Thursday, January 06, 2011
Alternative plan for NHS reform
This below is a response to Lansley's plans for dismantling the NHS. It was drawn up by Dr Tim bland, and has developed supporters through email lists. Tim is trying to get it into the letters columns of papers, without success so far. I believe this is because it is information-dense, and the media cannot cope with information. They deal with impressions.
Alternative Agenda for Healthcare Reform
4.1.2011
Letter for publication in The Guardian
Sir, Following Polly Toynbee’s comment article on the NHS published on page 29 on 4.1.2011 we are a doctors’campaign group who would like to keep the pressure up on the Government with an alternative agenda for NHS Reform. Healthcare does need reforming, but not in the destructive way the Government is signalling; so what should the government do? Unfortunately Labour is not offering a constructive alternative at the present time.
1 Put the White paper on hold and have a time of national consultation with all stakeholders. The new Secretary of State is moving “too far, too fast” with a level of reform that carries a huge risk of major failure. We need a national rethink on the way forward for the next 50 years, not the next five.
2 The coalition government needs to realise that this White Paper risks bringing about the end of the NHS as we know it by causing complete chaos followed by fragmentation and piecemeal privatisation. We should not put responsibility for running the whole NHS onto GPs, as is proposed by Mr Lansley.
3 We believe that the Government does want to retain our state-run healthcare system i.e. NHS, but that it is missing a golden opportunity to introduce changes that place more onus on individual responsibility for health and associated costs. The only way to save the NHS is to reform it. However, Mr Lansley is increasing patient expectation when he should be increasing patient responsibility.
4 A new contract would need to be established between the State and the Population for the continuation of a universally applicable, state-run, healthcare system. This would involve the Population accepting a reduced scope of NHS services, the State committing itself to long-term healthcare provision and all parties recognising that the NHS’s performance is crucial to the success of the greater project for national debt reduction.
5 Be true to the sensible, Conservative manifesto commitment to have no more major, reorganisational change in the NHS. Keep most existing structures in place and bring about rational, consensus-based, incremental change. This will be far less expensive and leave doctors free to focus on efficiency savings instead of being diverted to major reorganisational change.
6 Have a full, informed debate on the expensive, 20 year, experiment of the purchaser/ provider split, which began in 1990 with Kenneth Clarke and Margaret Thatcher. A decision needs to be made now on whether to keep it or get rid of it.
7 Abandon blind faith in the ideology that the free market will be an effective agent for “saving” the healthcare system. This blind faith is a pre-2008 idea, utterly discredited since the Banking Crisis broke upon us. This supreme faith in the free market needs to be downgraded onto a par with the many other healthcare ideologies in the intellectual market.
8 Focus on doing something urgently about the state of our hospital sector. Consultants should be given back power from managers and also the accountability that always used to go with the crucial link between each patient and their named consultant. Restore the traditional “firm system” of consultant-led teams; this could only be done by finding some way of reducing the drastic effect that the EWTD is having on our healthcare system; this would enable restoration of continuity of care in hospitals and proper training for the next generation of doctors, especially future surgeons. Do something about the national scandal of PFI costs that are bleeding the NHS dry. Get rid of the plethora of centrally driven targets.
9 Don’t force any change upon GPs that compromises their vital advocacy role on behalf of their patients or diverts their attention from patient care. Each patient has to know that his GP’s sole consideration is the patient’s best interest.
10 Make sure that the U.K retains its high level of medical training, medical research and public health, which are some of its greatest strengths.
We believe these ideas could be developed into a pragmatic, centrist philosophy for sustainable state-run healthcare that could command widespread support for many years to come. We want to bring this alternative agenda for NHS Reform to a wider, national and parliamentary audience
The NHS Twenty Ten Group of U.K. Doctors
Dr Tim Bland, GP, Chairman
Mr Wael Ismael, general surgeon
Dr Raj Patel, haematologist
Dr John O’Moore, GP
Dr Raj de Silva, neurologist
Dr Mohsen Khorshid, dermatologist
Mr Bhik Kotecha, ENT surgeon
Mr A Sivaraman, spinal surgeon
Dr Pushpa Chopra, GP
Mr Jag Chawla, ophthalmologist
Dr Ashok Kumar, GP locum
Dr Chaman Sajjanhar, GP retired
Mr Bhabu Chopra, ENT surgeon
Dr John Lee, GP
Dr Abdul Jabbar, GP
Dr S Subramaniam, GP
Mr Chitta Chowdhury, ENT surgeon
Dr Mani Subramanian, GP
Dr Badi Beheshti, GP
Mr Krishna Vemulapalli, orthopaedic surgeon
Dr Sridevi Vemulapalli, GP locum
Dr Maryline Punungwe, GP locum
Dr Pamela Punungwe, GP registrar
Dr Richard Lawson, GP locum
Dr T. C. Bland
NHS GP
Chairman of The NHS Twenty Ten Group of U.K. Doctors
Alternative Agenda for Healthcare Reform
4.1.2011
Letter for publication in The Guardian
Sir, Following Polly Toynbee’s comment article on the NHS published on page 29 on 4.1.2011 we are a doctors’campaign group who would like to keep the pressure up on the Government with an alternative agenda for NHS Reform. Healthcare does need reforming, but not in the destructive way the Government is signalling; so what should the government do? Unfortunately Labour is not offering a constructive alternative at the present time.
1 Put the White paper on hold and have a time of national consultation with all stakeholders. The new Secretary of State is moving “too far, too fast” with a level of reform that carries a huge risk of major failure. We need a national rethink on the way forward for the next 50 years, not the next five.
2 The coalition government needs to realise that this White Paper risks bringing about the end of the NHS as we know it by causing complete chaos followed by fragmentation and piecemeal privatisation. We should not put responsibility for running the whole NHS onto GPs, as is proposed by Mr Lansley.
3 We believe that the Government does want to retain our state-run healthcare system i.e. NHS, but that it is missing a golden opportunity to introduce changes that place more onus on individual responsibility for health and associated costs. The only way to save the NHS is to reform it. However, Mr Lansley is increasing patient expectation when he should be increasing patient responsibility.
4 A new contract would need to be established between the State and the Population for the continuation of a universally applicable, state-run, healthcare system. This would involve the Population accepting a reduced scope of NHS services, the State committing itself to long-term healthcare provision and all parties recognising that the NHS’s performance is crucial to the success of the greater project for national debt reduction.
5 Be true to the sensible, Conservative manifesto commitment to have no more major, reorganisational change in the NHS. Keep most existing structures in place and bring about rational, consensus-based, incremental change. This will be far less expensive and leave doctors free to focus on efficiency savings instead of being diverted to major reorganisational change.
6 Have a full, informed debate on the expensive, 20 year, experiment of the purchaser/ provider split, which began in 1990 with Kenneth Clarke and Margaret Thatcher. A decision needs to be made now on whether to keep it or get rid of it.
7 Abandon blind faith in the ideology that the free market will be an effective agent for “saving” the healthcare system. This blind faith is a pre-2008 idea, utterly discredited since the Banking Crisis broke upon us. This supreme faith in the free market needs to be downgraded onto a par with the many other healthcare ideologies in the intellectual market.
8 Focus on doing something urgently about the state of our hospital sector. Consultants should be given back power from managers and also the accountability that always used to go with the crucial link between each patient and their named consultant. Restore the traditional “firm system” of consultant-led teams; this could only be done by finding some way of reducing the drastic effect that the EWTD is having on our healthcare system; this would enable restoration of continuity of care in hospitals and proper training for the next generation of doctors, especially future surgeons. Do something about the national scandal of PFI costs that are bleeding the NHS dry. Get rid of the plethora of centrally driven targets.
9 Don’t force any change upon GPs that compromises their vital advocacy role on behalf of their patients or diverts their attention from patient care. Each patient has to know that his GP’s sole consideration is the patient’s best interest.
10 Make sure that the U.K retains its high level of medical training, medical research and public health, which are some of its greatest strengths.
We believe these ideas could be developed into a pragmatic, centrist philosophy for sustainable state-run healthcare that could command widespread support for many years to come. We want to bring this alternative agenda for NHS Reform to a wider, national and parliamentary audience
The NHS Twenty Ten Group of U.K. Doctors
Dr Tim Bland, GP, Chairman
Mr Wael Ismael, general surgeon
Dr Raj Patel, haematologist
Dr John O’Moore, GP
Dr Raj de Silva, neurologist
Dr Mohsen Khorshid, dermatologist
Mr Bhik Kotecha, ENT surgeon
Mr A Sivaraman, spinal surgeon
Dr Pushpa Chopra, GP
Mr Jag Chawla, ophthalmologist
Dr Ashok Kumar, GP locum
Dr Chaman Sajjanhar, GP retired
Mr Bhabu Chopra, ENT surgeon
Dr John Lee, GP
Dr Abdul Jabbar, GP
Dr S Subramaniam, GP
Mr Chitta Chowdhury, ENT surgeon
Dr Mani Subramanian, GP
Dr Badi Beheshti, GP
Mr Krishna Vemulapalli, orthopaedic surgeon
Dr Sridevi Vemulapalli, GP locum
Dr Maryline Punungwe, GP locum
Dr Pamela Punungwe, GP registrar
Dr Richard Lawson, GP locum
Dr T. C. Bland
NHS GP
Chairman of The NHS Twenty Ten Group of U.K. Doctors
Tuesday, January 04, 2011
Debt - should we be bothered?
I tweeted l link to this piece on the UK debt set in context.
Matthew Jeffries (@Berrieds) tweets back "Borrowing will not get us out of recession, will only weaken the private sector. A historical perspective" and links to this blog post on Thinking With a Hammer (TWAH).
TWAH says economic laws are not different between a nation and the individual.
RL: Well, they are different, so. Nation states command all the diverse resources, both human and natural, in their territory. Nation states have the ability to create money.
Yes there are similarities. Both nation states and individuals are compelled to satisfy their needs for water, food, warmth, shelter, and hygienic waste disposal. But the pure individual (think Robinson Crusoe) has no need to trade with himself, nor to administer his affairs, nor to have money.
So the premise is wrong.
TWAH says public expenditure does not create wealth. RL: Not true. If, say, the Government invested (either by borrowing, or better, by creating the money) in a Green New Deal, a massive project in energy conservation and renewable energy production) it would create wealth both in the short and long term. It would enable money otherwise spent on fossil fuels to be diverted elsewhere, and will cushion the impact of Peak Oil. It would also give our descendants plentiful cheap energy, and also help save them from the worse effects of global warming.
TWAH then gives a useful historical review of the UK's borrowing record since the war.
He argues that Keynesian policies only work when unemployment is high, and that they must be financed out of borrowing, not taxation. But borrowing burdens future generations: the det of WW2 was only paid off in 2006.
The UK National Debt now stands at somewhere between £2.2 and £3.8 trillion, depending how you count it.
Wilson, says TWAH, increased the debt 1964-70, leading to a devaluation. [This is barely visible as a lump on the falling graph], which led to higher costs for imported raw materials, which combined with higher OPEC oil prices, led to inflation. Heath's attempts to control inflation with wage restraint led to the miners' strike and a Labour Government, which ended in Healey needing a £3.9 bn loan from the IMF, with £2.5bn cuts in public spending.
Under Thatcher average wealth went up, but people hated her so much we got Labour, who inherited a public sector debt of 32% in 1997, and bequeathed one of 50%.
TWAH is big enough to recognise that some of this 50% figure is due to the banks, but puts the blame for that on Labour's slack regulation regime. [Like the Tories would have been tougher on the banks].
He ends with a general discussion, key to which is that it is a bad idea for an economy to be over dependent on the banks. See Ireland, Greece, [Iceland] - and the UK.
Overall, TWAH does a little historic review reiterating the notion that Tories cut and Labour spends. It is the old struggle between two dinosaurs, one wanting a bigger state and one a smaller state. The dinosaurs have no concept of true wealth, won from natural resources by human skill and intelligence, nor of the necessity to transform to a green economy, in harmony with the laws of nature, as far as possible cyclical in its use of materials instead of linear, an economy in which everyone feels motivated to play a part.
Debt is not good. It is indeed a burden on succeeding generations. Most of our national debt is dumped on us by our own forebears. However, the financial burden of debt that so concerns Osborne and his dupes is just the tip of an iceberg of ecological debt that we will be passing on. I'm talking about resource depletion, biodiversity loss, and change in global heat transfers . There is a bigger, unseen debt, the one we owe to our children. This we can address by the Green New Deal, greening the economy through a Green Wage Subsidy, and by measures such as reforestation of the whole planet. If there is a a financial cost to this, and if it is paid for by borrowing, it will benefit the generations who are required to pay for it.
This kind of consideration shows that it is time we move beyond the old, irrelevant tory/labour ding-dong, and begin to look at the economy in its correct ecological setting.
Matthew Jeffries (@Berrieds) tweets back "Borrowing will not get us out of recession, will only weaken the private sector. A historical perspective" and links to this blog post on Thinking With a Hammer (TWAH).
TWAH says economic laws are not different between a nation and the individual.
RL: Well, they are different, so. Nation states command all the diverse resources, both human and natural, in their territory. Nation states have the ability to create money.
Yes there are similarities. Both nation states and individuals are compelled to satisfy their needs for water, food, warmth, shelter, and hygienic waste disposal. But the pure individual (think Robinson Crusoe) has no need to trade with himself, nor to administer his affairs, nor to have money.
So the premise is wrong.
TWAH says public expenditure does not create wealth. RL: Not true. If, say, the Government invested (either by borrowing, or better, by creating the money) in a Green New Deal, a massive project in energy conservation and renewable energy production) it would create wealth both in the short and long term. It would enable money otherwise spent on fossil fuels to be diverted elsewhere, and will cushion the impact of Peak Oil. It would also give our descendants plentiful cheap energy, and also help save them from the worse effects of global warming.
TWAH then gives a useful historical review of the UK's borrowing record since the war.
He argues that Keynesian policies only work when unemployment is high, and that they must be financed out of borrowing, not taxation. But borrowing burdens future generations: the det of WW2 was only paid off in 2006.
The UK National Debt now stands at somewhere between £2.2 and £3.8 trillion, depending how you count it.
Wilson, says TWAH, increased the debt 1964-70, leading to a devaluation. [This is barely visible as a lump on the falling graph], which led to higher costs for imported raw materials, which combined with higher OPEC oil prices, led to inflation. Heath's attempts to control inflation with wage restraint led to the miners' strike and a Labour Government, which ended in Healey needing a £3.9 bn loan from the IMF, with £2.5bn cuts in public spending.
Under Thatcher average wealth went up, but people hated her so much we got Labour, who inherited a public sector debt of 32% in 1997, and bequeathed one of 50%.
TWAH is big enough to recognise that some of this 50% figure is due to the banks, but puts the blame for that on Labour's slack regulation regime. [Like the Tories would have been tougher on the banks].
He ends with a general discussion, key to which is that it is a bad idea for an economy to be over dependent on the banks. See Ireland, Greece, [Iceland] - and the UK.
Overall, TWAH does a little historic review reiterating the notion that Tories cut and Labour spends. It is the old struggle between two dinosaurs, one wanting a bigger state and one a smaller state. The dinosaurs have no concept of true wealth, won from natural resources by human skill and intelligence, nor of the necessity to transform to a green economy, in harmony with the laws of nature, as far as possible cyclical in its use of materials instead of linear, an economy in which everyone feels motivated to play a part.
Debt is not good. It is indeed a burden on succeeding generations. Most of our national debt is dumped on us by our own forebears. However, the financial burden of debt that so concerns Osborne and his dupes is just the tip of an iceberg of ecological debt that we will be passing on. I'm talking about resource depletion, biodiversity loss, and change in global heat transfers . There is a bigger, unseen debt, the one we owe to our children. This we can address by the Green New Deal, greening the economy through a Green Wage Subsidy, and by measures such as reforestation of the whole planet. If there is a a financial cost to this, and if it is paid for by borrowing, it will benefit the generations who are required to pay for it.
This kind of consideration shows that it is time we move beyond the old, irrelevant tory/labour ding-dong, and begin to look at the economy in its correct ecological setting.
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