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
*70% of all GPs WITH THE PLAN THAT OVER TIME ALL INDEPENDENT GPS WILL GO INTO THEM.
*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.

OBLITERATION OF DGHS- THE DECIMATION OF ACUTE CARE.
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.

DISINTEGRATION OF CARE
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;-
Home,
Polyclinics,
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.

THE POWER OF COMMISSIONING.
“ 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.

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.