Sadly, I am getting old enough to have seen Andrew Lansley’s ‘reform’ of the National Health Service before. Then it was the Tories introduction of the ‘Internal Market’;  it failed then and Lansley’s plan is going to fail this time.

It is going to fail is for three reasons.

One – Doctors are not administrators they are medical practitioners (though they managed to blag a pretty good deal off the last Labour Government for more pay less work).

Two –  The Tories are terrified of the Public Sector Unions, whose salaries and pensions they and we  cannot afford any longer.

Three –  We are in a National Emergency that the Tories think they can smooth over in a MacMillanesque ‘don’t frighten the horses’ way.

Doctors,  I would argue, cannot fix bones, diagnose illness and do all the other medical essentials whilst dealing with rafts of paperwork; the police were compelled to do this – net result more and more paperwork, less Cops running around with tasers, body armour and helicopters.

Equally Doctors are working in hospitals that were predicated on pre NHS sites, are generally in a poor state of repair and in a state of filth that would not shame Scutari. The incompetent Doctor is paid the same as the truly gifted.

The Public Service Unions are not interested in Public Service, they are interested in preserving their jobs and their bullet proof pensions. They are the Miners of the 2010’s , ultra Conservative, cannot see why their soviet style structures cannot remain and guarantee them a job for life, whilst wandering around with a clipboard.

The National Emergency – for God’s sake we learned yesterday that the ‘true’ level of public debt is over £2 Trillion. I thought my grandchildren would be paying this off in their dotage, I was wrong it will be my great grand children who most likely I will not be able to apologise to explain why.

The Welfare State has bled us dry for over sixty years, and is incapable of  self- reform. There comes a point when you have to shoot the wheezy old nag and buy a new horse. Putting a new set of shoes on it is not going to make any difference to its performance. Lansley is inside the system trying to reform it from within. It ain’t going to work. Turkeys don’t vote for Christmas.

In a National Emergency you need decisive Leadership, not compromise with the enemy.

Each local hospital should be given a date when it will be withdrawn from the NHS. That hospital will then be given two years to get itself into a state where the National Insurance contributions  of local people are directed at that hospital and its support services, not sucked into a vast bureaucracy. Then it truly becomes ‘our’ hospital, which will engender goodwill, charitable donations etc.

If the facilities are still decrepit, the bureaucracy inefficient, the medical staff a danger to themselves and their patients, notice to close be served and the local pool of National Insurance funds be directed at another service provider who can provide a medical service not a job creation scheme.

Big is not beautiful –  it is usually incompetent, unresponsive and expensive.

Lansley needs to step outside the loop, and only direct our funds at the most efficient and clean medical service providers. He is currently the NHS’ minister, he is their Minister, not our Minister looking after our money extorted at source.

Is this going to happen?  Of course not, Cameron has promised the NHS is safe with him, along with the thousands of public sector jobs.

Gloria Smudd
July 15, 2010 at 19:51

Once, many years ago I and a couple of other novices joined a bunch of
scarily-competent mountain-monkeys on a skiing holiday and three of us had to
learn from scratch. The other two learners were much better than I was and
progressed to parallel turns and a different group within minutes. Eqyually
quickly, one of the other novices had an accident and was taken to the v. busy
medical centre. There the busy doctor put her damaged limb through the x-ray
machine which was at his clinic, looked at the x-rays and told her she’d
sheared off a few vital bits of her ankle. He told her it was going to require
a big operation and 6 – 9 months in plaster and he asked her if she’d like to
go home to have this operation or stay in France. She said she’d like to go
home so the doctor did a ‘holding’ plaster and gave her the painkillers to get
her through the night before she could fly back and get ‘done’ back in the UK.

I realise that these ski resort clinics are likely to deal with skiing
accidents a little more efficiently than an East Anglian GP practice but if a
doctor in the Alps can have an x-ray machine and be trained to use it, is it
out of the question that a group of local practices could have a radiographer?
Instead of sending patients off to A&E or asking them to wait the 18 weeks
for an appointment for an x-ray, wouldn’t it be better for the patients to be
sent off to a shared unit where a radiographer or haematologist could refer on
behalf of the group of practices?

Jabba the Cat July
15, 2010 at 09:11

Putting aside the finer points about the new operating system for doctors,
it fills me with absolute joy at the imminent cull of all those useless pen
pushing and seat polishing jobsworths in all the health authorities.

Ed P July 14, 2010 at 21:10

Surely the funding decisions will be given to GPs, not hospital
doctors?

Most GP surgeries have Practice Managers & accounting expertise these
days, so the transition should be easy to implement.

Also, many hospitals have been modernised and are run well these days, with
stringent cleaning and improved morale – so some of NuLab’s efforts were
effective (although I’d rather not have to admit to it).

DavidNcl July 14, 2010 at 17:37

Nigel Lawson pointed out that the NHS is the nearest thing to a state
religion that we have. Think of it as the epitome of the state Methodism
rather than state Socialism and you begin to get a feel for how deep sentiment
runs.

That’s not an easy target.

I goes far, far beyond this. Into the nature of class privilege in Britain,
the role of the intellectuals. A blog comment isn’t the place for this

Stotty July 14, 2010 at 16:29

If Assura Medical, BUPA, et al, provide better value for money and better
patient care (not necessarily in that order), I really couldn’t give a toss if
they make billions over the years.

When is someone within the NHS actually going to stop seeing the
organistaion as their personal fiefdom based on their moral superiority and
realise the NHS is there to provide the best patient care. Period.

I watched Lansley on Newsnight on Monday night and was unexpectedly
impressed. But throughout the entire bloody programme, the word ‘patient’ was,
to the best of my memory, never used. It was all about ‘me’ and ‘us’ and never
about ‘them’.

Obnoxio The
Clown July 14, 2010 at 16:26

Oops. Sorry Andrew!
)

Obnoxio The
Clown July 14, 2010 at 16:25

Hear, hear, Ms Raccoon! Spot bloody on!

Antisthenes July 14, 2010 at 15:50

Doctors are not accountants and a lot of them are not good clinicians
either. However they can employ decent practice mangers some will some wont so
the service the patient gets will be still a postal code lottery. If patients
can swap practices with ease and the emphasis is on choice from the GP upwards
then yes the system will be considerably better than it is now.

The only way to have a half decent health service is to put the money under
the control of patients and as the NHS is free that is not practicable.
Lansley’s reform is probably the best of the worst that he can do under the
circumstances.

Fred July 14, 2010 at 15:32

It is health service privatisation.

http://witchdoctor.wordpress.com/2010/07/13/healthcare-and-the-pure-market/