Wednesday, 20 June 2007

Tory NHS Reform: British Leyland, meet your next patient...

The Conservatives have announced their plans for the NHS.

Instead of moving towards a government regulated but independent, pluralistic, self-tuning (via said pluralism) and responsive (same) health service which I have outlined we will still have a monolithic entity. This looks similar to the BMA view which I briefly commented on earlier.

Power will still not be devolved into the hands of those who PAY for the service, so it will always be dysfunctional. The cart is before the horse. If you give power to Doctors and other professionals it is at least better than now and to an extent welcome insofar as it gives respect and trust to those who know more than faceless bureaucrats. However, the objective of that power is to meet the healthcare needs of patients. Therefore you will see the power exercised indirectly and via a prism. It will also be exercised without the benefit of hundreds of thousands of small, subtle corrective hints that individual patient choice will give. Choice here should not be the false choice of "you can choose between four pre-selected and equally overloaded hospitals". The choice should be to the extent of "I am changing health insurance provider because they are too expensive" or that "I will go to any hospital but X, because I hear bad things about it". Such choice will either trigger improvements or result in the closing of dysfunctional parts. Shape up or ship out.

The Conservative reforms do no appear to move forward in this respect. If anything, they run the risk of putting another unaccountable entity in the rather too long a loop.

UPDATE: Phil A (in comments) has found this article on Bromley's woes. I suggest you read it. A key point in that article is the following:
The outcome is that hospitals that are cheaper to run will face cuts, while patients will be crammed into the more expensive PFI hospitals in an attempt to make them profitable.
This is most worrying and to me looks almost criminal - the PCT is forced to use the worst option due to the contract terms imposed by the slimey toe-rags PFI contractor. People need to be fired.

In such a case and under Roger's reforms, if the PCT cannot unhook the Hospital it would need to remain with that Hospital, tied to it like an albatross, and all other Hospitals would be moved to a new PCT in the interim. As outlined in the plan, the Hospital/PFI operator would need to reform itself or see the runt PCT implode. Such implosions would be contained within the runt PCT and not affect healthcare for the population using the main PCT. Roger would like to see those responsible made life Directors of the runt PCT and so any such fall-out would splatter them. That is not possible, but worth a jolly good try.

UPDATE2: Earlier I said people need to be fired. Upon reflection I was wrong. People need to be fired, re-hired and fired again just as they take out their little pencil case and packed lunch (containing a Viscount biscuit, I suspect). Each time they will not pass "Go", nor collect a redundancy package.


Phil A said...

'They' can’t afford to close Hospitals built, or rebuilt, under Private Finance Initiatives (PFI).

Although many are are so expensive to run they are more-or-less permanently in the red they can’t be closed, as the debts would still have to be paid, even if they were - and a hospital that is closed that you still have to pay for is even less use than these ones are open.

The debts would have to be paid even if the NHS were abolished.

Two PFI hospitals, Bromley Hospitals NHS Trust, and Queen Elizabeth Hospital, Woolwich in SE London, are technically bankrupt, with no prospect of repaying it!

They can’t be closed, so cuts are more likely at Queen Mary’s, Sidcup, also in debt but not sinking.

Roger Thornhill said...

Phil A, you are a star, thanks for finding that.