Hold your prayers

I have been mulling on a note informing the intended recipient that she would be prayed for, wondering somewhat facetiously whether those prayers wouldn’t best be put on hold, given this was what had happened to the appointment. God bless the idiosyncratic ways of our glorious NHS, inviting prospective patients in for a pre-op assessment without knowing the date of the operation itself. Whilst I love the principle, I continue to be bemused - and that’s being polite - at the level of waste and inefficiency we grant this 1.7 million tentacled behemoth.

I am perplexed too at those ivory-towered dwelling hospital consultants who in railing against reform speak of the dangers of fragmentation, giving the wholly erroneous perception that the many parts of the NHS sing in perfect harmony. Imagine a public diktat requiring Tesco, admittedly a minnow in comparison, to only sell food it had grown itself. Somehow they manage a huge number of suppliers in a joined-up fashion and in doing so provide a better service to the customer.

It is of course a heresy to compare the NHS to anything; it is unique, real-world comparisons simply don’t apply. Foolish me to suggest that any concerns over cherry-picking by those evil private corporations might be allayed with an overly simplistic analogy on 2-for-1 tubs of ice-cream; “when the offer stops we shop elsewhere” I suggested. “But you can’t” she replied, “You can’t compare the NHS to ice-cream”.

Burn ‘em, Burnham

To get his Bill thru, PM repeatedly told Commons #NHS waiting times were falling. We now know those claims were false. Cameron = NHS Conman.
-- 19-Apr-2012

This is, I presume, what passes for insightful political comment from the Shadow Health Secretary; or what we in the wider world recognise as frontier gibberish. I’m only commenting because 50+ unthinking sheep (and counting) have already re-tweeted this pearl. The trouble is:

1. I don’t remember waiting times being a key subject of the debate, the implication they were instrumental in getting the bill ‘thru’ is too silly; and this is because ...
2. If waiting times had been a key subject of the debate, you’d hardly claim they were falling and then use this as an argument for change. Conversely, if waiting times are in fact rising....

It’s almost as if Andy Burnham MP hasn’t thought it through.

49%

toothpastefordinner.com

So much misinformation, so let’s look at just one piece of nonsense; the hysteria raised at the news NHS hospitals will be allowed to generate up to 49% of their income from private patients. This has been presented as anything from “handing over 49% of the NHS to the private sector” to the only slightly less-nonsensical “49% of NHS resources being used for the private sector”. Such statements fail to note the private sector will have to pay. Also we can be confident in the assertion (since otherwise there would be nothing in it for the hospital) that any provision of services to the private sector would be at a charge greater than their cost - in other words, a profit - an important detail given that simple logic shows this will enable the treatment of more (not less) NHS patients.

In this illustration, whilst accepting that not all operations cost the same and therefore some beds cost more than others, we will for the sake of simplicity use a hospital bed as the financial unit of measurement. And since we accept there must be profit, in this example we will say it is in the order of “1 bed” profit for every “100 beds” of service to the private sector. This allows us to make the following three statements:

1. An NHS hospital funded by the tax-payer to the equivalent of “510 beds”, and with no income from private patients, has a capacity of 510 beds for use by NHS patients.
2. An NHS hospital providing “486 beds” to the private sector will make (rounding down) “4 beds” profit for NHS patients.
3. An NHS hospital funded by the tax-payer to the equivalent of “510 beds”, and with a private income of “490 beds” of which “4 beds” is profit, has a capacity of 514 beds for use by NHS patients.

Of course the service provided by a hospital is more than the number of beds, and in the example above we arbitrarily choose the level of profit, but what we can also see is that the 49% limit is entirely artificial and no doubt politically motivated. The fact remains that an NHS hospital having any level of profit generating private income will, for the same level of tax-payer funding as a hospital funded by the tax-payer alone, be able to provide more services to NHS patients. Indeed this statement is so patently obvious, I wonder at all the fuss.

Dispelling not-for-profit

I can understand arguments that proposed NHS changes may make the service less efficient. I can understand suggestions they won’t, as claimed, put the patient - or his/her GP - in the ‘driving seat’. I disagree, but I can understand, and in truth can imagine failure. I am less impressed with warnings of impending privatisation; what arrant nonsense. Nor do I care for the consternation apparent at the notion of a private company making a profit. That so many decry the idea of an NHS-run hospital closing - as a result of being open to competition and unable to compete - suggests either wilful obfuscation or an inability to understand the basics.

When the running of the national lottery was open for bids, Richard Branson made much of his group’s tender being not-for-profit; however, the relevant detail is revenue generated. Branson was courting public opinion, that he felt able to throw in this red herring is indicative of how easily confused we are. For example, should we accept a bid that will generate £800 million for the country and £100 million profit for the organisers, or should we accept a not-for-profit bid generating £750 million?

Understanding ‘commission versus provision’ is equally simple. When the NHS spends money on our behalf, would we for instance rather spend £3000 on an ‘in-house’ operation, or out-source to a private hospital charging £2800 for the same service, of which £300 might be profit? Of course these numbers are made up, I use them merely to illustrate that profit should have no bearing on the decision made. Accusations of cherry-picking by private consortia should, if we procure sensibly and ensure multiple providers, also prove irrelevant. An informed choice, one that allows for profit, will result in an NHS that costs less and/or one that can do more.

What is the NHS?

Close to where I live sits a cottage hospital. I have no idea what services it provides, how many people use it or how much it costs. Nor I suspect does anyone else. Regardless, I am quite sure that were an attempt made to close it the whole community would be ‘up in arms’, and before asking any of these questions. Similarly, it reminds me of a discussion I had many years ago with a friend who opined that nurses deserved ‘far more’ than they were getting paid, without even knowing how much they were getting paid. I didn’t either, but you’d have thought one statement would be predicated by the other.

That’s the thing about the National Health Service, it seems to exist in a logic-free vacuum; our relation to the institution is entirely emotional and our love measured in how many hospitals we build to house the 1.7 million people in its service. As the NHS website tells us:

Only the Chinese People’s Liberation Army, the Wal-Mart supermarket chain and the Indian Railways directly employ more people.

They’re so proud of this it’s stated before the rather more relevant figure of how many patients they treat. It does at least explain the reaction of various Guardianistas to GP commissioning, where one concern would seem to be that GPs may on occasion choose private service providers because they’re… er… cheaper. This is apparently a bad thing; why, the next thing you know they’ll be closing state-funded hospitals in favour of privately run alternatives, and then how will we show our love?

I’m not for one instant suggesting the NHS should morph into a commission only service, we need an element of state provision to keep the private sector honest, but regardless of the provider, to the patient the service remains free - albeit paid for through tax. What kind of hospital he or she ends up in is irrelevant, all we should really care about is the cost. The cheaper it is, the more we can treat; now remind me, just who is the NHS for?

The National Health Service’s new clothes

I’ve been rather irritated by the current disinformation campaign of the Republican Party in response to Barack Obama’s health plans. As far as I’m aware there are no plans to create a National Health Service, so holding up the UK as an example of what can go wrong is highly suspect.

I’m equally bemused by the response of most politicians in the UK who’ve rushed to the defence of the NHS; fighting to proclaim their love is true, that their love will last. Love is blind. It won’t be long before one, probably over-compensating Conservative, starts singing to the tune of all nurses are angels and all doctors are God. Absolute drivel – though I’ll admit to having met a few doctors who acted as if they were God. I'm presuming those wearing the rose-tinted spectacles have never had to wait a year (sometimes more) for treatment, or been misdiagnosed with Parkinson's disease and only after TEN years had the treatment corrected; this happened to my mother. Nor have they been victims of the 'postcode lottery' of NHS treatment after moving 20 miles, and in the process happening to move from one health trust that would fund treatment to one health trust that wouldn't; this happened to my wife.

The NHS is a glorious principle in which I whole-heartedly believe, but those holding it up as a paragon of virtue are about as useful as 'death panel' comments from Sarah Palin, or the idiot Conservative MEP Daniel Hannan describing the NHS as a 'sixty year mistake'. Slightly sinister, though hardly unexpected, is the response of Health Secretary Andy Burnham who described Mr Hannan's comments as unpatriotic. Do my comments make me unpatriotic too?