14 March 2009

An expensive dog's dinner?

Do you remember when Dr Grumble introduced you to the words 'contestability' and 'plurality'? He puzzled over these strange words and what they might mean. He came to the conclusion that they were veiled references to privatisation of large chunks of the NHS.

The trouble with privatising the NHS or with putting it on a private footing is that you lose two of the greatest strengths of the NHS. The first great strength was that it needed few administrators to run it. Of course that is no longer true. The number of managers is shooting up. The reason is that if you are working like a private organisation you need to look after the processes like billing and, yes, even advertising like a private organisation. The NHS never used to need to send out bills and advertise. How does this affect us at the coalface? To give just one example, Dr Grumble's hospital now has a very large press office and, from time to time, a large car is sent to whisk him to the heart of London to talk on the telly, or God forbid, even on LBC. All this is new. It all takes time. It all costs money. And none of it makes sense unless you have competition and choice - more favourite government words. And to have choice you need Choose and Book - which is also expensive. And to have competition you need to duplicate services. Which also costs more because you have at least two of everything. And you need to know what you are buying so it is claimed you need the execrable iwantgreatcare.org. And the end result is that you have a gleaming new polyclinic with lots of investment and advertising versus traditional GPs with good quality family doctoring. Which will win out do you think? Dr Grumble knows. If you can persuade people to pay for water they do not need the answer is clear. But people will not be getting what they really need for genuine quality care. They will be getting what they have been persuaded they need but really just want. Because of the power of advertising. Which will be another very expensive part of the process.

Those that didn't believe Dr Grumble (and there were many) when he said the health service was essentially being privatised should surely believe him now. A few short years and all has become clear. Of course for this to work you need multiple providers. You need world class commissioning. You need supermarket-type competition. And all this means that you lose the other great strength of the NHS - cooperation and collaboration. So, to deal with this you, have the Orwellian Cooperation and Competition Panel which doubtless will also waste yet more of your money. Nobody knows how this will work. Nobody knows if any of this will work. Nobody knows if all these things will cost more than they save. But you could have a good guess.

Here is some newspeak for you:

"a community in which power, wealth and opportunity are in the hands of the many not the few, where the rights we enjoy reflect the duties we owe...in which the enterprise of the market and the rigour of competition are joined with the forces of partnership and co-operation."

Where do you think that comes from? Yes. It's Nulabour-speak. Their new Clause 4. Would you believe it?

With thanks to Richard Taylor who was the inspiration for this post.

1 comment:

Dr Grumble said...

The book, Confuse and Conceal, tells the story, first as the government presented it, then as the House of Commons Health Select Committee tried to assess it, and finally as it really is - a bridgehead for the private sector to take over NHS services and staff on a steadily-growing scale.

It shows how the real aims of the programme have been obscured and how information on it has been regularly massaged or withheld. All over the country NHS trusts are closing services as patient income is diverted to for-profit providers on highly advantageous terms. The aim is to make NHS trusts compete in a new healthcare market. The effect is to accelerate the fragmentation of the NHS into a series of unequal units, in which profitability takes priority over patient needs.

Why is there all this obfuscation that required Dr Grumble a couple of years ago to decipher what was happening to his disbelieving colleagues. Why does our government confuse and conceal? It is, surely, antidemocratic. Why do they progress with what the Witch Doctor calls creep? It is, of course, because they want to avoid the normal democratic processes. They do not want the common person to have a say. That's why they support Common Purpose. It is all part of doing the opposite to what Nulabour refers to in its sanitised Clause 4. It is about the few not the many. It is about a small elite controlling masses of workers. And doctors are very much workers. We are, mostly, coalface workers. We don't do what the top people do which is set up businesses which require other more stupid people to do the hard grinding work to make money for the people who set up or funded the business in the first place. Doctors are not part of this elite. They are very much with the workers. They are workers. That's why so few doctors have been through Common Purpose. And the other reason is that we are not, in general, malleable.