I expect to be consulted.
ed: Consult me
ed 4.50am CAMERON
I expect to be consulted.
ed: Consult me
ed 4.50am CAMERON
NWO is like, what you make it.
Isn’t that how it werks?
Let’s make the World and society that we want
Let’s make a world where we progress
Let’s stop hurting people
Let’s change that ridiculous nonsense narrative
Can we please have a real challenge to that nonsense narrative <QUESTION MARK>
The New World Order.
It is for all to participate.
Let’s save the World
that is appreciated that totally different
New World Order
is of course
so easily possibe.
Because … of course
any New World Order
is for us to decide
We decide how it is to be
It is about controlling people by making them afraid.
Why not say it like it is?
Rich bastards are in charge.
The Occupy protestors were exactly right.
It’s the 1%.
Its clear that the 1% are so ridiculously rich and in charge.
Basically the richest 1% own everything and are in charge and are tax evasers. That’s it. The 1% are so rich that they are in charge. That’s how it works.
Even my pussy cat wants to fight.
This is it. Tory twats have been educated to believe that they are so superior to the extent that
they can shit on you
Bullingdon Club. Fuck you rich shits. I shit on you
They recognised the 1%
that rule the World
the 1% who control
with your fantstic and fantastical bullshit.
I am fighting you
I am Deep
Do we have to do anything?
Let’s have fun?
ed: I’ll have fun
I originally intended to concentrate on UK wealth distribution and tax evasion. That works well since UK wealth distribution and tax avoidance are inextricably (cannot be detangled) linked. We are (I am?) concerned with reality here and the reality that is becoming increasing clear is that UK wealth distribution is about wealth inequality, tax avoidance but also the austerity agenda.
As a prelude or preamble, a vid by 38degrees about TTIP (the Transatlantic Trade and Investment Partnership). I would urge people to be active in the democratic process because democracy needs active participation. You can join political campaigns like 38degrees or change.org, start a political blog like my own or even be a shouty man or woman ;)
1.50am ed: Apologies, I forgot again. I wonder if there’s a sadistic element to it. The bedroom tax and the withdrawal of tax credits for the most vulnerable is so nasty – is it not also sadistic? Forcing people to leave their homes of many decades and forcing people into more extreme poverty are the issues here.
The short NHS in crisis series of the past week or so went fairly well. We’ve learned
There are plenty of resources for further research e.g. there’s plenty on what junior doctors are and do at youtube.
I’ll be watching and reporting NHS news. Current NHS news is that the BMA have cancelled an intended 48 hour strike by junior doctors next Tuesday. I’m sure that everyone welcomes that news. Kent CCG (Clinical Commissioning Group) has also signed a deal with a hospital in Calais to treat NHS patients. Far from ideal? barking?
Let’s have a Socialist UK. It’s been denied to us for so long.
Let’s have a Socialist UK then.
The essential ed:thing about nuclear weapons is that they kill millions of innocent people.
C’mon let’s get rid of them and employ all these people in developing renewable energy, promoting insulation, etc.
ed: You have children? Even if you don’t have children, do you really want to kill everything? Do you really want to kill the Earth?
Come to think of it children are not really important – they’ll just burn like the rest of us. But at least you’ll have jobs, eh?
Is it about time for a Socialist revolution?
They leave a signiature…
In UK, it was reported as the Batalan theatre. Wasn’t it the Batalan Cafe with a band member known as the Devil while they were playing “Kiss the Devil”?
Various odds and ends today including Russel Brand and a shouty man in a car.
ed: Apologies, forgot the shouty man in a car
Clare Gerada on the strike by junior doctors.
Being a doctor – or any public sector worker – shouldn’t be such a battle. That’s why we must support junior doctors in their planned strikes.
For the last 9 years I have been the medical director of an NHS service providing confidential help to doctors and dentists with mental health problems, seeing a rising number of doctors week on week.
But our patients have changed.
In our early days the ‘typical’ patient was an older male (GP or psychiatrist) with alcohol problems.
Now nearly half of all new patients are under 30 years old. They come to us with depression, anxiety and symptoms akin to posttraumatic stress disorder. Many have worked in the NHS only a few years. They started out bushy tailed and bright eyed, but end up ‘burnt-out’ (a polite euphemism for depression) after only a few years working. Our youngest patients are only a few months qualified and many are in their Foundation years.
Patient after patient talks of feeling betrayed and bewildered by their loss of enthusiasm about a profession that they had strived to enter (often since their early teens). How their desire to care for patients is sapped by every working day. The language they use to describe their work is that of the battlefield. Being on the ‘front-line’, of ‘surviving’ another shift, being ‘at war’ with management. They talk of feeling abandoned by the NHS. Of working intolerable shifts that appear to have been designed by robots with no concept that humans will need to work them. Of having no sustenance – literally and metaphorically – as they try their best to deliver care to patients.
They talk of working in an unforgiving environment – where every error will lead to punishment and where every move is watched and recorded. They describe the fun having gone out of their profession. They say that they cannot see a future any more in medicine.
Hardly surprising therefore that the numbers progressing through training (from the early Foundation Years to the start of specialty training) is reducing. That now nearly half of doctors are not progressing. And that this is against a background of fewer of our brightest entering medicine in the first place.
Our junior doctors are striking for more than pay and conditions – important though these are. Their planned strike is consciously or unconsciously action to shine a light on what is going on within the NHS – to shine a light on the conflict between idealism and industrialization.
Increasing privatisation has changed the relationship doctors have with their patients. Constant reorganisation has fragmented services, and shattered long-standing teams. At a series of NHS listening events I held in 2014, the overwhelming term used by all NHS staff to describe their working environment was ‘Fear’.
The pay of junior doctors has never been good – not when calculated across the hours worked, the responsibilities they have and when compared to their non-medical peers.
But this was part of the compact we all had – we gave our all for our patients and the organisation we worked in gave their all to us – cared for us, nurtured us, trained us. We also knew that the intolerable hours would end as we climbed the medical career ladder. Now all of this has been fractured.
Instilling ‘fear’ in doctors, teachers, nurses and other public sector workers is deliberate government policy – as explicitly set out by Cameron’s policy guru, Oliver Letwin, in 2011.
The new junior doctor contract will erode not just pay but also the current safety net against exploitative hours of work. Saturdays will be counted the same as week-days (tell their children that when they are off school and wanting to see Mum or Dad). Women and others who take career breaks will be discriminated against. Junior doctors have been forced to look into the abyss and chose between pain today (strike action) or pain tomorrow (agreeing to an unfair and unsafe contract). They are being treated as children rather than the committed adults they are – their please ignored, instead accused by Jeremy Hunt of being ‘extreme’, ‘militants’, and even unpatriotic.
The junior doctors are not alone in their discontent. The nurses who are marching this Saturday, the teachers and social workers, in fact most public sector workers have seen insecurity, exploitation, fear, and subtle discrimination as the backdrop to their working lives.
The junior doctors are fighting for fairness for all of these workers. They are leading the charge for a restoration of the values that should drive our public services. For a change by those who employ them – ultimately our Government – who have a moral duty to protect those who care for some of the most vulnerable in society.
Without this change, goodwill will disappear forever and with it the glue that binds our public services together. The government must now stop their bullying tactics and accept that something is profoundly wrong the NHS today and act before it is too late.
This article is published under a Creative Commons Attribution-NonCommercial 4.0 International licence.
The junior doctor contract governs the pay and conditions of work from doctors’ foundation year to registrar level. All doctors who are not consultants or fully qualified GPs are considered ‘junior’ doctors. This contract was scheduled for renegotiation, but the British Medical Association (BMA) – the largest representative body of doctors – walked away because the offer on the table was not fair to doctors and not safe for patients.
The government’s initial response was brazen, and threatened to impose the new terms without consultation – a position it has had to water down since the BMA decided to ballot its members for strike action. Here’s why the BMA has done so the first time in 40 years:
Britain’s doctors have had enough. In a stretched and underfunded health system which doesn’t train enough doctors and nurses to meet its own needs – or invest in the infrastructure needed for new hospitals and facilities unless aprivate contractor is taking a nice slice of the pie – the solution seems to have been ‘work harder and take up the slack’. According to the Royal College of Physicians, the NHS “remains reliant on doctors working longer than their contracted hours…the amount of ‘goodwill work’ is increasing year-on-year.”
Trusts struggling to pay their tithes to the private owners of NHS hospital buildings have responded by reducing staff salaries, meaning fewer doctors and nurses are covering more patients and expected to do so for free. The situation has reached crisis point and doctors are experiencing enormous burnout, with more doctors applying to live abroad every year. Into this context came the new contract.
The ‘offer’ of the new contract has been condemned first and foremost as fundamentally unsafe. Just as with the recent tube strike, the new contract threatens to force doctors to work longer and later with fewer safeguards.
The BMA approached negotiations acknowledging financial limitations but determined to improve safety: it wanted no doctor to work more than 72 hours in a week; no more than four nights in a week on-call; a rest day either side of nights before starting back on day shifts; and facilities to sleep-in for those who otherwise make a dangerous long drive home.
The government was unwilling to accept these terms, and furthermore wanted to reduce breaks to just one 30 minute break in a ten hour on-call shift. As a recent viral video asked, could you save a life if you’d been up all night?
The new contract would mean a 15-40% pay-cut depending on your specialism, with GPs and emergency care doctors being some of the hardest hit. Let that sink in.
With wages starting beneath the national median anddecreasing yearly like all public sector pay, and out of pocket expenditure for licensing, exams and indemnities, junior doctors earn significantly less than the tabloids would have you believe. Their reports often use a cunning sleight of hand: taking the figures for the pay of those doctors doing the most private work – GPs who run a private practice and some consultants who run private clinics – and presenting the data as proof of ‘greedy’ public sector workers.
There are two ways doctors’ starting wages increase: extra pay for unsociable hours, and pay advancement as you progress through the ranks of seniority and responsibility. Both of these are under threat in the new contract.
The government has suggested that working from 7am until 10pm Monday to Saturday are sociable hours – and therefore should not be paid extra – which is funny considering MPs just reduced their own working hours and increased their own pay. As for pay progression with seniority, no actual offer was made.
The contract changes penalise those who take time out to start a family and those who work part-time –overwhelmingly affecting women in both cases. Additionally there are concerns that changes to breaks will make work more dangerous for pregnant women. As noted above GPs will be amongst those taking the largest wage cut, one of the few specialisms with more women than men.
More than 200k people signed the petition to debate a vote of no confidence in Jeremy Hunt. He wrongly and infamously implied that doctors don’t work at night or weekends. After blaming the A&E crisis last winter on people attending inappropriately (rather than, say, the reduction of roughly 13k hospital beds over the last five years), Mr Hunt felt it was appropriate to take his own children to A&E rather than wait for an appointment like, you know, the rest of us commoners.
But most of all:
Hunt and the government have shown a complete disdain for even the barest semblance of actual negotiation. When the BMA walked away from negotiations a year ago, it wasn’t as a strategy to get better terms, it was because the negotiations were a farce. It has taken the threat of industrial action for a pathetic attempt at reconciliation to come from the Department of Health, full of vague, unconvincing rhetoric. It is too little, too late. No fruitful discussions can continue with Hunt as health secretary. We have no reason to believe in his word or his competence.
We deserve more. Doctors do not take strike action lightly. Whilst we will always maintain emergency and essential services, the BMA will be balloting its members to strike against the contract in the next month. We hope to see you on the picket lines.
England’s Junior doctors held a 24-hour strike from 8am yesterday. It was the first of a planned series of strikes. Jeremy Corbyn’s Labour Party and the Green Party should be commended for their support of the strike. (The strike only applies to England).
[15/1/16 11.10am The Labour Party’s position on the strike is complex, ” … Labour’s health spokeswoman Heidi Alexander had explained to them that the party would stand by its policy of not supporting industrial action.” John McDonnell joined junior doctors despite Labour agreement to not endorse strike]
While it’s very tempting to address the strike, today’s featured article instead addresses a fundamental problem with the NHS which is largely ignored by corporate media – that of the huge bureaucratic overhead of imposing a fake, imaginary ‘market’ so that the private sector can extort it’s ‘tax’. The conclusions to be drawn from this article should be clear.
As calls mount for the NHS cash crisis to be ‘solved’ by charging patients, there is one pot of money that sits glistening and untouched…
But there is one pot of money that sits curiously unexamined, glistening and untouched.
It’s the cost of the NHS ‘market’ itself. Administering the hugely expensive artificial ‘marketplace’ created by successive governments to allow both NHS and private ‘providers’ to compete with each other to offer services to NHS and other ‘purchasers’.
No-one knows the exact cost of this bureaucratic ‘marketplace’. A recent estimate by rebel Lib Dems put the figure as high as £30billion a year. Dr Jacky Davis and other doctors and campaigners including the National Health Action Party have put it at £10billion a year. The Centre of Health & the Public Interest put it at a ‘conservative’ £4.5billion a year.
Even the most conservative of these estimates is a yearly amount which would, if re-directed away from useless market activities, fund both the £2billion annual NHS shortfall and free critical social care to everyone, which the Kings Fund’s Barker Commission recently said would cost ‘substantially less’ than £3billion a year.
Despite fierce urging from expert MPs to look at what the ‘market’ costs the NHS more closely, the government, mainstream media, think tanks and policy makers have dismissed, ignored and even suppressed this information, with unevidenced assertions that ‘modern healthcare systems’ need vastly expensive bureaucracy, market or no market.
Successive governments wedded to ‘market reform’ have refused to produce useful figures that would definitively establish the cost of the NHS market. It has been left to academics, MPs and activists to try and fill the void, through historical and international comparisons, as well as tentative attempts to cost different activities that are forced on the NHS by the ‘market’.
Hiding the figures
In 2010 the Health Select Committee found that running the NHS as a ‘market’ cost the NHS 14% of it’s budget a year.
The Select Committee noted that the NHS would have some administration expenses even if it didn’t run itself as a ‘market’. But they noted evidence from the NHS Chief Historian, Professor Charles Webster that in the pre-market late-80s, the NHS spent only 5% of its budget on administration.
The difference in administration costs pre- and post-market – 9% of the NHS budget – is over £10billion a year of the current £120bn budget. That’s more than the entire cost of every GP in the land.
The government tried to suppress the 14% figure, which was in a York University report it commissioned then refused to publish for 5 years. The York study found that ‘market’ mechanisms like “the purchaser-provider split, private finance, national tariffs…mean…transactions costs of providing care have increased, and may continue to increase.”
The Select Committee report suggested that “the purchaser / provider split may need to be abolished”. They added that they were “appalled” that the Department of Health “was unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing.”
MPs concluded “the suspicion must remain that the Department of Health does not want the full story to be revealed.”
£10billion a year may be a conservative estimate
In fact the increase in administration costs due to the ‘market’ is likely to be even higher than £10bn.
Professor Colin Leys, author of ‘The Plot Against the NHS’, told OurNHS that these figures relate to 2003, before the second big wave of market ‘reforms’ including “the Independent Sector Treatment programme, the huge expansion of the Commercial Directorate of the Department of Health, the marketing division set up to help trusts learn to advertise and sell their services, the Competition and Cooperation panel, Monitor’s vast expansion…”
The key driver of high NHS inflation is rising drug and medical device costs, new, expensive clinical possibilities, and rising demand as the population ages, runs the accepted wisdom. So why have administration costs kept pace with – or even outstripped – these unavoidable inflationary drivers? Shouldn’t we expect to see administration costs forming a falling proportion of NHS costs?
Professor Webster told OurNHS that instead, “serial reorganisations and escalating marketisation are imposing enormous cost and waste on the NHS, with administrative costs spiralling out of control since 1980.”
Professor Leys adds, “It of course depends on how much you think admin costs would have risen anyway to deal with more complex interactions of modern health care, but to my mind attributing 20% of all NHS costs to admin costs [ie about £25billion], and half of that to the costs of operating as a market, is very reasonable.”
Professor Paton takes a more conservative view, halving the £10billion figure to conclude that “the recurrent annual costs of the market can be estimated (conservatively) at £4.5 billion”.
He concludes in his report earlier this year that the NHS market itself is “an unaffordable ideological luxury”, with few if any discernible benefits.
The market and ‘transaction costs’
Away from the academic estimates, though, a quick glimpse at the empty hospital carpark after the managers and admin staff have left for the day, brings home the reality of how much must be being spent on paperwork and IT white elephants to administer the market.
The market introduces ‘transaction costs’ – advertising, negotiating, contracting, invoicing, billing, auditing, monitoring contracts, collecting information, resolving disputes both in courts and out, all employing and training a ballooning bureaucracy – even leaving aside any profits extracted by the private sector.
At the grassroots, Hackney GP Jonathan Tomlinson told OurNHS that applying the ‘market’ adds huge costs at every stage, “because they diffuse through every interaction, from a decision to prescribe or perform a scan, make a referral, set up a service or close a hospital.”
Then there’s what Paton calls the “circular re-organisation”, with endless “re-invention of expensive agencies under different names supposedly abolished, alongside the costly complexity of the new, often overlapping, agencies …”
How many managers does it take to change a health system?
Each competing NHS ‘provider’ Hospital and Ambulance Trust has executive officers on 6 figure sums, with their Chief Executives often earning more than the Prime Minister. Most spend millions on hiring even higher-paid management consultants in year after year, too – though these figures aren’t centrally collected anywhere.
Then there’s the 211 Clinical commissioning Groups, advised by soon-to-be privatised Commissioning Support Units and NHS England (the biggest quango in history). All of them shove a lot of cash at the management consultants, too (under central quango instructions).
Then there’s the ballooning bureaucracy created to regulate and further marketise this decentralised jumble – the NHS Trust Development Authority, Monitor, the Care Quality Commission, NHS Professionals, NHS Property Services, Healthcare UK… Some of these bodies are soon to be privatised themselves – but, just like the rest of the ‘shadow state’ of management consultants and thinktanks, they’ll still be receiving huge chunks of public money.
Just one of those organisations – West and South Yorkshire and Bassetlaw Commissioning Support Unit – employed 36 public relations workers at a cost of more than £1.4million a year.
Of course the NHS needs managers – but this many? Duplicated across so many fragmented, competing, deficit-ridden organisations?
There have been recent tentative attempts to cost some of the individual elements of the market. Just the legal fees to comply with one Clause of the Health & Social Care Act cost local Clinical Commissioning Groups £77million a year, Labour uncovered earlier this year.
However the Opposition’s critique focuses mainly on the £1.5-£3billion cost of the latest re-organisation – allowing the government to claim that these are one-off costs they’ll recoup in the long run.
Not one-off costs
The ongoing costs of the current system, however, are huge.
It costs the ‘purchasers’ a fortune. The government is now putting the ‘commissioning support’ infrastructure itself out to tender. It is offering to pay private companies another £5bn – not even to provide healthcare, but just to provide yet more advice on how to run the NHS as a market.
And hospital cash is sucked up in fending off the private sector, too. Earlier this year, the competition to run just one hospital – George Eliot – cost at least one and a half million pounds of public money, my Freedom of Information requests revealed. Over half, £771,000, went straight into the pockets of the big 4 management consultancy firms. Such sums are not atypical – nor is the fact this process changed absolutely nothing, in the end.
Another million pounds has just been blown on tendering ‘older people’s services’ in the East of England – again for the private sector to try (and fail) to demonstrate they could do a better job. But the private sector has got deep pockets – and will keep trying.
There are tens of thousands more of these expensive tenders underway or in the pipeline in every part of the NHS. Dr Tomlinson says “we had to cough up £40k to tender for a local practice that we were already successfully running – and at least that to tender for the Out of Hours contract.”
International comparisons are also helpful. A recent Commonwealth Fund reports suggest that the – til recently – less marketised UK system has been the most cost efficient in the developed world. A still more recent report found that Scotland now spends substantially less on hospital administration, than does England’s increasingly marketised system.
The Liberal Democrat conference this week heard a minority report from the NHS working group which suggested that scrapping the NHS market could save as much as 25% of the annual NHS budget. But their proposals to scrap the market were denied a vote by the party leadership.
The report noted that “countries where there is market competition in healthcare spend between 20% and 40% of their healthcare expenditure on administration”. It highlighted evidence from international experts that the increased use of markets in healthcare sharply increased administrative costs in New Zealand. Canada, Australia and Germany – soaring in the latter case by 63.3% between 1992 and 2003 and now standing at 20% of their health systems costs.
In the most marketised system of all, the USA, one healthcare dollar in every three is spent on adminstration of a system that delivers far poorer outcomes than the NHS. The Lib Dem report points out that healthcare billing alone cost up to 13%, noting “billing costs in healthcare providers are ten times the average of all businesses in the US. There is an inherent complexity to the business of delivering healthcare.”
These arguments are frequently dismissed by opponents. Former Editor of NHS managers bible the Health Services Journal, Richard Vize dismissed Labour’s tentative efforts to cost the market as “The old line that culling bureaucrats and lawyers is all that’s needed to fund new services…does not stand up to scrutiny.”
But where is that scrutiny?
The government told the Health Select Committee that the NHS still had “consistently low management and administration costs, ranging from 3-8%.”. But MPs on the Select Committee found “considerable lack of clarity and consistency in … these data.”
Professor Webster (former NHS Chief Historian and Fellow of All Souls) says the “the managerial lobby” have mounted “a clever distraction…a defensive response…artfully disguis(ing) the scale of the increase by accounting procedures, such as concentrating on Managers and Senior Managers, to the exclusion of other relevant staff categories, reducing ‘administrative’ costs back to 5 or even 3 per cent.” But even this, he adds, cannot disguise that “the percentage of admin and clerical staff in the NHS has doubled (from 12%) since 1980”.
The government now boasts of ‘cutting red tape’, saying “There are now over 20,500 fewer managers, senior managers and admin staff, and nearly 14,500 more professionally qualified clinicians than there were in 2010.”
But as Dr Tomlinson says, any reduction in admin staff doesn’t mean a reduction in admin costs,necessarily, as now “medical professionals are doing a lot of the work such as choose and book, coding, and so on, that could be said to be market costs.”
OurNHS asked Kings Fund Chief Economist John Appleby if the recent influential Barker Commission on the future of health and social care funding had looked at the cost of the NHS market.
Appleby replied “no it didn’t. wld need to look at net change..might not be net ‘saving’ as you assume.”
“One problem is no study yet to test cost-effectiveness of market in NHS”, Appleby added.
His own Kings Fund 2011 study on the market ‘reforms’ to date merely said the cost was ‘expensive’ but ‘unknowable’.
Who is served by the lack of intellectual curiosity by these unaccountable ‘think tanks’ to whom the Department of Health has largely outsourced policy-making? Although their accounts are not very helpful, insiders tell me that the Kings Fund make a substantial proportion of their income from advising this sprawling bureaucracy how to deal with the permanent revolution of the marketplace.
Privatisation doesn’t work
If competition and markets improved health, perhaps the extra costs would be worth it.
We’ve had twenty years of being told the NHS should be run like a supermarket, most recently from M&S man Sir Stuart Rose.
And – as an inquiry convened by Debbie Abrahams MP found earlier this year, there’s scant evidence the market improves quality or health equity (and plenty of evidence it worsens both),whilst costing considerably more.
Just about the only academic study that claimed some ‘cost-effective’ benefits for NHS competition has been criticised for its “heroic” assumptions and failing to factor in the “whole system costs” of competition.
But then, we’ve known since the pioneering work of Nobel Laureate Kenneth Arrow in 1963 that markets in health care simply don’t work. Being a ‘customer’ of healthcare is not like being a customer of, say, oranges – it takes expertise that you and I simply don’t have, and the consequences of the wrong ‘choice’, or a provider closing down, are far more serious.
Bevan and Beveridge’s vision was for not for pseudo-‘choice’ but for local, skilled professionals making decisions on the basis of a ‘strong public sector ethos characterised by commitment and altruism’. They recognised only a publicly owned system could avoid ‘opportunistic behaviour by those who would seek to profit from illness’, with incentives to over-treat and over-investigate, stimulate patient demand through advertising.
Few health economists can agree whether NHS ‘productivity’ has improved, declined, or isn’t an appropriate measure. But evidence from the ground shows patient satisfaction and NHS staff morale are now declining rapidly.
For the cost of the market isn’t just financial. Patients are inconvenienced and even endangered as they are shunted between competing hospitals, GPs, community services and ambulances, all trying to dump costs on each other. The Francis report into the failures of care at Mid Staffordshire found that drive to market-friendly ‘Foundation Trust’ status had created a “supposed ethos of competition and commercial negotiation” which promoted secrecy and undermined co-operation between medical professionals.
Hinchingbrooke, the first NHS hospital to be fully handed over to the private sector – is still a financial basket case, despite having cut corners – and staffing – to the extent that everyone from the Royal College of Nursing to the Care Quality Commission are united in their condemnation of poor standards ofcare and demoralised staff.
Imagine what improvements to our healthcare could have been made, had NHS financial and leadership resources not been squandered on creating a market. As Paton comments, the ‘opportunity costs’ are huge.
So how do we rid ourselves of the creaking edifice of the NHS market?
The market system is now so entrenched it has been compared by demoralised staff to Stalinism.
But the Berlin Wall could yet crumble. Professor Allyson Pollock this week launched a ‘Campaign for an NHS Reinstatement Bill’ which provides a legal route map to sweep away most of the trappings of the NHS ‘market’ and restore it as a publicly owned, publicly provided service. They’ve already done it in Scotland, abolishing Trusts and most of the ‘market’ trappings following devolution. And – unlike England – Scottish patients now report rapidly rising satisfaction with their NHS.
The proposed Bill has already attracted support from Lord David Owen, Green MP Caroline Lucas and the Green Party leadership, Labour Parliamentary candidates, the National Health Action Party and the author of the recent minority Lib Dem report on the NHS, Charles West.
Getting rid of the market would be uncomfortable for the cadre of NHS managers, management consultants and think tanks whose main skill is permanent reorganisation. But it wouldn’t happen all at once. They’d have one last big job on their hands before retraining as something more useful to society, leaving a slimmed down management and a beefed up medical workforce to get on with the job of running an NHS in the interests of patients, not profits.
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About the author
Caroline Molloy is Editor of OurNHS and a freelance writer. In 2011/12 she was part of a successful campaign which reversed one of the largest planned NHS privatisations in the country, involving 9 Gloucestershire hospitals. Since then she has been campaigning alongside local and national groups to defend the NHS.
This article is published under a Creative Commons Attribution-NonCommercial 3.0 licence.