Saturday, April 18, 2015

NHS & The Elite: Specialist & Community Hospitals!

In Health Care, death is irreversible.

The Elite

Zebra in fact belongs to the same family as the horse (Genus Equus) but unlike the horse has never been domesticated. It is believed that the stripes in a herd is protective as many animals merge together and thus appeared larger.     

©2012 Am Ang Zhang

There is now a new plot on the horizon: Persuade people that they only need community hospitals near them to be run by Primary Care and they may not even be doctors.


This way the punters might be tricked into not going to Hospital A&Es but Urgent Care Centres at these locals.




Punters would not be punters if they are that stupid.


No matter; as we will close A&Es and even their hospitals.




It is the one big drain on NHS spending and it cannot be controlled. We can pay GPs if they do not refer but self referrals to A&E is now the norm.


Hard on the heels of the announcement of the devolution of NHS powers in Greater Manchester comes news of the first wave of 29 “vanguard” sites for the new care models programme, heralded last October by Simon Stevens’ Five-Year Forward View for the NHS. These frontrunner sites are meant to lead the way for better integration of health and social care.

There are three types of model: MCPs (multi-specialty community providers), concerned with moving specialist care out of hospitals and into the community; PACs (primary and acute care system), with single organisations providing hospital, GP and community services; and enhanced health in care homes, with no apparent acronym as yet, but let’s call it HICH. These models are meant to offer more joined-up care, health and rehabilitation services. Some 5 million people could benefit from the first wave of transformation.

As Stevens noted in his forward view, there is considerable consensus about what needs to change to improve care and health: “The traditional divide between primary care, community services and hospitals – largely unaltered since the birth of the NHS – is increasingly a barrier to the personalised and coordinated health services patients need.”

Roy Lilley on Tarzan (Aka Simon Stevens):
 DIY cardiothoracic bypass surgery 

on the kitchen table

The Tories have left the NHS out of the Cameron 6 priorities and are promising to make a down-payment on Tarzan's 5YFV and ring-fence the Service.

It's the same as the Coalition are doing now.  Meaning; under 1% per annum more cash, against 4% growth in demand. Do the maths... they've hobbled the NHS and more of the same will cripple it.

The rest of the political parties (who might hold the balance of power) are trying to butter my parsnips; especially the Lib-Dems. They are promising the £8bn Tarzan says he needs to make his Plan A work.

However, Plan A comes with eye watering, never achieved before, yer-avin-a-larf, 3% savings from efficiency, modernisation, moving hospitals into GP surgeries, telemedicine and self-care including helpful web-based instructions for DIY cardiothoracic bypass surgery on the kitchen table. There is no Plan B.

A reprint:

NHS Reform: Democracy is for the Elite! So is Health Care!

Is it really that difficult to grasp! Our democracy is for the ELITE. Why pretend? So is Health 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.
Some very clever people indeed are working for the government. 

Is it Conspiracy or Cockup? You decide.

But strangely they thought there is still money to be made.

That is why many GPs in the consortia have links with private providers.

It would have been very unpopular for PCTs to continue to ration health. They have been doing it one way or another and it has been a costly exercise for some PCTs. 

It has even caused unnecessary deaths.

The current concern for the NHS Reform is perhaps too focused on privatisation.

The main aim by some very clever people in government is that somehow there must be a way to limit health spending.

The first obvious way is to find someone that could do it without the blame coming back to the politicians who needs to worry about the next election or next job.

GP Commissioning was thought to be the answer as the blame would now be on the GPs.

Integration of Health Care
Integration of Health Care now carries a new meaning: integrated as long as it is all within the remit of Primary Care and not between Primary and Secondary Care. Yet there is only so much that Primary Care can do unless they started employing their own consultants and running there specialist hospitals. That is one way of saving money.

The other way is to refer to Any Qualified Provider, the new NHS speak for Private Providers. Better still if these are owned by the same organisations that own some of the GP practices. Believe me, it is already happening and it will spread.

How could this be done? Simple, NHS Foundation Hospitals will not stand a chance if they have to continue with the expensive and unprofitable conditions or expensive dialysis and Intensive Care that many private insurers will not touch. In the new world order, they will fail and be closed or be bought by private companies. We have the regulator called Monitor that will see to it.

Again it will not be the politician’s fault: just bad management.

The new structure of HSCB is perfectly geared towards failing FT Hospitals. Some will survive through high levels of private work for those from wealthy countries. There is only a limited number of specialists to go round in England and in fact in most countries.

Which means that there will be a long waiting list for NHS patients!!!

Rationing by any other name.

It really does not need a genius to work out that Foundation Hospitals if they fail will be bought up by private firms.


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 hips or knees. 



A big portion of the NHS money will now be spent in the counting houses of the new Commissioning Offices. Gradually more and more of that money will be re-distributed to Privateers.


Those who could afford to will now get their own Health Insurance and when the Insurers refuse to cover some conditions you may have to return to the NHS. But who knows, it might just be too late then as those hospitals may no longer be there

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. 

Do we still have those: yes we do!  See here>>>>
In London alone these are specialist hospitals that are famous the world over:
The Maudsley Hospital

Then there is Papworth. Need I say more!!!
I know that when you visit them nowadays, these places seem to be full of: non locals. Or could it be that these are now the new locals, I doubt as you can sometimes see the lovely foreign plated cars parked outside them. If I am wrong, I do apologise.
The truth is that medical tourists come not for the GP services we provide, they come for the cutting edge medical procedures and in England, it is also about value for money.
So, opening up many of these rather precious hospitals for up to 49% private will mean a severe reduction in actual medical times available to NHS patients.

That is why: the pretending is over. No, at the end of the day it will not be the medical care you can get from your GP or Noctors, it will be well trained specialists with up to date complex procedures that you or one of your relatives may need!

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