NHS! (again)

NHS demo yesterday was a success with a good number of people from the Greens there. Well done to all those who helped with the Green Party placards: they were out in force on the day! Wish I could have helped with them too!

The following motion in support of the demonstration and against private involvement in the NHS was passed at the Green Left meeting on Saturday last week. I am not sure if it has been publicised since (having been somewhat out of the loop with e-mails, aside from during procrastination time, due to a heavy week on the wards trying to finish off my A&E module! – also the reason I haven’t blogged for a while):

“Green Left notes the attempts at increasing private involvement in the national health service. Recognizing that healthcare commissioning is to be tendered to private companies (including some with a bad reputation in the USA) and that implementation of the Darzi plan for polyclinics will probably involve some private sector companies, we affirm that this is against the public service ethos central to an ecosocialist future.

We strongly encourage involvement and support of the Keep Our NHS Public demonstration on Saturday November 3rd 2007.”

Anyway, best get back to work… Have a dissertation to write and wouldn’t mind getting a bit further on the new edition of Joel Kovel’s book.

Tyranny of the Bottom Line?

http://news.bbc.co.uk/1/hi/health/7037657.stm

Yet another example of what happens when hospitals put profit before people, when the ‘bottom line’ rules supreme. Instead of prioritising human health and happiness, the bottom line has been prioritised. This is absolutely disgusting and goes to show how powerful the ‘bottom line’ is in forcing individuals and groups to submit to its need to be preserved.

As with so many things, an economic system where capital does not rule supreme would help prevent such things happening. For the time being, at least an NHS where services aren’t outsourced and which is provided with an adequate budget to ensure that all hospitals have adequate nursing care all the time would be a start!

Merge?

The NHS is forever merging smaller hospitals together with claims of greater efficiency and better value for the public. However, the evidence contradicts this. It was stated in the BMJ during 1999, that economies of scale only apply to hospitals that have less than 200 beds. Given that the mean NHS hospital size in the UK is 300, and the optimal size for a hospital is between 200 and 400, why merge hospitals together? In fact, once we reach 600 beds in a hospital, prices start to increase again.

There are other good arguments for smaller hospitals: smaller hospitals are more likely to be directly attached to their local community. This means that the community will be more involved with the hospital, and it will probably be more accountable (or at least more closely watched) than a detached ’super-hospital’. Local services, near people’s homes, make them easier to access, reducing the disincentive to access healthcare and reducing congestion as people don’t need to travel quite so far.

Of course, for some specialist procedures, specialist centres are better and thus it is better to have referral centres – but this is only for a minority of hospital care in the NHS. For ‘bread and butter’ cases, however, small and local hospitals are best.

Relevant Green Party Policy

H304 Primary and hospital care will be more closely integrated. District staffing structures will be reviewed, with the aim of integrating hospital-based specialists into primary care and community health workers into hospital practice. The hospital programme will emphasise the development of appropriately-sized district and community hospitals, with a reduced role for larger regional centres. However, some specialised services will continue to be provided on a regional or sub-regional basis.

Virgin Stemcells

Richard Branson is to launch a stem cell bank (reported here by the BBC). Fantastic: capitalist, market economics getting in on something which is about saving lives. Is there anything it doesn’t permeate into?

Of course, some parents won’t be able to afford this technology. Do we really want to see the situation, say 20 years down the line, where parents who couldn’t afford to preserve some cord blood from their kids are left lamenting the ‘what if?’. It is a bit gross and perverse. With such a technology, I think there is an argument for banning it until it is proven to work. Once there is proof, the NHS should offer it for all babies or make the decision that it is prohibitively expenive and keep the ban. That is really the only way to prevent a massive double standard – otherwise it is incredibly unjust.

Morally, it is the equivalent of giving only those who can afford it the opportunity to have their cancer operated on.

=========================

In other news, Hillingdon PCT has proposed to hand over almost all of its functions to the private sector. The Trust’s Chief Exec has been quoted as saying, ““I want to get rid of everything, outsource it”.”

“PCT could slash 90 per cent of staff. A troubleshooter chief executive plans to strip an ailing primary care trust down to its core functions and reduce the number of staff from 300 to 30. Anthony Sumara, who has been interim chief executive of Hillingdon PCT since October, proposes to put three out of four commissioning support services out to tender, and to hand clinical services to a new provider. Under the proposals, the PCT would retain only its core functions like governance and emergency planning, as well as patient and public involvement. The move could see the PCT, which has �54m of historic debt, and is predicting an in-year deficit of �11m, reduced from a staff of ‘300 to 30′, he said. But he said the chances of the board agreeing to the move were 50:50. The Proposal to Procure commissioning strategic outline case was published by the PCT on January 23. It states: ‘Outsourcing the majority of the PCT commissioning functions gives the greatest benefit and the greatest probability of success,’ when compared with three other options: doing nothing, building internal capability and developing synergies with other organisations. If the project gets approval in June the contracts will go out to tender. Mr Sumara told HSJ: ‘I want to get rid of everything, outsource it – and we are distancing the PCT from its provider functions.’ The government’s commissioning framework allows PCTs to choose which areas they wish to outsource. The DoH is expected to publish its list of recommended commissioning experts within weeks. Hillingdon is looking at three of the four main categories identified in the framework: assessment and planning; contracting and procurement; and performance management to ensure better accountability. The organisation is currently working on defining what residual functions a PCT should hold. Mr Sumara said responsibility for monthly emergency planning, managing the outsourcing, governance of money, accountability and development of the market would remain with the PCT. ‘You need a PCT because you need a statutory body to receive the money from government. We are also deciding what will happen to the provider side – should it come under the hospital or become a social enterprise ? We will keep public-patient engagement as we have a better idea on how to engage with the public locally and the voluntary sector than, say, [information analysts] Dr Foster,’ he said. ‘The PCT is not giving up responsibility. We are doing this as part of our recovery and to get some clarity around what a PCT should be doing. It’s commercialising, not privatising and the public don’t care – it’s not about the provider services, it’s about men in grey suits. It will still be free at the point of access.’ The next step is to develop the outline business case for consideration by the board in April 2007 and appoint a dedicated project team. The strategic outline case states: ‘Hillingdon PCT commissioning is currently weak and not fit for purpose. For example, acute providers will continue to over-perform by �9.8m in 2006-07, adding to the historic debt.’ Mr Sumara said: ‘At the moment it is 50:50 whether it will be approved but I do think it will save us money and I do think it will get the go-ahead. I don’t think we are big enough for some companies but they will start with us with a view to providing a service across London.’ Some of the risk factors considered in the proposals include: the supplier’s set-up costs exceeding the potential gains of the contract; the delivery of financial balance for the PCT taking longer than currently planned; the requirement to repay the historic debt making the contract unattractive to outsourced suppliers; and an adverse reaction from the public.” Keep Our NHS Public Website.

I needn’t say much more really. The march towards privatization by this government seems almost unstoppable. Despite the fact that it has been shown not to work in the interests of the public (take the railways with astronomical train fares or british gas cutting off pensioners or royal mail’s struggles as just a few examples).

The private sector will take the easy, profitable cases and leave the rest for the NHS to deal with. The private sector is not interested in doing the best for people in the slightest. It is out to make money, and money it shall make.

More information, here, on the Keep Our NHS Public website.

Deary me.

When there is a limit to the amount of funds that can be spent on the NHS, it is a disgrace that money is spent on treatments that have no evidence of being effective and it is an even bigger disgrace that the British Homeopathic Association campaigns for wider availability of homeopathic treatments.

Ok, there are hundereds of other reasons for the defecit (PFI, Management Consultants and waste, to name three) but this is just a rediculous tipping of money down the drain. People battle and have battled for years to stop being deined vital treatment (e.g., here and here) whilst at the same time, others are getting homeopathy on the NHS!

Season’s Greetings (again)

An interesting post on NHS Blog Doctor comparing US and UK modes of healthcare. Just thought I should post it here since it is well worth a read!

Sell out

Interesting post about ‘Health Tescopolism‘ at Green the Health Service. How are people supposed to have confidence in their GPs when they are just employees of faceless corporations interested, not in improving peoples’ wellbeing, but in making a quick buck? In the end, it will mean that those in charge of our health surgeries are not concerned about how well they perform for society, but instead about how well they perform for their shareholders. The old small-business model, with all its faults, at least links the practice owner/manager to the patients on a regular basis instilling a greater sense of social responsibility and accountabilty.

Relevant Green Party Policy:

H336 The creation of NHS Trusts erased the democratic accountability of local NHS services. The rights of those who work in the NHS, especially to participate in its development and improvement, were widely undermined. Market forces cannot allocate healthcare fairly, nor even efficiently. The internal market has wasted badly needed resources on administration, and reduced the efficiency and morale of the whole system. The internal market opens the long term possibility of further privatisation of the NHS. The internal market should be wound up and replaced with clear financial and service accountability of decentralised service units to regional assemblies within a single corporate whole.

and

H332 Health spending in the UK has fallen well below the European average. It is recognised that this is in part due to the efficiencies of a large-scale, national, public service paid for by taxation. However, the NHS has been under-funded for many years and the Green Party believes it requires a sustained increase in resources. The party will continue to support the principle that the NHS is a national service, free at the point of entry and fully funded by taxation.

H333 An NHS Tax, earmarked to increase direct funding of the NHS, shall be introduced as part of general income and other taxation. We believe this will have wide support.

H334 The Green Party seeks to devolve more decision-making to local level, and widen local tax-raising powers. As those proceed, local choice and accountability will be increased by part of the NHS Tax being raised by Local Government for NHS provision for the local area.

H335 Health Service spending will be reviewed regularly, with a view to increasing the resources invested in health promotion, illness prevention, community care and community development, relative to spending on curative interventions.

=========================

Also, a truly odd and quite twisted article on CiF by Mick Hucknall supporting copyright on the grounds that is radical and redistributive (!?!?). I don’t know what more to say really: read it.

Oooh the excitement. This blog is apparently the 8th best Green blog out there. Well done to Jim for completing the list, which must have taken many hours of hard work with 100 blogs to be ranked. Alas, I shall have to move on from the excitement and return to blogging as usual.

=======

Several things have caught my attention on the blogosphere lately. Firstly, a really interesting post at Earthquake Cove. I will have to do a post on a few policies which I think require a radical rethink. I suppose it is something which any party which comes up with radical policies needs to be aware of – just because a policy is radical does not mean it will work! Was particularly interested in the policy banning dissection of animal parts as this was something I had read before and had found more than a little inconsistent for a party which is not proposing to ban carnivorism.

Also interesting was this post  in ‘the void’. I had no idea that Sanders had been up to no good! I have to say I felt disappointed, despite not being particularly surprised.

For an interesting health related issue, Stuart Jeffery’s blog throws out this post which is really about business as usual in New Labour. More of the same, more back-door influence from private companies. This government has truly lost all of the little faith people had. It has eroded trust away to such an extent where it really feels futile to even comment about it anymore! Sleaze is the norm rather than the exception.

===========

Bussing London.

London’s bus service, unlike the services in almost every other area of the UK, is going through a massive boom at the moment. This is mostly due to the namby pamby, protectionist policies of Ken Livingstone. It is truly disgusting how people are *leaving their cars* as they are finding a suitable alternative. What will we do? – nobody wants streets without cars and full of people walking to the nearest bus stop. People walking, on the street, is far too social an activity for the modern world. It is a slippery slope: next thing you know people might start *talking*. If they talk, they might discuss *issues*. What kind of a world would it be if people discussed issues???

I think I saw a bat outside.

I spent my first ever night on call last night. This meant I got about an hour of rest in 28-ish hours. The hospital was deadly quiet except for two key areas, the A&E and the MAU (Medical Admissions Unit, where all the patients to be admitted are sent after they have left A&E, ideally within the 4 hour target for waiting). It was definately a great experience, and a chance to get to speak to a number of patients I wouldn’t have spoken to otherwise. Reading up about Heparin and having teaching on X-Rays and ECGs at 2am was… different!

Presenting patients to the cousultant when that tired was an interesting experience – never had to do anything resembling logical thinking while that tired before!  I can’t help thinking what a priveledge it is to speak to patients during what is, in essence, a major life experience and then watch them being assisted on the road to recovery. (This is true about my whole experience of clinical medicine so far, but even more true when you get to see the patients at the moment they enter hospital.

I discovered an interesting blog after I woke up from my post-’on call’ slumber. the void is well worth a read and good fun too!

Competition

Long time no post, mainly because my internet has been down and I don’t think it is good use of NHS resources to use computers in hospitals for bloging!

I was thinking recently about competition. In Green Alternatives to Globalisation, Caroline Lucas and the late Mike Woodin posit the idea that economics should move away from competition for the cheapest to a system of co-operation for the best. I was wondering how far that idea is transferable. Is competition always a bad thing? Is it sometimes a good thing? Can it be made a better thing?

For example, if a group of medical students are left in a room, competiton will inevitably arise. Each student will try to show off their own strengths and come out the ‘winner’. On one hand, it means all the students work hard to reach the top and therefore  one could say that the overall standard is raised. On the other, it means that students at the top will want to maintain their position there. To do this, they will try to avoid providing other students with useful information that might help them become better; so, rather than the average going up as a result of competition, it would go down. Co-operation would mean that such information and knowledge would be distributed among all the students. Does this mean that competiton is inherently bad or does it mean that competition needs to be modulated to ensure it is healthy and that co-operation is facilitated within the competetive framework? How far can we apply these ideas – to learning? to sport? Perhaps competition is only good as long as the rewards are not so great as to make ”winners” value their own positions at the top too much and ensure that they are willing to co-operate to make others as good (or perhaps better) than themselves in that field. I guess that points to the idea of no monetary reward and back again to the idea of socialism, which lies partly on the idea that material reward shouldn’t be necessary to encourage people to work for the good of society.

===============

Other musings:

I spent two hours in a multi-discipinary meeting reviewing cancer patients today. It occured to me that in this day and age of patient involvement, a review of treatment for patients where there are no patients present might go quite against the prevailing ethos. I wonder if it is ok to make decisions about a patient while the patient is not present and (more importantly) not invited to be present. Of course, the logistical difficulties around having a multi-disciplinary team with patients while mainting each patient’s confidentiality make it practically very difficult (unless we have patients waiting to enter the room one by one, to be faced with about 20 consultants/nurses/students/radiologists/pathologists!). I just wonder if there is any way that it could be done more inclusively.

studentmedic