The NHS in Scotland and England

Oh the irony. Labour’s killer argument to win the next election –that the Tories are destroying the NHS – has become Alex Salmond’s killer argument to win independence and lose Labour some safe seats. Salmond argues that the privatization of the NHS in England will shrink the health budget and have a knock-on effect in Scotland, and that independence will protect the budget and also allow protection from future privatization to be (hastily) written into the Scottish constitution.

Yet the NHS in Scotland is already devolved and has the power to resist private providers. In Scotland, personal care, prescriptions, dental check-ups and eye-tests are all free. Scotland has more GPs, medical hospital staff, nursing, midwifery and health visiting staff per person. It has no ‘market’ in healthcare; there are no Foundation Trusts, just a few PFI hospitals and none of the extra bureaucracy and regulation needed to manage the market. It has comparatively little private provision either outside or within its NHS. Scotland’s spend on public health is highly focused and it was first to introduce the public smoking ban. And yet despite this publically funded, controlled and provided NHS, life expectancies in Scotland

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PRIVATES ON PARADE

Last month’s report by the Centre for Health and the Public Interest on patient safety risks in private hospitals made depressingly familiar reading. Over 802 people died ‘unexpectedly’ in private hospitals in the last 4 years and there were 921 serious injuries, but it’s very hard for patients or polticians to meaningfully compare this with safety in the NHS because private hospitals are still not required to make data on hospital deaths and safety incidents publicly available (Eyes passim).

Coding in private hospitals is often poor too but even without accurate data, the risks are obvious in an emergency. The majority have no intensive care beds, some have no dedicated resuscitation teams, and surgeons and anaesthetists usually work in isolation – without assistant surgeons and anaesthetists in training present. There is often very little experienced cover at night, with typically one very junior doctor covering and entire hospital, and there are gaps in after-care too if things go wrong.

The private hospital sector now gets over a quarter of its income from treating NHS-funded patients, so there is no excuse for not having comparable data available to patients about hospital performance and safety. The NHS

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My Background

I am an NHS doctor, investigative journalist, broadcaster, campaigner and comedian. I was previously a lecturer in medical communication at the Universities of Birmingham and Bristol, training medical students and doctors to cope with difficult consultations. As a doctor, I worked part time in general practice for over 20 years, and has also worked in sexual health. I currently works in a specialist NHS team for young people with chronic fatigue syndrome/ME.

I have been Private Eye’s medical correspondent since 1992, broke the story of the Bristol heart scandal that year after being given evidence of poor care by Dr (now Professor) Stephen Bolsin. I gave evidence to the subsequent Public Inquiry and have been an advocate for NHS whistle-blowers for 22 years, covering many of their stories. In 2012, I was shortlisted with Andrew Bousfield for the Martha Gellhorn Prize for Investigative Journalism for ‘Shoot the Messenger,’ a Private Eye investigation into the shocking treatment of NHS whistle-blowers (attached)

I am also a Vice President of the Patients’ Association and a patron of Meningitis UK, the Doctors’ Support Network, the Herpes Viruses Association, Patients First, PoTS, the NET Patient Foundation and Kissing It Better. I am also

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Myth Busting

“Demand for NHS services shows no signs of abating. With hospital finances increasingly weak, growing pressures on staffing, and the goal of moving care out of hospitals and into the community proving elusive, the NHS is heading for a funding crisis this year or next.” So reported the Nuffield Trust last month, with mental health services particularly hard hit. And may hospitals are now on ‘black alert’ and turning ambulances away in the summer So can anything achieve the quick and massive efficiency savings necessary to get the NHS out of financial meltdown?

No, is the simple answer- not that you’d realise it as the government and NHS England furiously try to paper over the cracks in the run up to an election. Many of the ideas doing the rounds make sense – investing in prevention, encouraging healthier lifestyles, moving care closer to home and better support for people with long term conditions. They could make the service better, but there is little evidence they will save it a lot of money. The average age of a GP patient is 75, and a hospital patient over 80, and as people live longer they simply need more care. Most

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Shop till you drop?

Is giving patients with chronic diseases their own health budget to buy the care they need a good idea? It’s certainly got Simon Stevens, NHS England’s new Chief Executive, very excited. Personal budgets for social care have been around for some years, and Stevens believes ‘north of five million patients’ will have a combined personal health and social care budget by 2018. £5 billion will be taken out of the NHS pot and handed directly to patients. What could go wrong?

Very few politicians will dare argue against such a grand scheme to ‘trust the people’, and if the people decide to buy all their healthcare from private providers rather than the NHS, it’ll be the cleverest Trojan horse to get private providers a slice of the NHS cake yet invented. That makes it even less likely that many in either House will kick up a fuss. Around 200 honourable members in the Lords and Commons voted through the Health and Social Care Act knowing the private health companies they have an interest in could benefit. None had the ethics or insight to abstain.

Personal budgets in health have been piloted in England only on a

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