15 August 2009

The NHS Debate

The debate about Dan Hannan's comments on the NHS are interesting; albeit, the Government reaction comes from a blinkered Socialist view about where we are.

Firstly, we should be proud of what has been accomplished with the NHS, but we should also recognise that universal health care is not unique to Britain. We ignore other models at our peril.

It is right that we continue to maintain our commitment to the principle of free health care, but we should also be examining what is going on elsewhere and learn and develop where we are.

There are some ludicrous anomalies in our system. I have kidney disease, and take blood pressure tablets as a precaution - it is essential that I do so - because high blood pressure and kidney disease don't mix. I have to pay for my prescriptions, yet diabetics get theirs free. Asthmatics also have to pay for prescriptions. I don't begrudge diabetics free prescriptions, but these issues need to be examined and corrected.

I am pleased the Conservatives have pledged to maintain spending on the NHS. It is our most essential service - health is everything. But we need to invest more in prevention to reduce reactive costs. We must also recognise that, like all Whitehall driven Government, it is massively over bureaucratic and that it is essential to streamline administration so that we can increase the proportion of money spent on the front line.

For this reason it is critical that we don't just bury ourselves in a debate that suggests the NHS as it stands is the only way. We must examine what is going on elsewhere and learn, whilst robustly maintaining the principle of universal health care free at the point of delivery.


03 January 2009

The NHS and Spin

There are two stories about the NHS in the news today. The first is in the Telegraph, that the Government has used made decisions on reforms to tobacco and alcohol law by using data from the anti-tobacco and alcohol bodies that it funds, claiming their consultations are an 'overwhelming' voice of public opinion. We do need to do more to reduce levels of smoking and to educate more about alcohol - but when people resort to these sort of tactics it simply undermines confidence in the underlying reason for changes.

The second story is that the Government are paying some agency staff at rates equivalent to over £1/4m a year. I don't know the detail in this, and I also know how difficult it is to eliminate agency staff where there are recruitment problems, but it does seem to suggest that the "bank" system that was supposedly introduced in hte NHS isn't working. This morning I heard someone suggest that the reason it wasn't working was because they were unable to use the same budget they pay agency staff from to pay overtime for people who had subscribed to their banking system. If that is the case it is ludicrous.

It really does disturb me that, of all the public services, it is the NHS that seems the most politicised, the most open to use spin and the service whose senior management is most subscribed to the worst practices of the National Government. These two examples add to the substantial case for more localism in the way the NHS is run.


17 February 2008

Why Big Brother Government Doesn't Work

There are two stories doing the round at the moment that show why the sort of Big Brother Government which Gordon Brown loves just doesn't work.

The first is the story that the latest New Labour whim is a move towards Super-Surgeries to replace single GPs. In Whittlesey we have two similar surgeries and they work well. But then we are in a Town where, for the most, people don't have to go far. Any system that moves towards bigger solutions has to take transport and access into account. But you can guarantee that this Government (who simply don't do rural) will stagger on blindly.

The other story is that the Government are going to ease back on police targets so they can focus on violent crime. I don't have a problem (in the right sort of places) with focusing on violence, but the reason to cut back on targets is so that the police can focus on priorities that are right for local communities rather than to suit Jacqui Smith's desire for a positive Home Office story. The police need to be freed up to deal with whatever they need to, not just to kowtow to a New Labour agenda. My fear is that those smaller towns which are blighted by low level crime and Anti-Social-Behaviour will now have police officers withdrawn to work in the cities to deal with the latest whim.

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18 October 2007

The Government punishes good behaviour

Today’s report from the Healthcare Commission is quite damning; 25% of trusts are failing to meet standards for infection control. Link this with the report on Maidstone and Tunbridge NHS Trust which highlighted that Central Government targets were a factor in the appalling c-deficile infections and deaths. The NHS has failed to deliver on Government promises on access to dentistry and many trusts continue to overspend. Alastair Darling rewarded the failing NHS with a 4% increase in funding.

Local Authorities are not perfect, but they are the only area of the Public Sector that has delivered on the Government’s efficiency agenda and, overall, have shown huge improvements, despite being massively hampered by the Government’s target-setting agenda which has severely limited the ability to deliver to a local agenda. Alastair Darling gave Local Government a 1% increase in funding.

We need to recognise the impact of this. The limits on what Local Authorities can deliver in many areas of Education and Adult Social Care have knock-on effects on the rest of the Public Sector and guarantee additional burdens in future years.

There can be only one reason for Alastair Darling’s decision, and that is because local Government can raise additional taxes. Local Government are, once gain, being asked to do Government’s dirty work and raise Council Tax above inflation.

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04 October 2007

Kidney Transplants - the real NHS story from today

There is a bit of a furore today about an interim NHS report appearing early, apparently as a piece of electioneering. To be honest it's a bit par for the course from New Labour and the best thing we can do is ignore it.

The real NHS story today is this one about two couples who have swapped kidneys. I have kidney disease (IgA Nephropathy), but have been very lucky in that it causes me little or no problems - but it does give me an interest in the issue. I admire anyone who chooses to donate a kidney as a live donor. It is a painful process, in fact it is more painful to donate a kidney than receive one. (When you receive a kidney they don't remove your old ones - just fit the new one in). The two donors in this arrangement should be congratulated.

There is a real lack of donor organs in Britain and we need new ways of making them available. This scheme is a great start.

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22 September 2007

Agreeing with the Lib Dems

I have to apologise because I find myself agreeing with the Lib Dems. This time it is Cambridge MP David Howarth who has called for the scrapping of Strategic Health Authorities (apparently the 8 Board Members of the Eastern Region SHA Cost the taxpayer over £900k).

He is absolutely right. During my time doing Health Scrutiny at the County Council we questioned the SHA a number of times and failed to work out what their job is - apart from taking money in from the Government and dishing it out - Government could easily just cut out the middle man and distribute the cash itself.

Come the blue revolution the SHAs and the Transport Commissioners should be the first against the wall.


20 August 2007

It's official - the Government don't understand efficiency

In response to David Cameron's comments today that he will fight Labour over the NHS and for the need to make tax cuts sustainable, Dawn Primarolo the Shadow Health Minister has accused David Cameron of being "simply dishonest" for pledging tax cuts whilst saying they will not cut services.

Actually, the truth is that tax cuts can be made through making the Public Sector more efficient, and it has got massively less efficient over the last 10 years. In fact local Government is the only sector that has responded to the Government's own failed efficiency agenda. This remark probably explains why.

Delivering better service at less cost is an option. So either Dawn Primarolo doesn't understand efficiency or she herself is being "simply dishonest". It would be nice to know which.

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15 June 2007

NHS Budget - The Truth

I said here that I didn't believe the information that we were being told about hte NHS balancing its budget. I was right, it was a fiddle.

Apparently Ms Hewitt kindly withheld about £2b worth of funding from NHS Trusts at the beginning of the last FY, this was money that was supposed to fund growth and training. This money was then thrown back into the sums for the NHS at the end of the year to show they were balanced. In truth it seems our PCTs were overspent by about £900m.

The worst part of this is, whilst hospitals were fighting off closure, nurses were being made redundant and NHS staff were being left untrained, Patricia Hewitt held on to £2b just so she could look good at the end of the year.

Aside from lying to send troops to their death, this is arguably the worst bit of Government deceit ever. I wonder how many people died as a result of this?

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06 June 2007

NHS Balances Budget

Apparently the NHS has returned a surplus of £50m for the year.

Quite frankly, I don't believe it, I suspect there is more to this than we are seeing. I hope I'm wrong, time will probably tell.


30 April 2007

Blair is partially right on the NHS

Blair is right to say that there have been improvements in the NHS since 1997. In particular, the reduction in waiting times is an achievement. However, he fails to properly acknowledge the significant failures which include; the poor service that patients with illnesses where there is no waiting time target receive; or the manipulation of waiting times through changes to the point when a Consultants appointment is made. But by far the most significant change has been a downturn in care for patients. The obsession with getting patients in and out of hospital as quickly as possible is not good.

The list of failures could go on and on; the horrendous cost of basic telephone and television services for patients; massive rises in MRSA; and awful mental health provision.

Basically there have been improvements, but there have been even bigger failures and the NHS offers lower value for money than at any time in its history. That should be part of the New Labour legacy.


19 April 2007

Consultants Pay - A mistake that cannot be undone

I have just been reading the article on Epolitix about the NHS consultants pay debacle which has
"resulted in a 25 per cent increase in salaries but less actual work than under the old system".

What a mess. The problem with this sort of error is that it cannot be wound back - so this will cost the taxpayer and the NHS year after year after year.


04 April 2007

The Great Patientline Rip-off

Never really had any involvement with Patientline, but watching the news about it this morning I was absolutely astonished. This is another stealth tax and nothing short of an absolute scandal.

  • Cost for anyone calling a patient - 49p a minute peak rate (but it's OK - only 39p per minute off-peak)
  • Cost for dialling out rising from 10p a minute to 26p a minute
  • Cost of Internet/TV access reducing from £3.50 to £2.90 a day

Patientline's excuse for this is that they haven't made any profit from their massive investment so far. That is no justification, they should have got their business case right; it is wrong for them to use their monopoly status to rip-off vulnerable people because their accountants can't add up.

What Patientline run is a series of simple Wide-Area Networks with Voice Over IP. It's nothing too complicated. They should be revisiting their business, slashing overheads and cutting out waste, not ripping off vulnerable people.

I hope the Conservatives pledge to sort this out, because this is a disgrace.

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18 March 2007

David Cameron - Fantastic Speech

Everything he said today about the NHS was abslutely spot on. I know I'm biased, but every time I look at the NHS I see an organisation that is full of bureaucracy and waste.

The perfect example is overspending. Despite the masses and masses of additional bureaucrats, those Trusts that are overspending just keep increasing their forecast overspend. Masses of extra bureaucrats and they still can't count.


19 February 2007

8 Week operations - who's paying

If Blair can pull off this task of cutting operation waiting times down to 8 weeks, I will take my hat off to him. But he has missed the point. No-one, I don't think, is claiming that there haven't been improvements in the NHS over the past 10 years.

The argument is (largely but not entirely) that those improvements have come at far too high a cost and that the disproportionate rise in bureaucracy in the NHS has eaten up money that should have also been used to improve patient care. I would also add that bureaucracy is now juggling with numbers to justify reductions in patient care services.

His pledge yesterday was a perfect example. Currently the NHS has no idea how it is going to manage its overspends, nor any idea how much that overspend is going to be. That failure means no-one can possibly have a clue how that pledge to reduce waiting times can be afforded. Gordon Brown has made it plain that significant funding increases are no longer an option.


08 February 2007

£52m and Counting

Cambridgeshire PCT is now forecasting a £52M overspend in FY 2006/2007. A month ago the forecast was £32m, a month before that £17m.

I repeat what I said a short while ago. With all the extra bureaucrats in the NHS, why is it that no-one can count?

The PCT are claiming they can recover, how can anyone have any confidence in that, when all the evidence is that they can't even mange overspending in-year.


17 January 2007

NHS In Crisis

In my short career as a Councillor I have never had such a depressing meeting as the one I went to yesterday - the Health Scrutiny Committee at the County Council. Everywhere you turn at the moment there are NHS Trusts overspending and cutting services to save money. Yet, despite all the money spent on bureaucracy nobody seems to be able to predict how much overspends will be; the figures just grow.

I don't blame anyone locally to me, the fact that this situation exists across the County means that it has to be down to New Labour. Rather than admit they've messed it up I have no doubt that Patricia Hewitt will stand up and tell us how much money they've thrown at the problem. Using taxpayers monney to pay for bureaucrats doesn't solve problems.


04 January 2007

SpinBlog solves the NHS Crisis

I notice that the leaked memo suggesting future shortages of Nurses in the NHS makes no mention of a potential shortage in bureaucrats?

I used to work for the MoD (before my conscience got the better of me). I remember, in the aftermath surrounding the end of the Cold War, the Department went through an exercise called "Options for Change" which looked forward to meeting future Defence challenges whilst recognising that the numbers of Servicemen were no longer sustainable. Part of that process was a call to all staff to identify possible areas where cuts could be made without impacting on the Front Line. The phrase "No Sacred Cows" was used as part of the message, which meant (in theory) everything was up for consideration and indeed some previous no go areas were seriously considered, such as the future of the Red Arrows.

I believe something similar to this is needed in the NHS, but using a programme headed by a very senior clinician instead of a self-serving bureaucrat. Only an experienced doctor could really understand whether a funding cut would effect front line services. Inviting anonymous comment from all staff members using modern technology might actually identify some significant areas of waste and could also serve to make staff feel part of the Health Service instead of just as mere minions in a massive bureaucratic machine.