NASTY SECRET PLAN BY THE NHS

Patients are being denied appointments with consultants in a systematic attempt to ration care and save the NHS money, The Times has learnt. Leaked documents passed to The Times show that while ministers promise patients choice, a series of barriers are being erected limiting GPs’ rights to refer people to consultants. The documents reveal that health trusts across London have drawn up plans to establish panels that will “monitor” how many patients are referred to hospital by GPs. Local health trusts have been told that they must cut GP referral rates to those of the lowest 10 per cent nationally. This, the document claims, would save 25 million pounds a year in the capital. Consultant-to-consultant referrals are also being limited, in many cases denying patients a second opinion.

Patients who use hospital accident and emergency units to obtain care that could be provided by GPs are also targeted. Emergency care practitioners in A&E departments will “redirect” 40-70 per cent of patients back to GPs or walk-in centres. Hospitals that treat people who ought to have been sent to their GPs will not be paid.

It is not known how many similar schemes are in existence, but the British Medical Association has confirmed it has found examples in Kent, Oxfordshire, Dorset, Wiltshire, Surrey, Sussex, Cornwall, Shropshire, Suffolk, Lancashire and Yorkshire, as well as London. The draft paper, headed Pan London Demand Management Arrangements 06-07, says that Hammersmith and Fulham has found that a fifth of consultant-to-consultant referrals are “clinically not necessary”. Matching that across London would save another 7 million pounds, the paper says. But the bureacracy needed to screen all the referrals will itself cost 1.6 million. The London paper says that primary care trusts (PCTs) which cannot demonstrate that their referrals match the lowest 10 per cent nationally will be required to help to set up “review panels” in dermatology, ear, nose and throat, gynaecology, ophthalmology, rheumatology, trauma and orthopaedics.

These panels will review referrals by GPs, and cut them back. What this means is that patients will be denied appointments that their GPs believe they need. The language of the document makes no pretence that this will improve care, and emphasises cost savings throughout. “It is imperative that London balances its books overall,” the first paragraph says. It also indicates that the measures proposed are “the bare minimum that we expect all PCTs to be doing”. Urgent consultant-to-consultant referrals will be audited. “All urgent clinical referrals found to be clinically inappropriate will not be paid for by the PCT,” the document says.

The BMA yesterday condemned such schemes. Hamish Meldrum, the chairman of the association’s GP committee, said that they left patients in limbo, with no one clear where the responsibility lay if the condition worsened or the patient died. Jonathan Fielden, deputy chairman of the BMA consultants committee, said: “It’s clear that clinicians don’t know how these referral management systems aid improvements in clinical care. To them they are purely cost-saving. “The way they work is not transparent or clear. If clinicians don’t know, patients cannot know either. That certainly flies in the face of the Government’s Patient Choice agenda.”

Hospitals will also be penalised for the common practice of admitting people who have waited almost four hours in accident and emergency departments without being dealt with — thus avoiding the four-hour A&E target being breached.

More here






DOUBTS ABOUT THE MASSACHUSETTS BRAINWAVE

Post lifted from Claremont

The New York Times reports that Massachusetts Governor (and 2008 presidential hopeful) Mitt Romney is set to sign a bill that would make his state the first in the nation to offer universal health care. “The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.” Fortunately, we are assured by a Brandeis professor quoted in the piece that “‘It is not a typical Massachusetts-Taxachusetts, oh-just-crazy-liberal plan.’” What is the new mechanism, then? “Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it.”

But that’s not all. “The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all.” So, Massachusetts residents will be forced to buy insurance, the price of which will be set for them, based on what the experts think they should be able to afford, with government subsidies to cover the rest. In short, another bureaucratic scheme just waiting to be taken advantage of.

And what about the hospitals and drug companies? Will they be re-staffed with saintly folk devoted to public charity? Certainly a lot of people go into the health care system out of a sense of good will to care for people. (Well, that and the God-complex, the money, and the women, but let’s stick with the good will for now). In the end, it's a business like any other. It may be crass, but if there are no incentives in that business, the quality of care will go down, the research for cures will decrease, and ultimately, more people will suffer.

The larger question is: when did it become government’s responsibility -- or for that matter, my employer’s -- to see that I have health insurance? Why not home-owner’s insurance? I have a “right” to shelter as much as health, don’t I? And how about some car owner’s insurance? Heck, why not a car? I mean, how else am I going to get to work? In fact, why doesn’t my employer or his government-appointed representative come over in the morning to make me some breakfast (Brian: I like to start the day with some cottage cheese and fruit). After all, it is the most important meal of the day. Should I be taxed if I jeopardize my health by skipping breakfast? Only time will tell.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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