Don\’tcha just love Polly\’s logic?

As pressure on the service grows, even the Telegraph and Mail blast away at queues of ambulances stacked up outside bursting A&Es, with emergency admissions up by 35%. The loss of 4,000 nurses doesn\’t look good. Public anger makes closure of A&E and maternity services impossible when beds are full to capacity. Patients waiting over six weeks for diagnostic tests are up by 88%. Hunt turns the blame on GPs, but they are seeing 40 patients a day with their appointments systems gridlocked. With two tough winters to survive before the election, he may not succeed in diverting blame to the NHS and its staff.

Forces unleashed by the Act are already at work. Section 75 requires almost everything to be tendered out to Any Qualified Provider. An overview of how much is turning private is hard to come by, but there are snapshots. NHS Direct is broken up among 46 bidders for local 111 services, paid only 30% of the old cost per call, so already many contracts are going bust. Meanwhile, unqualified call-centre operators pour extra patients into A&E with trivial complaints. The London ambulance service is using 10 times more private ambulances, at a cost of £4m a year. Between a quarter and a half of all community services are now run by VirginCare.

The NHS cannot meet the demand for its services. Thus it\’s an outrage that not NHS people can offer the same services.

I now have a desperate desire to stick my underpants on my head, pencils up my nostrils and shout \”Wibble\” repeatedly.

Yet we know that letting health slide towards private payment will cost everyone more: the US spends 18% of GDP, twice as much, for much less care, while the NHS is one of the world\’s most efficient ways to pay.

The current reforms are not about moving to an insurance based system like the US. Rather, they\’re about moving to a market based provision of services. You know, just like almost all European countries use?

16 thoughts on “Don\’tcha just love Polly\’s logic?”

  1. The NHS is a useless way of providing quality medical care.

    It’s one advantage is that it is cheap compared with how much other countries spend a a fraction of GDP on healthcare. This is altogether different from “efficient”, let alone “good”.

    The problem with this whole type of organisation is that it employs millions of people and then underutilises them through the imposition of hierarchical systems. Instead of a million people working freely to improve their own processes to get their own advantages, you have a tiny number of bright people making decisions and passing them down a chain as orders. Instead of a million brains, each of them thinking through problems to the best of their ability, you have a few thousand bright guys trying to manage the organisation and the other brains have their problems compartmentalised and focussed on too narrow a set of issues, rather than being freely and fully utilised.

    Doesn’t this seem rather obvious, given the many examples though recent history?

  2. “NHS Direct is broken up among 46 bidders for local 111 services, paid only 30% of the old cost per call, so already many contracts are going bust. Meanwhile, unqualified call-centre operators pour extra patients into A&E with trivial complaints.”

    One supplier has pulled out of two contracts because they say that the terms are “financially unsustainable”. The name of the supplier? NHS Direct. Their words:

    “NHS Direct has no option but to exit from the contract. The reason for this is that since the launch of NHS Direct’s other 111 services, we have established that the contract terms which NHS Direct had entered into are in fact, financially unsustainable.”.

    You’d think that the people who’d been running the service for years might have a clue about how much it cost to run the service.

  3. Polly says “while the NHS is one of the world’s most efficient ways to pay.”

    I say “A lie can fool most of the people most of the time, but it can’t fall all the people all of the time”.

  4. “Hunt turns the blame on GPs, but they are seeing 40 patients a day with their appointments systems gridlocked.”

    At my local GP surgery, it may be difficult at times to obtain an appointment with the Doctor you wish to see but this is NOT down to excess demand.

    All of the practice members work part-time. The practice leader works only two days a week and one other has swanned off to Africa for two months.

    Whenever I drop in to collect a prescription, there are no queues and frequently the waiting room is empty.

    The practice closes one working day every month for ‘training purposes’ and, of course, NEVER opens weekends or on Bank Holidays.

    Overworked GPs? Gridlocked?

  5. 44 out of 46 local contracts for the 111 service are financially viable at what Polly claims is 30% of the cost of the old service thereby releasing 70% of the previous cost of NHS Direct to be spent on treating patients.
    Polly thinks this is a scandal

  6. Can’t help but notice, Tim’s recent posts on the NHS haven’t provoked a response by its lost_nurse apologist. Maybe this single data point might be telling us something?

  7. Well the european standard might look more like a market than the NHS but in general the (public) insurers dictate prices, so either a particular service is available at great profit to the provider or isn’t available. That isn’t really a market and it isn’t necessarily a better system than the NHS, though it certainly has the potential to be.

  8. Do these reforms give the customer direct consumer power over which service provider they use? Does such choice impose economic decisions on that customer? If not, it’s not a market.

    The result mgith be better. It might be worse. But if it’s companies tendering for contracts with bureacrats, it’s not a market.

    Well, not a free market in the capitalist sense. And thus it’s not reasonable to call it “market based provision”. It’s government contractor provision, which is entirely different.

    Well, fairly different anyway.

  9. @Tim A”You’d think that the people who’d been running the service for years might have a clue about how much it cost to run the service.”

    Indeed. What this episode tells us that NHS Direct had no idea about the cost of the service they have been delivering for years which implies there were no financial incentives in the contract to drive down costs over time.

    Perhaps another case of Watt Tyler’s Simple Shopper?

  10. @BiS: I think the weight of hard evidence as to the awfulness of the NHS that has been oozing out over the last few months may have dampened the ardour of the ‘The NHS is wonderful, and anyway even if it it isn’t the alternatives are worse’ brigade somewhat. Its a bit difficult to argue for the status quo when its been proven to be killing thousands of its ‘customers’ in recent years.

  11. SimonF,

    My local hospital has just launched a text message reminder service, despite the fact that missed appointments cost them £4m/year, and that dentists and delivery services have been doing it for years (because it’s a lot cheaper than the alternative).

    To private businesses, it’s a no-brainer. Setting up an SMS gateway, even professionally, costs a few thousand and each message costs pennies.

  12. I have to wonder about Polly’s views on the most successful types of organisations doing NHS work. Hospices – NHS pays only a portion of the cost per patient, the rest raised from local or national sources – usually including the capital outlay of a building. One not far from me I take the wife to every few months (some NHS non terminal services operate from the building) is a lovely place at £3.5 million build cost.

    Hospices tend to be well liked by locals and provide a superior service than your basic NHS hospital ward. The parking is much much better too, without this pay and display system…

  13. “Maybe this single data point might be telling us something?”

    All it tells you is that I can’t be arsed arguing on the internet. Tim’s posts consistently demonstrate that he has no grasp of what is actually happening on the frontline – or why these reforms are making the situation a good deal worse. Hence, the pile-up in acute care is blamed on our old friend “bureaucracy” – as opposed to a considered assessment of why fragmented services are leading to increased A+E attendance, the lack of ‘step-down’ capacity for elderly patients, buck-passing by OOH providers etc etc. And yes, “cuts” in the PBI who are attempting to hold the line. Far from moving us towards the “market based provision of services” (very fcuking far, as it goes), the latest round of reform has more parallels with the screw-up that was rail privatisation. Hence, the taxpayer will be (once again) be subsidising Virgin et al. And, as has been alluded to, the better Euro efforts are by no means ‘pure’ market systems – mixed economy though they may be. They are also better invested than us.

    Besides which, it’s a nice day, and I’m off duty. I’m not hanging around here.

  14. lost_nurse,

    “Hence, the pile-up in acute care is blamed on our old friend “bureaucracy””

    Are you saying the NHS doesn’t have a bureaucracy problem, having burnt £10-20bn on a computer system that didn’t get delivered? And that it’s bureaucracy problem doesn’t cost it money that could then be better spent on treating patients?

  15. Its a bit difficult to argue for the status quo when its been proven to be killing thousands of its ‘customers’ in recent years.

    Nah, that’s just proof that the NHS needs MUCH MORE MONEY.

    That’s why government ‘services’ are almost always disastrous. In the private sector, if you do a bad job you usually get less money as customers take their business elsewhere. In the public sector, or the pseudo-private sector that makes most of its money from government contracts, if you do a bad job you complain that you’re not getting enough money and the government usually gives you more. There’s little incentive for the public sector to do a good job, and enormous incentives to do a bad one.

  16. What expertise do the NHS bosses have for spending money wisely? From media reports in recent months, very little it seems for a particular brand of ‘wise’.
    Perhaps we do need more frontline doctors and nurses. Do we need everything else that money is being spent on to the same degree too?

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