Posts tagged with Privatisation

The Law of Wet Paper Bags

There is a variant of Dennis Healey’s Law of Holes which says: when you are in a wet paper bag, stop pissing. Most folk who spend much time in wet paper bags appreciate the importance of this law to their survival, but it seems those folk who inhabit the wet paper bag more generally known as the British Medical Association have yet to turn off the tap. At a time when there is overwhelming and very visible professional opposition to the Health and Social Care Bill, and so a real prospect of nailing the bill, the BMA has turned on a golden shower of pension reform objections. There is even talk of industrial action.

The Patient on the Clapham Omnibus

The best argument against democracy is a five-minute conversation with the average voter.

–Sir Winston Churchill

The hills may be alive with the sound of music, but the UK medical blogosphere is alive with the sound of rebellion. Virtually all British medical bloggers – and much superb research and writing has been and is being done - are singing off the same hymn sheet: Broken Arrow’s NHS reforms will be at best disastrous, at worst will kill off the NHS.

The Royal College of Nursing has come out staunchly against the reforms; while the British Medical Association has been, to its shame, woefully timid, but is nonetheless critical of the proposals. And of course we have the wonderful Professor Allyson Pollock, the thinking doctor’s crumpet, writing sterling material in the medical journals and elsewhere.

The Listening Bank

Broken Arrow - so-called because he doesn’t work, and can’t be fired – stood up red-faced in the Commons on Monday. A nervous tie-fingering moment later, he launched into a resentful defensive downcast drone about his beloved Titanic Bill. It was already more than four fifths of the way across the Atlantic, he declared – it had concluded its committee stage, and eighty-seven percent of GPs covering forty-five million patients had already signed up to join the party. Labour jeered and heckled, and Broken Arrow’s face got redder. But a spectre of icebergs had loomed, and through gritted teeth, he admitted the most unTitanic of conduct: a slow down. The government, he said, would take advantage of a ‘natural break’ in the passage of the Bill to ‘pause, to listen, and to engage’. Labour, of course weren’t having any of it. Broken Arrow hadn’t listened before, so why should he start listening now?

Perhaps Not Optimal

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.

Snatcher Commissioning

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.

The Shrinking Raspberry – BMA Blows It Again

With friends like the British Medical Association, who needs enemies? On the day the Care Quality Commission revealed that three out of twelve hospitals it reported on were hanging elderly patients out to die, the BMA chose to blow its anti-Health and Social Care bill trumpet. But the Association’s call was inevitably drowned in the howls of anguish that arose in the face of hospitals turning biddies into Ryvitas on an industrial scale. Even Humph rose to the occasion, and adopted his best dishcloth wringing tone. No need to get bogged down in the statistics, said he, as he wrung the dishcloth of despair to its dying drop. As beads of disbelief coalesced on the brow of concern, he told the nation what it so desperately needed to hear: it was, he said in a whisper, about humanity. The BMA story, naturally, sunk like a stone in a pond.

Very Great Deal

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.

Demographic Panic

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’.

Jobs for the Boys

So – this is the day that Cambuffoon and his Lillie Langtry are to sprinkle drops of NHS blood on the oceans of commerce; and already the corporates are circling, to devour the NHS as a shark does its prey. Rich fat and valuable flesh will be stripped from bone, and all will go, save the profitless indigestible carcass of the weak, the poor, the chronic and the incurable.

These are the headline notes of the grim fate our government has in store for our health service. Already the rabble of the right is roused; and already the cry has gone up: The NHS is a wasteful and bloated sacred cow that should be slaughtered! The steely knife of market forces will excise all waste and all inefficiency on the trading floors of the agoræ, where ‘any willing provider’ can and will step up to the mark.

NHS – The Apprentice

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.