Whilst the Americans destroy Obamacare on the grounds of cost and perverse incentives, we are destroying something much better – the rump of the former NHS. It’s not easy for politicians in denial to admit their mistakes.. Good and experienced GP gatekeepers are valuable commodities. They have all round experience, know their limitations and when to ask for help. Asking too often is just as bad as asking too infrequently. Unfortunately GP Training is not universally equal. Psychiatry and Paediatrics can be omitted quite easily… Other countries such as Canada insist on adequate all round training and we should do the same. Referral management centres would not then be demanded.. There is no cross party consensus, and the difference between the UK and the USA is that they are destroying Obamacare deliberately, whereas we are destroying our service by neglect and denial, (and long term covert rationing).
Kailash Chand in the Guardian opines on 4th January 2017: 2016 was the worst year in NHS history – we must fight for its survival and Richard Vize says 6th Jan 2017: Improving NHS services should not feel like a quest in a labyrinth . Also today BBC reports “Social care funding: MPs urge ‘swift’ cross-party review”, …a letter signed by Clive Betts, chairman of the Communities and Local Government committee, Public Accounts Committee chairman Meg Hillier and her Health Committee counterpart Dr Sarah Wollaston says a long-term solution can only be found if there is cross-party consensus…
Chris Smyth reports 5th Jan 2016 in the Times: NHS paying private firms to block hospital referrals – (Referral Management Centres) whilst the Guardian’s take on this is “NHS groups ‘paying millions to private firms that block GP referrals’ – Referral management centres being used by some NHS bodies to scrutinise patient referrals to hospitals, BMJ inquiry finds
….In an investigation, the British Medical Journal (BMJ) sent freedom of information requests to all 211 CCGs in England. Of the 184 that responded, 72 (39%) said they commissioned some form of referral management scheme.
Almost a third (32%) of the schemes are provided by private companies, while a further 29% are provided in-house and 11% by local NHS trusts. Some 69% of the CCGs with schemes gave details of operating costs. These CCGs combined have spent at least £57m on schemes since April 2013.
Most CCGs were unable to provide evidence showing the scheme saved money…..
In the Guardian letters on 3rd jan 2017 Taxing questions about NHS funding Alan Bailey, and Nicholas Suaraz, comment:
Steve Richards’ proposal for a referendum on whether to tax more to invest in the NHS (Opinion, 3 January) is interesting. But his first “drawback” – that “the Treasury hates any form of earmarked taxation” – is not quite right. What the Treasury objects to (stating awkward facts, as usual) is that hypothecating an existing tax to a particular programme will put an unacknowledged extra burden on other programmes (actually or potentially). The problem with this proposal, as with any referendum, is that a “vote for change” lands the government with the further question: what change? In this case, what new tax? Indirect tax (VAT) is regressive. A straight proportionate increase in income tax looks unfair to low earners and harms incentives to work; but a steep increase in direct tax on rich individuals, or companies, will drive them to base their money, or themselves, abroad. This leaves a progressive tax on the value of fixed assets (land and buildings) – for example a reformed council tax; but how much would a government dare to tax “ordinary” property owners when house prices are already so high?
As this winter is indisputably showing, the NHS is slowly dying, and no doctor or nurse can save it. The cure can only be ministered by the British people. As the year turns they must decide whether or not they believe, as they did in 1948, that “illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community” (Aneurin Bevan). If they do, they should indicate through their elected representatives that they are willing to open their wallets and pay the cost through increased taxation. If they do not, they should accept that our health system, the envy of the world, will perish, leaving behind the country’s poorest and most vulnerable.
Dr Nicolas Suarez
Update: also in the news today 6th Jan 2017 is Norovirus, a disease of overcrowding in Health Service Hospitals which is never seen in private ones, and
Katie Gibbons: Call for extra NHS cash as norovirus hits 5-year high its a direct result of “undercapacity” rationing, and Mark Porter’s advice is good in the emergency but denies the longer term structural reasons. Dr Mark Porter: This season’s norovirus looks like a bad one. Here’s how to deal with it
There is a similar denial regarding Mental health. Rosemary Bennett reveals the well intentioned but mis-directed intentions of coroners trying to protect families (and life insurance policies): Thousands of suicides hidden to comfort grief-stricken families: Thousands of suicides hidden to comfort grief-stricken families