Posts tagged with Privatisation


So - the Lib Dem peers have folded up their cardboard swords faster than an Edwardian maid folding up her ladyship’s drawers, the fat lady has failed to sing, or rather sang on the wrong side of the choir, Chief Pongo ‘No Regrets’ Farron is crowing, and Clegg, ever the tetchy head of a minor public school, wants his flock to ‘move on’. To many, ‘shove off’ may seem les mots plus justes.

Meanwhile, the Medical Royal Colleges have been doing a bit of wobbling. The Royal College of Caring and Sharing cares so much it wants to hold Dave’s hand as it stabs his beloved bill in the back. The Royal College of Surgeons yesterday cut itself down the middle, and voted narrowly against calling for the bill to be withdrawn, by 99 to 76 votes. The Physicians, as ever, are still deliberating: their decision is due next week or the next, perhaps within hours of the bill gaining Royal Assent.

The Perils of Private Fog

This post is not, as it happens, about the misadventures of a trench soldier in the First World War, but is instead about the perils of language: for, if there is one word that fogs today’s NHS reform debate, it is surely privatisation. Unions, the media – only yesterday, Channel 4 reported on ‘proof’ that the ‘government plans to privatise the NHS’ (only to fog matters further by adding a terminal question mark) - and bloggers may all declare loudly that the Tories are privatising the health service. At the same time, the Tories and the DoH (and, of course, our very own Sam) say they are not. Clearly, both sides can’t be right. Or can they? It all depends on what we mean by privatisation, and that is where privatisation fog, like the recent weather, can bring progress to a grinding halt.

Choice Macht Frei

The Nazis – OK, it’s reductio ad Hitlerum time again, and why not – weren’t shy when it came to abusing words. Arrivals at the deaths camps were encouraged to keep their peckers up by a slogan emblazoned over the camp gates. ‘Arbeit Macht Frei’ – ‘Work Makes You Free’. It is hard to conceive of a more gratuitous exhortation on a gate that led not to freedom but to extermination: yet there it was, in all its mocking irony.

Duplicitousness is of course not limited to the Nazis. Closer to home, we have Idiot Duncan Smith rattling the cages of the poxed, the blind, the legless and otherwise variously impaired skivers and shirkers under his own ‘work makes you free’ banner. And even closer to home for all of us, the Tories are railroading through their health reforms under the brightest bluest banner of them all: Choice makes you free! Choice makes you free to choose your GP, to choose your hospital and, of course, choose your treatment! Why, you can even choose to go to Zurich!

Laughing at Democracy

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.

U-Turn If You Want To…

In a shock U-turn yesterday, Sports Minister Mr Andrew Lansley removed all references to bare-fist fighting in the ‘free-fights-for-all’ Boxing Bill currently before Parliament. Earlier drafts of the Bill had allowed ‘any willing contestant’ to fight ‘with or without gloves’. Critics of the Bill, including the British Medical Association, had pointed out that the wording ‘or without gloves’ provided an opportunity for contestants to fight bare-fisted if they so wished, a practice known to increase serious injury and fatalities.

My Lansley has insisted he never envisaged bare-fist fighting. Speaking in the House of Commons yesterday, he said: ‘I understand that references to ‘or without gloves’ in the Bill can be taken to mean that we want to allow bare-fist fighting. This was never the intention. I have therefore removed all references to ‘without gloves’ from the Bill.’

The announcement comes only days after Gordon Bennett, head of national fight regulator Monitor said: ‘an amount of bare-fist fighting will be appropriate’.

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.

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’.

Mary Portas: Queen of Clinic

It is a wonder they haven’t called in Mary Portas, Raptor of Retail, to fix the NHS. Nice Gerry tried a while ago, but tea and biscuits, even Nice Gerry’s 24/7 tea and biscuits, failed to hit the fan when it came to fixing the NHS. Nice Gerry’s biscuits did what biscuits do when faced with a sea of NHS tea. They got dunked - and disintegrated.

Raptor, of the other hand, would know exactly what to do. Dressed by Dallas out of Star Wars, she would stalk the wards and clinics, skewering managers. Layabout staff would be rounded up, and their nail varnish stuffed where the sun don’t shine. A wand of retail magic would be waved, dull clinics transformed in a halogen twinkle into fun interactive experiences. Freshly botoxed greeters in Thunderbird uniforms would be drafted in, and the warmth of the Mall would embrace all. Everybody would win, and all would have prizes.

Flat-Lining Round the Corners

Browsing the web about the latest round of Health and Social Care Bill backed pile-em-high, sell-em-higher NHS services currently out to private sector tender, Dr No chanced upon a success statement (SS) so hilarious his eyes would have popped (EWP) were it not for the fact that it came from the Orkneys, where Dr No had the privilege of spending a few weeks as a medical student with a real GP doing real medicine. The statement reads:


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.