I live in Scotland where since 2007 the NHS model has seen
the removal of 'competition' within the NHS and direct Scottish
Government action on poorly written PFI contracts,
especially in the case of Edinburgh Royal Infirmary where it impacted on
cross infection control. Further due to a change in how performance in
NHS Scotland is now measured performance targets are increasingly linked
to patient experience and not 'outputs'. The system is not perfect, no measurement
system ever is, but at least NHS Scotland would be recognizable to Mr Beveridge's
original 1942 idea of a NHS service, the White Paper of 1944 and the NHS Act
(Scotland) of 1948.
Having worked in the NHS on both sides
of the border all I can say of this latest plan for NHS England is it
does not have patients needs and expectations at its centre. The chance
to achieve that principal aim was lost when New Labour failed to back
Sir Liam Donaldson's proposed reform of NHS management and delivery in
the late 1990's. His aim was to take a proven UK created, world
recognised and effective quality assurance management model and apply it
to the NHS in England. The system was already in place in Sweden's equivalent of the NHS
and proving highly effective at improving responsibility for delivery at
all levels while holding all levels to account for their
activities. In other words the Swedish had used the model to create a
coherent and accountable public health care system with patient's needs and expectations at the centre.
The problem
of this model for the NHS in general, at all levels of vested interests,
is it requires all fiefdoms and empires to be broken up and the focus
moved from the Secretary of State for Health's current political demand,
for example, to that of patients' determined needs and expectations.
This fundamentally changes the power cascade from top down to bottom up
and reduces all vested interest control and inputs to the same value as
the patient. The very apotheosis of Blairite and New Labour policy and
politics. Systemic failures in Donaldson's proposed model for NHS
England would go to the top where true accountability lay.
In
Mid-Staffs the patient complaints would not have been dismissed in
Donaldson's proposed model but would have acted as a driver to correct
the issues causing the front line problems and put in place revised
systems to prevent (as far is humanly possible) the same errors occuring
at a future date. These problems and their effective solutions would
then have been notified to all other NHS Trusts in England creating the
prevention of possible problems occuring in the other trusts.
The
bottom line was the implementation of Donaldson's model, in full, would
have created the opportunity to save NHS England over a £1 billion in
pay outs of out of court and court settlements for negligence and
malpratice at 1996 figures.
Instead NHS England was given a fudge by New Labour
which was simply smoke and mirrors and jobs for the boys and girls in
the new 'NHS Quangos' while the vested interests carried on as before.
More top end cost for little improvement in meeting patient's determined
needs or expectations of NHS England. The Quango which was set up to
patrol 'Clinical Governance' has been shown to have demonstrably failed
in its core purpose of ensuring patient safety and best practice on
numerous occasions. They gave Mid-Staffs a clean bill of health right in
the middle of the unfolding disaster. NICE is notorious for shutting
the stable door well after the horse has not only bolted but turned up
in a Tesco burger.
Blair got his 'headlines' about NHS England
improvement, patients' needs and expectations continued to be ignored while
the plans for the marketisation (aka privatisation of NHS England) went
on a pace starting with PFI and its effective selling off of hospital
buildings and the land they were set on to the private sector. The cost
of which is going to rise to all four NHS entities across the UK, with
the downgrading of the UK's triple A rating, by a further estimated 33%
over the period of the current contracts. In Scotland that will be an
estimated £10 billion more lost to frontline patient care funding, on
top of the current cut backs to Scotland's pocket money from Westminster
which are already squeezing the NHS Scotland budget. The Red and Blue
Tories at Westminster will then use the outsourcing of NHS activities in
England to 'private companies' as an opportunity to reduce Barnet NHS
consequentials to Wales, Scotland and Northern Ireland - even further.
A 'yes' to Scottish independence looks increasingly to be the only way to preserve NHS Scotland in its current form.
Thanks for the piece and the time you took to write it,I will share it round various sites.We need to get the message out to as many folk as possible,the problem is many will not read it because it goes against their view of the union some still have religion in their psyche,and think its 1690 forever,can never get through to the small hard core of uneducated folk.It is shareholders that will be best served by the NHS.
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