Posts tagged with Privatisation


Would the Real GPs Please Stand Up

Monday’s Channel Four Dispatches programme featured Squeeze Esmail, a sharp professor of general practice, now turned part-time undercover Taliban operative. He lined up some stooges with a collection of red flag symptoms – so-called because they should indicate to any doctor the possibility of serious disease – and fitted them with spook-cams before sending them off to see dodgy GPs, most of whom had un-pronounceable names, and/or worked out of shady lock-up retail premises. The dodgy doctors duly obliged, failing to spot the suicide vests so visibly strapped to their patients chests. Jon Snow presented, with a mixture of knight’s move reporting and come-off-it interviews with Stilton, the chief pongo at the GMC. All in all, the programme raised some important questions, which Dr No may return to another day, but that didn’t stop the Jobbing Doctor from wailing, and hammering yet another nail into his already shattered foot on the cross.

Shakin’ Stevens

Yesterday’s news was bob-a-job docs, £55 for each and every dementia diagnosis, with old hands who should know better – they have been handbagging item of service fees in various shapes and forms since the beginning of time – decrying the idea as bribery, likely to cloud professional judgement, possibly even unethical. Dr No will believe their wails when they start handing back the contents of their handbags. For his part, Dr No thinks the idea, though crude, is not without merit, even if the sum is paltry for what is rather more long-term work than a snap diagnosis, because it sends a signal in terms the ex-apothecaries have always understood – payment for an item of service. Dementia is under-diagnosed, and patients and carers who want to know and plan miss out on help that is or at least should be available. Indeed, upping the recorded prevalence might even push up dementia funding. So all in all, though a bit grubby, the idea gets Dr No’s approval.

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.

Not Quite Tannochbrae

The Tories, it seems, have the hots for Big Bangs. In 1986, they famously blew open the Stock Market, deregulating the financial markets, arguably paving the way to a rather different kind of bang, more crash-bang than Big Bang, twenty one years later. Today’s Tory Big Bang target is none other than our National Health Service. Agent Lansley has been charged with blowing it to smithereens. Even before the debris settles, any willing cowboy will be welcomed to ride off with rich pickings, the drear and dross discarded, as dust on the desert floor.

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?

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.

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.

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.

Mildew and Mayhem, Churchill and Chamberlain

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.