Nurses for Reform Blog

Putting to one side the dire financial situation this country is in, I do still find it amazing that despite continued evidence that the NHS is failing the British people the trade unions continue to bury their heads in the sand.  While the rest of us, our family and friends are finding out on a daily basis that the NHS cannot and will not live up to the promises of the 1940s the unions are now threatening to make matters worse by going on strike.

What also interests me is that  for all their complaining and protesting I cannot find any evidence that Unison can suggest alternative ways of reforming the NHS.  They go on and on about fairness and equality but there is not one jot of a suggestion of how they would do things.   Maybe Dave Prentis knows the way to the pot of gold at the end of the rainbow that will solve all our problems, but in the real world the truth is that it will continue to be the elderly and the most vulnerable in society that suffer from the strike action proposed by Mr Prentis and his members.

This is the text of my speech to the retired members and fellows of the Royal College of Obstetricians and Gynaecologists.

Lades and gentlemen, thank you for inviting me here today.

The title of my talk is “why Nurses for Reform do not believe the Government’s health reforms go far enough”.

—

Nurses For Reform – or NFR – is a small organisation with only 200 nurses in membership.

It was established by me in 2006, and its objective is to promote genuine free market reforms across healthcare.

From the outset, NFR has been designed to be a low cost, lean and mean, cyber organisation and nurses who sign up, do so, free of charge.

Today, representing very much a minority perspective, we nevertheless attract a growing amount of media attention – and our views are starting to be taken seriously by politicians – across the political spectrum.

NRF regularly appears in the national press and media, and we now enjoy an ever-expanding on-line following.

In the last few weeks alone our views have been reported in The Daily Telegraph, The Guardian and I have been extensively interviewed on the BBC.

And it was not that long ago I spent an hour with David Cameron in his office presenting NFR’s policy ideas for substantive healthcare reform.

If you listen to John Prescott, The Daily Mirror and countless other friends on British the left, then NFR is the free market conspiracy in British healthcare!

—

Now, when the NHS was created back in 1948, not only was it established on the basis of taking into public ownership 3,118 independent hospitals and clinics, but, crucially a leaflet was posted through the door of every home in the country.

It contained – in black and white – the promise that was supposed to be full-blown state healthcare… its “founding principles”.

The leaflet stated, and I quote: “[the NHS]…will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it.”

The key word here was the word all.

The State was going to provide all medical, dental and nursing care.

—

Today, sixty three years on, the NHS has never come close to making good this promise.

Indeed, as time passes, UK healthcare is moving ever further away.

—

There have always been services that the NHS has never provided.

While at first doctors in NHS hospitals were encouraged to treat patients according to need, within a couple of years of the service having been established they found themselves working under the imposition of cash limits which soon turned them into the politicised allocators of scarce resource.

Soon, the supply of health – and social care – in the UK was rationed by massive queuing.

Crowded waiting rooms became common in most general practices and out-patient departments.

By the late 1960s, queuing had even become a significant factor for in-patients and those waiting for operations and treatments deemed a “priority”.

Indeed, certain health services have never been provided by the state, reducing demand still further.

Much psychiatry, the treatment of infertility and substance misuse are cases in point.

In reality, people have never had a right to free and equal treatment.

What they have had is a right to a promise of being treated at some distant point in the future and without much mention of quality when they actually get there.

It must also be noted that only in theory does the NHS treat everyone equally.

For as Professor Julian Le Grand of the London School of Economics and Tony Blair’s health adviser made clear a few years ago – relative to need – professional and managerial groups have tended to receive more than 40 per cent more NHS spending per illness episode than those in semi- and unskilled jobs.

—

Now, in the early years of the NHS, the government made very little investment in its newly acquired health estate.

In fact, during the first decade of the NHS, not a single new hospital was built.

None were even approved until 1956.

And then there was the Great Hospital Plan of 1962!

Even by the mid-1990s most of it had still not even been commenced.

As the health commentator Professor Allyson Pollock pointed out in the middle of the 1990s:

“The plan…remains unfulfilled, with only a third of the projected 224 schemes completed, and a third not yet started.”

—

In reality, the government never really did get around to investing on the capital side of the NHS, which is why Prime Ministers such as John Major and Tony Blair turned to private sector capital and expertise under their private finance and public private partnership initiatives.

It is with this background that Blair signed the Concordat with Britain’s private hospitals in 2000 – enabling NHS funded patients to get independent sector care and treatment for the first time.

This is why in 2001, a Labour government wanted a new generation of Independent Sector Treatment Centres.

It is why in 2003, the government tried to push through Independent Foundation Hospitals and wanted them to be able to raise private investment on the open market.

It is why we have the Patient Choice Agenda.

And it is why we now have the Health and Social Care Bill going through Parliament.

—

Make no mistake.

The NHS is being redefined and recast.

In the future, the NHS will simply be a funding mechanism but it will not be the owner of the facilities in which people are cared for or treated.

Looking further out, nor will it be the controller or manager of healthcare professionals.

—

At this point, I could of course talk about the collapse of NHS dentistry, or the way that spectacles were privatised in the 1980s, or the way that to manage NHS waiting lists the service has become ever more reliant on using capacity in the UK’s 220 independent hospitals…

But alas, I don’t have time for that…

—

What I want to do with the time that remains is tell you what I think the Bill going through Parliament is actually about, and why NFR does not think it goes far enough.

—

Overall, I am pleased that the government is planning to empower patients by introducing what will in effect be a shadow-voucher system.

For in enabling patients to freely choose their general practitioners and then having the vast majority of the NHS’s funds flow through their hands, the system can move towards a much more open and diverse market in provision and facilities.

In the future, I believe no one in this country should ever have to go into any hospital owned or directed by the state.

Whether for-profit or not-for-profit, mutual, worker co-operative, or charity, all our hospitals, clinics and care homes must be set free from political control and returned to independent forms of ownership.

These organisations should then be free to raise money commercially or as they see fit, and free to reap the rewards of serving patients well.

It is vital that UK hospitals and clinics are freed from the constraining and historic shackles of the Treasury.

—

When looking at the current Bill in Parliament, I think it is good that in the future, not only will hospitals be allowed to raise investment and capital from private sources, but that the caps on their private pay-bed work will also be removed.

For too long, high quality independent provision has been the preserve of the well-healed and those able to afford exclusivity.

For too long, private hospitals have profiteered with high margins from the manifest failings of nationalised provision.

However, where Nurses for Reform differs from the government is that we also believe national collective pay bargaining arrangements have run their course and should be abandoned.

Alongside privatizing NHS hospitals, NFR wants the government to encourage a more vibrant and open labour market for the benefit of all doctors, nurses and other health workers.

No one working in healthcare should ever have their professionalism and integrity undermined by uniform, one size fits all, politically decreed, pay scales.

Nor should remuneration be imposed and held back at regional level.

To properly value doctors, nurses and other healthcare professionals, remuneration must be set at realistic levels but this will only happen in a more open, dynamic and responsive market.

Similarly, NFR wants the government to end health censorship.

In today’s internet age it is absurd that advertising by doctors and pharmaceutical companies are still largely restricted or subject to outright bans.

Why can’t GPs advertise and compete with each other?

What can’t Foundation Trusts advertise on television or in local newspapers?

Why can’t many medicines operate under the rubric of commercial free speech?

To encourage informed patients and build trusted brands we must dramatically liberalise the laws surrounding health information: we must encourage a lot more advertising.

While there is no such thing as perfect information or perfect knowledge, better-informed people are able to make choices and better decisions.

Trusted brands can also deliver powerful checks against producer-capture and the monopoly abuses of those with professional – monopoly – legislative favour.

And that means you and the GMC and it means me and the Nursing and Midwifery Council.

—

Finally, I think the government should go much further to liberalise the planning laws surrounding the building of new hospitals and all other health and social care facilities.

We need to make it much easier in this country for social enterprises and entrepreneurs to build new healthcare facilities.

Instead of an ever shrinking healthcare estate we need to respond to the demographic and medical challenges of the future by enabling a rich and diverse tapestry of institutional arrangements more focused on consumers, quality and value for money than the politics of greedy vote motivated politicians and trade union leaders.

—

To conclude:

NFR is established and we here to stay.

We are small, but we have a distinct voice.

We are free marketeers who put patients and best value above professional and sectional vested interest.

We are not afraid to criticize the state or the NHS.

And we have a clear agenda.

While we think the current Bill before Parliament is at best only an incremental step in the right direction we also think it is a missed opportunity.

From a consumer perspective, it does not go far enough.

What we want is universal independent provision.

We want more healthcare advertising so as to inform and build trust.

We want an end to national collective pay bargaining.

And we want to do away with planning laws that restrict supply and keep prices artificially high.

What I want is better healthcare for all and I want the vote seekers to get out of the way!

—

Thank you.

This morning I as interviewed on LBC Radio’s breakfast show to discuss the reform of the NHS.

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.

I have said it before but I am happy to say it again and again until the message gets through.  Whichever party wins the general election on 6th May, below is the action that NFR believes must be taken to reform the NHS and to ensure that UK patients receive timely and effective healthcare.

Introduction

Mindful of a likely change of government in 2010, Nurses for Reform believes that the NHS should be renamed the National Health SYSTEM and that it should work through the universal supply of independent hospital care and treatment. Simply put, there should be no hospitals in this country owned by the state or managed by its agents.

Cheaper and Better

There was once a time before the industrial revolution when food production was onerous and costly.  Many could not afford a nourishing, diverse or pleasurable diet and all too often people went hungry.

There was a time before the invention of the steam, internal combustion and jet engines when options for travel were limited and any significant distance remained the preserve of the rich.

There was also a time, not so long ago, when telephones were rationed and lengthy calls were beyond the means of most people.

Yet today, thanks to open and innovative markets, people can afford diverse food, extensive travel and outstanding telecommunications. What was once beyond the dreams of avarice are now part of every day life and taken for granted.

Universal Independent Hospital Provision

That is why the next government must liberate health provision from the rationed and expensive world of top-down of un-innovative state control. All NHS hospitals must be returned to the independent sector, not least so that such provision reflects actual needs and not the political whims of vote-motivated politicians. At a practical level this means the following key points:

• In the post-bureaucratic age the Secretary of State for Health must no longer have any say over when or where hospitals are built, opened or closed.
• Following the planned changes in education, local planning laws must be reformed so as to enable a much greater diversity of – and investment in – independent provision.
• The planned Independent NHS Board should oversee the return of all UK hospitals to diverse forms of independent ownership (for-profit and not-for-profit).
• Health censorship must be outlawed and patients must be empowered with greater access to information. In this context hospitals, doctors and other health professionals including pharmaceutical suppliers should be free to advertise and build trusted brands. Only by allowing reputations to be built openly, bottom-up will the government be able to realise a lighter touch in regulation.
• To encourage openness, diversity and greater opportunity for staff, employers and patients, an incoming Conservative administration must also adopt the principle of subsidiarity when it comes to human resource management. Hospitals, care homes and all other health facilities should be able to set pay and conditions for staff as they think appropriate and take the lead in all medical and health training. National collective pay bargaining and professional monopolies should be abandoned in favour of a more post-bureaucratic approach.

By putting these key initiatives in place not only will there be a vast improvement in the provision of healthcare but, these changes will enable further micro-political changes to health funding. Overall, these reforms are necessary so that healthcare is pushed through the beneficial reforms that we now enjoy in so many other areas of our daily lives.

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.

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 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.

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.