LMITransactions&Report2014-15

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LMI Transactions and Report 2014 - 2015 Minutes of the Eleventh Ordinary Meeting Held on Thursday 12th March 2015 Joint Meeting with the BMA ‘Where Next for the NHS?’ Dr David Wrigley, GP, Carnforth Mr M McCormick, Dr D Wrigley and Dr P Dangerfield Dr Wrigley is a GP in Carnforth, north Lancashire. He sits on the British Medical Association UK Council and the BMA General Practice Committee and also a member of the Medical Practitioners Union. He is a member of the Labour party. He is also a spokesperson for Keep Our NHS Public – a non partisan campaigning group that seeks to bring about an NHS that is publicly funded, publicly provided and publicly accountable. He has written numerous articles and spoken widely on the marketisation of the English NHS and contributed to the 2013 book ‘NHS SOS’. A new book has just been published that he has co-authored with Dr Jacky Davis and John Lister titled ‘NHS for Sale – myths, lies and deceptions’. While he is a graduate of Sheffield Medical School, he did apply to Liverpool but was rejected and eventually entered medicine as a mature student through clearing! This is not so likely to happen today! In opening his talk, David introduced the audience to some key statistics related to the NHS, noting the colossal rise in costs from £33.5b in 1997 to £113b today, with millions treated by 147,000 doctors and 371,000 nurses. It was also noted that there are some 36,000 managers employed in the Service. For the population as a whole, the UK has 2.8 doctors per 1000 patients compared with Germany 4.0 or France 3.0, so is relatively under doctored. The NHS copes with 15.1m hospital admissions per year. To meet the demand, Medical Schools Intake has risen to 6262 in 2012. Overall, life expectancy varies in the country, but is still lowest in areas of denser population. Comparing the life expectancy to health spending per capita, David noted that the USA spends more on health care but overall has a lower life expectancy. In the launch of the NHS in 1948, the Evening Standard proclaimed “Free for all at a cost of £152m”. Every household got a leaflet about the new service explaining that “….everyone can use it for free, but it is not a charity so be responsible in its use. You are paying through your taxes…” There were charges for Spectacles though. 40
LMI Transactions and Report 2014 - 2015 The political consensus in England in the 1990s supported the concept of a market, and this was introduced by the Conservatives in 1991. BMA opposed the plans and were highly critical but were effectively frozen out of discussion. Following this new NHS structure, the parties such as New Labour, with Blair, Milburn and Stevens, were pro market. So were the Liberals with the Orange Book in 2004 and the latest legislation is very much more promarket, yet the devolved nations oppose it. Other aspects of the new NHS include private contribution through Labour’s PFI scheme. Milburn signed the concordat 2000 due to waiting lists and Labour put more money in to the NHS, thus allowing private hospitals to treat NHS patients. A purchaser/provider split was introduced together with new contracts. Patient choice was seen as helpful but did not mean more providers in the market. Payment by results also meant increased competition to get income by getting more work into the day. Any willing provider policy and the new Trusts allowed hospitals to be more in charge of their income. However, patient budgets have not really taken off, even though the concept was supposed to give more to a patient to look after their care. These changes were backed by provision of new insurance schemes to offer a policy to cope if your money ran out. Current policies have introduced the CCGs, choice is creating competition and plurality of provision allowing more choice. A 2010 Select Committee looked at the purchaser/provider split and concluded it offered no real benefit. The Commonwealth Fund looked at health care systems and found the NHS produced the best results compared with the rest of the world. For world health, comparing life expectancy with cost, showed highest cost in USA with the UK performing very well in spite of every negative comment made about it. Effectively, this demonstrated a market failure in practice in the USA. The USA system is a $2.3 trillion medical industrial complex but there are 50m people uninsured, and 62% personal bankrupts due to health care costs. ObamaCare came up against the lobby of industry opposition, using phrases like “socialised health care” and “look at the mess of the UK NHS”. The pressure for change was of course poor outcomes from life expectancies and infant mortality. As a case study, David noted that a North Carolina man got arrested for theft of $1 so he could get free health care, demonstrating a situation of desperation. Changes to the structure of NHS came from legislation in Parliament, setting up Strategic Health Authorities with Primary Care Trusts and NHS Trusts in the 1990s. The current 2013 structure is highly complex with different bodies. Dr Wrigley asserted that there were numerous myths circulating about the NHS. The first is that it is unaffordable. However, he pointed out that as a percentage of GDP, the cost is actually stable, running at about 30% up to 2007. David Nicholson, in 2008, met McKinsey secretly and a £20b cost saving challenge was introduced. Cuts from the budget of NHS quality, innovation, productivity and prevention challenges were viewed from a position of surplus in 2001. The politicians are not very open and honest either in their pronouncements. Spending was increased during 1970 to 2010 but the Coalition is presently only keeping income just above inflation. PFI keeps debt off the Government’s balance sheet but gives big returns to the private sector. It was introduced by Labour under Tony Blair, and now has costs of £180m per year. The deals are rock solid, government backed and can be traded on the open market. Deals are being sold overseas as they are seen as a very good investment deal. £12.2 billion could be £17.4 billion if Government borrowed the money on the markets, but the real cost is actually more like £80 billion. Interestingly, NHS logo guidelines allow private companies use the NHS logo, as it is seen as safe. In context of public opinion, YouGov polls looked at NHS, Rail, Energy and Mail and showed they were felt best in national ownership. The Health and Social Care Act was opposed by all the medical Colleges, Midwives and the BMA but was nonetheless adopted. The view is widely held that the present NHS reforms are the worst mistake by this Coalition Government. The speaker also pointed out that there were links between MPs who often ended up working for the private sector, giving rise to the ‘Revolving doors’ concept. The speaker then gave a number of quotes, including: “In the future the NHS will be a state insurance provider not a state deliverer…” and “…NHS will not 41
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