I wrote yesterday about the failure of the market in the NHS. Within hours the Guardian had reported:
NHS regulators are to take control of health services in three entire regions of England where hospitals are failing, the Guardian has learned. Essex, North Cumbria and Northern, Eastern and Western Devon are the areas affected by the move.
They explained this, saying:
Essex Hospitals there have been struggling with staff shortages, waiting time failures and financial problems that have damaged patient care.
Key NHS bodies and regulators will impose a newly-devised and euphemistically named “success regime” on the three parts of the country, and push through determined action to ensure hospitals, GP surgeries and other NHS service providers work together much more closely to tackle deep-seated problems which previous initiatives have failed to banish.
The admission is tacit, but is also very clear and is that the policy of making NHS organisations compete with each other, which was the foundation of the 2012 NHS reform forced through by the last government against enormous opposition, has failed. What has, very obviously, been admitted is that supposed competition has not driven up standards but has, instead, created a situation where the supply of integrated health care is impossible. The three Trusts involved will, no doubt, be described as those not embracing the spirit of change, but I do not think that anyone will believe this for a moment. They are simply the most stark indication of a system that is failing in a remarkably short period of time after its introduction, but in precisely the way that many of us predicted.
I hate to suggest another top-down reorganisation of the NHS, and yet it is very obvious that it will be necessary. The creation of a faux market and the breaking up of many of the strategic coordination functions within the NHS (motivated by a belief that such functions would be consistent with monopoly, and so be antithetical to competition policy) must be brought to an end and the supply of coordinated, integrated and consistent NHS services by a range of disciplines working together must instead become the priority not just for reasons of patient care but also to save both frontline and back-office costs, so guaranteeing the future supply of services people in this country require.
Coming so soon after the 2012 reforms such a reorganisation would be disruptive, but there is one redeeming feature. At least those working for the NHS would realise that this reform would be driven solely by a desire to help them deliver exactly the services they wish to supply to the patients in their care with the lowest level of dogmatic and administrative interference that politicians could impose upon them.
Jeremy Hunt has already admitted in the course of imposing these new measures upon whole regions that Andrew Lansley's reforms have failed. Now it is time to sweep them away.
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Within a month of being elected the government have backed down from abolishing the HRA (for now anyway) and have tacitly admitted that their 2012 NHS reforms have failed. we can but hope that their victory was a pyrrhic one and the whole stinking neoliberal edifice will come crumbling down around their ears.
Hi Richard
You sound a bit like the Government. The goal of Government policy is absolutely integration. Smash the NHS up with the Health Act 2012 which emphasises competition then bring it back together again in a way that looks a bit like Devo Manc.
‘Integration’ along the lines of the deeply unpopular US Health Maintenance Organisations is what is scheduled. Except these days they have been renamed ‘Accountable Care Organisations’. They are all the rage in the US as part of the Affordable Care Act, and they are coming over here.
Here’s Jeremy Hunt: https://www.gov.uk/government/speeches/better-care-fund-and-improving-care
Community Services, hospitals and GP surgeries are currently being encouraged to integrate to form multi-disciplinary teams to win contracts from CCGs. CCGs are being groomed into behaving like insurers and are being encouraged to make contracts in which they and the providers they contract with will both be allowed to keep money if they don’t spend it on treating people. It creates the familiar perverse incentives – a potential to make money by denial of care. An emphasis on ‘preventative care’ is a also big feature of HMOs.. focus on the patient looking after themselves and blame them when they don’t. It saves you having to spend money and also an excuse to reduce access to care. Referral to hospital is treated as a faliure of the system -they don’t like to use many, preferring the ‘care in the community’ approach.
It may help explain why we have the ex Vice-President of UnitedHealth, the largest insurer in the US currently in charge of NHS England. At the point he was hired for the NHS in 2013 he was in charge of global expansion of UnitedHealth’s business. They know all about HMOs and like other insurers are making a mint out of the Affordable Care Act.
The UK appears to be covertly copying the most expensively-run health system in the world whilst telling the public that there is no money. Mad times.
http://www.nottinghampost.com/Report-reveals-reasons-collapse-Nottingham-s/story-26636386-detail/story.html
And nobody ever said this would happen:
http://www.theguardian.com/society/2015/jun/06/nhs-data-released-against-patients-wishes?CMP=share_btn_tw
So now I have to go to Cambridge (35 miles) to see a specialist who then refers me to himself @MyTown, who then sends me back to @Him @Cambridge.
MyTown parking = £3.50/Hr (all day £27)
HisTown parking = £4.50/4-hours £13 all-day.
Solution = drive to park-and-ride (free) take bus to hospital (50P)
Oh well. Nobody said life had to be easy. Apparently the mortuary charges if you die…………..
Andrew Lansley’s reforms were only a failure if you think their purpose was to improve the NHS.
If their purpose was to ensure NHS failures, so as to encourage the public to think that a system of privatised health insurance would work better, then they weren’t such a failure were they?
My experience of NHS Doctors has been incredibly positive & I owe the lives of both of my children to them. As for the administration that is going on around them, I sometimes think they are almost as baffled as we, the patients, are!