Saturday, June 16, 2007

Tweety pie

Patricia Hewitt gave a speech to the London School of Economics outlining her brave vision of the future for the NHS, she started with:
'The NHS is under attack.'

Indeed the NHS has been under attack for the last ten years, thanks to her and her incompetent party's over controlling meddling. Frankly the rest of her speech doesn't even deserve a nice glob of purulent lobbed at it, it is beneath contempt and even puts Polly Toynbee to shame with its malignant dishonesty.

Hewitt is living in a fantasy land if she thinks that she has 'reversed the decline'. New Labour have frittered away billions on grandiose schemes which provide bugger all benefit to anyone except to the brain dead bureaucrats who are employed to shuffle the glossy bog roll around. Productivity and efficiency have been on the decline for years, despite endless meaningless statistics manufactured by the government that prove just how much better everything is.

Importantly Hewitt and the government's illogical denial of the rationing that is already commonplace in the NHS today borders on the insane. Are they not aware that standard surgical procedures and diagnostic tests are simply not allowed on Stalin's good old NHS, even when they are clinically indicated? This culture of top down idiocy has led to a state of affairs where doctors are left completely demoralised as their managers treat them as useless obstructions that only get in the way of never ending stream of utopian quango-created protocols. This is Hewitt's trademark management style, to empower committee dwelling mincers while disempowering the autonomous professionals who actually do the hard work on the ground.

Hewitt and New Labour have made a habit of doing exactly the opposite of what they claim. Their 'patient choice' equates to no choice and a dumbed down non-consultant led service, their 'market forces' equate to a top heavy centralised fuck up which only responds to the politician's meddling and not the demands of the individual; while their 'pursuit of excellence' really means fostering a culture of utter mediocrity which forces any excellence to emigrate. The words of Pierre-Joseph Proudhon sum up Hewitt and New Labour's philosophy pretty damn well:
“A common danger tends to concord. Communism is the exploitation of the strong by the weak. In Communism, inequality comes from placing mediocrity on a level with excellence.”

P.S. I never imagined that Dr Rant was the kind to be a bird watcher, let alone a bird listener. However it does appear that this little birdy did have something rather interesting to say.


Steve_Roberts said...

{quote]Labour have frittered away billions on grandiose schemes which provide bugger all benefit to anyone except to the brain dead bureaucrats who are employed to shuffle the glossy bog roll around.[/quote]

Not quite right, I'm sorry to say. There have been enormous benefits to big 'consultancy' companies.

Anonymous said...

IT companies aren't exactly crying all the way to the bank either....

Anonymous said...

I can't believe the Devil is remotely interested in the utterances of a tawdry opportunist and third rater such as Hewitt.

No, it's the prospect of an ideological battle that has adrenaline pumping through his market loving soul - hence the oblique reference to French anarchist and admirer of Marx [at least until Karl told him to do one], Perre Joseph Proudhon.

Hewitt epitomises all that is repellant when a politician clings to office despite overwhelming rancour and disapproval toward her from the rank and file - she is a latter day WW1 general, swilling port while soldiers are gunned down in the trenches.

But, she [or her speech writer] is absolutely correct about one pivotal issue contained in the LSE speech, Hewitt says something like;
Private insurance works on uncertainty and shared risk. As science removes uncertainty, private health insurance removes its risk by either,
[1] charging more, or
[2] EXCLUDING people.
Only the super rich can escape this plight she adds for dramatic effect.

A corollary of the private market is those with no economic value will [in time] receive a vastly inferior service, or no service at all [see USA] - but this state of affairs has nothing to do with clinical preferences, it is driven simply by the mechanistic reduction of ordinary people to units of economic worth.

Libertarians cling [uncrticially] to the illusion that the 'market' will drive up standards - it might, for some, but notions of a fair and universal system would soon be dispensed with as a tiny group of health conglomerates gobble up the UK market.

Anonymous said...

Well, said Steve Roberts and Julia M.

These IT and concultancy guys have made their soft loans to Nulab and are now extracting their pound of flesh.

From us, the unwitting taxpayers.

Devil's Kitchen said...

First, note that it was Dr De'ath who wrote this post. I have no idea whether he is a libertarian: all I know is that he is a doctor.

Second, "or no service at all [see USA]".

That is not entirely true, is it now?

There is a slight difference between Britain and the US, in that every single person who works pays health insurance in this country, whether they can afford it or not. It's called NI.

As I posted a couple of days ago, through the government's compulsory insurance scheme, when I was earning considerably under the median wage, I was paying roughly double what my medical insurnace would have cost privately; and, as we are seeing, it is far from guaranteed that I will even reap any benefits from that insurance.

At least if I pay my premiums to a private company, they are obliged to pay out. The government is not; so we see the increasing likelihood of a part-pay health system; we see it being made increasingly difficult for people to get the unemployment benefit that they have paid for; and we see people paying what could be considered unaffordable amounts into a state pension which is highly unlikely to exist by the time that I retire; and we see the plan for the state to charge us even more for a pension becuase they have already spent all of the money which was supposed to go into our pensions.

Can I take the government to court for breach of contract? No. Could I do so if it were a private company? Yes. So I'll go with the private insurnce option, thank you.

As for only a few companies bulking together to control the medical insurance market and making it unaffordably expensive... Well, I would believe that had it happened in any other area of insurance in this country, but it hasn't.

It doesn't even make market sense to do that; lots and lots of smaller premiums and upping the risk factor slightly is far better than a few very rich people paying a lot, c.f. Direct Line's original business plan.


the A&E Charge Nurse said...

Apologies Devil.
My ealier post was a case of what they call in analytical parlance, 'projection' - accusing you, when in fact it was me spoiling for an ideological bloodbath.

The insurance market so craved for by the libertarians might arrive sooner than you [or Dr De'ath] think, as the drip-drip effect of rubbishing the NHS eventually reaches a critical mass.

In fact as our society becomes ever more defined by the 'haves' and 'have nots' [think of property prices] why should health provision be any different ?

At least it will give a few jaded blogger something new to feel outraged about as heartbreaking scandals emerge of patients denied treatment because it is not covered by an el-cheapo policy.

Anonymous said...

"In fact as our society becomes ever more defined by the 'haves' and 'have nots' [think of property prices]..."

Don't worry, this will look totally different after the next house price crash, that started about a month ago, real prices will fall by about half over the next five years.

Dr De'Ath said...

A/E charge nurse,


just to briefly add that Dr De'Ath does not pigeon hole him/herself as right or left wing

there are no easy ways to fix the NHS, however I am a firm believer that New Labour have fucked it up in a royal fashion

the quote was used becuase it demonstrates the philosophy behind a lot of New Labout stuff- a philosophy that encourages mediocrity and stifles excellence, also a philosophy lead by a group of self serving 'weak' people

in my eyes one of the main problems with the NHS is not that it is publically run and not private, but that it is managed very badly by thick incompetents in a way that ignores the expert opinion further down the NHS chain of command

we'll be here to the cows come home if this turns into a debate on the future of the NHS again, but I am no believer that a market will as if by magic solve all the NHS' problems

However if the government listened to those with the knowledge a bit more and stopped trying to control everything obsessively from the top then things would certainy improve.

Roger Thornhill said...

a&e c-n: A corollary of the private market is those with no economic value will [in time] receive a vastly inferior service, or no service at all [see USA]

Which is the reverse of the state system which has those who pay receive a vastly inferior service in relation to contribution or have to go elsewhere and pay twice, whereas those who pay nothing get infinite benefit in relation to contribution.

Now, there is no perfect answer. What is the least worst option? Out of those two, the former, I would say.

Further, there is no reason why the State cannot enforce a rule about minimum cover provided by health insurance and also provide a safety-net as they do in Switzerland. Your version is a straw man, even if it is not as bad as the State system we now endure! For in the private version there is scope for people to fund charitable healthcare provision, which is exactly what happened before Year Zero, oh, I mean 1948.

the A&E Charge Nurse said...

Who are these leaders Dr De'ath ?
The greasy pole climbers at the BMA who turned a blind eye while the lost tribe were being fucked over ?
Thats the view of the junior doctors by the way, not mine.

Surely it's only a fantasy to imagine that honest foot-soldiers will rise from the ranks to assume a position powerful to influence policy - we both know this no more likely to happen than the lunatics taking over the asylum.

Many of those who can't wait to put shareholders between patients and doctors, will in time, come to reap the folly of consigning the NHS, what is essentially a decent and fair service, to the dustbin.

These days I just don't see how anyone has the luxury of trying to ride two horses at once - we either unleash GENUINE market forces on health services, or renew our committment to a tax funded, publicly owned service.

Changing a few leaders names on the door is merely pissing in the wind.

Dr De'Ath said...

I don't agree.

It's all about building on what Remedy have achieved this year, it's about politicising a generation of doctors so that they will never lie down and take it as our current establishment leaders have.

In this way those who lead the profession must be forced to represent the views of the majority, and a democracy of sorts can flourish.

If you look throughout history you will see that people on the ground can force those in their ivory towers to listen, bit it does take belief, militancy and persistence.

If we all just give up then things would carry on getting worse and worse, I believe that the events of this year as regards MMC/MTAS could be the start of something much bigger. It's about us all uniting and saying enough is enough, nothing can be forced through without our cooperation, we need to have more faith in our own power to change things.

It's a great trick of those in power, to make the majority believe they cannot change the way things are going, however just look back at history and it's abundantly clear thar the majority can force their views to be listened to. The DoH is running scared at the moment and it they know we can change things, this is why they are running.

the A&E Charge Nurse said...

Thanks Dr De'ath, don't forget I belong to the nursing tradition - I'm sure I don't need to point out that militancy and nursing are two mutually exclusive concepts.

Any profession that came into being wearing uniforms based on 'servants' attire is unlikely to intimidate the movers & shakers, although we could if a few more of us had your [metaphorical] balls.

Perhaps the abomination that is MTAS will energise political interest amongst the next generation of consultants - I sincerely hope it does providing the founding principles of the NHS are reaffirmed instead of handing health over to the sinister friends of the libertarians.

Dr De'Ath said...


It is the one thing that I admire most of the nursing unions, they represent their members and stand up for them.

The BMA could learn a lot from them. Doctors on the ground also need to be less apathetic and more militant.

Roger Thornhill said...

a&e c-nThese days I just don't see how anyone has the luxury of trying to ride two horses at once - we either unleash GENUINE market forces on health services, or renew our committment to a tax funded, publicly owned service.

False dichotomy.

Anonymous said...

Not much hope I'm afraid, snouts in the trough and all that. It has come to my attention, that certain NHS agencies are providing considerable financial inducements, to persuade GPs to brake the Data Protection Act, and supply confidential patient details for certain nefarious political shenanigans. Mind you, there are still some medical principled aka fuckwits who are doing it free of charge, but it'll never catch on.

Sorry, I didn't really mean nefarious political reasons's for the good of the patient ...honest.

chris said...

Private insurance works on uncertainty and shared risk. As science removes uncertainty, private health insurance removes its risk by either,
[1] charging more, or
[2] EXCLUDING people.

Like Smokers or the Obese?

the A&E Charge Nurse said...

Yes, Chris, god forbid that anybody should be expected to take any responsibilty for their own health outcomes.

Anyway, think how much extra cash will be generated in the private sector for the purveyors of liposuction, every cloud has a silver lining, eh ?

chris said...

OK. On one hand you say that private insurance by making people pay more if they choose to increase their risk is an absolute disaster which makes it a totally unsuitable as a funding system.

Then on the other you say that it is right these same people be completely denied the treatment that they already paid for and have always been told they could expect.

Make up your mind.

the A&E Charge Nurse said...

Thanks Chris - apologies, I made a few facetious comments in response to the perfectly valid points you raise.

For what it's worth I strongly object to the principle of discriminating against ANY patient on the grounds of lifestyle choices - you are absolutely correct to point out that they are entitled to treatment that has already been paid for through tax.

The two items you highlight tie in with Dr De'aths original post about the malign influence of NuLab on the NHS - in particular the dire consequences of short term cost cutting and job/service losses.

The million dollar question is whether or not the market worshiping libertarians can offer a realistic alternative that retains the founding principles of the NHS with respect to providing a fair and universal system

My own view is that it is virtually impossible, since the profit motive is likely to corrupt clinical integrity, sooner than you can say BUPA or Norwich Union - look how easily the docs have been manipulated by the pharmaceutical industry if you want an example of what I'm talking about.

Roger Thornhill said...

a&e, even the NHS cannot uphold the founding principles of "fair and universal"!

Further, how do you describe "fair"?

Is it "fair" that a non-smoker is denied or has delayed treatment because the system is busy caring for smokers?

Is it "fair" that a normal weight person is denied treatment because of resources diverted to catering for the self-inflicted chronically obese?

Is it "fair" that someone who has paid into the system has to wait in line with those who have not paid a penny and have absolutely NO intention of ever paying?

Docs are manipulated in any scenario. See how NICE have approved a smoking drug just as their ban comes into force...Nice indeed.

The issue is not about "profit" but about effectiveness through competition via the ever-watching population exercising choice.

We can have a plurality of not-for-profit healthcare providers and insurers competing against each other and the profit-making and the State engine. Who would provide a better, more efficient service? Who cares! The point is people could choose and if they do not shape up they have no option but to ship out.

Oh, and forget about "cherry picking" retorts as it is quite possible to regulate the market to ensure that insurers have obligations. See here for a summary of how the Swiss model works. Not perfect, but far better than the Communist, authoritarian ossified monopoly we endure now.

Anonymous said...

roger - have you seen how much the Swiss spend on health [as a proportion of GDP] the OECD stats prove it is infinitely greater than UK and just about second only to the USA.

chris said...

I strongly object to the principle of discriminating against ANY patient on the grounds of lifestyle choices

OK, thats good. And we both understand that since we live in a world with finite resources some kind of triage has to happen, with the medical professionals as those in the best place to conduct this based on clinical needs. This means getting the politicans out of the loop, they will always end up directing money into fashionable causes based on what gets the best headline not what gets the best health outcome.

For example the decades of underfunding of the mental health area (the archtypically unphotogenic area of medicine) with the result of many people with perfectly treatable illnesses ending up in (expensive) prison cells rather than getting the help they need.

Unfortunately getting the politicians out of the loop is near impossible with the current system, it was designed in. As Nye Bevan said:

"the Minister of Health will be the whipping-boy for the Health Service in Parliament. Every time a maid kicks over a bucket of slops in a ward an agonised wail will go through Whitehall."

Roger Thornhill said...

a&e - yes I have. They spend more, but they CHOOSE to spend more.

• Tax financed 24.9%
• Health insurance financed 37.5%
• Direct payments 28.8 %

The "basic" package is considered to be similar to a luxury package in a place like the US or Germany and this is the safety-net/compulsory level.

It is not that people spend (and are you now complaining about TOO MUCH spending?) but what they get for that spending and the fact that if they are not happy they can take their business elsewhere.

If you stuck to the "basic", the spending (tax + insurance) might well be about the level of the UK...and think of the quality of service you would get.

AntiCitizenOne said...

The NHS is killing thousands of people yearly and vested interests like A&E charge nurse are worried for their own selfish ends.

the sooner that NHS treatment rationing dies the better for the health of the nation.

Anonymous said...

Of course I'm selfish anticitizeneone - who isn't ?

But given my qualifications and many years of experience I don't have any particular fears about finding a job, irrespective of whether or not health is provided publically or by the private sector.

I also teach at uni on a sessional basis so if the hospital doesn't want me maybe the spotty students do ?

Have you seen the stats on increased rates of A&E attendences ?


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