The BBC reports that a thorough review of the NHS in England by the National Audit Office has found "little evidence" that patient’s complaints improved services. In fact, most don’t even bother to kick up a fuss because they don’t think it will make any difference, while those that do find the whole process a bureaucratic mess.
A spokesman for the Patients Association said: “Despite the army of people involved, the NHS is light years away from a genuine complaints service. It lacks compassion, is bureaucratic beyond belief and takes far too long. This is not a "service", it is a sham.'
In response to the report, a spokesman for the Department of Health has stated that: "From next year, we are simplifying the system. Greater emphasis is to be placed on working with the complainant to resolve cases satisfactorily at a local level. We are also requiring NHS organisations and local authorities to publicise the complaints procedure and encourage people to use it. In addition, local organisations will publish information on the number of complaints received and how they have been dealt with."
However, this response fails to address the underlying problem the report highlights. Although the process of complaining is arduous, the real problem is that apathy reigns supreme; patients rightly fail to see how such a vast inefficient bureaucracy can even hope to offer a decent service. As such, what point is there in complaining?
With most people taxed beyond the means of paying for private healthcare, patients are unable to take their custom elsewhere, surely the most common reaction to bad service in the private sector. Foundation Hospitals have failed to address this core problem. Instead, people should be free to divert their money – which the government currently wastes on the NHS – into privately provided healthcare. This would empower many more people to enjoy the undoubted benefits the private system, currently only enjoyed by the very wealthy.
The anti-smoking group ASH is claiming that “Treating smokers costs the NHS in England £2.7bn a year, compared with £1.7bn a decade ago". As such, they have policy suggestions to nudge, embarrass and generally slap smokers about the face until they wield to the unquestionable god-given will of those that would rather you didn’t.
However, that £2.7bn is not the whole picture, as smokers pay in excess of £9bn per year in taxes. Thus, instead of deriding the cigarette lover for using NHS resources, we should all gather round and thank them wholeheartedly for ploughing £6.3bn per year for the running of the state. So next time you are walking down the street and you hear the wheezing cough of a 40-a-day man, doff your metaphorical hat and thank him for helping the sick of this country.
In fact, in recognition the great work that smokers do, I suggest that we have a national smoking day in which we celebrate these great state benefactors. Perhaps our rulers will be kind enough to open up the doors of the once populated pubs of this country, allowing smokers to partake of that quaint pastime of smoking a cigarette while drinking a pint.
If not, I fear rebellion. The smokers of this country could demand a tax rebate of around £700 every year, and why not? If such a situation arises, may I suggest the government takes the much criticized ID Card scheme and transforms them into smokers loyalty cards to be accredited at newsagents and supermarkets with every purchase. At the end of the year these points could be turned into cash.
Alternatively, the government and ASH could simply leave the good smokers of this country alone.
The NHS is aiming to recruit a major new supplier of body parts and blood. Namely: our children. Schools Secretary Ed Balls is looking to indoctrinate educate school children in the benefits of organ and blood donation. Current benefits include cups of tea and loss of life, and an over bearing sense of self-worth with which you can bore your friends to death with.
Due to current shortages in the market of donors, the government can find no effective way of harvesting the 8,000 organs that are currently needed. This is despite there already being 15.7 million people registered.
What is most alarming about the incorporation of this into the curriculum is the subtle way that the government's attempt to nationalize our bodies is exposed by the 'lax' comments of John Dunford, General Secretary of the Association of School and College Leaders who said donation was a "crucial issue" that "must be addressed in schools" followed by: "I think it's good to encourage young people to become donors. I hope they'll encourage their parents to do the same."
And there we have it: the inescapable establishment of the Spies (the youth organization from 1984). Children are to become the mouthpieces of the state, to further pressure adults to act in the ways and forms the government requires. If the government had an iota of intelligence, they allow the financial compensation for people donating either body parts or body content (undertaken in only a minority of incidents). But alas they don’t. It seems that the government brain cell has been donated. I pity the recipient.
I spent another depressing evening this week among the deckchair-shufflers as RMS National Health Service sails gracefully towards the iceberg of our ageing population.
It was billed as a chance to meet some of the regulators, like Baroness (Barbara) Young, who's heading up the new Care Quality Commission, and fellow Scot Bill Moyes of Monitor, the NHS Trust regulator.
We were under the Chatham House rule, so I can't tell you what was said. But since nothing was said, that's no problem. I've rarely heard so many platitudes in a single evening. However, I'm sure the good Baroness wouldn't mind me reporting that she began her talk by explaining that she wanted the Care Quality Commission to be 'The People's Regulator'. I missed quite a bit of what followed because I had to leave to throw up.
The CQC, as we must learn to call it, has been given the task of bringing all health and social care, public and private, under the same regulatory umbrella. It replaces quangos that were set up under this government, which is rather an astonishing (and expensive) u- turn. Not so much the 'Not Invented Here' syndrome as the 'Nutty Invention Here' syndrome. The watchdog's 'Initial Manifesto' says it will be 'open, transparent and accountable...tough and fair...guided by care users...' Er, I feel sick again.
I'm afraid that Lady B has an impossible job in seeking to regulate the whole of health and social care. Just as the National Health Service has an impossible job in trying to deliver it. The NHS is too big to manage, and it's too big to control.
We don't need a Shoe Quality Commission to regulate the quality of our shoes. Customer choice and competition do the job perfectly well – and systematically, remorselessly and constantly, through every decision that every buyer of shoes makes. Bad shoemakers get driven out because people who buy bad shoes demand their money back and tell all their friends not to buy that brand. It's probably just as well. A Shoe Quality Commission would probably end up compiling a 7,000-page Shoe Quality Manual detailing rules for everything from the length of the laces to the thickness of each nail. It wouldn't do customers any good at all. Far better if we scrapped the state healthcare monopoly and used the real decisions of millions of healthcare customers to drive up quality. That would be far more effective than leaving it to a bunch of quango-crats on index-linked pensions.
News just in from the Lib Dem conference – the party is planning to give income tax breaks to the healthy. Under the proposals, Local Health Boards would be set up with powers to cut taxes for those who gain 'points' by attending regular cancer screenings and take part in physical activities. Activities would be logged via a swipe card system and points redeemed against proposed local income tax bills. Direct incentives would be backed up by penalties for failing to turn up to GP appointments.
At first glance the proposals appear to contain some sound principles – in particular the attempt to break the Stalinist grip Whitehall has over the health service by establishing directly elected Local Health Boards who would be "free to commission services from a range of providers to secure improved quality of care and value for money". The explicit incentives to get patients to take more responsibility for their healthcare would also bring a welcome shift in patient attitudes towards their health.
Last week I discussed Clegg’s proposals for directly elected health boards pointing out that a market based health system would provide a form of democracy far superior to that of merely voting every four years for a health board.
Similarly, proposals to recreate the incentives of a market based insurance system beg the question – if insurance companies have been so effective in incentivising healthy living why try to merely recreate these incentives? Why not just switch to the superior model? An insurance system would put the purchasing of health services firmly into the hands of the patient - simultaneously breaking the government monopoly on healthcare delivery, while providing patients with incentives to live healthy lifestyles. Clearly the Lib Dems believe that markets work – why not put those beliefs in to practice?
Previous blogs have highlighted concern over “immoral, incoherent and quite possibly illegal" NHS rules denying patients care if they choose to top-up their treatment privately. Now, the health think-tank, the King’s Fund, has said that the NHS should no longer be able to discriminate in such a way.
Currently, patients may lose the right to free NHS care if they pay privately for drugs rejected by the National Institute for Health and Clinical Excellence as not cost-effective. This seems highly inconsistent when people are able to top-up dental and optical treatment, as well as additional non-clinical treatment such as private rooms, but are denied this option when it comes to the prolonging their life.
Niall Dickson, Chief Executive of the King’s Fund, said that: "The current practice on top-ups, which prohibits people from privately purchasing drugs not available on the health service while continuing a course of NHS care, is untenable."
Some of the drugs concerned are not available on the NHS as they are only effective for some patients. The King’s Fund said that if the treatment is effective for the patient, then after a certain time period, particularly if the patient is financially unable to continue using the drug, the NHS should bare the cost.
Up until recently, ministers have said that top-up treatment would cause a two-tier health system, however, after recent high-profile cases of cancer patients being denied life prolonging drugs, they have agreed to reconsider the issue. Professor Sir Mike Richards, cancer expert, is currently preparing a report for ministers reviewing top-up policy that is likely to be ready in the next month.
When people look at the US healthcare system, they imagine that private healthcare has to be hugely expensive. But the reason it's expensive is because it's hugely over-regulated. Tax and regulatory rules promote insurance through employers – reducing individual choice and meaning you lose your insurance when you change jobs. You can't buy insurance across state lines – live in New York and you have to have a Rolls-Royce insurance plan of the kind New York specifies: you can't buy a SmartCar plan, even if that suits you better.
And of course a rising part of the US healthcare system is the federal Medicare and Medicaid plans - bigger than the UK National Health Service, and growing fast:, according to the CBO, Medicaid and Medicare alone will absorb 20% of GDP in 70 years' time.
There are some proposals to open up the insurance market: a standard personal tax deduction rather than favouring employer-based plans, allowing choice across state lines, and so on. But there are promising new alternatives too. Pioneered by drugstore chains CVS, Target and Walgreens, more than 1500 retail health clinics are now in operation, up from 800 last year. Wal-Mart plans to open another 400 by 2010.
Wal-Mart will lease space in their supermarkets for drop-in clinics run by local hospital and other providers. Nurse practitioners will staff them, and they will be open seven days and evenings each week. They will provide basic services and will refer more serious cases to doctors and hospitals. Prices will be typically in the $40-$65 region.
People will be able to get quick, cheap, convenient diagnostics, even if uninsured (about half of Wal-Mart clinics' patients are uninsured). That will break the physicians' monopoly, which will have very positive effects on driving down US healthcare costs more generally. I only hope that the Wal-Mart clinics come quickly – before the doctors lobby to outlaw them and restore the regulatory sclerosis that they naturally favour.
At an event hosted by the think tank Reform, Nick Clegg became the first of the three leading parties to commit to allowing patients to top-up their healthcare.
‘I'm a liberal. We cannot continue to deny people the right to top up their care’ he announced.
Good – as Tom has written here, preventing patients from topping up their NHS care privately is immoral, impractical, incoherent and (quite possibly) illegal.
However, the Lib Dem leader also rejected plans to move towards an insurance-based health system. Under Reform’s proposals patients would receive a healthcare premium of £2000 per year, which they would then us to purchase health insurance from a range of Health Protection Providers.
He also backed away from the idea of forcing Primary Care Trusts to compete with one another, instead advocating the option of creating local, electorally accountable PCTs with responsibility for the residents under their care. Such a move would, he maintained, remove some of the control that that Department of Health has on the NHS. The state would, however, continue to play a role in the distributing resources, setting standards and altering patient premiums to reward GPs who work in deprived areas.
Of course, what Clegg misses is the fact that, if left to the market, patients, rather than being given a chance to vote just once every few years for a Local Health Board, would vote every time they made a decision on where and in what form to purchase their healthcare. A real market in healthcare would give patients the right to choose and switch providers, thus driving up standards, increasing innovation in healthcare delivery and empowering patients - benefiting the many and not just the noisy few.
There is a clear indicator that the US healthcare sector is uncompetitive. When you go to see your lawyer, accountant or other professional, you are ushered into the reception area. When you go to see your doctor, you are led to the waiting room.
Dr John C Goodman of the National Center for Policy Analysis
What free markets achieved against the system of state socialism, may also be achieved to undermine socialist health care. The customers of health care, just like the East Germans who tore down the Berlin wall, may vote with their feet and crush the NHS and Medicare. The restriction of customers in these collective systems might be abandoned by as much as six million medical tourists worldwide by 2010.
Global competition in health care is allowing more patients from developed countries to travel for medical reasons to regions once characterized as "third world." Many of these "medical tourists" are not wealthy, but are seeking high quality medical care at affordable prices. To meet the growing demand, entrepreneurs are building technologically advanced facilities in India, Thailand, Latin America and elsewhere, and are hiring physicians, technicians and nurses trained to American and European standards to run them.
Health care in hospitals used to be a strictly local, but with technological progress and division of labor it is getting increasingly global. Today treatment abroad in many cases costs between one fifth or tenth what it would be in the US or Europe. The main reason for this is lower labor costs. In the US staff costs account for more than half of hospital operating costs. Doctors and nurses in India earn only half or one tenth respectively compared to their US colleagues. As Adam Smith has shown with his needle factory, the only way the West can offset the comparative advantage of these third world health care providers is through a boost in the division of labor of the health care work force. And the pressure is increasing to do just that.
The BBC 
The anti-smoking group ASH is 
The NHS is aiming to recruit a major new supplier of body parts and blood. Namely: our children. Schools Secretary Ed Balls is 
I spent another depressing evening this week among the deckchair-shufflers as RMS National Health Service sails gracefully towards the iceberg of our ageing population.
News just in from the Lib Dem conference – the party is planning to give income tax breaks to the healthy. Under the proposals, Local Health Boards would be set up with powers to cut taxes for those who gain 'points' by attending regular cancer screenings and take part in physical activities. Activities would be logged via a swipe card system and points redeemed against proposed local income tax bills. Direct incentives would be backed up by penalties for failing to turn up to GP appointments. .jpg)
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When people look at the US healthcare system, they imagine that private healthcare has to be hugely expensive. But the reason it's expensive is because it's hugely over-regulated. Tax and regulatory rules promote insurance through employers – reducing individual choice and meaning you lose your insurance when you change jobs. You can't buy insurance across state lines – live in New York and you have to have a Rolls-Royce insurance plan of the kind New York specifies: you can't buy a SmartCar plan, even if that suits you better.