The Tory NHS: Lies, Libels and Price-fixing

6:02 pm - January 13th 2010

by Unity    

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If you were to ask David Cameron to sum up the content of the Conservative Party’s draft health manifesto in three words then I dare say he’d reply, ‘decentralisation, accountability and transparency’.

Read the manifesto for yourself, and you’ll quickly find three much better words to describe it, ‘lies, libel and price-fixing‘.

Now, admittedly, you do expect that political parties will be somewhat economical with the truth in setting out their manifestos, but by any reasonable standards, the lie contained in this manifesto’s introduction is a whopper…

We understand the pressures the NHS faces. In recognition of its special place in our society, we are committed to protecting health spending in real terms – we will not make the sick pay for Labour’s Debt Crisis. But that doesn’t mean the NHS shouldn’t change. When you’re more likely to die of cancer in Britain than most other countries in Europe

You are not more likely to die of cancer in Britain than in most other European countries as a peer reviewed study of estimated cancer incidence and mortality rates in 39 European countries, which was published in 2007 in ‘Annals of Oncology’, clearly demonstrates.

What the European Cancer Statistics actually say.

For British men, the evidence in this paper is pretty much cut and dried.

Britain has, according to this study, the 11th lowest overall cancer mortality rate in Europe (215.4 deaths per 100,000 men), slightly behind Germany, which comes in 10th (213 deaths per 100,000 men) but well ahead of The Netherlands (21st, 235.7 deaths per 100,000), Spain (23rd, 237 deaths per 100,000)  and France (26th, 247.6 deaths per 100,000 men). In regards to some of the more common cancers in men, Britain has the 9th lowest mortality rate for stomach cancer, 8th lowest rate for collorectal cancer and the 10th lowest mortality rate for lung cancer. On paper, the only common cancer in men in which the UK has fallen behind, in relation to the rest of Europe, is prostate cancer, in which we come 23rd out of 39.

However, we have to be a little bit careful here as these figures are, for most of the countries included in the study, the mortality rates were derived from national incidence rates and rather than being taken from recorded standardised mortality rates. There were also some countries included in the study for which national incidence data was not available, in which case the researchers reversed the calculation and estimated the incidence of each cancer from its recorded mortality rate.

The upshot of is that some of the data, particularly for countries in Eastern Europe, looks to be rather suspect. On paper, both Serbia and Bulgaria are ranked higher than the UK and have a lower estimated mortality rate for all cancers, despite having higher mortality rates for stomach, collorectal and lung cancers and a much lower average male life expectancy than the UK (UK = 77.1 years, Bulgaria = 69.5 years and Serbia = 71.7 years). Both beat the UK by some distance on their mortality rates for prostate cancer, as does most of Eastern Europe, the Balkans and Southern Europe (except Portugal), and what most of these countries have in common is a much lower average male life expectancy than the UK.

Prostate cancer is a disease of old age and, importantly, a disease that men die with rather than die of – around half of all men who die after the age of 50 are found, at autopsy, to have had prostate cancer but only 1 in 26 men diagnosed with prostate cancer die of that illness. As such, the UK’s seemingly poor showing in its mortality rate for prostate cancer is almost certainly a consequence of its higher average male life expectancy.

Taking this into account moves the UK up three places and ahead of Bulgaria, Serbia and Malta, which has the fourth lowest average male left expectancy in Europe (65 years), giving the UK the 8th lowest male cancer mortality rate in Europe behind Switzerland, the Scandinavian bloc (including Iceland), Belgium and Luxembourg.

For women, the picture seems, at first sight, to be rather more mixed. Overall, the UK ranks 33rd in Europe for its female cancer mortality rate, despite having the 7th lowest mortality rate for stomach and collorectal cancers and 12th lowest for cancer of the uterus. Where the UK appears to do very poorly, on paper, is its female mortality rates for breast cancer and lung cancer, where the UK rolls in 32nd and 35th respectively.

There is, however, again good cause to question the validity of the statistical evidence for Eastern Europe, particularly in regards to breast cancer where it is clearly evident, when you look at the data as a whole, that the highest incidence and mortality rates are found almost entirely in those countries that have implemented a population-based national breast cancer screening programme, including the UK ans Scandinavia. Indeed, this assumes even greater importance in this particular study, given that in the majority of cases, the stated mortality rates have been estimated from national incidence rates, which are significantly higher in countries that screen women for breast cancer simply because doctors are routinely looking for it.

It also worth noting that although UK’s female mortality rate for lung cancer is one of the highest in Europe, so to are same mortality rates for much of Scandinavia, which is generally acknowledged as having amongst the best and most comprehensive healthcare systems in the world. Sweden, for example, is ranked 32nd, Norway 33rd, Iceland 38th and Denmark comes bottom of the table at 39th. What this suggests is that the poor showing of all these countries (and the Netherlands, which lies 36th, slightly behind the UK) almost certainly stems from a combination of higher average female life expectancy, relative to Eastern Europe, the Balkans and parts of Southern Europe (Italy & Greece) and a higher incidence of smoking in women in Northern-West Europe and not from shortcomings in the NHS relative to the healthcare systems of other European countries.

If anything, lifestyle factors appear to account for far more of the differences in mortality rates for certain cancers, in women, than the performance of their national healthcare system. Mortality rates for collorectal cancer are, for example, higher in Scandinavia, Germany and part of Central Europe than they are in the UK, which may well reflect that fact that these are areas in which red meat is larger component of the traditional local diet.

The Conservative’s claim that ‘you’re more likely to die of cancer in Britain than in most other parts of Europe’ does not stand up to scrutiny at all for men, while for women the picture is considerably more complex than a simple comparison of the mortality rate for all cancers suggests, on a purely superficial reading. Indeed, one of the key reasons that the UK appears to perform less well than much of the rest of Europe appears to be a direct consequence of measures undertaken specifically to reduce the mortality rate for breast cancer but which also have the unfortunate effect of inflating our own incidence and mortality statistics by ensuring both that more cases of breast cancer are diagnosed and recorded and by helping women to live longer than their Eastern European counterparts. Long enough – in fact – to die of cancer rather than of other causes.

After promising to focus on improving survival rates for cancer, the Tory manifesto adds:

We will measure our success against those countries with the most effective systems of healthcare…

Which will be nice, if the Tories ever manage to figure out what an effective healthcare system is and how to identify it, something they’ve signally failed to achieve in relation to cancer.

The Tory Libel Magnet.

The same paragraph continues by stating that that the plan to:

enable patients to rate hospitals and doctors according to the quality of their care.

Or to put it another way.

We will facilitate the systematic defamation of doctors and other medical professionals by every single fuckwit in Britain with a vague sense of grievance and has a massively over-inflated sense of their own self-importance.

I won’t dwell overmuch on this one, largely because the reasons why this is a lousy idea, not to mention a libel magnet, have been covered in considerable detail by the esteemed Dr Crippen, although I will give this one example of the kind of issues that arise when patients are given an open public platform to air their sometimes ill-conceived and unfounded grievances:

Dr Julia Webster is one of the senior partners at the Sleaford Medical Group. She and I overlapped at medical school, though I don’t recognise her name. Julia has just been “named and shamed” by Baconshit. It seems that she was a bit “short” with a patient who wanted to be treated by a homeopathist, or some such wibble merchant. For that “offence” she is castigated on “I want great care” Has she been consulted in advance before this defamatory material was published? I think not. Has she been given the chance to put her side of the story? I think not. One patient was upset because Julia was not prepared to discuss medical wibble, ergo, Julia is not a very good doctor.

Price-fixing – A strategy for the Rasputin generation

We’ve now done lie and libel, that just leaves price-fixing, which the manifesto mentions here:

British patients should be among the first in the world to use effective treatments, but under Labour they are among the last. The current system lets Ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS. We will reform the way drug companies are paid for NHS medicines so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of their new treatments.

Remember, this is the same manifesto that claims that:

Our reform plan is based on the methods of the post-bureaucratic age – decentralisation, accountability and transparency.

…and that promises to:

scrap all of the politically-motivated process targets

…but also plans to centralise decision-making on the efficacy and cost-effectiveness of new drugs and other treatments and medical devices on a [shadow] ministerial team that currently consists of an ex-civil servant, a former district nurse, a solicitor, a journalist and a chartered surveyor.

To make things even more interesting, that ministerial ‘brains trust’ is not only going to tell doctors what treatments they can’t and can’t prescribe but also tell pharmaceutical companies exactly what they can and can’t charge for their new drugs as well – in other words, its a new system that’s designed to let Ministers off the hook by blaming pharmaceutical companies for profiteering if they won’t supply the NHS on the cheap.

The Tories don’t seem to have thought this through properly.

Yes, there is no express reason why they couldn’t legislate to fix the price of new drugs but what they can’t do, without nationalising a bunch very large multi-national pharmaceutical companies, is compel those companies to supply the NHS at the price set by the government.

Most of high-profile disputes that NICE have been embroiled in the last couple of years have related to the latest generation of drug treatments for advanced-stage metastatic cancers and dementias, drugs for which there is very small market in the UK but which attract a very hefty premium because they extend the life of a terminally ill patient, or delay the onset of dementia, by a few months and, importantly, because people facing up those situations don’t, typically, make entirely rational decisions about their treatment options. The reason these decisions are controversial is because they involve putting a price on someone’s life in circumstances in which, for most people, money is no object and they would willingly pay anything for those extra few months.

Not only does a price-fixing policy not provide any guarantee whatsoever that British patients will be amongst the first in the world to use effective treatments – if Big Pharma doesn’t like the price, it doesn’t have to sell – but it puts Ministers right into the middle of the processes of putting a price on people’s lives – it’s the ultimate political hospital pass and poison chalice all rolled into one. Although most political careers ultimately end in failure, any Minister who willingly takes this idea on board is looking squarely at their career ending like Mussolini or Rasputin, such is the price of making a bad judgment call and fighting the wrong corner on this one.

If the Tories really are serious about implementing this policy then I’d also suggest that they quickly sign up Anjem Choudary, fast-track him into a nice safe seat and hand him the Health portfolio as he’s just about the only person in Britain, at the moment, who doesn’t seem to mind that everybody hates him.

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About the author
'Unity' is a regular contributor to Liberal Conspiracy. He also blogs at Ministry of Truth.
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Reader comments

As an NHS worker, A Tory government is a scary prospect.

2. Luis Enrique

good stuff Unity ….

[I presume you’d agree that many left wing thinkers might also advocate price setting in the drugs market?]


Your analysis of the paper is all very well, but perhaps attention being drawn to this quote would have been appropriate:

“In the UK, historical incidence data were available for the
populations of England and Scotland. The predicted rates for
England and Scotland combined were then applied to the
UK population.” (p. 582).

So whilst other countries figures were in need of reranking, they were at least contemporary. UK figures were based on predictions, and I have no idea of their accuracy on that basis.

I can’t comment on the whole thing as I haven’t read the draft manifesto – no link to it doesn’t encourage readers to confirm your opinions though.

Conservatives hate the NHS. Always have done and always will do. They voted against it’s setting up and they hate the idea of poor people getting made well and not having to pay for their treatment.

But what they really hate is that the public like it, and that pisses them off more than anything. Because they then have to pretend that they like it too.

Unity, you make sound points.

But this essay – and that’s what it is – is five times longer than it needed to be. Seriously man, sone self-editing really wouldn’t go amiss.

Unity – I think this is a very valiant effort, but I don’t think you quite meet the salient point. This is that you are more likely to die of illnesses amenable to healthcare in the UK than elsewhere in Europe. This from another peer reviewed study:

You have caught Cameron out but really only on a technicality. He should have said you are more likely to die of cancer in the UK, ONCE you have been diagnosed with it. But surely if we are looking at the effectiveness of a healthcare system, that is what we should be zeroing in on, not these other figures which can’t take out the effects of lifestyle. Sure Cameron is hyping up the problem, but it isn’t libellous to say one exists.

No, it’s long because it needs to be.

Those, like me, who concentrate & read all the way through do so because we know it is a worthwhile thing to do.

*I* am more likely to die of cancer in Britain than in most other countries in Europe.

But then, I only occasionally go to them, and if I discovered I had cancer, I would come home.

@Paul Sagar maybe you should rewrite Unity’s posts for use as flyers.

I like the verbosity it means when I write something long, as I’ve just published, I can compare myself to another blogger like Unity, rather than being just another windbag.

The trouble with manifesto promises is there’s a presumption they’re part propaganda so only have to approximate the truth. Or at least they are expected to be beefed out by politicians.

There’s also a focus on sounding good, like theirs unworkable nonsense on reviewing hospitals and doctors.

@James Crowley Its not just those in the healthcare workers who worry about a Tory Govt.

10. the a&e charge nurse

[6] the data you are quoting seems to relate to 2002-3.

We can see a significant improvement in the NHS’s performance compared to 5 years earlier (97-98).

Perhaps the NHS has continued to climb the table if we look at amenable mortality during the last 5 years?

Do you have a link to more recent figures?

Well that study was Feb 2008 and I imagine it takes a while to crunch the new figures. But far be it for me to deny that Blair’s moderate moves towards internal NHS markets combined with a load of extra cash didn’t put a dent in our outcomes.

You should also bare in mind that our improvements have taken place in the context of systematic improvements in healthcare outcomes across the world which, partly because of our low starting point, are emphasised in our own improvements. Essentially, all poorly performing healthcare system improve faster than the better healthcare systems when new innovations creep in. Apart from the US, which as everyone should admit, is more than a bit shit and has been getting worse over the years.

12. David Bouvier

As Nick points out you are putting a construction on manifesto words that is probably not that intended of it. I think they are saying that the survival rates n years after diagnosis in the UK are inferior to comparable countries, which my recollection is that this is correct. Overall cancer rates are basically an indicator of what proportion of the population is elderly.

You may not like the idea of providing scope for rating of doctors by patients, but that does not make the idea illegitimate. There are some doctors out there whose behaviour leaves a lot to be desired. There may be issues to address, but instead I take it that you believe we should be grateful for whatever healthcare we get, delivered in whatever manner the doctor feels like.

Again if you understand the context of e.g. outcomes based payment for Aricept, the issues of NICE decisions not being implemented because of budget issues, and hte pretence that drug availability is not about the health budget, then suggesting some kind of therapeutic value based pricing at a level that makes the UK an early launch country is not unreasonable. But again you seem to rely on an over-simplistic interpretation of manifesto text. I have planned the launch of cancer drugs across Europe for biotech companies and can tell you that NICEs history of restricting effective cancer drugs means that people have second thoughts on bothering to launch early in the UK.

Is this seriously intended as analysis, or is it supposed to be a crowd pleasing polemic?

It’s just possible that the draft manifesto has a good idea. I’m not sure what is meant by the statement that “we will reform the way drug companies are paid for NHS medicines … with drug providers paid according to the value of their new treatments”.

The current system, in which drug development costs are recovered by charging a price per dose, means that new drugs have to be rationed, even though the marginal cost of it production is very low. To understand why this isn’t a good idea, imagine a word processing software package in which the costs of software development were recovered by charging users a price per word typed.

As Dean Baker has pointed out, it would be more efficient for governments to buy up the patent rights of new drugs so that they could be manufactured and sold at marginal cost. There are various ways to achieve this, but the general principle is to pay for drug development up front, rather than per dose.

14. Alisdair Cameron

The Tories will simply finish the job that New Labour have done dismantling the NHS (FTs are a precursor to ‘competition’ future sell-offs as they are placed on a ‘level playing field’ with the private sector). The libel magnet notion is already here, flagged up by successive Newlab health ministers (Burnham continuing with it, and the risible notion of a TripAdvisor for doctors).Sure some will say, ooh, look at the shiny new hospitals: bollocks, CABE amongst others have condemned the PFI builds for being shoddy, substandard and outrageously overpriced. More staff, better paid, perhaps, but that means little when morale is rock bottom, you are de-skilled, micro-managed and constantly reconfigured.It’s the strangulating top-down managerialism, with a new initiative every 4 hours from fuckwits in the dept of health, all Newlab technocrat cronies, none of whom operate at the sharp end.Add in the bleeding likes of McKinseys who alone have taken well over a billion pounds (yup, a billion) out of the NHS in fees on NewLab’s watch (eg Salaries of NHS medical consultants (2005-06) – £340m
Salaries of NHS management consultants (2005-06) – £325m).
Read some Allyson Pollock to see just how privatised, marketised and fucked up the NHS has become under Blair and Brown. Let’s not kid ourselves the NHS is safe in the hands of either shower of neo-liberal shits.


The construction I placed on the manifesto statement is, quite deliberately, the construction that an average voter would place on it, i.e. it would be taken at face value.

The debate surrounding survival rates is even more complex than the one surrounding mortality rates because, as I’m sure you’re perfectly well aware, n year survival rates can easily, like incidence rates, be skewed by age at diagnosis, staging and the use of mass screening.

As I noted, mortality rates for breast cancer do not show the expected correlation with average life expectancy that is evident in other common cancers, precisely because the data is skewed by the use of mass screening.

Yes, there are doctors whose conduct leave much to be desired and who do need to be called to account. I’ve got no problem with that, but I do have a problem with with the idea of using the internet as public pillory. Let’s not forget, that a doctor who gets slagged off by a patient on such a website has very little scope for defending themselves because, more often that not, to respond publicly to such criticism would require them to breach patient confidentiality.

I’m all for taking bad doctors to task, but lets at least do it using a fair and just mechanism.

As for NICE, I’ve read a number of the more controversial reviews, including Sutent and Nexavar, and by far the biggest issue that seems to crop up is the lack of comparative studies with the current best available treatment.

The major problem, as I see it, has been in part that NICE has not always been clear about its requirement, but also that the standard research practices of most pharma companies are, understandably, geared towards the much larger US market, where the key requirements are those of establishing safety and effectiveness over and above placebo/palliative care.

Most drug companies don’t run comparative studies against current best treatment because that’s not required in their biggest markets – its left to doctors to read the studies and make their own judgements about whether to the benefits are sufficient to justify the cost.

The lack of that type of study both delays the review process and leads to disputes over the correct method of calculating cost per QALY, which is the critical metric in most high-end reviews.

Again, however, the interpretation of the manifesto statement I’ve taken is only the face value one that most voters would take, one that would assume that the government could exert a far greater degree of control over pricing and supply than would, in reality, be the case.

One I should perhaps add is that something I think would bear consideration that might help biotech companies would be variable length patents – it seems reasonable, for example, to allow biotech companies more time to recoup the development costs on treatments for long-term progressive illnesses, where the lead time is proving efficacy extends beyond the normal timescales for clinical trials.

It’s just possible that the draft manifesto has a good idea. I’m not sure what is meant by the statement that “we will reform the way drug companies are paid for NHS medicines … with drug providers paid according to the value of their new treatments”.

You may well be right.

One of the novel features of this election will be that manifestos will come under far more detailed scrutiny than ever before. If bloggers are good for one thing then its fisking stuff that looks iffy. In that sense, releasing drafts is not a bad idea, not just in terms of soliciting support but also because anything that looks off or doesn’t stack up will get a kicking long before the final version sees the light of day and can be fixed in the meantime without taking too much damage.

Except, of course, that bloggers also have long memories, so any major changes between the draft and final version had better be backed up with a good argument or they’ll get nailed for making U-turns as well.


Sorry about the lack of manifesto link – just forget to put it in but have added it.

[I presume you’d agree that many left wing thinkers might also advocate price setting in the drugs market?]

It’s a populist idea, but then so was maximum price law during the French Revolution, but not one that’s viable in a global market.

It would be easier to try and nationalise Big Pharma, or at least take the South African route of telling Big Pharma to take hike and manufacture off-licence, but no more effective in the long run.

Despite what some free market ideologues think, I’m not convinced that its possible to apply rational choice theory to the healthcare market, at least not in a manner that reduces costs and generate significant efficiencies, largely because we are, as a society, just not that rational when it comes to our own health.

Many free market ideologues don’t hold too much to rational choice theory either. People are (generally) rational at the margins of their decision making, but this is not the key advantage of markets. Instead it is their capacity to allow for discovery and innovation. And I am sure that profit motive will never fulfill our entire and always expanding healthcare needs. Which is fine because, fortunately, people are interested in healing people and developing new treatments for all sorts of reasons besides profit.

Unity for PM!

21. the a&e charge nurse

[19] “people are interested in healing people and developing new treatments for all sorts of reasons besides profit”.

Yes, an important point, for example;
“Annual employment figures show nurses work an average of more than four hours unpaid every week, and more than seven if they do overtime”.

So given that there are 400,000 nurses working in the NHS how many millions of free working hours does this amount to every year?
It goes without saying that until relatively recently junior doctors put in at least a full weeks work GRATIS (virtually every week) until the EWTD restricted their hours.

Is this daily gift to the NHS driven by staff belief in the NHS ethos – I might be wrong but I doubt if similar loyalty would be shown to bearded entrepreneurs like Alan (you’re fired) Sugar or Richard (don’t pay the cabin crews) Branson?

“Annual employment figures show nurses work an average of more than four hours unpaid every week, and more than seven if they do overtime”.

I shudder to think how many unpaid hours I have worked over the past four years – probably more than ten hours a week on average. On occasion I’ve worked ten hours unpaid in one day.

But then, I’m a professional and contractual hours are barely even a reference point. If you’re not paid by the hour, you’re more likely to work to the job.

23. the a&e charge nurse

[22] ahh, but there is a bit of a difference between x1 individual who puts in a few extra hours, as opposed to a workforce of 400,000 who have been putting the additional free work in for decades.

You may have same data for your own sector?

After all, junior doctors of yesteryear could only dream of putting in a mere 10 hours on top of their contracted working day.
It wasn’t that long ago they did 100+ hrs …………. routinely.

By the way, do you work Xmas day, nights over New Years Eve, etc?

23 – I’m a lawyer. Contract hours for almost all City lawyers are 9.30-5.30, with a
lunch hour, making a contracted 35 hour working week. I might even have done this once or twice. My longest week to date was about 100 hours (counting the weekend, and putting in two all nighters, and I’m a slacker. The entire City works like this, making the whole ‘unpaid hours’ thing a bit of a farce when it comes to bankers, lawyers etc. If the City worked contract hours, the whole thing would fall apart.

Yup, have worked Christmas day (once… Middle Eastern clients) and New Years eve too. Once worked all four days of Easter bank holiday, on a deal that was shelved on the Tuesday…

Tim J – and how much do you earn compared to the average nurse.

If you are working as a lawyer in the City it will be at least three or four times more. You are also working towards a partnership, if you are not yet there. When you make it, you will be earning a salary way into six figures, perhaps seven if you are at a top firm.

Oh sure, I earn a lot more. I’m just gently questioning the belief that unpaid overtime is the exclusive possession of the NHS – it’s been an ever-present feature of just about every job I’ve seen.

Oh, one exception. When I was working with (or, more accurately, against) the OFT, the entire team was home at five on the dot. Lucky so and sos…

a&e – out of interest what do you make of the concern that the surgeons of the future will have had so many fewer hours experience/training before wielding the scalpel?

28. Luis Enrique

Unity #18

sorry I don’t follow your point about rational choice. All I was doing was pointing out that at supposedly free market party (the Tories) is pushing a policy that is associated with the left wing (price controls).

29. the a&e charge nurse

[26] “I’m just gently questioning the belief that unpaid overtime is the exclusive possession of the NHS”.

Then perhaps you have misunderstood, slightly?

I did not claim that unpaid work was the ‘exclusive possession of the NHS’.

But I AM claiming that this unpaid work is widespread (and without the substantial financial rewards/annual bonuses that motivate City professionals) and more importantly driven to a large extent by a long term commitment to the NHS ethos, the kind of commitment that might be slightly less forthcoming if the main benefactor was not the patient but company shareholders.

Dave Cameron no doubts sees a mouthwatering business prospect in the NHS (given it cost £100 billion each year) but introducing markets can have deleterious consequences as many patients found out after NuLab’s disastrous reconfiguration of Out-of-Hours (GP) services – apart from anything else it demonstrated how little the DoH mandarins understood about the coal face (or perhaps did know but simply didn’t care too much if one or two were badly affected.

Meanwhile the likes of Alyson Pollock claim that £2-3 billion has been wasted on ISTCs and some £65 billion on PFI contracts – I’m sure Dave’s city mates are already rubbing their hands?

30. the a&e charge nurse

[27] Hi cjcjc – I am not a surgeon, obviously (although I have been known to slice the odd abscess and suture one or two wounds).

There are some who argue that standard operating procedurers, and stricter audit of surgical outcomes (as well as greater reliance on regional centres for certaain procedures, such as paediatric cleft lip/palate, for example) will off-set the reduced number of training hours, at least to a certain degree, but, yes this is certainly a concern and many of the medical bloggers are asking similar questions.

There are some who argue that standard operating procedurers, and stricter audit of surgical outcomes (as well as greater reliance on regional centres for certaain procedures, such as paediatric cleft lip/palate, for example) will off-set the reduced number of training hours, at least to a certain degree.

With some considerable justification.

I know that in US one of the main professional bodies for anaesthetists were,a few years back, promoted by concerns over the spiralling cost of malpractice insurance, to invest heavily in building up their evidence base in order to improve the quality of training provided to their members.

This had the happy effect of significantly reducing the incidence of clinical errors for which the profession was rewarded with a fairly sizeable reduction in its member’s annual insurance premiums.

One of key issues that rarely gets the attention it deserves is that surgeons and other specialists are often prevented from learning from their mistakes because the whole culture surrounding clinical errors, negligence and malpractice too often precludes the carrying out of the kind of detailed reviews of adverse events and outcomes that would generate lessons that improve clinical practice.

Doctors are too often discouraged from investigating mistakes in detail by the fear that any detailed evidence they uncover will only end up being used against them in court.

The flip side is that surgeons of the future, whilst possibly having fewer hours of experience, should hopefully have had more a few hours of sleep in the run-up to cutting you open. I’d rather not be operated on by someone suffering from sleep deprivation, no matter how experienced. I used to work long shifts, and by the end of the week I could barely tie my shoelaces.

33. the a&e charge nurse

[31] “Doctors are too often discouraged from investigating mistakes in detail by the fear that any detailed evidence they uncover will only end up being used against them in court”.

This video should be mandatory viewing for anybody who makes clinical decisions, especially given that so many medical errors arise due to ‘human factors’.

This paper gives more background (p2442) – looking at the approach to errors in a medical setting compared to the aviation industry (75% of accidents in the aviation industry are said to be related to ‘human factors’).

As well as many thousands of overtime hours given freely to the NHS by all grades, there are hundreds of volunteers who give their time freely on the basis that it is not a private healthcare service. Not to mention the blood donar service, who have occasionally had to turn away volunteers because of sheer numbers.
Those who have argued that it would be better to contract out to private healthcare services fail to take account of this enormous free resource, after all, who would would give-up their lunch hour to freely give blood to a plc?

35. the a&e charge nurse

[36] Are you sure you are not mistaking this case with a non-NHS hospital?

36. the a&e charge nurse

Dave appears to have overlooked these exciting developments from the Tory health manifesto.

It looks the like the rot has started even before they have got in office?

Unity, thanks for more analysis on the Tory draft manifesto, great points.

Over the last couple of weeks I have been blogging point-by-point on the Tory proposals on my Tory Lies blog. I posted my conclusions on Friday.

The one thing that jumped out at me was the lack of commitment to existing NHS providers. The “manifesto” hardly ever mentions existing NHS providers. It does, however, mention private providers a lot. More worryingly, is the mention of “new providers”. This phrase crops up all over the place.

Now, let us take Cameron’s “ring fence” at face value, that the NHS budget will be protected. Those of us who have any connection with the NHS know that investment in the NHS to make up for the 18 years of neglect from the Tories during the Thatcher/Major years is still in progress. The existing NHS providers need the investment to continue. So where are all of these “new providers” going to get their money from (admittedly, that will be a lot of money)? Well, it is from that “ring fenced” NHS budget, of course, and since the “manifesto” clearly has little commitment to the existing NHS providers it is clear that David Cameron wants money to be diverted to the private sector. A very clever action from Cameron, to make it look like he’s protecting the NHS while in actual fact he’s cutting funding to existing NHS providers and diverting that money to new private providers. It is no wonder he wanted to “ring fence” the NHS budget!

When you look further (and read the Tory’s health policy document published a year ago), you see that the new super-quango, the NHS Board, will be responsible for producing “commissioning guidelines”, that is, they will tell local commissioners where to get the services that the NHS will fund. You can bet that the NHS Board (which will be appointed by the Conservative Secretary of State) will dictate that local commissioners must use a certain percentage of services from the private sector. My prediction is that the first health bill from a Cameron government will be similar to the 1990 Broadcasting Act (which mandated that 25% of the programmes broadcast by the BBC should be from independent production companies). This will be the source of the “new providers” that the “manifesto” keeps talking about.

Of course, if Cameron was honest (he isn’t, hence the title of my blog) he would say that he is planning this large scale privatisation of the NHS. Instead he launches a presidential campaign saying that he will not cut the NHS.

38. the a&e charge nurse

[39] sadly the question of which health provider delivers the actual treatment is far less contentious than suggesting that the NHS should be fully privatised.

Others have argued that plurality of provider should drive up clinical standards when, in fact, ALL the evidence, so far, suggests quite the opposite (when we consider disastrous NuLab initiatives such as PFIs, ISTCs and Out of Hours, etc).

Cameron has calculated that the public will not care too much about who is providing the service (many will not even be aware) providing they don’t have to PAY FOR IT at the point of delivery.

It doesn’t take Einstein to calculate that once the fat cats have got their feet under the table their stranglehold on the health market will grow exponentially under Cameron’s Tories.

Dave’s quest is nothing less than the road toward privatisation by stealth – it would be nice if he had the balls to admit it, fat chance, eh?


“Dave’s quest is nothing less than the road toward privatisation by stealth – it would be nice if he had the balls to admit it, fat chance, eh?”

Indeed. I have to have a chuckle when I read the ranting on ConsHome about the ring fence, there are lots of Tories who do not like the idea and have to accept it with gritted teeth because they say “it is necessary to get Dave elected”, yet they are too dumb to realise that the ring fence is a vital part of his privatisation plan.

Of course this has always been the case with privatisations – more public money has to be thrown at the service being privatised before it can be sold off, so whenever I see that government is “increasing investment” I always have to check twice to see where the privatisation agenda is 😉

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  1. Liberal Conspiracy

    :: The Tory NHS: Lies, Libels and Price-fixing

  2. Evidence Matters

    @bengoldacre rt @libcon The Tory NHS: Lies, Libels & Price-fixing by @Unity_MoT

  3. ben goldacre

    .@EvidenceMatters mm not sure about unity's cancer figures either. but right on with libel and bizarre drugs committee

  4. Michelle Brook

    Makes for an interesting read; a breakdown on Conservative Party’s draft health manifesto (via @bengoldacre)

  5. asquith


  6. James Cowley

    RT @libcon: :: The Tory NHS: Lies, Libels and Price-fixing

  7. Gareth Winchester

    RT @libcon The Tory NHS: Lies, Libels & Price-fixing by @Unity_MoT #welovetheNHS

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    […] This post was mentioned on Twitter by ben goldacre, Michelle Brook. Michelle Brook said: Makes for an interesting read; a breakdown on Conservative Party’s draft health manifesto (via @bengoldacre) […]

  10. Heleno84

    Another Tory fail: Better get used to this nonsense if they win I suppose.

  11. Linky Love for the 14th of January « Left Outside

    […] Unity exposes the Tories’ NHS plans as Lies, Libel and Price Fixing […]

  12. George Allwell

    Liberal Conspiracy » The Tory NHS: Lies, Libels and Price-fixing

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