Is it possible to have a sane and rational discussion about NHS reform? Let's try shall we?
Ok, so what sort of system of healthcare do we have in the UK. I would say we have one of the very best in the world. If you are poor, you won't be thrown to the wolves because you can't pay for it. If you are middle class and you get a long term debilitating illness, you won't be bankrupted, when your healthcare plan runs out and they kick you off. If your children become ill, you might worry about how they respond to treatment, but you don't worry how you pay for it.
There is also one aspect that is never discussed. If you are stinking rich, what do you get? Well you get all the above + you get the ability to pay for a healthcare plan and jump the queue. This is why I get really sick of millionaires sticking their oar in and moaning about the health service. It wasn't designed for them. They will be alright whatever the healthcare system we end up with. I just saw on the news that the government wants to introduce more choice. This is utter bollocks. How does this supposedly work. "Mrs Jones, you've got cancer. You can go and see Dr Black who is really crap and you'll die in two weeks or you can see Dr Burgundy who is great and you'll live till you're 116, which would you prefer?" What would your choice be? Sounds like a great system, this internal market, doesn't it?
Nope, sorry that's not how it will work. It will work like this. Your GP will know that sending you to Dr Black will cost his budget £50,000 and sending you to Dr Burgundy will cost his budget £100,000. The choice is his, not yours, because you don't have the facts as to who is better. Who do you think your GP will send you to. If he sends you to Dr Burgundy, that's £50,000 less in his budget to pay himself a bonus. What do you think he'll say?
Or look at how private corporations may run wards/services. Just suppose the Barnet Eye wants to go into provision of Health care. Barnfield General want me to take over some provision of services. They give me the choice between running the A&E department or the oncology department. Which would I, as an astute businessman rather run? Simple really. The one I can make most money from. So how do I do this? Well they agree a menu of prices for services and I then look at how I can provide them as cheaply as possible. Just suppose I happen to know that Dr Burgundy is the worlds greatest oncologist and he's working there. Because he's so marvellous, the Wellfishy trust pay him £250,000 a year and he has a whole team of highly trained, long term staff who know what they are doing. I look at this and say "Dr Burgundy is charging £100,000 for a course of treatment. Dr Black in Walford General only charges £50,000 and so he's getting more business and the hospital make more money". What do I do? Do I say "but Dr Burgundy is the finest oncologist in the world". Do I hell. I sack him and break up his team and get Dr White in, who has no track record whatsoever, but can provide the treatment for £40,000. Then I undercut Dr Black. Who suffers? Not me, I make shedloads of money. What do I care, happy days are here.
But three years down the line, when the survival rates start to drop, the consequences become apparent and the true cost is revealed, it is too late. Dr Burgundy has long gone, his team have been scattered and the damage is done. What happens then? That is how "internal markets" work. That is how private companies conduct their business. I'm not saying that all private companies are always bad, or that all health care trusts will act with complete disregard for the patient as described. Of course their are SLA's and quality targets. It's just that at the end of the day, private corporations exist to make profits. If prices are fixed, these can only be maximised by cutting costs. Cutting costs forces out the best people. Where do they go? Into private clinics where rich individuals can afford to pay a premium.
I don't believe that quality of medical care should be purely driven by the ability of the patient to pay. I believe that in a civilised society, we should all expect, as a right, the best quality healthcare. This may be expensive, but if we got rid of the managers, lawyers and accountants who run the internal market, it would be a damn sight less expensive than the current system. I guess the difference between myself writing this and Clegg/Cameron who will actually decide is this. They are millionaires so the effects will never hurt them. Neither of them has ever run a business, so they have no idea what decisions you make on a daily basis to make your business efficient. Perhaps the biggest difference of the lot though, unlike Mr Clegg and Mr Cameron, when I last visited a hospital, I didn't get red carpet treatment because I was an important politician. I wouldn't want it, but how on earth can they pretend to know what sort of treatment the rest of us get?
Ok, so what sort of system of healthcare do we have in the UK. I would say we have one of the very best in the world. If you are poor, you won't be thrown to the wolves because you can't pay for it. If you are middle class and you get a long term debilitating illness, you won't be bankrupted, when your healthcare plan runs out and they kick you off. If your children become ill, you might worry about how they respond to treatment, but you don't worry how you pay for it.
There is also one aspect that is never discussed. If you are stinking rich, what do you get? Well you get all the above + you get the ability to pay for a healthcare plan and jump the queue. This is why I get really sick of millionaires sticking their oar in and moaning about the health service. It wasn't designed for them. They will be alright whatever the healthcare system we end up with. I just saw on the news that the government wants to introduce more choice. This is utter bollocks. How does this supposedly work. "Mrs Jones, you've got cancer. You can go and see Dr Black who is really crap and you'll die in two weeks or you can see Dr Burgundy who is great and you'll live till you're 116, which would you prefer?" What would your choice be? Sounds like a great system, this internal market, doesn't it?
Nope, sorry that's not how it will work. It will work like this. Your GP will know that sending you to Dr Black will cost his budget £50,000 and sending you to Dr Burgundy will cost his budget £100,000. The choice is his, not yours, because you don't have the facts as to who is better. Who do you think your GP will send you to. If he sends you to Dr Burgundy, that's £50,000 less in his budget to pay himself a bonus. What do you think he'll say?
Or look at how private corporations may run wards/services. Just suppose the Barnet Eye wants to go into provision of Health care. Barnfield General want me to take over some provision of services. They give me the choice between running the A&E department or the oncology department. Which would I, as an astute businessman rather run? Simple really. The one I can make most money from. So how do I do this? Well they agree a menu of prices for services and I then look at how I can provide them as cheaply as possible. Just suppose I happen to know that Dr Burgundy is the worlds greatest oncologist and he's working there. Because he's so marvellous, the Wellfishy trust pay him £250,000 a year and he has a whole team of highly trained, long term staff who know what they are doing. I look at this and say "Dr Burgundy is charging £100,000 for a course of treatment. Dr Black in Walford General only charges £50,000 and so he's getting more business and the hospital make more money". What do I do? Do I say "but Dr Burgundy is the finest oncologist in the world". Do I hell. I sack him and break up his team and get Dr White in, who has no track record whatsoever, but can provide the treatment for £40,000. Then I undercut Dr Black. Who suffers? Not me, I make shedloads of money. What do I care, happy days are here.
But three years down the line, when the survival rates start to drop, the consequences become apparent and the true cost is revealed, it is too late. Dr Burgundy has long gone, his team have been scattered and the damage is done. What happens then? That is how "internal markets" work. That is how private companies conduct their business. I'm not saying that all private companies are always bad, or that all health care trusts will act with complete disregard for the patient as described. Of course their are SLA's and quality targets. It's just that at the end of the day, private corporations exist to make profits. If prices are fixed, these can only be maximised by cutting costs. Cutting costs forces out the best people. Where do they go? Into private clinics where rich individuals can afford to pay a premium.
I don't believe that quality of medical care should be purely driven by the ability of the patient to pay. I believe that in a civilised society, we should all expect, as a right, the best quality healthcare. This may be expensive, but if we got rid of the managers, lawyers and accountants who run the internal market, it would be a damn sight less expensive than the current system. I guess the difference between myself writing this and Clegg/Cameron who will actually decide is this. They are millionaires so the effects will never hurt them. Neither of them has ever run a business, so they have no idea what decisions you make on a daily basis to make your business efficient. Perhaps the biggest difference of the lot though, unlike Mr Clegg and Mr Cameron, when I last visited a hospital, I didn't get red carpet treatment because I was an important politician. I wouldn't want it, but how on earth can they pretend to know what sort of treatment the rest of us get?
I really could not have put it better myself.
ReplyDeleteWell done!
Thanks, appreciate the comment.
ReplyDelete