My satirical post yesterday was out of frustration because the Prime Minister and Secretary of State have such a breezy contempt for evidence.
When SoS Lansley came to visit my surgery yesterday with Nick Robinson from the BBC, the interesting discussions were stopped by Nick Robinson for being too ‘technical’. But evidence is technical. Political propaganda on the other hand is deceptively simple. So when Dr Deborah Colvin challenged SoS Lansley’s assertions that the UK health outcomes are way behind Europe and she quoted Porfessor John Appleby’s highly critical analysis of the data published in the BMJ, Lansley quite literally, with a sweeping gesture, dismissed her concerns and Nick Robinson steered the conversation back to sound-bite stuff.
Doctors spend their lives explaining medical problems in language patients understand. They are trained for a long time to do this and have to be sure that their information is accurate and clearly understood. It is the basis of informed consent. Politicians on the other hand have no duty to explain political problems to the same standards. Deception, over simplification (or the opposite), propaganda and rhetoric are the tools of their communication trade.
There have been excellent straightforward criticisms of the “myths and facts” put out by Cameron, published in the Times, and also available on the Number 10 website.
For starters he [Cameron] chastises the NHS for poor outcomes. We are “behind the best in Europe”. Readers will know John Appleby from the King’s Fund, gave that a good kicking over the weekend. It is not true
The PM says he wants to improve patent choice. As the great unwashed, like you and me, are obliged to register with one practice only, we will only be able to benefit from the care-pathways, treatments and locations that our practice’s Consortia have agreed. We have no input into that process and there is no legal requirement for the Consortia to make a place for a patient at the top table. So that argument bombs.
Next, he tells us the GPs are gagging for it. One hundred and forty one pathfinder consortia are hopping and skipping along the yellow brick road towards the blue horizon of a perfect future. Er, apparently not. We publish, today, the outcome of the Royal College of General Practitioners’ survey of GP’s views on the reforms. It is the biggest survey, so far. If you are reading this in the DH or Downing Street, sit down and pour a strong cup of coffee.
GPs are about two to one (sometimes three to one) against it and don’t believe it will improve anything. (More coverage in the Guardian). So why are GPs joining up? Pathfinders are GPs quickly getting into comfy groups with their mates before someone else dictates who they have to play with. In some parts of the country they are trying to buttress collapsing PCTs. In nearly all cases GPs are not trying to run pathfinders, they are creating PCT-lite, hiring other people to do it for them.
The RCGP survey could not have been more accurately delivered by Guy Gibson. It is a Dam Buster.
The PM moved on to his next target; he tells us we have to cut the costs of bureaucracy. Let’s look at the facts. [Administration] costs in the NHS are about 5%. In the US healthcare system they are about +25%. In industry in general the percentage of management is about 16%. In the NHS it is 13%. There were 152 PCTs, now we are likely to have 200+ overlapping Consortia, meaning more management, not less. All this is from a really interesting one-pager from Leeds University Business School. Another prang for Downing Street.
Two final points in his letter; pharma prices are going up and there are more older people who will need treatment. Neither of which the NHS can do much about.
In yesterday’s lobby briefing the PMs spokesperson admitted he is running to catch-up.
I can’t find any bomb-proof reasons to blow-up the NHS. MPs have voted for the Bill at the second reading. I guess they just don’t realise; NHS outcomes are in line, or as good as the rest of the world, or on a trajectory to better them. Management costs are well within industry norms and could easily be reduced without destabilising the service. There will be no improvements in choice as practices are bound to Consortia who are doing nothing more that PCTs used to do and there is already plenty of room to involve the private sector if the DH’s FAQs on AWP are to be believed.
More important; they should look at the RCGP survey. The Prime Minister has made much of having GP support. It appears that is not the case and LaLa is running out of reasons. Perhaps you should write to your MP and put them straight?
Thank you Roy. firstname.lastname@example.org
There is another excellent response to the same myths from Andy Cowper of Health Policy Insight with evidence (and swearing) here. Well said Mr Cowper.
And here is a response from the Times by Richard Horton, editor of the Lancet:
No, Mr Cameron, you are peddling myths about NHS reform. If the Government truly wants to reduce inefficiency, it should abandon the mantra of competition and market forces
Sir, David Cameron (Opinion, Jan 31) insists that “only by modernising [the NHS] can we achieve the world-class care that we all want to see”. But his five myths are dangerous untruths.
First, health professionals know the NHS needs to change. We understand that some health outcomes fall short of what we should all expect. What we are asking for is the evidence that Andrew Lansley’s reforms provide the right changes to address these shortcomings. The truth is, there is no evidence, not a shred. What we do know from GP fundholding in the 1990s is that the promised benefits to healthcare never materialised. There is no reason to believe that benefits will accrue this time around.
Second, this is a revolution, not an evolution. For the first time in the history of the NHS, private non-NHS providers are preparing to take over large sections of NHS care. For example, in its presentation to investors last year, Tribal Group, a private provider of commissioning services to the NHS, listed “Commissioning for GP consortia”, “clinical support services”, and “patient management services” as key “growth priorities” in the UK.
Third, doctors are being forced to do something many don’t wish to do. The Lansley reforms are not optional. They are being implemented right across the NHS. Mr Cameron’s revolution is coercive, not collaborative.
Fourth, this is privatisation by the back door. Tribal’s strategy, along with other private providers, is to respond to “major changes in structure of UK health markets” by focusing its “health business on emerging service delivery opportunities”. What is this, if not privatisation?
And finally, Mr Cameron suggests that patient care will not suffer. I hope he is right. But hope is the only evidence we have. It is not satisfactory to base the future health of our nation on such an ill-informed and ideological plan.
Dr Richard Horton
Editor, The Lancet
Well said Richard.
And finally an excellent overview of the evidence from another blogger, RedEaredRabbit: Facts Evasion