“The report title are those hypothecated as being “amenable to healthcare”, assuming that the “amenable mortality rate” for the UK can be measured against that for “selected European countries”.”

It took me a good three minutes to work out that “The report title are those…” is supposed to mean something like “the lives referred to in the report title are those…”.

What ‘hypothecated’ is supposed to mean in this context I have yet to figure out.

“The lives referred to in the report title are those pledged as security for a debt as being “amenable to healthcare”…”

No, can’t be that. How about:

“The lives referred to in the report title are those raised as tax revenue and allocated to a specific purpose as being “amenable to healthcare”…

Nope, can’t be that either.

If you meant “deemed ‘amenable to healthcare,’” or “judged to be ‘amenable to healthcare,’” you’d just say that – right?

The TPA is a lobby group for people who can afford comprehensive private medical insurance and education – and would rather pay a premium for it than subsidise the rest – so what yu you expect?

A more balanced view can be found in the OECD’s recent report on healthcare – http://goo.gl/Cg6V0 – which rates the NHS very highly in comparison with the health systems of other developed countries, which all cost more. The NHS costs around 8.5% of GDP compared with 17% in the US -where 50m are uninsured and 80% of medical bankruptcies (the second highest cause of bankruptcy) involve those with insurance.

It’s interesting to note that the benchmark chosen by the TPA is set at a time before the ‘internal market’ was introduced, driving up administrative costs and bringing in new layers of management (in the US, administration, advertising, billing, etc. consume more than a quarter of the total spend on healthcare) – perhaps the TPA should be calling for an end to internal markets, rather than for the privatisation of the NHS on the American model.

See: http://goo.gl/y50yE

@1 Does it make more sense over at his blog? Might have been edited down into incoherence to fit.

@ Cylux

Right you are, thanks. Although ‘hypothecated’ is still in there. Maybe it’s supposed to mean ‘singled out’, as in “G.O. hypothecated the fourth paragraph of this post as being almost incomprehensible”.

As Clifford Singer has pointed out, the TPA has actually included comparative cost data – well, a little of it – but managed not to refer to it in the narrative. I’ve updated the original blogpost, which appears on LC in edited form:

http://zelo.tv/q6uPi8

Mortality amenable to healthcare is a fascinating area, although one that is far from straightforward
http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/does-healthcare-save-lives-mar04.pdf

In fact. “The question of whether health services make a meaningful contribution to population health has long been debated.Several authors, writing from a historical perspective in the late 1970s, argued persuasively that health care had contributed little to the decline in mortality that had occurred in industrialised countries from the mid nineteenth to mid twentieth century. They proposed that this improvement was most likely to be due to the influence of factors outside the health care sector, in particular nutrition, but also improvements in the environment. Indeed some, such as Illich, have argued that developments in health care in the 1950s and 1960s were actually damaging health,
introducing the word iatrogenesis” (p11-12).

Of course, once this data is in the hands of the TPA it becomes little more than a barely concealed form of political posturing.

Why don’t they stick to simple mission statements like the NHS is crap and must be replaced by the market?

Why would you even bother to have a debate on this wnen nobody cares what the right wing Tax Dodgers Alliance say.

@6

Would that this were true.

As I’ve previously noted, former TPA staffer Susie Squire is now a SpAd for Iain Duncan Smith at the DWP, and yesterday at PMQs a suitably compliant Tory back bencher quoted the TPA to Young Dave, who replied in a way that suggested he found the group authoritative.

Also, as I’ve also pointed out, the numbers Francis Maude quoted on trade union reps’ facility time in the civil service did not come from official sources, but from the TPA (in update):

http://zelo.tv/qPJok6

So someone in Government is listening to the TPA.

@ 6 Paul

“Why would you even bother to have a debate on this wnen nobody cares what the right wing Tax Dodgers Alliance say.”

What Tim said – plus the papers are more than happy to ensure the TPA’s importance is out of all scale with its membership (I think they started getting national-level citations when there were about two of them). The fact that you and I dislike them doesn’t mean they’re ignored.

If the lie dems were Actually paying attention to the loons they have gone into govt with,they might put a stop to this idiicy.But they are too busy congratulating their leaders for being ministers and having official titles.

You would hope that eithe Labour or lie dem would start a campaign to reveal who is funding the rich tax payers bullshit outfit. But no. There is no opposition, we are all free market morons now.

Oh, look!

http://www.bmj.com/content/327/7424/1129.full

British Medical Journal from 2003.

The NHS is 18 th out of 19 systems studied in mortality amenable to health care.

My word, the tax dodgers are such bastards for pointing out what the medical profession already knows, eh?

[10] “Mortality and population data were extracted from WHO mortality files for 1998″ – hardly srprising given that the NHS had been struggling during almost 20 years of tory underfunding.
Now they are back in power I think we can all guess what the direction of funding will goingin?

The more recent OECD data (measuring up to 2007) demonstrates the NHS was making steady progress with rates comparable to Germany, a country that always has and still spends much more on health than the NHS
http://www.oecd-ilibrary.org/docserver/download/fulltext/5kgj35f9f8s2.pdf?expires=1318538363&id=id&accname=guest&checksum=D64A67EAFCC6AB702722F1C5DB73F8E3

What was your point exactly?

I don’t think there’s much point in trying to rubbish the TPA’s figures, which seem fair enough. And on the “potentially most important” point of costs, the WHO Ranking of the World’s Health Systems, which placed the UK at 18th, did indeed take cost into account. (Admittedly this report dates from 2000; the WHO subsequently abandoned such rankings as too complex a task.) The BMJ paper cited above uses more restricted criteria than the WHO report, but arrives at a fairly similar ranking for the UK.

By all means critique the TPA’s conclusions and recommendations, but, as the man said, we’re all entitled to our opinions but we’re not entitled to our own facts.

Firstly, as the TPA at least concedes, is the lifestyle factor, which is known to influence significantly life expectancy levels across the UK.

Yes but does it matter? Is a heart attack amenable to health care if it is caused by fat lazy bastards watching too much TV and eating too many chips? Surely it doesn’t matter if the measure you are looking at is whether the hospital system does any good at all?

Second, the TPA seems unable to limit its comparison to the Netherlands, France and Spain, bringing in comparisons with Australia, Sweden, Norway, Canada and even Cuba.

All, except Cuba, roughly comparable countries. Why should this be a bad thing? You want less data? Fewer comparisons? Why?

So the NHS is getting rubbished by comparing it to systems across Europe and elsewhere, but there is no comparison of costs, just the inference that the NHS model is wrong and everyone else’s is better.

I am not follow this – are you saying it is all right for British hospitals to be useless at saving lives as long as they are cheap?

13. Churm Rincewind

And on the “potentially most important” point of costs, the WHO Ranking of the World’s Health Systems, which placed the UK at 18th, did indeed take cost into account.

But only in the sense that their index was created specifically to make the US look bad and so punished private spending on health care.

Which makes Britain’s poor showing more worrying.

@15 – No, it was created to make Pakistan look bad

@11

The NHS – by the TPA’s own admission (though you might miss it, as the narrative doesn’t say so) – has not got anywhere near the level of spending that the “EU-peer” selected countries have for the best part of 30 years.

But what the heck? The superior insights of the Adam Smith Institute, that well known museum of outdated economic thought that has fraudulently appropriated the name of the founder of economics, clearly trump that, especially when the odd bit of pejorative language is thrown in.

More means Worstall, once again.

@11 I know conservatives like the idea of living in the past, but Tim do you understand we aren’t in 2003 anymore?

@18.

So, I wish to make the point that we’ve known for some years that the NHS is not very good at “mortality amenable to health care”. The reason I wish to make this point is so that I can point out that what the TPA is saying is generally known indeed has been generally known for some years.

To show that this has been generally known for some years I used a report from the past. That’s the way you do it you see: to show people that we’ve known things for some time you need to show a report from some time ago.

I’m then accused of living in history?

So, back to my point once again. What the TPA is saying about mortality amenable to health care is not new. It has been known for some time: as that report from the BMJ in 2003 shows.

[19] “What the TPA is saying about mortality amenable to health care is not new. It has been known for some time: as that report from the BMJ in 2003 shows” – well,let’s go a bit a further and ask.

Do the TPA discuss any of the conceptual difficulties with MAHC – such as the arbitrary upper age limit (75 year) – if you are 76 is mortality not amenable to health care?
Do they provide any data on the cumulative difference in health spend over the last 50 years?
Or why more recent studies demonstrate the NHS has improved MAHC year on year, and is now close to Germany despite spending significantly less (see OECD link @12)?

Let’s be honest – the only purpose of the report is to contribute to a climate that will make it slightly easier to consign the NHS to history?

@ 20. You mean this paper?

Mortality Amenable to Health
Care in 31 OECD Countries

The one showing that while the NHS has indeed improved it is still behind Italy, Spain and, for goodness sake, Greece?

But at least we’re now agreeing that MAHC is a useful thing to be measuring…..

What Tim Fenton’s original post fails to show is anything wrong with the report. It seems accurate in its summation, but its treatment of figures is not actually a problem. They may not say what Tim wants, but that’s by-the-by.

Lifestyle is clearly irrelevant – it says nothing about care in hospital (unless you want to imply the nursing staff are too lazy, something that is fortunately in general not true…), and as the measure being used is deaths which might be avoided, not those that are inevitable due to lifestyle, I can’t see it having much impact on the figures.

As pointed out by So Much For Subtlety, surely more comparisons rather strengthen the point of the report – so not sure what the obsfurication there is for.

As to the cost, well, this is the Taxpayers Alliance. I think their interest in cost might be indicated by their name? However, their basic argument does not rely on cost – it relies on the relatively poor level of treatment. It relies on the unfortunate fact that it is far too common for someone to go into hospital for treatement for one thing and die from something they did not have before going into hospital – and that other countries do not have similiar rates of this.

In light of the fact that apparently treatment of elderly patients in a significant minority of hospitals is legally abusive, it seems a bit strange to try and simply defend bad practice in the NHS. It cannot be beyond the wit of those who believe in the large, monolithic, centrally-controlled system of NHS provision we currently still have to suggest how it could deal with the problems within it, rather than bleating on about ‘abolition of the NHS’ (hint – even free marketeers like me like the idea of the NHS – but experience as well as statistics has taught me it is not as good as it could be). Rather than engage with those who want change in the NHS to improve it, you end up defending a model of provision that clearly has imperfections by trying to downplay the problems rather than find solutions.

The NHS is a concept – free healthcare for all provided as a service by the government. It need not be the current system, which in some cases clearly does not work (despite Tim’s attempts to pretend otherwise). If you are convinced that the current system is the best solution, it is time to show those of us who currently disagree how this works. Lying to yourselves and others that the government intends to destroy the NHS (there is no evidence for this – and their reforms do not remove free healthcare) is not really helping anyone that I can see. The left-wing narrative is increasingly fighting a battle that is far from reality, and as with free schools (and I suspect with tuition fees) it will become clear that it is a battle that you cannot win, but you can cause damage and fear in fighting. And ultimately, is that in anyone’s interest (remember – we need a left-wing alternative for democracy to work)?

@ Tim Worstall

‘I wish to make the point that we’ve known for some years that the NHS is not very good at “mortality amenable to health care”… To show that this has been generally known for some years I used a report from the past. That’s the way you do it you see: to show people that we’ve known things for some time you need to show a report from some time ago.’

*What*? I wouldn’t expect this sort of howler from one of my slower first years, never mind a bright chap like you. You may as well say “We’ve known for some years that there are around 650 cases of MRSA infection each month in UK hospitals, and to prove it here’s a newspaper report from 2004″.

[22] “even free marketeers like me like the idea of the NHS” – of course you do, nobody in their right mind would want a health service driven by for-profit providers.

We can meet half way to the extent that we can easily agree that there are some serious problems with the NHS, but these are problems that contain increasingly existential elements, such as how far we medicalise the inevitable consequences of old age (for example 80% of the population now die in institutional settings).

Death , I guess, is being framed by the TPA as some kind of failure so that we have the likes of Tim suggesting that as a result of the NHS the poor old British public is worse off than the Greeks – this is plainly stuff and nonsense, and should alert any discerning commentator to the fact we must not jump to hasty conclusions on snippets of information, especially when this inforamation falls into the class of factoid rather than hard science.

BTW – do you think the timing of the TPA’s ‘analysis’ has anything to do with the HSCB going the through the Lords?

Nursey, you were the one who prompted me to read that report that shows that the Greeks do better on MACH than the NHS does….

[25] which time frame are you talking about? – perhaps mortality amenable to health care is not quite as good today in Greece as it was in 1847, the period cited by the TPA propaganda,sorry, I meant analysis?

Interestingly when asked, ‘are hospitals overwhelmed’ – it was reported, “public hospitals are. The economic crisis has left fewer people able to pay for private care. Private hospital admissions have fallen by as much as 30%, and patients are instead flooding into public health-care facilities. There are even reports of “bribes given to medical staff to jump queues in overstretched hospitals,” the authors of the study in The Lancet wrote. Many Greeks are resorting to visiting street clinics run by humanitarian groups, such as Doctors without Borders, which used to almost exclusively serve low-income immigrants”.
http://news.yahoo.com/greeces-austerity-driven-health-crisis-130900377.html

Surely the private Greek hospital are not turning patients away because they can no longer afford to pay for their health care?

Nope, sorry, you don’t get to do this.

You pointed me to a report, said I should read it. I did. The report you pointed me to (based on 2007 numbers, or the most recent at that date) showed that the Greek health care system was better than the NHS at dealing with mortality amenable to health care.

It’s your evidence recall. You don’t get to moan about it once you’ve tried to use it yourself.

[27] all it proves is that evidence must be WEIGHTED and CONTEXTUALISED before it makes sense.

It’s very simple – the TPA are saying, ‘ooh. look how many patients the NHS are killing’ with an implied solution that the market knows – the timing of their “analysis” obviously coincides with the passage of the HSCB.

As I say weight and context especially when data is being pushed by a tainted source.

a&e (in reference to 24 mainly),

We can meet half way to the extent that we can easily agree that there are some serious problems with the NHS, but these are problems that contain increasingly existential elements, such as how far we medicalise the inevitable consequences of old age (for example 80% of the population now die in institutional settings).

Are inevitable consequences of old age not an automatic exclusion from amenable mortality rates anyway? I do agree this is a problem for an NHS – but it seems to be one a long way from this argument.

Death , I guess, is being framed by the TPA as some kind of failure so that we have the likes of Tim suggesting that as a result of the NHS the poor old British public is worse off than the Greeks – this is plainly stuff and nonsense, and should alert any discerning commentator to the fact we must not jump to hasty conclusions on snippets of information, especially when this inforamation falls into the class of factoid rather than hard science.

Avoidable death, as opposed to death, is a definite failure of any system. That seems clear enough, and is the point here – the rate of avoidable death in the current system that implements the NHS (a phrase I am using to avoid conflating system and NHS) is unacceptably high compared to comparators. If, as some defenders of the present system maintain, the NHS is implemented through the best system in the world, that should surely not be the case, unless other targets can be somehow be shown to be more important?

BTW – do you think the timing of the TPA’s ‘analysis’ has anything to do with the HSCB going the through the Lords?

I think there is something more than a possibility of that being the case… It does however not invalidate the argument – it is much more effective to release an argument when it is topical remember, and that’s what think tanks and pressure groups do. Just because it is politics does not make it wrong (in fact, one problem with the debate about the NHS is those who seem to think that politicians cannot debate the NHS at all).

[19] ‘To show that this has been generally known for some years I used a report from the past. That’s the way you do it you see: to show people that we’ve known things for some time you need to show a report from some time ago.’

@19

Really Tim!? thats how we do it?! My goodness you should tell the scientific community! they have been wasting all of that time replicating studies every few years to establish those pointless trend lines. Who knew I could make sweeping generalizations about the present state of the NHS with data collected in 1998!

@Everyone else
On a side note, does anyone else find it funny when Tim says something really stupid in a condescending way? I think its freaking hilarious!

@G.O.
Careful G.O. you might scare Tim, he doesn’t understand the subtleties of
past =/= present

Regarding US healthcare:

Medicare and medicaid put up prices in the states (i.e. increasing socialism lead to price inflation meaning the charity hospitals were put out of business, laws favoured provision from big insurance companies versus out of pocket payment).

A National Bureau of Economic Research paper places medicare and medicaid as responsible for 40% of the increase in healthcare costs between 1950-1990:

http://www.nber.org/aginghealth/fall05/w11619.html

But of course no-one is aware of actual facts concerning America and just continues to scream ‘free-market medicine…’.

With regards to British healthcare:

The OECD figures show we have lower cancer survival, lower diagnostic tools, lower ICU beds. A recent Surgical College paper highlights that death rates for emergency abdominal surgery are 40% higher than the states.

So, yes of course, more are dying here than elsewhere.

Yes, are spending is about the OECD average in GDP terms (and our GDP is higher than many OECD countries) and PPP terms.

Yes, we are even beaten by ex-communist countries now.

Yes, we doubled NHS spending under Labour which in turn has led to a 20 billion black hole which is mistakenly called a ‘cut’ in spending when spending has been maintained.

So please, spare me the non-factual points (such as, but the OECD favours the British system) and realise that in Britian, we have a totally rotten and financially non-viable healthcare system.

[31] the term “lower cancer survival” needs unpicking.

The term cancer accounts for over 200 diseases and in some respects is about as useful as the term ‘infection’.

So a few simple questions;
*which of the 200 diseases are you talking about?
*how does international data on remission rates compare?
*is palliative care included in the data?

It may be that life expectancy is SLIGHTLY longer in some countries for some cancers but if this time is overshadowed by fighting the effects of advanced metastasis not to mention the arduous after effects of chemo, surgery or radiotherapy then it may be something of a mixed blessing.

Or it may be that the apparent difference (for some cancers) may relate to earlier detection rates even though the eventual outcome in the majority of cases may not be substantially different?

32:

Go to the OECD data and find out.

Check out the CONCORD study from The Lancet and see for yourself.

I think they looked at about 20 different cancers:

bowel
breast
prostate
haematological
endocrinological
pancreatic

amongst others.

I think 5 year survival rates are excellent ways of an almost ‘no-holds barred’ comparison.

It’s not perfect, but bias can be grossly reduced (e.g. versus artificial ‘healthcare rankings’).

Furthermore, levels of technology and ICU beds are also a good comparison as modern healthcare relies on such things as does treating the sickest (a myth often believed in Britain is that we do well on emergency and critical care – we don’t).

Let’s face it…. when the nurses no longer want to nurse and nursing assistants then need to be recruited… something has gone seriously pear shaped..

Unfortunately the NHS debate is simple one of protecting the vested interests of the public sector workers.. if it was results / care driven, we’d have adopted the French model decades ago..

Unfortunately that would result in public sector workers becoming private sector workers and thus will never happen.

So what, if as Stafford proved, hundreds and thousands of people have to die unneccesarily, it’s all about the pensions etc….

And yet the left claim the moral high ground…..

if you want to say “this is not a new point”, as Tim says he wanted to, then you do need to show the point being made in some old report … that’s fine …. if you want to say “and not much has changed since then” you need a more recent report. What’s to argue about?

@34 psst… You have a bit of foam still on your chin. Better wipe it before anyone comments….oops too late.

[34] “Unfortunately the NHS debate is simple one of protecting the vested interests of the public sector workers” – when did this startling insight occur to you, or more to the point what do you base it on?
Are you a clever mind reader, because with a workforce of well over 1 million NHS staff that’s a lot of minds?

There are 350,000 nurses in the NHS yet none of them want to nurse, according to your inane rambling – perhaps if they all failed to turn up to work for a week you might get some idea about what it is we actually do?

Of course nothing ever goes wrong with the French system you are pining for, now does it?
http://www.infiniteunknown.net/2010/12/28/the-worst-health-scandal-in-french-history-state-sudsidised-deadly-diabetes-drug-completely-ignored-warnings/

Mason,

Whilst I agree with you about the tone, is there anything other than that which you can actually argue against?

[33] “Go to the OECD data and find out” – surprise, surprise, you don’t actually know, do you?

@ Watchman

Sure, however the big question in response to you comment, is there any point? I doubt any foamy mouthed commenter will change their opinion even if I provide data. Internet comment sections are hardly the place for reasoned debate (See any internet forum for evidence). I just enjoy poking people who take themselves too seriously.

‘However the big question in response to your* comment.’

@ Watchman. please excuse the spelling error.

@34 – The role of the nurse has become more skilled over the decades. It’s that sort of basic shift which you’re ignoring…

@ Mason

Standard leftist debate – play the man not the ball…. well done… And as for the comment about foam… jesus have you seen CiF etc. where every anti-government article immedately gets 200 “the tories want to eat your babies” style deranged comments…

@ the a&e charge nurse

I’m not so much making my point about the individual workers, more towards the unions and the labour party who blindly advocate that only the public sector can deliver NHS care. OK so the French system isn’t perfect, but by Christ on pretty much any objective measure you care to name it trounces ours.

Our system is broken – it costs a fortune, delivers poor returns, and even the Healthcare Quality commission has had to identify terrible lapses in basic care.

And rounding all off – where did Stafford Hospitals former Chief Exec wind up…? You guessed it Chief Exec of the Healthcare Quality commission – now there’s a reward for failure to be proud of…

[43] “Our system is broken – it costs a fortune” – yet costs considerably less than the French.
So far none of the other right wing NHS detractors have been able to put a figure to the cumulative difference in spend over the last 50 years – care to have a stab at it yourself?

Anyway, if the NHS ‘costs a fortune’ as you claim how on earth will be able to pay for the vastly more expensive French model?

According to this recent study, “In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-
effective over the period”.
http://shortreports.rsmjournals.com/content/2/7/60.full.pdf

1.Inequalities: fewer adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs in the UK than in any of the other 11 countries surveyed by the Commonwealth Fund last year. They also found that: adults in the United States are by far the most likely to go without care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with insurers or payments denied.

2. We have the lowest inequity in the world for access to a GP or a specialist according to the OECD.
The point of the NHS is to provide care on the basis of need. Since health problems are more frequent and more severe among people from lower socio?economic groups access to care should not be a privilege for the rich. In many countries inequitable access results in wealthier, healthier people having better access to GPs and specialists. This is an example of the Inverse Care Law, which states that “The availability of good medical care tends to vary inversely with the need for it in the population served. This … operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.” (Hart, 1971)

3.UK healthcare costs per capita are amongst the lowest in Europe. They are less than Sweeden, Norway, Netherlands, Luxemburg, Ireland, Greece, Germany, France, Belgium and Austria.

4. Satisfaction has never been higher. Two-thirds of people are now either very or quite happy with the state-run health care, the largest proportion since the in-depth British Social Attitudes study began in 1983. The attempt by the government to suppress this data has been described, rightly, by health policy expert Andy Cowper as “suspect in the extreme”

5. Desire for change is the lowest in the world: Members of the public were surveyed from 11 countries; UK, Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the US.

Still, cling on to your obsession with the French, or belief in ‘consumer self interest’ if it makes you happy.

@43 Well when the ball is flat all you can do is play the man. Unfortunately looks like the best thing you have is stereotyping the ‘leftists’ and “they did it first, mommy!” technique. Keep trying though, throw enough darts and you will hit something! Plus your mouth foaming makes you sound crazy and entertains me to no end. Ooo can you call me a socialist fascist next time rather than a leftist, I dont think leftist sums me up just right…

Fun argument!

“According to this recent study, “In cost-effective terms, i.e. economic input versus clinical output, the USA healthcare system was one of the least cost-effective in reducing mortality rates whereas the UK was one of the most cost-
effective over the period”.”

Yah, the NHS kills people but it’s cheap!

Amazingly, the same argument seems not to work when:

Private fire brigades, they’ll be cheap!

But people will die! etc cont. pg 94.

We can argue that the NHS is cheap and people die because the NHS is cheap. OK, I’m fine with that argument. We can also argue that other services should/might be cheaper. OK, I’m fine with that too. But when we argue that other services should not be cheap like the NHS because people will die…..ermm, no.

One or the other argument, not both…..

@ 44:

“Satisfaction has never been higher… Desire for change is the lowest in the world”

Given that people in this country seem to have been convinced that the only two options are “the NHS run roughly as it is now” and “no State-funded healthcare system whatsoever”, I’m not sure how much weight we can attach to those findings.

Ok… Let me try another tack.

If you went to the CEO of GE / Microsoft / Ford etc. and said:

“I want to manage a company that has 1.2. Million employees, 70 Million customers and has a goal to deliver personalised care from cradle to grave to each of those customers, they would say there is no case study for doing this effectively.

They would probably prose break down both sides into smaller units – smaller pools of customers being served by smaller delivery organisations.. with the markets acting as the glue between them.

Well that’s the french model.

What we’re trying in the UK is doomed to failure… and is clearly delivering failure today…

It’s not a criticism of the employees – it’s the monolithic structure that can’t work. But on the other hand, the employees shouldn’t fight decentralisation on the basis of purely protecting their terms and conditions. Well they can, but they can’t claim the moral high ground while doing so.

@46 – Except the NHS’s outcomes are simply not that bad. When we have the American outcomes and the poor are dying, AND we’re spending just as much, I’m sure you’ll be very happy with YOUR healthcare.

Baroness Kennedy of The Shaws: My Lords, I make a declaration that I am a fellow of three royal colleges, too, like the noble Baroness, Lady Cumberlege. I should also say that I am married to a surgeon who has spent his life in the National Health Service. He is from a dynasty of doctors. His grandfather was a doctor, his mother a doctor, his aunt a doctor and now our daughter is entering medical school. They all entered medicine not because they are interested in making money but because they want to care for people. It is the idea of being at the service of others that draws most health carers into medicine. They do not want to run businesses; they do not see their patients as consumers or themselves as providers. They do not see their relationship as commercial and they do not want to be part of anything other than a publicly funded and provided National Health Service.

Health professionals also feel proud, as all of my husband’s colleagues do, that Britain is the only country in the industrialised world where wealth does not in some measure determine access to healthcare. They are saddened that the National Health Service is now facing the prospect of becoming a competitive market of private providers funded by the taxpayer. When we hear talk of accountability, they point out that nothing in the Bill requires the boards of NHS-funded bodies to meet in public, so there will be a lack of transparency. That will be complicated by the fact that private providers are not subject to the Freedom of Information Act, so they can cite commercial sensitivity to cover their activities.

Others have spoken of the removal of the duty on the Secretary of State to provide healthcare services and pointed out that that duty is now to be with unelected commissioning consortia accountable to a quango, the national Commissioning Board. The Bill does not state that comprehensive services must be provided, so there may well be large gaps in service provision in parts of the country, with no Secretary of State answerable. Providers will be able to close local services without reference of the decision to the Secretary of State. Although the Government say that the treatment will be free at the point of delivery-we hear the calm reassurances-the power to charge is to be given to consortia. That paves the way for top-up charging and could lead eventually to an insurance-based model.

Monitor, the regulator, is to have the duty to sniff out and eliminate anti-competitive behaviour-and, of course, to promote competition. According to the Explanatory Notes to the original Bill, Monitor is modelled on
“precedents from the utilities, rail and telecoms industries”.
How is that for reassurance to the general public? If anything should be a warning that this spells catastrophe, it should be that this is another step in the disastrous selling-off of the family silver to the private sector, with the public eventually being held to ransom and quality becoming second to profitability.

The regulator, Monitor, will have the power to fine hospital trusts 10 per cent of their income for anti-competitive behaviour. Any decent doctor will tell you that for seamless, efficient care for patients, integration is key to improving quality of life and patient experience. The question is whether competition and integration can co-exist. Evidence from the Netherlands is that they cannot. There, market-style health reforms designed to promote competitive behaviour have meant that healthcare providers have been prevented from entering into agreements that restrict competition, so networks involving GPs, geriatricians, nursing homes and social care providers have been ruled anti-competitive. There is a fear that care pathways, integrated services and equitable access to care in this country will be lost when placed second to market interests.

Under the delusion of greater patient choice, people are to be given a personal health budget. I am interested to hear what happens if it runs out halfway through the year. Private hospitals will enter the fray as treatment providers and, as in other arenas, they will undoubtedly, as others have said, cherry-pick and offer treatment for cases where they can treat a high number of low-risk patients and make a profit-for example, hip and knee replacement, cataracts, ENT and gynae procedures.

It is essential in an acute teaching hospital to retain the case mix, though, so it will be the teaching hospitals that will also provide the loss-making services such as accident and emergency and intensive care and deal with chronic illness and the diseases of the poor, such as obesity-we can name them all. These are essential services but they are also very costly. An ordinary hospital cannot provide them if it does not have the quick throughput cases as well to maintain a financial balance. If relatively easy procedures go to private providers, the loss of revenue to the trusts will eventually lead to them being unable to provide the costly essential services. It will mean that doctors trained in these places are not exposed to all aspects of patient care. Private companies cherry-picking services undermines and destabilises the ability of the NHS to deliver essential services like, as I have mentioned, intensive care units, accident and emergency, teaching, training and research.

Clause 294 allows for the transferring of NHS assets, including land, to third parties, and the selling off of assets. Clause 160 allows for the raising of loans by trusts, so hospitals taken over by the private sector could be asset-stripped and then sold on, as happened with Southern Cross homes.

The removal of practice boundaries and primary care trust boundaries will mean that commissioning groups will not be coterminous with social services in local authorities, so vulnerable people are more likely to fall through the gaps between GP practices. GPs will also be able to cherry-pick by excluding patients who cost more money and can lead to overspend.

Then there is the issue of the cost of market-based healthcare. Advertising, billing, legal disputes-I say this as a lawyer-multimillion-pound executive salaries, dividends and fraud could end up consuming a huge amount of the pot that can be spent on front-line services. We will end up, as in America, with that extra stuff taking up 20 per cent of the health budget. The downward spiral of ethics, the increase in dishonesty and the conflicts of interest become huge, and you see the destruction of the public service ethos.

I want to scream to the public, “Don’t let them do it”-and in fact the public are responding by saying in turn, “Don’t let them do it”. Market competition in healthcare does not improve outcomes. The US has the highest spending in the world and the outcomes are mediocre. The US overdiagnoses, overtreats and overtests. Why? Because that increases revenue. You change the nature of the relationship between doctors and their patients. You get more lawsuits and doctors therefore practise defensive medicine. You ruin your system.

I say this particularly to colleagues on the Liberal Democrat Benches. They may be being encouraged to think that voting against the Bill may bring down the coalition, but all I can say is that the electorate is watching. If people feel failed by the party on this, I am afraid that it will pay a terrible price.

This has been a 25-year project, done by stealth. It started with the internal market and is now moving to the external market. It was not thought up by mere politicians but by the money men, the private healthcare companies and the consultancies like McKinsey-the people, in fact, who in many ways brought us the banking crisis. They have funded pro-market think tanks and achieved deep penetration into the Department of Health, into many of our health organisations and right into some of the senior levels of my party as well as those on the other Benches.

The NHS is totemic. It is about a pool of altruism and it speaks to who we are as a nation. It is the mortar that binds us in the way that the American constitution does the American people. For us, it is about this system. It really is the place where we are “all in it together”-one of the few places, it would seem at the moment. Doctors get 88 per cent trust ratings with the public, while politicians get 14 per cent. The vast majority of doctors are saying to us, “Withdraw this Bill”. We should be listening.

(hat tip – jobbing doctor)

@ 2The TPA is a lobby group for people who can afford comprehensive private medical insurance and educatiom

Until they are ill when they find out that the insurance companies generally do anything to avoid paying out.

Actually the neo con TPA is also trying to convince people who earn rather little of their anti NHS cause. This is where the neo cons have been successful in stalling US health reform. The low paid often support the US system despite it not being in their interests.