As the ConDems savour their power, with increasing confidence, imbued with the enthusiasm of born again Christians, maybe we should compare it to that which occurred, when the major transportation system of the UK was sold off to the highest bidders, ( the lowest, in truth) for each region, or service. The end result of the Tory plan was a disjointed 'mish mash', of competing companies, supported by ever increasing volumes of Taxpayer Gold, that made millionaires of some, bankrupt a few, and produced a worse service than we ever saw under the old British Rail. We also saw the rise and demise of Railtrack and its substitution with Network Rail, the governing body of the Industry and owner of the Infrastructure. It is a Company Limited by Guarantee and thus has no Shareholders. The DfT is a member, but does not own it. It pretty much does what it likes because Blair, who set it up, did not want the sort of Governance that had plagued him with other bodies. The result has been a huge increase in accidents, poor or even absent maintenance, overcharging, overcrowding, lack of any real democratic input or control.
So what has this to do with the NHS, one might ask. Well we are going down the same road. NICE is to lose its role of cost benefit analysis and negotiation with 'Big Pharma' the (piss poor) Care Quality Commission will be replaced by Monitor, because all Trusts will become Foundation Trusts. PCT's will become no more, being replaced with GP Consortia in the role of the Commissioning bodies; poacher and gamekeeper under the same hat. ISTC's, the 'Big Four' accounting and management bodies (PwC, KPMG etc), will be handed roles on a plate, to organise or even provide services,despite their complicity in the debacle of Banking Audit, and the Private Healthcare companies, are 'to be encouraged' (bribed), to bid for contracts, to provide and commission services, for Healthcare. And the useless Complaints System will become a battleground of even more complexity and futility, being hamstrung by the lack of any Public Scrutiny brought about by the constitution of the changes.
Just as in the Railways, there will be a bewildering array of bodies, organisations, some spawned from 'Big Pharma' themselves, all trying to make a profit out of misery and accident. The rigid safety mechanisms overseen by the military precision of the engineers who ruled British Rail (nearly all ex REME engineers) was supplanted by companies who lost lives due to lack of safeguards and planned maintenance. The result has been escalating costs, obscene profits, lack of forward planning and danger to the passenger.
For passenger, substitute patient and you will see what I am getting at.
When the NHS was instituted, the decision-making doctors were reluctant to be part of it, or else, perhaps, they grasped the opportunity to make a fast buck. To persuade them to become part of the NHS, they were bribed in two ways - 1) a lorra lorra money - See http://en.wikipedia.org/wiki/Aneurin_Bevan: "On the "appointed day", 5 July 1948, having overcome political opposition from both the Conservative Party and from within his own party, and after a dramatic showdown with the British Medical Association, which had threatened to derail the National Health Service scheme before it had even begun, as medical practitioners continued to withhold their support just months before the launch of the service, Bevan's National Health Service Act of 1946 came into force. After 18 months of ongoing dispute between the Ministry of Health and the BMA, Bevan finally managed to win over the support of the vast majority of the medical profession by offering a couple of minor concessions, but without compromising on the fundamental principles of his NHS proposals. Bevan later gave the famous quote that, in order to broker the deal, he had "stuffed their mouths with gold"." and 2) freedom from accountability in matters of medical negligence. - I'm sorry, I can give you no reference for 2), so you must make of it what you will - believe me or don't believe me. It's not the sort of proviso either party would want to subscribe to in documents accessible in the public domain. But certainly for decades after the NHS's birth, there was no system for complaining about the treatment you had received. You were supposed to be very grateful to have been treated at all! even if you had suffered by it. To complain about it was considered an impertinence.
ReplyDeleteSometime later around the end of the 70s, I think, you became allowed to make a complaint. But this has never moved on to getting anything appropriate actually done about a complaint.
So the two actual founding structures of the NHS are loads of money for the doctors and a free rein to get away with providing very poor treatment. These commitments have been faithfully adhered to by successive governments of all parties.