in charge at Hinchingbrooke and apparently, fed the BBC's@adambrimelow a load of codswallop.  In consequence this load of bunkum appeared on the BBC web-site. The unusually gullible Today Programme made it their lead story!

As you can imagine, Twitter exploded with outrage. By eight o'clock it looked like Today's editors twigged they'd been had and hauled their Home Affairs editor in front of a microphone to do a flim-flam  'wrap-around' piece saying how important the success of Circle is to the Coalition. He was followed by Parsa, Circle's braggadocio boss. Groan.

Here was my take a little while back:

Antigone & Circle: Bells toll for Greece or NHS?

Are the bells tolling for Greece or the NHS?©2011 Am An Zhang

Most of us do not realise how brilliant those people that have worked at Goldman Sachs are: 
Antigone managed to help Greece "relocate" their debt before they entered the EU. In the business world, Antigone or Addy was highly regarded:

"A defiant Goldman Sachs says it did nothing wrong by concocting a deal that temporarily masked Greece's bloated government debt, an arrangement that has sparked outrage across Europe."

Now Ali Parsa is from the same Goldman Sachs stock and he is either altruistic or very smart & has done the unthinkable of "buying" a failing NHS hospital. "Buying" is perhaps wrong as he is smart and will not do anything like that. There were little if any detail about the deal but knowing someone with a Goldman background, the government would not be a match at all as far as the contract goes. But then the government was not that good with ISTC or PFIs. 

For Hinchingbrooks to succeed it must do more cases and yet CCGs are suppose to cut referrals to hospitals. Ali Parsa must know that and my assumption is that it will not happen with Hinchinbrooks. Being private means we the public cannot access the details of the deal.

Another smart move then.

But perhaps they too were smart as it is one means for the ruling class to secure their future and ration health care at the same time. Sorry---getting GPs to ration Health Care

After all Greece still has more Porsche per capita if you must know and most of their rulers' money are safe in Switzerland.

To say the Circle is the John Lewis of Health Care is indeed a blatant insult to that much loved high street store. John Lewis had no Cayman connection and Circle is not fully 100% employee co-owned.

But Circle is really a first step by our government to COVERTLY ration HEALTH CARE. Canada is doing it using waiting time and so are many western and indeed eastern countries. 

The distraction of the current NHS Reform is to allow the debate to be focused on Primary Care.

That has now changed thanks to Circle. 

Please everybody it is about Consultants & Secondary CARE!!!

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.

So we are going to but in a peculiar manner as the NHS used to be state run and free. Reform is needed!!! Enter GP commissioning. If it is your GP doing the rationing it is no longer the State's problem.

According to the NAO:

In 2009 the total value of the market for PH(Private Healthcare) in the UK was estimated at just over £5.8 billion. Private hospitals and clinics account for the largest part of the overall PH market, generating an estimated £3.75 billion in revenue during 2009. Fees to surgeons, anaesthetists and physicians generated an estimated £1.6 billion in 2009.

The total number of UK citizens with Private Insurance is estimated to be around 90,000. It is not difficult to work out what good value the NHS has always been.

The NHS was not perfect, far from it and yet successive attempts at fixing it has produce the opposite effect: it needs more fixing.

If you read that line again from the NAO report, it was clear where the problem was: fees to surgeons, anaesthetists and physicians!!!

Yes, that was the main recipient of Private Health income.

To become a Consultant in the NHS used to be prestigious and even those aiming to doing mainly private work will have to wait till they achieve Consultant status in the NHS.

The NHS for all its sins tried to keep every consultant as close to the MAYO ideal by insisting on the same pay-scale.

Several levels of Distinction Awards were used to keep some professors and top consultants happy. Later the name of the Awards was changed and yet it was still the same soup.

If Consultants were prepared to give up one session of pay, then there is no limit as to the private work they can take on. It was a safe way to start your private work and you keep the rather nice NHS pension.


What is generally not talked about is that you keep one foot in your NHS hospital and one in your private one.

So far so good and yet this is where the problem starts.

It does not need a genius to work out that people worry about their health and do not want to wait for a suspicious lump to stay in their body too long. They will pay. We need not even mention the manipulation of waiting lists, etc. Then big companies realise that they can attract staff by offering Health Insurance and the rest is as they say history.

Then the rules changed and every consultant can do a maximum of 10% of their NHS pay in private work without having to give up anything. Some hospitals even allow you to use their facilities for a small fee.

Why not, more private patient means less expenditure for the NHS.

Private Insurers discovered that too and they started offering a small fee if you can wait for your operation at your free NHS hospital.

There has never been any control of Health Insurers and I suspect if was not even because they have a strong lobby: just the feeling that the NHS was for everybody so no one could be excluded.

But Health Insurers are cleverer, they exclude chronic conditions, many psychiatric ones belong to that group and often they will exclude after a while.

So, indeed it was a clever move by the present government to simply hand over a portion of money to the GPs and say: get on with it, the best price or better still, why not treat them yourself. You are all doctors, forgetting one of their own just had neurosurgery done at Queen Square.

Until, now Consultants are to be excluded from the consortia. Most are not making too much noise for a very good reason.

There just are not enough of us Consultants and the reform is really COVERT rationing by any other name.

How else could the government continue to claim that competition will improve standard and bring down cost.

Private or NHS, they are the same Surgeons, Anesthetists and  Physicians. Yes, the same consultants. Only in Private Hospitals you may get free cappuccinos.

It is so simple: Private Providers need to make a profit so there is going to be less money for patient care, not more.

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.

"Like blood, health care is too precious, 

intimate and corruptible to entrust 

to the market"

NHS & Market Forces: Fund Holding & Medical Ethics

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