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How to Tank the Bill


Posted on 04 October 2011

tanked_3.jpgNot so long ago, Meccano Flanders got herself into mild hot water for allegedly tanking the English language, by using the verb ‘to tank’, as in ‘If the Bank of England were really serious about helping the economy, it would be trying to tank the housing market’. Putting aside the correct but perhaps vaguely anachronistic use of the conditional subjunctive, the use of ‘tank’ as in ‘tank the housing market’ seems admirable to Dr No: a short crump of a word that perfectly conveys meaning. And so it is that Dr No too is also quite happy to talk of tanking, and so of how to tank the Bill, as in the Health and Social Care Bill; by which he means how to bring about its downfall1.

The general consensus these days seems to be that it is up to the Lords to tank the Bill. A variety of schemes and stratagems have been devised to assist the Lords in their Noble Cause, ranging from ‘Adopt a Lord’ programmes, apparently modelled on commendable animal welfare lines, to the submission of Stiffly Worded Letters, most recently from a group of four hundred senior doctors.

Now, the Lords, were they to have an eye for the main chance - as in not getting tanked by the coalition’s proposals for Upper House reform - would do well to contemplate the ample reward and support they will gain from the British people were they to tank the Bill. But Dr No fears, indeed very much fears, that the Lords will not tank the Bill.

The coalition has already called in the cross-bench peers, no doubt for a stout talking-to, and will lean heavily on its chief stooge, Prof Field, who day by day looks and now even sounds as if his head has been blown up with a bicycle pump, to shepherd wayward peers grazing on the wrong side of the fence back into the coalition paddock. Even Dame Shirley (of the short hair), who not so long ago threatened to put a cold finger through the Bill, has gone quiet; and Dr Death appears, as is often the way with these things, to have lived up to his name.

No, Sir, the peers aren’t going to tank this Bill. There may be some mileage in getting them to focus on the crucial and readily grasped importance of recovering and retaining the Secretary of State’s duty to provide a comprehensive health service, but the bulk of the Bill, with more clauses in it than an ermine has hairs, will, as it did to MPs, drown the peers in a swamp of ever-deepening complexity from which there will be no escape. In time, the Bill, like a German U-Boat, will resurface downstream, unscathed, and continue its deadly mission.

There is, however, one group – and we know from surveys this group exists, and is large enough - who can tank the Bill. Dr No has said it before, and will say it again: it is easily within the grasp of rank and file general practitioners to tank this Bill. Even if they are sucked – often against their will - into commissioning groups, they can still tank the Bill, or more accurately its implementation, by not playing ball with the coalition’s any willing cowboy game; and instead continue to commission from, and mostly only from, and so support, a public national health service. Some might say such action amounts to civil disobedience – and no doubt Monitor would soon be involved in anti-competition claims. But, even with relatively small numbers of dissident GPs, Monitor – or which ever branch of the NHS Gestapo is now to be charged with enforcing competition - would soon be quite overwhelmed. And the NHS privatisation project, as Meccano Flanders might say, would just as soon be tanked…

So Dr No suggests: no need to adopt a peer, and get lost in all that ermine: adopt your GP instead. Ask him or her what he or she is doing to protect the health service. Urge him or her to be a lion and not a donkey; and not play ball with silly coalition schemes that will destroy the NHS. That, Dr No suggests, is the simplest, most effective way to tank this deadly Bill.

1. OED: Draft Additions December 2005: tank, v. – intr. colloq. (orig. U.S.). To fall rapidly in estimation, value, etc.; to fail; spec. (of an economy or share price) to crash. e.g. 1987 Inc. (Nexis) Nov. 116 The new product they were working on just tanked; 2005 R. W. Campoy Case Study Anal. vii. 149 By the time he reached middle school, his grades had completely tanked.

5 comments:

In the end, we are with the Ruling Class and we will let the PEASANTS have their day and then we will let them toil under the sun and provide us with food and pay us tax.

Looks like you may well be right or better still, you are right: the END GAME is here and on Twitter land, a few of us (around 5 and certainly less than 10) is trying to take on the ruling class who had Marshall Field doing all the listening and un-listening. (We listened and made 180 changes of no significance! What else do you want,peasants?)

Look at Wales, they are stupid (honest) so their C. difficile rate is still as high as 4 years ago (as England NHS). NOW England has half. Wow, must be due to Serco then.

Years ago Prof. Sargent (psychiatry) never had a case of collapse vertebrae from straight ECT: I never Xray my EC patients. Very clever. Someone learned something from history.

My friend had C. difficile in an English Hosp. and he had 2 children who are doctors. C. difficile was never ever mentioned in the report to his GP (his children got the report). Very clever.

The end is near and be very afraid.

I think there will be (is) a lot of this. And what's more most patients will want to continue to use their local hospital. I'll see if I can get my lackadaisical peers to muster a coordinated response to this excellent idea. JT

I agree, the Bill will be passed and the only hope for the NHS is to make the AQP policy unworkable.

"by not playing ball with the coalition’s any willing cowboy game; and instead continue to commission from, and mostly only from, and so support, a public national health service"

No can do. As you say "no doubt Monitor would soon be involved in anti-competition claims" and once GPs income is threatened (as it will be if Monitor applies the cosh) they will reluctantly (in some cases less than others) go ahead and implement AQP. To be frank, I do not think it is appropriate to try and persuade GPs to effectively break the law.

Also, the DH policy document on AQP says (dh_125638):

To qualify as an AQP, providers will be subject to a qualification process. ...

Commissioners (PCTs and consortia) can set reasonable additional contractually binding quality standards to meet the needs of particular communities or patient groups. This could include referral protocols and thresholds to manage demand and support integration with local services. Providers will be expected to work within and as part of the local health system.

Commissioners cannot refuse to accept qualified providers once qualified, unless providers fail quality standards, reject the agreed price or refuse to comply with any reasonable, additional, locally set standards. ...

Tendering will, however, remain an option for commissioners where significant change is required to existing provider markets to deliver, ... It will be for commissioners to decide when to use tendering, but the presumption will be that for most services patients will have a choice of Any Qualified Provider.

I have put in bold parts which are relevant. The point is that if Monitor follows this policy to the word then GPs will not be able to use "commissioning" to divert patients to NHS providers since patient choice will trump commissioning.

However - and please forgive me for saying this - you are taking a typically high handed GP attitude to this. Patients do know what is going on and are capable of doing things themselves (but they may need a little help...)! Use patient choice.

If GPs want to help then persuade them to explain to patients the difference between the providers in Choose and Book (NHS, private, voluntary sector); point out which are profit making (and taking a slice of the money that should be used for care); point out the knock-on effect of using a non-NHS provider for their treatment on the other services the local NHS hospital provides (ie, other services may close and they will have to travel further to get that service from another hospital).

I know GPs should only concern themselves with patient care, and explaining the local health economy to a patient is not what they are there to do, but it is the only way to save our NHS.

(oops formatting seems to have tanked there.)

I agree, the Bill will be passed and the only hope for the NHS is to make the AQP policy unworkable.

"by not playing ball with the coalition’s any willing cowboy game; and instead continue to commission from, and mostly only from, and so support, a public national health service"

No can do. As you say "no doubt Monitor would soon be involved in anti-competition claims" and once GPs income is threatened (as it will be if Monitor applies the cosh) they will reluctantly (in some cases less than others) go ahead and implement AQP. To be frank, I do not think it is appropriate to try and persuade GPs to effectively break the law.

Also, the DH policy document on AQP says (dh_125638):

---------------
To qualify as an AQP, providers will be subject to a qualification process. ...

Commissioners (PCTs and consortia) can set reasonable additional contractually binding quality standards to meet the needs of particular communities or patient groups. This could include referral protocols and thresholds to manage demand and support integration with local services. Providers will be expected to work within and as part of the local health system.

Commissioners cannot refuse to accept qualified providers once qualified, unless providers fail quality standards, reject the agreed price or refuse to comply with any reasonable, additional, locally set standards. ...

Tendering will, however, remain an option for commissioners where significant change is required to existing provider markets to deliver, ... It will be for commissioners to decide when to use tendering, but the presumption will be that for most services patients will have a choice of Any Qualified Provider.
---------------

I have put in bold parts which are relevant. The point is that if Monitor follows this policy to the word then GPs will not be able to use "commissioning" to divert patients to NHS providers since patient choice will trump commissioning.

However - and please forgive me for saying this - you are taking a typically high handed GP attitude to this. Patients do know what is going on and are capable of doing things themselves (but they may need a little help...)! Use patient choice.

If GPs want to help then persuade them to explain to patients the difference between the providers in Choose and Book (NHS, private, voluntary sector); point out which are profit making (and taking a slice of the money that should be used for care); point out the knock-on effect of using a non-NHS provider for their treatment on the other services the local NHS hospital provides (ie, other services may close and they will have to travel further to get that service from another hospital).

I know GPs should only concern themselves with patient care, and explaining the local health economy to a patient is not what they are there to do, but it is the only way to save our NHS.

RB - catchy word, 'tank', isn't it!

DN did realise he was approaching advocating breaking the law, and that is why he wrapped it up as 'civil disobedience'. His premise was/is that if enough GP commissioners don't play ball with AWC then it will only be a matter of time before Monitor and/or the CCP tank(s) under the strain of dealing with all those naughty commissioners.

More generally, there are ethical questions here. To what extent, for example, is a doctor obliged to follow a law that on the face of it may harm patients? Is handing patients over to the medical equivalent of Southern Cross really in their best interests? What would Stilton have to say?

That said, you are quite right about the use of patient choice. Dr No was thinking in his typical doctor-centric way. Even better, there is a delicious sweet irony in turning the Tories's 'patient choice' mantra into a weapon with which to tank their damn Bill.


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