Monday, May 09, 2011

NHS Reform: getting rid of Andrew Lansley isn't the point

According to this morning's Times, one of the prices to be paid for securing the Coalition is the head of Andrew Lansley.

To be honest, that's a bit too easy for my taste. Don't get me wrong, I hold no candle for the MP for South Cambridgeshire, but he isn't the problem. The problem is the policy, in that it isn't wildly popular. That doesn't make it bad policy, ironically, because popular isn't always good - dangerous dogs, anyone? - but it does mean that revisiting the drawing board might be a very good idea indeed.

Firstly, strip out the entirely artificial deadlines. All they do is create an undue sense of urgency and make transition management a nightmare, a car crash waiting to happen. That's not only bad politics, but bad administration. Good policy is straightforward to administrate, so that you can make it happen.

Second, decide upon your criteria for a well-run NHS. Cost-efficiency, improved care standards and democratic accountability are not mutually exclusive, and a proper debate on the future of health provision might just make for better decision making. And that means not simply demanding the full ice cream sundae with whipped cream, a flake and a cherry on the top, it means a realistic assessment of what we need in the future and what we can afford.

Thirdly, the notion of private sector cherry-picking is something that some Conservatives do not, or do not want to, get. And yes, there do appear to be some in the Labour and Liberal Democrats who suffer from the same myopia. That isn't to say that there isn't a place in health provision for the private sector, but it makes people nervous. So, for example, why not allow private companies to run an NHS Region leasing all of the buildings and equipment from the State? Any savings could be split on a shared basis between provider and government, and the assets revert to us when the contract ends. Indeed, you could even allow said provider to subcontract bits of work, so as to open up opportunities to small and medium sized enterprises.

Ultimately though, the problem is less about policy than about fear and trust. On the NHS, people don't trust the Conservatives, and the fact that the changes appear to be all about one of the three key criteria - cost - excites suspicion. And it isn't the job of the Liberal Democrats to reassure people that Andrew Lansley has the best interest of the NHS and patients at heart, it's our job to test, prod and probe the policy, and to do it publicly. If it survives proper scrutiny, then fine.

And if Andrew Lansley doesn't like it, he can quit, rather than be sacked. That way he gets to retain his honour and his integrity, and we take a small step towards the new politics that people keep talking about.


Anonymous said...

i am sorry, but I disagree with your comments. Mr Lansley's Bill is NHS privatisation by the backdoor, sold to the Public under the magnimonious statement "value for Tax payer's money" !
How can it be "Value for Tax paye'r maney" when there is no extra income generated and all monies coming into the NHS is the tax payers contribution which then Companies like SERCO come into the NHS take over services, cut jobs to cut cost and pay their shareholdrers the dividedds ? where did this profit come from if not the Taxpayer! I would rather use that saving to plough it back into front line service that makes direct difference to the patient then give a penny of my tax money to a shareholder.
yours truly
A Very Disillusioned, NHS worker with first Hand knowledge and EXPERIENCE of the very situation I have mentioned.

Mark Valladares said...

Disillusioned NHS Worker,

I share your pain, working as I do in another, albeit rather less loved, part of the public sector.

However, there is a genuine question about getting value for money, as we have always rationed healthcare in this country, even if we've never admitted it. And given the costs of geriatric care, we're going to have to find ways of doing things better.

I share your view that, in all likelihood, the current policy is a step down the road towards privatisation. That's why I want to see it given some genuine scrutiny, not the ersatz brand you get in the House of Commons.

I'm not an expert in health economics, far from it, but I've visited a generic pharmaceutical plant in India, where drugs can be produced at a fraction of the cost paid by the NHS, and I've seen other ways of doing things that might improve patient care without spending excessively.

And this Bill doesn't really achieve those things, it merely risks fragmentation of the NHS.

However, if any organisation, voluntary, public or private, can offer a means of cutting costs and not standards, don't we have a duty to test it out? And will we get those ideas without some form of incentive?

So it is more complex than politicians and the media would like to believe, but we can't close our eyes to the possibilities that exist. We do have to ensure that the public feel secure in their belief in a genuine national health service though.

Mark Valladares said...
This comment has been removed by the author.
Anonymous said...

Thank you for taking my comment seriously.
I agree with you in as far as costs and ageing population, but have a great concern where making profit in healthcare - which by the way is very different from making a choice between two drugs - giving the SAME effect - except one being branded therefore more expensive whilst the other being generic — therefore cheaper.

I pose a question — if the generics per se are cheaper, why do we not produce them in this country? Or is it the case that the generics are cheaper because they are produced in a country like India (and I am very familiar with that setting )where the labour cost is cheaper therefore the price is affordable?

The main difference is that the materials we use in providing health can be sourced cheaper, but the direct patient care given should not be for profit because as soon as you introduce freedom to make money - the Company is already making changes with the view to cut cost - which includes jobs, cut corners in the tests performed, use inferior materials, etc and increase the profit which does not IMPROVE patient experience.
My experience shows that they are in process of getting rid of experienced staff - who by the way costs too much according to them and replace them with barely qualified staff - much cheaper to employ.
This is a disaster waiting to happen - just like the cytoscreener episode some years ago - where the Govt to save money decided to let untrained or less experienced staff screen and report on cervical smears. Many people got the wrong diagnosis and many a cervical cancers got missed causing unnecessary delay in treatment which sometimes ended up in death that could have been avoided by the early and right diagnosis.
Apologise for going on about it - but only the person who understands the workings of the NHS hospitals and is seeing first hand the effects of these changes can tell you how it is.

The real savings can be done by taking out the army of Managers - not directly involved in front line patient care, but are there to serve the DOH and political party with statistics to win their elections. Health is not a party political subject - it should be removed from the politics and made into a National Trust For Health. Run as a Charity organisation and then can include volunteers to do some of the jobs. If money is an issue, you can even introduce a membership fees, but not for profit, no shareholders, free health from cradle to grave without means testing. Introduce fancy private wards, but not the treatment or queue jumping, let it be frils or no frill stay give fancy food and charge for it, but let the basic provision still be free and none of it for profit for shareholders. Let teh money made from these extra icing be used by the Trust for providing better service and facilities for all patients.

Or am I living in a dreamworld?

yours truly,
A caring NHS worker