21 May 2011

The devastating power of words

Everybody now knows that there is widespread disquiet over Lansley's Bill. There is no argument about that. And it is becoming increasingly clear that Mr Cameron's pause and listen is really just a political ploy to enable what will essentially amount to the original bill being railroaded through parliament much as was originally intended.

What was originally intended? The answer is in the draft Conservative Manifesto published in 2010. Here it states:

With less political interference in the NHS, we will turn the Department of Health into a Department of Public Health so that the prevention of illness gets the attention from government it needs.

Just one sentence. Innocuous enough you might think. When Grumble read this he thought this was a cosmetic name change. Governments like to change the names of things. It gives the illusion of progress when in fact all that has happened is that the label over the departmental portico has been repainted. But when it comes to the health service the real intent is not always spelt out. It is not just the Conservative party that has been calculatedly vague: New Labour were masters of obfuscation. Read that paragraph carefully and extrapolate and all is revealed.

You see Public Health is actually only a very small part of health. About 3% in fact. It is important but it is hardly what most people would call healthcare. It is about preventing the spread of infectious diseases and the like. It is something that government has to be involved in because these things cannot be dealt with just at a local level. There has to be an input from national government. It is not a duty you can palm off on others.

OK so far? The next bit is where you have to read between the lines. If the Department of Health is going to do Public Health which will have "the attention from government it needs" what happens to everything else the Department of Health (and government) used to have a responsibility for? The answer, if Grumble's interpretation is correct, is that these other things do not need the attention of government. That is essentially the meaning of "less political interference in the NHS". It is a euphemism for government abandoning the NHS to its own devices. OK. Dr Grumble is sensitive to how his sceptical readers may be thinking. This could be an extrapolation too far.

So let's now take a look at the new Bill. But before we do we need to know where we start from. Here is a key responsibility for the Secretary of State as laid down in the National Health Service Act 2006.

National Health Service Act 2006

1 Secretary of State's duty to promote health service

(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness.

(2) The Secretary of State must for that purpose provide or secure the provision of services in accordance with this Act.

Take a look at (2). Here you see a clear statement that the Secretary of State has to provide or secure the provision of services to prevent, diagnose and treat physical and mental illnesses amongst the people of England. That anyway is Grumble's interpretation of the words of the law. Grumble could be wrong. He is not a lawyer but that is how the law seems to read. To be frank, it is a pretty tall order. Our government has to provide for the health needs of each and every one of us. It is a very British thing. Electing governments to look after our health is something we in England do. It is something the electorate wants and expects. It is one of the things we have governments for. They need to defend the realm and look after us, including our healthcare. It has been like that for more than 60 years. And we want it to stay that way.

Of course this is an enormous responsibility for a government so it is no surprise that all the major political parties want to be rid of this commitment. Just as they do not want to run the railways, schools or universities or, well, anything. Today's citizen must stand up on his own two feet and look after himself. It is inconvenient for the old Etonians in charge that the public might actually expect them to provide some infrastructure for the country like decent roads and a rail network and schooling for our children and universities. But there it is. We do. And we are not impressed that students with no money have to pay for their own education. We are not at all impressed. It might be OK for your children, Mr Cameron. It might even be OK for Grumble's children but it is hardly fair on the children from the council estate.

Grumble is digressing somewhat but you can see there is a theme here. And the theme extends to the NHS. Because they don't want to provide that any more either. Who do they expect to do that? Well, it's your GP isn't it? You might think your GP was busy enough seeing patients. And you might well be right but he now has to run the NHS as well - instead of the Secretary of State.

Now we come to the important bit because Grumble has, up to now, been speculating. It could be that things aren't really quite this bad. So let's now take a look at the Mr Lansley's Bill. Is there anything in the new words of the law that gives credence to Grumble's eccentric suspicions? Here is the relevant bit :

The Lansley Bill

Secretary of State's duty to promote health service

(1) The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a) in the physical and mental health of the people of England, and

(b) in the prevention, diagnosis and treatment of illness.

In other words, whereas previously the Secretary of State had to "provide or secure the provision of services" he now only has to "promote a comprehensive health service".

Please forgive Dr Grumble if he has got this wrong. Grumble has no legal training. The law is perplexing but Grumble can read and it looks very much as if Lansley is largely washing his hands of any responsibility for having to provide healthcare to us all. This is a momentous change. It is one that those of us who do not have the time to trawl through the legal gobbledegook may have missed. These words are crucial. For the NHS they are devastating.


Grumble was made aware of this drastic change by Dr No. Richard Blogger has also contributed to Grumble's understanding as well as the Witch Doctor who has also heightened Grumble's concern over this crucial element of an insidious bill. Dr Grumble thanks them all.

20 May 2011

Right wing, wrong approach

Which of these can you trust?

Can you trust this man?

Can you trust this man?

This what not quite the sort of action Dr Grumble had in mind.

19 May 2011

March to save the NHS

Saving healthcare costs with technology

Dr Grumble is often being told by management consultants and the like that his patients can now be looked after in their own homes instead of the hospital with the aid of various bits of innovative kit that will monitor their condition and alert doctors via the internet when they are becoming unwell. Grumble has always been somewhat baffled these claims. Can technology really be the answer to rising costs in healthcare? The question is addressed in this video.

The answer is no surprise to Dr Grumble. Perhaps it is not obvious to the management consultants. They know about finance but they really do not seem to grasp the fundamentals of healthcare. Healthcare as a business is rather different from what most managers are familiar with. They understand the problem: healthcare costs. But soultions like privatisation are never going to solve this. Quite the opposite. A very different approach is needed. The video makes that clear.

18 May 2011

Poll on NHS Reforms

Dr Grumble is not clever enough to do a poll but a colleague has emailed this.

The Plot Against the NHS

Please buy the book. Please.

10 May 2011

Does globalisation stink?

The older you get the more easy it is to predict the future that you will not see. When you are young it seems that things have always been as you find them. After you have lived over, say, half a century you witness very great changes. There is nothing very new about the pace of change though the management consultants might tell you otherwise. Dr Grumble's grandmother lived to the age of 96. As a young women she used to go about in a pony and trap. Decades before she died men landed on the moon.

One of the things that Grumble predicted though he failed to mention on the blog is that the wealthy would soon be able to buy places at university. There were a number of things that suggested that this would happen. Universities are now run like private companies. They are contract research organisations rather than academic institutions. The teaching they do has gone the same way. The student will pay and somehow recover the cost of the fees later. The management consultants say that this will improve teaching because the students will demand it. They might be right as students are, in some ways, already more demanding than they once were. We shall see.

Of course all this talk of students demanding higher standards which will benefit them and get them better teaching is really an attempt to justify the global university market. Chinese students will want to come to Britain for their education and we must prevent them going to other English-speaking nations. That's today's management mantra. You can see where they are coming from. Only last week Dr Grumble's Oxbridge college wrote to him to explain that they are running out of money as government funding has been cut back. They want Grumble to help out. Their position is unsustainable.

They didn't say so in the letter but there is an obvious light on the horizon. What Chinese youngster would not like to spend a few years in Oxford or Cambridge? Many could now easily pay for the privilege. They could just sell places to the highest bidder and their problems would be over.

This is one of the things that Grumble has been predicting. It really is inevitable. There is one more inevitable thing that Grumble has been predicting which follows from this. If wealthy foreigners can buy themselves a place at Oxbridge, why shouldn't wealthy Britons? Which is why Grumble is not at all surprised by today's news.

Many years ago Grumble got caught in a traffic jam with one of his scientific colleagues who was then, perhaps, in his 50s. He looked out of the window at the cars and said, "Thank goodness I will be dead soon." Dr Grumble though it was a joke and laughed heartily. Now he is not so sure.

03 May 2011

Who is telling the truth?

First an explanation:

Now one intepretation:

Now another:

Who is telling it as it is? Who is trying to mislead you? How will you vote?