Just four months in, Andrew Lansley’s NHS vision is turning into the Kingdom of the Blind.

Andrew Lansley has abolished the cap limiting the proportion of total income hospitals can earn from private patients. The reason is simple: he wants to plug the £20 billion black hole of NHS funding left by the profligacy of the last lot, by attracting the fat uberklass from abroad. But like so many of a blinkered Thatcherite hue, he seems unable to grasp the fact that money talks – whereas a calling to heal the sick is struck dumb by the amorality of it all.

I try to keep purely anecdotal posts to a minimum, as hard evidence is so much more convincing and reliable. But this episode comes unfiltered by gossip – and from the mouth of a person of such ethical goodness, I have to share it with you….and try perhaps to raise the alarm about where Britain is headed if we’re not careful. This is one case where the appalling treatment of one patient is backed up by official figures.

We have a chum in her early sixties who has been diagnosed as needing a hip replacement. She is neither overweight nor ancient….just genetically prone to bone decay, as some of us are. Having been asked by her GP to ring for an appointment to see a consultant (in my day they did it for you) she was told by Exeter General recently that they were not making any new appointments right now – as they are ‘too busy’.

Her pain being difficult to bear- we’re talking about a seriously stoical person here – she rang for a private appointment….and got it straight away. She has now been booked in for a private operation during January. She is not a wealthy woman. She’s not even what you’d call ‘comfortably off’. She’s a lone pensioner with bills to meet. But she comes from that generation preferring not to ‘make a fuss’.

It’s another case of the situation on the ground bearing no relation at all to the bollocks being spouted from the Despatch Box….thanks to the cynicism of elected politicians and cunning bureacrats. But let me first of all explain what’s going on here.

Our chum was refused an appointment because, once having made one, the hospital would then be committed to completing a consult, operate and discharge schedule within a given time. And the NHS Trust involved knows there are two chances of of that being achieved – given the current state of staff and resources. (Hold that thought, and go back to the piece I posted earlier this year about The Madness of Andrew Lansley).

Meanwhile, let’s look at what the latest statistics suggest. As it happens, I was glancing through some at the ONS site last Tuesday, after reading the grim news about exports and inflation. A follow-up to this led me to visit PULSE, the website for primary care (GP) professionals. The following was posted on 7th December this year:

‘The number of patients missing out on treatment within 18 weeks of referral jumped by 15% between July and September this year, after PCTs were released [by the Coalition]  from their strict obligation to meet the target in June. Legal experts warned the rise could leave GP consortia at risk of being sued by patients when they take over commissioning, since being treated within 18 weeks remains a right under the NHS Constitution….’

Ah yes: the sound of hip-hop business-orientated patient-facing GP’s covering buttocks. But harken unto other noises off, for the ONS figures show that 45,000 patients missed out on treatment in 18 weeks to September, up 15% from 39,000 in July. In fact, some 12.6% of patients awaiting orthopaedic or trauma treatment, and 10.6% awaiting oral surgery, waited more than 18 weeks.

Health professionals admit that waiting times are slipping. NHS South Central says health systems in Oxfordshire, Southampton and south-west Hampshire have been assessed as failing ‘principally due to financial issues and concerns on workforce and 18 weeks’.

Is this just Leftie agitprop? Well, that all depends on whether you’d put the the Daily Mail in that category. Because today, the Mail runs with a well-documented piece about how Andrew Lansley’s desire to abolish primary care trusts (and hand the money over to ‘GP consortia’) is going to leave the bloated NHS bureacracy exactly where it was before he started:

‘Thousands of NHS managers due to be sacked as part of plans to streamline the NHS will now have to be kept on to help run the new system, the Government admitted yesterday. Announcing plans for a massive shake-up, Health Secretary Andrew Lansley confirmed that primary care trusts would be abolished by 2013 and their responsibilities for overseeing medical services devolved to groups of GPs.

But because GPs have neither the expertise nor the time to micro-manage budgets they will need to employ experienced administrators. This is likely to lead to a ‘revolving door’ in the NHS with managers leaving the abolished PCTs only to pick up another position in GP practices.’

So to sum up, NHS patients who’ve paid their stamp throughout the decades are now being fraudulently persuaded to spend their hard-earned, overtaxed earnings on bailing the political class out of its own mess – by offering them, not just a rationed service, but no appointments at all….but the commissars will remain untouched by all this. It’s like something out of a Solzhenytsin short story.

This Sovietesque situation has not been brought about by cynicism alone: there is also some standard Ministerial muddle involved. As The Slog warned but a few months ago, Andrew Lansley’s rejig of the NHS budget share-out starts from the ridiculous assumption that GPs deserve an even higher percentage of the total available. From next year, GP Care Trusts will get £89 billion of funding – out of just £110 billion for the NHS as a whole. How can any sane human being imagine that invasive, life-saving hospital medicine deserves that small a slice of the cake?

The argument in favour of this Swiftian strategy runs as follows: catch symptoms quickly, and the patients will never need surgical intervention. Surrey GP Dr Graham Tyrrell, who is part of the Guildford and Waverley Commissioning Group (and therefore set to make a nice pile from all this smoke and mirrors) argues “If you get them early, they get better quickly – if you can prevent some patients going into hospital, keep them at home, it’s making available those beds that would otherwise be occupied.”

Such a theory begs many questions, notably how much money might be saved. Dr Tyrell can show that, on his patch, savings of £1.7m could be made in any given year. Hang out more flags: this would deliver the NHS a whopping 0.013% saving nationally during the next fiscal. When it comes to socio-economic logic, this is several levels beneath risible. That level might be called invisible – or perhaps even indivisible. It is a reasoning based on the arrogant – but sadly, all too accurate – belief that a dumbed-down, distracted electorate will never get within a country mile of working it out.

When it comes to the detail, the Coalition Government is at best sloppy and at worst devious. We must once and for all embrace a simple reality in relation to the NHS: either we give it a more limited and realistic role; or – and this is my preferred option – we abandon it in favour of a different model of how to fund a genuinely fair level of health provision in a modern, civilised society. Decades of sacred-cow worship by idiots like Gordon Brown have reduced us to this pathetic parody we enjoy today. But pernicious, creeping privatisation will result in the obvious: a morally gross system under which the wealthy will be well, and the poor will be poorly.

The Health Secretary has no grasp of  Britain’s true public health needs. He should resign without delay – or be fired by his boss.

Related pieces: What makes for a good GP?

NHS reforms….a dog’s dinner from Andrew Lansley



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