Future Prime Minister Gordon Brown can’t cure Britain's paralysed NHS, so he plans to privatise it

The former Granada boss Sir Gerry Robinson recently spent six months trying to reform Rotherham general hospital. The result was shown in three hours of fly-on-the-wall television on BBC2 last week. It was rightly put after the watershed: as politics it was certificate 18. At the end of each day Robinson could be seen slumped in the back of his car, his face buried in his hands. A tycoon sobbing in a limousine is the perfect icon of Labour’s health service.

So die all who try to reform the National Health Service. They have been doing so since a despairing Margaret Thatcher appointed Roy Griffiths, boss of Sainsbury’s, to the task in 1983. The NHS is the North-West Frontier of the public sector. If the health union Tajiks don’t get you, the Pashtun consultants will. You can throw as many men into the Khyber Pass as you like but they never return.

The one laugh in the programme was Robinson’s conclusion that the NHS was “unmanaged”. Yet each frame was crammed with managers falling over each other, with clipboards, pagers, consultancy reports and meeting agendas. There were nursing managers, surgical managers, recovery managers, manager managers, chief executive managers. The one thing they did not do was manage but that, of course, was not their fault.

Through this jungle wandered a charismatic megaspecies, the consultants, whom everyone agreed were “unmanageable”. They were like the weather, an immutable constant. It did not matter what the NHS or its patients wanted, the consultants ruled, which enabled everyone else to be equally obtuse. They seemed to regard their first duty as to the heraldic privileges of their specialist tribe, be it paediatrician, anaesthetist or ophthalmologist.

We watched the consultants, often in league with “health and safety”, blocking rationalisation of a system that had some of them doing three operations a morning and some seven. They demanded their own anaesthetists, who in turn demanded their own schedules. Surgeons wandered in and out of their private practices as waiting lists stretched over the horizon. NHS productivity would not improve because the fruit machine never yielded oranges in a row. There was always a lemon in the way — unless you were lucky enough to have Robinson and a television camera to move it.

The message of Robinson’s inquiry was devastating and explains the ostensibly terminal chaos enveloping the NHS under Patricia Hewitt. The central arm of government, the Treasury, has clearly given up on NHS reform. No government, Labour or Tory, has the guts to break the consultants’ restrictive practices, the GPs’ “lifestyle” demands or the healthcare unions. The Treasury itself capitulated to the unions by rubber-stamping the ridiculously expensive 2004 NHS pay deal, depriving Britons for the first time of proper out-of-hours GP cover.

After a quarter century of seeing money piling up in the upper echelons of the NHS, and being wasted on management consultants and useless computers, the paymasters have had enough. While Thatcher hoped for reform by shoving the private sector into the NHS, Gordon Brown is shoving the NHS into the private sector. If Rotherham hospital can do only half a dozen cataracts a session when it has capacity for 20 or 30, why not give the job to a bunch of South Africans in a caravan in the car park? Outsource routine operations. Switch a few regional general hospitals to accident and acute care and let the public drive to find them. Hence the decision to subcontract 40% of NHS operations to something called a “partners’ network” (Blairism for the private sector). We can hear a muffled cheer rising over the Thatcher home in Chester Square.

Treasury loss of faith in the corporate NHS has all but collapsed public investment in the hospital service, switching some £12 billion of it to private finance. This will be astronomically expensive, consuming reserves that would previously have gone on healthcare. The new Woolwich hospital must find £100m a year from its revenue budget and the Royal London and Barts £120m to service private loans forced on them by the Treasury in the fond belief that private money is more “efficient”.

More alarming is that internal pricing and payment-per-treatment will leave these mastodons financially exposed through loss of business to the private sector. In an attempt to favour this sector, the Treasury and Hewitt are refusing to allow NHS hospitals to cut tariffs to compete. Small wonder James Johnson, the British Medical Association chairman, parodied Blair’s 1997 battle cry, “24 hours to save the NHS” by saying there was now “one year to save the NHS”.

Many hospital trusts are building up large deficits that they cannot possibly cover; 29 are contemplating some 60 “reconfigurations”, code for closures, at a time when Hewitt is also talking of somehow building 50 cottage hospitals. She must also now contend with 11 of her ministerial colleagues declared to be in open opposition. Meanwhile manpower planning is in disarray, with hiring cuts or freezes almost everywhere and a reported surplus of 3,200 expensively trained NHS consultants by 2010.

How this has been achieved despite five years of 7% annual real rises in health spending is no mystery. A lethal coalition of medical staff and private financiers is walking away with the money. Few demoralised managers will bother to imitate Robinson’s efforts at Rotherham when the lead from Whitehall is to capitulate. Since many trusts are supposedly free-standing — which means bankruptable — it is possible that swathes of the NHS will end the decade in the notional ownership of City banks. Yet even this, for Brown, is preferable to the existing NHS.

The Robinson programme showed what amounted to the collapse of the “public service ethos” in Britain. The government would ideally like to privatise not just the bulk of the NHS but the Post Office, the probation service, the jobcentre network and, it was reported last week, most care of the elderly.

It has clearly lost confidence in the capacity of public officials to administer services (as opposed to regulate and form policy in Whitehall). That this should be the work of a Labour government is ironic since the purpose is to circumvent those classic legacies of socialism: trade unions and the risk aversion of large organisations.

Nothing better illustrates this than the shambles at the Home Office where privatisation is of limited application. Its capacity to administer a service, be it immigration, drug treatment or prisons, has all but failed. Its boss, John Reid, has rewritten the rulebook of corporate accountability. He will take no collective responsibility for the actions of his forebears as home secretary, though he sat in the same cabinet as them. Nor will he take blame for any decision if he can prove he was “not told about it”. Bang goes the theory of corporate negligence.

The catalogue of Whitehall organisations no longer fit for purpose is lengthening by the week. It embraces the farm payments agency, the child support agency, the immigration service and the criminal assets recovery agency.

In the old days such fiascos would have led to parliamentary uproar and heads rolling. Nowadays they are part of the tragic Whitehall soap opera, cause for rejoicing only among civil servants leaving to join management consultancies and parastatals such as Capita and Serco.

It is hard to imagine what morale must be like among officials in the Home Office or health department. Perhaps the public service ethos is out of date, irretrievably polluted by trade unionism and bureaucratic protectionism. Perhaps it is true that only the hope of personal gain will induce Britons to help their fellow men and women.

Source






Australia: A government aged-care hospital at work


Melbourne is at the moment in the middle of one of their notoriously hot summers. But no airconditioning or other coooling for you if you are old and poor and sick there

Airconditioning, lights and radios have been switched off and windows locked with curtains drawn to slash power use at Melbourne's biggest rehab and aged-care hospital. The bans at the 400-resident Kingston Centre were introduced on January 4, as the outside temperature rose to 39C [102 degrees F], a Sunday Herald Sun investigation has revealed.

Kettles, toasters and microwaves also have been unplugged at the sprawling, dilapidated century-old Cheltenham hospital while patients and elderly residents sweltered in the dark. And tougher restrictions -- yet to be triggered under the power-saving regimen -- will see all non-clinical computers switched off, laundry and machinery operation scaled back, out-patients' service closed and at-risk residents sent home or to other facilities. A plan to replace hot meals with sandwiches has been mooted, prompting fears that patients who have difficulty swallowing could be at risk of choking. Staff have told how they found it difficult to find door locks with their keys in the darkness. And patients reportedly stumbled and almost fell in the gloom.

The draconian regimen was exposed after the Sunday Herald Sun saw a directive from centre bosses to department and ward managers, which was sent on January 4, ordering "Stage 1" actions. The directive read: "All managers, please note we are currently at 80 per cent usage of power on site due to the hot weather . . . " Southern Health spokesman Kim Minett confirmed restrictions, but said there were limits to how much electricity use the old building could cope with

Source

***************************

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 Pages are here or here or here.

***************************