Friday, 13 July 2007

Private vs State Healthcare

Readers of medical blogs will know that the most heated debates revolve around the best way to provide health care. Unfortunately, for all the heat there is little light and the protagonists remain entrenched in their positions.

The right wing, free market supporters argue that health care would be better, and even possibly cheaper, if patients could take their custom where they choose while the supporters of socialized health care argue that a comprehensive, fair and truly national provision can only be provided by the state run N.H.S.

I think that the problem is that we are not arguing about the same thing. It has long been a Nulabour ambition to abolish private medicine in the UK and it is also a Nulabour ambition to destroy ("modernize") the network of District General Hospitals which form the backbone of the N.H.S. Abolishing private practice at a time when the government were pledging to cut waiting lists would have been suicide and this was put on the back burner. Dr Richard Taylor gave Nulabour a drubbing over the "modernization" of the D.G.H. at Kidderminster and continues to be a thorn in their side as an MP, so more subtle means had to be employed.

The Nulabour plan, and it seems it will be continued under the I-had-nothing-to-do-with-Nulabour Brown Party, is to pay private companies to take over the role of the N.H.S. This is not the same as private medicine and it is this involvement of the private sector that I, and many doctors object to. This untried experiment in health care will combine the worst aspects of profit hungry, short term interest, Venture Capitalists with the take-it-or-leave-it attitude of a monopoly provider and employer. It will do nothing to improve patient care, safeguard employee conditions or provide for training and future development of services. The potential for chaos and disaster is huge and unknown.

We have seen Mercury Diagnostics win a contract to provide scanning in the W.Midlands on such generous terms (all set up costs and 80% of income guaranteed for 5 years) that it immediately sold the contract on for £77 million, without ever providing one scan. This was taxpayers money essentially given away. Contrast this to when telecom operators bid for 3G licenses about 10 years ago which brought in £billions to the state at the expense of private companies. We see the same process with PFI, where private companies are paid so handsomely that some building companies (eg Laing) now find that there is more money to be made from winning contracts from the Government and selling them on than in actually doing any building. The government is essentially subsidizing private companies to compete against the N.H.S. and then arguing that the private sector can do it better and cheaper. There is some evidence that this policy is beginning to collapse and even Nulabour are unable to continue to claim it has been a success.

Readers may know that I work in the NHS and I have also worked in a private, not-for-profit hospital in the U.S.A. I also work in a private, not-for-profit hospital in the UK and I am also trying to provide a private service within an NHS hospital via UK-radiology.

My experiment with UK-radiology continues to succeed and, to me, represents the way forward. Whereas before, the managers got a bonus if the consultants worked harder, I have been able to align the consultants interests with that of the Trust by providing reward for private work consultants do in the Trust. This means that the consultants can use their ability, ingenuity and capacity for hard work to attract income to the trust. The income is used to fund improvements to the NHS service and protect NHS jobs so that capacity is not lost. This, in turn, will allow us to compete with the private sector NHS providers and maintain a real choice for both NHS and private patients.

Control needs to pass back to the doctors as we have a long term interest in health care provision, as employees, entrepreneurs and potential patients. Venture Capitalists, Chief Executives and politicians move on when they see there is money or votes to be had elsewhere and can afford private health care for themselves when required. When all the political interference is over we will still be there sorting out the mess.


Nursing Student said...

A very good point Dr Ray. The fact is that your system works as you are are doctor, taking decisions as a doctor. The current NHS status usually means muddled, disorganised, ill concieved, target obsessed management consultants trying to emulate such things, will little knowledge base, and weak evidence/research to support their assertions.
The problem with ripping the NHS up and replacing it with a private/commerialised/payment based system is that some people (I am sure you know from which blog and the contributor) forget that the intrisic factor of the NHS is that it encapsulates the Health Act 1977. To change the system means to change the law, which I fear will start a deadly legal reaction in years to come should it happen.

Dr Ray said...

Thanks nursing student.
I didn't know what you meant by the Health Act but I looked it up. I think the important bit is:

"All NHS bodies shall comply with the "Maintaining High Professional Standards in the Modern NHS"
Framework ("the framework") as set out in the document annexed to these Directions."

This probably doesn't apply to private operators doing NHS work since they are not NHS bodies

So far the private operators have been able to fly in surgeons on short contracts bypassing UK requirements for recognition as a consultant and they are now starting to send scans abroad, where UK regulations don't apply.