GP private firms grab NHS cash

The perverse incentives inherent in the ill thought out English system are aired in The Sunday Times (31st March 2013) by Stephen May.

FLAGSHIP health reforms are mired in controversy over members of new NHS  commissioning bodies who award lucrative contracts to themselves.

In one case, a clinical commissioning group (CCG) awarded a £150,000 deal to a  company created by its chairman. The revelations expose potential conflicts  of interest in the first wave of contracts under the health service reforms  launched tomorrow.

Critics believe they will blight the 211 new CCGs and drag the government into  a fresh row over its NHS shake-up……..

The truth is that not many GPs have engaged with the new arrangements, and those that have are tempted to have business interests which are conflicts of interest. Most GPs like to see their patients, and few either have the interest or the skills to be involved in commissioing.  In the RCGP we had an educational programme called “What Sort of Doctor” (WhatSoD} some years ago… It takes a very special, or a disillusioned doctor to take on the extra work and reading, and to run a business: the scapegoat role for government  Watch this space, but Welsh GPs predict it will all end in tears in England.

The Nuffield Trust. Rationing health care

The Nuffield Trust. Rationing health care: is it time to set out more clearly what is funded by the NHS?

Too true it’s time. The professions have been waiting for many years for the politicians to address reality. The problem is that by saying what is funded, they will by implication be saying what is NOT funded, and outwith the NHS – i.e. rationed. And they still dont want to use that word and fear that the first party to do so will be anathema. So it has to get worse…

Imploding NHS

Four stories today all show different aspects of failure to face reality – by our Politicians.

1. Sky news reports NHS Drug Plea For Child With Blood Disorder. At £250,000 a year its obvious why we don’t fund – or is it? The condition is very rare and the next patient suffering might occur years away. So how much do we spend on paracetamol nationally annually from the NHS?  The strength of the evidence for benefit of this drug is irrelevant: it may or may not work. It is the principal that matters – does the NHS cover high cost treatments that its members could not otherwise afford, in preference to low cost services that they could afford? Denial of which brings back more fear?

2. BBC news reports that the Wye Valley NHS Trust exploring five future options. Another case of why we must change because of the budget – rationing by another name.

3. The Telegraph reports Doctors want homeopathy on the NHS to end – you might say about time too – placebos only work (and they work very well) if patients believe in them but they are VERY cheap and if the patient chooses them instead of conventional therapy rather than as an adjunct…. Why bother to attack something which costs so little and has such a long history of dysfunctional thinking behind it? In tactical terms this is a side battle – and would take away a cheap idiosyncratic treatment option? I appreciate the argument for excluding homeopathy is scientifically stronger than that for paracetamol – but if everyone payed a prescription charge, even in Wales, the number of those foolish enought to pay would show how much support there was for Homeopathy. After all, if choice is paramount should we not retain it, even if illogical?

4. The Guardian – Doctors say Health act means the death of the NHS as we know it – Yes this new act and re-organisation is certainly going to fail without a change in the “rules of the game” – one of which is that Health Board members cannot speak out to say what they really think, especially on finishing their spell on the board. (Exit interview)

Have a great Easter. Get new followers and spread this site around please. It may chronicle the end of the NHS – something I and almost all readers would hate to see happen.

Secret NHS plan to share personal records

Confidential medical information could be shared among doctors, researchers and managers under plans to “override” patients’ objections, it can be revealed.

By James Kirkup, Deputy Political Editor, Daily Telegraph, 29 Mar 2013

Confidential medical information could be shared among doctors, researchers and managers under plans to “override” patients’ objections, it can be revealed.

Sensitive medical and personal details could be distributed widely

By James Kirkup, Deputy Political Editor

12:01AM GMT 29 Mar 2013 (I don’t know if I can really believe this news item – a duty of confidentiality persists after death. Does the coalition government really wish to score more own goals?) I accept there is a need for universal primary care led information systems within regions, with specialisms bolted on (ICU, Casualty, Anaesthetics, etc) but patients must be able to opt out. How would politicians like their notes in the public domain – with our salacious and vindictive media? Medical notes contain much social and psychiatric material, as well as clinical, and the opportunity to use this would be too much to resist.

A secret NHS document, seen by The Daily Telegraph, has raised fears that patient confidentiality will be watered down.

The draft code of practice for patients’ information was circulated among NHS managers earlier this month. It tells staff that they can sometimes ignore patients’ wishes over the distribution of “identifiable” records and refers to “the wide range of purposes that information is used for outside of direct care”.

The document has led to warnings that sensitive medical and personal details could be distributed widely and even passed to pharmaceutical firms, regardless of patients’ wishes.

Phil Booth, of medConfidential, a campaign group, said the draft code could usher in “the most radical downgrading of medical confidentiality the NHS has ever seen.”

Budget 2013 – How much on health – The Facts

Budget 2013: where the money comes from, and where it goes.

Health uses £137 out of £720 million and this is without the £31 million on Social Services. Taken individually Health uses 19.02% and with Social Services 23.33% of GDP. The total budget shortfall for 2013 is projected at £108 million. Even in 2017/18 we will be borrowing 2.2% and the cumulative deficit for the next 5 years is 22.3% of one year’s GDP.

You may have heard that health budget is “ring fenced”. Be aware that this means health expenditure will reduce in real terms as health inflation costs are well above normal inflation. We are in for some VERY hard times in the heath service unless we ration overtly. Indeed, the demographic changes suggest that those who do best will be those who know how best to game the Post Code Lottery.

NHS head facing calls to resign over ‘disturbing’ closure of children’s heart unit

The Daily Telegraph 31st March 2013

NHS head facing calls to resign over ‘disturbing’ closure of children’s heart unit

Sir Bruce Keogh, the medical director of the NHS, is facing calls to resign following the suspension of children’s congenital heart surgery at Leeds General Infirmary, a day after the High Court quashed plans to close the unit.

Denial of the accuracy and appropriateness of the figures followed (Elspeth Brown on BBC News 30th March 2013)

The Independant comments: Row grows over decision to shut Leeds Infirmary’s heart unit

Children’s cardiac centre deaths only ‘a little high’, says expert, as faulty data blamed for closure

GPs fear sending their relations to hospitals

The Daily Telegraph 31st March 2013

GPs fear sending their relations to hospitals

Almost half of family doctors and practice nurses do not believe their local hospitals are good enough to treat their own families, a poll has found.

Hunt drops clause that puts NHS patients first

The Daily Telegraph 31st March 2013

Jeremy Hunt has defied the central recommendation of the Mid Staffordshire
inquiry, that the rights of patients be formally enshrined at the heart of the
NHS.

By Robert Winnett, and Peter Dominiczak

Robert Francis, the inquiry chairman, said that one of his top priorities was for the NHS constitution to be rewritten, making it explicit that “patients are put first” and “everything done by the NHS should be informed by this ethos”.

He recommended that the Health Secretary also consider stipulating that NHS staff “put patients before themselves”.

But the redrafted constitution, quietly released last week, simply states that the health service will “aspire” to put patients first.

This is a tacit assumtion of both rationing (we cant deliver what we would like to) and the perverse nature of Health Care Systems which have to look after their budget before anything else (e.g. patient choice).

Performance relative to other countries. Commonwealth fund “mirror”.

Interesting advice on the Commonwealth Fund website about systems and table showing comparison indicators for different HealthCare systems.

An example of rationing – under another name

NHS NE Exceptional Treatment Policies update and review Report.

This is an example, repeated across the country, of exceptions to treatment, this time in the North East. There are similar documents for all regions and PCTs LHBs. This is rationing, and simply obfuscating it under other names (exceptions, limitations, restrictions) hides the issue from the public, who only find out what is not available when they or their relatives need it.

In my own area, West Wales (Hywel Dda Trust minutes 27th Jan 2011), there is a “restriction” on second cataract operations, for which rules are unclear and subject to a “freedom of information” request.