NHS reforms

Yes, this is the point:

Campaigners\’ fears are not about pace and scale but about the underlying intent of the proposed legislation. It is clear now that the endgame is to transform the NHS into a system that finances but does not provide healthcare – a national insurance system which pays the bills while care is provided by competing private, publicly owned and voluntary organisations. There is nothing yet to suggest this has changed.

It has long been true that the French system has been ranked as the best in the world by the WHO and similar organisations. The French system is a system that finances but does not provide healthcare – a national insurance system which pays the bills while care is provided by competing private, publicly owned and voluntary organisations.

If we wish to have the best health care system in the world it doesn\’t seem all that odd that we might copy the structure of the best health care system in the world.

And yes, we do know that even the limited amount of competition currently found within the NHS does improve health care.

GP commissioning, seen by many as the heart of the reforms, is the bait with which Lansley hoped to reel in the GPs. Most have spotted the hook, and believe the price they are being asked to pay is too high. They recognise that they will be held responsible for cuts and rationing, and that that will do irreparable damage to the patient-doctor relationship. As one doctor noted: \”Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income? For me it\’s simple, I prefer my GP to remain a GP.\”

Whether or not it\’s the GP who does the business calculations it is true that someone, somewhere, has to do them. One of the faults of the NHS as it is is that no one is in fact doing them. And given Hayek\’s point, that knowledge is local, the GPs probably are the right people to be performing this task: informed, on the spot, probably the best people (other than the patients themselves) to be doing it.

Yes, I\’m sure there will be problems with the reforms, the system is simply too large for there not to be. But the basic idea, the very point of it all, the introduction of more competition and that competition guided by the most informed people within the whole system, seems perfectly sensible to me.

9 comments on “NHS reforms

  1. Knowledge may be local, but people generally want the responsibility for delivering bad news to be as remote as possible.

  2. “If we wish to have the best health care system in the world it doesn’t seem all that odd that we might copy the structure of the best health care system in the world.”

    Admittedly I haven’t been watching this closely but I haven’t seen any Minister or such put it so simply. I think it would *massively* aid the case if they did.

  3. Agreed, French hospitals are clean, which is an advance on the NHS. But I’m not sure that replacing a monopoly health care provider with a monopoly insurance system is quite as progressive as you think, Tim. Here the monopoly insurer has an abyssal deficit, abuse of prescriptions is rampant, costs are out of control.
    Obamacare seeks to imitate the French system, and the polls show that the richest, healthiest most informed population in the world doesn’t, on balance, want to go down that road.

  4. Australia has a system like the French one in which the government pays but does much less provision, and Australian healthcare is much better than the NHS in the UK. (And yes, it has many of the same problems described by blokeinfrance).

    However, the GP situation is where an NHS type system is at its very worst. Attempting to register with a GP practice in the UK is entering a weird Stalinist nightmare. In Australia, it feels more like being a customer of any other small private business. This is much better.

  5. Have you checked out the comments on that link? What a terrifying array of ignorant (and offensively ignorant) wibble! How can one debate policy when those who care most strongly are determined not to know anything about the real nature of the systems in various parts of the world?

  6. This statement is of course ridicule:

    “Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income?”

    Business people try to maximise cash flows (or actually NPVs) and they know full well that to do that you have to treat your customers well. Cause if you don’t treat them well they’ll go somewhere else. So it’s not about minimising costs and maximising incomes but about maximising the trade-off between the two.

  7. “In Australia, it feels more like being a customer of any other small private business. This is much better.”

    Well it did, but they are about to introduce fundholding here too, so beware.

    “Business people try to maximise cash flows (or actually NPVs) and they know full well that to do that you have to treat your customers well.”

    Well sort of, but given that the customers have no idea how much the health care costs, and doctors and nurses are often just as ignorant (I have seen the raw data where staff were asked to cost evrything from CTs to plasters), there is no way that the current system can allow the invisible hand to work effectively.

    It’s actually the PATIENTS not the doctors who need to be making the decisions.

  8. GP’s at the moment are businesses and spend their time maximizing their income.

    Jacky Davis rants on doctors.net as well. Just ignore.

    This is the shreaking of people who see their power being transferred to the patient.

  9. Prior to 1948, and in the first 25 years of the NHS, most morbidity was caused by the old infectious fevers – TB, scarlett fever, blood poisoning and so on. After the war the demand for health care related mainly to the prevalence of such fevers, and antibiotics proved a cheap and effective way of satisfying that demand – without the existence of a price mechanism to match supply and demand. However, as the fevers were overcome, scientific advances and new expensive treatments for previously fatal afflictions (eg Cancers) created new demand. Now governments were in a bind – no cheap antibiotics existed for the new demands, no price mechanism existed to control demand, and taxpayers would not fund the insatiable demand for ever. So the search started for structural ways of controlling costs. It started in 1974, went into the 80’s (Rayner etc), the 90’s (fund-holders, NHS trusts), into the new millenum (Foundation Trusts, PCT’s) and now GP consortia. None of these worked nor will work. The public see the NHS as a free good, demand will continue to rise if treatment is free at the point of use, and the costs will rise also. The introduction of more private providers might slow the rise in costs – but will not halt it. I am pessimistic about the future. There is no political will to go for a ‘priced’ system. The best I can see is a shrinkage of the NHS to a core tax-funded service with everything else privatised.

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