Posts tagged with Privatisation

Opening Titles: Camera swoops across London teaching hospital rooftops – St Thomas’, Guy’s Tower, the cruciform Royal Free. The second half of Mars from Holst’s The Planets throbs loudly. Cut to UCL’s Accident & Emergency entrance at night. A large NHS blue Roller, Registration Mark NHS 1, arrives, with what appears to be a Belisha Beacon in the back seat. The door opens, and Lord Sugar steps out, looking very grim. He points at an Ambulance Paramedic.

Sugar: You’re Fired.

Paramedic: Thank you, Lord Sugar. (walks off, trailing a defibrillator trolley on wheels, towards a waiting taxi. The Belisha Beacon gets noticeably oranger).

Voiceover: The NHS. A decayed, inefficient state monopoly that consumes money as a waterfall does water. Waste is everywhere, and indifference is rife. Even nice Gerry Robinson couldn’t fix the NHS. Lord Sugar has had enough.

Sugar (to camera): It’s a shambles, a bloody disgrace.

It is fair to say that Snatcher Thatcher was and for many still is the high priestess of marketisation and privatisation, and of choice and competition, and so in the interests of brevity, Dr No will call the commissioning measures contained within the Health and Social Care Bill Snatcher Commissioning. Such a name also has the utility of high-lighting what will be one of the defining characteristics of the bill’s reforms, should they come to pass: hundreds if not thousands of private concerns all competing to snatch their share of the commissioning cake.

It is also fair to say that a bill running to hundreds of pages, and an amending bill at that, now further burdened by hundreds of amendments to the amendments, lacks clarity. It may even be that it is so complicated that it lacks internal coherence; Dr No cannot be sure, because he has yet to master the feat of holding hundreds of amendments, further amended by other amendments, in his head at one time. Nor is it any surprise, given the weight of complexity, that many, including politicians and health care staff, not to mention the public, have little concept, let alone understanding, of how Snatcher Commissioning will work in practice. And so, in the interests of shining a light into those dark recesses where the sun don’t shine, and the milk of human kindness sure don’t flow, here is Dr No’s back of the (large) envelope guide to how Snatcher Commissioning will work in practice.

Right queer goings on at the Lib Dem Spring Conference this weekend, after Shirley Williams started bowling from the pavilion end last week. A procedural vote yesterday to decide which NHS motion should be debated today had the ditch-the-bill motion win on first past the post; and then, by some quirk of bent Lib Dem voting logic, the Williams didn’t-we-do-well motion won. Since the two motions were in some respects mirror images of each other, it did not seem to Dr No that yesterday’s vote was the end of the world: a vote against Squirls’ motion sends much the same message as a vote for the ditch-the-bill motion, the only significant difference being the former lacks the explicit ‘ditch’ directive of the latter.

Lord Mildew of That Ilk, Chief Pongo at the British Medical Association, is worried about his eggs. Speaking at the Association’s Special Representative Meeting yesterday, the first such meeting in nearly twenty years, he implored his delegates not to put all their ‘negotiating eggs in one basket’. To Dr No, the pleas of The Lord of the Ilks sounded more in line with a foolish game-keeper laying out all his eggs individually, the better that the foxes might easily pick them off later, one by one, than a fighting chief calling his clan to arms.

The reason for the exceptional SRM was that the BMA wanted to vote on a number of motions to do with the government’s proposed changes to the NHS. As is BMA way, the agenda was pre-loaded with motions deploring the decline in the standard of NHS biscuits, but in amongst the chaff there was no mistaking the wheat. The BMA mill was spinning for none other than the government’s chief architect of, and ambassador for, its ruinous Health and Social Care Bill, Secretary of State Andrew ‘Ribbentrop’ Lansley. The crux of the meeting, to be decided at the final vote, was whether to oppose this architect of doom by gentle jaw-jaw, or by the husk shattering steam hammer of war.

After a quiet few days, there have been some yelps squeaks and barks from UK medical bloggers about the British Medical Association’s SRM (Sham Representative Meeting) called earlier this week to decide the Association’s position on the government’s proposed NHS reforms. Dr Grumble meanwhile has adopted an “I’ve been telling you for years, will you believe me now” tone under a reckless headline on the ways of parliament. Or perhaps it isn’t so reckless after all – for who knows how many tens of thousands will die unnecessarily if the Tory health reforms become reality.

The trouble with all these yelps squeaks and barks (and Dr No has been at it too) is that they are faux-outrage at what is in fact inevitable. It is the inevitable result of what many of us call democracy, but which is in fact nothing of the sort, being instead something which Dr No called Sham Dem eighteen months ago; and the thing about Sham Dem is that it is anything but democracy, by any accepted definition of the term. It is, to give it a more descriptive but less snappy name, serial, or perhaps more accurately, interval, oligarchy. If that sounds a bit technical, Dr No apologises, but hopes to make all plain.

The government has now tabled yet more ‘amendments to the amendments’ to the HSCB – this time 137 of them, complete with ‘briefing notes’. The pace of developments is making Dr No quite giddy, so he settled down with his opium pipe, and before long it dawned on him: the government isn’t making laws, it’s making movies…

After the success of the 1994 movie Speed, starring Sandra Bullock and Keanu Reeves, and the dismal sequel Speed 2: Cruise Control, there was for a while a suggestion of a triquel, Speed 3: Ignition, but it turned out to be a hoax. No doubt the catastrophic bombing of Speed 2 blew up any chance of Hollywood making Speed 3, but never mind – for we have our very own Speed 3, already up to speed and running fast at an NHS trust near you. It is, of course, Speed 3: Health and Social Care Bill, produced by David “Wide-screen” Cameron, and directed by Andrew “One-track” Lansley.

Dear Reader–

I have recently been travelling around the country, on your behalf and at your expense, visiting some of the chaps with whom I hope to be shaping your NHS. I went first to Wales, to Llwelliwindywillow, and there I spoke with the Welsh health minister, Ms Llwesley Griffiyd, and we exchanged many frank words in our respective languages, so precious little came of that in the way of understanding. I did however remonstrate with her that offering free PIP implants was reckless, and I am told she remonstrated with me that not offering free PIP implants was reckless.

The Internet Association for Tree Hugging, Badger Loving, NHS Saving, Petition Signing and Other Worthy Causes Too Numerous To Mention, more generally known as 38 Degrees, has, at great expense, assisted a clutch of learned friends with their mortgage payments. In return, the learned friends have produced an opinion.

A few months back, Dr Death opened his coffin, exhaled a similar set of legal opinions, and retired, the silk-lined lid closing silently behind him. He has since remained as silent as a stiff on the matter.

In both cases, Dr No believes the seekers of the legal opinions have committed an error, perhaps even grave enough to put in some jeopardy the ultimate aim, that of bringing about the withdrawal of the Health and Social Care Bill. He believes 38 Degrees’ error to be especially unfortunate, occurring as it does only days before the Bill’s third reading.

Speaking on the Today programme, their business reporter did his best to put some heat into a cold December morning. ‘Despicable cartel like practices,’ he flamed, quite putting Humph and the rest of the gang in the shade, over OFT allegations that UK private healthcare providers have rigged the market. The lady from the OFT stayed cool, although she did concede that the performance of the market was ‘perhaps not optimal’. To Dr No, the turn of phrase made about as much sense as if NASA public relations had used the words to describe the performance of the space shuttle Challenger on its last fateful flight.

The OFT, Monitor’s big brother, have been investigating the £5 billion UK private healthcare market, and – provisionally – it does not like what it saw. Provisionally – no one’s sticking their neck out here – it found ‘a number of features that, individually or in combination, prevent, restrict or distort competition’ – or cartels and rigged markets to the rest of us. Private healthcare, it appears – provisionally, of course - to be not so much about stitching up patients with subcutaneous Dexon, as stitching them up financially, in a web of cartels, restrictions and misinformation. The OFT plans – provisionally, as they don’t jump guns at the OFT – to refer the market to the Competition Commission.

One of the factors that is said to underpin the ‘no change is not an option’ need to reform the NHS is our ageing population, the so-called grey tsunami, or demographic time bomb. This all party political IED is sitting there, we are told, with a short and inextinguishable fuse. If we don’t do something now to counter it, then we are all, as Frazer would have put it, doomed. But are we? Captain Mainwaring and his platoon survived any number of Frazer’s doom-laden predictions.

Dr No rather suspects that this alleged time bomb is indeed more political wheeze to panic us into accepting the ‘necessity’ for ‘radical’ reform – opening up the NHS to private service providers, and inevitably in due course private funding - than reality. Let us for a moment consider some of the alleged ‘facts’.