The Grumble Credo

In its bricks and mortar, people and services, the NHS embodies something which is truly great about Britain. That something is equity: the spirit of fairness for all and the equal right of everyone regardless of age, background or circumstance to get the healthcare they need.

Those words are a bit cloying but it is what Dr Grumble believes. After all Dr Grumble has been described by overseas commentators as a socialist blogger. Praise for the NHS is what the Grumble readers expect as a general election draws closer. So let Grumble continue:

The NHS really is one of the most precious gifts we enjoy as British citizens.

Perhaps by now you have realised. These words are too sugary to be Dr Grumble's. Can you guess who wrote them? The writer believes them. He has good reason to write these words. Personal reasons and political reasons. The writer is, believe it or not, David Cameron.

Unfortunately people close to David Cameron probably do not think of the NHS in quite the same way.

Here is a clue to the way the Cameron henchmen are thinking:

Despite believing that market mechanisms work, [Labour] have failed to open up the market for the provision of NHS care so as to drive up standards.

You can find all this in the Conservative's NHS Improvement Plan (pdf). Here they laud Labour for privatising parts of the health service, recognise that this policy has failed and imply that the solution is to throw even more NHS services out to the market wolves. The failure of the market is recognised yet the response is to propose more of the same. There is no recognition of the vast sums now being spent on running the costly market processes. There is no mention of how the well heeled bureaucrats employed to commission the services are sucking up the billions that we all know are no longer reaching the front line. Despite all that has happened in finance as a result of the present government leaving things to a market free-for-all (encouraged it would seem by the opposition) there is still the widespread blinkered view that markets will somehow solve the problems of the NHS. It is just not true. Markets are causing the problems.

There are those elsewhere who think even more misguidedly. Take this quote which begins with a wonderful pun:

Focused eye surgery centres, heart health and orthopaedic hospitals, for example, can streamline processes and deliver far higher output and quality than the hotchpotch of services provided in general hospitals.

This fails to recognise that operating on elderly people with multiple pathologies in a streamlined highly efficient centre is not a good idea. General hospitals are not places where you have general doctors who have a stab at anything and do nothing well. They are places where there are teams of experts so that individuals can get the full range of expertise they need. When you fracture your hip and go into heart failure it is really not a good idea to have the heart doctors in their own streamlined centre across town. We need bigger hospitals not smaller. NHS patients have suffered too much already being transferred from one hospital to another because of failures to provide the full range of what patients may need all under the same roof.

Here is another nonsense:

At present, the NHS locks in inefficiencies due to two antiquated models: the general hospital and the general practice – both designed a century ago when medicine lacked evidence-base and was largely intuitive. Far more productive, now that we can make definitive diagnoses in many cases, would be to integrate the diagnostic work across the two, and hive off many procedures that occur after a definitive diagnosis to specialist centres.

This makes little sense to Dr Grumble. Whatever does the author think happens now? If you need your stitches taken out it makes sense for your GP's nurse to do it. If you need your appendix removed this is no longer done on the kitchen table. You go to the hospital. And what about today's news on the increase in children's admissions? What's the betting that that is the consequence of the loss of the antiquated 24/7 care that used to be the responsibility of individual GPs?

Here's more:

Real reform should thus look at the demand side too; at breaking PCTs up into groups of competing social insurers, as already exists to great effect in many European states such as France, Germany, the Netherlands and Switzerland. This is not a threat to universal and comprehensive ideals. With the state paying for, or topping up, premiums for those that cannot afford health insurance or with chronic conditions, these ideals are preserved – just as Europe. The difference is that healthcare premiums are paid direct to insurers, rather than to the state through taxation, and people are able to choose between them on the basis of quality and price. If service is poor, or insurers fail to back innovative providers, declining custom gives a powerful incentive to improve.

Anybody who thinks this will make healthcare more cost effective than the NHS used to be before the recent meddling is clearly living in cloud cuckoo land. But then a lot of people do, it seems, live in cloud cuckoo land.

Dr Grumble agrees that large improvements in funding in the NHS over the past ten years have not brought matching improvements in services. There are all sorts of reasons for this. One major factor has been the cost of running a failed NHS market.