Posts tagged with Privatisation

Going Full Circle

So – Hinchingbrooke NHS Trust has gone down the plug-hole. Privately controlled vultures have been circling over-head - Hinchingbrooke’s demise has been long fore-told – and, neatly enough, it was the circling Circle Health Ltd who have been allowed to swoop down and pluck the entrails of the Trust from the clutch of the drains. We now have, Circle say, the ‘first franchised NHS trust’. NHS East of England, the SHA ‘overseeing’ the deal, was far more upbeat. ‘History was made today’ was their clarion call, as a ‘groundbreaking’ deal secured a ‘bright future’ for the debt-laden Trust.

Now there are some who say that this is privatisation. In fact it is not - yet. The ‘balance sheet assets’ – beds, bricks and mortar etc – remain, we are told, in NHS ownership, and the staff, we are told, will be seconded on NHS terms to Circle. Instead of privatising the Trust, Circle have been given the franchise to run the hospital – and the franchise model is not a privatisation model.

The GPs’ Den

By a coincidence last week saw both the announcement of the coalition government’s shake up of the NHS, and the start of this summer’s season of ritual humiliation in The Dragons’ Den. On the face of it these two events have little in common, but it does not take long to see that The Dragons’ Den is in fact the model for the coalition’s vision of GP based commissioning. Most jobbing doctors will see it as an irritation and a diversion, but a hardcore of latent fundholders will emerge – indeed already have emerged – to grasp what some have called a poisoned chalice, but what Dr Dollar will see – indeed already has seen - as a Golden Opportunity. Before we know it, Dr Dollar and his pals will form up into consortia, and the BBC will spot a chance for another easy reality show. The GPs’ Den will be the new Dragons’ Den.

Jobs for the Boys

It is said British general practice is a broad church, and indeed it is. No branch of medicine collects under its wing such a panoply of talent and motivation. While most GPs sit somewhere near the centre, the tails of the bell shaped curve contain a diverse collection of crackpots, duds and no-hopers at one end; and at the other a rare collection of the exceptional – the exceptionally talented, the exceptionally compassionate – and the exceptionally greedy.

Despite the fact that general practitioners are adequately remunerated (we will leave the remuneration bun-fight for another day) for the work they do, a percentage – Dr No estimates perhaps fifteen to twenty percent – want more. Some of these individuals have an over-inflated opinion of their value to society, and consider that value should be reflected in their bank balance. And others – lets not beat about the bush here - are just plain greedy. Their primary purpose in practising medicine is to make money – lots of money.

Actuarial Design of Risk Pools

Americans, Fanny Trollope observed in that acetic manner of hers, pursue the DOLLAR with such a unity of purpose, such a sympathy of feeling as found nowhere else, except, perhaps, in an ants' nest. “The result” she added “ is exactly what might be anticipated. This sordid object, for ever before their eyes, must inevitably produce a sordid tone of mind, and, worse still, it produces a seared and blunted conscience on all questions of probity.” To which we on Blighty’s shores might happily reply “Amen to that”, were it not that American ants’ nests have lately appeared with pestilential frequency in NHS offices up and down the land.

The Prongs of Privatisation

In the ocean of amendments and opinions swilling round and threatening to drown sensible debate about the Tories’ Health and Social Care Bill, and its likely impact on the national health service, there is nonetheless a constant tide that ebbs and flows: the question of privatisation. Critics of the Bill – including Dr No – claim the Bill will, not so much by a big bang, as by the back door, bring about wholesale privatisation of our once national health service. Those for the Bill have been equally vehement that nothing could be further from the truth. Indeed, the Department of Health in its recent tabloid style ‘Myth Buster’ release – BIFF! SoS won’t wash his hands of the NHS! ZAP! Private patients won’t jump the NHS queue! – dismissed the privatisation claim as CRUMP! ‘ludicrous scaremongering!’. For the better understanding of any thickos who still haven’t got the point, the Department adds: ‘We have made it crystal clear, time and again, that we will never, ever, privatise the NHS’.

The Secret Nail Exposed

News of a sort emerged last week that the Iranian Hospitalier’s circle of shadowy investors are to receive an annual bung for stitching up Hinchingbrooke Hospital. The first £2 million of any surplus will be top-sliced, and wired to Jersey, or perhaps some other island where the sun shines a lot. The sweetener came to light after the Health Service Journal unearthed a letter deposited in the House of Commons Library last November by Lord Howe. In it, Howe writes: ‘Under the contract with Circle at Hinchingbrooke NHS Trust, the first £2 million of any year’s surplus will go to the Franchisee, Circle, as it must cover its costs and earn a fee [emphasis added]’. Howe may call it a fee, but to Dr No it looks uncommonly like a kick-back. No wonder the thinking epidemiologist’s crumpet, Professor Allyson Pollock, is scandalised.

Saturn Calling...

An extraordinary letter has appeared in The Telegraph this morning, online version here, a letter so bizarre that it elevates those chirpy Eurovision Song Contest result package links to communiqués of Kissingerian consequence. Signed by a clutch of GP chavs, it appears to be the brainchild of a scuba-diving Masonic medical wax chandler (motto: Non Angelus sed Anglus - No Angel but at least I'm English) who, tellingly, lists Conservative poiltics as one of his ‘interests’, which is putting it mildly: here he is blogging in 2009 about what the Tories are going to do to the Labour legacy once the Tories had achieved the ‘moral authority of victory’ in the 2010 election. Taken together with today’s Telegraph letter, it appears that Pimlico GP Dr Jonathon Munday’s zeal for nuking Labour legislation is matched only by an equal and opposite zeal for propping up Broken Arrow’s dud legislation.

Three Stabs and You’re Out

Broken Arrow is today staggering around, two daggers in his back. Earlier this week, Downing Street let it be known that there was a view that he should be ‘taken out and shot’; today, the editor of ConservativeHome has let it be known that three cabinet ministers want pretty much the same thing. That’s right: within the space of a few days, both Downing street and a bevy of cabinet ministers have let it be known: Lansley, and with him his blasted bill, must go. Other Tories, including Dodders, have been twiddling knives, but Dodders is a gentle man, and one suspects a stab in the back from him would be more Private Godfrey bear-hug than Corporal Jones bayonet.

Vinyl Migraine

Dr No doesn’t really get Hendrix; nor does he get migraines. But if he did get the latter, listening to the former might bring on the latter. Given Dylan’s own haunted enigmatic recording of All Along the Watchtower, why strangle genius in a dustbin of dying cats?

Such odd thoughts come to Dr No as news emerges that the Land of the Baskervilles is soon to decide on who should run Children’s Services in Devon. There are two front runners: neither is NHS; both are for-profit. One is Branson’s Virgin, the other SerCo – the ‘Service Company’.

Captain Mainwaring’s Commissioning

The government continues to push its quaint vision of local GPs doing local healthcare commissioning. Many who know rather more about the National Health Service than the government do have pointed out this is a non-starter. But let us imagine for a moment what might happen if all GPs did take on commissioning. It might go something like this:

Scene: Walmington-on-Sea Church Hall. Platoon drawn up, Mainwaring and Wilson face them.

MAINWARING: Right, Men. I’ve a very important announcement to make. (inflates chest) We’ve orders from the ministry to fix the NHS. Its going to be the next big thing. (inflates chest further, taps swagger stick on flipchart for emphasis) Its called Home Guard Commissioning. We’re going to show these Johnny-come-lately American chaps how it’s done.