Ending ‘target-driven’ culture
The last government brought in a raft of NHS targets, such as GPs having to see patients within 48 hours, and maximum of four hours waiting time for A&E treatment.
The Government is abolishing ‘targets’ and replacing them with ‘goals’. Suspiciously synonymous jargon aside,
The focus in targets/goals/aims (delete as appropriate) is shifting rather than talking about lengths of waiting lists themselves, the focus will be on reducing the number of people developing serious cancer – through reducing waiting lists among other methods.
Clearly this is better, because instead of doctors working to get people in and out as quickly as possible to meet targets, it takes a more holistic view on how we can actually achieve what we’re after in the first place, which is better healthier lives.
At the same time, it may mean that waiting lists get longer – the abolishing of the 18-week wait for secondary care last year has predictably led to many patients being left untreated for longer periods.
Whether this will improve health overall remains to be seen.
‘Any willing provider’, or privatisation
The majority of care is provided by the publically-owned NHS. The previous Labour government opened up the NHS to private providers to compete to provide some services.
The Government is allowing, nay, ensuring the broader introduction of ‘other providers’. By that, read private healthcare companies. There is nothing wrong with people who want to spend their money on private healthcare doing so, as long as it doesn’t affect everyone else who doesn’t want to.
The problem is that it will affect other people. Because competition rules and Monitor, the soon-to-be ‘economic regulator’ will force commissioners to buy services from the cheapest provider, irrespective of the quality of service, reliability, accountability, or the social benefits from employing people under the better conditions the public sector allows.
Further, the likelihood is that private healthcare providers will claim the cheaper, easier services – those which balance out the longer, harder and more expensive treatments on the NHS budget sheet. Allowing providers to cherry-pick and offer loss-leading prices to undercut public bids will ultimately leave only the loss-making services to the NHS – and they will inevitably go bust. And as the coalition government have made clear, there will be no bailouts.
For all the talk about ‘NHS bureaucracy’, we’ll be transformed from having a few hundred bureaucratic organisations to many more several times over (151 PCTs to be turned into several hundred ‘consortia’).
GPs will now have to do the administration, or more likely pay someone else to take on the administration of commissioning. Commissioning already sucks away 14% of NHS money, before you even take into account likely increased costs of more wide-scale commissioning.
The ideological desperation to wrench private healthcare companies into the NHS means that not only will GPs be obliged to commission from private companies, as stipulated by a new quango being set up for the purpose.
Healthcare companies will be able to lay claim to infrastructure such as hospital beds, being able to compete for the most cost-efficient services with loss-leading undercutting, while leaving the loss-making services in NHS hands. If hospitals go bankrupt, there are no bail-outs. Meanwhile, privately-paying patients will effectively be able to jump the queue over those using the facilities on the NHS.
There is little or no democratic accountability, with responsibility for scrutiny more or less disappearing at local authority level, and being whisked away to suspiciously vague consumer organisations and boards, whose membership is yet to be defined.
Cameron’s right to term his coalition government as ‘radical’ – they’re radically dogmatic. It’s a scary mix of incompetence and blinding ideology that’s driving them. They are forcing a top-down reorganisation of completely untested proposals, against the wishes of most – without even bothering to stop and see if the model works.
There is a fundamental, or some might say deliberate lack of understanding about how public services work.
The whole point about public healthcare is so that it is regulated and uniform, so that everyone receives near enough the same service. Of course it will never be totally identical or meet all our aspirations – because after all the NHS is run by mere fallible humans trying to meet possibly endless demands with finite resources.
However, the aspiration that founded the NHS was access to healthcare regardless of background and wealth. And these plans seek to contravene this very principle. Even right-wing voters won’t countenance the privatisation of two key services – the NHS and postal services – so the coalition are going about doing it in the most surreptitious of manners. We’ll have a completely devastated healthcare service with the trustworthy NHS logo plastered over it.
Disturbingly the whole saga is masked in the Orwellian newspeak of ‘choice’. While this is a worthwhile aim in general, it seems a distraction. Two points; upon having a medical emergency, no one I’ve spoken to wants to spend several hours trawling through the new published reporting doctors will be forced to do, to then be offered every possible treatment to pick from. Requirement for healthcare isn’t usually like picking cereals in the supermarket – otherwise we’d all be qualified physicians.
Secondly, the need for ‘choice’ is rendered irrelevant if difference is eliminated and we have good immediate and accessible healthcare for all. Government shouldn’t be encouraging difference but attempting to equalise it as best as is possible.
Meanwhile, the pre-election promises of ‘cutting the deficit, not the NHS’ ring hollow when experts show that the paltry 0.1% increase in budgets amounts to real-terms cuts when you take into account inflation, increasing demands on services, and the rising cost of medicines and treatments.
The whole thing is a shambles, and more and more people are beginning to recognise it. The bill will, of course, carry with the government majority – but it will be a few years when hospitals begin closing down, and people aren’t able to access the care they need because it’s deemed to expensive or luxurious to be provided by the new people running the system.
All I can say is be afraid, and for God’s sakes, avoid getting sick.