Patients first..

According to PoliticalScrapbook.net even cabinet secretary Sir Jeremy Heywood - David Cameron's most senior civil servant - now wants him to scrap the Health Bill. And his reason? This new top-down reorganisation will take away whitehall's (top down) control of the health service. Yep, that's right. The biggest vested interest of them all - the civil service - wants the bill scrapped because it takes away their powers to control the health service and puts it into the hands of those the health service is supposed to serve - patients. You could not make this stuff up. People simply wouldn't believe you.

Patients First...

Writing in the New Statesman blog, Rafael Behr admits the real truth surrounding Labour's unprincipled opposition to the Coalition's NHS reforms in one sentence - Another way of putting this might be that market forces are tolerable when Labour allows them to operate in a carefully controlled environment, but destructive and corrosive when unleashed by Tories and Lib Dems. That sentence sums up the opposition. Its not about patients. Its not even about policy. Just visceral hatred of anything proposed by the Conservatives. But the real shame - and no doubt Ed Miliband calculates these things to carefully advantage his union paymasters - is that once again, Labour is on the side of vested interests, against the interests of patients for whom the health service should be run.

I can understand why professional trade unions like the BMA and the royal colleges will always resist change believing, quite wrongly, that they alone know how a health service should be run. They fought every reform through Blair's New Labour years, as well as the original creation of the NHS back in 1947.

But a political party which claims to represent the people? Surely not. Labour is now the only major party clinging desperately to the past. Preferring instead to support the bureaucratic processes and vested interests who want no reform. It is deeply shameful of Ed Miliband - the most left wing leader since Michael Foot - to deny ordinary people a National Health Service driven by patients - their needs, their choices, their health.



 

Patients first...

Imagine how our banking system would look if it were run for the customer. Modernist glass and beach wood waiting rooms fitted with plush, comfortable chairs before your Relationship Manager ushers you in to a private room for a consultation where their undivided attention addresses your financial health.

But rather than being paid for selling you more and expensive products, the opposite is true. After several years of in-depth training on the full range of financial products, they have a professional duty to ensure that any advice they give is demonstrably in the interests of the customer. Not the bank. A world where complaints are taken so seriously, that a Relationship Manager could be struck off by their professional body and serious fines imposed on the bank if incompetent practise were found.

Furthermore, that Manager is responsible for reappraising and reviewing any financial commitments at every stage of your life. Indeed, were any new commitment required - a smaller mortgage for instance - your Manager would not only explain and gain your consent, they would negotiate the terms with the lender, set up the contract and once up and running, review the commitment at regular intervals, mindful that better deals may well be switched into at any time. Wouldn't that be wonderful?

Well that is exactly what the Coalition's Health and Social Care bill is all about. Putting the patient first. And just like the scene above, when GPs are given commissioning powers, they'll manage the care of their patients, knowing exactly what is best for them, right through to a successful outcome and beyond. How terrifying is that?

Alice Miles on NHS reforms - Go to Cumbria

Rejected by the BMA, the Royal College of Nursing, Royal College of Surgeons, physiotherapists, unions, health charities such as DiabetesUK and the British Heart Foundation, not to mention Shirley Williams and the patients themselves writes Alice Thomson in today's Times(£) about the Coalition's proposed NHS reforms. A pretty convincing 'no' you might think. Not quite. Go to Cumbria she urges.

Mr Lansley has been unable to express his plans clearly but in Cumbria they are already working. GPs have control of budgets, they have virtually abolished primary care trusts and, crucially, patients receive better service.

The reforms in Cumbria came about because of a huge funding crisis several years ago when the local primary care trust ended up £37 million in the red. It planned to close all nine of Cumbria's community hospitals to make up the deficit. But then a woman named Sue Page was appointed as Chief Executive and she decided on a new approach - allowing doctors to get involved in decision-making so that they could keep patients out of the two main hospitals and save money.

Putting GPs in charge of a patient's progress allowed more treatment at home and less in expensive hospital beds. Slowly GPs took charge of the local hospitals and finances and by next month they will manage 97 per cent of the £800 million primary care budget. Since they took over there hasn't been one case of drug-resistant clostridium difficile in the nine community hospitals and the average stay has dropped from 36 days to 10.

One GP, Peter Weaving, says: "Its gold standard service on your doorstep, cheaper and better." He is convinced that when his colleagues see the benefits, they will understand the changes.

The first really convincing piece I have read about the Coalition's NHS reforms.

GP commissioning reforms were always at the heart of the Coalition

Huge criticism this week of the Coalition's plans for GP commissioning, principally on the grounds that there is no mandate for such reform because it was never mentioned during the election campaign. This is quite wrong.

Caroline Spelman told the BBC Question Time audience on Thursday that page 46 of the Conservative manifesto outlines the plans and I'm greatful to @sjbaker for his tweet this morning pointing out that the Conservative Draft Health Manifesto published just over a year ago on Jan 18 2010 also says the party will give GP's the power to hold patients' budgets and commission care on their behalf. Seems pretty straight forward to me. It adds incidentally, that they will also link GP's pay to the quality of the results they deliver something we have not yet heard much about...

Well I think it's a nice idea says Polly Toynbee in this weeks Politics Weekly podcast from the Guardian. Surprisingly, she really is talking about GP commissioning of healthcare as proposed by the Coalition and continues in some ways (it is) quite rational that GP's should control the budget because GP's - these are the ones who really spend it - if so in the end their decision to refer someone to X or Y , if someone really needs this treatment, decides what the NHS spends, so it does make some sense. So why so much opposition to the reform? Because its from the Coalition of course. Pure tribalism as usual. 

It is right at the heart of this Coalition government that the people's interest should be put before those of vested interests - the producers. In every area of policy and under various different titles - big society, free schools, bottom-up politics, voting reform, localism - the people are being put first.

Increasingly Labour are finding themselves on the wrong side of this argument defending the producer interest in each case. As Janet Daly points out in a well argued article for today's Telegraph entitled Reform must be rushed, or it won't happen at all, the argument we weren't given enough warning really means we need time to organise obstruction to anything that interferes with our habitual ways of doing things. How very Labour. 

NHS v US Healthcare

So it seems that Michael Jackson's private physician would prescribe anything he wanted, so long as he paid the exorbitant fees - reported to be $100,000 per month. Can't really see that happening on the NHS. Probably something to do with medical ethics:

"I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism." (from The Hippocratic Oath)

If Michael Jackson had believed in an ethically-based healthcare system uninfluenced by money at the point of delivery, he would still be alive today.

NHS

My family has enthusiastically supported and used the NHS all our lives. We do not share Daniel Hannan’s views of the service, nor his advocacy for individual health accounts. Clinical need - not wealth - should be the determinant of healthcare. But however well intentioned, the NHS also has a darker side.

My grandmother - once a nurse in a TB hospital in Portsmouth during the 1930’s – died after a long and full life. Apart from the usual aches and pains of growing old, she had rarely been ill before suffering a stroke at the age of 97. I still remember that terrible moment when I first saw her as the GP - attempting to gauge some form of cognitive ability - asked her how many fingers he was showing, as if she were a three year old child. But mostly I remember the look on her face. A face that I had grown up with and loved, a face that had shared so many precious moments, now staring at me without recognition - vacant and distorted - as if someone had drained all emotion and warmth from her cheeks.

Rushed to Hospital, I was amazed at the quality of the care she received. St Peter’s, Chertsey, is a bright new hospital designed intelligently into a series of 10 – 12 bed wards off comfortably sofa’d corridors which soothed both patients and visitors. The ward bristled with specialist stroke equipment around each bed and bustled with serious, green-scrubbed clinical staff. This was modern medicine at its most impressive; spotless, high-tech and concentrated.

The stroke turned out to be minor and within two days she was able to get out of bed. That evening I had my last lucid conversation with her as she sat on a chair beside her bed talking comfortably about returning home.

Two days later, we heard she had been transferred to a general ward at Ashford Hospital - within the same NHS trust – and visited with relaxed expectations. I have never seen such a transformation. Listlessly fidgeting in and out of consciousness, she had been dressed in a tight-fitting, all-in romper suit because she was continually pushing back her bedclothes. High-sides had been attached to the bed in an effort to stop her desperately trying to get out. This was a seriously ill woman. When I visited the next day, she had been moved to a side room on her own. The ward sister explained that all visitors would have to wear gowns, gloves and masks. She had MRSA.

She lasted two more days. I knew she would. She died at a quarter past midnight on the morning of my birthday. I had spent two hours that evening sitting beside her, masked and gloved, unable to even kiss her. And just for the record, MRSA was not listed on her death certificate.