03 September 2011

Still time to save the NHS?

Dr Grumble's reader has been in touch with him to find out why he has not been posting recently. The answer is that he has been worn down. The progressive changes that have been taking place to the NHS are approaching their zenith. Always inexorable they are now unstoppable. The faux listening exercise and the apparent response has silenced the dissent. For Grumble it is very sad. The service that he has devoted his working life to is on the verge of destruction. The NHS the public loves will be no more. Not, anyway, in its present form.

That is the negative view. Others, like the redoubtable Clare Gerada, take the alternative view. Clare, or St Clare as Dr Grumble likes to call her, takes the view that all is not lost. Is she right?

Mrs Grumble has noticed the depths of Grumble's depression over the reforms. She took Grumble back to the time of the Iraq war when millions protested and reminded him that he stayed at home that day and left others to waste their time demonstrating. And she reminded him that this is a decision that he now regrets. Not, of course, that it made a blind bit of difference. Is there any point in simply registering a protest when it's clear that it's not going to alter anything?

Is a masked man ever trustworthy?

What puzzles Dr Grumble most about major governmental decisions is just how wrong they can be. You just would not think that any committee of sensible people could get things so utterly wrong. Committees do make mistakes but not on the scale the government does. There must be a reason for this.

What is the reason when it comes to the NHS? There is evidence that relatively dispassionate parliamentary committees, after listening carefully to the evidence, can actually see the truth. Here's what Kevin Barron, Health Committee Chair, said about commissioning:

"It is a sorry story if, after 20 years of attempting to operate commissioning, we remain in the dark about what good it has actually done. The Government must make a bold decision: if improvements fail to materialise, it could be time to blow the final whistle."

The final paragraph of his Committee's report reads:

A number of witnesses argued that we have had the disadvantages of an adversarial system without as yet seeing many benefits from the purchaser/provider split. If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.

So there you have it. The problem is not with committees. The problem is at the highest level of government where decisions are made based on a prevailing dogma driven by intense outside financial interests. The latter have enormous resources at their disposal and they use them to maximum effect. They are very clever, clever enough to defend the indefensible. Only this week Grumble nearly crashed his car as he heard somebody from KPMG extolling the virtues of PFI. The piece was masterly. But wrong. All the pros came across but none of the cons. It didn't take Grumble long to find evidence of a vested interest.

What interests Grumble are the drivers to the government's NHS reforms. Why have successive governments got it so wrong? How is it that the ConDems are able to press on with their misguided plans to essentially sell off our NHS against the wishes of the electorate? Read Liberating the NHS: source and destination of the Lansley reform to find out more.


Dr Grumble said...

For those that can't be bothered with long documents here's the final paragraph from Liberating the NHS: source and destination of the Lansley reform:

"It is time to defend our system of health care, provided to those in need from pooled contributions across society which are made when people are most able to pay. Our current system has benefited from substantial recent investment, simultaneously producing strong health outcomes in comparison with other developed countries and excellent cost-effectiveness.

"The general public rates the services they have received highly, but they have been misled by all the talk of “modernisation” and “choice” into believing that this reform is intended to improve the NHS and not to destroy it. The evidence presented here clearly refutes these beliefs."

In case anybody is wondering, we must follow the lead of St Clare. We must continue to protest. We must never surrender to these insidious reforms.

Jobbing Doctor said...

My dear Grumble,

I am relieved that you have awoken from your torpor to give your point of view.

You will not be surprised that I agree 100% with you, and we are beginning to see the inevitable disappearance of the NHS, butchered (either by design or neglect) by a whole group of rich and influential people.

This has been compounded by the help given to the project by a whole variety of useful idiots.

I do what I can, but every little bit of help is useful.

Please keep us informed of the view from the hospital end.

Jobbing Doctor.

PS I went on the anti-Iraq war march. Didn't change the mind of that lying millionaire Blair, though.

Dr Grumble said...

Mrs Grumble was on the march. I should have gone too. At least you can tell your children and your children's children that you were there and you did what you could. There's too much torpor. The likes of KPMG with their vast resources are difficult to compete with and it does wear people down.

Cockroach Catcher said...

For me. You really have not gone completely as you have provided us with share items.

In any case, you have been missed.

Isn't it true that one is most creative when depressed? Just look at all the writers and artists and composers. But the drug firms would not hear of it when I suggested an anti-happiness pill.

The sad truth is that most of us have sensed that they are bulldozing through everything indeed and one way or another NHS will be like the Dental Services.

Anyone for Australia? Or in fact just Scotland?

Anonymous said...

Yesterday, I gave blood. While waiting, I read the national blood service magazine. It spoke of how much it sells blood to hospitals for (I think it's about £130/unit).

Somehow it left a bad taste in my mouth that part of the cost of what I give is swallowed up in the cost of administering the sale/purchase process.

I found myself wondering whether under the new system, foreign blood banks will tender for contracts to supply blood.

I will continue to give blood of course.

the a&e charge nurse said...

Dr Grumble, there is a funny side to the Perkinesque position you seem to have arrived at?

Northern Doc said...

Welcome back Dr G we here up North hope we will hear more of your wisdom for we have missed your insight but watched your shared items for our CPD (not)we meant our own personal education.

We had feared that the Stasi had got you. We hope you are well.


The team.

billgav said...

Go to 38degrees use link from there to email your MP if you dont try you wont succeed the Liberals and a few conservatives are wavering.Its not time to give up.

Doctor Zorro said...

"Is a masked man ever trustworthy? "

DZ is deeply hurt

And what about the Lone Ranger?

Dr Grumble said...

What a mistake! Dr Zorro and the Lone Ranger can surely be trusted.

But evidence is accumulating that the man who said: "Let me make clear: there will be no privatisation," cannot.

Crinkly & Ragged Arsed Philosophers said...

One of the main strategies of a tyranny is to appear as any thing other than what its true purpose is.

In order to do that it utilises every diversity such as the Libyan conflict and the financial meltdown and even its own incompetence to advance its own ideology, to the extent that no news is, for it, good news.

While the bewildered herd are fed distractions the covert privatisation of the NHS can be introduced piecemeal. Just as the new pension crises can be used to introduce a new pension plan can be introduced to exempt the failure of the old national insurance fraud and failed private pension plans that rewarded the asset managers more than their clients the gullible consumer is regarded as the foolish moveable feast that will foot the bill.

Improvement of the NHS should be measured entirely on the quality of medical and health service it provides provides. In this respect it's not perfect and never will be. But as a general rule - and its the rule that really matters - it does a pretty good job and the practitioners within it are keen. on the whole, to do better.

In this respect it has a value beyond price. But this is a value not understood by the bottom line toadies of administration or governance tied in to the ideologies of capitalisms' welfare and, unfortunately the bewildered herd will not understand the consequence until they find their credit card or insurance doesn't cover them for the removal of their tumor.

the a&e charge nurse said...

"How is it that the ConDems are able to press on with their misguided plans to essentially sell off our NHS against the wishes of the electorate? ".
Well, first of all, shroud the entire process in the sort of impenetrable language that leaves most casual observers cold.

In fact, avoid asking any direct questions (such as would the public prefer privatisation of the NHS) while forgetting to mention in your pre-election manifesto that billions will be spent on yet another health reform.

If the tories, sorry, coalition ARE challenged about covert privatisation simply emphasise the exciting developments initiated by Tony and his NuLab placemen, PFI, ITC's, 'out of hours' care, etc, while reassuring skeptics that the odd privately run hospital is just more of the same.

The time for futile gestures has never seemed so inviting - at least that's how it feels if the fate of the NHS rests on the shoulders of Shirley Vivian Teresa Brittain Catlin?

Brambo said...

Another hearty 'welcome back' from me, Grumbs. The acolytes of the 'smash & grab' Chicago School of Economics are now everywhere and have facilitated the largest heist of publically-owned assets in history. The NHS is just another rich picking for the bankster 'feral elite' who are busily deeply feathering their nests in anticipation of the total collapse of the world's economy that their unbridled greed has engineered. We have a duty to our patients and the NHS to inform our patients that this is happening. Let's see if the same type of response from a hitherto 'silent majority' that we are witnessing in Israel can catch afire here.

Betty M said...

Good to see you back here and on Twitter. It is so very depressing as a patient to see this happening to a service that has done amazing things for me and my family. I have written twice to my LbDem MP and have received only standard form responses. chances of her showing any backbone on this are nil.

Dr Grumble said...

To get on in parliament you have to toe the line which results in a process that is not exactly democratic.

Rebs said...

Welcome back Dr Grumble!

I emailed my MP a few days ago and got a letter back today stating that he would be voting against the Bill. That is Gerald Kaufman, Labour.

Have you read the DOH's response to the opinion of Stephen Cragg, published by 38 Degrees?


Julie said...

Glad to see you back Dr G.

Don't lose heart. Even if this vote goes against us, the HSCB still has to run the gauntlet of the House of Lords. They are very, very good at gutting bills that they don't like- they did for the Legislatory and Regulatory Reform Act and they also gutted various punitive measures dreamed up after 9-11 that would have removed various civil liberties.
They don't like this bill, believe me. Just keep going just now - I know it's hard, but Mrs G was right; you will regret it if you don't.

Anonymouse said...

"Is a masked man ever trustworthy? "

But I thought masked men, and womwn, in blue are some of the most trusted professionals on earth Dr G! They are, aren't they?

... and I happen to trust that particular one in your picture as well, he gave a 'personal' pledge not to privatise, or Americanise, the NHS, and I trust he will keep his word.

As for the bill, why panic since it's in good hands too?!

Better wait and see, which is exactly what I am doing :-)

the a&e charge nurse said...

"I happen to trust that particular one in your picture as well, he gave a 'personal' pledge not to privatise, or Americanise, the NHS" - the trend towards markets and profitability in the NHS go way beyond the cocooned, and insular views of rich toffs like Cameron.

Apart from anything else Cameron may well be out of office in a few years time and will have no more influence than former health ministers like Milburn & Hewitt - opportunists who must now look back misty eyed (from their seat on the board) as Lansley finally gives birth to their unwanted health baby.

The road to privatisation is gathering pace, but let's not forget that it was a project instigated by Tony B and his tory-lite version of the labour party some 10 years earlier.

As I mention above there are two essential elements to the overall strategy;
[1] introduce change through small incremental steps.
[2] disguise the process in terms that will alienate casual observers.

Lansley's bill is said to fail the 'Nick Clegg' test
GPs should not be forced into signing up to commissioning consortia.
The pace needs to be slowed.
All artificial deadlines need to be removed.
The NHS needs to be protected rather than undermined.

According to the Gruniard, "The amended bill does not meet any of Clegg's demands: rather, it makes it worse.The core privatisation principle remains intact".
Again from the same article it is claimed "The NHS reforms remain driven by pure market ideology, without a shred of evidence that they will benefit the English population. On the contrary, the evidence shows that if you create an American-style healthcare system the result will be denial of care and huge costs for the taxpayer. If the bill is passed, coming generations will not forgive us for taking the "National" out of the NHS".

Paradoxically a recent study (conducted by the Royal Society of Medicine) found "In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost- effective over the period".

The obvious question is this - if D-Cam is not trying to privatise the NHS THEN what IS he trying to do?
The evidence and the views of the vast majority of experienced clinicians are dead set against Lansley's dog's dinner of a bill - hell even Shirley Williams and most of the liberals are against it.

One imagines Cameron is plowing on because the private promises he has made to other rich men must exert a vice like grip on his ability to consider the needs of those who may not live in a big house in Notting Hill?

Anonymouse said...

"the trend towards markets and profitability in the NHS go way beyond the cocooned, and insular views of rich toffs like Cameron."

That 'rich toff' card has long since past it's sell by date A&E Charge Nurse. I'm sure any intelligent person, including yourself, knows better than to judge people from such superficial angle alone and omit the character attributes that matter. I like to look at the whole, and in this case I like what I see; a dedicated and hardworking person with a strong set of values who wants to implement same for the benefit of his people and a strong moral code to help him do just that, hence I believe he will keep his word.

"Apart from anything else Cameron may well be out of office in a few years time and will have no more influence than former health ministers like Milburn & Hewitt"

Only he is no Milburn or Hewitt ... and Co, nor a back office boy who will just be forgotten once he leaves office, a good few terms away, me thinks, but 'The Prime Minister' whose every word and deed will be scrutinised not only by the people of this country and worldwide, but by history too, and history is not known for kindness! So rest assured a shrewd man like Cameron, and what he stands for, would never allow his so far impeccable reputation to be tarnished in this regard, although whatever he's trying to do is for the benefit of 'the people' first and foremost, the reason why he stopped and listened on a few occasions and didn't shy away as others do and end in disaster, if you know what I mean. I respect him for that too. Cameron is a man you can trust, and so, I am sticking to that.

As for the bill, which matters to me because I am a mother of docs in trianing as well as potential NHS patient, I think Cameron did make good concessions following the listening exercise, which I thought went a long way to ensure the NHS remains intact ... but then again, I am no expert, but it is in the hands of the most equipped ones in the land now. So, let's wait and see what those think, specially when the bill goes to the upper house.

the a&e charge nurse said...

"That 'rich toff' card has long since past it's sell by date", I disagree - whatever happens to the NHS Cameron and people like him will always have sufficient resources to obtain the best in health care.

Just like in education - the children of the rich don't need to worry how crap state schools are because they have always had access to expensive private education.

In some ways this is EXACTLY what markets are about - winners and losers.

Instead of attaching so much importance to Cameron's personal qualities wouldn't it be better to consider the evidence associated with the way different health care systems are delivered?

The first gaping hole in Lansley's bill is that there is virtually no evidence (although plenty of ideology) that ordinary patients will be any better off - in fact quite the reverse.
Dave's Notting Hill crew will be able to avail themselves of the most secure insurance policies (the next link in the chain, once this hump has been got over) - while those with chronic and less profitable conditions will be fighting for a smaller and smaller piece of the health cake.

Rebs said...

@ Anonymous

Let’s take a common sense approach on this one.

If ALL the main bodies of the medical profession are asking for further, significant changes or the complete removal of the Health Bill and on the other side you have got our 'out of touch' Eaton boys, who employ really trustworthy people like Andy Coulson, saying, 'No, we can be trusted, the NHS is safe in our hands', who are you going to believe? The majority of the medical profession, who have trained and worked all their lives in the NHS and have patient needs and the best for the medical profession at the heart of their interests or the political leaders, who are of course balancing any number of invested interests in other areas of business and politics, all at the same time?

It really, isn't that difficult to work out is it? But I'm happy that you are happy, at least someone is.

You say, 'So rest assured a shrewd man like Cameron, and what he stands for, would never allow his so far impeccable reputation to be tarnished in this regard'...


David Cameron is VERY tarnished thank you very much.

Ask the thousands of young people entering Higher Education what they think of our lovely, kind hearted David Cameron and his coalition government. Ask the thousands of graduates trying to start a degree in medicine, who are facing upfront fee costs of £45,000 on a five-year medical degree from 2012 onwards. I think you will find his name is WELL AND TRULY TARNISHED FORVER and no, history will not be kind.

Let's not forget my generation IS the future and WE HATE David Cameron and what he stands for.

Anonymouse said...

Only, as Andy Burnham once said; Labour would've had to make cuts too, and theirs would've wouldn't have made them popular either. Don't forget that even the Libral Democrats had to abandon a pledge on tuition fees because of the same reason; reducing the huge national debt.

the a&e charge nurse said...

"Don't forget that even the Libral Democrats had to abandon a pledge on tuition fees because of the same reason" - the liberals abandoned their pledge because political expediency usually trumps conviction politics.

How can anybody take this man seriously after utterances like this?