Tue, 25 Jan 2011
Guest Post - NHS facts
This article is not written by me, but is a guest post written by someone who asked me to post this for them as they are unable to comment publically under their own name.
Paul Burstow writes on Lib Dem Voice Some Facts about the NHS.
The greatest enemy of truth is not the lie but the myth. This could have been written with our health proposals in mind. Let me start with the myth that our plans are 'revolutionary'. The 'revolutionary' label embodies neatly what many people wrongly envisage to be untried and untested changes to the NHS. Swamped by all the myth, misunderstanding and mistruths, the facts have struggled to get heard. So let me give you a few of the facts.
Under the previous Labour Government healthcare spending increased significantly. But where Britain spent big, other countries spent better. That is why Britain has some of the worst survival rates for cervical, colorectal and breast cancers in the OECD; the highest number of deaths per 1,000 live births in Western Europe; and why around one in four cancer patients are only diagnosed when they turn up as emergencies. Satisfaction levels in the NHS have reportedly never been higher, but if that is truly the case why were there also a record number of complaints made last year?
You state that Britain under Labour spent big, but Europe spent better. However, the spending of the UK on NHS in the last decade has been below average spending of Europe. Therefore we can only expect below average performance on Healthcare.
Cutting budgets to 80% and reworking the NHS will not improve these health outcomes. I am not a public member about to be bought by Spin on 'myth' when the truth is largely in the budgeting and balance sheets.
In addition to this, public satisfaction with the NHS is higher than ever, alongside high complaint records. Waiting times are down and targets are being met. Do not quote one statistic above others to create a filter of opinion.
One 'revolutionary' charge that I am more than happy to accept is that the Secretary of State will no longer have the power to interfere in NHS organisations. Unlike the last Labour Government, we want an NHS that is free from political interference. Services should not be decided from behind a desk in Whitehall. Instead we will trust family GPs, patients and local government to decide what matters and design the services that deliver world class results.
And I applaud this. However, it does mean that the NHS organisations are no longer accountable to government.
Under Labour Primary Care Trusts (PCTs) were effectively left to stand by the supermarket till, holding the credit card, waiting to see what GPs had put in their shopping trolleys. At a time when one in every four pounds we spend is borrowed, we can't afford a go-between. That is why we are abolishing PCTs and giving GPs their spending powers; putting the credit card in the same hands as the shopping list, making sure every pound spent delivers the best for their patients.
Neither will putting Labour Squeeze in every paragraph incite me to agree to a move which is already distracting healthcare staff. The methodology in Lib Dem approach is for the people, not nodding along with Tory squeeze when the figures do not add up. Within my own trust, I have witnessed commissioners pulling service improvement groups on the basis they don't know if they have jobs so why should they consult with the public to develop care pathways if it's all being handed over to GPCs. As a result, public facing research on patient experience. PSCQC requirements and need are being obliterated before consortia are in place. Because of this white paper.
It is also important to bear in mind that GPs are not being forced to do paperwork and administration. GP commissioning consortia will be resourced, as PCTs are now, to secure the support and expertise they need to undertake the managerial and administrative functions needed to discharge their duties. Labour's campaign to save the PCT is indicative of an opposition party caught in the past defending a failed status quo. Instead of giving trust and control to GPs and patients, Labour have made it their mission to save a costly layer of management.
If GP Consortia will outsource administration and management costs (conveniently putting them in the category of commercial sensitivity and therefore outside of public scrutiny) why are you abolishing PCTs at all? Why not simply change the command structure so that PCTs are accountable to GPs on a locality basis and save jobs, health and health outcomes? By abolishing a structure, you are putting staff in line for redundancy, you are risking the health of people who the staff serve and you are creating a period where all care is delivered poorly during the transition.
While all the attention has been focused on GP consortia a big change has gone largely unnoticed: the new role for local government. That role includes democratic accountability for health, integrating health and social care services and responsibility for public health, All of this will come together in councillor led Health and Well-being Boards and Health and Well-being Strategies' These reforms will bring the NHS and local government closer together than ever before creating the opportunity to really tackle the causes of ill health not just treat its consequences.
You talk of pillars of democratic accountability. Studying the responses to the DoH white paper consultation, one has to accept that the majority of respondents do not want this transition. Therefore the very basis of the white paper is flawed in concept, before initiating that concept.
And there in lies further irony, by transferring GPC management structures to commercial environments, their role is protected by commercial sensitivity and as such, no comparable data can be analysed under FOI, therefore they cannot be held accountable by their actions. This is neither liberal or democratic.
The principles of the NHS are universal healthcare. There is nothing universal about competitive rates for consortia. The only universality in the proposals is the cutting of funding and refusal to bail GPCs out. Therefore people will be un-universally maligned where major disasters occur, or where predictions on budget forecasts are wrong. This will put more lives at risk than the current system.
On the charge of privatisation, our message is absolutely clear; we will never ask people to pay for their healthcare. We are not changing the fundamental basis on which the NHS is funded - out of general taxation. We have no ideological preference for private sector provision over the NHS - in marked contrast to the previous Government, which set a target for the number of NHS procedures it wanted to see undertaken by the private sector. In addition, the reforms we are implementing will prohibit the possibility of any preferential payments to private sector providers, and ensure that the private sector does not make any undue profits from delivering NHS services. This, again, stands in sharp contrast to the position of the previous Government, which paid the private sector substantially more than the NHS would have been paid for the same work.
You discuss avoiding the privatisation of NHS. However, privatisation is a significantly vaster issue than paying for healthcare. Providing funding to private and commercial funds to deliver NHS services is simply a transference of privatisation.
The final myth to expose is the idea that patient choice is built on a surplus of good hospitals. It isn't. It is built on choice of care and choice of treatment. Under Labour this option was denied to patients under their 'preferred provider' model, which prevented many innovative charitable providers from competing on a level playing field.
Choice in provider may indeed create competition which will drive up the levels of service. For those who can wait for the time to get into the better hospitals or access the better consultants. But this again undermines the very basis of universal healthcare. If I break a leg, I don't care where I go, just that the care I receive, wherever I am, is universal across the NHS. I see nothing in the proposals to underpin this integral value of the NHS.
One such example, which was excluded under Labour's model, is the drugs charity Addiction and their 'Breaking the Cycle' programme. Seven months of Breaking the Cycle support for one family costs £1,700. Within eight months, that is likely to have saved the state £20,000. Under our proposals to introduce an 'Any Willing Provider' model, we will ensure that all providers can compete on a fair playing field, making this kind of choice of treatment possible for all patients across the country. Compete yes, but a competition on quality and outcomes, not price.
The proposed changes announced today in the publication of the Health and Social Care Bill will lead to better quality care, more choice and improved outcomes for patients, as well as long-term financial savings for the NHS, which will be available for reinvestment to improve care. Over £5 billion will be saved by 2014/15 and then £1.7 billion every year after that- enough for over 40,000 extra nurses, 17,000 extra doctors or over 11,000 extra consultants every year.
The NHS will always be free at the point of use and fair to all who need it. By trusting patients and carers to make the best choices, we will make the NHS focus on delivering high quality. Our goal is simple: we want to free the NHS to innovate, to liberate the talent, experience and dedication of NHS staff to deliver the right care, at the right time in the right place.
Ultimately, choice negates the very basis of healthcare, the consultation process is a fait accompli yet used to underpin the proposals and there is nothing in the economic assessments to improve the health outcomes for the foreseeable future.
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