Nurses for Reform Blog

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

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.

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.

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.

I normally do not comment on clinical or individual nursing issues, but this story has annoyed me so much I felt that I had to post a small blog.

While I am happy to respect all religious beliefs, as long as they do not impose on my personal beliefs (just as I would not impose my beliefs on others) I must disagree with the nurse who has recently made an issue of wearing a necklace showing a Christian symbol at work.

In my view this is not a religious issue but a clinical one.  When I began my nurse training in the 1980s one of the first things that we were told was that nurses must never wear necklaces of any kind while on duty, as an ill or confused patient may be able to get hold of the necklace and try to cause the nurse an injury with it.  This is why all lanyards for ID badges have quick release mechanisms so that staff cannot be harmed while wearing them.

Therefore, rather than bleating on about religious beliefs I believe that this nurse should get a grip and realise that no clinical staff should be wearing anything around their necks that could be used to harm them.  Her employers, indeed all employers of clinical and care staff must also ensure that they enforce neckwear rules across the religious spectrum.

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.

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!

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.

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.

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.”