Tuesday, 23 November 2010
The ConDems NHS (What Do We Make Of It So Far).
Six months down the line from the lack of any decisive victory over, well anyone, lets look at what has been achieved and what is planned.
GP Commissioning has been lauded, as the only way forward for the majority of Healthcare within the NHS. It is the Lansley answer, to all the previous 'top down', centralised decision process, that hallmarked the reign of NuLabour, but is largely the path that had already been ordained by Andy Burnham, before his demise as Health Secretary (and what a piss poor one he was). There is some 'spin' to this. GP's are the front line of all Medicine and Healthcare. The first point of contact (except for A&E), where the public becomes patient. Thus, it is posited that they should control the purse strings and commission any services, or treatments that, spring from that Primary Care role. In the process, we largely rid ourselves of the cumbersome and expensive, Primary Care Trusts (PCT). Except of course, that for all their faults the PCT's did most of the Admin, the Commissioning and Governance. And of course they provided the 'out of hours' cover the GP's wriggled out of for 6% of salary.
If then, the GP's are to cover all of this, they will have to undergo a step change in roles. One that they have little or no experience of, and, judging by the lack of enthusiasm displayed by many, one they have very little desire to fulfill. They will likely have to engage some of the Managers they have expressed considerable disdain for, or another organisation to undertake all the 'back office' work. Step forward the Private Sector, be it in the form of the 'Big Four' accountant/management bodies, or one of the many Private providers (Welcome to the Boots - Price,Waterhouse,Coopers, Healthcare Consortia, operated on behalf of NHS UK plc). I do not wish to be a merchant of neither doom nor gloom, but a void tends to be filled by the one who is quickest on their feet, and these people are pretty damn quick. When you ( a GP) are floundering in a mire of bureaucracy and red tape; have no real idea of the ramifications of what your new role needs, to give it credibility, with the National body that approves your Consortia; if someone offers you a 'model' that removes the doubt, many will grasp it.
Maybe some will gravitate toward the 'not for profit' social enterprise model, which could be a good thing, but the pitfalls and dangers, not the least of which is the very real possibility of 'inheriting' the debt and forward contracts of the existing PCT's, which Lansley has said he will not cancel or guarantee, may well put you off. Put you off, without the sort of financial 'clout' and dubious, but successful creative accounting capability of a well known Accounting LLP (remember the inspired auditing of the Banks that got us here in the first place).
And what about assuming the role of procurer of the drugs and supplies, now that NICE is to be emasculated? How do you evaluate the claims of 'Big Pharmas' products and devices, in a world of pitfalls and dubious trials, all proclaiming much, but generally delivering very little, except possible death in a bubble pack? How do you evaluate and procure an out of hours service for your patients? Do it yourself? There is a singular lack of enthusiasm to go back to that, I'm sure. Certainly from the sigh of relief that emanated from BMA Towers, when the Government gave it to the PCT's to provide, would lead one to that view. And, I'm pretty sure that giving GP's their 6% back will be met with howls of derision as an inappropriate value for such an onerous task.Will you spend your hard won budget at the local trust Hospital or contract with the ISTC or even BMI for routine operations?
I am not certain that such decisions should, or even could be made effectively by GP's. I am certain that many will not even want to. This is the largest change in Healthcare since the birth of the NHS. Whilst consultation is taking place, it is largely with those organisations, that most feel have failed to deliver a just and fair NHS that addresses inequalities; the GP bodies (see last post). I do have hope; not a lot, because I have little faith in any breed of Politician, especially those that are trying to make me happy, whilst removing hope of any prosperity in the next, how ever many years. I'm not at a time in my life, like many others, where there are years available to me, to observe these policies through to any conclusion.
I despair of the much that is happening. The complete madness of a 'responsibility deal' with the major fast food retailers (McDonald's, Pepsico etc) is akin to placing regulation of game keeping with the poachers. As is enjoining with the major food and drink suppliers, to promote 'health'. That any of these, will actively pursue a policy based upon any motive, other than self interest and profit, is somewhere between naivety and lunacy. They already produce products laced with the toxic, man made, chemicals that have likely caused much of the ailments that modern flesh is heir to. To devolve even more power of damage to these architects of high carbohydrate diets, infiltrated with High Fructose Corn Syrup, Soy fed meats, Hydrolysed Vegetable Protein and other injurious additives is madness of a scale only to be found in the USA. Do we wish to emulate a society where the food lobby guides Government Policy and the Drugs Industry then feeds off the damage? Because that is where we are going. If Lansley and Cameron have their way, that is where we will arrive.
PS This is one view. That from the Black Tower. If nothing else it is amusing.