Nurses for Reform Blog

For the next few days I will be visiting the Czech Republic, Slovakia and Austria to explore a range of healthcare reforms in
Central Europe. Having heard that Slovakia is at the forefront of market-oriented reforms in Europe I am particularly looking forward to visiting Bratislava and leaning at first hand how the health system is being developed.  As such, this blog will be a little bare for the next few days. Normal service will be resumed from Wednesday 7 February 2007 onwards.

I was heartened to read the results of the recent NHS Confederation Mori poll (1) which asked the general public who should decide on the availability of NHS medicines:

• 70 per cent said clinicians
• 33 per cent said patient representatives
• 23 per cent said NHS managers and
• Only 9 per cent said MP’s and
• Only 6 per cent said local councillors.

This appears to be a massive vote of confidence for Nurses and Doctors on behalf of the general public.

The question of political control of the NHS is being hotly debated at the moment. Rationing of new expensive treatments is one key confluence of national politics and clinical decision-making where the issue of political control is often tested to the utmost. There is a long saga of dramas on the subject from the child B case to the more recent court cases over the availability of herceptin. This poll seems to indicate that the public trust the clinicians as the final arbiter in each local circumstance. The question is – would they if the reality was that it was their own life on the line rather than the abstract case? If they did, the issue of rationing would be solved once and for all, and the service could largely manage itself. It would also allow each individual trained nurse and doctor to use their years of training and experience to better effect for the nation. Power to the clinicians.

(1) Health Services Journal: 25^th January, 2007 pp 9 see article ‘Prescribing: survey suggests public wants treatment rationing left to clinicians and managers’.

Alice Mahon, the former Member of Parliament for Halifax and a long time supporter of the NHS, has finally experienced at first hand the atrocious realities of British nationalised healthcare. 

Having spent years pontificating about the wonders of an equitable state run health system she has finally come up against the institutional reality of the NHS.

Having sadly lost much of her sight in one eye due to age-related macular degeneration (AMD) she now looks set to lose it in the other one because Calderdale Primary Care Trust has refused to fund a medicine which might well help to stabilise or improve the situation.

Complaining she has “been an ardent supporter of the NHS all my life, and now feel totally let down” she quite rightly saw the light and has gone down a radically different path. To avoid totally losing her eyesight she has privately self funded to the tune of £5,325.

Just think, if only she had thought more rationally about health policy over the years she would not be in this sorry state. If only she and her colleagues had done us all a favour and campaigned for more co-payments or an expansion of private medical insurance then millions of people would not be experiencing the type of shoddy, restrictive and rationed service she now is. 

The UK’s Department of Health (DoH) has recently given the green light to the idea of all hospitals – NHS and independent sector – advertising their wares. 

In the US, hospital advertising slogans such as ‘Tomorrow’s medicine today’ and ‘Every life deserves world-class care’ abound. As a result people are more informed about what is available and healthy competition helps to drive up standards.

Back in the UK, it is not yet clear what the DoH’s code in this area will contain – as it is still out for consultation. But NFR believes that advertising is a basic human right. Commercial free speech is as important to the maintenance of a civilised society as property rights, the rule of law and free speech for individuals.

The problem with this issue therefore is not that the DoH are moving in a more liberal direction but that they are not going as far and as quickly as they should.

To empower consumers and galvanise patient choice three reforms should be allowed:

1. Enable all health professionals – including doctors, nurses and others – to freely advertise their wares;
2. Enable all health and care institutions – including hospitals – to openly advertise in the manner of their choice;
3. Enable prescription medicines to be similarly advertised.

Today, in the world of real time global communications and the internet, it is ludicrous that nurses have not yet championed these vital and necessary reforms. Reforms that would do so much to empower consumers and genuinely drive better outcomes for all involved.

For doctors and other health professionals to hide behind the antiquated argument that you cannot give people information because they could not be trusted with it was always a non-starter. I have no idea how my television or car works but that is why in a free society brands are allowed to emerge. Competing brands are the means by which we don’t have to be experts in a subject but through which we can obtain reputable outcomes.

Today, by not pushing the three reforms mentioned above nurses have ended up with their worst nightmares. By criminalising the reputable advertising of prescription medicines, society is now awash with a highly dangerous black market in health information. While reputable pharmaceutical companies are not allowed to advertise their wares – every charlatan and criminal known to man is doing just that on the internet. State regulation is not the answer – liberal freedom and reputation building is.

Similarly, by not allowing doctors, health professionals and hospitals to openly advertise and compete for custom we have ended up as nurses being locked into a governmentally driven bureaucratic paper trail that tries to find out, top down, what health professionals and their institutions are doing and ‘how they are performing’. You know the kind of thing – are we meeting our ‘targets’ and all that involves!

NFR says, end this crazy and counterproductive healthcare censorship now. It is time for nurses to get real about openness and through the empowerment of consumers establish better healthcare brands so that we can work in a better marketplace.

The President of the Centre for the New Europe, Europe’s leading Brussels based free market think tank, has just had this excellent article published in The Times

Headed ‘I bet I know why the BMA is banging on about that’, Stephen Pollard exposes the pseudo-science and professional self-interest behind this a new report from the BMA 

The BMA, no doubt mindful of new Gabling Act which allows people to make more decisions on how they spend their money, concludes that problem gambling should be treated on the NHS like any other illness and, wait for it:

“The BMA is concerned that there are insufficient treatment facilities available.”

As Pollard points out, the BMA recommends that an extra £10 million should be spent through the NHS, and another £10 million on campaigns against gambling. He concludes:

“To translate: hand over your money to us now.”

Here we go again! Another year of healthcare and another year of pay bargaining. I see the DoH in the form of Stephen Johnson has floated a 2% across the board annual uplift for NHS staff, below the retail prices index inflation figure of 3.3% (1). The NHS has never really solved the dilemma of the annual pay round, i.e., whether to have one large national negotiation with all of the health unions or to leave it to the market and allow the Trusts to determine pay and conditions locally. Instead, we always get a fudge where there is much lip service paid to local pay bargaining but Chief Executives are set clear national pay boundaries to stay within.

Surely the 30 or so existing Foundation Trusts will break out of this and start to set their own pay rates. With a projected shortfall of nurses to the tune of something like 14,000 by 2010-2011 (from the DoH’s own current workforce growth projections) this can only be good for qualified nurses who will be able to negotiate better than average settlements for themselves based on a market shortfall of their skills. It would, after all, be gratifying to see Consultant pay pegged for a while and qualified nurses pay go up in real terms. With a similar excess of consultant grade doctors to the tune of 3,200 by 2010-2011, this is what should happen. It will be very interesting to see if a Labour Government for once, doesn’t ‘stuff the doctors’ mouths with gold’ but allows nursing to catch up the medical profession a bit on pay. I hope they do because it is only this kind of market mechanism that will result in more young people wanting to join the nursing profession.

(1) ‘Warning over union action on pay’: Helen Mooney, HSJ, pp 9 4^th January, 2007.

Have you noticed how trade union leaders who endlessly bang on about the NHS being a free service and how ‘people’s healthcare is so important that it should be beyond monetary consideration’ are at the same time the most vocal when it comes to obsessively demanding more money?

Peter Carter of the RCN is no exception. No sooner than he has arrived in post the RCN Bulletin read’s “We will be worse off with 1.5% rise. RCN members angry over pay proposals”. Forget a free NHS here – for the RCN it is all about money, money, money!

NFR believes the RCN and Unison should get real about nurses pay and stop trying to live in an axiomatic cloud cuckoo land. The bottom line is if you want nurses to be valued and well paid you have to stop arguing such incoherent nonsense as ‘people’s healthcare is so important it is beyond monetary consideration’. In the real world all healthcare has a monetary dimension and we should not be ashamed of this fact.

Given all healthcare is financially rooted these trade unions should start their campaigns by pointing out that if you want quality healthcare you first have to pay for it and secondly you have to have an institutional framework in place which provides the optimal incentives for the professionals involved to actually deliver.

On this latter point there are only two possibilities: (a) a state system driven by the vote motive; (b) a market system driven by the profit motive.

It is only when trade unions fully and openly understand the pros and cons of both these systems and get real about the central importance of money in all healthcare that they will do nurses and the public a favour.

NFR says stop the flannel and camouflage. The NHS is not free. No healthcare can be. All healthcare in any system is about money and nurses want to be valued appropriately.

We know that a state healthcare system is primarily driven by the vote motive. Would we and our patients not do better in a system driven by profit and surplus?

According to the chairman of the British Medical Association (BMA), James Johnson, there is just one year to save the NHS.

Accepting that the NHS has been given in recent years huge annual increases of 7% with little to show for it, there are clear signs that the leadership of the doctors union is tentatively positioning itself to abandon a financially holed NHS.

No doubt mindful that in the years to come NHS funding will merely increase in line with inflation, Johnson has suggested a range of questions that ask whether the NHS should continue to provide everything or if people need to contribute towards their treatment privately.

Always ready to follow the money, the doctors’ leader has wisely covered the bases when he concluded:

“Don’t assume there’s anything automatic about the system we have at the moment continuing into perpetuity.”

NFR would like to welcome Dr. Peter Carter, the new General Secretary of the Royal College of Nursing, who takes up post this week.

Now is a crucial time for nurses, patients and the provision of health care. As such, NFR would encourage Dr. Carter to move away from the inappropriate practice of demanding ever more tax payers’ money for the NHS and ever more legislative favour for his members.

Instead, he and the RCN should capture the moral and intellectual high ground of debate by championing substantive reform. It is time that patients are treated as consumers and for the organised nursing profession to be seen to ditch its counter-productive fetish with bland and uniform state healthcare.

Healthcare in the UK must be opened up to a world of trusted brands and a genuine market; a world in which nurses will find themselves working in an environment with the incentives and resources to deliver popular and truly high quality services.

In reality, this means that Dr. Carter and the RCN should focus on six campaigning themes:

1. Openly recognise that so long as UK healthcare remains nationalised the ministers running the thing will demand an endless array of information and statistics and all the attendant bureaucracy so that they can propagandise at the dispatch box of the House of Commons
2. Openly recognise that the real cost of a ‘democratic state health system’ is because it is not run for consumers along genuine business lines it will inevitably be overseen by politicians pursuing the vote motive
3. Encourage the government re-cast the NHS as simply an important – but not sole – funder of UK healthcare services. Lobby the government to allow people to co-fund their healthcare and thereby grow the pot available. Do not even think about asking the already overburdened tax payers and patients of Britain for any more tax money
4. Encourage the government to set free – through a range of for and not-for-profit privatisations – all NHS hospitals, particularly the poor performers
5. Encourage local diversities to blossom. Encourage all UK hospitals to openly compete with each other. Failures should be allowed and in some instances will be taken over by more successful operations. Allow all hospitals to engage a dynamic labour market by abandoning the counter-productive idea of national pay agreements for nurses.
6. Encourage commercial free speech across healthcare. Campaign for hospitals, doctors, and other healthcare providers to openly advertise their wares and to pro-actively inform consumers of where the best deals are to be found.

If Dr. Carter and his colleagues at the RCN follow these points then they will not only champion the long term cause of nurses but most importantly the rights of patients as consumers.

I am delighted to report that NFR has had this letter published in today’s edition of The Times.

Aptly placed under the heading ‘NHS needs fresh ideas, not more cash’ it correctly concludes:

“It is only when healthcare is opened up to real consumers and trusted brands in a genuine market that nurses will find themselves working in a sustainable environment with the incentives, resources and encouragement to deliver a responsive, popular and truly high-quality service.”