The case for NHS reform

DavidDP

"A further problem is the shocking variation in performance among PCTs"

This will get worse if you implement market reforms. this is not to say that market reforms will be a bad thing, but they are predicated on there being poor hospitals which poepl choose to avoid. In otherwords, complaint about a postcode lottery are inconsistent with a view that the NHS needs to move away from being a monolithic structure.

strapworld

As I was saying in an earlier blog, until I was rudely interrupted, Cameron has to show real leadership and tell the people that the NHS is not fit for purpose.

Just read Littlejohn, in today's Daily Mail, and he illustrates the difference between a hospital in the USA in which his mother is receiving treatment, and NHS hospitals in which the chances are that, in the wrong one, she could have died!

The fact is that bad management IS to blame. Political correctness, Executive Directors wanting higher salaries- to the detriment of patient services. That can be the only reason why Foundation Hospitals were allowed!

And before someone can throw insults my way, I was for eight years a Chairman of an NHS Trust so I do know a bit of what I am writing about.

The time has come for real political leadership. But, as I have said many times, Cameron is not that politician.

There is a void in our public life. We have no leaders, just pygmies.

I do hope that the Conservative Party, that my father died working for, wake up and get a TORY to lead them!

charles hercock

What more evidence do you want that money spent on clipboard administrators peddling targets rather than a push on quality has been THE major Brown failing.He gave the NHS some money but had no management nouse to ensure spending on wht was important.It is your and my money wasted on these premature deaths

Snowman

Q: How do you double the value of a Skoda car? A: Fill it with petrol. You recall jokes like that? Not any more though, the Skodas are getting a word or two of praise even from Jeremy Clarkson, yet the car has been put together by the same Slav people throughout its history, and soon after the company was taken over by VW by literally the same people.

Under the tenets of the communist societal model with quality inspectors, targets, central planning and asset allocation, management appointed by the centre and the rest of the trappings of a communist societal model, the plants used to turn out jokes on wheels.

The new cars are judged on quality, reliability, affordability and the rest of what matters to consumers by the market. No direct Government involvement, no watchdogs, inspections and endless reports, no resource allocations from a bunch of far removed apparatchiks, no nothing that smells of a market free environment.

Does it tell you anything?

DavidDP

How odd - your father died working for a party with leaders occupying arguably the same political ground as Cameron, if not marginaly more to the left (how much of an internal market did MacMillan or Heath create in the NHS?). Was he in the right party?

malone

'A further problem is the shocking variation in performance among PCTs"

Geographical variations are probably more likely to be due to variations in patient presentation patterns, different socioeconomic class and all the variants in risk factors thereof, rather than a variation in performance the local PCT. It would be reasonable to conclude though that the PCT in Glasgow East is a little less on the ball than that in Kensington and Chelsea. A lose lose situation then for all born in the Goebbels. And they still vote Labour.

Sally Chatterjee

NHS spending has increased and it takes time for this to impact the results. But I'd also suggest too much money has been spent on shiny buildings and rewarding non-clinical vested interests, from PFI operators to very generous GP pay packages.

The UK still rations health care that is supplied in comparable countries like Germany or France, for example British women are screened for breast or cervical cancer far less often than abroad: screening is rationed. There are people alive in these countries who would be dead if they were British.

egh

Too pathetic.

Why does anyone believe anything that comes from the euSSR?
Also, how about a good hard analysis of the people who ochestrate the 'survival' rates - or even the diagnoses?
Furthermore, how about a good hard analysis of the people who don't want to survive in the miasma you've created in your own image?

Reform? Please. Try reforming yourselves for a change.

euro-zone

having lived most of my working life in germany and switzerland I am now living from a disability pension having been diagnosed with lung cancer in january 2005 with less than a year to live without treatment, the nurses who treated me told me that the treatment was the equivalent of the cost of a detached house, all this without knowing whether I would ever work again. That is the big difference!
Here in germany I pay approx. 7.5% of my gross salary into a health insurance, my then employer paid another approx. 7%, now I pay 15% through my own fault but I still have over 1400.- pounds sterling to live on monthly, so all I can say is that I am very gratefull not to live in the UK

2trueblue

The fact that we have a por ratio of doctors to population say it all.
The total waste of money in the management area is incredible. There are 18 different Patient Admission Systems in the UK. This is unbelievable, the money that has been wasted, especially as they do not link up!

The more one knows the more waste discovered, and it just goes on and on.
One thing that is noticable when we visit our son in France, the doctor runes his own clinics for certain things!

There is a huge amount of dead wood that needs to be pruned. We have paid for the service and deserve better.

Can Cameron do any worse? It would be quite a feat to get it as wrong as Labour have and a punt probably worth taking.

2trueblue

Forgot to say if we spent the money that Labour have spent on 'Management Consultans' on Consultants and Doctors we would probably save money.

David Blackburn

Malone,

Thank you, I expressed myself poorly.

ndm

I wonder how much of the problem with cancer outcomes in the UK is due to prospective patients doing a bit of the stiff upper lip stuff and muddling through for too long before going to see their GP. A doctor can't treat a cancer until he sees the patient - regardless of how fancy the treatment facility is.

Snowman

Here’s an idea from the ‘thinking the unthinkable’ stable.

To run the NHS cost currently each man, woman, and a child over £2,000pa. How about giving each of us a voucher for the £2,000, allowing us to top it if we want to, and freeing most of the hospitals from the yoke of the State by selling them to private bidders.

Everyone would have to cash the voucher each year with a medical institutions of his/her choosing operating under a license from NICE covering GP services and broad health maintenance (to be decided by negotiations with the newly privatized hospital and the Dept. of Health). Everything above that could be covered by insurance, and compensation for medical mishaps would be restricted by law.

The few remaining NHS hospitals would concentrate on research, teaching and such like.

Do you reckon it could work?

strapworld

Churchill and Macmillan did far more and showed far greater leadership than Cameron ever will!

Macmillan was behind the largest housebuilding throughout the land. No politician has macthed his achievements..Perhaps you may read some history and discover that Kennedy relied greatly on Macmillan's advice. especially over the Cuban Missile Crisis.

Heath and Cameron are equal. Although Frank Cousins did tell me that he had high regard for Heath but that Barber (Then Chancellor of the Exchequer) ensured the major problems with the unions.

But you cannot compare the Conservative Party of those days with the Liberal Democrats even former Commies running the party now!

But, as the son of a former mill worker in Oldham, brought up in a council estate, whose father went on to become a conservative party agent, it amazed me that he was a conservative rather than a socialist. But he certainly loved working for them, so to answer your question, I believe he was definately in the right party. I was, and am, extremely proud of him.

DavidDP

"Macmillan was behind the largest housebuilding throughout the land."

Oh, you want more state activity and government spending.Cameron too right wing for you, eh?

strapworld

David DP.

Yes!

Ben

"...World class care is a target determined by outcomes, not an outcome determined by targets..." nice soundbite David, and true. I'm a surgeon who also does clinical management. Silly political gimmicks are economically unound, but immediately affect shop floor decisions, to a surprising degree. Sadly, but inevitably, those medics whom the government chooses to listen to have long gone over to the dark side - Donaldson, Catto etc. I like Dave, but I have real doubts as to whether he will really change things - he needs the right advice. Who is providing it?

Roger Daley

I could have died in my local hospital in early 2006 - Misdiagnosed, ignored and left in post-op pain for three years before the next nearest hospital managed to improve my quality of life. I am still not right but glad to be alive and would terrified to go back into the first hospital.

Anne Wotana Kaye

The evil of government statisticians knows no bounds. It is general medical practice to judge cancer survival figures once five years have passed from the initial prognosis. This slime ball of a regime has reduced it to one year. That's a cunning way to tailor the results.

TomTom

Well ndm as one who has watched relatives die of cancer it is late diagnosis. They visit the GP for chronic ailments but the tests at the hospital come very late - endoscopy has a waiting list. Then there is the need for budget; the use of general surgeons instead of specialist cancer surgeons, and the simple fact that detection is too late and the cancer has seeded.

The fact is the NHS does not want cancer diagnosed because it cannot afford to treat it. In the US a lot of cancers are found during insurance company medicals - but look at Britain where the obsession is female breast cancer when more women die of lung cancer.

From British media you would think that cancer only affects women, and then only their breasts

lola

"Put simply, there are too few GPs referring to too few specialists." I have just suffered under that very problem.

Roger Davies

If something is considered to be free then it is perceived to be of little value. It is vital that the Users of health services understand the true cost of their individual care and as a consequence learn to judge it's true value. The removal of the profit motive seems to always result in confused, disorganised and inefficient management systems as targets tend to become vague and subjective. I do not believe that a State run Health Service like the NHS can ever become more than an average provider, however, there is potential for improvement. But we cannot believe that trusting medical professionals to be excellent managers is the solution. The NHS needs to be radically overhauled, re-focussed and privatised.

Snowman

Roger Davies - hear, hear

David Bouvier

Tom Tom - agreed; you would also think that mostly young women died of breast cancer, when it is like most cancers massively more prevalent among the old.

Actually, so much so that the EU death rate numbers would only give you any insight into health system performance if they are standardised for population age distribution.

Snowman - good thinking, though a nuance you need to appreciate is that the cost varies a lot by age - high at birth, declining in the early years, to a few hundred pounds in the 20s to 40s, and then rising ever higher as age increases.

Within that, it is unevenly spread out, being dominated by relatively few very ill people, among the non-old by trauma (road traffic accidents probably).

Then among the older people, typical costs rise, with then serious illnesses and end-of-life care being seriously expensive (of course you don't always know it is end-of-life care until after the event).

So any funding mechanism needs to take care of:

Provision for the congentially ill or those with acquired illnesses, who will face massive lifetime health costs.

Insurance (or other risk pooling) for highly uncertain healthcare costs for those teen to middle age in the otherwise more-or-less healthy general population, along with funding for routine primary care - perhaps including out-of-pocket copayments.

Funding for higher costs for emerging chronic conditions, later-life diseases and end-of-life care.