British government rats to desert a sinking ship

Buckpassing on a national scale proposed

A top NHS strategist called yesterday for Government control of the health service to end so that it could be run by an independent body. Brian Edwards, Emeritus Professor of Healthcare Development at the University of Sheffield, and a former chief executive of a major NHS authority, said the treatment of the NHS as a political football had a negative impact on staff morale, decision-making, recruitment and doctor-patient relationships. The health service was also in danger of being "encased in political ice".

Gordon Brown, soon to take over as Prime Minister, is understood to be keen on the idea of removing the health service from political control, after his much-praised move to give the Bank of England control of interest rates. He has said he will make the NHS his "priority" and there has been speculation that he intends to replace the current Health Secretary, Patricia Hewitt, who has suffered much criticism.

Prof Edwards said that anything that took up almost nine per cent of a country's wealth was never going to be free of political influence, but the current NHS structure was unsustainable and change by the next prime minister was "essential". In a 72-page report commissioned by the Nuffield Trust, an independent health policy charity, Prof Edwards said that with the establishment of foundation trusts - which are independent of Whitehall - the current structure of the NHS had already altered fundamentally. "It is time to give the leaders of the health professions room to move the system. Ministers can never escape their ultimate responsibilities for the health of the people of the UK and creating more space for the NHS to modernise will require an act of great political courage and wisdom."

Labour and the Tories are looking at how much ministers should be involved in running the NHS. Kim Beazor, of the Nuffield Trust, said: "This report reviews the options available for alternative systems of governance that have so far escaped analysis. The Trust commissioned this project to move the debate on to neutral territory." He said the Government was used to developing regulatory structures for organisations such as the BBC and postal services and it was now time to look at the NHS. "With a new Prime Minister about to enter Downing Street, it seems likely that the issue of NHS independence will once again be on the agenda, and we hope this report will help ensure a balanced and rational debate," Mr Beazor said.

Last night Andrew Lansley, the shadow health secretary, said the Nuffield Trust report put fresh pressure on Mr Brown to declare his plans for the NHS. Mr Lansley said Mr Brown appeared to have "gone cold" on giving the NHS more independence. "As this report illustrates, we need to combine greater day-to-day freedoms and better outcomes for patients with a robust accountability structure."

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Australia: Wait for elective surgery getting longer

WAITING times for elective surgery have jumped, with patients nationally now typically having to wait more than a month before receiving the treatment they need -- and in many cases nearly a year. Median waiting times for patients admitted to hospital from waiting lists have been creeping up since 2001-02 by one extra day each financial year, reaching 29 days in 2004-05.

The latest nationwide hospital statistics, published today by the Australian Institute of Health and Welfare, show patients needing elective surgery had to wait a median of 32 days in 2005-06. This means half of the patients waited 32 days or more. Waiting times are blowing out on some other measures too, such as the time needed to get 90 per cent of patients admitted. In 2005-06 this was 237 days, up from 217 days a year earlier, and 44 days more than in 2003-04.

However, the Australian Hospital Statistics 2005-06 report found a lot of variation between states and territories. Queensland took only 127 days to see 90 per cent of the patients, whereas the ACT took more than a year, 372 days. The ACT was the worst performer on elective surgery waiting times, with 10.3 per cent of its elective patients waiting for more than a year.

Of the states, Tasmania performed the worst, with 8.7 per cent of elective admissions taking more than a year and 90 per cent of patients seen within 332 days. The Northern Territory was next (7.7 per cent waiting for more than a year, and 313 days needed to see 90 per cent of patients), followed by NSW (5.4 per cent and 291 days). However, the proportion of patients nationally having to wait more than a year fell slightly - from 4.8 per cent in 2004-05 to 4.6 last year.

A spokesman for ACT Health Minister Katy Gallagher said the territory's median waiting figures had increased due to a policy of targeting patients facing extremely long waits. An extra 94 patients who had been waiting two to three years had their operations in 2005-06 and the "additional throughput" had affected median waiting times. A spokesman for the Tasmanian Government said the biggest hospital reforms in the state's history, including plans for an elective surgery hospital, had been launched. A spokeswoman for NSW Health Minister Reba Meagher said more elective surgery was being done than ever before, and only 66 people had been waiting longer than a year for elective surgery - down from more than 10,000 in January 2005.

John Dwyer, chairman of the Australian Healthcare Reform Alliance, said long waits cost the system more because patients often required expensive drugs.

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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?

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