The media and the Health reforms

 

                 This week has seen at least two attempts to destabilise the health reforms. Channel 4 came up with a very sloppy piece of journalism, wrongly claiming that the whole of Parliament had failed to spot an error in the Health Bill that would allow GPs to profit from conflicts of interest. The Today programme followed up yesterday by seeking to show that regional and national “reconfigurations” of services would not be possible if GP consortia do the buying, whilst missing the obvious point that the reconfigurations they seemed to want were not happening under the current regionally managed system.

         They clearly do not enjoy interviewing Andrew Lansley, as he knows his NHS inside out and makes them look silly by setting out the facts and the context. The interviewer is left spluttering that he wants shorter answers, in the hope that there will then be a loose phrase they can blow up out of all proportions.

         The new spectre at the feast is that someone may profit from the NHS. What kind of world do these people live in? Have they not seen the profits over many years earned by the leading pharmaceutical companies out of supplying the NHS? Or the profits of the management consultants, advertising agencies, recruitment consultants and other business advisers who had plenty of contracts under Labour? Or the profits of the cleaning, catering and supplying companies that keep the hotel services going in hospitals? Some NHS money has always gone into profits.

          Have they not also grasped that under Labour incentive pay and higher pay for directly employed managers and other senior personnel was a big part of the deal. Many senior staff now earn more for performing in certain ways. I agree with incentive pay, but it is a way of profiting from the employment.

          The new canard Channel 4 introduced was a GP might both have power to decide where someone went for care, and have shares in a private sector nursing home or private health care company which he used for some patients. Ministers made it clear the Bill said GPs should not exploit  conflicts of interest, and they are putting in Monitor, a Regulator with the duty of stopping that and other bad conduct. So why did the story run when it was clearly denied by reference to the Bill?

          Did these same journalists spend time in the last thirteen years trying to see if any GPs did behave like that?  It would be possible for a GP under the existing system to behave badly, against the spirit of the NHS, and have shares in private companies that profit from NHS purchasing. Maybe  the absence of such stories shows that GPs behave better than Channel 4 journalists expect.

          When it comes to  planning national and regional services, the criticism was again ill judged. As Mr Lansley pointed out, GP consortia can persuade the providers of health care to change what they offer through their large buying power. The irony was that the chosen case in South London was an example of where the current system of planning had failed.

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25 Comments

  1. lifelogic
    Posted March 4, 2011 at 7:07 am | Permalink

    Does a nurse not profit from her NHS pay? What is wrong with profit so long as the market is open, fair good look to the people profiting and may they spend their profits wisely. Profit is what get things done and people treated.

    Reorganising medicine efficiently is hard as often the patients do not know what treatment they actually need. There is thus a large scope for malpractice if dishonest doctors/medical professionals can profit from suggesting extra and unneeded tests and treatments – as is often seen in the private and insured systems around the world.

    The NHS certainly need radical treatment however – as does the whole medical industry.
    Incentives need to be correctly targeted and related good to outcomes and best practice.

    • lifelogic
      Posted March 4, 2011 at 8:52 am | Permalink

      “Luck” I must get a proof reader.

      Does the Barnsley election result not perhaps give an indication of how AV might work in practice.

      In AV people can place their first vote largely with no consequence as they choose and then use the second more tactically. In Barnsley Labour were clearly always going to win to other voters were similarly free.

      Labour 14724
      UKIP 2953
      Conservative 1999
      BNP 1463
      Lib Dem 1012

      Why does Cameron want to jump off the cliff at the next election with his big state, anti business, pro EU agenda like Heath, Major & Brown and why are Liberals so keen on AV anyway?

      • Geoff not Hoon
        Posted March 4, 2011 at 9:51 am | Permalink

        Lifelogic, I dont always agree with everything you post but your last para. above IMHO is 100% right. We are overdue for the changes promised before the election and yet, as JR’s figures show this week, most sections of government, despite the ‘noise’ are carrying on oblivious. I said months ago on here that the Libdems would virtually dissappear at the next election, I now think we are facing the same for the Conservative party and, if they can find a good leader, Labour wont need to win anything they will be given it.

        • lifelogic
          Posted March 4, 2011 at 11:38 am | Permalink

          Ah yes “changes promised before the election” I remember those – Well sort of promised anyway but with suitable, cast rubber, escape clauses and now with the Liberals as a fig leaf to protect from any embarrassment.

          What is there that you disagree with anyway – all just moderate common sense surely?

          • Geoff not Hoon
            Posted March 4, 2011 at 6:52 pm | Permalink

            LL, small issues many days ago and so important i’m afraid I cant remember what they are as I sit typing. More important is how much of your comment I think probably everybody agrees with including me. I do believe, as I think you do, unless there is substantial change of current policy David Cameron has about as much chance of taking the party to a second term as Screeming Lord Sutch were he still alive!!

      • StrongholdBarricades
        Posted March 4, 2011 at 10:27 am | Permalink

        to use the New Liebour yardstick:

        Over 60% of those who could have voted, did not cast their intention for the winning candidate.

        The turnout makes a mockery of democracy, and is an embarrassement for parliament.

      • BobE
        Posted March 4, 2011 at 9:30 pm | Permalink

        The Lib Dems will be destroyed at the next election. The young vote they had won will shift. Most probably that will give Labour a landslide. Cameron and Clegg must be aware that they only have four years in office. AV would perhaps give lib dems second votes assuming the young would switch to vote Labour 1. and Lib Dem 2.
        Without AV the Lib Dems will vanish.
        BobE, Region 6, EUSSR.

    • wab
      Posted March 4, 2011 at 9:09 am | Permalink

      The issue raised by Channel 4 was not whether anyone should profit but whether anyone should profit from a conflict of interest. The Tory spokesperson on Channel 4, and Mr Redwood here, claim that this potential conflict of interest will be properly regulated. We shall see. And, needless to say, such conflicts of interest should be avoided not just by GPs but also their immediate relatives.

  2. FatBigot
    Posted March 4, 2011 at 8:05 am | Permalink

    Neither doctors nor nurses work for subsistence wages, they all make a profit out of the NHS and quite right too.

    This all goes to a pretty fundamental point. It is not the case that making a profit reduces the service you provide. People shop at Asda, Tesco, Lidle and Aldi because they provide what is wanted at a price that can be afforded. They are also profit-making businesses. Were these massive businesses operated on a non-profit basis there is little chance they could offer their customers the choice and low prices they enjoy today because they would have no incentive to do so.

    No sane person would argue that the provision of emergency healthcare in a developed country should depend on the patient being able to pay (although I have heard it suggested, erroneously, by members of the wealthy Islington and Hampstead socialist chatterati, that this is what happens in the USA). Apart from emergency treatment health care is no different from the provision of food, indeed it is generally less important than food because we call on it once every so often rather than three times a day (ok, five in my case but I’m a fat boy).

    No sane person would suggest we should have a state hospital bed company, a state hospital sheet company, a state surgical instrument company, a state bandage company, a state disinfectant company, a state aspirin company, a state plaster cast company, a state syringe company or a state anything else used in healthcare company. The best prices and the best improvements in quality come from these things being open to competition from allcomers.

    The same applies to everything the NHS does other than emergency treatment.

    How something is funded and how it is delivered are different things. I see no sensible alternative than tax funding of non-elective healthcare, but leaving delivery in the hands of those who have no incentive to improve the service they provide because they are immune from competition is simply barmy.

  3. Brian Tomkinson
    Posted March 4, 2011 at 9:05 am | Permalink

    Sounds rather like a story that has been prompted by someone with a vested interest and an axe to grind within the NHS. Another of Sir Humphrey’s techniques to try and foil a government that has decided to make decisions instead of leaving it to the Civil Service who know best about all things.

  4. waramess
    Posted March 4, 2011 at 9:53 am | Permalink

    What a sad state of affairs that a Conservative should be making a case for a socialist inspired institution. OK Lansley is reversing the order of priorities to more closely follow the free market principles of letting consumer demand determine supply but it still falls far short of privatising the system as a whole.

    Where for example do GP’s incentives lie? Politics, or ensuring their patients get what is best? I suspect that there will be a good many who are socialist and will try to ensure the new system will not work under any circumstances.

    Please don’t pussy-foot around the problem; there will be far less public opposition to full privatisation provided the case is put sensibly and the whole point about profitability and competition is that they provide an incentive to supply the very best there is.

    If rigorous action is not taken to privatise the NHS in the near future an opportunity will be lost and the UK will become resigned to receiving a progressively poor service of medical care in the years ahead, Lansley or no Lansley.

    Lansley’s reforms are not the answer and the fact he has found the need to become an expert on the NHS just goes to show how very badly it is run.

    The only answer is to sell it off piecemeal and put in place robust regulation over the quality delivered.

  5. John Ward
    Posted March 4, 2011 at 9:53 am | Permalink

    Sloppy journalism indeed, but be careful Mr Redwood – God is in the detail, and in some ways Mr Lansley’s calculations about GP ‘entrepreneurial’ skills reflect only his own – not theirs.

    I’m bound to say as well that it doesn’t look like the detail was that important to Jeremy Hunt over the BSkyB decision….

    Reply: Mr Hunt accepted the advice of the regulators – both to refer the original bid and to accept the revised bid. he is now consulting on his provisional conclusions.

    • lifelogic
      Posted March 4, 2011 at 12:55 pm | Permalink

      I think he was broadly right on Sky but how on earth can he appoint Lord (Chris) Patton to the BBC trustees so they will surely ever remain a left wing, ever bigger government, pro the green scare/exaggeration, pro “equality”agenda & broadly anti what all true Tories believe in and what actually works in practice. Does he want to loose the next election to get an EU job or something?

  6. Denis Cooper
    Posted March 4, 2011 at 9:54 am | Permalink

    Having watched that Channel 4 report I was left thinking that the Bill should have stronger provisions to prevent any GP preferentially sending his patients to a clinic in which he has a personal financial interest.

    It’s no good Lord Howe saying that the government wouldn’t allow that to happen and that the detailed rules would prevent it. Experience has taught us that ministerial reassurances of that kind are worthless, and the preventative measure needs to be embedded in the law and not dependent on the attitude of government ministers now and in the future.

    Nor is it any good saying that a regulator would prevent it happening. Again experience has shown we can’t rely on regulators to do their job even to a passable standard.

    Surely it must be possible to draw up a new clause for the Bill which would make it crystal clear to GPs that when they’re spending public money they must not give preferential treatment to clinics in which they have financial interests, and preferably specifying criminal penalties for any GP who is convicted of doing so.

    Then it would be on the face of the Act and so readily accessible to and citeable by members of the general public, who may in fact do a better job of keeping an eye on their GP than the regulator.

  7. Alte Fritz
    Posted March 4, 2011 at 10:23 am | Permalink

    There is a widely believed fiction that the NHS is staffed by saints and that anything done by any Conservative in relation to it is intended to dismantle ‘our’ beloved NHS. (Note how the possessive prounoun has become current since, I think, Clare Raynor left her message for Mr Cameron).

    Well, no organisation is perfect, so they all need watching and, sometimes, reform. Extra money did not prevent the MRSA scandal nor many others which have come to light in recent years.

    It is a good idea to insist on arguing on the facts as Mr Lansley can given his tenure in office. There needs to be more though. A Frankenstein like creature having the qualities of Alastair Campbell and Mandy needs to be created to hit lie mongering journalists where it hurts.

  8. StrongholdBarricades
    Posted March 4, 2011 at 10:38 am | Permalink

    With regard to the National Illness Service reforms, and as one who has suffered the NHS for some time with a chronic deterioating condition, I would say that my only real problem with the reforms is that the GP’s are not accountable to their patients. The only real people employed by the NHS are nurses. All the others are self employed contractors in a fixed and uncompetitive market.

    A local example: my town has only one GP surgery, and if I decide to go elsewhere it is several miles away. My GP surgery also has access to two health authorities. One who is moving most of their services to the opposite end of the county, whilst the other relies on services provided on an ad hoc basis in a satellite resource.

    Under the last administration, as far as I can see, money was poured into the NHS which sucked in large numbers of overseas doctors (is that why we still have to pay “compensation” to India through International Aid?), and their salaries increased inline above that of the cash flow. As far as I’m aware no extra doctors were “produced” by “our” universities during that time.

    The reforms will not drive down the inherent cost indicators, nor allow standards to be driven up because it is too difficult to make doctors realise that they “provide a service”, and just like Tesco if it doesn’t work for me then as a tax payer I want my money back. Then they will be accountable

    • Dr Sawbones
      Posted March 6, 2011 at 12:25 am | Permalink

      You are quite wrong about medical immigration. The rules changed some years ago making it very difficult to get a work visa as a non EU doctor wanting to work here. Talented Indian doctors go to the USA now. The number of UK medical undergraduates registering as doctors has nearly doubled from 4200 to 7800 since 1997.

      A lot of these UK trained doctors are British Asians, often in the family tradition, and 70% are female. White male doctors are now less than 20% of UK graduates, considerably less than the general population. The disaster of Modernising Medical Careers and computerised application in 2007 has caused a fair number to either quit the country or quit medicine. Those who are left are plodding through a demoralising and dumbed down system. I know of no coalition plans to reverse these disastrous new labour changes. A commitment to sorting out this and dumping the expensive and useless revalidation process would do more for medical morale than any pay issue. It may make a lot of doctors more sympathetic to Lansleys other reforms.

      The dumbing down of British medical training means that I am planning to retire abroad. I write This as a senior consultant surgeon with responsibilities for training undergraduates and postgraduates. The mechanism of paying doctors via private or public organisations is a secondary one. As doctors my age retire over the next decade or so the quality of work will go substantially down.

      You may want your Indian doctor back then…

  9. Lindsay McDougall
    Posted March 4, 2011 at 11:42 am | Permalink

    I very much approve of the direction of these reforms. Since GP group practices will control budgets, we may eventually get more customer orientated hospitals (possibly forming chains) and drugs companies.

    However, my question is: who will determine the budgets and by what methods – especially where there are competing GP practices?

    On related matters, prescription charges have just risen to £7-40 in England and have been entirely eliminated. Time to look at the Barnett formula again; let us reduce Scotland’s 17% premium on public expenditure per capita to 5%, which is enough to cover cold weather costs and sparsely populated areas. I would so like to wipe the self satisfied smirk off Alex Salmond’s face.

  10. Lindsay McDougall
    Posted March 4, 2011 at 11:52 am | Permalink

    Sorry. My final para should read ” ………………………. entirely eliminated in Scotland. ………………………………”

  11. Tony E
    Posted March 4, 2011 at 1:21 pm | Permalink

    Unfortunately, this government is already in deep trouble – but not because of it’s policy decisions.

    It finds it impossible to transmit its colective ideas into the public arena without having to filter them through the prism of left wing jounalists. The agenda day in, day out, is set by the Today Programme, (the forward brigade of the Guardian and therefore the Labour Party). Unless the PM, and those close to him, decide to be a lot more hostile in their approach to these outlets, and are prepared to call them out for the liars that they often are, this government will succeed only to see themselves wiped out at the ballot box next time around. The the population will have been told that they have failed, and they will beleive it, despite the evidence before their own eyes.

    The BBC especially has become a propaganda machine for the left – it’s time for the government to act.

    • lifelogic
      Posted March 4, 2011 at 5:04 pm | Permalink

      Unfortunately they have acted in the opposite direction by appointing a big government, left of centre, pro EU, arts graduate to be chairman of the BBC trustees.

      To join all the rest of a similar mind set.

  12. lifelogic
    Posted March 4, 2011 at 1:48 pm | Permalink

    And now, I assume as a silly distraction from serious matters, they want to get rid of the best bank holiday of the year just when England is at it’s best in May.

  13. Michael Read
    Posted March 4, 2011 at 3:02 pm | Permalink

    Yes, but pity you didn’t see to spell out your plans for “reconfiguration” before the election. Another case of the wood purposively buried in the trees. And just look where it got you a month ago when you tried to finesse a similar deceit.

    reply: As this blog demonstrated some time ago the Manifesto made clear the changes to the NHS.

  14. Bazman
    Posted March 4, 2011 at 5:08 pm | Permalink

    Now you have Murdoch in the cabinet John all the facts will soon be right. I know how much the contributors to this site love SKY. It must the the quality of the programming, so much better than the BBC and Channel 4. The sooner he owns all the media the better. SKY net is not to far away.

    • lifelogic
      Posted March 6, 2011 at 7:58 pm | Permalink

      I almost never watch sky mainly BBC 2 and 4 and radio 3/4 and enjoy a great deal of it. Woman’s hour is always very funny indeed with their lefty, feminist, chip on thje shoulder, Guardian type, all will be equal agenda and their completely unscientific approach to almost any subject.

      Always failing to distinguish between cause and effect on the equal pay issue but finishing off with a good recipe and always slipping in a mention of superior multitasking and the superior communication or emotional skills of women.

      Very odd BBC type token men they seem to have on hand to discuss any issue too.

      All great fun.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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