Nurses for Reform Blog

Nurses for Reform is delighted with the breaking news that the government has rightly decided to scrap the exorbitantly expensive, inefficient and frequently useless NHS Direct helpline.  NFR has long campaigned for the ruthless dismantleing of such pseudo-services instead preferring wholesale privatisation.

On the downside, NFR is hugely skeptical of the new 1-1-1 Helpline currently being piloted in the North-East of England.  Instead of such state funded monopolists NFR prefers a much more open and diverse approach to healthcare advice.

Following Andrew Lansley’s announcement last week that he will be cutting a number of NHS quangos including the Health Protection Agency (HPA) I have spent some time thinking about what can be done to stop these agencies reinventing themselves.

For this is actually one of the biggest challenges that the Government faces.  As I have already commented, the Food Standards Agency have been the first organisation to get the better of the politicians.

To enable the Health Secretary to counter the appeals that are going to come his way he only really has to look to the market.  For example one of the responsibilities of the HPA is to collect statistics on Healthcare Acquired Infection, well, Dr Foster does that, and much more, far better and has been doing so for many years.  If NHS trusts want to attract custom from the commissioning GPs and from consumers (patients!) they will quickly learn to publish the information that people are interested in. It’s called marketing!  The HPA also provide infection control advice put again, private companies have been doing this for years and can be contracted by commissioning GPs as and when required.

The message to Mr Lansley is simple.  You have lost the first round to the FSA.  Don’t let the rest of these state funded bodies follow in their wake.  Be ready, be ruthless and make the NHS Reforms worth much more than the paper they are written on!

This is a very encouraging story from the BBC reporting David Willett’s announcement that the UK’s Coalition Government are going to allow the establishment of more private universities.

The first, run by BPP will expand it’s courses to include the training of healthcare professionals such as nurses.  NFR welcomes this move as evidence that the Government are following yet more of our policy ideas, for we have long believed that nurse education and the definition of what constitutes being a nurse should be set free from government and the Nursing and Midwifery Council.  It is imperative that this new university is allowed to set its own curriculum for nurse training and set it’s own standards.  I am sure that Foundation Trusts and hospitals from the independent sector will be more than happy to work with an institution that has high standards and that trains nurses who provide high quality patient care.

The unions that are decrying this initiative are peddling pure fallacy when they say that:

“Encouraging the growth of private providers and making it easier for them to call themselves universities would be a disaster for the UK’s academic reputation. It would also represent a huge threat to academic freedom and standards.”

For in truth, if this university wants to survive it will have to provide and maintain exceptional standards to retain its reputation and to continue to attract the best students.  Just as the pioneer of private universities in the UK,  The University of Buckingham has done for many decades.

This story from the BBC announcing a reprieve for the Food Standards Agency  (FSA) is, if true, very worrying for a number of reasons.

Not only will the Government have gone back on its promise of abolishing Quangos, but it will also have fallen soundly at the first hurdle in its bid to reform the NHS.  For this move will send out signals to Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) that if you make enough noise to justify your existence and roll with the punches to reinvent yourselves,  you will be saved.

One can imagine the mutterings in the SHAs and PCTs about being seen to support the changes as long as they do not go so far as too get rid of any “our” jobs or layers of bureaucracy!

It is vital that Andrew Lansley and his health team recognise the forces that they are up against.  They have lost the first battle against the FSA, they must now regroup and begin to close down all avenues that could allow the SHAs and the PCTs to have any chance of survival.  Otherwise all talk of reform and the ‘Big Society’ will be dealt a blow from the outset.

This is a great piece posted at Conservative Home this morning by Steve Baker MP.

NFR is pleased with reports that the government is finally accepting the organisation’s arguments that national collective pay bargaining must be ended across the public sector, including the National Health Service.  NFR is also delighted that in denationalising NHS hospitals, turning them in to genuinely independent foundation hospitals, private worker ownership and mutuality is on the agenda.  Not only will a more vibrant and competitive labour market be good for nurses, doctors and other health workers, but in removing the cap on the amount of private work former state hospitals can do, will give consumers and patients access to much more competitive provision.  For too long Britain’s private hospitals have benefited from failing state hospitals and profiteered accordingly.

It is now vital that trade unions welcome this more market based approach to healthcare and step up to the plate of supporting greater plurality of provision – including worker ownership, co-operatives and mututals.  It is vital that Britain’s private hospitals do not repeat their memorable and disasterous tactic of the early noughties; when faced with the prospect of Blair’s independent foundation hospitals they actually worked alongside an unholy alliance of Frank Dobson, left wing MPs, trades unionists and a cabal of opposition Tories to undermine the legislation. Britain’s private hospitals have long talked the talk of consumer competition, it will soon be time for them to walk the walk of a paradigm-shifting and wholly privatised market. For while NFR wants the abandonment of national collective pay bargaining, and therefore does not believe that simple regionalisation of pay goes far enough, we can be sure that the government’s proposals represent a shift towards health privatisation on the provision side. By initially putting the vast majority of the NHS budget in the hands of general practitioners, whom the patients are themselves free to choose, the government is setting up a shadow voucher scheme.  Once the money follows patients through GPs, and it can be spent in a diverse and open market of non-State provision, the next step will be to allow all providers to sell, if they choose, their own local insurance products.  For many years private health cash plans such as H.S.A. Simply Health have sold their wares giving a proportion of their profits to local NHS hospitals. In future, NFR envisions a deregulated world in which local independent health providers, both large and small, are able to advertise and sell whatever health coverage or insurance products are desired.

Today, health is so important no-one should have to go in to any hospital, surgery, or clinic owned or directed by the state.  No health professional should be tied to out-of-date and Sovetised pay scales that demean their integrity and professionalism. As such, the future is clear. The NHS is being soundly re-engineered as a funding mechanism. Provision is rightly going the way of a freer market and professionals are being tentatively liberated from the shackles of top down direction.

In time, a more open, competitive and private funding revolution must follow. So too must the private training of all health professionals and the opening up of state monopolies such as the General Medical Council and the Nursing and Midwifery Council.

Nurses for Reform is pleased with today’s reports that the Government is soon to launch a white paper on the NHS.  NFR heard of these changes a few weeks back and we are supportive of the idea of introducing a shadow toll system whereby money follows the patients via their GPs and in a much less bureaucratic NHS structure.

NFR has long believed that Strategic Health Authorities and Primary Care Trusts should be scrapped. NFR also believes that the NHS should be a funding mechanism but that no hospital, care home or clinic should be owned or run by the state.  While initial reports of the white paper are positive it is vital that it spells out that the state will never build another hospital again and that our existing stock embrasses diverse forms of ownership, including cooperative and not-for-profit, and that all provision is independent.  No-one in this country should ever have to go to a state run hospital again, moreover, the staff who work in these hospitals should be similarly denationalised.  National collective pay bargaining should be replaced by a more dynamic and responsive labour market and monopoly authorities such as the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) should face stiff competition from a raft of competitors offering competing standards and ways of doing things.

In this context Andrew Lansley’s white paper is unlikely to go far enough.  Still trying to make socialism work NFR suspects that he will chicken out of necessary labour market reforms and will remain on side with elite legislative favour so beloved by the GMS and the NMC.  As such NFR is only likely to give next week’s white paper 3/10

Apparently the Health Secretary Andrew Lansley is planning to remove NHS targets such as minimum waiting times for NHS care and replace them with a set of minimum care standards.  If this report from the BBC is accurate then although it is a good start it does not go nearly far enough.

I do believe that this could be an effective way of the NHS measuring patients outcomes but only with the following provisos:

1. First, that the NHS is no longer a care provider. All NHS hospitals should be removed from State ownership.  They  must be owned and run by private companies, mutuals, cooperatives and other for and not-for-profit organisations.
2. The NHS will then become an institution that funds and sets minimum standards for healthcare provision.
3. Contracts for care must be awarded to these independent hospitals and their performance measured against the Health Secretaries’ minimum standards
4. If the hospitals are not achieving the standards stipulated then contracts must be removed.

The final point is vital.  By introducing the system outlined above healthcare providers will become truly accountable for the care that they give their patients because if they do not provide high quality care for all patients they should be taken over by those who can turn them around or they will go out of business.

This article clearly demonstrates that the UKs parents and indeed many teachers, do not believe that the state is providing the education that they want for their children.  The demand to be allowed to set up free schools has been far greater than expected.

NFR believes that the Coalition Government should not just stop at schools, hospitals should be next in line.  As I have written before, local planning laws must be changed to allow much greater diversity of provision.  Hospitals could be set up for example by private companies, mutuals, charities, patient groups etc and they should also be able to take over failing NHS hospitals and to compete for care for and treat NHS patients.

With the election out of the way and a new Conservative-Liberal Democrat Government it will be interesting to see how the NHS actually fares given the size of the burgeoning national debt.

While Conservatives are often thought of as free marketeers and Lib-Dems are often thought of as being a bit lefty the rise of the so-called Orange Book Crowd in the Lib-Dems over recent years could make for interesting politics.  For the Orange Bookers are often not only more socially liberal than the most libertarian of Tories but they are more free-market than many Thatcherites.  While the NHS will suffer some cuts over the course of this parliament NFR believes that more complimentary private funding schemes could well come on to the radar screen of both the Conservatives and the Lib-Dems over the next five to ten years.

Watch this space…