Over the last few weeks I have been outlining the nature of the reforms that NHS commissioners will need to implement if they are to transform NHS health care. Last week I explored two different forms of contractual relationships that are being created and will be necessary if there are to be different relationships with providers. Read the rest of this entry »
Filed Under (GP Commissioning, Patient Choice) by Paul on 12-09-2011
Over the next few weeks the Bill will be going through a quiet period, so it’s a worthwhile opportunity to take a different look at some of the highly politicised issues that we discussed last week. Today I thought it would be useful to run through a review that was published in July this year by the Cooperation and Competition Panel concerning how patient choice for any willing provider was actually working. Read the rest of this entry »
Filed Under (BMA, Patient Choice) by Paul on 09-09-2011
Last week’s BMA briefing on the Health and Social Care Bill not only argued their continuing opposition to the Government reform, but demonstrated how much they wanted to move the NHS away from modern society.
In June readers will remember that the Government’s reform of its reforms argued that they would amend their Bill to make it clear that they would outlaw any Health Minister that argued for a change in the proportion of NHS services that were provided by the public sector, the private sector or the voluntary sector. They did this because they had been stung by the accusation that they had a policy of increasing the share of NHS services to be provided by the private sector.
So, true to their principles, they reversed the policy from being one in favour of increasing the size of the private sector to one where you were not legally allowed to have a view on it at all.
This new law would outlaw a policy where a Minister, or Monitor, argued – for example – for a higher proportion of third sector organisation hospices providing services for end of life care. The outlawing of this statement was meant to prevent the accusation that the Government was in some way against NHS public service provision.
If the current state of provision was, say, 30% private, 30% third sector, and 40% public sector then freezing proportions may in some way make sense. But given that for most parts the NHS provides well over 90% of provision, this policy freezes provision in very unequal proportions.
The aim of this new law was to argue that Government could not have a policy of increasing the proportion of care from a sector. However the Government was NOT saying that they would stop individual patients from choosing whatever provision they wanted. So if a large number of patients chose, for example, to move their end of life care from an NHS hospital to a voluntary sector hospice, the government would say this was up to them and not caused by Government policy.
It was not having a policy which would tell patients what to do that has made them fall foul of the BMA. .
At the time I suggested that whilst the BMA and other public sector trades unions would welcome the fact that the Government no longer wanted to have a policy of increasing competition in the NHS, the policy of Government neutrality would not appease them.
They would not rest until the Government had a policy of outlawing the private sector from providing any more services for NHS patients.
Last week’s BMA briefing made it clear that this was now their position.
“ In relation to the increased use of the private sector in providing care, the changes in the Bill put a duty on the Secretary of State, Monitor and the NHSCB not to ‘exercise <their> functions for the purpose of causing a variation in the proportion of services provided by any sector. This does not prevent such a variation taking place as a result of market forces < e.g. patients choosing more providers from a particular sector through AQP- any qualified provider>
The BMA believes that
- Although the Government has attempted to address concerns about the increased use of the private sector, there is still too much emphasis on using ‘market forces’ to shape health services. The Bill still allows for there to be an increase in the use of private sector providers”
BMA briefing page 2
This is a really important explanation of the BMA’s position and it gives us a view of the kind of society that they want to create. It demonstrates how far they are prepared to change the nature of an open society in order to appease their own fear of the private sector.
Since they argue that the Bill is flawed because it “allows for there to be an increase in the use of private sector providers”, presumably a good Bill would in some way outlaw any such increase.
Since the Bill does not ‘prevent such a variation taking place as a result of market forces – for example patients choosing more providers for a particular sector’ presumably a good Bill would in some way outlaw patient choice if that choice was to result in a higher proportion of NHS care being provided by the private sector.
In an open society this is extreme stuff. It is worth a moment’s quiet thought about the sort of society these restrictions would create.
The BMA want a bill that would make it illegal for private sector organisations to provide a higher proportion of NHS health care than they do at the moment. Even more shocking is the fact that the BMA would be satisfied with a Bill that would make it illegal for patients to choose to have their operation carried out by a private sector provider if that movement increased the proportion of provision for NHS patients from the private sector.
In the past there has been much talk by the BMA about their concern that patients are individually not really up to making these choices.
But here it is clear that they are not frightened of the individual capability of patients to make these choices but they are really worried that the overall outcome of making these choices might increase the proportion of private sector providers for NHS patients.
They want to restrict patient choice for directly political reasons.
But what sort of society do they want to create?
Regular readers will have noticed that the relationship between integration and competition is an topic upon which I have posted a couple of times in the last few weeks. In my view all the commentators pointing out the importance of creating integrated care services for the NHS are correct. Read the rest of this entry »
Filed Under (Competition, Kings Fund, Patient Choice) by Paul on 03-06-2011
One of the more interesting aspects of the period that the Government has taken to have a bit of a think about its reforms has been the way in which organisations that have had a long term solution to the problems faced by the NHS have used this space to suggest that their solution can solve its problems. Read the rest of this entry »
Filed Under (GPs, Patient Choice) by Paul on 25-05-2011
One of the most interesting outcomes of blogging regularly is that I am often surprised about what is contentious, and what is not. Last week I discussed some evidence about the outcomes of patients being able to choose their GPs and received a range of different comments, most of which argued against giving the public the right to choose their GP. Read the rest of this entry »
Filed Under (Culture of the NHS, Narrative of reform, Patient Choice) by Paul on 20-05-2011
Over the last few weeks a few people have been surprised to receive an invitation to breakfast – or a meeting – in an embossed envelope. The embossed mark over the flap looks important and, when they open it, most of them will have been surprised and even a little bit thrilled to find it was an invitation to meet with the Prime Minister to talk about the NHS. Read the rest of this entry »
There is quite rightly a great deal of discussion about the public’s need to be active in the prevention of diseases that could ruin or even shorten their lives. It is of course much more sensible to, for example, lose weight before you get type 2 diabetes; or start an exercise programme before you get very depressed. But for many the motivation to do something to prevent the onset of something bad in the future is just not high enough. People don’t believe that it will happen, and given how hard it is to change their behaviour, don’t bother. Read the rest of this entry »
Filed Under (Innovation, Listening Groups, Patient Choice, Reform of the NHS) by Paul on 15-04-2011
In my previous two posts in outlining the arguments against increasing patient choice and the repercussions of that choice in terms of the flow of resources, I have tried to substantiate that, for a few people, there is a strong moral case against NHS patient choice. But the moral case against choice per se goes strongly against the mainstream grain of our society. In England not many believe that the state should tell us what to do in so many aspects of lives – which clothes to wear, and even which school or college to go to. Equally there are not many who believe that resources should be distributed to organisations irrespective of whether people have chosen to use services from those organisations. Most of us feel that making consumer choices – and having resources follow those choices – are a part of the way in which we live our lives. Read the rest of this entry »
Yesterday I attempted to tackle some of the arguments against the extension of patient choice into the NHS. One of the reasons for extending this much further is to demonstrate that socialised medicine, paid for out of general taxation, can provide the taxpayer/consumer with the kind of experience that used to be only available to those that paid privately. Read the rest of this entry »