Health

Have the Public Accounts Committee (PAC) completely missed the point?  They have recently criticised the Dept. of Health’s deal with Dr Foster, who provide the Good Hospital Guide.  They have helpfully (and rightly) pointed out that the contract represents poor value for money due to a less than competitive tendering procedure. 

The implementation of a plan to merge and renew three out of date hospitals into a superhospital in London has been criticised by the Public Accounts Committee. The original plan estmated the total cost to be £300m and the project to be completed by 2006. But my May 2005 costs had risen to £894m and the hospital was expected to be finished only by 2013. The superhospital plans were cancelled in June 2006 after 5 years of struggle to get the project on course.

The Department of Health left the planning and managing of such a huge project to local staff who were not capable of overseeing the work carried out by DH's chosen PFI partners. The department did not set out sound plans from the outset and it was made worse by the fact that the creation of the superhotel was left in the hands of amateur and incompetent civil servants.  

Since the new government contract with GPs, the average pay for GPs is now more than £100,000. The new contract was designed to give general practices additional funds to invest in improving and developing services to patients. But it was not anticipated that GPs would take higher share of income in profits and would not use the money to imrpove the services.

GP earnings have risen 63% in three years but many of them have given up out-of-hours work, home visits, working during the weekends and on average a GP works only 44 hours a week (from the Guardian).

Today's papers are reporting further mismanagement of the NHS. A leaked document has revealed that the government expects a shortage of nurses and GPs in four years but the NHS will have to reduce the number of hospital doctors to save money. Also, many trusts are cancelling and postponing operations and treatments to reduce the deficit for the financial year.

Mark and Lezley Gibson and Marcus Davies were convicted on 15 December of distributing cannabis-laced chocolate bars to multiple sclerosis (MS) sufferers. They await sentencing on 26 January.

Lezley is herself a MS-sufferer, who was told at the age of 21 that she would be incontinent and wheel-chair bound within a few years. Conventional treatment (steroid injections) had such unpleasant side-effects that she could not continue. In her search for alternatives, she came across comments on the benefits of cannabis, which she discovered worked for her. She is now 42 and living a quality of life that the medical profession had considered improbable when she was first diagnosed.

Pregnant Germans are trying to delay the birth of their babies until 1 January, the BBC report, because parents of babies born after that date will receive 25,200 euros (£16,911, $33,300 at current exchange rates) to "ease the financial burden of parenthood".

The handout is part of German plans to increase the national birthrate, which, at 1.37 children per woman, is well below the 2.1 children per woman needed to maintain the population level (assuming that immigration is not an acceptable alternative way to maintain the population level).

The Guardian reports that 13 NHS trusts are "technically bankrupt with no chance of meeting a legal obligation to balance their books." The deficits are mainly caused by a financial regime known as Resource Accounting and Budgeting (RAB). RAB has caused deficits to escalate and for example, Queen Elizabeth Hospital in Woolwich culmulative deficit by end of March is predicted to stand at over £65 million.

The Government is only now promising to look into the problems caused by RAB. It should have been clear from the first few years that the system is not working for trusts and should have changed it then and not now as some of the trusts are in deep deficits.

The PM has defended the NHS reform and is convinced that it will lead to a better patient care. It comes as an IPPR report supports the closure of local A&E departments to be replaced by a network of specialist units. But a vast majority of public and practicioners are not convinced of the changes, which was demonstrated at the last week's rally. And the Guardian reports that ministers have accepted in private that they have failed to sell NHS reform effectively to the public.

The NHS is likely to give dance classes to tackle declining fitness levels and counter a national obesity crisis according to the Independent. Trials have been carried out costing £2.5 million and the DoH said that dance classes have proven to be very successful. It is not clear how the people who can dance on the NHS' cost will be chosen. Can anyone wishing to avoid paying for their dance classes or gym membership sign up? What if some people do not like dancing and will demand their exercise costs to be paid by the NHS?

The Telegraph reports that hopitals are advised not to treat patients "too promptly" as this is costing too much money. The "Choose and Book" system has allowed patients to book early appointments which means that hospitals might lose money by giving appointments to patients that have waited less than 8 weeks. The "Choose and Book" system was created to give patients a wide choice of hospitals and to be treated promptly. But by restiricting available appointments to save money the Labour government contradicts its health policies yet again.

The Guardian writes on its front page on how personal medical records are to be uploaded regardless of patients' wishes to a central national database which can be accessed by a huge number of NHS staff and from where the information can be made available to police and security services There is also a lack of safeguards once a patient's data is saved to the system.

Most examples of picking losers are normally quite subtle. Very often, the offending policy is well-meaning, and the harm unintentional. But the abuse by the Labour Party of their control of the levers of power to steer funding towards Labour constituencies and away from Conservative and LibDem constituencies is blatant, intentional and vicious.

For the past decade, the West has been relatively immune to price-/wage-inflation, despite significant expansions of the money supply and movement of various national balances from credit to debit, thanks to the deflationary effects of competition from emerging nations such as China and India. This has bred a complacent attitude that all it takes to control inflation is interest-rate policy designed to keep a cap on price-increases. The lessons of the twentieth century, which showed clearly that money supply was linked to inflation, that government interventions that caused an imbalance between the natural levels of saving and consumption were connected to the "boom-and-bust" trade cycles and that inflation, once started, could be very hard to stop, have largely been relegated in the concerns of policy-makers. Wage competition from immigrants, price competition from the East, and regular tweaking of inflation indices and interest rates are enough, so the theory goes, to make the old disciplines unnecessary.

It is probably this complacent consensus that explains why there has been so little comment on the inflationary aspects of the current dispute over NHS wages. There has been much sympathetic coverage of the below-inflation wage offer that has been made by the Government to NHS workers. They are deemed to be justified in their complaints, because a below-inflation wage offer is, so the analysis goes, a real-terms cut in wages. Nevermind that NHS wages have gone up, sometimes massively, above inflation in the last few years. And critically, nevermind that the corollary of that argument is that public servants should always receive pay offers that are no less than the current rate of inflation.

If employees feel that a pay offer in line with inflation is no increase at all, and therefore a minimum offer, then what happens as inflation creeps higher, as is happening? Wage offers track or exceed price-increases, which feeds the inflationary spiral. This is exactly back to the territory of the 1970s, and yet no one seems to have noticed.

As reported by the Telegraph, but strangely not available on their website, the charity Inter Care has been forced to shut down its operations by the Environment Agency (EA). Inter Care sends unused drugs from the UK to African hospitals. The EA has ordered them to suspend shipment because they may be breaching European Union regulations on waste disposal. Clinics in Africa are now running short of drugs as a result.

You can pick your enemy in this story. Maybe the fault is the European Union, for legislating in such a way that it would prevent something as beneficial as this. Or maybe it is the fault of the EA for excessive pedantry in the application of regulations. Experience of the EA would strongly suggest the latter, but experience of the EU would suggest the former. Is this the perfect confluence of two of the most sclerotic government bodies in the world? The perfect bureaucratic storm?

Following on from the item on birth centres, we now learn that upto eighty cottage hospitals may be facing cuts. As per birthcare, it's not the cuts themselves that are necessarily the problem, but the fact that this is no economic choice, in the sense of matching demand to supply, but a bureaucratic choice. NHS managers have calculated that these facilities are the ones that will be least missed. How do they know? There is no market in healthcare, so there is no way for people to reveal their preferences.

Someone in Whitehall decided that the most efficient way of dealing with out-of-hours medical enquiries was to have a centralised phone enquiry system (NHS Direct), rather than doctors on call. This would save money and make doctors' working hours more civilised. Unfortunately, remote diagnosis is not easy, or else the doctors on call would have been handling most of their calls in this way. Not surprisingly, this change has not reduced the number of patients who cannot be diagnosed over the phone. They therefore have to go somewhere. We now discover that where they are going is to the Accident & Emergency (A&E) services of their local hospital (Sunday Telegraph, 1 Oct 2006, News. p.8). There were an extra million visits to A&E in 2005/6 than the previous year. An A&E consultant has estimated that over half of those visiting A&E could have been dealt with by a GP.

Upto 20% of Britain's "home-style" birth centres may be closed due to the NHS's "funding crisis" (read, "spending crisis"), the Sunday Telegraph reports. Your options during childbirth will now, even more than before, depend on where you live and the vagaries of government allocation of funds, and NHS managers' priorities.