Dictat vs Democracy: Cameron and Lansley try and force through plans to destroy the NHS

The NHS reforms are now being exposed for what they are ... top-down dictat set to systematically destroy the NHS ... that no-one voted for and that no honorable / honest healthcare professional could ever support ...

Before entering office Cameron said his number one priority was the NHS, and that the NHS would be "safe in his hands". He also said he was "determined to put an end to top-down re-organisations".

Yet on entering office we find the complete opposite. Their plans (conceived and developed over many years by Lansley whilst in opposition) are in fact set to systematically destroy the NHS through the most callous, fundamental and profound top-down re-organisation embarked upon in recent UK history ... and prior to the creation of the NHS.

On encountering opposition to their reforms, Cameron announced a "pause" in the bill, "to listen" ... and said "for the reforms to succeed they would clearly need the support of healthcare professionals". Yet on initiating the "pause" it was clear this was nothing more than a PR stunt and that the real purpose was indeed not to listen, but to spend more time persuading! Cameron continually insisted that the problem was one of communication, and not the bill itself. Yet the most "callous" part of this so-called "pause" was not this, but that there was no actual pause at all - as in private Cameron told people to press-on quickly with the reforms (in particular GP commissioning) so they could argue that it was too late to turn back (which they have since repeatedly used). 

By not listening and pressing-on regardless, virtually every healthcare professional group has been forced to harden its position and to call for the bill to be scrapped. It is clear that even the majority of GP's oppose it now, with the minority of greedy GP's (who wanted to profit heavily by getting virtually the entire NHS budget into their own hands) being increasingly exposed (and sidelined) by the vast majority (due to the action of Democracy, as demonstrated by the Royal College of GP's).

And, instead of actually taking time to really listen to doctors and nurses now, Cameron and Lansley have decided to completely ignore them and try to force through their top-down re-organisation, inviting to meetings only those who will do what they say (i.e. Dictat) ... and push back against all those who get in their way ...

Will the UK continue to allow Dictat to crush Democracy ... let's see ... 

Poweromics, demonstrated by people such as Cameron and Lansley, must be challenged ... as Ignorance is not bliss ... and Apathy will kill ...


As another blogger put it ... "Putting the Tories in charge of the NHS is like re-employing Harold Shipman as your GP..."

Irony and Hypocrisy: Corrupt GP's saying the NHS 'in peril' if they are NOT given the money!

With key Royal Colleges and healthcare representatives expressing concern, and in most cases, outright opposition to the proposed NHS reforms, Andrew Lansley and David Cameron are under increasing pressure. 

No-one voted for these NHS reforms and Cameron stated at the last election that he was committed to putting a stop to top-down reforms! David Cameron also said that the NHS would be safe in his hands and that any reforms would need the support of the healthcare professionals, yet despite all these fine words he is still ploughing on despite their outright opposition!

Hypocrisy indeed!

And what is Lansley doing? ... well he clearly decided to call upon a few GP 'friends' to write to the Telegraph to say they back the reforms, with typically threatening rhetoric ... "The NHS will be 'in peril' if the Government's controversial health reforms are prevented from going ahead".

However the letter wasn't signed by any GP, but 56 GP's specifically setting up new commissioning groups who, under the bill, will effectively replace primary care trusts (PCTs) and be handed the almost entire NHS Budget £80bn to manage (and personally profit from)!

The cold reality is most GP's are actually not at the fore-front of healthcare, with many out of date in terms of knowledge, and acting more like money orientated businessmen than healthcare professionals, already pocketing 6 figure+ salaries ... and these 56 particular GP's are looking to take over virtually the entire NHS budget so they can get massive kick-backs, bungs and bonuses (e.g. from rationing healthcare, steering away from optimal clinical decisions and receiving share options/dividends) and in doing so, become Government made multi-millionaires at the expense of patients and taxpayers.

Last November the BMA moved to a position of total opposition to the Bill, and in the New Year the Royal College of Nurses and the Royal College of Midwives  followed suit. The Royal College of GPs is itself is deeply sceptical, although it's not publicly in total opposition yet (due to representations/lobbying from immoral/corrupt GP's like the ones who signed this letter), even though 90%+ are apparently in opposition (due to clear conflicts of interests between 'cashing in' and 'care').

Dr Clare Gerada, chair of the RCGPs, said: "GPs must understand their role in commissioning and we support the principle of greater clinician involvement. But many of our members feel that this could have been done in a less disruptive way by placing GPs on the boards of existing PCTs."

The Government, when it 'paused' to 'listen' to concerns, did not pause in its quest to abolish PCT's and the process of bribing corrupt GP's to ration and privatise healthcare. It therefore no surprise, given the stench of self-interest and personal gain, that these people are providing the only voice backing the reforms. 

Most healthcare professionals, royal colleges and professional bodies know exactly what the Government and these corrupt GP's are up to ... but are finding it difficult to say so publicly. When will one or more of these bodies finally spill the beans and make it completely clear to everyone what is actually going on ... as they certainly have a professional and moral obligation to do so, as ignorance is unfortunately not bliss, and any apathy on their part will almost certainly kill ... literally!

The reality is that the NHS is indeed 'in peril', but only if we give these people the money, not if we don't!

BMA rejects health reforms - for the second time!

David Cameron and Nick Clegg were quick to call their 'listening exercise' a 'success', and point out how much the NHS reform bill is being changed ... however, doctors and the BMA have been just as quick to reject it! 

In its annual conference this week the BMA overwhelmingly rejected plans to reform health and social care in England, saying the government could not be trusted.

Hamish Meldrum, head of the BMA, who recently referred to the Government's 'slash and burn' approach to NHS reform, was also quick to point out one particular area of concern ... potential conflicts of interests resulting from proposed payments to GP's (known as the 'quality premium'). 

He said the "Government's plan to reward GP's for 'doing well' in commissioning, in arranging services for their patients, will damage the trust patients have if GP's are seen to be paid for just organizing their services, or maybe, in patients minds, being paid for restricting access to services because of the financial problems" ... and went on to say "it is unnecessary and potentially damaging to pay doctors in this way".

His comments follow on from a recent debate at an annual conference of GP's, where a Bedfordshire GP said that "payment by results" was a "hideous undercurrent" in health secretary Andrew Lansley's health bill, describing it as a system that "threatens patient trust". He went on to say that if the government's plans are implemented in their current form, delicate decisions will be "corrupted by financial decisions" and would "result in no trust whatsoever between patients and doctors."

During a speech at the event, Dr Iona Heath, president of the Royal College of General Practitioners (RCGP), also said that GPs need to "badly put our house in order to acknowledge the extent of conflicts of interest pervading the context within which we work".

"We need to make it clear that there is a limit to which we will respond to ethically dubious financial incentives. Only then can we begin to provide the urgently necessary critique of the pervasiveness of financial conflicts of interests within policy making in the NHS."

Indeed so ... and well said! It is heartwarming to see there are still trustworthy honorable GP's (and doctors) prepared to expose the clear conflicts of interests and making equally clear their unacceptability (on ethical grounds) ... let's see if the Government are going to try 'listen' ... second time around !

Government still want to reward GP's for rationing healthcare

Before entering office David Cameron said the NHS was safe in his hands and promised to put an end to top-down reforms. Yet on entering office, his Government immediately embarked upon radical top-down reforms of the NHS, which no-one knew about and no-one voted for. 

The reforms contain fundamental conflicts of interest and put the future of the NHS at risk, prompting opposition and anger from the public as well as every professional healthcare group (e.g. the BMA, the Royal College of Nursing, Royal College of Surgeons ...).  

So Cameron said the Government would embark on a 'listening exercise", but in reality the Government listened very little (but talked a lot) and continued to quietly press ahead with GP commissioning (so there could deliberately be no turning back in this part of the plan)!

David Cameron has now given five pledges about reforming the NHS, but they are most noted for their omissions rather than what they include ... as there is no plan to stop GP's from profiteering from rationing healthcare ... i.e. the most blatant conflict of interest.  

GP's have shown themselves to be more than happy to profiteer from NHS changes in the past ... and many are looking to these reforms to provide the biggest opportunity yet ... e.g. by profiteering from bonuses (and shares in commissioning companies) for rationing healthcare to patients, as well as  being able to commission work to themselves or to companies they have interest in (e.g. shares, directorships).

David Cameron is making 'pledges' in many areas, but they are clearly not going to change the strategy of bribing GP's in order to ration healthcare - as this is the way that the Government plans to make £20bn of savings in the NHS ... and when you take out the additional profiteering from GP's, the real decrease in actual healthcare spending is going to be much more!




NB The Government are also still toying with imposing more competition from private health companies, and they're still looking to scrap their legal duty to provide the same level of healthcare to everyone wherever they live too! Which also go to show that the "listening exercise" was nothing of the sort, and that Cameron's 'pledges' are also not worth the paper they are written on ...

Pausing to 'listen' ... or 'avoiding a massacre' (in the forthcoming elections)?

At last - the BBC is finally starting to raise the fundamental issues raised by current NHS reforms ... e.g. rewarding GP's for rationing healthcare (a clear conflict of interest - i.e. profiteering from patients and from not referring patients properly), as well all the other fundamental issues raised by every medical professional body (e.g. British Medical Association, Royal College of Surgeons, Royal College of Nursing etc etc).

And its worth remembering that the BMA only 'backed' 'GP commissioning' due to private lobbying/voting from 'greedy' GP's. Everyone else is against these reforms, including the vast majority of honest, trustworthy and honorable GP's (take a look at this post  and this one for instance). 

To push through these reforms the Government are trying to bribe the 'greedy' GP's to take part, by offering them lucrative personal rewards (e.g. fees, bonuses and shares in commissioning groups, as well as lucrative deals in which they can profiteer from rationising healthcare and referring work to themselves). They have also been quietly trying to force those GP's against the reforms into commissioning (which they are still trying to resist), but the Government are now saying they'll let another 'GP consortium' profiteer from doing it instead!

The Government will still try to press ahead with these controversial reforms, which will be to the detriment of everyone's health and well-being, and which will eventually destroy the NHS. 

These reforms were not asked for, or voted for, by anyone (and were in no party manifesto) ... the introduction of the NHS was a key moment in UK history, and its effective destruction will be equally as dramatic ... we must not lest this happen ... and IMHO the BBC have a duty of care to continue to raise these issues too ... to ensure the public voice is heard!

In the meantime everyone can sign the petition to the Government ... as well as the petition being sent directly to their MP.

IMHO the Government are not 'delaying' to take time to 'listen' ... but to make sure they don't suffer a complete massacre in the forthcoming elections in May! Believing these people will listen is like believing Gaddafi will ensure a ceasefire ... and voters need to make sure their voice is heard in these elections ... as only by ensuring the coalition are crushed in these elections will they actually listen to anyone ... and stop the destruction of the NHS, as well as the removal of patient trust in their doctor to act in their best interests!

Bloggers are attacking the reforms from every direction, let's see if the Government listen ... I thought this post from a new blogger, Dr John Taylor, summed things up well by asking one simple question:

"The question is: Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income? For me it's simple, I prefer my GP to remain a GP".

to which I added ... 

"a fantastic post and I fully agree - this one simple question sums up the problem with these reforms perfectly ... and it highlights how/why the government have been trying to bribe GP's to back the reforms ... as he can't do it without them and he needs their help to ration NHS care at source (i.e. before being referred any treatment) - hence they were prepared to offer GP's part of the profits/savings (e.g. as fees, bonuses, shares in commissioning companies, referral work to themselves instead of hospitals)"!

Let's see how people vote in the elections too, and let's see if they start to listen then!

BBC - Duty of Care ... and a Dereliction of Duty

To date the BBC has singularly (and deliberately) failed to address the fundamental issues raised by current NHS reforms ... e.g. rewarding GP's for rationing healthcare (a clear conflict of interest), as well all the other fundamental issues raised by every medical professional body (e.g. British Medical Association, Royal College of Surgeons, Royal College of Nursing etc etc)

In my humble opinion this is not only a dereliction of duty, but also points towards a deliberate conspiracy between the BBC and the Government, which is allowing the Government to press ahead with controversial and detrimental NHS reforms which affect everyone's health and well-being, and destroy the NHS. For instance, ask yourself why the Government are trying hard to bribe the greedy GP's to take part (with lucrative personal rewards for implementing it) ... and why all the true, honest, trustworthy and honorable GP's are so against it.

Current NHS reform were not asked for, or voted for, by anyone ... yet are being pushed through rapidly by this Government regardless of all the concerns raised by professional bodies and the general public. The introduction of the NHS was a key moment in UK history, and its destruction is equally as dramatic. Yet the BBC are failing to cover this issue in any real way (despite the public repeatedly asking them to). Nick Robinson is conveniently (for the Government) and deliberately not addressing it, preferring to focus all his attention on Libya instead, and the BBC's health correspondent, Fergus Walsh, is not addressing the issue either (despite his stated aim of wanting to look into the future and into the ethical issues associated with healthcare in particular).

Here is what I have posted on his blog when discussing the sharing/adoption of good practice (nb my post, the first post in response to his blog, was referred to their moderators rather than posted, despite the fact it broke no house rules ... and was then left that way!) 

Hospital managers also have a responsibility to adopt world class leadership and management practices ... but unfortunately such practices are almost completely opposite to what most managers currently understand/practice! However in leading hospitals the adoption of 21st century practices is quietly (and successfully) transforming patient outcomes, radically improving patient care and reducing unnecessary stress for both patients and staff. The problem is this type of 'management' is radically different to 'traditional management' ... and needs far less 'management' ... which perhaps goes some way to explaining why some managers are rather slow to spot it and adopt it! (i.e. it's a mixture of ignorance, apathy and self interest on the part of leaders and managers). Why don't you have a look into this area as well?

PS Why are you not also blogging about the ethics of profits v patient care (e.g. rewarding GP's for rationing healthcare)? IMHO if this blog is worth anything at all it should really be tackling this. Or is this an 'agreed no go-area' for the BBC! I note Nick Robinson is also completely avoiding this area and is happy to allow the Government to quietly destroy the NHS too ... through reforms no-one voted for and every professional body is against ... yet no-one is being listened to ... ethics, democracy, an independent BBC? I think not.

... and here is what I subsequently posted (post 11), which the BBC did reluctantly post!

Post 1 was referred for no good reason and has still not been reviewed/published! 

IMHO the BBC health blog is failing in its duty of care by not tackling the fundamental (and once in a lifetime) ethical issues/crisis which the NHS is facing at the moment (e.g. allowing GP's to profit from rationing healthcare - i.e. conflicts of interest), and Nick Robinson isn't either (preferring to focus only on Libya), despite the fundamental concerns raised by every professional medical body. Incompetence, dereliction of duty, conspiracy ... could be any or all of them.

The BBC appear not to want to upset their paymasters ... and this is not the licence fee payer - but the Government who decide how much (if anything) the licence fee payer has to pay! Independent ... I think not! They are just as bad as the politicians ... i.e. looking after themselves with no responsibility/duty of care.

I think these posts say it all really ... i.e. don't expect the BBC to feel they have a duty of care to the public (who they are supposed to serve - as we pay their salary), as they know the group who actually decide their fate is the Government  ... who agree the level of BBC licence fee and force people to pay ... but then most learned people in the blogosphere realise this already (nb the ex-director general of the BBC, Greg Dyke, Jeremy Paxman and Peter Sissons etc have all previously voiced their concern about this in the past).

Selfishness - a Recipe for Failure

For many years "The Apprentice" has offered UK viewers the unedifying sight of desperate contestants fighting it out to become Lord Sugar’s next business protege. However, the show’s celebration of selfishness and ruthlessness as the keys to success in the world of commerce has been debunked by one of the country’s leading businessmen.

Newly-departed Tesco boss Sir Terry Leahy said getting on with others and a work ethic of giving ‘more than you take’ were far more valuable assets – and ones that schools should be instilling in children.

Sir Terry, 55, who left Tesco earlier this month after 14 years at the helm during which he took the supermarket’s annual pre-tax profits from £750million to more than £3billion, said that the show was ‘not a very accurate reflection of business - The Apprentice is good entertainment but it’s got nothing to do with business or how to be successful in business'. 

‘If you’re ruthless and selfish, you won’t do well in business’, and went on to say, ‘Everyone wants a successful society, but to have a successful society you need a successful economy and to have a successful economy you want the best and the brightest wanting to go into business, into enterprise, and seeing it as worthwhile and noble work, which it is.' 

Sir Terry believes that schools should undertake ‘social skills training’ to equip pupils for the workplace as they must be able to work with other people. He said: ‘I think that employers need to be clearer with schools and universities that they also want teaching of values, of citizenship, of how as an individual it’s important to give more than you take. That’s what makes you effective in the workplace – that people like working with you and you’re a useful member of a team and you’re keen and happy to give service.’

Sir Terry left his chief executive role at Tesco three weeks ago, having built the supermarket into the UK market leader. It now has 30 per cent of the market, nearly double that of closest rival Asda.

Sir Terry Leahy speaks a lot of common sense (see my Book, Chapter 6), but unfortunately 'common sense' is not all that 'common', particularly in larger organisations ... where most 'leaders' fail to listen to anyone and enjoy telling people what to do. Flawed HR reward systems also drive people's selfishness and short-term self-interest (partly due to outdated/flawed practices still being taught in business schools), rather than promoting teamwork, listening to customers, and ensuring that everyone's intrinsically motivated and committed to continuously improving the value provided (i.e. through its products, services and solutions) to their customers (which engenders loyalty and creates long-term, sustainable success). 

Sir Terry is also right about the importance of getting things right with regard to creating a successful economy and a successful society ... however, unfortunately for Sir Terry, and the nation, selfishness and self-interest still rule, which is why we are where we are today. Put bluntly, if the UK were already doing what Sir Terry suggests, the UK would not be in the state it's in! 

... and things will have to change rapidly (and fundamentally) if the UK's going to not only survive but prosper. The real challenge faced is all the self-interest shown by current 'leaders', including politicians, the bankers, the landowners, the media and the judiciary, as well as the vast majority of 'leaders' of public bodies and large corporations, who profit heavily from how things currently are and who'll resist any change that's not in their own self-interest.

Indeed, if we look at major changes currently occurring, things are changing ... but change is going in totally the wrong direction! For instance the Government, rather than improving 'leadership practice'*, is currently trying to bribe GP's, using lucrative personal bonuses/deals, to ration healthcare and destroy the NHS, whilst creating fundamental conflicts of interest and destroying the trust between doctor and patient ... contrary to society's best interests ... which is now dividing the GP community ... between the 'good' and the 'greedy'.

Selfishness, self-interest and greed are all around us ... and are destroying this once great nation ... a nation previous generations died in order to protect! Will we see the people of this once great nation once again stand up and be counted ... we shall see! The 'good' GP's/doctors are trying to ... and thousands more besides (sign the petition and join the protests by clicking HERE).

* NB changing 'leadership practice' is currently transforming 'leading' hospitals out of all recognition (e.g. 50%+ improvement in performance, customer satisfaction and staff morale, all in less than a year - referred to in my book too), but this is being completely ignored (because Cameron/Lansley want to ration healthcare and privatise the NHS, not improve it, and prefer to use NHS money to bribe GP's to back their reforms, instead of using it to improve the health of the nation)!

NHS reforms - a nice little earner for GP's

Exposed further - GPs could be earning around £140,000 extra each if they set up a private commissioning company – on top of their basic salary and bonuses. Have a read of the article below, written by Kieran Walshe (professor of health policy and management at Manchester Business School), and published in the Guardian:

GPs have always had an ambiguous position in the NHS. On the one hand, they are self-employed entrepreneurs, employing their own staff, owning their own premises and providing services for a fee, just like a solicitor or estate agent. Indeed, many GPs have diversified into owning private clinics, nursing homes and other businesses.

On the other hand, they are seen by patients as part of the NHS. They get a final salary pension just as NHS employees do, most of the services they provide are funded directly by primary care trusts through a nationally negotiated contract which GPs do not have to compete to get or keep, and once appointed it is almost impossible for PCTs to remove them. GPs have always been pretty hard-nosed about negotiating that contract with the Department of Health, and using it to maximise their income.

Will they be equally good at profiting from the NHS reforms? They could do so in four main ways:

• They will be paid to set up and run GP commissioning consortiums – a "management allowance" of about £55,000 per GP. This money could be spent on employing other people to do the work of the consortium, or they could pay their existing staff or themselves with this money.

• They will be paid a new "quality premium" for taking on commissioning, which the government says will be based on outcomes and efficiency. No one knows how much it will be, and GPs fear it will come out of existing income and will be intended to incentivise them to refer fewer patients to hospital.

• GPs could start to provide services which their own consortium commissions from them, often instead of patients having to go to an NHS trust or another provider. This already happens in services such as minor surgery but it could dramatically expand. For example, GPs who set up and own their own diagnostics centre could send patients there for ultrasounds and X-rays, instead of sending them to the local hospital.

• GPs in a consortium could set up a private company which they own, and then get the consortium to contract out the commissioning of healthcare to that company. If that company can make savings by spending less than it gets from the consortium, the surplus could then be distributed to the shareholders – the GPs – as profit. This is where the big money is: if they can save 5%, the surplus for redistribution would be about £140,000 per GP.

The NHS reforms envisage a much bigger role for the private sector in both commissioning and providing NHS-funded healthcare. Once NHS money flows out of public bodies such as PCTs and the new GP commissioning consortiums into the private sector, it's very hard to work out how it's being used and who is profiting from it. The Freedom of Information Act does not apply to private companies, the National Audit Office has no powers to require data from them, and past experience suggests that NHS bodies will claim that the details of contracts with private companies are commercially confidential. So we may never know who makes how much money from these reforms.

As highlighted yesterday, this is the real reason the BMA find themselves caught between two stools - between greedy GP's who are looking forward to profiteering ... and the concerned/honorable GP's (as well as hospital doctor's and consultants) who disagree with this and want to ensure that NHS money is channelled into caring for patients and not GP's bank balances (thereby avoiding any conflicts of interest).

However, as the BMA makes its stand, alongside the Liberal Democrats (who are part of the coalition government!) as well as the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Nursing,  it appears David Cameron is looking to ignore them all and press ahead ('what was that about listening to the people David? ... oh yes! ... and what about listening to your own party Nick Clegg? ... oh yes! 

Entirely predictable, both of them ... we'll have to see whether a little bit of 'real people power' emerges now to stop them!




UPDATE: and just to show not all GP's are greedy, here's a post from one GP:

NiallB

16 March 2011 12:50PM

I am a GP.

I think this is a well argued article that explains why the profession is split in two by these reforms. One group of GPs 'the Pathfinders' are the entrepreneurs who will set up limited companies to cream money off the NHS. The others like me simply aren't interested, because we have enough work to do just seeing patients, and regard ourselves as already well paid for what we do.