Tuesday, July 20, 2010

NHS in safe hands?

Jane Bruton abseiling 500ft. face of Guys Hospital, London, in health fundraiser.
Takes nerve, but is it as dangerous as trusting this government with the NHS?
(photo by her partner, Paul Mason)

TORY Health Secretary Andrew Lansley has announced plans for the the "biggest shake up" of the NHS, supposedly transferring powers from primary care trusts to local GPs, and getting rid of bureaucracy. As usual we're getting the Tory buzzword "choice", along with promises to "shape the services around the patient rather than make the patient fit the service".

Lansley had "just spoken to more NHS managers than he will ever do again", commented the Health Service Journal, reporting that the Health Secretary had told the NHS confederation conference to expect a minimum of £220 million "shaved" from management costs this year, and of course, redundancies.

Lansley says fewer managers will be needed, because targets will be abolished, and GPs will be in charge of the money. The government has promised £80 million will be found for the change.

I hate bureaucracy, and despise "targets", which make for top-heavy organisations, with three people needed to change a lightbulb - one putting the bulb into the holder, one writing up the report, and the third checking the paperwork. (The bloke footing the ladder - that's me - was made redundant. Get rid of that big fellow standing about, what's all this health and safety nonsense?). Plus forgetting the object, or in this case the person involved, the patient's health, in favour of getting the figures right.

All the same, as an ordinary punter, I'm sceptical about proposals to put the GP in charge. How is it that someone who can barely find five minutes to see each patient at the surgery, and prescribe medicines, is supposedly going to take charge of everyone's health needs, keep abreast of what's happening in the hospitals, and see the public's money is well spent?

The government's White Paper includes provisions to give GPs the power to commission mental health services. But mental health charity Rethink discovered that only 31% of GPs feel equipped to take on the role for mental health. While three quarters of GPs say they can take responsibility for diabetes and asthma services, less than a third felt the same for mental health services.

Rethink is concerned that unless there’s a national plan to up-skill GPs in mental health many of the 1.5 million people with severe mental illnesses may fail to get the treatment they need.
As a former hospital worker I am also remembering the part played by catering staff,porters,cleaners, maintenance, laundry, storekeepers and purchasing, and yes, accounts. Not to mention radiologists, pharmacists,ambulance crews,social workers and all the other trades and professions whom our politicians seem never to have heard of, or regard as unimportant. We know they are all essential to the running of the hospital, even if they don't all figure in the hospital soaps and childhood games of doctors and nurses which seem the height of ministerial and media imaginations.

But I was forgetting of course. Everything can be privatised. We have all seen what a marvellous improvement contract cleaners have made to our hospitals' hygiene standards, enabling more people to catch more complaints than previous generations had even heard of. There I go, with my old fashioned ideas, standing in the way of progress. If it's all a bit complicated for our GPs on top of their own jobs, I'm sure there will be plenty of bumf coming through the door from suppliers and service providers, as there has been from the drug companies, with promotions and conferences to help them keep up.

Then again, as part of David Cameron's 'Great Society' idea we could consider the role of volunteers (or kids doing community service?). Though funnily enough the volunteer ladies who used to run sweet shops, or provide outpatients and visitors with a cup of tea and slice of home made cake, to raise funds for patients' extras, have been elbowed out by costly commercial chain outlets.

But over the years, volunteers have been finding bolder and more adventurous ways to raise funds for the NHS, and not just for extras. When St.George's hospital in Tooting, South London, was raising money to install an ultra-sonic scanner unit back in the 1990s, fundraising ranged from students dressing up in funny outfits to shake collecting tins around the Broadway, pretty old-hat, to firefighters abseiling down the outside of Lanesbrough wing on a Saturday afternoon.

I was reminded of this when, with justified pride, Paul Mason posted pictures on Facebook of his partner, Jane Bruton, and her friends, abseiling down the 500 foot face of Guys Hospital at the weekend, to raise money for research on treatment of Myasthenia Gravis. Jane explained "Myasthenia Gravis is a neurological condition where the nerves don't fire properly so the muscles are weak. I nursed people with this when I first was a qualified nurse". Nowadays she is a successful journalist and editor.

There are some great people around, but we have not got Cameron's 'Great Society'. In the 1990s we'd had Cameron's predecessor Margaret Thatcher declaring contemptuously that "there's no such thing as society". We also had people going around the hospital explaining that patients were henceforth "customers", and contrary to our idea that everyone, consultant or cleaner, was part of a team, colleagues in other departments were also our "customers". As for other hospitals, which had supposedly become our competitors, if they should happen also to be customers - like when their incinerator broke down - well, that would be work for the accountants.

GP fundholding had been introduced by the Tories first time round in 1991. A couple of years later, when St.George's scanner unit was up and running, the community in south London which had opened its hearts and wallets for the appeal learned that it would not be for them. GPs in the St.George's catchment area had insufficient funds to refer patients to the unit. NHS patients would have to wait behind the more affluent customers.

So we can't say we've not had a foretaste of what the Tories plans entail. Maybe that is why they did not think it necessary to tell us about it before the election, and it was not even mentioned in the coalition agreement with the Lib Dems. But never mind, people say it is a gamble, and like every shake up you roll the dice, and see who wins. Then maybe wonder if it has been fixed?

"A private health firm is set to rake in millions from a shake-up of the NHS – eight months after the boss’s wife donated £21,000 to Tory health secretary Andrew Lansley.

"Care UK expects to earn a fortune in the biggest reform of the NHS for 60 years as private companies win a lucrative role in providing services to local GPs. As one of the UK’s biggest healthcare providers, it already runs GP surgeries, NHS walk-in centres and cares for half a million people a year.

"And Mr Lansley faces accusations of a conflict of interest for accepting a donation from the wife of John Nash, chairman of Care UK at the time of the donation. The row comes amid warnings that Mr Lansley’s shake-up will cost thousands of jobs and represents a giant gamble with the nation’s health.

"The Health Secretary accepted Caroline Nash’s money in November to help pay for the running of his private office. The hand-out came just weeks after her husband predicted future Government policy would help make his company – which earns 96 per cent of its money from the NHS – even richer.

"Mr Nash stood down as chairman in March, when Care UK sold out to a private equity firm, but he is still a consultant. Unite’s nursing spokesman Barrie Brown said: 'These dangerous and untested ConDem plans will see private companies given an even greater stake in the NHS.

'And it is particularly alarming how one of the biggest private healthcare firms out there could be so closely aligned to Mr Lansley.'

"Dr. John Lister, of campaign group Health Emergency, added: 'The fact that the man in charge of dismantling the NHS has taken cash from one of the companies looking to profit from his plans stinks.' Under Mr Lansley’s plans announced last week, primary care trusts will be scrapped and family doctors given £80 billion to spend.

"Now private companies are gearing up to help GPs manage their new roles in a market worth up to £500million. A spokesman for Care UK said yesterday: 'The donation was from our former chairman’s wife, who we understand regularly makes donations to the Conservative Party.'”

This post was first published on The Mirror

London Health Emergency, which was campaigning to warn people about planned NHS cuts even before the Tories got in says this new plan could mean the end of the NHS. In a statement on July 13, Dr. John Lister said:
"This new set of policies builds on all the worst elements of the previous government's so-called reforms.

"It will establish even more private providers making profit from the public purse, while NHS staff could become a virtually extinct species in England.

"Any GPs who really believe that they can deliver improved care for their patients in this type of health competitive market are kidding themselves.
"Some campaigners have wrongly cried 'wolf' at earlier reform packages, but this White Paper leaves every previous attempt at privatisation and marketisation standing. This time we really are facing the end of the NHS as we know it - by 2015.

"Now is the time for every health union, professional body, pensioners' group, campaigner and member of the public to get together to force the Con-Dems to back off."


Indeed, we may ask what mandate the government has to introduce such measures without warning, and stay in office.



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