Nurses for Reform Blog

Yesterday I had an article published in the Daily Telegraph, discussing the future of the NHS and how NFR believes the process towards achieving better healthcare for the UK population should be started.

To read to complete article click here.

I also urge you to take time to read the comments.  It is amazing not only how people interpret what I have said differently but also how people have completely different expectations of what the NHS should be and do.

There has been a lot of publicity recently about the poor care given to patients by Mid-Staffordshire NHS Trust

It has been found that patients were routinely neglected, left to die and “cared” for in appalling conditions.  For me though, one of the interesting and appalling things about this is that in all of the media reports I have listened to I heard few genuine apologies.  In the main hospital managers, so-called nursing leaders such as Dr Peter Carter the General Secretary of the Royal College of Nursing and various Politicians have all been rushing to shift the blame on to each other.  I have heard no one come up with any long-term plans to improve the situation and to stop patients from dying at the hands of the NHS.

One thing that NFR believes should not happen is a rush of new target driven reforms, it is time that the Government realised that all targets do is to pull resources away from patient care and in to the administration of reports to the Department of Health.

Radical reform is needed across the NHS it is time that the Government had less involvement not more in the delivery of patient treatment and care.  As a start, Mid-Staffordshire, and indeed all other failing NHS Trusts, must be given over to new management, ideally from the private sector as has happened here.  If hospitals or trusts continue to fail their patients they must expect to be closed or taken over by new management.

It is time that we stopped tolerating this NHS that is failing in its duty time and time again.

This is a fantastic article by my friend and colleague Stephen Pollard welcoming David Cameron’s announcement that the Conservative Party, if they win the forthcoming general election, will allow public sector workers to run the services that they work in as co-operatives.  In truth this project will probably start in education but is likely to very quickly spread to healthcare services.

This is a real step in the right direction as far as Nurses for Reform is concerned.  As regular readers of this blog will recall, we have always championed the rediscovery of the UK’s wonderful history of mutual and co-operative funding and provision of healthcare and we are so happy that David Cameron and his Conservative Party are taking on our policy ideas (here, here and here).

For NFR the saddest part of this is that the people who should be welcoming the empowerment of their members more any other are against it Unite, the largest public sector union have been publicly condemning this move.  Well, shame on them.  They have now demonstrated that they are far more interested in playing politics than really looking after the interests of their members and the workers that they claim to represent.

Unite and indeed the Labour Party must welcome this policy, they have to see this as a triumph for their ideas.

In line with public choice theory economics, I have long believed that health systems driven by greedy vote motivated politicians will have the opposite effect of their professed consequences. It is in this context that one expects to read articles like this. Billions spent and nothing to show for it.

A million miles away from the rhetoric of equality and all that top down pontificating beloved by our political class, the NHS and our wider welfare system is continually exposed for being a deeply dystopian and elitist operation. Its masters pretend otherwise. But, as Stephen Pollard and Andrew (now Lord) Adonis argued in their excellent book, A Class Act, Myth of Britain’s Classless Society,  the NHS is the microcosom of a class based system. That is what it is.

It has essentially white male doctors and administrators at the top and a raft of poorly paid ethnic minorities doing the auxiliary services at the bottom. As a system overseen by the ‘Royal’ Colleges, built on legislative favour, and which taxes ordinary people to the tune of more than £100 billion a year, is it any wonder that the poor are kept poor – and made ill earlier?

Forget social justice and equality. The key to making poor people healthier is to enable them to get rich. That is why government should get out of the way.  Indeed, it should allow welfare to flourish without the state. Forget politics and coercion. What we want is much more open, diverse and dynamic forms of health and welfare organised bottom up.

Ladies and Gentlemen, in 1948 the British government put a leaflet through the door of every household. It said, in black and white, that: “the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”

Today, we live in a country where our political class is seemingly proud of the target that: “the longest you should wait after being referred by your GP until you start your treatment is 18 weeks”. More than 4 months. There is even a web site called:

www.18 weeks.nhs.uk !

Today, there are tens of thousands of people trying to get onto these waiting lists. Many are delayed so that the official 18 week clock does not start to tick.

According to Professor Julian LeGrand of the LSE, people from professional and managerial backgrounds access – on average – more than 40% more NHS resources per illness episode than those in lower social groupings. Today, 1 in 10 people in NHS hospitals pick up infections and illnesses that they did not have prior to being admitted. Over the last five years, more than 30,000 people have died from Healthcare Acquired Infections related to NHS care.

Indeed, things are now so bad in our state health service, that even basic nutrition has become an issue. According to the National Patients Safety Agency, NHS malnutrition incidents rose from 15,473 in 2005 to 29,138 in 2007. Overall, during this period, almost 70,000 NHS malnutrition and starvation “patient incidents” were reported.

Today, as students at this fine university, you are residing in a country that is a long way from the politicians’ promises of 1948. You are now in a country were where some 7 million people have private medical insurance. Where 6 million people have private health cash plans – many of them are members of trade unions. This year, 8 million will pay towards private complementary treatments. And many, many, tens of thousands of others will chose to self-fund for private surgery and treatment.

More than a quarter of all people in nursing and residential care homes now pay privately. Spectacles went private back in the 1980s. Dentistry is now going – as many of you will know – the same way.

Today, in 2010, the NHS is not doing all medical, dental and nursing care. Far from it.

Sometimes, the NHS does get things right. But, all too often, it does things badly. As my good friend Dr. Eamonn Butler put it a few years back:

““If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients.

Now, given the side of the debate I am on this evening, I wish I could tell you that America has got it right. It has not. I wish I could tell you that America is a genuine free market system. But it is not. Instead, away from all the propaganda and all the statements of those greedy vote-motivated politicians, America has much more of a mixed economy than most on this side of the pond realise.

Today, the US taxpayer spends a fortune on its Federal healthcare programs: Medicare, Medicaid and S-Chip. Who do you think has the larger budget? The Pentagon; or US government healthcare programs? The Answer, is US government healthcare.

I ask you: historically, which government do you think has spent a greater proportion of its GDP on its government healthcare programs: Britain or America? Well, averaging the last thirty years, the answer is America.

We hear a lot in Britain about the poor in America. We hear a lot about the 45 million uninsured. But who are they? 17m of the 45m live in households with incomes above $50,000. That is 38% of the uninsured in America. 9 million – or 20% of the uninsured – live in households bringing in more than $75,000 a year. And then there are the young-invincibles. These are the 18m Americans aged between 18 and 34 who chose to spend 4 times as much on alcohol, tobacco, entertainment and dining out, than they do on out of pocket spending on healthcare. They represent 40% of the uninsured in America.

Today, US federal law dictates that American hospitals have to treat – irrespective of ability or willingness to pay – anyone who comes within 250 yards of their Accident and Emergency department. That, my friends, is why so many Americans don’t bother with insurance. Many know that the government will already be there for them.

Now, there are probably 9 million people in America who are genuinely outside the system. But they refuse assistance and help from all sectors: be it public, private or charitable. We have those people here too: the homeless, the dispossessed, the mentally ill. For whatever reason, they want to operate on the edge of the mainstream and tonight they will probably be looked after by the Salvation Army or a myriad other good people in the independent charitable sector.

I could have talked tonight about how an American cannot buy insurance from another state. Or how the government skews the whole US insurance system so it rests with employers. I could have talked about the need for tort law reform. But, I don’t have the time to touch on these matters.

Instead, I simply want you to understand the size of US government intervention in healthcare, and to understand that like our own system, it has precious little to do with a free market.

However, I still believe that the US system is generally, better than ours in the UK. Overall it provides better rounded, more timely care for patients of all backgrounds.  This not only means that in America patients have better access to the most up to date medicines, medical and surgical procedures. It also means that if they need a hip replacement or cardiac surgery they are not left for months, or years waiting in pain or unable to leave their homes, as happens in the UK.

Indeed, I believe both systems would be better if they were more open, diverse and competitive. In short, if they were more free market.

I am not a politician. I am not an eminent medical doctor. I am a nurse. I have worked in and around the NHS for more than 25 years. And my concern his high quality patient care.

Away from Westminster, the Royal College of Surgeons and all the other vested interests, it is people like me, day and night, at ward level, who know and can talk about, the harsh realities of the NHS.

What I know, is that in this country today, most families have a horror story about the care, they or a loved one, has received in the NHS. Today, I know people find it difficult to get GP appointments. People are not able to register with NHS dentists. Increasingly, they are not always able to get the ambulances they need… When they do get one, they sometimes wait outside accident and emergency departments because the hospitals are full. If they were let in, the hospital would fall fowl of government targets on length of wait.

More than 4 months waits to get treatment? MS patients denied Beta Interferon? Patients with Kidney Cancer unable to get drugs that could prolong their lives? Women with Breast cancer not able to get Herceptin? 1 in 10 patients picking up healthcare acquired infections? 30,000 dead in 5 years? 70,000 malnourished or starved? All this, on this little Island?

You take it from me; someone who really knows;  someone who cares, on the frontline; tonight you would rather be unwell in America than here in our nationalized, vote-motivated, health system.

Thank you.

As this fabulous paper against the medical monopoly makes clear, state monopolies initially set up to protect standards in the name of public interest invariably degenerate into the total and utter reputational shambles that they pretend to oppose.

It is with this in mind that I recently noted this story .  You cannot make it up really. If only the Competition Commission would intervene to end the General Medical Council’s monopoly then perhaps things might start to turn around for doctors’ reputations.

For if allowed to chose, consumers would finally be free to decide between different brands, schools and philosophies of doctor. In such a world I would not chose a GMC doctor. Like millions of others, I would go out of my way to avoid members of an organisation that has consistently given the impression it exists to administer clubbable cover-ups for the benefit of its relatively well-healed members.

Come to think of it, why doesn’t the government allow a rival Competition Commission? Oh, no, silly me! That would be far too much like a market. Yes, it is much better to have one monopolist in the name of the ‘public interest’!

Serious point: to truly break state healthcare you have to sweep aside the medical monopoly. In the UK, that means removing the legislation that surrounds protected groups like the GMC. Like all other moral outfits they should stand or fall by their reputation in open, diverse and honorable competition. NFR says, let the people decide.

One of the big stories in British politics over the last two years has been the way in which bloggers have progressively broken the all too cosy relationship between the lobby correspondents and the politicians. All too reliant on politicians for their stories, too many mainstream journalists ended up pulling their punches and failing the public. In opening up completely new avenues of information and discourse, the old guard of the BBC and the national press are slowly giving way to a new players such as Guido Fawkes who are increasingly becoming the key agenda setters. In the world of blogging and tweeting Westminster reporters could no longer sweep the expenses scandal under the carpet or fail to expose questionable political characters such as Damien McBride. No, the mainstream and established media are under real pressure now.

However, as in Westminster, UK healthcare journalists have for far too long also been guilty of the same sort of complicity. Reliant on politicians, civil servants, trade union leaders and other NHS types for their stories, very little real thinking or criticism has been leveled at the idea of state healthcare and socialised medicine. Indeed, most UK healthcare journalists are now so co-opted and ill-informed on the basic facts of health policy NFR believes they are setting themselves up for a fall.

In the last couple of weeks I have been interviewed by the Nursing Times and the Nursing Standard. I have talked to journalists on countless other health and professional publications. However, in all cases, I find that I am dealing with people who do not understand the basics.

Tell a UK health journalist that in America the US government now spends more on Medicaid, Medicare and S-Chip than the Pentagon does on the military and you will be met by uninformed disbelief. This, from journalists who believe that the US has a free market health system!

Tell a UK journalist that in Britain 7 million people have private medical insurance; 6 million have private health cash plans; 8 million pay annually for private complimentary treatments; that 200,000 self fund for surgery in private hospitals; that more than a quarter of people pay privately for their nursing and residential care home places, or that nearly 40 per cent of people are now going private for their dentistry and you will be greeted with the words “I had no idea about those numbers”.

Ask a UK journalist what they think about health savings accounts, or what health censorship is, how it came about in this country at the beginning of the twentieth century and why it might be bad for patients and you will hear “I no nothing about any of this”. Yet, these are the people who endlessly report that patients ‘lack information’!

Now, I like journalists and some of them ‘are my best friends’. Charlotte Santry of the Nursing Times was charming on the phone and I very much hope we will stay in touch. But all too often they are lazy, ill informed and unquestioning. Often unconsciously co-opted by old myths and elite interests they, like their friends in Westminster, will surely loose ground in the more competitive age of open communications.

For NFR, UK health journalism is due a good hard kick up the bottom. The idea that the NHS is great and that America somehow represents a free market is a non-starter when you know your subject. We can and we will do better than this.

Since the recent meeting with David Cameron Nurses for Reform has attracted a vast amount of media attention. Perhaps most importantly we have also picked up lots of new support from registered nurses who have decided to formally sign up and support the organisation. Appalled by the horrific realities of state run healthcare many nurses have clearly been relieved to finally find an organisation that spells out some home truths about the NHS and campaigns to put the long term interests of patients first.

On the media front, NFR has been reported in The Daily Telegraph.  We have also been reported in The Mirror, here, here and here .  And we have been reported on major UK political blogs – such as Samizdata and the Adam Smith Institute .

There have been numerous other blogs about the organisation – including Liberal Conspiracy, Labourlist , and Tom Harris MP’s blog (to detail just a few) – and early this week I was interviewed by the Nursing Standard (readers will be able to see the result of this when the NS gets around to publishing it in a few weeks).

The really heartening thing about this episode is the dozens of nurses who have signed up to support NFR and what we stand for. Their emails and messages of support characteristically represent a profession who are tired of being gagged by politicians and misrepresented by the usual political class types at Unison and the Royal College of Nursing.

On the down side, NFR is mindful that many people in the UK and Europe still do not get how hostile the organisation is to American state healthcare. In failing to understand that the US government spends more on Medicare, Medicaid and S-Chip than the Pentagon spends on the military, it would be helpful if some of our detractors at least read this NFR article on why America does not have a free market healthcare system and therefore why NFR is hostile to the American healthcare system.

I have an article published today on the Adam Smith Institute Blog.  Titled “The Micropolitics of Hospital Privatisation” it details the actions that NFR believes must be taken to improve UK healthcare provision. You can read the full text here.

I am pleased to confirm that earlier this week I had an interesting hour with Tory leader David Cameron in his private office in the House of Commons. I had been invited by him to discuss NFR’s ideas on the future of health policy and presented a range of ideas. Amongst others, these included the end of national collective pay bargaining for nurses and doctors, the view that the state should not own or have any of its agents manage hospitals, a world of widespread health advertising (to overcome problems of patient ignorance through trusted brands) and a dramatic liberalisation of hospital planning laws. On this latter point, central government should have no say in when and where any hospital is opened or closed. If he becomes Prime Minister I have no doubt NFR will meet with him and his policy team again. But whatever happens, he can rest assured that NFR will remain very much on the outside of his – and any other party political – tent. As a libertarian organisation, NFR has a profound mistrust of all politicians. As such, we will remain dangerous and continue to think the unthinkable.