Monday, 16 August 2010

Liberating the NHS: some thoughts on the Great Patriotic White Paper 005 of 007.


Well fellow comrade GPs we are now engaged in a war of liberation for “our” NHS. The nights are starting to draw in, and temperatures are starting to drop up North, but still our all wise and knowing Marshals NC/DC shall ensure our victory in the Great Patriotic War of Liberation of the NHS via that most powerful of weapons the White Paper.

Let us mount up and rally onto chapter 4 “Autonomy, accountability and democratic legitimacy”. More stirring words of freedom for all NHS comrade workers from our leaders. Read on.

The Government’s reforms will liberate professionals and providers from top-down control”.

Fantastic we can stop reading and go home and do our job for the first time in 13 years.

Sadly no for we are due “Greater autonomy . . . matched by increased accountability . . .”. More regulation anyone?

Onto “GP commissioning consortia” which we think are the ConDems new version of multifunds which arose during fundholding - the prequel to Commissioning the Movie III outlined in the next few paragraphs.

Lots and lots of buzzword bingo words follow like “patient pathways”, “clinically-led”, “. . . crucial role that GPs already play in committing NHS resources through their daily decisions. . .”.

Is that the same as GPs treating patients?

Our model is neither a recreation of GP fundholding nor a complete rejection of practice-based commissioning.”

Is that the same as the previous Party’s commissioning is not fundholding idea for “Fundholding led to a two-tier NHS; . . .” but the ConDems version will not cause this as all GP Consortia will be created equally good comrades?

Another cuddly little grey box follows full of La La land happy thoughts and oh look the NHS Commissioning Board has yet another job to do.

A number of PCTs have made important progress in developing commissioning experience . . .”.

Quite right comrade Marshals. NHS management has increased at a far greater rate than frontline healthcare provision and we suspect will continue to do so at an exponential rate from what we have read thus far.

Primary care trusts will have an important task in the next two years in supporting practices to prepare for these new arrangements.” We would like to think up North that this important task would be to disappear completely but we fear this means that the idiots running the current local healthcare system will lose their jobs at the local Soviet and some will be reemployed via GP consortia.

Comrade workers paragraph 4.9 must reassure all those fighting the liberation war for the NHS as it says “The final shape of these proposals will depend upon our consultation findings . . .”.

We all know that consultation means the decisions have already been made.

Now comrades we must not be dehumanised or brutalised by the fight to liberate the NHS for just working for it does the same so let us move onto “An autonomous NHS Commissioning Board”.

You can skip the next few paragraphs as it sounds like the reinvention of the Department of Health by another name despite another cuddly grey box and the rather worrying words “It will not manage providers or be the NHS headquarters”.

It will just “ . . .hold GP consortia to account for their performance and quality”.

Worryingly is the start of “Establishing the Board and managing the transition” section which starts with the words “The Board will be established in shadow form as a special health authority from April 2011 . . . it will be converted . . . into a statutory body . . .and will go live in April 2012.”

So until this body goes live and NICE has its 150 outcomes what happens to local GP consortia? Well thought through this liberation war looks like the motor has stalled until at least 2012.

The NHS Commissioning Board it would appear will not just be the Department of Health 2 but a SHA (special health authority aka strategic health authority) as well para 4.13.

Look comrades there may be light on the horizon for the next section is entitled “A new relationship between the NHS and the Government”. Could this be one where healthcare professionals are allowed to work free of political interference in order to provide the best for their patients?

Another cuddly grey box follows which outlines the Secretary of State’s relationship with the new Department of Health, sorry NHS Commissioning Board, but we can’t see the words healthcare workers anywhere within this box.

Onto “Local democratic legitimacy”. This predicts the demise of PCTs but more worryingly suggests the transfer of “ . . . PCT health improvement functions to local authorities . . .”.

So the ConDems now see your local council as the new PCTs? Better start looking at the school league tables to see what your healthcare is likely to be like “ . . . the power of the local authority to promote local well being . . .”.

Grammar school good, comprehensive bad? Another cuddly grey box follows outlining the role of your local council, we think, in providing your healthcare. Given that they are probably cash strapped and short staffed can we guess who might just be joining their payroll at no expense to central government?

GPs working with local councillors? Interesting.

We march on across the steppes to the section “Freeing existing NHS providers”.

Autonomy in commissioning will be matched by autonomy for providers”. This can’t be a hint that privatisation via commissioning is about to loom on the horizon of the war of liberation of the NHS? We are too cynical we must return to just cleaning our weapons and let the comrade commissars do the thinking, Sergei.

We are onto a new concept “Our ambition is to create the largest and most vibrant social enterprise sector in the world. The Government’s intention is to free foundation trusts from constraints . . .”.

What the hell is “social enterprise”? We first heard this phrase when we played a video on the most excellent Ferret Fancier’s blog site.

Read para 4.21 for we think mixed left and right wing messages here. Suggests the coalition ain’t got a clue about healthcare.

Economic regulation and quality inspection to enable provider freedom”.

Providers will no longer be part of a system of top-down management, subject to political interference”.

Does that mean we as GPs can do our own thing? Somehow we doubt it for whenever freedom is offered unconditionally it is always followed by loads of conditions. Enter stage right Monitor “. . .the current regulator of foundation trusts . . .” whose sterling work in Staffordshire will no doubt mean some honours going their way.

Combined with added power from the Care Quality Commission whose first leader also had some Staffordshire involvement we know we are talking toothless tiger regulation by whom and for whom?

Who are the providers?

Another cuddly grey box follows about the role of the Care quality Commission. In the same way that a soldier on the ground takes comfort from their weapon and body armour the average NHS patient will be well served by these 2 pieces of NHS Personal Protection Equipment (Care Quality Commission and Monitor)for both should be awarded the Congressional Medal of Honour for their sterling service to patients to date.

Onto “Monitor’s scope and powers”. Mixed messages here some suggesting a possible free market laissez faire approach other hinting at a “market” with regulated prices. A little diagram follows and guess who is at the bottom of the pile? None other than the patients and public.

Onwards to para 4.31 “Valuing staff”.

The biggest cost to any organization is only now recognized with 6 lines of corporate bullshit. Why not just say you are all going to be shafted and ignored rather than use non words like “ . . . staff engagement, partnership working . . . improve staff health and wellbeing.

And for those of us who do not know who Dr Steve Boorman here is a link. Looks a bit like Al Borland from the TV series Home Improvements. You know we are well cultured in our TV watching habits here at ND Central.

The last three bits of section 4 actually relate to things that matter to NHS staff.

The first is “Training and education”. Lots of fine words and again the NHS Commissioning Board has it hands in education. It would seem that there will be “education commissioning plans” which will be “led locally and nationally by the healthcare profession through Medical Education England”.

In case you hadn’t heard of this organization here is a link.

The second is “NHS pay”. Don’t hold your breath regarding any increases or an end to central regulation we are in a recession with crippling National Debt as well. A few woolly words re need to end national control and move to local terms and conditions so no great changes.

The third is “NHS pensions”. If a government doesn’t like something you can bet it will order a review. So the words “. . . ensuring that pension solutions are found that are fair to the workforce in the health service and fair to the tax payer” properly mean we are all going to work longer to get less if we live that long.

Such is the nature of wars of liberation and so ends battle 4.

Praise be to the Party and its war of liberation. Only 2 more sections to go and it will soon be Christmas. Who knows we might then get a banana, or an orange, this year, if we are good little comrade serfs?

We certainly won’t get anything else other than unpaid work from what we have read thus far and our patients? What will their reward be for funding all of this liberation?