Saturday, 23 April 2011

The market, university education and the NHS.

This week it was announced on one of the evening news bulletins that most universities will be charging the maximum allowed by the Party for university tuition fees of £ 9,000 per year. According to the figures in this piece 75% of universities will be charging the maximum.

This is interesting as one minister said that the higher figure would only be charged in “exceptional circumstances”. Another one thought that about £ 7,000 would be the norm with maybe only the Oxbridge universities would be the exceptions.

It is always nice to see politicians come unstuck with their policies and certainly there was outrage in a bit of southern Northernshire when shortly after Oxbridge announced they would be charging the maximum for a mediocre education a former polytechnic now promoted to a university announced that it too would be charging the maximum for something far superior.

This is not too dissimilar to what is going on in the health service which is being reformed by the same politicians who have overseen the university fee changes. They too have set a maximum fee for medical treatment but in this case there is less leeway for there is only one price so patients will not have to haggle over cost for healthcare will be “free”.

Instead the only “market” choice in healthcare for the “consumer”, an alien word to those us that still treat patients, will be the place of treatment and its quality.

Now if the price is the same, as it will be for most universities and healthcare providers, then the “choice” of place of learning/healthcare might be a factor in “consumer” choice.

For most people who want a serious education you would want the best university for your chosen subject or child so Oxbridge would probably be high on ones wish list certainly way above a former Northernshire polytechnic. This will not always be the case (in education) for some universities/polytechnics provide very specialised specific courses which others do not.

Now admission to a given university is usually via an admission procedure and based on academic criteria and interview and of course will not be based on ability to pay. You can apply to any university as long as you can afford the tuition fees and to live.

You will not be able to “apply” to a hospital in the same way that you as an individual would apply to a university but in both cases the cost of your “care” has been fixed by the Party.

So if “choice” of location is going to be consortia decided, overseen by the NHS Commissioning Board et al, and the price is fixed then the only real thing the NHS customer is going to get to choose via NHS “Choice” is “quality”.

So if say you do a history degree at Oxbridge for £ 9,000 will the quality of the education/healthcare provider you get there be the same as a history degree at a former Northernshire polytechnic/healthcare provider that also charges almost £ 9,000?

In other words will the fixing of price in education/healthcare lead to similar outcomes between say Oxbridge and the former Northenshire polytechnic? If it was your child who was going to have to find the £ 9,000 per year of fees as an investment where would you rather they get their education?

Ask now the same of your healthcare.

If the price is fixed, your NHS “Choice” consortia limited and your only choice is “quality” then where do you get the best healthcare and can you, or will you, be able to do so?

The market has worked well in education with the consumer paying more so will a similar fixed price market improve access, quality and drive down costs as per education?

Given that prices for education and healthcare are fixed then if education and healthcare are meant to make a profit how can a fixed price market generate a profit whilst maintaining quality?

Something will have to give. Price (fixed), location (fixed) and quality (variable).

Can you guess what will change for the better?

Praise be to the Party for pushing on with reforms whilst listening. It seems that in education the market has not listened to the politicians. Will it do the same in healthcare?

After all education has become “more” available and “affordable” to more people as a result of these reforms, hasn’t it?

Wednesday, 13 April 2011

NHS theorems for beginners.

The British patient does not like paying for anything.

The National Health Service is free.

Ergo the British patient is happy.


The British patient believes they have the best health service in the world.

The British patient is ignorant but believes this because their healthcare is free.

Ergo the British patient is happy.


The British public understand the market.

If it is cheap at a supermarket they will buy it even if they don’t need it.

If healthcare is free at the point of delivery the British public will use it even if they don’t need it.

The British public understand the NHS market.

Ergo the market works for politicians.


Politicians believe that the National Health Service is the best in the world.

The British patient is ignorant but believes this because their healthcare is free.

The Politicians know better for it is too expensive.

Ergo reform is essential.


Politicians know nothing about healthcare.

They are therefore best placed to deliver healthcare.

They believe reform is essential and believe it works.

Ergo more reform is always essential.


For those of us in healthcare what is QED?

Quite Extensive Destruction by those who know nothing about healthcare.

The patient gets healthcare for free but the healthcare worker gets shafted by each successive group of politicians. Absolute power corrupts absolutely therefore politicians can succeed with numerous reforms which deliver what?

Quite Extensive Destruction of that which works at the expense of public service to service pockets' politic at the expense of the taxpayer for management costs rise while health service provision falls.

Praise be to the Party for all of their misguided politically driven reforms. Imagine if these idiots ran a Formula 1 team. Where do you think that team DoH would be after all the miriad of changes? The best team in the world or driving in different directions for each race they enter while still trying to win something?

Are we having a pit stop now?

Friday, 8 April 2011

More Orwellian porcine equality.

One of the old Party’s great white elephants that it has bequeathed to the British public that is neither use nor ornament is the idea of the national Summary Care Record (SCR). The idea is that there would be a huge but “secure” summary of everyone’s medical record available to a selected few million plus (bureaucrats) at the touch of a button to preserve patient confidentiality.

If you were unlucky enough to have a cardiac arrest in some unknown ‘hood in the UK then while you were lying unconscious and rapidly approaching the reaper’s scythe, the caring medical team would find your wallet and immediately find some form of ID. Those caring for you (robbing you?) would have achieved basic cardiopulmonary resuscitation (CPR) at this stage and then they would then proceed with no delay to advanced Party CPR.

They would reach for their own personal life saving NHS Smartcard and rapidly log on to the computer by your side in the street where you happened to have collapsed and (in a mere matter of minutes) find your SCR.

Having found out all about your past medical history, drugs, allergies, address and telephone number all of which are essential before any medical professional could access the how to do CPR protocol on the same street side computer (what a marvel NHS IT is when saving lives) and only then could any Smartcard enabled individual start to do something useful such as save your life.

Given that our staff frequently cannot access anything Smartcard enabled service for hours at a time let us return to the real world. Fortunately not all of us live in Holby City, or work in the BBC Doctor GP practice, and if you were to have a cardiac arrest at ND Central you would not be treated by accessing a protocol or your SCR but by people who were trained and knew what to do without the “benefit” of either. They also know where to place a Smartcard for maximum patient benefit in such a situation.

The benevolence of the Party extends to applying the well known Orwellian pig principle to all who were to be allowed to opt out of the SCR and we were told that important people like Tony Blair would not have their records accessible to Jo or Josephine GP or a drug addicted clerk in a PCT typing pool. A little article shows that the new Party has had a little rethink and you can read about it here. The comments underneath are quite good too.

It would appear that a new super race are to be extended the politician’s porcine privilege of being SCR invisible. Now who might you ask are these? MI5 and 6 operatives? Undercover police officers? Other people whose work places them in life threatening and dangerous situations which might lead to them being targeted by international terrorists or criminal gangs? Teachers? Magistrates? High Court Judges?

Well according to the article only a mere 2000 people are currently considered Blairly important enough to be “flagged” but that number might soon increase for the new super race are none other than . . .


Thank God that Jedward will be afforded the same security as the blessed Tony Blair while poor Professor Hawking’s medical record will be on public display.

The comment at the end by a GP that

“The need for politicians and celebrities to opt out of the care record demonstrates that it remains the chocolate firewall of NHS IT.”

is we think understated for a bar of chocolate would hold more water than the security of the NHS SCR sieve with its million plus holes.

Praise be to the Party for once again demonstrating its commitment to extending porcine equality to all pigs it serves and for value for money in procuring white elephants.

The Americans said they would put a man on the moon (and bring him back too!) within a decade and did. How long has the NHS computer system been in the delivering nothing useful stages and at what cost? Recession anyone and possible savings?

Tuesday, 5 April 2011

Unfair taxes and the myth of a “National” Health Service.

For most people in the UK there is the myth of a National Health Service when in fact there are 4 nation’s worth of health services. This subtlety is wasted on Jo Public for as long as they get to see a doctor for free they cannot be bothered (ar*sed) by the politics.

One of the first NHS charges to be introduced was the prescription charge and one of the team who is quite old remembers hearing a doctor talk about the early days of the NHS when everything was free saying that doctors would actively conclude with patient’s requests for medicines because no-one had to pay for anything then. The story we recall was someone asking for a bandage for a limb injury and then because this was a common injury could they have 9 more just in case and the doctor said they used to give in.

An item on the BBC News reminded us of the fact that English prescription charges will go up to £ 7.40 per item from the 1st April this year while in the other 3 nation health services you do not pay the tax.

However how many people actually pay the tax? The BBC report says that 90% of prescriptions are dispensed for free anyway and from memory this has in one of our professional lifetimes increased from 80% to 85% so 90% was an eye opener.

So who doesn’t pay? Well the 19% of the population under sixteen and the 16% per cent over 65 (should be 60 and over) eliminates at one fell swoop at least 35% of the population. Add in those on low incomes, those on benefits of various types, those between 16-18 in full time education, those with certain medical conditions and pregnant do not and the number available to tax falls very rapidly indeed.

It is a very fair tax as the full time GP writing this is exempt from the tax while the medical students with us with huge debts in their final year are paying it. No tax is fair but clearly some taxes are fairer than others based on the ability to be charged not on the ability to pay or on clinical need. We are sure this was one of the NHS founding principles.

We are currently being governed by a Party committed to a “market” of some description in healthcare but do those who pay the prescription charge get a free market choice?

The answer is an emphatic No you don’t for two good reasons.

One you get no choice as to where you can get your NHS prescriptions dispensed. You can take it to any NHS pharmacy pay your tax to the Government tax collector, the pharmacist, who then pays the Government and you get your drugs.

Reason two is because this is a State monopoly the price is fixed. We are grateful for some colleagues who work in a dispensing practice for the following prices which we have rounded up to the nearest 10s of pence.

Suppose you have a chest infection and are given a prescription for an antibiotic called Amoxycillin for a week you now pay £ 7.40 for your treatment. The pharmacist can buy the drug for £ 0.40 wholesale.

Now let us say the chemist could do as used to be done add 100% mark up and a £ 2.00 dispensing fee to cover the costs of bottles, labelling, staff etc. you could push the cost up to a hefty £ 2.80 as a commercial transaction but for the Party this is a steal at a mere £ 7.40.

Supposing you have a heart condition and are on the following drugs: Aspirin, Amlodipine and Simvastatin the wholesale cost of all 3 would be about £ 1.80 but the Party will be screwing you for £ 23.20 a month although you would if you have more than 2 items per month be better off with the prepayment option which comes from this website site euphemistically called NHS Business Services Authority or should it be the State Servicing its own Business Authority?

Many years ago doctors in some parts of the UK used to write private prescriptions for their patients so that they could get the same drugs cheaper than the then prescription charge. Now no Party, however benevolent it is to its tax payers, likes losing revenue currently about half a billion creamed off the 10% of prescription charge taxpayers (like our medical students) and they made it so that if you as a doctor treat a patient under the NHS you have to issue them with a NHS prescription regardless of the cost of the drug.

So GPs who know the cost of drugs (look at your doctors prescribing screen where wholesale costs may pop up) are actually issuing patients with expensive prescriptions for a few pence worth of drugs. We like the NHS free market here at ND Central it is so fair and free just like the NHS Internal Market.

Jo Stalin’s boys in all political parties have kept the red flag and Soviet market system going in all its glory for the benefit of those 10% in England allowed to pay this tax.

So if next time you pay for your NHS prescription why not ask your pharmacist how much the drugs actually cost to buy and then ask your MP to explain the “market” within the NHS. Go on have a laugh there could even be a competition for the best MP’s explanation.

If any of them understood it in the first place.

Praise be to the Party for unfair taxes, the truth about the “National” Health Service and “free” market economics. They are all so good at all three.

Monday, 4 April 2011

A letter from a Party organ and maybe the future?

In amongst the 1500+ letters we get a week here at ND Central one of the team noticed a missive from one of the few ISTC (Independent Sector Treatment Centres) in our neck of the woods. For those who have missed it, these are private hospitals which provide elective surgery for uncomplicated NHS cases and consume huge amounts of public money, are underused and have higher complication rates than normal NHS hospitals. You can read about them here in their own words or another view is here.

It was concerning the “Aftercare Service”. This “service” was currently provided by nurses who did 3 home visits after certain types of surgery to remove stitches and change dressings. The missive said that the Party organ had found that this was no longer cost effective.

Let us read on further into the Party organ’s edict for it reads that to make the “service” more “efficient” and “cost effective” those treated at the ISTC will now be “invited” to attend a clinic at the ISTC which is many miles away from ND Central to have their stitches removed and dressings changed. As a Brucie bonus if those so invited attended they will be rewarded with some dressings to change using a self care protocol.

In the extremely unlikely event that some comrade patients feel that a 60 mile round trip is too far then the punters (sorry patient or is it clients now?) MAY be offered transport (cost effective?) or a (cost effective?) home visit MAY be arranged and (can you see what is coming yet?) in an exceptionally rare and highly unlikely scenario the punters may be asked to travel the few hundred yards to their GP surgery.

Wonder which one of these options most non paying patients will take? 60 miles of petrol versus a few hundred yards surely “market forces” will determine patient “choice”?

Private sector dumping on the NHS to maximise profits surely not? Or possibly the start of the thin end of a very long wedge whereby those in the private sector already cherry picking patients are now also discharging their clinical responsibility in the interests of a “more efficient and cost effective service”.

Praise be to the Party for providing GPs with a level playing field which whenever there is extra work to be dumped always leans towards the GPs’ and their staffs’ direction. The White Paper we are sure will put an end to such practices won’t it? In the same way that these world-class commissioned ISTCs won’t be able to weedle out of their robustly commissioned contracts.

Sunday, 3 April 2011

Intelligence and shopping - a curse or a blessing?

Spring in Northernshire comes a week or two later than it does in the enlightened South where our political masters reside and determine those of us less able’s futures. In General Practice one notices that the great poikilothermic mass of Old Age Pensioners who can never get to surgery in the winter for it is “too cold” (to leave their centrally heated urine smelling homes and traverse the polar ice cap of some 3 yards of clear tarmac to a relative’s over heated car) start to emerge in the spring sunshine and venture forth from hibernation to attend the surgery.

This is presumably because with the sun being up earlier they can sit on their rocks and warm up enough to move in the same way that on a spring day they can venture forth in full thermal Womble wear to local shopping malls where they will collapse in droves and be transported to A&E departments across the land due to self inflicted overheating induced vasovagal episodes (faints).

Now GPs are not immune to seasonal trends and one of the team was forced to go to a garden centre full of thermally clad Wombles being wheeled or walked on their turbo charged wheeled Zimmer frames by their children and grandchildren (it was remember the day before Mother’s Day) to whom they were dispensing many words of wisdom like “I am sure they had pigs here once” (in 1942) and

“Is that a rose?”

“No mother it is a Primrose.”

“But it says it is a rose.” (the sooner that cataract is done the better).

This sortie was not of our making and we were dependant on our pilot who suddenly decided they wanted a device for a garden hose and they dispatched one of the team to where they thought it would be located – it wasn’t. So another sortie was ordered back to where we had just been 20 minutes earlier in order to locate a few pence worth of hardware which under orders we did.

The helpful but cigarette smelling young person found the hardware and told us the price £ 0.50 and we joined the queue at the checkout. Here intelligence was a curse for the next 5 minutes was unbelievable.

The husband and wife team in front, older than the ND team member, were paying with cash in the form of small change and dealing with someone younger than the ND team member. The 5 coins were clearly visible to our team member as was the one note and mental arithmetic was done in a second or two.

Not so for the 3 people in front who came up with 3 different amounts - the correct one, one which was 5p too short the other was 45p too much and they then had to re calculate several times until all 3 finally agreed after several minutes that the correct amount had been tendered.

Then the team member approached the Pythagoras of the garden centre and handed the piece of hardware to them which was met with a blank face and the expression “Where did you get this from?” (Good start).

“Directly behind you.”

Long pause as they looked at the box where the hardware had been procured from and then asked “How much are they?”

We knew the answer and said nothing having seen what had gone before. Pythagoras looked at the box where the hardware came from and said “99p” even though nothing was on the front of the box the price was on the back.

We paid and exited ASAP. The thought of having to explain the difference between 50 and 99p to Pythagoras and a quick mental calculation of time spent multiplied by the national minimum wage meant that anyone would have lost money to try and save a few pence.

Praise be to the Party for universal education which means that both the young and old cannot do money or maths. But then those with the benefit of a private education cannot either hence our current economic status and that of the NHS.

Still at present Pythagoras doesn’t have to worry about healthcare or money to buy it. If he did who would be quids in? Pythagoras the patient or the provider?