Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Who cares what doctors or the BMA thinks?
- Neville W Goodman (30 June 2006)
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The world is run by those who turn up!
- Steven Ford (30 June 2006)
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If you are serious about quality, say yes to the market
- Geoffrey M Knox (30 June 2006)
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Say no to ideologically dug-in heels
- Shefaly Yogendra (30 June 2006)
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SAY 'No' TO THE MARKET
- Christopher W IDE (1 July 2006)
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say no to weather
- L S Lewis (2 July 2006)
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Not the ‘market’ but the cutting edge quality.
- Jeevan P Marasinghe, Amarasinghe A A W, MD, Mcdonough, Georgia, USA. (4 July 2006)
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Lets apply these priciples to the BMJ!
- Andrew J Ashworth (5 July 2006)
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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From the lead story in this morning's Guardian (1), headline: £64bn NHS privatisation plan revealed. A secret plan to privatise an entire tier of the NHS in England was revealed... when the Department of Health asked multinational firms to manage services worth up to £64bn. The department's commercial directorate placed an advertisement in the EU official journal inviting companies to begin "a competitive dialogue" about [taking over] purchasing of healthcare... ...Under the new system, the PCTs would contract out the commissioning to big healthcare management consortiums with greater purchasing muscle. Contenders for the contracts are likely to include... United Health and Kaiser Permanente [and maybe] BUPA and PPP... ...Lord Warner said: "The government has no plans to privatise the NHS." ... 1. (Byline) John Carvel, Guardian 30 June 2006, p1, col 1; and at guardian.co.uk Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice. NE47 6LA.
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Editor It has been an enduring puzzle to me that the profession can be in large measures of agreement over the folly of successive government's policies but the option of direct political action is almost never discussed. Much of that which is happening to the NHS is almost wholly condemned by those who work in it but the BMA response is routinely nicely measured, delivered with restrained eloquence and characterised by a remorseless reasonableness. It is my belief that the next election will be the last at which any substantial impact can be made and that we should mobilise now, with other concerned groups such as the RCN, and have pro-NHS candidates in every constituency. We have the example of Dr. Richard Taylor MP who has been elected twice on a health ticket. A colleague recently supplied an apt phrase - 'the world is run by those who turn up.' We are all concerned, we command the confidence of a far larger section of the electorate than many, we can be articulate, we could be a very effective parliamentary influence - who knows - we might even win. Why does the profession not mobilise politically? I'm game - anyone else? Yours sincerely Steven Ford Competing interests: None beyond the obvious - a devoted NHS wage slave. |
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Geoffrey M Knox, Director, Pain Solutions Ltd Lancashire, BB5 5UA
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Dear Editor, In "say no to the Market" you argue that performance and quality are key to developing our vision for future a healthcare system. I agree that quality and performance measures are vital but disagree with your editorial and the BMA, because if we are serious about performance and quality then my view is that the Market is a necessity. In an NHS monopoly, providers can deliver good or bad services safe in the knowledge that commissioners cannot go elsewhere for their services. In a Market, organisations have to stand up and account for what they have done with funding and what they propose to do in the future not in isolation but in competition with other providers - thus commissioners can actively base choices on quality and performance thus making these factors prime drivers for change. We all know excellent NHS services, sadly we also know of poorly performing services, the monopoly NHS inadvertently provides safety and security for both types of service. The Market provides a way for comparison of services and choice for commissioners that is most worrying for people working in poorly performing services. A commissioner seeking quality who also has a choice of providers can ensure that the people who stand to profit the most from the Market - are the patients. Say yes to quality, say yes to the market. yours Dr. G. M. Knox
Competing interests: I am a director of a company that offers the NHS an alternative provider for pain services |
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Shefaly Yogendra, Doctoral scholar, University of Cambridge CB2 1AG
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One cannot nowadays read an assessment of the US healthcare system without hearing about the "familiar spectacle of inefficient and fragmented care, spiralling costs, and growing inequities of access" and as Fiona Godlee adds, "there's now evidence that quality of care is patchy and worse overall than in other developed nations". It is worth asking first if 'good health' is a universal or indeed human right. If it is indeed so, it is worth asking if it is entirely the government's responsibility to deliver it with little, if any, individual responsibility attached for one's own health. Even if it is agreed that it is the responsibility of the government to deliver a uniform standard of healthcare - an oxymoron in terms because population-wide levels of health and individual propensities vary so much that it is nigh impossible to deliver on this metric - does that allow the primary delivery organisation to operate inefficiently or worse, ineffectively? I think the outright rejection of the market model - however that may be defined, because for the large part NHS remain publicly funded - is at least as ideologically driven as Labour's NHS reform programmes being decried by the BMA. A debate this ideologically entrenched, no matter how long it goes on, may not help improve the quality of patient care which should be the main goal of both the government and the caregivers. PS: My doctoral research explores various dimensions of health policy formulation in a UK/ US comparison. Competing interests: None declared |
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Christopher W IDE, Consultant Physician in Occupational Medicine Salus Occupational Health & Safet,y, Centrum, Park, Hagmill Road, COATBRIDGE ML5 4TD
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Editor, In your leading article, you criticise the US healthcare system and write "No other developed country has adopted such as system." As far as I am aware, no other democracy has provided health care by imitating the NHS system, all following some sort of mixed social and private insurance model. Yours sincerely, Competing interests: None declared |
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L S Lewis, GP Surgery, Newport, Pembrokeshire, SA42 0TJ
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your article makes no attempt to define 'market', but exhorts us all to say no to it .. Get real ! The market - a recognition that services , providers, consumers will all interact, and usually at a price - is as unavoidable as weather. The NHS buys drugs largely from private companies, at considerable cost. NHS Hospitals are built with public money by private building firms. Nurses, doctors, cleaners, and patient managers all look at alternative employment options outside the NHS. The BMA attempts to exert a trade-union pressure to exact a price for doctor's labour. Medical schools train generations of doctors, who may or may not find work in the UK. Even the BMJ comes at a price. Having recognised the pointlessness of 'saying no to the market', it is worthwhile agreeing these principles of the NHS:- 1. Free at the point of use ( in Wales - no prescription charge) 2. Funded entirely from general taxation ( with extra taxes on smokers and drinkers ! ) 3. Universal in its cover ( everybody can have anything, but may have to wait a very long time.. ) Nowhere is there a law that says NHS contracts for cataracts cannot be given to Private Ophthalmologists. Bring on the Tariff, I say - and let's get 'competitive' in our service quality and delivery ! Indeed , we GPs have had mixed fortunes over fifty+ years, varying this form of private-provider public-payment contract, whilst Dentists have largely given up on it. But did patients have their needs met as best the country could afford ? Competing interests: I am 'INDEPENDENT' GP working under contract to the NHS |
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Jeevan P Marasinghe, Registrar in Obstetrics and Gynecology,Teaching Hospital ,Peradeniya,Sri Lanka. 203000, Amarasinghe A A W, MD, Mcdonough, Georgia, USA.
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We all have to agree that UK has the world class environment for provision of good quality health and the health care providers are well motivated and adopted to deliver ground breaking new medicines and treatments. Through generations this has been the tradition of UK health care system and it should not be clouded by market strategies or a business minded minority. The health care system in any nation whether it be UK,USA,China,India or Sri Lanka should be a kind representative of the whole society and is bound to care the whole general population and it should be publicly funded and freely available. This will make sure that everybody in the society will have a chance to enjoy the cutting edge, innovative medical therapies. Any health care service whether it be NHS or any other similar authority should be funded on a population basis or in other words general taxation (1). Each and every individual then have the rights to enjoy the facilities in an appropriate manner. Sadly the patient’s responsibility towards the health care system tends to be diminished due to free accessibility of leading edge service and due to ignorance. It is quiet clear that the public must be bold enough not to overuse valuable resources and “the doctor shopping” (2) has to be thoroughly discouraged. Unfortunately this is quite common in Sri Lanka where almost all the health care facilities are free of charge and sometimes it is not uncommon to find a patient with a handful of same type of investigation reports performed at several hospitals. This needs a radical shake up of the way things have been done up to now and patients have to be well stressed on their duties and responsibilities when enjoying a service which is funded by population based taxation. Moreover the patients should be encouraged to participate in clinical trials, teaching sessions to medical students and junior doctors which will enhance the health of the population in long run. Collectively these efforts would make any health care authority a forefront in service, clinical research and teaching. This would create immense benefits to present and future citizens of a country and economic development when fully implemented. At the end of the day it is not the ‘market’ but the humanity that the patients love to see from us. References. (1)Fiona Godlee. Say no to the market BMJ 2006; 333(1 July) (2)Olsen DM.Medical care as a commodity: an exploration of the shopping behavior of patients.J community health 1976 winter; 2(2):85-91. Competing interests: None declared |
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Andrew J Ashworth, GP Davidsons Mains Medical Centre, EH4 5BP
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The Editor of the BMJ apparently beilieves that the BMA members "want a vision for health care that does not involve the market, uses ethical rationing based on clinical need, has commissioning driven by quality not profit, is patient not shareholder centred, and is clinician led.” Would we, the members of the BMA, be happy if our Editor was demanding this as a model for our journal (of which she is the temporary paid custodian)? If it is not to involve the market, the BMJ should stop taking payment for advertisements, rather assessing each on its potential to satisfy the needs of BMA members. It should “ration” its publications to those subjects and questions for which there is an evidence based need from the membership (perhaps based on focus groups – LMCs would do!), commissioning should be based on quality as defined by members not the editorial cabal currently in control of policy, should not be influenced by providers (the implied interpretation of “shareholders” in this statement) meaning that the Editor should never attend academic meetings at our expense. By “clinician led” she presumably means that the NHS should do what its workers say rather than what its customers say. Is the Editor (and the membership) too young to remember the pre-Thatcher, Union controlled, Britain in hock to the IMF? She made a fuss when the Canadian Medical Association took issue with its Editors undermining its political work on behalf of its members – do we really believe she should be unaccountable? An alternative explanation is that the Editor might be prepared to eschew the Market and work simply on the basis of the membership meeting her basic needs in the Soviet system she and the section of the BMA membership she reports on appear to crave! The ARM should be careful that its left wing, "holier than thou" assumptions will simply be used to reduce the remuneration of the vast majority of us who see the BMA's principal function as negoting pay and conditions on our behalf! Competing interests: I am not prepared to do the job I love for nothing! |
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