17 January 2009

A shot across the bows?

Some years ago now Dr Grumble had dinner with Lord Warner. OK, Dr Grumble was not actually at Lord Warner's table but he was there at the dinner. Lord Warner was introduced by a surgeon. Not exactly a jobbing surgeon but a surgeon anyway. Surgeons are good at cutting to the chase and when Lord Warner was introduced he casually mentioned how perplexed he was by the terms 'plurality' and 'contestability'. Dr Grumble had also been struggling with these strange words. Plurality and contestability come from the Department of Health buzz word generator but they are more sinister than that. They are really a form of newspeak. They are designed to get you thinking in a certain way without actually knowing what you are thinking about. After all, when you look up these words in a standard dictionary you do not find the meaning that the Department attaches to them. When Dr Grumble first tackled this topic he came to the conclusion that these words really meant privatisation. He has since learned that 'contestability' is in fact a technical economics term which refers to the concept that monopolies will buck up their ideas if you threaten them with competition. Lord Warner did not say that. Presumably if you reveal to the monopoly provider that these are just threats and you are not really going to pass the business elsewhere then the threat has no effect. Anyway, Dr Grumble has since heard directly from a most senior source in the NHS (forgive the Chatham House rule) that some of these initiatives were indeed just intended to shake up the NHS monolith. So all that money wasted on independent treatment centres was not money down the drain at all. It was simply a ploy to get the NHS management to buck up their ideas. Is the world really this mad? Is this the only way of getting our NHS house in order?

Enter now the world of the Personal Health Budget. What on earth is the aim here? Dr Grumble is perplexed once more. Is this yet another ploy to galvanise action from the NHS management? Or is this the beginning of privatisation? Is the government really intent on putting the NHS into private hands? Here too Dr Grumble's thinking has moved on. He is now of the view that it's not necessarily the Bransons of this world the government has in mind to run the NHS. It's not privatisation they want so much as denationalisation. New providers could include any non-NHS organisation. Charities for example. If this is really the policy what could be the real purpose of Foundation Trusts? Are they intended to be bought by the likes of Branson and run like private companies? Or will they become or be taken over by charities? Or will some become parts of academic organisations? We cannot tell from the impenetrable newspeak. How will these major changes be supported? Could charities even do that? What evidence do we have that these new ways will be more efficient or better than what we already have? The answer as always is none.

One thing is for sure. Giving people the money to buy their own health care cannot possibly be a sensible way forward. Unless, of course, it is just to galvanise some action. To learn that this may well be the case you need to read the small print of the Department of Health documents where you will find:

What’s the rationale of personal health budgets?

The main aim of introducing personal budgets is to support the cultural change that is needed to create a more personalised NHS. It may be that only a relatively small number of patients would find that their needs lend themselves to a personal health budget, but their impact on the way care is delivered may be much wider.
Lets hope that they are just trying to get us to buck up our ideas and that this is more a shot across the bows than a real policy.

These are the ideas emanating from Richmond House:
We have already heard that those with long term conditions, those receiving NHS Continuing Healthcare and users of mental health services might be well placed to benefit. We would like to hear your views on where personal budgets would be most useful, for example patient groups, services and circumstances.
So they are going to give money to 'users of mental health services'. Surely users of mental health services are mentally ill? So that means that the Department of Health is going to give money to vulnerable people with mental health problems to buy treatment? Is this really an ideal group to have shopping around?

Tell the people in the Department of Health what you think. They would be really pleased to hear from you (see the end of this pdf for contact details).


Jobbing Doctor said...

I can't yet make this one out. It might be a terrific idea, it might be nonsense on stilts.

It is predicated on the assumptions that (a) the patient knows and understands best and (b) these matters are simple.

I would certainly welcome some decent services for patients with Parkinson's disease in my patch, but mental health? That's really problematic.

I suspect that it a novel idea by an ingenue politician ('Lord' Darzi) who approaches matters from the rather less complex avenues of surgery.

Dr Grumble said...

Whether this has any chance of working or not might depend on why it is that your PD services are poor.

Over the years Dr Grumble has been very critical of the service provided by neurologists in general. What is the matter with neurologists? Why do they leave all their work to Dr Grumble who has no special expertise in this area?

An estimated three million people in the United Kingdom have neurological disorders, but each specialist is expected to serve a population of 177 000. The United States has one neurologist per 26 000 people and France has one per 39 000 (from BMJ 2001). Could it be that neurologists are not the lazy people they seem but are grossly overworked?

If that is the problem putting cash in the patient's hand is not going to solve it.

Anonymous said...

This is a rehash of the the right-wing education voucher idea. http://www.edweek.org/rc/issues/vouchers. The worry for NHS patients, (or should that be clients?) is that rather like insurance companies certain health organisations will choose 'clients' who keep within their personal budget and ditch those who have greater needs and therefore cost more. I would be surprised if budgets remain uncapped. Glad to see Labour has ditched the old Marxist thinking of "from each according to ability to each according to need" to the Christian teaching of "to him who hath shall be given"...so much more New Labour.