29 January 2011

Letting the cat out of the bag

Aware of the growing concerns doctors have about yet another tranche of NHS reforms, Andrew Lansley has been desperately trying to get his grim message across as best he can. In recent weeks Dr Grumble has been unable to escape the Health Secretary who seems to be on both radio and TV at every opportunity. Hands-off Dave seems to be so worried that he has been trying to use his clout to bail out the hapless Health Secretary. It does not help that they have not really been honest with us. That creates suspicion.

There are a great many very reasonable concerns about Lansley's plans. Foremost in the minds of many would be why we need yet another reorganisation. We all know that, even if reorganisations work, there is usually a fall-off in performance before any improvement. And a lot of money is wasted on the reorganisation itself.

To create even more suspicion there is the perception that Andrew Lansley has been beavering away largely on his own with his misguided grand plan for the NHS. It certainly does rather seem to have been sprung on us all - including, perhaps, our prime minister. Given this background, it was not unreasonable for a specialist trainee to have asked Mr Lansley the following question:

In such times of financial austerity, why are you ring-fencing several billion pounds for yet more structural reform of the NHS?

To Dr Grumble it seems a perfectly reasonable question. It would have been quite possible for GPs to have been much more involved in commissioning without this level of upheaval. So what is the real purpose of such a costly change? While Dr Grumble does know the real purpose of the reorganisation, Mr Lansley's actual answer was something of a surprise. The interview is available only to doctors so presumably he knows that we, unlike most of the public, know what this is really about.

So here is Lansley's answer to what appears to Grumble to be a perfectly reasonable, innocent question without any side whatsoever:

Yeah, well, I can see where that question is from. It's called public good private bad and, um, you know, it's not quite like that actually....

So there you have it. In response to a question that was not in any way about privatisation but about the costs of the reorganisation, the cat is let out of the bag. Money is being set aside to privatise the NHS.

When it comes to privatisation of the NHS the ConDems, following New Labour's example, talk in riddles. The reason is that they don't actually want the public to know what this is all about. That's why the Lansley plans appear to have come out of the blue. They did not want the electorate to know what they had in mind until they had been elected - which is not very democratic really.

Dr Grumble has been aware of what all the parties have been planning for our NHS for years. At one time nobody believed him. Now it is too late to do anything about it.

Why don't politicians practise what they preach: no decision about us without us?


Interview given by Andrew Lansley to dnuk in November 2010


Dr Grumble said...

Dr No has tried to post this comment but for some reason it hasn't appeared:

Lansley has been working on his plans for years, which is presumably why the they emerged so soon after the election. They had already been made.

The whole GP commissioning thing is a smoke screen. As any O level student of the NHS knows, grass roots GPs will never manage commissioning. Most aren't interested, and haven't got the time, let alone the necessary skills.

As I pointed out over on Bad Medicine, so called GP commissioning isn't general practitioner commissioning, it is general practice ie primary care level commissioning. Anyone - including the private sector - can - and is - getting a look in. Hounslow is already an HMO providing managed care for their population in all but name.

Healthcare the American way is already here. A lot of bags are already short of their feline contents...

Dr Grumble said...

I know, No. You are, of course, right. It is just that not everybody quite understands what is happening and that is largely because what is intended is not made explicit by our political masters.

Dr No said...

Dr G - thanks for posting my earlier comment. Not sure what happened - it came up with the usual 'your comment has been published, may take a minute to appear' confirmation - but nothing further happened. Perhaps Lansley and his pals intercepted it!

Dr Grumble said...

Dr Aust had a similar problem. Perhaps they have control of us in Cheltenham.


Old Codger said...

Don't really understand why privatisation appears to be such a problem. As I understand it the medical profession was against the NHS when it was being mooted after the war. Doctors apparently had to be "bribed" to accept it. Now it seems you are against reversing that process.

I do have concerns though because government generally is not good at contracting services and this lot have not impressed me with their competence. If they can farm it out retaining the universal service and a minimum level of quality across the country then, in time, it should work out well because professional medical staff will (I hope) do all that they can to ensure patients are properly cared for.

Trouble is the government will still be providing the money so political priorities will still win out but now doctors might get blamed.

Dr Grumble said...

Old Codger, you have explained very well one of the reasons why privatisation is a problem.

Patients will no longer trust GPs who will have to hold the purse strings as well as be patient advocates. When it all goes wrong the government will blame doctors. For a government that knows the NHS will soon be in trouble that is a very clever move.

Julie said...

Just to let you know,the second reading of the bill is this Monday. They're obviously rushing it through.

Anonymous said...

Dr Grumble - why don't you submit a comment piece for the Guardian anonymously of course - they take submissions on CIF.

It would get your concerns out to a wider audience.

I don't think most people have a clue what the reforms mean and once they've gone through - it will be too late.

There have been a lot of pro-reform GPs and medical professionals fielded in the media - so people think that doctors are all on board.

Dr Grumble said...

It's great if at least one Grumble reader considers him to be of Guardian material.

Unfortunately we are working against a powerful political machine. Our political masters do not work the way we do. Doctors like to gather evidence and approach problems as much as we can using a scientific method. Politicians decide where they want to go according to their ideology and then assemble the evidence to make the case they never really had. They have all the power so what they want happens. You could demolish Dave's childish letter point by point but they would never agree that they have got it wrong. The ConDems and New Labour all want to go down the same road and we will never stop them. They do not understand what the NHS is all about and they will not believe that the NHS is much the best system if we want cost-effective healthcare. They have also failed to grasp that we must give patients what they need and not what they want to keep the lid on spending.

Grumble could make these and many other points to the Guardian but, in truth, others already have. Part of the blame must lie with a public that knows very much want it wants but is too apathetic to pay attention to what is happening.

Getting GPs involved in this has actually been a master stroke. The public trust them. The question is whether they will go on trusting them now that they are going to have to implement changes which the public definitely do not want.

If jobbing GPs really were to be in charge there is a small hope they can limit the damage. Unfortunately what will happen is that a few greedy individuals will take over aided and abetted by private companies and there is then a risk that Big Business will take over with the aim of creaming off as much of the taxpayer's money as possible.

The disaster of PFI makes it fairly certain which way we shall go.

Betty M said...

Dr Grumble it is depressing that you are so defeatist. There are plenty of ordinary patients out there who realise the nightmare in store if this goes through and the private profiteers are allowed free rein. There could be a mobilisation like that of the students which might serve to at least persuade some MPs to fight to amend the Bill. Surely it is worth trying?

Old Codger said...

Dr Grumble, I do not think the problem is Doctors holding the purse strings. The problem is that there will not be enough money so doctors will have to do the rationing. The politicians will then blame the doctors.

IMHO, if we are to have privatisation, the money should follow the patient. The doctor, the clinic, the hospital, the surgeon get paid for treating the patient. Lots of detail to be added, like a per capita fee for administrating groups of patients registered with a surgery.

Dr Grumble said...

Certainly the money will run out and that means that doctors will be in the invidious position of being an advocate for patients while having to limit the care they can get. It is very reasonable to ration care but these two functions should be separated.

Paying all those people is a costly process in itself. Commissioning care is costly. That's why 50,000 people are involved in it at present. i doubt GPs have the time that is needed, they certainly do not have the training and many do not have the inclination. Fortunately they are generally able and adaptable but the bottom line is that this is going to cost an awful lot at a time that we really need to be saving.

All in all I think it is a terrible mistake. It wouldn't be so bad if the public had been informed before the election but they weren't and they are not on board with these changes at all.