Nurses for Reform Blog

At last the main stream media has realised something that I have championing for years.  The American government spend a greater proportion of GDP on their state healthcare than we in the UK spend on the NHS.

For many years there has been a dialogue of the deaf between the UK and the US.  While we believe that they have a totally private system that will leave people dying in street if they do not have private insurance, they believe that we have this wonderful state system that gives everyone everything they want. Nothing could be further from the truth.

Both systems are badly flawed and in dire need of more market oriented reform.

I am delighted to be appointed as a Senior Fellow at the think tank Progressive Vision.   They have some very interesting things to say about healthcare and the NHS and I look forward to a long term collaboration with them.

In his first major interview since becoming Health Secretary Andrew Lansley sets out his plans for the NHS.  To me this is just more tinkering around the edges.  He talks about nurses spending more time with patients and reducing health care acquired infections, while these are laudable intentions it sounds like he is rearranging the deck chairs on the Titanic.

The NHS does not need more or new targets.  Targets are part of the problem of this broken system.  What we must hear from Andrew Lansley is how is going to change the system itself.  We have had more than 60 years of trying to make the NHS work and it still failing patients every day.

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…

As the NHS electronic patient record system starts to be rolled out, here is yet another story of the disastrous management of patient information by the NHS.  Granted the system has been suspended for the time being, but don’t let this fool you, it will be back.

Regular readers of this blog will know that I, and others, have been warning against these systems for many years.

I would urge all UK readers of this blog to head to this website, download the opt-out form, complete it and take it to your GP.  I am also going to ask for written confirmation that my request has been adhered to.  It’s not that I don’t trust them, but…

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.

Last week, I spoke against the NHS and whole idea of socialised medicine at an Oxford Union debate. Against me were the usual political class types including Andrew Lansley MP (Conservative Shadow Secretary of State for Health), Kevin Barron MP (Labour), Norman Lamb MP (Liberal Democrat) and that doyen of producer power and legislative favour, the President of the British Medical Association, Professor Averil Mansfield.

It was a great evening and everyone enjoyed themselves hugely. I certainly did and was delighted to have on my side the top cancer specialist Dr. Karol Sikora. He has long demanded changes to the ‘Stalinist NHS Quango’ and all in all we had immense fun together.

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.

Following this post the Daily Mirror published this rather good article:  Apart from making the mistake that NFR is in anyway allied to the Tories (that is offensive!), it helps to get some important history out in the public domain. Intellectually, the NHS and the welfare-warfare state does have some unsavory roots that no one should deny.

Indeed, there have been two recent comments posted on this blog that are so good I have decided to reproduce them here. Here is number one;

“The history behind the NHS and the eugenics movement does have common elements, to pretend otherwise is to live in a fantasy world.

Specifically, it was the beginning of national health statistics in the late 19th century that led to the moral panic of “degeneracy”,which came from the combination of Darwinian ideas applied to social sciences, and the emergence of medical data about the health of working class people.

One part of this panic was to promote the idea of deliberately removing “undesirables”, a process begun in the USA in the early part of the 20th century, but applied most horrifically in Nazi occupied countries from 1933 onwards.

But the other, whilst less violent, had the same objective: the national improvement of collective healthcare. The Fabians originally believed that the “feeble minded” should be institutionalized (given electro-shock therapy), homosexuality was considered “a mental illness” and state control of hospitals became an ideological programme.

This is why Nazi Germany was the first European country to adopt major campaigns against smoking, and why the various prohibitionist movements were strong in late 19th-early 20th century USA and UK.

What part of the NHS’ rationing of healthcare to deny treatment for old people, or smokers, or the obese, do the commentators above think Hitler would object to? I can think of none. As for the smoking ban in pubs: no fascist dictator would have dared introduced such a thing, but Hitler, would certainly approve.

As for A Davidson, I would merely point out, that it seems wise to ask if the reasons for Hitler’s support for socialized healthcare (which you admit) are bad, shouldn’t we consider them? If Hitler was right to think that socilized medicine would advance racialist policies, are we wrong to make sure this does not happen?

One last thought. Harold Shipman. Clearly, this was an extreme individual, but his attitude towards patients was entirely logical, once one accepted the notion that it is not the patient to control healthcare provision or objectives.”

Now, for those of you interested in the burgeoning literature and research into this history – much of it written by socialist writers – see comment number two:

“Even those who like the NHS have to accept that it does have some very strange intellectual underpinnings.

It is curious how the existence of an alliance of statist Toryism and Socialism has fallen out of any popular consciousness. One of the few studies can be found in Semmel, B., (1960) Imperialism and State Reform: English Social-Imperial Thought, 1895-1914, Harvard University Press, Cambridge M.A. There is a growing literature on eugenics, ‘right wing’ (that is, anti-capitalist and anti-liberal) social Darwinism and paternalism. See: Searle, G. R, (1971) The Quest for National Efficiency, Oxford Universisty Press, Oxford and (1986) Social Hygiene in Twentieth Century Britain, Croom Helm, London. Soloway, R. A., (1990) Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth Century Britain, University of North Carolina Press, Chapel Hill. Some socialist scholars are also beginning to reconsider the origins and nature of the rise of the welfare state in light of such evidence. See: Skocpol, T., (1992) Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States, Belknap Press/Harvard University Press, Cambridge M.A. Jamieson, L., and Corr, H., (eds) (1990) State, Private Life and Political Change, Macmillan, London. Dwork, D., (1987) War is Good For Babies and Other Young Children, Tavistock Publications, London.

Under analysis, the origins of the welfare state looks less like the pure juice of human kindness and altruism, a liberation of the masses, and increasingly more like authoritarian social engineering for the sake of national strength, war or racial hygiene.”

Yesterday I was told something very strange. If it is true, then it is quite a coup. But so far, I simply don’t know.

Did you happen to notice that this Christmas there were fewer government drink driving adds on the television? I don’t always watch a lot of TV and I honestly don’t know about this. But, apparently, having written this and this I am advised that the government decided to do less preaching this Christmas.

Was it NFR? Was it that there is an election coming up and politicians don’t want to appear to be too nanny-ish? Were there really fewer drink driving adds on the box? I simply don’t know. You tell me. Is this true?