NHS Reforms

From the Guardian..

Dr Middleton said there was no great opposition to the planned move to place public health services such as smoking cessation within local authorities. "But the letter is a recognition from the public health community that the reforms proposed around the NHS are deeply damaging to the public health in themselves," he said. There was concern that they would lead to inequalities in healthcare and less access for the poorest and most deprived to the services they need.
"The experience of other countries that have 'liberated' their health systems has resulted in very poor health services for their communities. I'm thinking of Russia and China where a free market in health resulted in major falls in life expectancy and systems that had provided some safety net cover have failed," he said.

OK, the guy has this completely wrong. The research in The Lancet was around the effects of privatisation of the former Soviet Union in general and the unemployment that followed it, not of their health service.

And China?




life expectancy looking like a pretty steady upward climb to me....

and what do The Economist have to say about healthcare in China?

Privatisation, or at least greater private involvement, may therefore have a lot to be said for it. In Huailai County of Hebei Province, 75 km (45 miles) north-west of Beijing, officials quietly decided four years ago to allow township hospitals to be taken over by private contractors. Hospital staff there say treatment costs remain the same, but far more people use the facilities because of improved service and investment in new equipment. With a nice sense of irony, one hospital has even decorated its forecourt with one of Chairman Mao's slogans: “serve the people.”

NHS Reform

From the BBC:-

Hospitals may have to close under reforms to the NHS in England, a report from the NHS Confederation suggests. 

Huh? A huge building built for medical purposes, filled with lots of specialist medical equipment is going to close? Even if we went for full-on free market reform of the health service, someone is going to buy up those buildings and use them to run a hospital, even if it's only for £1.

The findings, reported in the Observer, criticise ministers for not explaining the need for the reforms, describing some of the process as "extraordinarily risky." 

That's just absurd. There's simply no evidence that opening up something to the market is "extraordinarily risky". We've opened up the airline market and the optician market in my lifetime, and there has been no problem in terms of safety with either. And I guarantee this: if any private hospital was like Stafford Hospital, they'd be out of business within a very short period of time, because people would tell their GP that they'd rather wait and go elsewhere.

The confederation represents bodies such as foundation hospitals, primary care trusts and doctors' groups.

According to The Observer, the NHS Confederation report will also raise concerns over the new system under which consortia of GPs will be able to send patients to whichever provider they judge will offer the best treatment, warning that this will force the NHS to shrink in order to make space for new healthcare providers.
The policy of "price competition", allowing hospitals to undercut one another to attract patients, poses a risk to standards of care, the report is expected to warn.

Written as though the NHS' standards of care were something to cheer from the rooftops. Here's my guess: you could cut 10% off what the NHS costs for operation, make a profit and still run it more efficiently and to the same clinical standards.

Lansley Goes to War

And jolly good, say I. The BMA, as the trade union of doctors has a quite typical response to a bit of competition:-

Dr Meldrum said: ‘The BMA has given very careful consideration to these wide-ranging proposals, and we hope the government will demonstrate that it really does want doctors to be in the driving seat by listening to what doctors are telling them. 

‘Doctors want to build on the principles of the NHS, and to maintain and improve services despite the hugely challenging financial climate. 

‘However, success depends on working in partnership with others, a holistic approach to care and a reduction in bureaucracy. The insistence on a market-based approach risks fragmentation, inefficiency and increased transaction costs.’

The problem is that there isn't a scrap of evidence anywhere in the world that says that more competition causes inefficiency, and I challenge the BMA to produce some. Introducing competition into the opticians market in the 80s is what gave us cheaper spectacles from Specsavers. Competition for airlines gave us cheaper fares. More recently, the arrival of Firefox on the browser arena is what gave us better, faster, safer internet browsers. Microsoft had disbanded the Internet Explorer team because they didn't need to make it any better.

As I like to tell people here, I would have fired a couple of people who dealt with a health problem of mine, if I had a choice, and I like the idea that they wouldn't get the gravy but that someone else would instead.

And yes, it works inside organisations too. Tom Peters in In Search of Excellence talked about how certain companies had sales teams competing for the same turf, and they all worked harder as a result and achieved better sales, despite the fact that it looks wasteful to the sort of bureaucrats that run most large companies.

A Good News Story

From The Vancouver Sun:-

Breast-cancer sufferers could avoid the need for surgery in the future after doctors discovered a way of destroying tumours by freezing them.

The scientists adapted a technique used to treat prostate cancer to successfully destroy breast-cancer tumours in 13 patients, a conference was told.

Early days and all that, but it sounds promising.

It's important to put these things into context. Add up all the scientific and technological advances over 5 years, and very few political leaders can measure up in terms of improving their country.

Idea: Replacing GPs with Specialists

I've been mulling over the idea of replacing GPs with specialists as the bulk of patient to doctor relationships.

It strikes me that when people get ill, they normally know where the problem is. So, why are people not going straight to a specialist who knows about their area?

This isn't to say that you don't need GPs, but that GPs would be more like "holistic specialists"*. That is to say, when there's a problem which a specialist can't diagnose which is about pain in one part of the body being affected by another, these people would then come into effect, perhaps creating a team of specialists to analyse the problem.

Am I missing something in this?

Because what strikes me is that GPs come from olden times, when people were less mobile so that you had to have 1 jack-of-all-trades to treat everything. When you've got towns of 200,000 or more people, I see no reason that you couldn't have a number of specialists.

* holistic as defined by Aristotle, not the new age ecobollocks use of it.

Cameron on Hannan

"He does have some quite eccentric views about some things, and political parties always include some people who don't toe the party line on one issue or another issue."

Eccentric? Look, Hannan's views aren't eccentric. Apart from the bit about "it makes people iller" which was a bit extreme and his opinion that lots of people didn't like it (tragically, they do), everything that he said about the NHS was factually correct.

What I really want to know is exactly what the Conservatives are going to do that's going to reform it to make it a whole lot more efficient than what's there now. While telling me that my local hospital is terrible might make me better informed, if I am still stuck with being sent there, it doesn't make any chuffing difference.

David Davis On Google

From The Times

When I read in the pages of this newspaper this month that the Conservative Party was planning to transfer people’s health data to Google, my heart sank. The policy described was so naive I could only hope that it was an unapproved kite-flying exercise by a young researcher in Conservative HQ. If not, what was proposed was both dangerous in its own right, and hazardous to the public acceptability of necessary reforms to the state’s handling of our private information.

There are powerful arguments for people owning their own information and having rights to control it. There are massive weaknesses in the NHS’s bloated central database and there are benefits from using the private sector. But there are also enormous risks, so we are still a long step from being able to give personal data to any company, let alone Google.

That's right. The "powerful argument" for owning my own data is that I can choose a competent company, like Google or Microsoft to look after it, not some Fred Karno's Army of subcontractors who will leave it on a USB stick.

Google is the last company I would trust with data belonging to me. In the words of human rights watchdog Privacy International

Those are the guys who objected to StreetView as an invasion of privacy, aren't they? So, definitely not nutters, then?

This highlights how careful we must be in using private companies to handle personal data. Actual and potential misuse of such data will be a recurrent public concern of the next several decades. This is because of the huge commercial value of a near-monopoly internet presence, combined with legally unfettered use of personal data. This is what gives Google a market capitalisation of $130 billion (£79 billion). It represents the value of exploiting its customers’ private data for commercial ends.

Yup. So maybe Google takes some things, works out general patterns of people's behaviour and people like drug companies are interested in that. They won't provide actual records to people though.

It was the prospect of huge profits that pushed Google into its amoral deal with China and drove its high- handed approach to the intrusion on people’s privacy with Streetview. These profits also explain its cavalier approach to European legislation (which it claims does not apply to it). This means we have to be rigorous about how we allow any private- sector operator to manage state-originated personal data.

Just like any photographer taking photos in the street, StreetView was not an invasion of privacy. And everyone whores themselves for China. Microsoft and Yahoo do exactly the same sort of censoring to operate in China.

A Conservative spokesman was quoted last week as saying: “We fully expect that there will be multiple providers that will almost certainly be free to users.” If so, the question arises of how the providers will pay for it. It should not be possible to make money out of holding health data. Health information has to be secure, and should not be available to be used for commercial purposes. That means it should not be sold on, it should not be data mined for commercial insights, and it should not be used for targeted advertising.

Excuse me, but the development of the NHS IT system is using outsourced companies. That means they're making money out of holding health data right now. Google's model seems to be a bit more efficient and open to competition.

Furthermore, any companies allowed to hold this data must be required to do so on computers within the UK, with no possibility of transfer. This is the only way we can enforce UK privacy standards and laws. Paradoxically, such a contract might be of no interest to Google, because it denies the opportunity to profit from data exploitation. If a new government is not careful about these so-called “post-bureaucratic” policies, data-loss and data-misuse scandals will kill public confidence in it. This would be a tragedy.

In case you hadn't noticed, Davis. Google don't have a data loss problem. It's the UK government with it's departments littered with unencrypted USB sticks that does.

So private companies are better than the state, but they are not saints. Accordingly, before any government privatises personal data management, we should be clear about the rules and the structure. The protection of the individual’s right to control his or her own data must be plain and strong. An individual is unlikely to mount, let alone win, a legal challenge against a large corporation unless that is so.

The point about the idea that the Conservative chap came up with is that there would be competing systems. And the Americans are already ahead of us on this with the CCD and CCR protocol. It's supported by Google Health, Microsoft HealthVault and some other systems. So, if you don't want to be with Google, you don't have to be. Heck, you could create your own server that presented your own health record and no-one would ever see it but you.

That is so even for their personal “commercial” data, such as shopping patterns. When it comes to more private information such as health records or tax-and-benefit history, we should go one step further and learn from the financial crash of the past two years. The financial “masters of the universe” were allowed to be too big to challenge, and too big to fail. Only three years ago, they were “cool”. Now they cripple our economy with their incompetence.

Oh, FFS. That was down to pisspoor regulation and property boom, not size.

It is a similar situation with the companies we eventually entrust with our personal data. They have to be subject to personal, judicial, and national influence. They should not be beyond control. So when we are handing out these state contracts, being a multinational mega- corporation is for once a competitive disadvantage. Google need not apply.

Missing the point entirely. This isn't about "state contracts". It's about individuals choosing where their data goes. And frankly, I'd happily put my data with Google than most of the cunts that get government contracts