Covert rationing…. and the “honest debate” needed to change the culture.

In a word, the word is “honesty”. This is what is needed to win the hearts and minds of the doctors working at the coal face in the Regional Health Services.

End Game horse cartoon

On Sunday Sept 11th 2011 The Cockroachcatcher , reflections of a child psychiatrist, opines: NHS Reform: Rationing & Redistribution

Rationing of Health Care is unpopular at the best of times and different ways have been tried by the previous governments first through Fund Holding and later PCTs.  It would have been very unpopular for PCTs to continue to ration health. They have been doing it one way or another and it has been a costly exercise for some PCTs. It has even caused unnecessary deaths. The current concern for the NHS Reform is perhaps too focused on privatisation. The main aim by some very clever people in government is that somehow there must be a way to limit health spending. The first obvious way is to find someone that could do it without the blame coming back to the politicians who needs to worry about the next election or next job…..
GP Commissioning was thought to be the answer as the blame would now be on the GPs.

Sofia Lind in Pulse on 7th September 2012 reports: RCGP commissioning champion resigns in protest at ‘covert rationing’
Dr Helena McKeown, an RCGP council member, and a GP in Salisbury, said she had become ‘too disillusioned to be associated with the reality’ of commissioning to continue in the role, and said she wanted to instead ‘expose what GPs are being set up to do’.

Peter Watt (ex general secretary of the Labour party) on 21st February 2013 writes in Labour Uncut: Our political parties need to be honest about NHS rationing

Andrew Cave in The Telegraph 15th April 2013 reports: Monday Interview: Why the NHS must learn to tackle risk of rationing

We need to debate priorities, says healthcare chief, even if that means rationing services .

Garry Watts has an elephant in the room.

The former chief executive of condoms-to-footcare group SSL International may have gone “plural” since selling it to Reckitt Benckiser for £2.5bn in 2010; and he may be chairman of FTSE250 pharmaceuticals group BTG, deputy chairman of transport operator Stagecoach and a non-executive director of Coca-Cola Enterprises.

But, in his role as chairman of Spire Healthcare, Britain’s second largest private hospitals group, he now inevitably – and contentiously, perhaps – now has to get himself involved in discussions about the National Health Service and how it operates, and Watts doesn’t shirk the issue.

“Health is such an emotive issue,” he says. “It’s difficult to have an open debate of any sort about how we should structure healthcare in the UK without it getting drowned in a welter of what are frankly not much more than soundbites.

“But it’s a self-evident truth that the NHS can’t do all things for all people at all times regardless of cost and demand…..

Before Its News in N America reported Eliz Price Foley 22nd May 2014 saying that UK Health rationing was overt (to everyone except politicians and managers): ‘Covert Rationing’ Is A Feature Of Single-Payer Health Care

“…..Rationing care can take many forms. It can be overt, like the Canadian or British health care systems, which have unambiguous, publicly-announced waiting times and coverage denials for certain procedures. Or rationing can be more subtle, with little or no public participation. This latter, covert form of rationing is what the VA has adopted.

In recent years, though, Great Britain’s NHS has engaged in plenty of covert rationing in addition to the overt kind.  (I suspect Foley knows this and was merely making a distinction and not implying officials in Britain’s NHS don’t try to hide its rationing when they can.)….”

Health, Medicine and Society: Key Theories, Future Agendas

In such circumstances two of the core principles on which the NHS was … it must be emphasised that the NHS system was never ‘uniform’ due to covert rationing …

Open – The Scottish

Government “Delivering the Future Program” and a group of NHS Borders General …. the public around wider strategic issues such as overt and covert rationing.

The Journal of the RCGP latest edition has a leader by Roger Jones The future NHS (Br J Gen Pract 2014 Nov; 64(628): 550-551): time for another change? (550.full) and Why doesn’t anyone want to be a GP: and what can we do about it? by Naomi Abbt, and Steven Alderson (579.full) (Br J Gen Pract 2014 Nov; 64(628): 579-579. Neither of these writers comments on rationing, or the “lie” that there is none, which is perpetuated by officials and politicians. However, as far as recruitment for GPs is concerned, it would help if the professions was given more time for more research with it’s vast information, as this would raise it’s profile, and reduce the critique which is endemic in hospitals. … “Do you really want to be a GP? What a waste of all that training and intellect?” is the unspoken but commonly thought attitude of consultants. Their juniors are quick to pick up the lack of respect……


3 thoughts on “Covert rationing…. and the “honest debate” needed to change the culture.

  1. Pingback: Lord Darzi calls for overt rationing. We can’t afford what we are doing – but which politician will do anything about it? Stop ‘pointless’ cancer care for dying, says former minister… | NHS reality. An NHS soapbox. Speakers' cor

  2. Pingback: Why Liberal philosophies are better for the UK. Who will be the first party to re-invent a truly National Health Service? | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  3. Pingback: Is it progressive to reduce us all to same day appointments? | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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