Monthly Archives: January 2016

The health divide increases. Doctors deny patients the right to choice..

Choice and diversity are the issues which West Wales is trying to attract workers with.

Unfortunately choice in the Welsh Health service has long gone. Now it appears that the reality of lack of choice is apparent to the English Health service. Chris Smyth reports 25th Jan 2016 in The Times: Doctors refusing patients the right to choose hospital. Choice is only important to the population when there is overcapacity. We have undercapacity, therefore choice is unimportant within the state health services. This means choice becomes a “private” option, either by direct payment or insurance. This increases the health divide (see previous posts below). We have a choice – ration covertly as now, or overtly as advocated by NHSreality. The Guardian leader refers to the National Sickness Industry, and advocates choice for consumers. It fails however to advocated duty rather than rights, and overt rather than covert rationing. (a recent example of the latter is exclusion of docatexel for prostate cancer – now changed – in England)

Health is closely correlated to Wealth – If you are poor you get no choice (Wales), and live a shorter life, but if you are rich, or born abroad, you live longer and you do get choice! So much for equity…

The Election. Health v Wealth? Or a more balanced approach…

Health is Wealth: How parts of Britain are now poorer than POLAND with families in Wales and Cornwall among Europe’s worst off

Stop the NHS runaway train before it’s too late. The health service is consuming all our wealth ..

The times article reads:

Fewer patients are being given a choice over where they are treated by the NHS, prompting warnings that their care is suffering.

Forty per cent of patients were offered a choice of hospital and clinic by their GP, down from 50 per cent in 2010, according to official surveys.

Advocates of choice say that family doctors are neglecting patients’ rights as they revert to “default” local hospitals, and that they are getting away with it because choice has slipped down the agenda while health chiefs deal with a financial crisis.

Howard Freeman, the medical director of the NHS Partners Network, said: “It’s how GPs are programmed to work — we keep coming back to the default position of the local hospital. Choice is something that has to be programmed into them — and it was in the 2000s.”

Giving patients the right to choose where they are treated on the NHS was one of the main health policies of the Labour government. The proportion of patients who remembered being offered a choice of hospital or clinic increased from 30 per cent in 2006 to 49 per cent four years later.

Despite significant reforms that were criticised by doctors for broadening the scope of markets within the NHS, Conservative ministers have made little fuss about the importance of patient choice.

The latest survey found that only 40 per cent of patients were offered a choice over where they were treated, and that only 47 per cent were aware that they had the right to choose where they were treated.

Dr Freeman said that GPs ought to be confronted with data showing how many patients they had referred to places other than the local hospital, so that they could compare themselves with their colleagues.

“We do need to focus on it again,” he said. “The drug industry gets people to go round reminding prescribers about their products. What we need to be doing is reminding people about this product.”

He added: “It is better for patients, that’s one thing I’m absolutely clear about. Many patients [think] that a hospital is a hospital and they’re all the same. As a clinical professional, I know that’s not correct.”

Richard Vautrey, the deputy chairman of the British Medical Association’s general practitioners’ committee, played down the importance of choice, saying: “It’s never been a significant priority for patients. They are more interested in having a good local hospital than travelling.”

He added that while choice was fine for big cities, it did not mean much in rural areas and was deservedly taking a back seat. “It’s become less of a political priority. The focus is very much on the integration of services and bringing local health bodies to work together rather than on competing. I don’t think there’s very much evidence that choice is driving [improvement]. It leads to a more fragmented service.”

 

Why don’t doctors come to rural Wales?

Not enough doctors trained, lack of aspiration, falling educational standards. Sian Griffiths reported in The Sunday Times 24th Jan 2016: Welsh pupils ‘risk being left behind’ and prospective medics for Wales might consider The Sunday Times Schools Guide where The UK’s top 2,000 schools revealed (England only) so they can find comparators – and they cannot for Wales. Welsh education has been in decline compared to the rest of Europe for some time. Nicola Woodcock reports on the increasing competition to live in aspiring areas Number of pupils at grammar schools is highest for 35 years – these are the areas with most competition to be a doctor. How close are the rural shires to civil unrest can be assessed in the BBC “Any Questions” in Pembroke Dock this week. Readers may now feel more able to answer the question, but there are other factors such as ignorance of how sociable we are, and how beautiful the country is. Bringing back grammar schools might help, as then more students might obtain places in UK medical schools. Changing the politics might help.. It looks as if education as well as health has suffered under devolution. Wales needs to empower it’s youth to aspire and achieve. Even the Economist in “Young, gifted and held back” agrees.  They say that, contrary to the Liberal promise, smaller class sizes are not necessary. This is however what parents want.. West Wales wants to attract GPs. This video may help, but it does not address the educational deficit.

Update 30th Jan 2016: Melanie Phillips in The Times (School class warriors only hurt the poor ) opines…”The real issue is social mobility. Class war has been the battle cry of the left for decades. But they have merely widened the divisions. Obsessed by equality and redistribution, they set about replacing the notion of a meritocracy, with its winners and losers, by the supposedly level playing field of the comprehensive school.

Social mobility has gone backwards ever since. A study by Oxford University published last year reported that, over the past four decades, it had become more difficult to rise up the social ladder; young people were even sliding downwards.

Back in 1997, Andrew (now Lord) Adonis and Stephen Pollard wrote in their book A Class Act: “The comprehensive revolution has not removed the link between education and class but strengthened it.”

ITV News 25th Jan 2016: Concerns about ‘variability’ in the quality of education in Wales

South Wales Argus 26th Jan 2016: Education chief: ‘Schools must take a fresh look at teaching …

The Sunday Times article. PUPILS in Wales are at risk of being left behind in the global competition for jobs and university places, the chief inspector of schools for England has warned.

In a controversial interview ahead of a television documentary about the Welsh education system, Sir Michael Wilshaw said: “I am of the view that the English education system is moving ahead quickly . . . It now really is up to the Welsh government to look at its own performance to ensure it matches the performance of England.”

Wilshaw’s intervention comes a few months before elections to the Welsh assembly in May. Control of education is devolved to the assembly.

About half (48%) of state school pupils in England went to university in 2013. By contrast, it was 36% in Wales.

Wales also ranked bottom of the UK countries for maths, science and reading in the 2012 Programme for International Student Assessment (Pisa), a study of 68 countries by the Organisation for Economic Co-operation and Development.

Andreas Schleicher, the director of Pisa who will also appear in It’s an Education, a BBC1 Wales documentary to be broadcast on Tuesday at 10.40pm, warned that the teenage children of Chinese builders performed better than the offspring of the wealthiest professional families in Wales.

“Poverty is a challenge but poverty is not destiny,” he said. “You can see, for example, that the 10% of the poorest children in Shanghai come from backgrounds where their parents have no education, where they work as construction workers in the large cities.

“Those children outperform the 10% of the most privileged children in Wales.”

Wilshaw suggests the decision by the Welsh government to scrap performance measures — such as school league tables based on exam results and the national testing of 11 year olds in maths and English — may also have contributed to a decline.

“If you take away those accountability measures it drives down standards rather than drives them up. My view is that that’s what probably happened so they might want to reconsider those policies,” he said.

He also suggested that the Welsh government should consider copying England by allowing schools to become academies, which are free from local council control. “Bureaucracies do not improve schools. People sitting behind desks in the town hall do not improve schools,” he said.

Huw Lewis, the Welsh education minister who recently announced he would step down from the assembly after the elections in May, rejected Wilshaw’s criticisms.

While he accepted that the 2012 Pisa results had been “a wake up call”, Lewis said steps had been taken since then to improve education in Wales.

Lewis insisted that reforms in Welsh education since 2012 were working and said he was confident that Wales’s scores would have improved when Pisa’s next rankings are published in December.

Update: The parlous State of NHS Wales and its aspirations does not help doctor recruitment.

The Welsh Government (Assembly) is a parasite. It is sucking the life out of Health and Education

Education Education Education!!! Our politicians have failed us all.

Poverty in Wales

Recruiting and retaining Profesionals into poorer regions of the UK.

Deprivation differences…. especially across the UK – revisited

Devolution of health to Wales was a mistake?

Gender bias. The one sex change on the NHS that nobody has been talking about

We need more doctors. The gender bias for female applicants at 18 can be levelled off at 21 years old. Graduate entry to Medical Schools should become the norm. More and more women are outperforming men. (Where are the men? Gender gap hits record at universities The Times 4th Feb 2016) and (Head teachers have clashed over the benefits of single-sex schooling – Sunday Times 31st Jan 2016), but it is from these schools that many doctors come from.

Top results for girls

Dominic Lawson in the Sunday Times 17th Jan 2016 reports: The one sex change on the NHS that nobody has been talking about

Every now and then, a conflict arises that splits apart not just the country but even individual families — the dispatch of British troops to the Suez Canal in 1956 and to Iraq almost half a century later, for example. Contentious military invasions have that consequence. Yet now a mere industrial dispute — that between the British Medical Association (BMA) and the Department of Health over a new contract for junior doctors — is having a similar effect.

This was seen with excruciating clarity in the letters pages of one national newspaper last week. On Tuesday Dr Russell Hopkins introduced himself: “In 1998 I was elected a fellow of the BMA in recognition of outstanding service.” He then went on to damn the present-day doctors’ union for its withdrawal of labour in protest at what it claims to be a contract enforcing excessive antisocial working hours as “pressing the financial needs of the profession, giving little thought to patient care, ethical practice or the need for out-of-hours care . . . This is not the same organisation I was once proud to serve.” (the shape of the job?)

Two days later a reply appeared from Dr Claire Hopkins: “I read the letter from my father, Russell Hopkins, with some dismay. He has been out of clinical practice for so long that he is disconnected from the problems facing the profession today . . . My father and his generation enjoyed a career where they had respect and autonomy, were lavished with hospitality by drug companies and then retired on final-salary NHS pensions. They would not recognise the job today. As a consultant surgeon I — along with most of my colleagues — support the junior doctors in their decision to strike.” You don’t have to know either Dr Hopkins to wince at such a cruelly personal exposure of intergenerational dispute.

Those two doctors are divided not just by age but also by sex. The latter is, though not mentioned during last week’s strike, a significant factor in the row over “antisocial hours”. The profession has become one in which new graduates are more likely to be women than men. This would have been almost inconceivable two generations ago. Not much observed by the public, a debate has raged for years in the pages of the British Medical Journal about what its disputants refer to as “the feminisation of medicine”.

In 2008 one of its contributors, Brian McKinstry, then a senior research fellow at Edinburgh University, warned: “Increasing numbers of female graduates will create a major shortfall in primary care provision . . . Fewer women than men choose to work out of hours, and the increase in women doctors may have partly influenced the recent abandonment of out-of-hours work by general practitioners in the UK.” That was a reasonable supposition; the consequence has been an increasing pile-up in the accident and emergency wards of our hospitals.

It’s not just a matter of wanting to avoid “antisocial hours” that interfere with family life — an institution to which men tend to pay homage but that women are actually more likely to put ahead of their career. Last year Dr Max Pemberton wrote: “We are facing a crisis in the NHS . . . It’s a crisis caused by having too many female doctors . . . Quite simply, the average male medical graduate will work full-time, while the average female won’t. In fact, a study of doctors 15 years after graduation showed that . . . after career breaks and part-time working are taken into account, women work 25% less than their male counterparts.”

When you consider that it costs roughly £500,000 to bring each medical student up to the status of a fully trained professional, it becomes obvious why governments have been reluctant, especially at a time of vast public sector deficits, to increase the number of medical degrees to fill staffing shortfalls created by the swelling number of “part-time” female doctors.

Or as Dr Chris Heath, a 40-year NHS veteran, wrote to me: “Women doctors don’t like weekend rotas . . . This is one of the reasons why paediatric units are failing: 70% of their junior staff being women and therefore frequently off on maternity leave.” I wonder what Dr Heath would make of Sarah el-Sheikha, who complained in The Guardian that the government’s proposed change will “particularly damage specialities such as anaesthetics, a department that has striven to make itself family friendly”. What about being friendly to the families who need to use the service?

There is a statistical counter-argument to those put by Drs Pemberton and Heath: that opening up the profession to women as equal participants will tend to increase the quality of those graduating — the bigger the talent pool, the better the doctors that emerge. That, however, is no consolation to the patient who can’t get a GP appointment or has to wait longer in A&E during “antisocial hours”.

The societal split emphasised by the doctors’ dispute is not just along grounds of generation and sex. There is also that between private and public sector. While I suspect the overwhelming number of other public sector employees will be supporting the junior doctors in their industrial action, those in the private sector, who do not get time and a half for working on Saturdays, see things differently. So I have received quite a few perplexed letters from airline pilots — who also, in a different way, hold our lives in their hands — pointing out that they don’t get paid different rates for flights at weekends to compensate them for the disruption to their family life. But then how many female airline pilots have you ever met?

Those of us on the profit-making, tax-generating side of the private/public schism are much more fortunate in one respect. While businesses — at least those that prosper — have abandoned the corporate monolith mentality and become much better at encouraging employees to come up with their own ideas, the NHS has moved in the opposite direction.

Its doctors are no longer allowed to be the rather free-wheeling, occasionally eccentric, day-and-night, autonomous professional elite that I recall from my youth — long before anyone had heard of the EU’s working time directive and its average 48-hour week limit. Now, they are monitored incessantly by swollen ranks of administrators, who seem to think the medics should share their bureaucratic fascination with the filling-out of forms. The target-driven agenda of the Blair-Brown years had a rational motivation, as far as the politicians were concerned, but it made doctors feel as though they were wage slaves, being paid for pure hours worked and, yes, forms filled.

In this context, the decision of the BMA to take industrial action (leading to the cancellation of many thousands of operations) becomes less surprising. If you are no longer treated as a professional elite, you will not behave like one.

Funnily enough, some feminist writers have a theory that ties this all together: that when women become accepted into an elite, it ceases to be treated with the same respect as previously.

Perhaps. Though, whether it’s male or female doctors waving placards and chanting slogans outside their hospitals, neither exudes the sense of quiet authority traditionally associated with their position.

I’d better say no more, however, or my daughter might write a letter to this newspaper, shooting me down in flames.

Correspondence from a week later 24th Jan 2016: Misdiagnosing female junior doctors as the cause of A&E problems (And all the NHS ills..?)

‘More doctors than ever’ coming to UK from Europe

Medical Student debt – time for government to change policy on doctor recruitment

Women (& medical students) “.. from poor homes storm the best universities and Medical Schools

First UK private medical school opens with £36,000 fees. A regressive development, which could increase inequalities further.

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Medical Student debt – time for government to change policy on doctor recruitment

It was the best job in the world – for me 1979-2012 – but now there are not enough of us to cover the country

Unreal manpower planning. It’s too late for a decade. GP services face ‘retirement crisis’. It’s the shape of the job silly.

 

 

 

 

General Practice is “a house of cards….”

The looming closure of a local GP practice in Cardigan and the recruitment crisis in General practice across Pembrokeshire may well lead to a Domino effect on surrounding practices already at breaking point in terms of GP morale and staffing levels ! It reminded me of this post from Pulse magazine in the same vein…..

 

Changing the rules of the game

General practice has become a house of cards. I am constantly hearing about practices handing back their contracts to NHS England, citing recruitment or financial issues, or a combination of both. What is even more shocking is that these are not in locations you’d be sent to for bad behaviour – they are leafy suburbs with relatively affluent surroundings.

My own home town of Bristol, the gateway to the South-West, has long been an extremely desirable part of the country in which to live and work. It is one of the most competitive areas for GP training places, but even we couldn’t manage to fill them at the last round of recruitment – and the situation is likely to worsen next year. The town has also seen one of the most recent casualties of the falling cards, when partners at the Northville Family Practice handed back their contracts in October.

Our partnership contracts belong somewhere in quaint Peter and Jane books

So how can we find the glue to stick these cards together so they don’t tumble down one after another?  In spite of the RCGP propaganda that ‘It’s never been a better time to be a GP’, we all know the sad truth. No one wants to be a GP because the pay and conditions suck. And if you are a partner, they suck even more  …………

Our partnership contracts belong somewhere in quaint Peter and Jane books, while all around us we see the rise of APMS contracts, marketisation of the health service and AQP. We are being asked to compete within a corporate business world, yet we are still shackled by the independent contractor rules of 1948. How many accountants or lawyers are personally responsible for their firm’s liabilities if it goes bust?  The answer is that they are all part of a limited liability partnership, or LLP. This has the same structure as a GP partnership but limits liabilities in the same way as a limited company. The reason GPs can’t change to this structure is simple – it does not allow you to hold a GMS contract or be a vehicle for NHS pensions.

Now, I may be naïve about business and corporate matters, but it is baffling to me that our representatives at the RCGP and GPC have not campaigned for this simple rule change, which might just help us to glue the remaining cards in place and even rebuild.

Yet in this brave new Tory world, the practices that are handing back their contracts will potentially be taken over by companies on an APMS contract with limited liabilities and nothing to lose. And the house of cards will keep falling.

Dr Shaba Nabi is a GP trainer in Bristol

Also included  an article from the Guardian along similar lines.

http://www.theguardian.com/society/2015/mar/08/life-of-a-gp-we-are-crumbling-under-the-pressures-of-workload

The new model GP army

The following article is from the Guardian it provides an insight into the new vision of GP that JH and DC would like us to buy into the problem is it too will be subsumed by the Tsunami of demand unless the model of care provision and the way that care is funded is altered ……time for an honest debate ?

The new model GP army: on-site vasectomies and Facebook diagnosis

The Haxby group of practices is innovative, collaborative and expansionist. But the old NHS ethos is at its heart, its GPs insist

by

“In Dr Myers’ day it was a lot more NHS-ish,” says Geoff, 69, recalling Haxby and Wigginton surgery’s GP when he first became a patient in 1975. That was long before it was one of 10 practices in the Haxby group and occupied these functional, unpretty premises.

What does NHS-ish mean? “You sat still and you said nothing,” says Kris Holliday, 74. “The doctor was more on a pedestal, whatever the doctor said went,” adds Paul Jackson, who at 50 has also been using the surgery in York for 40 years, often accompanying his wife, Jayne, 57, while she had kidney dialysis and finally a transplant. “You’re dealing with a practice now,” says Holliday. “I’m surprised to hear myself say it, but doctors have become team players and we, as patients, are part of the team.”

The Haxby group is the new model GP army. They work with other “like-minded” surgeries, as senior partner Dr David Hayward puts it. This may not sound particularly novel or political, but Dr Fiona Scott, in one of the Hull surgeries, says briskly: “When we arrived in Hull, nobody talked to anyone.” “There’s still a lot of one-man bands in Hull,” adds her colleague Dr Laura Balouch, ruefully. Many of the Haxby GPs have acted on the clinical commissioning group (CCG) boards – which under Andrew Lansley’s reforms were meant to have GPs at their heart. Every doctor I met had stood down, citing time pressures when asked about it, in a resolute “that’s all I want to say on the matter” tone of voice.

The real innovation – the bit that might ring alarm bells of privatisation with some – is not so much their commissioning relationship with hospitals as their expansionist nature. They have six surgeries in York, run along traditional partnership lines with a general medical services (GMS) contract with NHS England; and four in Hull, for which they won the newer alternative provider of medical services (APMS) contracts, devised in 2013. These have to be run as limited companies – partnership was not an option in the bidding process. Other innovations, such as two on-site pharmacies they have set up, are also limited companies…………….

  • Some patient names have been changed.

Juniors offer Hunt statistics aid

Junior doctors bring mirth to the strikes with a fitting gift to Mr J Hunt MP from the Doctorsnet website 

Juniors offer Hunt statistics aid 1922/01/2016

Junior doctors have urged health secretary to brush up on his statistics, accusing him of misquoting medical research on weekend working.

A group of doctors made their point yesterday by delivering an eight foot high version of a classic medical text book to the Department of Health.

The book “How to Read a Paper” is by GP Professor Trisha Greenhalgh.

The doctors delivered a letter with the book – stating there is “no objective evidence” to link weekend mortality rates to medical staffing.

Anaesthetist Nadia Masood told the Daily Mirror: “With the doctors’ strike, the NHS is in the news everywhere and government ministers – not just Jeremy Hunt but the Prime Minister too – have been using statistics incorrectly.

“The public are being led to believe weekend care in hospitals is not safe and if they have a stroke they won’t be safe to come in. p> “We’re beginning to see patients avoiding and delaying coming to hospital at the weekend and coming to harm.”

Professor Greenhalgh said: “To use data uncritically is irresponsible. To use data irresponsibly for political purposes is unethical and could lead to deaths.”

A Department of Health spokesman said: “There is clear clinical evidence that standards of care are not uniform across the week – the Freemantle study in the BMJ and clinical evidence from NHS England show that stroke patients have a 20% greater risk of dying if admitted at the weekend.”

Clinical excellence may become impossible in state provided health care.

NHSreality wants the now regional health services to succeed, but this is not possible in the current climate of denial by politicians, and distrust by doctors. Yes there have always been Perverse Incentives in either system, public or private, but as things get worse in the state provision, the temptation to go private will increase. So will the health divide. NICE knows the truth.. Clinical excellence may become impossible in state provided health care in the average DGH.

Paul Hobday for “open democracy” comments on the “Seven things the private healthcare insurance adverts won’t tell you”

The NHS financial crisis is being used by healthcare insurers to try and sell their products – but what are the risks?

Like any big business the UK’s £5 billion medical insurance industry has to sell its product to satisfy share-holders. An abundance of advertising and websites extoll the virtues of private health insurance. Their message can usually be summed up thus:

“You can jump queues, have a TV in your room, choose your specialist and appointment, and perhaps have treatment unavailable on the NHS”. What such messages fail to tell us is the following.

  1. Private medicine over-investigates and over-treats and you may get surgery that is not in your best interests. In the US it is estimated at least a third of all healthcare activity brings no benefits to patients. Every link in the chain has a financial incentive to do more to you and that can be dangerous.
  2. Private hospitals do not have the same level of scrutiny of safety as NHS facilities. In fact it is very difficult to get worthwhile information from them. As you cannot find out properly about safety and risk, what value is there in being able to select your specialist?
  3. Increasingly, you won’t have that choice anyway. Some companies are increasingly restricting the hospitals and specialists used. If you want your cataracts done, some companies now send you to Optical Express.
  4. The price of private health cover has nearly quadrupled over the last decade. And premiums rise even more sharply as you get older. But even with the most expensive policy, full reimbursement of all costs is not guaranteed. You might have to fight for it – not much different from insuring your car. New terms and conditions have been introduced that exclude policyholders from claiming, apply ‘excesses’ or co-payments, find excuses not to reimburse certain fees and limit how much can be claimed in a year. Complaints have surged.
  5. Companies will encourage you go for NHS treatment if your care is expensive. BUPA have been criticised for offering ‘bribes’ to policyholders to use the NHS rather than their private hospitals.
  6. Care can be very “fragmented” when it is vital that it is integrated well, for example with cancer care that requires a good team approach. Some companies boast of being able to supply cancer drugs – but the drugs only materialise if all NHS routes have been exhausted first, and patients often have to plead with your insurer to keep supplying the drugs longer than a year.
  7. Private medicine in the U.S.A. spends 36% on administration. The Institute of Medicine estimates that an astonishing $750 billion a year of healthcare expenditure is wasted through fraud, overcharging, unnecessary treatment and other leakages. 62% of US personal bankruptcies are due to medical bills – and of these, 78% had insurance (but it found ways not to meet their costs). Insurance companies control everything and often dictate who your doctor is. If you want to help push us in that direction, then support private medicine.

Private medical care is expensive – so the healthcare firms admit their big hope is a failing NHS. As Spire told its shareholders recently: “Growing NHS deficits will put increasing pressure on waiting lists and drive increased formal and informal rationing of NHS procedures, which will over time significantly grow demand for private care”.

In other words, the private sector is licking its lips at the idea that underinvestment in the NHS, bed closures, hospital downgrades and rationing of services will drives patients to private hospitals (either funded by insurance, or pay as you go).

And the NHS is paying them large sums, too, as government underinvestment forces NHS hospitals to ‘outsource’ patients to private hospitals to plug the gap between supply and demand. In West Kent, the new expensive PFI Pembury hospital has only one MRI scanner and so has had to “outsource” requests to local private hospitals. Mental health patients are now routinely sent long distances to private sector beds because there are no NHS beds available. The trend is only likely to increase as we face the worst NHS underinvestment in a generation.

If you want healthcare’s prime raison d’etre to be not a service, but a business making some people very rich, like in the USA, then you can help by taking out private health insurance. You can please the numerous MPs who have a financial interest in private healthcare companies. If you think a future where your health is looked after in the same way as your car is worth aspiring to, then sign up today.

If however you see the benefits of us truly all “being in this together”, helping each other, and want to support rather than run-down the most cost-effective healthcare system in the world, then forget private health insurance. Don’t waste your money, or risk your health – but demand politicians change direction back towards a publicly funded, publicly provided and publicly accountable health service.

NHS heads for catastrophic failure

Do as I do? NHS agency splashes out on private healthcare for staff

Do we all need to move to “private”? Nigel Farage: Choose private healthcare if you can afford it

“That’s the standard technique of privatization: defund, make sure things don’t work, people get angry, you hand it over to private capital.”

The risks of private care… overstated?

Paid for by the NHS, treated privately

The pride of ownership and self employment: Opening general practice to private providers ‘may have worsened patient care’. The partnership model has been killed off..

Michael Sheen, who lives in Los Angeles, and will have private cover, defends the (Welsh) NHS

Lets sell the family silver – abandon your Health Service to market forces and covert rationing

Will Wales’ professionals be tempted to take out group private medical insurance?

Patients are ready for privatised care, health chief claims

Private hospital ‘putting patients lives at risk’

GP private firms grab NHS cash

Private: Modernise or vanish, Google warns NHS

Charges are acceptable – at last the ideology of 1948 is challenged

Kent NHS ‘to send surgery patients to France’ – setting a precedent? Can the fragmented UK health services recover without some form of zero-budgeting and revolutionary reconfiguration based on overt rationing?”