Nurses for Reform Blog

This is a fantastic website by the Heritage Foundation.  It fully explains the issues surrounding the healthcare debate in the US, and is aware that although the Obamacare proposals are not what is required, US healthcare does need some major reform.

I urge you to take a look at this site to really get to grips with what is happening in the US.

In recent days Lord Peter Mandelson, the UKs Business Secretary and former EU Commissioner has undergone surgery in the NHS and left hospital praising the staff and the NHS for his care.

This is a classic demonstration of how the NHS is not the equitable service that was envisaged when it was set up and still promoted by politicians today, who are trying to con the public in to believing that only the NHS can ensure that everyone has access to so-called world class healthcare.  I am prepared to bet that Lord Mandelson did not sit on any waiting list for months until an appointment was finally made for him to see his consultant, or indeed then sit on another waiting list to have a date set for his operation. I am also pretty sure that he didn’t have his operation postponed several times due to shortage of beds.

Professor Julian Le Grande, one of Tony Blair’s healthcare advisors, found that the professional and middle classes achieved 40% more NHS spending per illness episode than people further down the social scale.  This is bad enough, but I just wonder how much extra spending the political class manage to achieve!

This article in the Daily Mail picks up some very interesting points from David Cameron’s speech about the NHS last week.  Of course there was the inevitable waffle about NHS spending, that did not tell us very much at all, but for me the crucial sentence was:

The Tories would allow “any willing provider” – including more private firms – to supply quality care to NHS patients.

Regular readers of this blog will know that I do not think this goes nearly far enough.  As I have written here, I believe that all NHS hospitals and care facilities must be put in to the independent sector and that the NHS should become a funder of care and a minimum standard setting institution.

However, as we get closer to the next general election I will look forward to what else Mr Cameron has to say about the use of the independent sector in UK healthcare.   I know that he has a copy of the Institute of Economic Affairs book ‘Towards a Liberal Utopia’, in which I co-wrote the chapter on health, so maybe he does consider that NFR has some good ideas!

This article in the Daily Mail announces that David Cameron will make a speech today stating that the Tories are the best party to look after the NHS and that they do have plans for its improvement.  Well I hope that this is true because the UK’s healthcare provision is in need of not only some ‘big plans’ but some action too, to ensure that it really does become an ‘envy of the world’.

To begin with my suggestion would be that all NHS institutions and facilities must be removed from the state sector, whether it be through management buy outs, sales to for-profit or not-for-profit organisations or the setting up of independent charities to run them. In the future, all hospitals, clinics and community services etc., must be independently owned and run.

Then then next action can be to de-nationalise the staff.  All doctors, nurses, therapists and other health professionals should no longer be employed by the state or be paid according to national collective bargaining processes.  Instead, these decisions should be decided by a diverse, competitive and consumer-led market. 

It is the belief of NFR that only when these basic actions have been implemented we will start to witness the benefits of a dynamic health market that can then be more substantively reformed on the funding side. By allowing nurses, doctors,  hospitals and clinics etc., to openly advertise their wares patients will start to benefit from a flourishing range of brands that they can trust. It is in this world that finally state regulation can give way to market-borne, bottom-up, reputation.

Finally, a reality that NFR has long been aware of is being picked up by the mainstream press. The NHS ambulance service has long been in decline.  Increasingly rationed and bureaucratised, it has not only failed me personally (with near deadly consequences) and an ever increasing number of family and friends, but now a woman has been reduced to giving birth on a pavement because she was refused an ambulance.  NFR believes this is just the tip of a very large and yet to be made public iceberg.  Ask around. Talk to your family and friends. In particular, talk to the people you know in our larger cities and remote rural locations and you will find that the collapse of the NHS ambulance service is not so far behind that of NHS dentistry.

NFR today calls on the government to launch a major Christmas TV ad campaign warning against the grave and widespread dangers of patient malnutrition and starvation on NHS wards, and insists that the money to pay for it be diverted from the annual drink driving TV ad campaign.

NFR research reveals that while the number of people killed in UK road accidents fell by 7% from 3,172 in 2006 to 2,946 in 2007, the number of patients starving on NHS wards more than doubled.

Not only did the number of NHS malnutrition incidents rise from 15, 473 in 2005 to 29,138 in 2007 but overall, according to the National Patient Safety Agency (NPSA), almost 70,000 ‘patient incidents’ relating to malnutrition and starvation were reported.

In typical Soviet-speak the NPSA defines such an incident as ‘any unintended or unexpected incident which could have or did lead to harm for one or more patient receiving NHS care.

NFR concludes that in these difficult economic times it is vital that money is spent on the public safety campaigns that will deliver the greatest value for money.  In comparison to road safety the NHS is a disaster.  On basic public health and safety grounds, people must be made aware of the facts.  Drink driving is bad but the NHS is 10 times worse.

While Dan Hannan understandably accused the NHS of being Marxian, for NFR he would have done better to point out that it is national socialist in character and practice.

For not only does it engender the worst kind of bogus nationalist and xenophobic – ‘best in the world’ – rhetoric under the guise of patriotism, but in constantly trying to impose a counter-productive egalitarianism (which inevitably leads to all kinds of post-code and political voice lotteries) it marginalises those it purports to look after such as the elderly, the mentally ill and the poor .

Today, there are hundreds of thousands of people on waiting lists, with tens of thousands more trying to get onto them. On average, professional and managerial types receive 40 per cent more resource per illness episode than those at the bottom of the social scale. Ten per cent of NHS patients pick up infections and illnesses during their hospital stays that they did not have prior to being admitted.

Forget Marxism. This is a system that engenders survival of the fittest and through NICE increasingly seeks to legitimate its eugenicist approach to human life.

Following the debate around UK and US healthcare over the past couple of weeks I have noticed some phrases being used in the media as facts such as the NHS being free, that we need the NHS because it is free at the point of delivery and that the NHS is the only system that can serve the poor.  I think that these points deserve a little clarification, so here we go:

1. The NHS is not free, it costs tax payers over a hundred billion pounds per year.
2. The NHS is not the only system that is free at the point of delivery.  Individuals who chose to have private medical insurance and many other voluntary healthcare funding schemes have care outside of the NHS that is free at the point of delivery.  I have recently been in to a UK private hospital and my insurance company paid, making my care ‘free at the point delivery’.
3. The NHS is not the only system that can help the poor.  In fact the NHS systematically fails the poor.  Research by one of Tony Blair’s health advisors demonstrated that the professional and skilled social groups achieved 40% more NHS spending per illness episode than the unskilled and lower social groups.

So when reading the main stream media I think that it is vital that we start to challenge these ‘facts’ and continue the debate about how things really work in UK healthcare.

I couldn’t put this opinion any better than this letter in the Daily Telegraph;

SIR – Professor Stephen Hawking and some of your correspondents (Letters, August 15) claim they would not be alive today without the NHS. They assume that unless the state provides it, universal health care would not exist.

However, there was good universal health care in Britain before the NHS, provided partly by charitable hospitals and trusts dating, in some cases, from the Middle Ages, partly by friendly societies to which millions paid subscriptions, and all underpinned by a strong ethic among doctors that treatment should not be withheld on purely financial grounds.

These trusts were ambushed by Bevan in the biggest forced expropriation since the Dissolution of the Monasteries. The friendly societies withered and died, leaving us in the hands of a vast state monopoly. And the doctors had their mouths “stuffed with gold” to silence their doubts. That stuffing continues to this day.

When Attlee’s administration set up the NHS, it made no claim that health care was inadequate. It simply argued that provision would be more efficient if centralised. Sixty years on, we know what value to place on that proposition.

Nicholas Guitard 
Poundstock, Cornwall

While I am appreciative that in this blog posting last Friday Mark Wadsworth is one of the few people to join NFR in separating out health provision (the facilities) from funding, I would venture to suggest that with appropriate reform the state should no longer remain as a major funder of healthcare – as he suggests.

As Brian Mickelthwait, long ago pointed out in his excellent Libertarian Alliance pamphlet, virtually all healthcare on this planet is effectively nationalised as every country imposes a price fixing monopoly through numerous equivalents of the General Medical Council. Privatise all the provision, open up healthcare to advertsing – and therefore the building of trusted brands – and remove a host of restrictive practices supported by the state and one might start to have a functioning market that most people could afford.

One of the really interesting things about UK healthcare today is that far from doing the really big critical care issues the state has already vacated these areas. Today, if you have cancer you are more than likely to be looked after by a McMillan nurse – ie the charitable funded. If you have Parkinsons disease one of your major support elements will come from the Parkinsons Disease Society, etc, etc. 

Thankfully, when you are near death you will likewise be looked after by the hospice movement of which more than 99 per cent is both funded and provided by independent sector.

In a proper market, the state does not have to be a major funder.