Choice Words

When MD debated the Health and Social Care Act with its creator, Andrew Lansley, on BBC 1’s Question time 3 years ago, my main concern was its focus on competition (86 mentions) over collaboration (0). The most competitive, consumerist health service in the world (America) is also the most expensive, unfair and wasteful. It spends 16.9% of its GDP on health, compared to the UK’s 9.27%, and yet average life expectancy is lower. The UK also spends considerably less than Holland (11.77%), France (11.61%), Denmark (10.98%) and Canada (10.93%). No wonder it’s struggling.

Competition and choice require spare capacity which the NHS was never going to be able to provide with an ageing population and a £30 billion black hole in its finances, and it’s not easy to shop around and travel for treatment when you’re ill. Yet when the Bill was enacted, a ‘factsheet’ was produced by the DH claiming ‘choice and competition are a powerful means for the NHS to deliver high quality services for patients, and value for money for taxpayers’ and ‘there is emerging evidence of the benefits of competition in the NHS. Where there is competition and choice, it leads

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The Rt Hon Jeremy Hunt MP

Secretary of State for Health

Department of Health

Richmond House,

79 Whitehall,

London SW1A 2NS

Wednesday 10 December 2014

Dear Mr Hunt,

You will be aware that on November 18 the Patients Association published a report outlining numerous failings on the part of the Parliamentary and Health Service Ombudsman (PHSO). We included in our report the personal accounts from a sample of seven patients, or their relatives, who had experienced an unacceptably poor service from the PHSO. The report provides evidence of incompetence by the PHSO in its flawed investigations process, unacceptable delays, bias in favour of the service being complained about, lack of transparency and, perhaps most shocking of all, a complete lack of compassion in their dealings with people who are seeking their help.

We are greatly concerned for the impact of the failing PHSO on those people who have contacted the Patients Association to tell us of their experiences. What is of equal concern is that a key part of the role of the PHSO – to ensure that learning from these tragedies takes place at local level – is not happening. The PHSO should be finding out

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This one of my favourite investigative reports by the brilliant, much missed Private Eye journalist Paul Foot. The current PFI debt disaster facing the NHS was entirely predictable, and predicted by many even before Labour took office in 1997 (most notably Professor Allyson Pollock and her colleagues) We now know how truly staggering PFI debts for the NHS are. For example,

North East build cost £812 million,  total repayment  costs by NHS  £5512 million

North West build cost £1345 million, total repayment costs by NHS 10,325 million

North (Leeds area) build cost £903 million, total repayment costs by NHS £4,388 million

Even allowing for maintenance and running costs, these mark ups would amaze any loan shark. Especially given that the NHS wont even own the buildings even if it does manage to pay back the outrageous loans.

PFI was the brainchild of the Tory frontbencher David ‘Two Brains” Willets.  Labour and the TUC vigorously opposed it in 1996, and in a commons debate on May 1, Labour frontbencher Sam Galbraith nailed its attraction to the Treasury: ‘The Private Finance Initiative is basically about government bodies borrowing money but not having to set it against the public sector borrowing requirement. Today the private

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Justice delayed, GMC style

On September 30 2011, MD and Andrew Bousfield asked the GMC to investigate whether consultant paediatrician Dr David Elliman had failed in his professional duty to address the concerns of consultants about patient safety at the Child Development Clinic in Haringey where Baby P was seen (see Shoot the Messenger). These concerns predated the death of Baby P, which might have been prevented had they been acted on. A mere 38 months later, the GMC is still considering the matter.

This is hugely unfair to whistleblowers such as Dr Kim Holt, who paid such a heavy professional price for speaking up and refusing to be bought off and gagged by Great Ormond Street Hospital (see Eye last), but also for Dr Elliman who has been waiting as long as MD for an outcome. On November 3, Michael Hudspith, Investigation Officer on the GMC’s Fitness to Practise Directorate, wrote to MD. ‘I am afraid we do not yet have an outcome… Dr Elliman’s response to the allegations is currently the subject of further legal review. We expect this review to complete by next week. All case papers will then be considered by a medical and a lay

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What a Waste

It’s a shame that the Academy of Medical Royal Colleges report on protecting NHS resources is subtitled: ‘a doctor’s guide to cutting waste in clinical care.’ NHS waste is everyone’s responsibility, from patients to politicians. The report claims 20% of mainstream clinical practice brings no benefit to patients and there is widespread overuse of tests and interventions. The cost of prescribed medicines wasted is around £300 million each year. The average NHS cost of admission to general hospital is £1713, a consultant outpatient £135, an outpatient psychiatric assessment £145, one bed day for adult mental health inpatient £430, 11.7 minutes with a GP £45, prescription cost per GP consultation £41, cost of an MRI scan £187, cost of ambulance call out £235, cost of a hip replacement £5485. The carbon footprint of most of these interventions is listed, and a scenario where one patient ends up having many of these when they could have been avoided.

Interventions towards the end of life are often futile, costly and unkind and yet staff may feel pressured into doing something by patients and relatives. No mention is made of the waste of political reform. The current ideological absurdity –

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