Monday, 2 August 2010

Liberating the NHS: some thoughts on the Great Patriotic White Paper 004 of 007.

Uri, Sergei, wake up fellow comrade GPs. We have a war to fight. The war to liberate our NHS. We have to work as GPs during the day and now run the rest of the Health Service in our spare time. Wake up Comrades, liberation from the scourge of more work may be upon us . . .

Quiet comrade soldiers for Marshals NC/DC have said the following so listen up.

We are now into section 3 of the war of liberation called “Improving health outcomes”.

We are told that the “The primary purpose of the NHS is to improve the outcomes of health for all:

Funny that, we thought its primary purpose was to treat patients.

We will start by discarding what blocks progress in the NHS today:

Does this means an end to constant Government interference with the NHS?

Sadly no, it means:

the overwhelming importance attached to certain top-down targets”.

In future, performance will be driven by patient choice and commissioning; as a result there will be no excuse or hiding place for deteriorating standards and our proposals will drive improving standards.

At last patient “choice”?

I have a sore throat give me antibiotics. Excellent. Medical science out of the window patient choice and commissioning is now the new science of medicine.

We will replace the relationship between the politicians and professionals with relationships between professionals and patients”.

Nice thought but whenever politicians offer bread and circuses it is always by offering the NHS as their Games. Healthcare professionals are sacrificed as gladiators in the Politicians’ games.

Instead of national process targets, the NHS will, wherever possible, use clinically credible and evidenced-based measures that clinicians themselves use.”

Never? A Government relying on doctors and nurses to tell them what should be done next? They will be asking airline pilots how to fly aircraft next but for some reason you never hear of politicians telling airline pilots how to fly the planes they fly in. They do, however, always tell doctors and nurses how to treat their patients.

In future the Secretary of Sate will hold the NHS to account for improving outcomes.

Maybe we are a bit thick here up North, but is the word “outcome” the new word for “target”?

The NHS, not politicians, will be responsible for determining how best to deliver this within a clear and coherent policy framework”.

But who, or what is the NHS?

Are GPs as “independent contractors” the NHS?

Or is the “Department of Health” the NHS?

Anyone know the telephone number for “the NHS”?

So we move onto “The NHS Outcomes Framework”.

The current performance regime will be replaced with separate frameworks for outcomes that set direction for the NHS.

At last targets are replaced and now we have a “current performance regime” replaced by “separate frameworks” for “outcomes” that set “directions” for the NHS.

Just look at how many words have replaced targets, the things “that blocks progress in the NHS today”.

A new NHS Outcomes Framework will provide direction for the NHS”.

A new set of targets, sorry comrades, outcomes. Outcomes are not targets in the same way that commissioning is not fundholding.

It will include a focused set of national outcomes determined by the Secretary of State against which the NHS Commissioning Board will be held to account . . .

Focussed, national outcomes all new words for new central Soviet style “targets”, sorry outcomes?

Onto “Developing and implementing quality standards”.

Listen to this one comrades:

Progress on outcomes will be supported by quality standards. These will be developed for the NHS Commissioning Board by NICE . . .”

So no moron medicine here directed by politicians just “real world” science modified by “evidence-based” medicine “politically influenced” by the “independent nice people” at NICE.

NICE expects to produce 150 “standards” = targets or outcomes, dumbed down medicine for the thick and they will develop “authoritative standards setting out each part of the patient pathway”.

“Pathway = journey”. More word tinkering “To support the development of quality standards . . . "?

Furthermore “NICE . . . will advise on research priorities”.

We look forward to NICE research on is the Earth flat for this is surely nothing more than political control of the NHS by failed academics wanting a gong?

More frightening is the “We will expand the role of NICE . . .The Health Bill will put NICE on a firmer statutory footing . . .

Za Nu Labour reborn with legal clout? Sound familiar?

Central control on professional thought and independence leading to its being outlawed?

Think outside the new Party (grey) box comrade GP and the jackboot will get you but it will be a NICE and a legal jackboot too.

There then follows another cuddly grey box all about how the new Party thinks one should prevent DVTs and PEs.

Bet they have never spoken to any Coroners that realize that death happens regardless of guidelines followed or not.

However, if a Party puts “guidelines” or “outcomes” or “targets” in place, the Party can prevent all known deaths from DVTs and PEs. Coroners can now safely retire as from now on there will be no DVT or PE deaths because everything will be NICE.

We like the “Patients/carers are offered verbal and written information on VTE prevention as part of the admission process.”

Bet that will frighten off evil Johnny DVT and save countless lives at the cost of a few hundred hectares of Amazonian rain forest and the employment of not one extra nurse on any understaffed ward who might be able to mobilize a patient.

Clearly Marshals ND/DC like NICE as they think that “NICE quality standards will be reflected in commissioning contracts and financial incentives.

Once again no political interference here, comrade, just NICE, simple medicine.

Onto “Research”.

Research has usually been independent of Government so unless you are going to fund it, keep out. DNA and splitting the atom were not discovered by Government or anything NICE.

We now come to “Incentives for quality improvement”. Start rubbing your hands with glee for this surely must be where we, the evil under worked, overpaid GPs find out how much huge wonga wads are coming our way for our additional commissioning work.

The absence of an effective payment system in many parts of the NHS severely restricts the ability of commissioners and providers to improve outcomes, increase efficiency and increase patient choice”.

Does this mean an end to the flawed Soviet style market system where all prices are fixed nationally? Read on:

In future, the structure of payment systems will be the responsibility of the NHS Commissioning Board and the economic regulator will be responsible for pricing.

How are they going to cope, those busy little boys and girls at the NHS Commissioning Board, with it being so much bigger with each paragraph we have read thus far?

A new Department of Health 2 - The Sequel being born? And where did the economic regulator come from?

It is clear that the failed internal market is not dead it is a case of long live the “market” as “money follows the patient and reflects quality”.

Notice the subtle changes in wording so that what was once the NHS tariff is now “a set of currencies”. Does that mean health tourism is to be developed as a new income stream?

But Uri, Sergei come here quickly for para 3.22 tells us how we can make loads of money:

. . . we will introduce a new dentistry contract . . .

We must go away to dental school for if it is as successful as the last one there will be an even greater need for private dentists!

Praise be to the Party for giving us more of the same with different words. This war of liberation seems uncannily similar to what happened at the end of the Second World War in Eastern Europe.

Will our liberation now, be the same as theirs, was then?