Wednesday, 31 October 2007

Darzi exposed

Resistance is futile

Most medical people recognise that Darzi was brought in to give a veneer of clinician support to the wholesale transfer of healthcare to the private sector. While we recognise it, we are individually powerless to resist this and our BMA representatives are, at best, supine to the extreme, and at worst, enabling the government in its plans by suggesting that, for example, doctors' work could be done by pharmacists, nurses, paramedics and other various jumped up quacks who did not possess the intelligence and work ethic to train as real doctors.

With her permission, I have reproduced a posting on DNUK (a doctors only site) by Miss Anna Athow, a Consultant Surgeon with 35 years experience as a doctor. Although it is perhaps overlong it does dissect the truth behind Darzi's reforms and needs a broader readership.

Darzi's 'Framework of Action'=NHS privatisation in England

The “Framework for Action” plan for Londons healthcare fronted By Professor Sir Ara Darzi, proposes the destruction of a publicly provided NHS in London. It is a blue print for privatising the NHS nationally.

Lord Darzi, the National Advisor on Surgery, has been working with the Labour government for 10 years on the NHS plan and promoted the separation of elective from emergency surgery into independent sector treatment centres( ISTCs). Under Gordon Brown he has been elevated to under secretary of state for health and he is being used to pretend that doctors are in favour of dismantling the NHS.

This lengthy document, is designed to deceive the unwary, laced as it is with fine phrases about improving healthcare and ending inequality. Nothing could be further from the truth.

It claims to be about services not institutions. In fact it proposes to smash the fundamental institutions of the NHS; NHS general practices and district general hospitals (DGHs), and replace them with brand new institutions; POLYCLINICS

Though the report does not say so, these would be owned and run by private healthcare corporations and would act like American health maintenance organisations.

The essence of the destruction plan is to be found in the Technical document. Accountant have analysed all the health care procedures performed in London in 2005/6 . Using the techniques developed for payments by results ( PBR) tariffs, every healthcare procedure perfomed in London in 2005/6 has been classified by HRG ( Health Resource Group ) and the volume of each of them recorded.

London’s entire healthcare is then viewed from a commercial perspective and is laid out as a prospectus to attract private healthcare investors. It is is the complete antithesis of a medical approach to healthcare, which begins from clinical needs.
This document starts out from the financial interests of the private healthcare providers and divides the whole of medicine into arbitrary “ Service Lines” based on estimated profitability.

Elective surgery for example is divided into – complex, "high throughput", minor procedures and under 17s. “ High throughput” surgery consists of procedures such as cataracts, arthroscopies and inguinal hernia repairs. These belong to the surgical specialties of ophthalmology, orthopaedics and general surgery, but are all lumped together because they are attractive to ISTCs as short episodes of surgical care.

We are told that the small group behind the technical paper worked to basic principles the first of which, was to allocate to Polyclinics every aspect of healthcare they could. This is what they have done. Essentially every walking patient having a daytime procedures has been allocated to polyclinic care.

60% of London's healthcare would end up in them.They would contain
*50% of community care, (district nurses health visitors etc)
*50% of outpatients clinics, shifted out of hospitals
* 50% of A&E patients shifted from hospitals into walk in urgent care centres
*all ‘routine’ diagnostics such as xrays, CTscans, other tests.
Also, regular attenders, patients with Long term conditions, non emergency medical procedures such as endoscopies, patients having chemo therapy, minor operations etc.

Polyclinics would predominantly employ GPs and nurse practitioners or other practitioners. There would be few consultants and staff nurse support. There would be no junior doctors.
For 150 new polyclinics each with catchment areas of 50,000 population to be successfully launched, Londons district general hospital are to be largely destroyed.

Darzi says. “ The days of the DGH doing all services to high standard are over.”
The plan is that the 32 DGHs in London would be reduced to between 8 to 16 acute major hospitals.
The other 16 to 24 DGHs would be destroyed or turned into rumps called Local hospitals.
Local hospitals would have medical inpatients only. There would be no surgeons or anaesthetists on site. Intensive care units would be closed. The A&E department would remain open, but would be in the dangerous situation of not having surgery on site. So if a surgical emergency arrived or developed, they propose that either a surgeon would be called in from another hospital or if the patient were very ill, he would intubated and ventilated and shipped across London in an ambulance to one of the few acute major hospitals left.

Supposedly, ambulance men would be trained to decide which patient should go to the urgent care centre in the polyclinic, which to a Local Hospital and which to a major acute hospital. They would learn to “bypass” hospitals.
Those DGHs closed completely, as is planned at Chase Farm Hospital in Enfield, would become sites for polyclinics, walk in urgent care centres +/- elective surgical centres (ISTCs).

Darzi says that six clinical working groups were set up to advise him on the new models for healthcare ( mental health left to one side )
1. maternity and new born
2. staying healthy
3. acute care
4. planned care
5. longterm conditions
6. end of life care.
The division of healthcare into these apparently arbitrary divisions becomes clear on reading the recommendations. 1. 3 and 5. are to be cut to the bone. 2. 4. and 6. are to enjoy huge new investment for the private sector.
1.3.5. all comprise consultant intensive hospital specialties.
1. Consultant led obstetric units are to be reduced and replaced with midwife led birthing units and home births (to increase from 2% now to 10% target in the future.)
3. Paediatrics, emergency and elective surgery and intensive care units are to be stripped out of DGHs as described above.
5. Patients with long term conditions such as diabetes, who in their old age make up the majority of acute hospital admissions are to have their acute care massively cut. Every effort is to be made to keep them out of hospital. They are to look after themselves, and go to polyclinics.

2.4. and 6 are to be expanded. Private enterprises are to be employed keeping people healthy. Planned care like outpatients, diagnostics and elective surgery are to shifted into polyclinics and ISTCs. As for the dying, the DoH has suddenly developed great enthusiasm for helping patients to die out of hospital and in their own home. Private companies called “ End of Life service providers”are to get the lucrative contracts.

What we had in the NHS was primary care (GPs and community care ), which was local and personal, secondary care ( DGHs and teaching hospitals) embracing all aspects of care on one site and providing training for the next generation of doctors and other staff, and tertiary care ( more specialised hospitals for less prevalent conditions such as neurosurgery, burns, etc )
The Darzis plan proposed to disentegrate care into seven models;-
Local hospitals
Elective surgery centres
Major acute hospital, specialist hospitals. Academic Health Science Centres.
Polyclinics, and elective surgery centres would be owned and run by private corporations. The latter hospitals have to become foundation trusts by 2008 so these would be run as businesses. The plan for local hospitals is probably to starve them of funds and gradually run them down. There would be no NHS left.

“ Commissioning can only drive change if it has a direct impact on the income of healthcare providers. Funding flows need to be used to incentivise the best practice contained in this report. At its simplest, this means commissioners defining the best practice for a patient pathway and then ensuring that this best and only this is the best practice they pay for.”
These stark words say it all. The commissioners will dictate so called “ best practice”. If that means that a patient can only be seen by a nurse practitioner in a polyclinic and not by a consultant at a hospital, so it will be.
The commissioning role of PCTs is now being outsourced so that the private corporations will be laying down the rules of so called “ best practice ” pathways.

THE DARZI PLAN MUST BE TOTALLY REJECTED. It represents a fatal reduction in the volume and quality of healthcare for Londoners in the interests of big business. The BMA should unite with other unions in fighting to defend the NHS. The government has no mandate for privatising the NHS and must go. It must be replaced with a government which will fully fund a publicly provided NHS.

Sunday, 28 October 2007

On yer bike

An unbelievable story in the Telegraph today. If it really is true it illustrates just how bonkers this country has become.
Robert Stewart was discovered in his locked room, wearing only a T-shirt and gyrating his hips against a bike as if to simulate a sexual act.
Now, in my mind, having sex with a bike rates as some way less depraved than having anal intercourse with a stranger, which is perfectly legal, in private, and, in fact, is apparently practiced by some of our political masters.
Poor Mr Stewart, however, has been placed on the sex offenders register. This would be funny if it was not such a stark example of the Judiciary misusing it's power. While it seems Mr Stewart may be going through a bad patch (he lives in a hostel), placing him on the sex offenders list will essentially prevent him ever getting employment and will restrict the chance of him ever returning to normal society.
And what exactly was his crime? The article doesn't state the bike's age or whether it consented to the act but I was not aware the law took this into consideration. Mr Stewart had taken the trouble to lock his room so the act was in private. He was only caught because the cleaners had used a master key to enter his room. Contrast this to the firemen who were fined £1000 and demoted after a complaint that they had disturbed a quartet of homosexuals engaged in public (and therefore illegal) sex. The complainant and his partners did not face prosecution.
So essentially Mr Stewart has been criminalised for using an inanimate object as a masturbatory aid in the privacy of his own locked room. A quick look at the sort of online adult shops we are not allowed to access from work suggests that he might not be the first person to have done this and I am given to understand that such devices are on sale in Boots up and down the country.
Perhaps the story has not been accurately reported and perhaps there was someone strapped to the bike against their will at the time but, to me, the Law looks like an ass here and I hope the judgment is reversed and Mr Stewart awarded a six-figure sum in compensation for defamation and mental anguish. On the other hand he doesn't seem like the sort of person who could afford Max Clifford or, the late, George Carman QC

Saturday, 20 October 2007

"The days of the DGH are numbered"

Lord Darzi of Harlesden

This quote is from Lord Darzi before he started his consultation on the future of NHS provision.
It is quite clear that Nulabour has wanted to close down the network of district general hospitals for many years. District general hospitals provide the bulk of NHS secondary care and employ large numbers of staff. Staff are employed under rigid T&C of service and this leaves little scope for reducing costs within the NHS even with the ready availability of vast numbers of people from Eastern Europe and beyond who would be willing to work for a fraction of current NHS wages. If the service could be provided in a parallel system run by the private sector, issues such as staff wages, qualifications and training could be conveniently circumvented.
Nulabour initially tried a direct approach in Kidderminster and were shocked to lose a safe seat to Dr Richard Taylor who campaigned on keeping the hospital open. Since then more devious methods have been employed including the Darzi review with its sham consultations and predetermined outcome.
Dr Phil Hammond, the clap doctor, medical journalist and TV personality has written on this on a doctors' only medical site called Univadis. His column is like a blog but he gets paid to write it. I don't, so I don't feel too bad about copying it in full because he makes the points I want to make rather well:

"Should we have one union that represents all NHS workers? This thought struck me at a UNISON meeting I was asked to speak at m in Cambridge. The East of England SHA was £800 million in debt when it came into existence and has never quite recovered. Two district general hospitals in Hertfordshire are in the process of being ‘downsized', despite the fact that they are treating more patients than ever, to be replaced by ‘acute care centres' to be run by GPs, allegedly. Management claims that many A&E attendances are inappropriate, but 90% of acute admissions to both hospitals come via A&E. These are hardly inappropriate and if you close the front door of any hospital, what's left is very vulnerable. Job losses have started but any protest by UNISON to the SHA is answered with ‘clinicians want this.'

This is the latest Labour wheeze, to claim that the reform programme is based around what clinicians want. Lord Darzi, a very eminent clinician, is leading the charge, and doubtless in a workforce as diverse as the NHS it's possible to rustle up some pro-Labour doctors to rubber stamp reconfiguration. But the last twenty years of clinical medicine has been about abandoning the dubious opinions of experts and focusing on the best available evidence. The same approach should be applied to NHS reforms.

The best evidence so far on NHS reconfiguration comes from a comprehensive analysis by the Academy of Medical Royal Colleges. Hardly the most radical organisation, but their message was simple. There is a case for the centralisation of specialist services onto fewer sites, but only in three areas; major trauma, neurosurgery and vascular surgery. However, there is no evidence – in terms of quality and safety - to support the centralisation of the non-complex and high volume work that is the bread and butter of district general hospitals. If you've got any sort of breathing difficulty (asthma, choking, anaphylaxis), you want to get to a local A&E, and quickly.

This report was conveniently buried under all that mock election hubris, superseded by Lord Darzi's interim review which contained such gems as ‘we need to change the way we lead change.' Have you ever met a surgeon who speaks like that? What has ‘new' Labour done to the poor man? His report was largely a smokescreen for the real story, that Labour has ‘approved' 14 private forms to help PCTs with commissioning (McKinsey, UnitedHealth, KPMG, Dr Foster Intelligence (sic) etc). Given that PCT commissioning is worth £64 billion, this is clearly something that a united NHS workforce should challenge. But we're not united, and we still work in silos with ridiculous inter-professional rivalries. And without one union representing us all, from doctors to domestics, we're quietly sleepwalking towards a privatised NHS. I don't think clinicians do want this, but we're too supine to complain. Wakey, wakey. As Joni Mitchell put it; ‘We won't know what we've got till it's gone.' "

Lord Darzi was appointed as Health Minister so that Nulabour can argue that it has listened to the clinicians when they give health care to the private companies to run. If the experiment works they will take the credit; if it doesn't and the population realise they have been hoodwinked when they lose their local services they will blame us.


More plagiarism: a joke sent to me from South Africa

The phone rings and the lady of the house answers.
"Hello. Mrs. Ward, please."


"Mrs. Ward, this is Doctor Jones at the Medical Testing Laboratory.
When your doctor sent your husband's biopsy to the lab yesterday,
a biopsy from another Mr. Ward arrived as well, and we are now uncertain
which one is your husband's.
Frankly the results are either bad or terrible."

"What do you mean?" asked Mrs. Ward nervously.

"Well, one of the specimens tested positive for Alzheimer's,
and the other one tested positive for AIDS. We can't tell which is your

"That's dreadful! Can't you do the test again?" asked Mrs. Ward.

Normally we can, but Medicare will only pay for these expensive tests
one time."

"Well, what am I supposed to do now?" asked Mrs. Ward.

"The people at Medicare recommend that you drop your husband off
somewhere in the middle of town.
If he finds his way home, don't sleep with him."

Sunday, 14 October 2007

"Helping the nation spend wisely" Sir John Bourn

A visitor from Mars, looking at the way government spending and taxation have increased over the last 10 years, would surmise that we have wasteful and profligate politicians. On the contrary, our leaders approach government spending as if taxpayers' money was their own and, if they do squander it, they have the National Audit Office to answer to.
The National Audit Office is funded by the taxpayer but independent of government. Sir John Bourn, head of NAO, has, for example, congratulated NHS Direct on its success:
"NHS Direct, the national telephone healthcare advice service operated by nurses, has achieved a high level of customer satisfaction since its introduction. The service, which has been fully available throughout England and Wales since November 2000, has a good safety record. Evidence at the local level suggests that it can help reduce demand on healthcare services provided outside normal working hours, for example by GPs, and is directing callers to more appropriate forms of care during the day." This was the same NHS Direct where the operators pretended to be answering machines to avoid dealing with callers and has been widely blamed for directing patients unnecessarily to A&E departments while conversely delaying the treatment of severely ill children.
On the National Programme for IT in the NHS, Sir John commented:
"Substantial progress has been made with the National Programme for IT. The Programme promises to revolutionise the way in which the NHS uses information to improve services and patient care. But significant challenges remain for the Department and NHS Connecting for Health." This is the same NHShIT that is widely seen as unworkable, overambitious, wasteful and unwanted by the medical profession and is projected to cost more than £20 billion with no measurable benefit. In fact the most widely touted benefit of having the patients records available online in an emergency is now being offered for free by Microsoft, and PACS (digital imaging and archiving), for which the NHShIT is widely praised, owes as much to the NHShIT programme as the move from film to digital photography.
A later NAO report on the progress, (or more accurately the lack of progress) of NHShIT was, according to documents discovered by the BBC, altered by the Department of Health to remove the more critical findings.
Still, even if the NAO isn't as independent as we would like it to be, at least its head, Sir John Bourn, is an honourable man, leaving no stone unturned and enduring any personal hardship in his protection of the public purse.
It comes as a shock therefore to find he has his nose in the trough too. A BBC report of Sir John's spending for the 6 months to September 2007 revealed he had spent £16500 on five overseas trips and £1650 on business meals. This was after having previously been criticised for spending £336,000 on 45 business trips in a 3 year period. Maybe this is not an unusual level of spending for a high ranking public servant but the accounts reveal that the trips were taken as First or Business class and the taxpayer was picking up the tab for entertaining parliamentarians and senior government officials at 5* London hotels and upmarket restaurants. Even more surprising, for the person in charge of safeguarding the taxpayers money, his wife accompanied him on some of the trips and was paid for by the taxpayer. For comparison, the code of practice governing doctors and the pharmaceutical industry stipulates that the choice of venue for meetings should be no better than a doctor would normally choose for themselves and the entertainment of doctors' spouse is strictly prohibited.
One wonders why the taxpayer has been paying for Mrs Bourn to go on overseas trips. It can't be that Sir John is hopeless without her because he managed single handedly on his trips to Kazahkstan, Moldova and Belfast but was accompanied to the much more desirable tourist locations of San Francisco, Lisbon and Venice.
I think the taxpayer will be reassured that our money is being wisely spent to benefit our population and that the NAO is leading the way by example.
Update 25th October
He's resigned

Thursday, 11 October 2007

The spin and the reality

The Spin - Happy Shiny People from the DoH "A New Ambition for Stroke" document which sets a target for CT scan within 60 minutes for patients thought to have suffered a stroke.

The Reality - "Many of the buildings, especially at the Kent and Sussex Hospital, were old and in a poor state of repair. Many of the wards did not have sufficient storage, space in utility rooms, or hand basins, making the control of infection difficult. The beds on several wards were much too close together, making it difficult to clean between them and seriously compromising the privacy of patients. Although there had been improvements generally in cleanliness and hygiene since the outbreak was declared, there were still some serious concerns. When we visited, we observed levels of contamination that were unacceptable, such as bedpans that had been washed but were still visibly contaminated with faeces."

"Other medical wards such as Cornwallis and John Day also had high bed occupancy figures of over 100% for several months. Whatman ward consistently had a rate of between 85 and 94%. In April 2006, when functioning as a cohort ward, its bed occupancy rate increased to 110%."

"Many attributed much of the poor care to the shortage of nurses and talked of seeing exhausted nurses in despair, with their heads in their hands. However others talked about poor attitude of some staff, including agency nurses. They described instances of nurses shouting at patients, leaving them unattended for hours, and not providing a proper level of care."

Report of the Healthcare Commission: "Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust" which killed 90 patients.

Sunday, 7 October 2007

We're loving it.

"enhancing the client’s reputation by positioning them as open, engaging, listening and responding."

Readers of the right-wing blogs might come away with the idea that there is widespread dissatisfaction with our current political leader. Readers of medical blogs might think that the millions of pounds of taxpayers money have been wasted. This is far from the truth.

Take Opinion Leader Research for example. This company has been running the Citizens' Juries for NuLabour. OLR thinks taxpayers money has been well spent. Why does this matter? It matters because if OLR thinks it then you think it too - that is their job. They proudly claim: "Opinion Leader influences". Why do they think the money has been well spent? It has been well spent because a large amount of it has gone to them. The tag-line "enhancing the client’s reputation by positioning them as open, engaging, listening and responding." is also from their website. It tells us clearly what our money has bought. It hasn't told us anything about public opinion; it has been used to give the impression that this government cares about public opinion and thus enhances its reputation.

As an extension of the democratic process the Citizens' Juries are profoundly undemocratic. OLR gets to pick the participants and gets to chose the questions. The participants are only told selected aspects of the argument and, in the atmosphere generated during the "consultation" can be manipulated by skilled moderators (or social influencers as OLR prefers to call them). There seems to be no rigorous audit of the selection or voting process.

OLR conducted the "Your Health, Your Care, Your Say" Citizens' Jury for Patricia Hewitt in 2005. Never heard of it? Pulse magazine said:

"The Government has fixed its flagship listening exercise on the future of primary care to ensure it backs pre-stated plans for dual registration, walk-in centres and an increase in private providers."

Sounds familiar? This seems to have been a dry run for the current Darzi review and had only 89 participants.
Pulse later did a FOI Act inquiry on the event. Its conclusions were:

"The finding supports accusations by GPs and academics (Pulse, 24 September) that the consultation was a sham exercise because it focused on a restricted range of issues relating to access, but marginalised others such as continuity of care.

The documents also reveal that Opinion Leader Research was asked to write a proposal for the Your Health, Your Care, Your Say consultation before other organisations were even asked to tender."

It also found out that OLR were chosen instead of other pollsters, ICM and MORI, even though the OLR tender, at over £2,000,000, was more than 10 times higher.

OLR are also involved in "consultations" over nuclear power. An item on the Channel 4 website is eerily familiar:

"In the videos - alternative viewpoints had doom-ridden music in the background. The government's view was then given against calm, relaxing music. I feel I have been mugged."

"Not at all a consultation, merely a sleek marketing ploy."

"I went in with an open mind... myself and others felt we were being misled and manipulated."

So-much-so that Greenpeace withdrew from the consultation and made a formal complaint to the Market Research Standards Board. Unlike the recent Citizens Jury on the NHS, which I documented last month, many people have come forward to complain about the conduct of the Nuclear Energy consultation. Their description of events confirms the tactics routinely used by OLR to give the government the answer it wants while appearing to consult.

OLR's stated aim is to "enhance the client's reputation". Taxpayers are footing the bill for enhancing NuLabours reputation. Well, you can't polish a turd (not even with another turd) so this is money wasted and NuLabours reputation further damaged, if that were possible.

Here's a novel idea for the Clunking Fister. How about we give real democracy a try and let us elect our own Prime Minister?

Saturday, 6 October 2007

More NuLabour deceit

Guido Fawkes thinks Yvette was faking it.

A few days after the infamous "Citizens Jury", where selected "participants" were paid £75 cash in plain envelopes, Yvette Cooper, Minister for Housing and wife of Ed Balls held a webchat on the Downing Street website. I came across this on the thoroughly recommended Guido Fawkes blog.

Transcript of Webchat:
"Karen Doran: What is the government doing to make sure their policy on housing (regeneration and growth) is aligned to policies designed to promote economic growth. Could the Minister give practical examples of the opportunities this presents to local authorities in their place shaping role?
Yvette replies: You are right Karen that new homes need to be planned alongside new jobs -- as we are doing in the Thames Gateway, which is a major area of regeneration and housing growth. But housing and economic policies need to work closely together for existing communities too. Look at what cities like Manchester and Birmingham have done in their city centres -- creating new jobs, but bringing people back into the cities to live as well.

Guido writes:
If that patsy question reads like a planted question, it is because it is almost certainly exactly that. Now why she needed to ask the question in a "public engagement" exercise is beyond Guido. Karen Doran works on the Community Housing Task Force (formerly part of the office of the Deputy Prime Minister) where she advises on "Communications and Consultation Strategy". So it seems unnecessary for her to pose as a member of the public to ask the housing minister a question."

I do wish these revelations got better coverage in the mainstream media because the bloggers already know how deceitful NuLabour are. It needs wider coverage to stop them getting away with this.

Dr Ray gets all heated up.

The, unfortunately named, "Becton Bunny Boiler"

Dr Ray has been drawing admiring glances from Dr Rita Pal, the author of NHSexposedblog. This has all been very welcome and part of me is pleased that someone has finally recognised my stunning good looks, cutting wit and lofty intellect. The image she has of me is a sort of cross between Oscar Wilde and Pierce Brosnan.
I have two problems with this.
Firstly I am a bit concerned about what she might do if our relationship were to turn sour and I prove to be a disappointment to her. Looking through her website, NHSexposed, Dr Pal is not the sort of lady I would like to cross. I don't know the full details of her problems with the GMC but from reading NHSexposed it seems she has taken on the might of the Medical and Legal establishment virtually single-handedly and won.
The second problem, faced by many men of my age, is a pressure to perform adequately. While I am generally happy to tootle along being mediocre with the occasional earthmoving performance, the expectation that I can satisfy Rita on a regular basis is a bit daunting. The Dr Rant team tackle the problem by organising themselves into a sort of shift system so that the pressure is off each individual member. Meanwhile, Dr Crippen, has indeed been the envy of every medical blogger by rising to the challenge on daily basis with enough output left over to fill a couple of pages of a newspaper, but even he has recently had to rest. We hope to see him back with his towering organ in the near future.
If I don't succeed in lowering Rita's expectations gently at least our pet rabbit already died of myxomatosis this summer and our dog is too big to get into a pot

Tuesday, 2 October 2007

Spending your money wisely

Department of Health Spending Plans

Today I visited the Aston Villa Football Club directors suite for a bit of lunch courtesy of MercuryHealth.
I have mentioned MercuryHealth previously. This company won the contract to provide diagnostic services to the West Midlands as part of NuLabours 2nd wave independant sector contracts. The government has commissioned them to carry out up to 190,000 procedures per year including almost 70,000 MRI scans. The scans are provided by a fleet of 9 mobile MRI scanners and 1 mobile CT scanner each with 2 trailers of supporting facilities.
You might think this is an expensive service to provide, and you would be right. Fortunately, for MercuryHealth, their set up costs have been met by our generous taxpayers who have even guaranteed 80% of projected income over the next 5 years.
We are told that the introduction of the private sector shifts the financial risk away from the taxpayer. We know that has not been true for PFI hospitals and we can see it isn't true with 2nd wave diagnostic centres. We are also told that the NHS is expensive and inefficient and that the private sector would introduce efficiency savings and do the work better and at lower cost. Let us see how true this is.
MercuryHealth was due to start providing its service in April 2007 but the launch was delayed until June 2007. Today we were given the activity figures for the first 3 full months of operation. Total MRI scans for September was 154. That is 9 scanners working 12 hours per day 6 days a week. For comparison, our inefficient NHS unit does 16-20 scans per day on one scanner. Of more interest were the CT scan figures. For the last 3 full months of operation MercuryHealth has carried out 1 scan. That isn't a typo; 1 scan. That is a fully staffed mobile unit with two supporting trailers over a three month period. Our NHS unit does around 25 scans per day and provides an out of hours service. It isn't Mercury's fault. This government was warned that private sector involvement was not needed and not wanted. They were told that what was needed was adequate funding of the NHS units but they had their own agenda (para 139) and went ahead regardless.
Still, I don't think Mercury will be that upset about this because they are being paid anyway. In fact the payment-by-results tariff system means they are paid as much for every patient they do not scan as the NHS unit is paid for every patient we do scan.
To add the final insult to the assembled audience, some letters, allegedly from grateful patients and GPs, were read out. They praised Mercury for the service they provided. I'm not surprised. If we were scanning our only patient in three months at UK-radiology I would treat both the patient and the referrer to a Champagne reception and a night of debauchery at Hereford's finest lap-dancing club. And I wouldn't expect the taxpayer to pick up the tab.