Doctors blame untested policies for financial crisis in the NHSBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7557.9 (Published 29 June 2006) Cite this as: BMJ 2006;333:9
All rapid responses
In response to Mr Black, there is no evidence that the
(re)introduction of the internal market (as Practice-Based Commissioning
and Payment By Results, in place of fundholding) will lead to significant
improvements in population health. Comparison of UK and USA population
health indicators show, in virtually all cases, that the market-driven US
health system fails to deliver across the whole population compared with
the UK. We can do better, but moving towards privatisation is not the
direction we should take.
Indeed, there are major concerns that the introduction of market
principles such as practice-based commissioning and redirection of
finances into the associated administration will serve only to worsen
health inequalities for the most deprived populations. The replication of
US style health systems in the UK, delivered by giants like United Health
Europe and Kaiser Permanente, will not provide quality care for those with
the least ability to exercise 'choice' - the poorest in our society. Most
patients do not want to 'choose and book' from a plurality of competing
providers miles away from their homes - they want good, locally delivered
health care that is accessible and equitable.
The NHS is currently undergoing yet another demoralising service
reorganisation, led in the main by a vanguard of external management
consultants and private providers who stand to pick at the choicest meat
from a dying NHS carcass abandoned to profit seekers. The NHS spent over
£1 billion on 'advisors' who seem to have a tenuous grasp of the clinical
realities of delivering high quality services across populations with
widely differing health needs. While clinical staff are increasingly
required, quite correctly, to base their clinical and public health
interventions on solid research evidence, there appears to be no
equivalent requirement for management consulting interventions to be
evidence-based. The introduction of untested management theories is mainly
to provide political capital to be seen to be 'doing something' and to
dismantle covertly for profit an NHS/social care system which is already
highly efficient compared to other health care models.
When the vultures have finally flown away, bellies full, what a
pathetic skeleton service will remain for the most disadvantaged people in
the UK. It is time to depoliticise the NHS, and to prevent politicians and
businesses solely interested in the profit margin from abandoning the
health needs of the poor.
Doctor working in the NHS who is is a supporter of 'Keep The NHS Public'
Competing interests: No competing interests
Is the BMA positioning itself like an old-fashioned trade union: out
to protect its members from any sort of change regardless of the impact on
the public? This is often the implication of the rhetoric at the BMA
Here are some examples of where the rhetoric is disconnected from
One speaker moans about the huge sums spent on IT. Another that
nurses have to spend more time scurrying around to find free beds instead
of caring for patients. Neither sees the irony of the fact that the way to
avoid the latter problem is to spend more on the former. Computers are
good at keeping track of patients and free beds, but the BMA would prefer
the money spent on "front-line" staff. The result being that hospitals are
like a hotel where, to find a free room, you have to knock on every door
and check for guests. In fact the NHS spends a great deal less on
computers than almost any other organisation and wastes a great deal of
staff time and energy as a result. But actually fixing problems is not
what the rhetoric is about is it?
Another speaker complains that the internal market makes it
impossible for trusts to control their costs. This one I just don't get.
The market doesn't affect trusts' costs: they are an internal problem for
trusts and they have the same control over them as they have always had.
The market affects their income and patient flow. The impact of that is
that trusts can no longer compensate for poor control of costs and
inefficiency by doing cushy deals with commissioners or being bailed out
by SHAs. That means that trusts might actually have to get a grip on their
costs. A true union can't tolerate this sort of interference with its
members rights. We can't go around admitting that some doctors and some
hospitals are more efficient that others, can we?
Managment consultant working in health
Competing interests: No competing interests