Nurses for Reform Blog

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.

Following the success of papers I have written for organisations such as The Heritage Foundation, I have recently been asked to write a new paper for the Hoover Institution.

The Hoover Institution is one of the United States most prestigious academic think tanks and closely affiliated to Stanford University.  The institution greatly influences public policy development globally  with its ongoing research agenda and I am very honoured to be asked to write for them.

This is a great piece in the Daily Mail by Dr Karol Sikora.  In it he points out that NHS patients are being put at risk by hospitals using untested doctors to ensure that they achieve government targets.

What is interesting here is the contrast with the UK’s independent sector.  Patient safety is paramount to the independent sector, as harming their patients harms their reputation and this would ultimately destroy their business.  The independent sector are much more careful of the staff that they employ or allow admitting rights to their hospitals, Consultants wishing to have admitting rights to independent sector hospitals are subject to strict scrutiny and peer review and only allowed in when it is trusted that they will bring benefit to the organisation.

The problem with Government setting targets for NHS hospitals it that the target not the patient becomes the priority, as NHS managers strive to please their political paymasters they lose sight of the damage that is being done to the people who should really matter, the patients!

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 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.

This story about filthy and dangerous NHS hospitals has really gained momentum over the weekend. What is really bad news for the government is that not only is this is not a one off rogue trust, but that many of our hospitals are in this state and the problem has only been accurately identified by the private sector in the form of Dr Foster.  

For me it is not surprising that the Care Quality Commission (CQC) managed to rate many of these Trusts as “good” and then for Dr Foster to obtain more accurate results.  I have recently been in discussion with a number of colleagues about the CQC and the general opinion of them is that they are disorganised, incoherent and generally do not have a clue what they are doing.  In fact when some nurses that I know asked them for an opinion they were unable to give any helpful or coherent advice.

I am sure that this story and the others like it that will follow will bring calls from interest groups for more regulation.  This is the wrong way to solve this problem.  There are two courses of action that must now be taken as a matter of urgency.

First, the NHS has shown that it is now failing to provide clean, safe care with monotonous regularity.  All healthcare provision in the UK must be returned to the independent sector as a matter of urgency.

Second, the CQC has demonstrated that it is incapable of making accurate assessments of the state of our hospitals so why not abolish it immediately and let the public rely on more respected and reliable brands such as Dr Foster and Which to inform then of the true state of healthcare provision.

The only way forward is for less regulation from government and more market forces and self regulation.

This is a step in the right direction in the reform of UK healthcare provision.  However, the Government has to be more radical than this in its solutions if it wants to create real improvements.  While it is right to enable NHS patients to access higher quality private provision NFR believes that the Government should follow its policy approach to the logical next step.  No britsh hospital should remain in the state sector, all healthcare provision in this country must be put in to the independent sector, both for profit and not-for-profit.

Just as the NHS can fund its patients to go to a few private hospitals to enable politicians to appear to keep some promises, so in the future it must make this opportunity open to all patients by setting the UKs health provision market free to private sector knowhow, investment and quality. An incoming Conservative government should be clear, there will be no government owned and politically controlled hospitals.

This is yet one more warning to Americans who think that the money set aside for Comparative Effectiveness in President Obama’s stimulus package is money well spent.

The Nation Institute for Health and Clinical Effectiveness in the UK (NICE) has again denied  women with breast cancer potentially life saving treatment.  I have said it before and I will say it again, Governments are putting prices on our lives and if the treatments that we need are considered to be too expensive then we are expendable.

This is a great article from Grace-Marie Turner of the Galen Institute commenting on President Obama’s key note speech on his healthcare reform made earlier this week to both houses of congress in the US.

A Speech Not A Plan

President Obama’s speech last night soared with oratory but fell flat in delivering on his promise to present details or any substantive new policy initiatives for his health reform plan. He may get a few days of lift from the passion and cheers in the House chambers, but the hard realities of policy will continue to chill prospects for getting sweeping reform legislation enacted. A few examples:

Paying for reform. The president said “the plan I’m proposing will cost around $900 billion over 10 years” and that “we’ve estimated that most of this plan can be paid for by finding savings within the existing health care system, a system that is currently full of waste and abuse.” 

He dropped talk of higher taxes on the rich to pay for the reform plan, perhaps after realizing that much of the burden would fall on small businesses. So that means that, apart from some new taxes on health insurance (which will just be passed along to consumers), the massive coverage expansions will be paid for by curtailing Medicare and Medicaid waste and abuse and making them more efficient. 

That doesn’t pass the laugh test. I testified before the House Energy and Commerce Committee in 2008 about seven rules that the Bush administration had written to curtail documented fraud and abuse in the Medicaid program. The fraud was documented by the Government Accountability Office and the Inspector General at the Department of Health and Human Services — things such as using Medicaid money to take people shopping for party dresses and to Bingo games. 

But Congress has done everything it can to stop implementation of the Bush rules to stop documented fraud. What do you think the chances are that they will be able to pay for their $900 billion reform plan mostly with savings from Medicare and Medicaid?

Rising health costs. Gone is the campaign promise that every family will save $2,500 a year on health costs when the Obama plan is implemented. It has been replaced with new language that says reform “will slow the growth of health care costs for our families, our businesses, and our government.” 

Slowing the growth of health costs is a much different agenda. But even with that, he offered little or nothing of substance to explain how he would achieve that goal.

Keeping the coverage you have now. The president has changed his rhetoric about no one losing the coverage or doctors they have now. Now he says “nothing in this plan will require you or your employer to change the coverage or the doctor you have.” The operable word is “require.” 

But the employer mandate is still in place, and the president still wants the new public plan. So there would be every incentive for employers to drop coverage, pay the new tax, and send their employees packing to the public plan, many involuntarily. The Lewin Group says between 88 million and 120 million Americans would find themselves in the new government-run health program. But they wouldn’t be required to join. 

Do you find that reassuring?

So what we heard last night was a campaign speech which was, by the way, alarming in his threats to those who oppose him. Promises made are not promises kept. Michael Tanner of Cato has a good new paper out that details the very difficult challenges of getting from promise to policy. The president began his speech by saying: “We know we must reform this system. The question is how.” We’re still waiting for answers.

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.