NHS plc?

Sicko.

As Andrew Lansley's 'brave new world' of GP Commissioning takes shape, I would like to examine the substance of that which will prevail in the future, and the effect it will have on all of our lives, yes, even the rich!

I have made no secret, of my view that, this is a covert plan, to 'privatise' the majority of services that are provided by the NHS, although a surprising number already are, such as Care UK and others, who almost exclusively contract for Prison Healthcare in the UK. There in fact, seems to be a 'model' forged to an extent by the last Government and continued by this one but at a more accelerated pace. It is the US Healthcare model.

Numerous consultations took place between the 'last lot', 'this lot' and US Healthcare giant Kaiser, to provide advice on the structure of the NHS. The concept of making Hospitals into Trusts especially Foundation Trusts, is a construct largely inspired by them, together with the enforced change upon all Hospitals to become the latter by 2014. As such these bodies will have to be in surplus, or fold. So the prospect of a Hospital closing because it is bankrupt moves ever closer, with Lansley clearly stating that there will be no 'bailouts' (don't remember him saying that about the Banks). This makes them a 'ripe fruit' to pluck, at rock bottom price for an aspiring Private provider.

 Primary in this role will be the FESC (Framework for procuring External Support for Commissioning), who will be ideally placed to design the procurement 'tools' for the GP cohort, flung into the maelstrom of designing a system about which they have little knowledge, or even desire to engineer.In this body we have a list of Private providers, including BUPA, Dr. Foster, KPMG, McKinsey, Tribal, United Health and others, all poised to take a slice of the cake. Close on their heels is the Cambridge Health Network, fronted by Dr. Penny Dash, which provides " Health Leadership and Enterprise", which is a euphemism for promoting the sponsors, which include; Halliburton (of Gulf Oil fame), General Electric, Virgin, BUPA, GlaxoSmithKline and of course, Carillion, to the DofH. Dr. Dash is of course, a McKinsey partner, and ex Head of Strategy and Planning at DofH, and now enjoys the ear of many in Government. Copperfield has this view about her in Pulse in 2009.

Many ex-Government politicians and advisers will be found within this organisations companies, including Patricia Hewitt (BUPA), former Blair adviser Simon Stevens (United Health), Mark Britnell, former DofH, head of commissioning (KPMG), Penny Dash (McKinsey), the list is almost endless, of those employed in Healthcare who have exited by the revolving door between, Public and Private Healthcare Providers. Is it likely that these and others, will be able to exercise influence in directing commissioning toward the 'private' model. Well do bears s**t in the woods?

Would this exercise to bring Private Medicine into the NHS be a bad thing? Well if we are to judge it by simple maths then let's work on Healthcare costs as a percentage of GDP, because the US has a larger population than do we, but is used by many as the model for Western Medicines excellence. It cost slightly more than 15% of US GDP in 2008, but only 9.2% in the UK to provide healthcare universally, but of course healthcare is not available to all in the US, only those who pay, so that comparison is even more favourable than it seems. In world terms we are 20th for life expectancy, yet the US, for all this expenditure, only ranks 36th and whilst we ought to be higher, if the belief that privatising the NHS is to bring benefits, then surely these figures must explode that myth.

The likely result is that cost savings will be heralded, certainly at Commissioning stage,  as it was with ISTC's, but the results a little further down the line will be one of reduced services, 'cheap' operations, based on dumbing down the staff cohort, and doing production line procedures, such as Arthroplasty, and leaving the NHS to take care of Trauma, until it goes broke, because it cannot compete. The end result will be, without doubt, less for the same, or eventually, as in the US, less for more.

Mandate, What Mandate?

The current ConDems have launched the Health and Social Care Bill, onto a largely unsuspecting public, who did not vote for them, and did not vote for almost any of the elements of this tawdry piece of 'Privatisation'. During the election, Cameron promised to ring fence the NHS, "I'll cut the deficit, not the NHS", was the clarion cry. He was going to stop "top-down reorganisation". He also promised to not raise VAT, and not to raise tuition fees, but that's another story (lying b*****d), but it displays the treachery, of an unholy alliance, of politicians, without any mandate from the people, to attempt to invoke such policies, completely contrary to their hollow promises.

This Bill takes an axe to the NHS, where a surgeons scalpel was needed. It gives the responsibility for Primary Care into the hands of a somewhat bewildered bunch of Doctors, who have little experience of Commissioning health care, and will be placed in the position of both poacher and gamekeeper. Under the requirement to allow 'any willing provider', to provide services, it will become illegal, not to allow the likes of Tribal, Circle, Virgin, Serco et al, to tender for services, which will be decided on price, at the expense of quality, due to the ability they have, to provide care, at less than 'tariff prices'. They will manage this, by 'dumbing down' the staff cohort with, nurse practitioners, salaried GP's and the Health Services versions, of the 'Polish plumber'.

We do need some perspective on this, I think, because I am not one who holds the NHS in reverence, in fact I have often treated it  with contempt ( which it deserved), and described many aspects of it with unguarded venom. But this was because of the many within it, who have meekly accepted substandard levels of care, turned a blind eye to their colleague's incompetence, and worse lied, to protect them, and thus, deny legitimate complainants, justice and candour. But was it ever the same? Doctors have been hiding behind the protection of the 'Bolam Test' for generations, on the simple principle that they are above the laws, that us mere mortals have to abide by. This is the unacceptable face of health care, both in the past and in the 21st century. As the paymaster of physicians, we deserve better.

But, the concept of 'free' health care for all (which is far from free), remains steadfastly my abiding belief. I spent a good part of my youth, and indeed my life, fighting for this goal, both for myself and for others. I became jaded by the actuality, many years ago (politics that is), after years of smoke filled rooms, far from the public eye, where the real decisions were made. The chamber was just the 'window dressing', for public view. 'Real Politic' was conducted always, behind closed doors. I gave it up, to wield my talents, for what they are worth, as someone in the 'real world', where you are judged by your peers, as competent, or having integrity and is the abiding tenet, I live by.

The NHS is important. But it has been flawed. A concept, conceived in the aftermath, of a war that was to change everything, was taken over by the self aggrandising, elite Doctor cohort, who began to manipulate the 'system' for their own ends. This was a construct, that within a few years, became a self perpetuating 'gravy train' for senior Doctors, Surgeons, and Consultants who had a foot in both the Public and Private camps. Manipulating the system, to enhance their income by 'cherry picking' the patients who could pay. Government stood by without demur, simply to keep them 'on side'. Thatcher ended some of that, probably, with an even worse system, that typified the excesses of the USA, where the concept of 'invoicing' everyone, for well, everything, was born. Another 'top down' re-organisation'  conceived in an era, that was to provide a legacy for the future, we have yet to shed; Neo-Thatcherism.

Blair et al, pursued this ideal, with PFI, PPI, Darzi and all the rest of the 'slieght of hand' that attempted to hoodwink, the populace, that 'World Class Commissioning' was the legacy we were to enjoy, by gist of the huge additional funding deployed, to bring the NHS to a 21st century health care standard. De-regulation, privatisation and draconian social policy, was continued with renewed vigour.  Like many before him, he bought off the GP's with new contracts, that they could only have dreamed of. The private sector boomed and management blossomed, together with the 'new era' of measuring everything, except care. NICE was born, the Quality Outcome Framework, was born, and we became gripped by surrogacy in our designs for measuring outcomes, instead of preventing disease or death. We believed the rhetoric peddled by 'Big Pharma', spurred on by that benign presence, in many of our lives, since childhood, our GP, who also bought into this, or retired (many did).

But what a betrayal! That same GP was being paid, quite considerable sums, to achieve these dubious, and often unrelated goals of lower LDL, increased HDL, lower BP, lower fasting plasma glucose, all founded in a flawed, even 'barmy' concept, with little or no scientific evidence to back it's goals. My masked hero has complained about this himself, here and here.

The public bestow, far too much benevolence, on those employed in Healthcare generally, and 'the hard pressed GP' in particular. Yet we are treated, with these appalling protocols, that are costing the earth, to no real effect, except of course the lovely money that accrues to GP's practise, and 'Big Pharma'. This is where real and meaningful cuts, should be made. And I do believe that QOF,s, ISTC contracts,  and PFI's that are eating up the NHS budgets to a far distant horizon, and 'rubbish', protocols that do nothing to advance the health of the Nation, is a folly we will live to regret, and will bring us closer to the 'NHS' plc of nightmare proportion.