Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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NHS privatisation was piloted in prisons
- Andrew J Ashworth (19 May 2006)
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Changing drivers in the NHS
- Elizabeth D Barrett (22 May 2006)
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In a word "NO"
- Roberta Smith (27 May 2006)
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Not a winning battle
- Binit Koirala (28 May 2006)
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Andrew J Ashworth, GP Davidsons Mains Medical Centre, 5 Quality Street, EDINBURGH EH4 5BP
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It is no surprise to see NHS General Practice being eroded by big business. Doctors advocate for al their patients; politicians (the “owners” of the NHS) have pressures that are often at odds with those of patients and therefore their GPs. Big business is well placed to act as the agent of Government untroubled by contact with real people, GPs see patient needs having priority over Government targets. By seeking a system that reduces doctors… “responsibility” for patients to an employment contract (with minimum AND MAXIMUM standards set by managers), politicians can have less hassle, perhaps at the expense of reduced patient care but without the electoral risk of providing for free an increasingly expensive product to an increasing number of clients within a limited budget. In Scotland some years ago, a group of senior prison doctors attempted to bid for the contract to provide health services to Scottish prisoners but were thwarted by a tender process that appeared biased towards a single service provider with a commercial track record. During the run up to the process, proposals to set up a clinical partnership with an academic department of General Practice to provide much needed clinical research into custodial medical care failed in the face of the plans to contract out to a “single service provider” by Scottish Prison Service. From a professional clinical perspective the episode made no sense but it became much easier to homogenise prisoner care and to downplay prisoner specific issues (such as transmission of Hepatitis C) whose solutions might have been seen as controversial. It is common practice for public bodies to have tender processes that favour big business over small businesses. “Risk reduction” is a term used to camouflage the bias away from professionally led services to easily managed services. In Government terms, “risk reduction” often involves transferring risk away from politically sensitive bureaucratic bodies to patients (including prisoners) whose individual catastrophes are irrelevant to those who foot the bill. The BMA has the resources to take counsel and seek Judicial Review of the current process of privatisation of the NHS: dotors and their patients needed that process before prisoner care was degraded in Scotland ‚ we now need it for law abiding patients across the UK! Competing interests: Former Chairman of BMA CIvil Service Committee, Former Prison Doctor |
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Elizabeth D Barrett, GP Shires Health Care, 18 Main Street, Shirebrook, NG20 8DG
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In referring to my semi-retired GP husband as a ‘spare driver’, I must have confused matters! Although he did drive a bus for Glasgow Transport, as a medical student, his strength was in his potential flexibility in a project that was likely to involve development and change. His PSV licence has long since expired! The Langwith case reached the High Court over whether there was an obligation to activate section 11 of the 2001 Health and Social Care Act, in this particular case. The Act states, among other things, that patients should be involved in the development and consideration of proposals for changes in the ‘way’ in which their services are provided. Among the many interesting questions that have been addressed, there is no suggestion that patient views should, necessarily, determine outcomes; the issue is about the process of taking them into account. The national debate on privatization is a separate issue, but the publicity given to this case has been an important part of informing people as to how the culture and the drivers are changing in the NHS. Although, when we put in our bid, we had no idea of what was about to happen, we subsequently allowed our bid to be used as an illustration of process. I believe that the NHS belongs to the electorate, and not to the Government or to professionals. It is worrying that the views of the electorate have not yet been sought, nationally, on the profound implications of allowing multi-national companies entry into the NHS. It is beyond belief that there has been no meaningful debate in Parliament. There are clearly arguments on both sides and the electorate should be given the opportunity to air them. There is a basic need for a ‘risk assessment’, if nothing else. Merely re-defining GPs as ‘private’ and saying that they must become more commercial, in order to compete, does not address the ethical weakness that the principle had already been conceded without a public debate. Hoping that ‘hybrids’ will emerge is not a robust approach to a profoundly moral issue. We are currently seeing a Government wringing its hands because it sold off rail franchises according to free-market criteria. Now, it expects the companies to run the rail service according to codes of public service. The result is not a happy one. Structures are not neutral; to allege that they are is to demonstrate ignorance of the profound effect of structures on behaviour. We need to face up to the reality that it may be impossible to have a private sector that can deliver public service values as its priority - and still survive. So, perhaps it’s time to talk. Competing interests: GP involved in local bid to run Langwith surgery. Lead GP for Patient Liaison in her present practice. Recently became a member of Keep Our NHS Public |
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Roberta Smith, Between jobs UK
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Doctors do not have a hope of being able to compete with big business. As an NHS patient, it has being an interesting process watching the unfolding drama of the NHS being partially privatised. What must not be forgotten is that there may be lots of areas in the UK that are in need of good quality healthcare. But what must also be taken into account is the patients. We (Generation X, the ecstacy/body shock generation - Maggie Thatchers children) were brought up with privatisation. We are these patients. Do remember that as ill as we all may be, we have all still had to work and earn money. We all had to do this in the private sector, as the country was sold to the dogs - Which means we are the employees of the private sector. That means we ARE the big business. Yes, some of us are heroin addicts, some are depressed, some of us have cancer - Most of us have something. But ones things for sure, Maggie taught us all well - If we don't like you, we'll sell you. Competing interests: None declared |
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Binit Koirala, MBBS student BPKIHS Dharan Nepal
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GPs cannot win the battle with big businesses as far as I can see, due to the lack of financial support which makes the big businesses have the upper hand in the playing field.Even with the help of organisations like the NHS and the medical associations , this battle looks a bleak one and unlikely to win from the point of view of the medical profession. Competing interests: None declared |
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