Stop the creative destruction of the NHS

'There are over 40,000 premature deaths each year in the UK due to just two air pollutants8 - Ozone and PM 2.5. These are mostly attributable to traffic. On the email lists there were slogan suggestions, one of which was 4WD=WMD - how utterly true that is. 40,000 premature deaths each year... no action taken. We have our own WMDs and they are being ignored.' Stuart Jeffery, Green Party health speaker, spring 2006 conference.


Green health is a huge topic and one I need to post about more. Social justice is important because poverty breeds illness. Environmental quality is also key. I want today to flag up the excellent job that people like Stuart Jeffery the Green Party of England and Wales health spokesperson are doing in contesting the creeping privatisation of the NHS. Here is his conference speech. Hope by the way that some of you will come to Party conference in Hove at the end of September.

Stuart asks why deaths from pollution are not front page news, I think we know the answer, blogs though are part of the battle for ideas..please spread the word.

Health Service Panel - the view from the Green Party speaker on health

18th Mar 2006

By: Stuart Jeffery

Green Party Spring Conference 2006 Stuart Jeffery on the Green Party and the health service


Creative destruction - The NHS is suffering from creative destruction. This is how the former Head of Strategy for the DH has described the current set of policies and reforms being unleashed on the NHS.1 New policies, health care market reforms, the 24th major restructuring in the past 32 years, private sector involvement, unfunded targets, unfunded pay reforms, and a culture of bullying and intimidation2 have left the NHS in tatters. Public health services are collapsing, they lack teeth and watch as thousands die. Yet the public are not aware of public health issues and don't hold politicians accountable. And a £1 billion deficit this year with worse to come next year3. A £1 billion deficit that could have been afforded if the government hadn't spent £3.1 billion4 on an illegal war in Iraq. Last week Nigel Crisp took the can for the financial deficit and was sacked / took early retirement from being Chief Exec of the NHS. The retirement package included a peerage of course... The government has claimed record investment in the NHS so why is there a problem? Reductions in waiting lists were not funded 29% of the increased funding went on filling a gap in the pensions scheme 39% went on pay and pay reform 13% went on the increased cost of drugs A massive 2.4% went on increasing NHS capacity, i.e.more beds and staff - 2.4% - yet demand for health care has been rising at 3% each year.5 Yes, they can claim record investment - but with serious spin. Record investment - that still leaves us in the bottom half of spending levels in the EU. Record investment - but still about half the level of spending in the US - and we know how bad the US healthcare system is with millions of people not having access to health care.

This record investment was supposed to reduce waiting lists. The average length of wait to see a consultant has dropped from 7.7 weeks in 1997 to 6.6 weeks in 2005, eight days quicker.6 They have done better with waits for operations with the number waiting for operations dropping by 33% - hardly surprising with the waiting times targets being known as P45 targets by manager, miss them and you're out. Recently they have discovered hidden waits! Perhaps this is where that 33% went... Following a few high profile 'but I've been waiting years' comments the government discovered that people can wait very long times between initially seeing a consultant and getting diagnostic tests. Once the initial visit to the consultant has happened, there are no more targets until the consultant decides to operate - so people can wait and wait.

'Creative destruction' - payment by results. Let's just look at this, the most perfect example of madness, the new NHS healthcare funding system, called "payment by results". Each visit to a consultant is billed to the Primary Care Trust that the patient is registered with, each spell in hospital is billed to a Primary Care Trust. Almost 1100 set prices for set types of care - what better mechanism to allow the private providers to enter the NHS. The latest in market reforms has made healthcare the same as giving your credit card to your children and then to send them shopping at Tescos.

But health care doesn't work like shopping at Tescos. When you shop at Tescos you can decide how much food to put in your basket, you can budget, you can make choices. A Primary Care Trust can be responsible for the funding of health care for 250,000 people. Each time any of them turn up at any hospital the Primary Care Trust gets billed. This bill isn't agreed, or known, in advance and the hospitals are even able to manipulate the bill to get it higher. The Primary Care Trusts have had all controls removed from them, yet are supposed to balance their books. Hospitals, too, have no certainty of income - it depends on how much care they deliver, unfortunately their costs are fixed unlike their income. Of course, hospitals need an army of data clerks and managers to run payment by results making sure that every visit to the hospital is counted and coded and billed. Primary Care Trusts also need an army of data clerks and managers, to spot the tricks that the other army is using to bump up the price of the visit.

Last week on Question Time, Hazel Blears said that hospitals were given budgets to work to at the start of each year and must learn operate within those budgets. A fairly straight forward suggestion, you might think! Under Payment by Results, hospitals have to estimate the number of operations, the number of GP referrals and the number of attendances at A&E; then guess what type of operations / referrals and attendances they are; then (for next year) guess how much each will valued at, before finally guessing what their income might be. Bradford got it wrong, 2 years ago, to the tune of £12 million. The £1 billion deficit is 1% of the total NHS spend, estimating health care demand and supply, i.e. people's behaviours as well as illnesses, cannot be accurate to level. The one thing hospitals don't know until after the end of the financial year is how much they have to spend. So Hazel Blears was completely wrong, nice soundbite but completely untrue. Businesses (back to Tesco again) operate with this type of uncertainty, but they can make profits to help buffer the odd shortfall - or get a short term loan - but the NHS can't and shouldn't be able to do that. (Except for the unaccountable Foundation Trusts)

The latest addition to this madness - 'Practice Based Commissioning'- devolves the responsibility for the Primary Care Trust budgets to GPs, who, while not having to carry the can if they overspend on secondary care, are allowed to keep some of the underspend - assuming there is any. This signals a return to GP fundholding - a Tory invention that Labour removed, renamed and reintroduced.

The market economy in health care introduced by the Tories and expanded by Labour is wrong in principle and wrong in practice.

If the NHS is in a mess, it has nothing on the state of public health...

Since 1997 the health gap has widened. Infant mortality rates, one of the best indicators of health, between the rich and poor are getting wider and wider7 - why is this not a national scandal - why is this not front page news time and time again?

There are over 40,000 premature deaths each year in the UK due to just two air pollutants8 - Ozone and PM 2.5. These are mostly attributable to traffic. On the email lists there were slogan suggestions, one of which was 4WD=WMD - how utterly true that is. 40,000 premature deaths each year... no action taken. We have our own WMDs and they are being ignored.

Childhood obesity is rising - kids are getting driven to school so that if they don't die of an obesity related problem, then the air pollution will surely get them. School meals came in for a high profile campaign so what did the government do...? For the first time ever life expectancy is beginning to fall - because of the childhood obesity epidemic.

So what has the government done - a nice white paper 'choosing health' and £150 million to fund health promotion activities but... these are sticking plaster tactics with scale of these problems and then the government forgets to ring fence the money and gives it to Primary Care Trusts who can't pay for operations... guess what Primary Care Trusts will do with the money - they will pay off their overdrafts.

So in the face of financial crisis and policies that wreak 'creative destruction' on the NHS what does the government decide to do? In the face of instability, it decides to change things... The 24th restructuring is underway. Generally increasing the size of PCTs (making them less responsive to local needs) and getting them to mirror unitary and social services boundaries (itself an excellent idea) - it's a good job that there isn't a review of local government structure about to kick off!