If elections are the hallmark of a successful democracy, Britain isn’t doing too badly. We can vote in person, by post or by proxy in regular elections to borough, county and parish councils, the London Assembly, mayoral elections, parliaments in Wales, Scotland and Northern Ireland, and the European and Westminster parliaments. Throw in Britain’s Got Talent and The X Factor and we have a veritable orgy of voting going on. But if we judge democracy on whether our votes make a difference, things look worse. Around four in ten electors will be so disillusioned that they won’t vote at all in this election. Democracy isn’t just about voting. It’s also about all the other rights that people have won – the right to organise, freedom of speech, the right to a fair trial by your peers. These democratic freedoms, like the vote, are founded on the revolutionary principle that we are all equal. Yet rich public school children grow up to be Tory judges who overturn democratic strike ballots to help the captains of industry – who are their family and friends. The failings of British democracy aren’t due to people being naturally greedy or corrupt. Democracy will never flourish under capitalism because underlying economic inequality fatally undermines the formal equality between individuals.
As Karl Marx argued, when everyone has equal rights, individuals with the most power will dominate. He said, “Between equal rights force decides.” Nominal equality is no match for the huge inequalities of wealth, power and violence that are deployed to enforce the rule of the rich minority. It sounds painfully familiar when we hear some political commentators recently talking about the benefits of a hung parliament that could provide a “broad-based” coalition government that “represents everyone”. Nothing exposes the hollowness of parliamentary democracy so much as the prospect of all political parties working together in the “national interest”. Consensus can exist in parliament while the dictators in banks and boardrooms continue sacking people and repossessing homes, and the generals continue their wars. In 1931, during a devastating economic depression, Ramsay MacDonald dissolved his democratically elected Labour government and agreed to the unelected king’s suggestion that he head up a coalition government.This was to reassure the bosses that there would be no opposition to public spending cuts and discourage them from taking their wealth out of the country. Labour could have taken direct control of their factories, raw materials and land. Instead the “national interest” government put the interests of the rich and powerful ahead of the majority. This sums up the problem with the cliches about making a “real difference” by voting for a “real alternative” – this election is about choosing who will manage capitalism, not about what kind of society we want.
The bosses want cuts in public spending and each party is offering up a timetable to deliver them. The media help us to understand our “choices” by running opinion polls on whether we would like the cuts a) now b) later and in a) health b) education or c) transport. It’s fantastic when socialists stand in elections and expose the lies of the mainstream parties, but it’s not easy terrain for us. Working people are not stupid. They know that electing a socialist won’t change how the system runs – so many will applaud the socialist, but vote to support the least worst party likely to form a government. The advent of the NHS, council housing and comprehensive schools seemed to show the potential of Labour to democratise society. But under capitalism democratic gains are fragile. The union leaders who reined in the industrial power of their members to ease Labour’s time in office have made excuses for the party as it rolls back the gains we fought for. But the corruption of Labour Party politics is more endemic than the recent expenses and lobbying scandals. It is the corruption of a million compromises just to “get elected”, of vanities flattered by pomp and prestige and of powerlessness in the face of the establishment.
At election time the dominant message hammered home is our lack of choice; that is one reason why some people vote for Nazis and racists who feed off despair. If the Nazis get elected they will try to do away with all vestiges of democracy – which is why abstaining from voting is not an option. Many workers will vote Labour despite their demoralisation. But overcoming that demoralisation will take more than voting in elections. It will require masses of people actively challenging the power of the ruling class through our own actions. Socialism in Britain will not come from voting for MPs to declare it, but from organising ourselves collectively to fight for it. If we do that we will also create a democracy of a much higher order than capitalism can deliver. Every time workers have significantly challenged the power of the ruling class they have set up new structures that involve people in the planning and running of society. When class is abolished and we hold the wealth of the world in common we will have a democracy founded on debating how best to meet our collective needs as a society. Marx summed it up as a society where each would give according to their ability and receive according to their needs. I reckon, given the choice, lots of people would vote for Britain to be like that.
Showing posts with label health. Show all posts
Showing posts with label health. Show all posts
Wednesday, 21 April 2010
Sunday, 11 April 2010
Election fever bad for your health
Gordon Brown has fired the starting gun for a race that was already in full flow. In four weeks we will know who has won the 2010 general election. Many angry activists, frustrated at new Labour's adherence to Thatcher's anti-union laws and continuation of her privatisation offensive, have argued that there is "no choice" between the main parties. But one area this is clearly not true is the NHS. While 18 years of Tory rule saw the NHS face cuts, the privatisation of hospital support services, Thatcher's mad, costly and wasteful "internal market" reforms, more cuts, soaring waiting lists and a growing gulf between the quality of British health care and much of Europe, 13 years of Labour rule has brought a real transformation. Huge new resources have been pumped in to the NHS. Spending has risen at the fastest rate in 60 years, with the health budget almost trebled since 1997, with generous above-inflation year-on-year increases since 2001, and the share of national wealth spent on health has increased towards the European average. Waiting times are down and with the 18-week maximum wait they are now among the best in Europe. And staff numbers are up - even if too many of these are managers. There are new hospitals, too, far more than since the late 1960s - although almost all of these have been funded through the controversial private finance initiative, the most expensive possible way to secure the money. PFI is just one of many weaknesses in Labour's record, of which we are all aware.
Another fundamental problem is that instead of sticking to his promise to sweep away Thatcher's costly and wasteful market system, Blair, and now Brown, have hung on to it, made it more complex and bureaucratic and brought in far more private-sector involvement than the Tories ever dreamed of. Overhead costs have mushroomed, while the talk of "efficiency" has never been louder. With the market has come today's indecipherable and pointless jargon of "world-class commissioning," swarms of private-sector management consultants, and the relentless drive to draw in private providers to deliver clinical services and even community and mental health services through the Transforming Community Services policy. With the market has come the establishment of a biased Co-operation and Competition Panel as a platform for whingeing private entrepreneurs to complain at their failure to win contracts, the positioning of Richard Branson's Virgin group and Care UK to exploit the current fad for expensive new "polyclinics" and privatisation of primary care, and the expensive irrelevance of independent-sector treatment centres creaming off the simplest and most profitable elective services at higher cost - and often delivering far fewer than the contracted numbers of operations.
The market system has also brought the "patient's choice" initiative encouraging NHS patients to seek simple elective treatment in private hospitals, leaving their local NHS hospitals facing financial losses and, of course, the costly folly of the billions squandered on a complex computer system that still doesn't work. But while Labour could obviously have spent much of the extra money more wisely - and even now could save billions painlessly by changing course on some of these policies - we know from their previous 18 years in office that the Tories wouldn't have spent the extra money at all. Left to them, the waiting list would still be with us, with tens of thousands of people still waiting 18 months or more for treatment in crumbling and poorly cleaned hospitals. And while Labour has stupidly rolled out the red carpet for private providers, the Tories would be even more eager to please any of their big business friends, like Sir Peter Gershon, who fancy a slice of the NHS £105 billion budget. So let's use the election period to keep the pressure on all the main parties to halt the £20 billion of cuts in the next few years, which threaten to devastate many local services, close hospitals, axe tens of thousands of beds and NHS jobs, and throw more qualified staff on the dole queue. Both parties threaten that, and these cuts must be fought, no matter what the result of the election.
But let's not forget that in 62 years of the NHS only one party has had the courage to pump much-needed resources into health care and create a service that gives us so much to defend. Ignore that difference and we could have years to regret a Cameron government. The pace and scale of planned cutbacks in health care and hospital services has been gathering pace up to the "purdah" period between now and May 6. Top of the cutters seems to be Southampton University Hospital Trust, which is seeking to axe a staggering £100m and 1,400 jobs over four years. Salford Royal - once known quite ironically as Hope Hospital - is to axe 750 jobs over three years, cutting its budget by 15 per cent. The most hurried cuts seem to be in Leicestershire, where the hospitals trust announced plans to cut £58m of spending in just one year with the loss of 700 jobs. But jobs and spending are being hacked back in Oxford, Cambridge, Leeds, Nottingham, Derby, Gateshead, Wirral, Portsmouth, Gloucester, Basildon and Slough. The NHS is Europe's biggest employer. The loss of these jobs, with a knock-on impact on local suppliers and businesses in each area, seems certain to contribute much more to a double-dip recession than Labour's plan to add 1 per cent to national insurance. As soon as "normal" politics resumes on May 7, each of these and many more cuts will need to be challenged by local campaigners and health unions.
Another fundamental problem is that instead of sticking to his promise to sweep away Thatcher's costly and wasteful market system, Blair, and now Brown, have hung on to it, made it more complex and bureaucratic and brought in far more private-sector involvement than the Tories ever dreamed of. Overhead costs have mushroomed, while the talk of "efficiency" has never been louder. With the market has come today's indecipherable and pointless jargon of "world-class commissioning," swarms of private-sector management consultants, and the relentless drive to draw in private providers to deliver clinical services and even community and mental health services through the Transforming Community Services policy. With the market has come the establishment of a biased Co-operation and Competition Panel as a platform for whingeing private entrepreneurs to complain at their failure to win contracts, the positioning of Richard Branson's Virgin group and Care UK to exploit the current fad for expensive new "polyclinics" and privatisation of primary care, and the expensive irrelevance of independent-sector treatment centres creaming off the simplest and most profitable elective services at higher cost - and often delivering far fewer than the contracted numbers of operations.
The market system has also brought the "patient's choice" initiative encouraging NHS patients to seek simple elective treatment in private hospitals, leaving their local NHS hospitals facing financial losses and, of course, the costly folly of the billions squandered on a complex computer system that still doesn't work. But while Labour could obviously have spent much of the extra money more wisely - and even now could save billions painlessly by changing course on some of these policies - we know from their previous 18 years in office that the Tories wouldn't have spent the extra money at all. Left to them, the waiting list would still be with us, with tens of thousands of people still waiting 18 months or more for treatment in crumbling and poorly cleaned hospitals. And while Labour has stupidly rolled out the red carpet for private providers, the Tories would be even more eager to please any of their big business friends, like Sir Peter Gershon, who fancy a slice of the NHS £105 billion budget. So let's use the election period to keep the pressure on all the main parties to halt the £20 billion of cuts in the next few years, which threaten to devastate many local services, close hospitals, axe tens of thousands of beds and NHS jobs, and throw more qualified staff on the dole queue. Both parties threaten that, and these cuts must be fought, no matter what the result of the election.
But let's not forget that in 62 years of the NHS only one party has had the courage to pump much-needed resources into health care and create a service that gives us so much to defend. Ignore that difference and we could have years to regret a Cameron government. The pace and scale of planned cutbacks in health care and hospital services has been gathering pace up to the "purdah" period between now and May 6. Top of the cutters seems to be Southampton University Hospital Trust, which is seeking to axe a staggering £100m and 1,400 jobs over four years. Salford Royal - once known quite ironically as Hope Hospital - is to axe 750 jobs over three years, cutting its budget by 15 per cent. The most hurried cuts seem to be in Leicestershire, where the hospitals trust announced plans to cut £58m of spending in just one year with the loss of 700 jobs. But jobs and spending are being hacked back in Oxford, Cambridge, Leeds, Nottingham, Derby, Gateshead, Wirral, Portsmouth, Gloucester, Basildon and Slough. The NHS is Europe's biggest employer. The loss of these jobs, with a knock-on impact on local suppliers and businesses in each area, seems certain to contribute much more to a double-dip recession than Labour's plan to add 1 per cent to national insurance. As soon as "normal" politics resumes on May 7, each of these and many more cuts will need to be challenged by local campaigners and health unions.
Friday, 9 April 2010
Blueprint for NHS sell-off
What will the Tories do to the NHS? I am returning to this question because it says a lot about where the two parties stand in the forthcoming election. It tells us Cameron is standing on policies as airbrushed as his face. And Labour is sitting on its hands because a proper punch at Cameron might also biff some of its chums on the chin. Both Labour and the Tories know the NHS is sensitive for Cameron - the Tory leader works hard to shake off popular suspicions that his party is anti-NHS. This is why he plastered up posters promising not to cut the health service. It is why he was desperate to distance himself from MEP Dan Hannan when the latter called the NHS a "mistake." And it is why Labour MPs have highlighted Cameron's pre-Christmas meeting with a group called Nurses for Reform. Nurses for Reform is a hard-right group which argues that the "NHS is no longer a dearly loved British institution. It is a Stalinist nationalised embarrassment that should now be quietly and deftly consigned to the dustbin of history." So Cameron was keen to play down the significance of the time he spent with it. I am going to agree with Cameron - slightly.
Nurses for Reform does not represent his most significant adviser. It is a bit more libertarian than purely Tory and more ultra in the free-market freakiness than he is. But a group called Doctors for Reform is much closer to the Tory centre. It is part of a think tank called Reform which has many strong Conservative connections. Tory shadow minister Ed Vaizey sits on the Reform advisory board. So does Christopher Gent, the ex-Lehman Brothers banker who funds the Tories and sits on Cameron's "recovery committee." Adrian Bull, boss of NHS privatisation firm Carillion Health, also sits on Reform's "advisory council." Doctors for Reform's policies are bound to please the think tank's advisers. They square the circle between "backing" the NHS and wanting to let free-market dogma and private health profiteering run riot in the health service. Doctors for Reform says that if "the founding principles of the NHS are to be preserved the following changes need to be adopted and implemented." Its changes preserve the NHS in the same way a butcher preserves a pig. They include: "Supply competition. Patients should be allowed to exercise real, informed choice about where, how and by whom they are treated." Instead of NHS hospitals treating NHS patients, the health service would dole out cash to private companies like Carillion. The health service would stop being a system of hospitals and clinics and become a big money tap pouring cash into the mouths of contractors.
The second change is "Topping up the basic level of care. The NHS should allow patients to spend their own money on treatment provided by either the independent sector or the NHS, where it might make a charge for treatments not normally available." So posh people could take their NHS money out of the health service, add a bit of their own cash and spend it at luxury hospitals. The third change is "Universal coverage with an insurance element. Our current system provides universal coverage but would benefit from having an insurance element." By raising NHS money through insurance schemes rather than tax, the burden of payment would be shifted away from the better off. This would lay the ground to opening up the NHS to the insurance industry. Now, I have gone to the trouble of looking at Doctors for Reform's proposals to dig out this plan to cut the NHS as a provider and shift it towards a voucher system funding the private health sector. But are these plans really secret? No - most of them are already in or compatible with the Tory draft health manifesto. In his manifesto Cameron promises to "open up the NHS to include new independent and voluntary sector providers." So when his billboards say that he will not cut the NHS, he means that he will.
He won't cut government spending on health, but he won't give the money to the NHS hospitals and clinics. Instead he will give the cash to his private health firm pals. Cameron's promise not to cut the NHS rests on a division between the NHS as a funder and as a provider. This arbitrary division is quite common in the minds of MPs, ministers, policy wonks and other Westminster folk, even though it is pretty much unknown in the wider world. And this will be done through a great big marketing drive, because Cameron says: "The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any health-care provider that meets NHS standards." So Carillion Health, for example, could grab the NHS cash from as many patients as it could persuade through its doors. It could use advertising drives, loss leaders and other tricks to starve local NHS hospitals. This would open the door to non-NHS health firms taking both NHS "voucher" payments and extra top-up fees for a little luxury. The only element of the Doctors for Reform plan not in Cameron's draft is the top-up insurance funding. So there is a lot of room to attack Cameron as wanting to take cash from the NHS and give it to his business pals. But Labour will not launch this attack because it did it first.
After years of campaigning by unions and activists, Health Secretary Andy Burnham finally stalled the handover of NHS money to private contractors. Because Labour has its own friends in the private health industry you get the feeling that it would want to restart the scheme as soon as possible if it was re-elected anyway. Essentially Labour is slow to attack Cameron's unpopular policies because they are too popular among its own team.
Nurses for Reform does not represent his most significant adviser. It is a bit more libertarian than purely Tory and more ultra in the free-market freakiness than he is. But a group called Doctors for Reform is much closer to the Tory centre. It is part of a think tank called Reform which has many strong Conservative connections. Tory shadow minister Ed Vaizey sits on the Reform advisory board. So does Christopher Gent, the ex-Lehman Brothers banker who funds the Tories and sits on Cameron's "recovery committee." Adrian Bull, boss of NHS privatisation firm Carillion Health, also sits on Reform's "advisory council." Doctors for Reform's policies are bound to please the think tank's advisers. They square the circle between "backing" the NHS and wanting to let free-market dogma and private health profiteering run riot in the health service. Doctors for Reform says that if "the founding principles of the NHS are to be preserved the following changes need to be adopted and implemented." Its changes preserve the NHS in the same way a butcher preserves a pig. They include: "Supply competition. Patients should be allowed to exercise real, informed choice about where, how and by whom they are treated." Instead of NHS hospitals treating NHS patients, the health service would dole out cash to private companies like Carillion. The health service would stop being a system of hospitals and clinics and become a big money tap pouring cash into the mouths of contractors.
The second change is "Topping up the basic level of care. The NHS should allow patients to spend their own money on treatment provided by either the independent sector or the NHS, where it might make a charge for treatments not normally available." So posh people could take their NHS money out of the health service, add a bit of their own cash and spend it at luxury hospitals. The third change is "Universal coverage with an insurance element. Our current system provides universal coverage but would benefit from having an insurance element." By raising NHS money through insurance schemes rather than tax, the burden of payment would be shifted away from the better off. This would lay the ground to opening up the NHS to the insurance industry. Now, I have gone to the trouble of looking at Doctors for Reform's proposals to dig out this plan to cut the NHS as a provider and shift it towards a voucher system funding the private health sector. But are these plans really secret? No - most of them are already in or compatible with the Tory draft health manifesto. In his manifesto Cameron promises to "open up the NHS to include new independent and voluntary sector providers." So when his billboards say that he will not cut the NHS, he means that he will.
He won't cut government spending on health, but he won't give the money to the NHS hospitals and clinics. Instead he will give the cash to his private health firm pals. Cameron's promise not to cut the NHS rests on a division between the NHS as a funder and as a provider. This arbitrary division is quite common in the minds of MPs, ministers, policy wonks and other Westminster folk, even though it is pretty much unknown in the wider world. And this will be done through a great big marketing drive, because Cameron says: "The next step is to create an NHS where patients are in the driving seat. We will give everyone the power to choose any health-care provider that meets NHS standards." So Carillion Health, for example, could grab the NHS cash from as many patients as it could persuade through its doors. It could use advertising drives, loss leaders and other tricks to starve local NHS hospitals. This would open the door to non-NHS health firms taking both NHS "voucher" payments and extra top-up fees for a little luxury. The only element of the Doctors for Reform plan not in Cameron's draft is the top-up insurance funding. So there is a lot of room to attack Cameron as wanting to take cash from the NHS and give it to his business pals. But Labour will not launch this attack because it did it first.
After years of campaigning by unions and activists, Health Secretary Andy Burnham finally stalled the handover of NHS money to private contractors. Because Labour has its own friends in the private health industry you get the feeling that it would want to restart the scheme as soon as possible if it was re-elected anyway. Essentially Labour is slow to attack Cameron's unpopular policies because they are too popular among its own team.
Saturday, 3 April 2010
New decade, old enemies for NHS
Perhaps against the odds, 2009 turned out to be a successful year in which campaigning and pressure forced a significant retreat on controversial policies in the NHS. The pell-mell drive to privatise community and primary care services that had until recently been directly provided by primary care trusts appears to have been slowed, if not halted, although very few people in the wider electorate even knew that it was going on. The change of policy is a result of consistent trade union pressure on health ministers - although sadly not before services in Hull, Bromley and Kingston had been lined up for take-over by "social enterprises." Private and "non-profit" voluntary sector organisations that fancied carving themselves a generous slice of the £11 billion NHS budget for these services, and some of the senior managers lining up to take advantage of Lord Darzi's so-called "right to request" that an NHS unit be hived off as a "social enterprise," have been twitching with anger at Health Secretary Andy Burnham. The so-called co-operation and competition panel, set up as a sounding board for aggrieved private-sector punters to complain they have been treated unfairly, has apparently received complaints from various aggrieved parties bitter at Burnham's October declaration that the NHS should be the "preferred provider" unless all efforts to improve NHS services had failed.
But to his credit Burnham has not only stuck to his guns, apparently having won the support of Gordon Brown - he has even suggested he may review the working of the competition panel itself. NHS managers have been - in some cases reluctantly - dragged into line on the new policy. If only we could look forward to similar successes in this new year. But sadly, the new decade is opening with the NHS facing new and very serious threats. The new danger is the old enemy that the London Health Emergency was formed to fight back against in 1983 - cuts and closures. All the main political parties are agreed that massive cuts should be inflicted on health care, education and other public services - not because these services have failed in any way, but because of a huge private-sector failure. They are cutting health care in a bid to cover the colossal £175 billion costs of bailing out failed and irresponsible bankers. Of course the party leaders won't admit that they plan cuts in the NHS, least of all in the run-up to the general election in May. So each of them claims to be "protecting" front-line services by increasing funding in line with inflation - ignoring the fact that the NHS needs billions more in real terms each year to keep pace with the costs of a growing population, rising numbers of elderly and new drugs and technology. And even if front-line budgets were to be protected, many spending plans for the next few years already assume massive "efficiency" savings of up to 5 per cent a year, without any evidence that unprecedented savings on this scale can be achieved without cuts.
To make matters worse, much of the 5 per cent of the NHS which is not seen as "front line" - and therefore not protected - includes training and research budgets which are likely to be slashed. Even NHS chief executive David Nicholson admits that the coming cuts are "tougher than the NHS has ever had, through its history. And it's for a sustained period." The squeeze will hit hospital services hardest of all - with a four-year freeze on the "payment by results" tariff which determines hospital budgets, and a massive 70 per cent cut in funding for any additional A&E patients treated in excess of the 2008-9 caseload. A Health Service Journal analysis argues that by 2014 "savings on this scale could entail perhaps half a dozen general hospitals going to the wall in each Strategic Health Authority." Hardest hit will be hospitals with large fixed overhead costs - in particular those funded through the private finance initiative. But primary care trusts and strategic health authorities are also required to cut their management costs by 30 per cent - some might say not before time. They are even looking to cut the massive amount they are wasting each year on hiring costly private-sector management consultants. While NHS chiefs are already discussing these issues in secret, the plans are only beginning to emerge. NHS London is leading the charge, with cuts - based on a secret briefing by US-based private management consultants McKinsey - aimed at slashing up to £5 billion from the capital's £13 billion primary care trust budget by 2017.
NHS London has said quite openly that it wants primary care trusts to chop A&E caseloads by 60 per cent - diverting almost 2 million patients a year to unproven or as yet non-existent primary care "polysystems." This seems especially bizarre in the context of this winter of snow and swine flu, in which all of the existing A&E units are full to bursting and running well above target. NHS London also wants primary care trusts to cut hospital outpatient attendances by 55 per cent - diverting upwards of five million appointments to other "settings" such as polyclinics and health centres, where highly paid consultants would have to travel to see a fraction of the number they could see in a properly equipped hospital. Even on Lord Darzi's inadequate and outdated figures in 2007, these two changes would mean cutting well over £1 billion from London hospital budgets, forcing a drastic round of service cuts and closures. But primary care and mental health face cutbacks too. GPs have been caught up in the new cash squeeze and required for the first time ever to deliver efficiency savings, but NHS London also wants to slash staffing in "non-acute" services by 66 per cent - and even cut GP appointment times by 33 per cent. The list goes on and on. NHS London is frogmarching the capital's primary care trusts deep into unknown territory. Nobody anywhere has changed an established health-care system on this scale before, let alone at the breakneck speed it proposes, with virtually none of the alternative services that would be required even planned, let alone in place.
All of these potentially devastating cutbacks are based on the assumptions and assertions in the secret McKinsey document. In other words, there is absolutely no published evidence that these changes could even be achieved, or that they would save money, enhance efficiency or deliver acceptable levels of patient care. The few Darzi-style health centres that have been established so far are not only much more expensive than the average primary care but they have generally failed to sign up their "drop-in" patients to regular lists.
The NHS London plan seems to be guesswork hatched up by management consultants from the US, the land of the world's most costly, exclusive, wasteful and hugely inefficient health-care system. And if the guesses go wrong, the health care of millions will be put at risk. Let's stop them before it's too late.
But to his credit Burnham has not only stuck to his guns, apparently having won the support of Gordon Brown - he has even suggested he may review the working of the competition panel itself. NHS managers have been - in some cases reluctantly - dragged into line on the new policy. If only we could look forward to similar successes in this new year. But sadly, the new decade is opening with the NHS facing new and very serious threats. The new danger is the old enemy that the London Health Emergency was formed to fight back against in 1983 - cuts and closures. All the main political parties are agreed that massive cuts should be inflicted on health care, education and other public services - not because these services have failed in any way, but because of a huge private-sector failure. They are cutting health care in a bid to cover the colossal £175 billion costs of bailing out failed and irresponsible bankers. Of course the party leaders won't admit that they plan cuts in the NHS, least of all in the run-up to the general election in May. So each of them claims to be "protecting" front-line services by increasing funding in line with inflation - ignoring the fact that the NHS needs billions more in real terms each year to keep pace with the costs of a growing population, rising numbers of elderly and new drugs and technology. And even if front-line budgets were to be protected, many spending plans for the next few years already assume massive "efficiency" savings of up to 5 per cent a year, without any evidence that unprecedented savings on this scale can be achieved without cuts.
To make matters worse, much of the 5 per cent of the NHS which is not seen as "front line" - and therefore not protected - includes training and research budgets which are likely to be slashed. Even NHS chief executive David Nicholson admits that the coming cuts are "tougher than the NHS has ever had, through its history. And it's for a sustained period." The squeeze will hit hospital services hardest of all - with a four-year freeze on the "payment by results" tariff which determines hospital budgets, and a massive 70 per cent cut in funding for any additional A&E patients treated in excess of the 2008-9 caseload. A Health Service Journal analysis argues that by 2014 "savings on this scale could entail perhaps half a dozen general hospitals going to the wall in each Strategic Health Authority." Hardest hit will be hospitals with large fixed overhead costs - in particular those funded through the private finance initiative. But primary care trusts and strategic health authorities are also required to cut their management costs by 30 per cent - some might say not before time. They are even looking to cut the massive amount they are wasting each year on hiring costly private-sector management consultants. While NHS chiefs are already discussing these issues in secret, the plans are only beginning to emerge. NHS London is leading the charge, with cuts - based on a secret briefing by US-based private management consultants McKinsey - aimed at slashing up to £5 billion from the capital's £13 billion primary care trust budget by 2017.
NHS London has said quite openly that it wants primary care trusts to chop A&E caseloads by 60 per cent - diverting almost 2 million patients a year to unproven or as yet non-existent primary care "polysystems." This seems especially bizarre in the context of this winter of snow and swine flu, in which all of the existing A&E units are full to bursting and running well above target. NHS London also wants primary care trusts to cut hospital outpatient attendances by 55 per cent - diverting upwards of five million appointments to other "settings" such as polyclinics and health centres, where highly paid consultants would have to travel to see a fraction of the number they could see in a properly equipped hospital. Even on Lord Darzi's inadequate and outdated figures in 2007, these two changes would mean cutting well over £1 billion from London hospital budgets, forcing a drastic round of service cuts and closures. But primary care and mental health face cutbacks too. GPs have been caught up in the new cash squeeze and required for the first time ever to deliver efficiency savings, but NHS London also wants to slash staffing in "non-acute" services by 66 per cent - and even cut GP appointment times by 33 per cent. The list goes on and on. NHS London is frogmarching the capital's primary care trusts deep into unknown territory. Nobody anywhere has changed an established health-care system on this scale before, let alone at the breakneck speed it proposes, with virtually none of the alternative services that would be required even planned, let alone in place.
All of these potentially devastating cutbacks are based on the assumptions and assertions in the secret McKinsey document. In other words, there is absolutely no published evidence that these changes could even be achieved, or that they would save money, enhance efficiency or deliver acceptable levels of patient care. The few Darzi-style health centres that have been established so far are not only much more expensive than the average primary care but they have generally failed to sign up their "drop-in" patients to regular lists.
The NHS London plan seems to be guesswork hatched up by management consultants from the US, the land of the world's most costly, exclusive, wasteful and hugely inefficient health-care system. And if the guesses go wrong, the health care of millions will be put at risk. Let's stop them before it's too late.
Thursday, 25 March 2010
When efficiency means health service cuts
Health minister Mike O'Brien has said he believes health bosses such as NHS London should keep a veil of secrecy over their discussions on how to impose wholesale changes to the service's operation. If information leaked out, he told MPs this week, opponents of the plans could "attack them over their lack of evidence." What a telling admission. Not only are paranoid levels of secrecy now official government policy, but ministers are actively encouraging health chiefs to hatch up plans for which there is no evidence - while opposing those of us who point out that these policies are potentially dangerous. The three remaining strategic health authorities that have so far kept a stony silence on their plans are expected to reveal how they intend to generate their share of a £20 billion financial "gap" in the service in the new financial year. Their policy changes, as called for by NHS boss Sir David Nicholson, are unlikely to contain many surprises. Across the country the same rhetoric is being wheeled out to justify proposals for astronomical increases in "efficiency" and "productivity" which will wind up as cuts. Buzz-words such as "reinventing care pathways" (dumping patients out of hospital A&Es onto untested, supposedly cheaper alternatives in primary care such as "polysystems" - see below) "working smarter" and "innovation" crop up again and again.
But so do more obvious, unambiguous phrases such as "affordability analysis," "decommissioning," "savings," and "tariff reductions" - in other words cutting the amount paid to NHS trusts for each episode of treatment.
Perhaps the most blunt statement about the real driving force behind the various new policies comes from NHS Southwark, which declares openly that its proposals are cash-driven. "Our financial modelling shows that the primary care trust's (PCT's) current profile of expenditure is unaffordable over the next five years. "The affordability analysis requires £18m of savings in 2010/2011. Our commissioning strategy is driven by the need to achieve a system of healthcare which is financially sustainable." (Strategic Plan 2010/11 to 2016/17)." But this highlights a major question. Can the proposals outlined by health bosses actually work, delivering services to patients while saving a large amount of money? Central to the guidelines laid down by NHS London for cutting £5 billion from its PCTs' spending by 2017 is an assumption that 60 per cent of people who currently attend A&E units with relatively minor problems could be treated satisfactorily in primary care.
On this basis NHS London wants to divert around 2 million people annually away from hospitals and into a new, expensive network of "polysystems" - controversial centralised super-facilities which were originally designated "polyclinics" in Lord Darzi's 2007 suggestions for reform. Similar assumptions have also been made elsewhere and A&E has been a major focus for redesigning "pathways." I have consistently challenged these assumptions, which have become more and more extravagant since the early 1990s, and pointed to the failure of previous attempts to divert smaller numbers patients from A&E to "minor injury units." These turned out to treat mere handfuls of patients at high costs, while queues at A&Es were undiminished. But now we also know for a fact that NHS London's 60 per cent assumption is wrong. A recently released Primary Care Foundation report commissioned by the Department of Health found that less than half the A&E patients included in that figure were suitable for treatment only by GPs. Their figure showed that in some cases as few as 10 per cent, and a maximum of 30 per cent of people in A&E had no need of any form of hospital care. Since we now have fresh and reliable evidence that the 60 per cent figure was wrong, one obvious question is where such a false assumption came from.
It appears to flow from the top-secret document produced for NHS London by US-based management consultants McKinsey's. But where did McKinsey's get the number? Is it based on anything substantial, or just made up to drive forward the reorganisation of hospital care? Another question arises: would it save any money to deliver minor A&E services in polyclinics? Again the answer seems to be No. Lord Darzi's 2007 report on London, which argued A&E patients should be switched to polyclinics, estimated that the cost would be £66 per visit to a polyclinic compared with £81 at a hospital. However transferring the patients brings the added cost of building or renting the new polyclinic and running it day by day. Darzi-style health centres that are already running on a much smaller scale than the London plans are "jaw-droppingly" expensive compared with existing primary care services - with costs ranging from three to seven times more per patient. It seems most improbable that a new network of polyclinics in London will come in any cheaper, especially since private-sector providers such as Richard Branson's Virgin group now see them as an attractive future profit stream. Health chiefs have also been keen to switch a large volume of outpatient treatment - up to half, equivalent to 5 million appointments a year in London - away from hospitals and into polyclinics.
Yet even according to Lord Darzi's projections this would save no money at all. Instead it would massively inflate the costs of providing and running the polyclinic. It would also of course make running hospital services less efficient if consultants and staff have to spend hours at a time trekking round to small-scale clinics instead of working from a central base. The Audit Commission at the end of last year highlighted another reason to doubt the viability of these plans. Their report More For Less pointed out that while hospital unit costs were falling and productivity improving, there had been "no shift from hospitals to care closer to home in the community; either in terms of investment or activity." Nor, argues the Audit Commission, had PCTs succeeded in "dampening demand" for hospital care, despite years of promises. In fact the most recent figures show another substantial increase in numbers of patients referred to hospitals by GPs for inpatient care. These are not "inappropriate attenders" in A&E, but people whose condition requires treatment that primary care and community services cannot provide.
Flying in the face of all this hard evidence of rising demand, and offering no explanation on how it might be achieved, NHS London has said it wants to cut the number of hospital beds in the capital by a third. Even if they only focus on front-line acute beds that would mean a staggering 5,700 beds to go - equivalent to around 12 district general hospitals. This might save money - but only if the services are not replaced by any alternative. None of these proposals seems to have any basis in evidence in this country or elsewhere. Nor do they seem to fit with experience on the ground. Doctors are increasingly required to demonstrate the "evidence base" for the treatment they deliver.
But it appears that the most senior levels of NHS management feel no equivalent obligation to show that their plans are evidence-based, organisationally viable or likely to yield the promised cuts in costs. If the plans go wrong patients and NHS staff lose out either way. If they prove to save little or nothing, these policies will widen the gap they are supposed to help close and force another round of even bigger cuts. On the other hand short-sighted closures and excessive reduction in staff numbers can result in local collapse in service and the quality of care. Lurking in the background is the grim example of Mid Staffordshire hospitals, where the quest for just £10m of cuts resulted in the loss of 150 clinical posts and a total collapse in care, with dozens or hundreds losing their lives as a result. Managers who fail to learn from existing evidence could be doomed to repeat this type of failure.
But so do more obvious, unambiguous phrases such as "affordability analysis," "decommissioning," "savings," and "tariff reductions" - in other words cutting the amount paid to NHS trusts for each episode of treatment.
Perhaps the most blunt statement about the real driving force behind the various new policies comes from NHS Southwark, which declares openly that its proposals are cash-driven. "Our financial modelling shows that the primary care trust's (PCT's) current profile of expenditure is unaffordable over the next five years. "The affordability analysis requires £18m of savings in 2010/2011. Our commissioning strategy is driven by the need to achieve a system of healthcare which is financially sustainable." (Strategic Plan 2010/11 to 2016/17)." But this highlights a major question. Can the proposals outlined by health bosses actually work, delivering services to patients while saving a large amount of money? Central to the guidelines laid down by NHS London for cutting £5 billion from its PCTs' spending by 2017 is an assumption that 60 per cent of people who currently attend A&E units with relatively minor problems could be treated satisfactorily in primary care.
On this basis NHS London wants to divert around 2 million people annually away from hospitals and into a new, expensive network of "polysystems" - controversial centralised super-facilities which were originally designated "polyclinics" in Lord Darzi's 2007 suggestions for reform. Similar assumptions have also been made elsewhere and A&E has been a major focus for redesigning "pathways." I have consistently challenged these assumptions, which have become more and more extravagant since the early 1990s, and pointed to the failure of previous attempts to divert smaller numbers patients from A&E to "minor injury units." These turned out to treat mere handfuls of patients at high costs, while queues at A&Es were undiminished. But now we also know for a fact that NHS London's 60 per cent assumption is wrong. A recently released Primary Care Foundation report commissioned by the Department of Health found that less than half the A&E patients included in that figure were suitable for treatment only by GPs. Their figure showed that in some cases as few as 10 per cent, and a maximum of 30 per cent of people in A&E had no need of any form of hospital care. Since we now have fresh and reliable evidence that the 60 per cent figure was wrong, one obvious question is where such a false assumption came from.
It appears to flow from the top-secret document produced for NHS London by US-based management consultants McKinsey's. But where did McKinsey's get the number? Is it based on anything substantial, or just made up to drive forward the reorganisation of hospital care? Another question arises: would it save any money to deliver minor A&E services in polyclinics? Again the answer seems to be No. Lord Darzi's 2007 report on London, which argued A&E patients should be switched to polyclinics, estimated that the cost would be £66 per visit to a polyclinic compared with £81 at a hospital. However transferring the patients brings the added cost of building or renting the new polyclinic and running it day by day. Darzi-style health centres that are already running on a much smaller scale than the London plans are "jaw-droppingly" expensive compared with existing primary care services - with costs ranging from three to seven times more per patient. It seems most improbable that a new network of polyclinics in London will come in any cheaper, especially since private-sector providers such as Richard Branson's Virgin group now see them as an attractive future profit stream. Health chiefs have also been keen to switch a large volume of outpatient treatment - up to half, equivalent to 5 million appointments a year in London - away from hospitals and into polyclinics.
Yet even according to Lord Darzi's projections this would save no money at all. Instead it would massively inflate the costs of providing and running the polyclinic. It would also of course make running hospital services less efficient if consultants and staff have to spend hours at a time trekking round to small-scale clinics instead of working from a central base. The Audit Commission at the end of last year highlighted another reason to doubt the viability of these plans. Their report More For Less pointed out that while hospital unit costs were falling and productivity improving, there had been "no shift from hospitals to care closer to home in the community; either in terms of investment or activity." Nor, argues the Audit Commission, had PCTs succeeded in "dampening demand" for hospital care, despite years of promises. In fact the most recent figures show another substantial increase in numbers of patients referred to hospitals by GPs for inpatient care. These are not "inappropriate attenders" in A&E, but people whose condition requires treatment that primary care and community services cannot provide.
Flying in the face of all this hard evidence of rising demand, and offering no explanation on how it might be achieved, NHS London has said it wants to cut the number of hospital beds in the capital by a third. Even if they only focus on front-line acute beds that would mean a staggering 5,700 beds to go - equivalent to around 12 district general hospitals. This might save money - but only if the services are not replaced by any alternative. None of these proposals seems to have any basis in evidence in this country or elsewhere. Nor do they seem to fit with experience on the ground. Doctors are increasingly required to demonstrate the "evidence base" for the treatment they deliver.
But it appears that the most senior levels of NHS management feel no equivalent obligation to show that their plans are evidence-based, organisationally viable or likely to yield the promised cuts in costs. If the plans go wrong patients and NHS staff lose out either way. If they prove to save little or nothing, these policies will widen the gap they are supposed to help close and force another round of even bigger cuts. On the other hand short-sighted closures and excessive reduction in staff numbers can result in local collapse in service and the quality of care. Lurking in the background is the grim example of Mid Staffordshire hospitals, where the quest for just £10m of cuts resulted in the loss of 150 clinical posts and a total collapse in care, with dozens or hundreds losing their lives as a result. Managers who fail to learn from existing evidence could be doomed to repeat this type of failure.
Thursday, 25 February 2010
NHS not safe in mainstream hands
"You call this cuts - I'm not scared to say cuts... The amount of money available to the NHS is decided by the government. We will have less money to meet rising demands... There are hard decisions to be made. I have to balance the books." That was the £140,000 a year chief executive of North Central London NHS (NCL) trying to explain to 350 people at a protest meeting why NCL were discussing seven different "scenarios" to cut £560 million from its £2.27 billion budget by 2016-17. These NHS bureaucrats, who blame the "global recession", plan to cut services at local hospitals, particularly closing some Accident and Emergency (A&E) departments. Highly paid NHS officials put a positive spin on this, proposing to set up enlarged neighbourhood health centres ("Urgent Care Centres") outside hospital entrances and saying that long-term treatment for conditions like asthma and diabetes should move to new 'polyclinics'.But, whatever the merits of polyclinics in an integrated health system, they are being promoted now as a way both of cutting spending and providing further opportunities to effectively privatise health services.
There is widespread opposition to these cuts - one north London hospital, the Whittington, treats 80,000 A&E patients annually. With a general election and London borough elections pending, all the local political parties have been protesting, but none gets to the root of the crisis in NHS spending. Some election candidates just say: no cuts in 'my' borough. This helps NHS bureaucrats play a 'divide and rule' game. So while Labour leaders insist that the National Health Service is safe, proposed cuts in services countrywide threaten to hit the NHS hard. Campaigns against the local NHS cuts and closures need to be linked to the wider battle. The economy's decline and the huge amounts spent bailing out the banks have brought mounting pressure for cuts in working peoples' living standards and services. Determined local campaigns with protest rallies, meetings, lobbies and demonstrations can save particular NHS facilities, and such victories are welcome.
But as national cuts are being prepared, we also need a generalised nationwide campaign that challenges the government's policies; otherwise repeated anti-cuts campaigns will be unavoidable. The Tories will probably be worse than Labour on the NHS, but this is no reason to go soft on the Labour government's plans. Unfortunately this is what many trade union leaders and backbench Labour MPs have done. Alongside local campaigns, the longer term battle to save and improve the NHS needs a real socialist alternative to the Labour, Tory and LibDem parties' pro-capitalist policies. In the coming election, candidates from the Trade Unionist and Socialist Coalition (TUSC) can vitally help link together different local campaigns. This should be part of a drive to build a national movement to resist the bosses' efforts to make working people pay for the economic crisis.
There is widespread opposition to these cuts - one north London hospital, the Whittington, treats 80,000 A&E patients annually. With a general election and London borough elections pending, all the local political parties have been protesting, but none gets to the root of the crisis in NHS spending. Some election candidates just say: no cuts in 'my' borough. This helps NHS bureaucrats play a 'divide and rule' game. So while Labour leaders insist that the National Health Service is safe, proposed cuts in services countrywide threaten to hit the NHS hard. Campaigns against the local NHS cuts and closures need to be linked to the wider battle. The economy's decline and the huge amounts spent bailing out the banks have brought mounting pressure for cuts in working peoples' living standards and services. Determined local campaigns with protest rallies, meetings, lobbies and demonstrations can save particular NHS facilities, and such victories are welcome.
But as national cuts are being prepared, we also need a generalised nationwide campaign that challenges the government's policies; otherwise repeated anti-cuts campaigns will be unavoidable. The Tories will probably be worse than Labour on the NHS, but this is no reason to go soft on the Labour government's plans. Unfortunately this is what many trade union leaders and backbench Labour MPs have done. Alongside local campaigns, the longer term battle to save and improve the NHS needs a real socialist alternative to the Labour, Tory and LibDem parties' pro-capitalist policies. In the coming election, candidates from the Trade Unionist and Socialist Coalition (TUSC) can vitally help link together different local campaigns. This should be part of a drive to build a national movement to resist the bosses' efforts to make working people pay for the economic crisis.
Sunday, 21 February 2010
The great class divide widens
"In England, people living in the poorest neighbourhoods, will, on average, die seven years earlier than people in the richest neighbourhoods. Even more disturbing, the average difference in disability-free life expectancy is 17 years. So, people in poorer areas not only die sooner they will also spend more of their shorter lives with a disability." The report, Fair Society, Healthy Lives, was commissioned because the government has a target of reducing the gap by 10% but they are going to miss it. The gap in the rate of infant mortality, for example, will rise to 25% by 2011. "Put simply, the higher one's social position, the better one's health is likely to be". And the gap is getting wider. For men in poor areas the gap has widened by 2% and for women by 11%. There are regional differences but there are stark differences also even within a region. For example, men in parts of Kensington and Chelsea, the wealthiest area in London, have a life expectancy of 88. A few miles away in Tottenham Green, one of the poorest areas in London, male life expectancy is 71. It also notes that the poor pay 38% tax on their income compared to 35% for the richest.
The government is moving towards retirement at 68. However, "more than three quarters of the population do not have a disability-free life expectancy as far as the age of 68. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 million and 2.5 million extra years of life. Many diverse and wide-reaching proposals are developed. Good quality nurseries, apprenticeships, greater security and flexibility of employment, a "minimum income for healthy living", reducing social isolation, investing in health prevention and a whole list of others. Socialists would warmly welcome the many and varied ideas in the report. However, its limitations are revealed: "There will be those that say that our recommendations cannot be afforded, particularly in the present economic climate... we need courage and imagination to rise to the challenge..." And there's the rub. Even the modest target of increasing the lifetime of a poor person by three years in the next decade is unobtainable under the present system.
What the report brutally reveals is that we are living in a vicious, class divided society. Unfairness and inequalities are emphasised and underlined over and over again in facts, figures, charts and graphs but no hint as to why this is the case. Of course, it is naïve in the extreme to expect a well meaning scholarly review by academics to change anything fundamentally. Nevertheless, it makes you boil with rage. The bosses work us to death so that they can live longer and healthier. They get rich on our broken corpses. To see the ideas in this review (and much more), fully implemented, capitalist society will have to be removed first.
The government is moving towards retirement at 68. However, "more than three quarters of the population do not have a disability-free life expectancy as far as the age of 68. In England, the many people who are currently dying prematurely each year as a result of health inequalities would otherwise have enjoyed, in total, between 1.3 million and 2.5 million extra years of life. Many diverse and wide-reaching proposals are developed. Good quality nurseries, apprenticeships, greater security and flexibility of employment, a "minimum income for healthy living", reducing social isolation, investing in health prevention and a whole list of others. Socialists would warmly welcome the many and varied ideas in the report. However, its limitations are revealed: "There will be those that say that our recommendations cannot be afforded, particularly in the present economic climate... we need courage and imagination to rise to the challenge..." And there's the rub. Even the modest target of increasing the lifetime of a poor person by three years in the next decade is unobtainable under the present system.
What the report brutally reveals is that we are living in a vicious, class divided society. Unfairness and inequalities are emphasised and underlined over and over again in facts, figures, charts and graphs but no hint as to why this is the case. Of course, it is naïve in the extreme to expect a well meaning scholarly review by academics to change anything fundamentally. Nevertheless, it makes you boil with rage. The bosses work us to death so that they can live longer and healthier. They get rich on our broken corpses. To see the ideas in this review (and much more), fully implemented, capitalist society will have to be removed first.
Monday, 1 February 2010
Another civil right up in smoke
Smokers are under attack again. After banning us from lighting in public places, even open-aired such as bus stops and train stations, the health fascists are plotting to curb smoker's rights with new measures such as removing branding from packets and banning cigarette vending machines, as will happen in Scotland next year. Smokers' lobby group Forest criticised the proposals for eroding people's ability to make lifestyle choices. Health charity Ash said that while it supported the plans in principle, there was a need for more detail and stronger pledges. The government strategy includes a commitment to try to stop young people taking up smoking by cracking down on illegally imported cheap cigarettes. Every smoker will be able to get help from the NHS to suit them if they want to give up. And there will be a review of smoking legislation, which could see public bans extended to places such as the entrances of buildings. Health Secretary Andy Burnham said: "We've come so far and now we'll go even further, to push forward and save even more lives. This strategy renews our commitment to virtually eradicate the health harms caused by smoking, and I firmly believe we can halve smoking by 2020. In 10 years' time, only one-in-10 people will smoke."
The government said each year smoking caused 80,000 deaths and cost the NHS £2.7bn - the same as alcohol related illness and injury. We can all understand and fully accept the health risks of smoking and the nature of that risk. Indeed, the health risks have been known for so long (the US Surgeon General first announced a link between smoking and lung cancer in 1964) we believe there cannot be a sane adult in the UK who is not aware of the potential danger. We do however have a problem with the tactics adopted by politicians and the health industry who routinely use the health argument to say they are "protecting" smokers from themselves. The health argument is then presented in one of several ways. The first is to frighten smokers into believing that they will almost certainly die before their time ("Quit or die"). The problem with this message is that it is so obviously false. As a great many families (and even doctors) will testify, many smokers live a long and healthy life, sometimes outliving their non-smoking peers. Moreover, with one major exception (lung cancer), none of the illnesses described as "smoking-related" is exclusive to smokers and all are primarily diseases of the elderly. In reality, two-thirds of all deaths in the UK are caused by "smoking-related diseases", despite the fact that only half of those people actually smoke.
Common sense would suggest that something else must be responsible for these "smoking-related diseases" (and, no, it's not passive smoking!) which is unrelated to smoking. Diet, perhaps, or genetic factors, or even general lifestyle (lack of exercise, for example). Or maybe (horror of horrors) it's just old age. One disease that smoking cannot ignore is lung cancer for the simple reason that it very, very rarely afflicts non-smokers. (The average annual risk of a non-smoker getting lung cancer has been calculated to be 0.01%.) Even for smokers, however, the quit or die message seems a bit excessive. According to Professor Sir Richard Doll (the man who first discovered a correlation between smoking and lung cancer in the 1950s) research suggests that if you start smoking as a teenager and quit aged 30, the risk of developing lung cancer is 2%; give up at 50 and the risk goes up to 8%; give up at 70 (by which time you have been smoking for more than 50 years) and the risk rises to 16%. Surprised? Let's face it, these figures paint a rather different picture from the anti-smoking lobby which gives the impression that most if not all smokers are going to die a horrible, agonising death well before their time. Again, this isn't to deny the health risks, but let's get this in perspective. In spite of what some people would have you believe, smoking is not a one-way ticket to Death Row.
Revealingly, the anti-smoking lobby refuses point blank to acknowledge that smoking has any beneficial qualities whatsoever. The health risks of smoking may outweight the health risks of stress, for example, but there are many smokers who believe passionately that the former helps reduce the latter. Likewise, many smokers believe (rightly or wrongly) that smoking (and the occasional smoking break) helps improve their concentration and makes them more efficient at work. Meanwhile, instead of welcoming research which suggests that smoking may help ward off Alzheimer's Disease (one of most debilitating illnesses known to man), the anti-smokers pour scorn on the idea. Why? Finally, there is a clear lack of perspective in the smoking debate, a factor most clearly illustrated by the anti-smokers' complaint that James Bond, in the 2002 film Die Another Day, was filmed smoking a cigar. The fact that they had no problem with 007 having casual, unprotected sex, driving dangerously fast or being in possession of a loaded gun (with intent to kill!) reveals more about their narrow-minded obsession than it does about the dangers of smoking.
Smoking may have been banned in the workplace, but smoking is still an issue for many employers and their employees. Unfortunately the emotive nature of the debate often sees common sense relegated to the bottom of the list when employers are considering what type of smoking policy to introduce. While it is against the law to discriminate against people on the basis, for example, of race and religion, it is perfectly legal for employers to refuse to hire smokers and, under certain circumstances, fire them. In December 2005 the World Health Organisation said it would no longer recruit people who smoke or otherwise use tobacco. The ban applies to any applicants who smoke and say they would continue to smoke, either daily or occasionally. In January 2005 four employees at a healthcare company based in Michigan, USA, were fired after they refused the firm’s ultimatum to quit smoking. The company began random drug tests for nicotine at the beginning of that year saying it would fire workers who failed the test or refused to quit smoking. Other US firms are refusing to hire applicants who admit they smoke while many American companies require workers to take breathalyser tests that detect traces of carbon monoxide in the lungs or else submit to urine tests to detect nicotine.
In Florida a sheriff’s office demanded that all job applicants who have a recent history of smoking pass a polygraph test proving they no longer smoke outside work; this was later rescinded when the sheriff’s office was unable to recruit enough properly qualified police officers. US legal experts say there’s not much smokers can do if other bosses bring in similar rules. Kathleen Bogas, National Employment Lawyers’ Association vice president, said: “This will empower employers to take further steps to restrict the rights of employees – and that is the tragedy.” n the UK reports that British companies were refusing to employ smokers, even if they promised not to smoke during working hours, first appeared in 2001. After Forest highlighted the issue, the issue did not reappear until October 2004 when anti-smoking campaigners called for Manchester health workers to be banned from lighting up in public - even when they are off duty. The call came after health bosses in Suffolk announced plans to sack staff caught smoking, while wearing uniform or identity badges even if they are off the premises or in their own cars. The moves would be one step further than the toughest bans currently in place in the region, which stop some council and hospital staff from smoking on work premises.
That same month it was reported that bosses of a UK company, who dismissed an employee after 15 minutes when they found she smoked, acted legally. Lawyer Cathy Tailby said, “There is no law which would expressly prevent an employer imposing a condition that it will only employ non-smokers. As a rule, an employer can employ whomever it wants, so long as it does not breach a statute that outlaws particular sorts of discrimination.” In January 2006 ambulance staff in Staffordshire were banned from smoking in public even when off-duty, if they can be recognised by their uniform or name badge. Spokesman Bob Lee said the tough measures were being brought in, in common with other health organisations across the country. “I am not defending smoking but, for some people, smoking is a form of stress relief,” he said. “But this is the policy we are having to bring in due to national guidelines and government pressure.” The following month BT announced it would ban its workers from smoking in its offices and vans. BT’s 100,000 employees across the world, including 20,000 outside the UK will not be allowed to smoke on company premises or in vans bearing the BT logo. The decision was “warmly welcomed by anti-smoking groups who urged other companies to follow suit”.
In March 2006 two leading luxury hotels in Scotland threatened to sack staff that smell of smoke. In a move that goes well beyond what is required by the law, the hotels issued strict guidelines to hundreds of staff on complying with the legislation. In April 2006 Marks & Spencer employees were banned from lighting up in public with their uniforms on show. Bosses barred workers from smoking outside stores a week after banning it inside company premises and vehicles. In May 2006 a Dublin-based e-commerce business advertised for new employees saying that smokers were not welcome. The Advertising Authority of Ireland confirmed that the advertisement did not contravene its code and the Irish Government said they had no power to clamp down on such advertisements. Company director Philip Tobin commented, “If I get away with this, there is no doubt in my mind that other firms will follow suit and I certainly hope that is the case.” Meanwhile, in England, a company in Howdendyke extended its no smoking policy to a half-mile radius of the firm’s buildings. Anyone at the warehouse who was seen smoking would be sacked. In June 2006 seven supermarket workers in Scotland were fired for smoking. The employees of Morrisons in Inverurie lost their jobs after they were caught on CCTV having a cigarette break during the night shift.
Unusually, smokers have to look west - to the United States - for signs of common sense. An editorial in the Los Angeles Times reported that company moves against employees who smoke could backlash. Apparenty, around 30 states have passed legislation prohibiting companies from discriminating against people who embrace lifestyle choices such as smoking. Smoking in the workplace should be approached like any other workplace issue - as a management problem to be solved - rather than allowing emotion to govern the decision making process. A solution that accommodates both non-smokers and smokers has to be better than one that openly discriminates against one party. A poorly conceived smoking policy - banning smoking anywhere on company property - can have a profoundly negative effect on both staff and management. The worst of all solutions is prohibition without consultation, a policy that leaves many employees feeling neglected and hard done to. A failure to make proper provision for smokers within the premises - leaving them no with alternative but to smoke at, or nearby, the entrance to the premises - reflects badly on the employer because it illustrates an inconsiderate attitude towards staff who smoke, and looks unpleasant for any client approaching to do business.
Smokers pay £19,000 a minute to the Exchequer, and that's enough to pay for the whole police force. Or to put it another way, for every £1 we cost the NHS, we give it £3.60. Please don't encourage the state to dictate how I live your life. If you want to smoke you should be allowed to do so. For those who smoke it is a natural, relaxing part of life. Years of anti-smoking laws and campaigns have amounted to a public shaming of smokers that could make it harder for them to quit, a group of UBC researchers argue in a new report. There is an "urgent" need for governments to revisit their anti-smoking policies, the academics say, suggesting that the stigma around smoking could lead to patients hiding their tobacco use from doctors, and feeling desperate about ever kicking the habit. The policies run counter to how other addictions are treated by the public-health field, they argue. Their work looks at a range of anti-smoking measures they contend have "de-normalized" smoking and smokers themselves. Those include restrictions on where people can light up, bans on convenience-store "power walls" and other limits on tobacco sales, publicity campaigns to deter smoking, and graphic warnings on cigarette packages. Such programs have generally been hailed as a public-health triumph, with smoking rates plummeting to about 20% in Canada from 50% in the 1960s, according to the most recent federal statistics.
Intentionally or not, though, such policies have also stigmatized the remaining smokers, with various potentially negative impacts, the paper argues. It cites anecdotal reports of surgeons and other doctors refusing to treat cancer patients who smoke heavily. As many as one in four doctors who responded to a 2005 Canadian Lung Association survey admitted to providing lesser care to smokers. A University of Washington survey published last year found just under one in 10 smokers hid their tobacco use from doctors, often because of stigma. In a survey of smokers and ex-smokers soon-to-be published by the UBC group, respondents talked of being refused access to city buses after they were spotted smoking at a bus stop, harassed by strangers in public and otherwise treated as pariahs. "You really are labelled as a bad person if you smoke," said one person. Tobacco policies also now disproportionately affect the poor, as smoking rates are almost twice as high amongst those on low income as the highest income group. Katherine Frohlich, a public-health expert at the University of Montreal, said studies found that poorer smokers feel the policies have discriminated against them by, for instance, restricting their social interaction and isolating them at home.
Cynthia Callard of the group Physicians for a Smoke-free Canada rejected the notion, however, that smoking is now a predominately low-income phenomenon. The rates may be higher among the poor, but the sheer numbers are still much larger in middle-and upper-income groups, she said. But evidence proves otherwise, as yet another minority are increasingly marginalised and discriminated against; that smoking is a choice should be completely irrelevant. I've been smoking for five years this summer, and have no wish to quit. I know about the many health risks. I know about how much it's costing me, and how much it makes my clothes smell. I know how it could potentially cut my life expectancy considerably; my grandmother died aged just 51 from a heart condition possibly exacerbated by her heavy smoking habit. Despite all this there's a certain pleasure I receive from smoking - as do most of my friends evidently. One mate of mine lets me smoke in the house, and we are forever scrounging for a cigarette from each other, or anyone else we can manage to convince to give one up. I go through about fifteen fags a day, but I refuse to be looked down on by the health Nazis attempting to stop me from enjoying a few minutes every now and then to spark up. It's relaxing, and it helps me to concentrate. Why should anyone take those benefits away from me because they disagree with smoking? What makes it alright for them to claim their moral high ground whilst increasingly forcing us to quit smoking or suffer as second-class citizens?
The government said each year smoking caused 80,000 deaths and cost the NHS £2.7bn - the same as alcohol related illness and injury. We can all understand and fully accept the health risks of smoking and the nature of that risk. Indeed, the health risks have been known for so long (the US Surgeon General first announced a link between smoking and lung cancer in 1964) we believe there cannot be a sane adult in the UK who is not aware of the potential danger. We do however have a problem with the tactics adopted by politicians and the health industry who routinely use the health argument to say they are "protecting" smokers from themselves. The health argument is then presented in one of several ways. The first is to frighten smokers into believing that they will almost certainly die before their time ("Quit or die"). The problem with this message is that it is so obviously false. As a great many families (and even doctors) will testify, many smokers live a long and healthy life, sometimes outliving their non-smoking peers. Moreover, with one major exception (lung cancer), none of the illnesses described as "smoking-related" is exclusive to smokers and all are primarily diseases of the elderly. In reality, two-thirds of all deaths in the UK are caused by "smoking-related diseases", despite the fact that only half of those people actually smoke.
Common sense would suggest that something else must be responsible for these "smoking-related diseases" (and, no, it's not passive smoking!) which is unrelated to smoking. Diet, perhaps, or genetic factors, or even general lifestyle (lack of exercise, for example). Or maybe (horror of horrors) it's just old age. One disease that smoking cannot ignore is lung cancer for the simple reason that it very, very rarely afflicts non-smokers. (The average annual risk of a non-smoker getting lung cancer has been calculated to be 0.01%.) Even for smokers, however, the quit or die message seems a bit excessive. According to Professor Sir Richard Doll (the man who first discovered a correlation between smoking and lung cancer in the 1950s) research suggests that if you start smoking as a teenager and quit aged 30, the risk of developing lung cancer is 2%; give up at 50 and the risk goes up to 8%; give up at 70 (by which time you have been smoking for more than 50 years) and the risk rises to 16%. Surprised? Let's face it, these figures paint a rather different picture from the anti-smoking lobby which gives the impression that most if not all smokers are going to die a horrible, agonising death well before their time. Again, this isn't to deny the health risks, but let's get this in perspective. In spite of what some people would have you believe, smoking is not a one-way ticket to Death Row.
Revealingly, the anti-smoking lobby refuses point blank to acknowledge that smoking has any beneficial qualities whatsoever. The health risks of smoking may outweight the health risks of stress, for example, but there are many smokers who believe passionately that the former helps reduce the latter. Likewise, many smokers believe (rightly or wrongly) that smoking (and the occasional smoking break) helps improve their concentration and makes them more efficient at work. Meanwhile, instead of welcoming research which suggests that smoking may help ward off Alzheimer's Disease (one of most debilitating illnesses known to man), the anti-smokers pour scorn on the idea. Why? Finally, there is a clear lack of perspective in the smoking debate, a factor most clearly illustrated by the anti-smokers' complaint that James Bond, in the 2002 film Die Another Day, was filmed smoking a cigar. The fact that they had no problem with 007 having casual, unprotected sex, driving dangerously fast or being in possession of a loaded gun (with intent to kill!) reveals more about their narrow-minded obsession than it does about the dangers of smoking.
Smoking may have been banned in the workplace, but smoking is still an issue for many employers and their employees. Unfortunately the emotive nature of the debate often sees common sense relegated to the bottom of the list when employers are considering what type of smoking policy to introduce. While it is against the law to discriminate against people on the basis, for example, of race and religion, it is perfectly legal for employers to refuse to hire smokers and, under certain circumstances, fire them. In December 2005 the World Health Organisation said it would no longer recruit people who smoke or otherwise use tobacco. The ban applies to any applicants who smoke and say they would continue to smoke, either daily or occasionally. In January 2005 four employees at a healthcare company based in Michigan, USA, were fired after they refused the firm’s ultimatum to quit smoking. The company began random drug tests for nicotine at the beginning of that year saying it would fire workers who failed the test or refused to quit smoking. Other US firms are refusing to hire applicants who admit they smoke while many American companies require workers to take breathalyser tests that detect traces of carbon monoxide in the lungs or else submit to urine tests to detect nicotine.
In Florida a sheriff’s office demanded that all job applicants who have a recent history of smoking pass a polygraph test proving they no longer smoke outside work; this was later rescinded when the sheriff’s office was unable to recruit enough properly qualified police officers. US legal experts say there’s not much smokers can do if other bosses bring in similar rules. Kathleen Bogas, National Employment Lawyers’ Association vice president, said: “This will empower employers to take further steps to restrict the rights of employees – and that is the tragedy.” n the UK reports that British companies were refusing to employ smokers, even if they promised not to smoke during working hours, first appeared in 2001. After Forest highlighted the issue, the issue did not reappear until October 2004 when anti-smoking campaigners called for Manchester health workers to be banned from lighting up in public - even when they are off duty. The call came after health bosses in Suffolk announced plans to sack staff caught smoking, while wearing uniform or identity badges even if they are off the premises or in their own cars. The moves would be one step further than the toughest bans currently in place in the region, which stop some council and hospital staff from smoking on work premises.
That same month it was reported that bosses of a UK company, who dismissed an employee after 15 minutes when they found she smoked, acted legally. Lawyer Cathy Tailby said, “There is no law which would expressly prevent an employer imposing a condition that it will only employ non-smokers. As a rule, an employer can employ whomever it wants, so long as it does not breach a statute that outlaws particular sorts of discrimination.” In January 2006 ambulance staff in Staffordshire were banned from smoking in public even when off-duty, if they can be recognised by their uniform or name badge. Spokesman Bob Lee said the tough measures were being brought in, in common with other health organisations across the country. “I am not defending smoking but, for some people, smoking is a form of stress relief,” he said. “But this is the policy we are having to bring in due to national guidelines and government pressure.” The following month BT announced it would ban its workers from smoking in its offices and vans. BT’s 100,000 employees across the world, including 20,000 outside the UK will not be allowed to smoke on company premises or in vans bearing the BT logo. The decision was “warmly welcomed by anti-smoking groups who urged other companies to follow suit”.
In March 2006 two leading luxury hotels in Scotland threatened to sack staff that smell of smoke. In a move that goes well beyond what is required by the law, the hotels issued strict guidelines to hundreds of staff on complying with the legislation. In April 2006 Marks & Spencer employees were banned from lighting up in public with their uniforms on show. Bosses barred workers from smoking outside stores a week after banning it inside company premises and vehicles. In May 2006 a Dublin-based e-commerce business advertised for new employees saying that smokers were not welcome. The Advertising Authority of Ireland confirmed that the advertisement did not contravene its code and the Irish Government said they had no power to clamp down on such advertisements. Company director Philip Tobin commented, “If I get away with this, there is no doubt in my mind that other firms will follow suit and I certainly hope that is the case.” Meanwhile, in England, a company in Howdendyke extended its no smoking policy to a half-mile radius of the firm’s buildings. Anyone at the warehouse who was seen smoking would be sacked. In June 2006 seven supermarket workers in Scotland were fired for smoking. The employees of Morrisons in Inverurie lost their jobs after they were caught on CCTV having a cigarette break during the night shift.
Unusually, smokers have to look west - to the United States - for signs of common sense. An editorial in the Los Angeles Times reported that company moves against employees who smoke could backlash. Apparenty, around 30 states have passed legislation prohibiting companies from discriminating against people who embrace lifestyle choices such as smoking. Smoking in the workplace should be approached like any other workplace issue - as a management problem to be solved - rather than allowing emotion to govern the decision making process. A solution that accommodates both non-smokers and smokers has to be better than one that openly discriminates against one party. A poorly conceived smoking policy - banning smoking anywhere on company property - can have a profoundly negative effect on both staff and management. The worst of all solutions is prohibition without consultation, a policy that leaves many employees feeling neglected and hard done to. A failure to make proper provision for smokers within the premises - leaving them no with alternative but to smoke at, or nearby, the entrance to the premises - reflects badly on the employer because it illustrates an inconsiderate attitude towards staff who smoke, and looks unpleasant for any client approaching to do business.
Smokers pay £19,000 a minute to the Exchequer, and that's enough to pay for the whole police force. Or to put it another way, for every £1 we cost the NHS, we give it £3.60. Please don't encourage the state to dictate how I live your life. If you want to smoke you should be allowed to do so. For those who smoke it is a natural, relaxing part of life. Years of anti-smoking laws and campaigns have amounted to a public shaming of smokers that could make it harder for them to quit, a group of UBC researchers argue in a new report. There is an "urgent" need for governments to revisit their anti-smoking policies, the academics say, suggesting that the stigma around smoking could lead to patients hiding their tobacco use from doctors, and feeling desperate about ever kicking the habit. The policies run counter to how other addictions are treated by the public-health field, they argue. Their work looks at a range of anti-smoking measures they contend have "de-normalized" smoking and smokers themselves. Those include restrictions on where people can light up, bans on convenience-store "power walls" and other limits on tobacco sales, publicity campaigns to deter smoking, and graphic warnings on cigarette packages. Such programs have generally been hailed as a public-health triumph, with smoking rates plummeting to about 20% in Canada from 50% in the 1960s, according to the most recent federal statistics.
Intentionally or not, though, such policies have also stigmatized the remaining smokers, with various potentially negative impacts, the paper argues. It cites anecdotal reports of surgeons and other doctors refusing to treat cancer patients who smoke heavily. As many as one in four doctors who responded to a 2005 Canadian Lung Association survey admitted to providing lesser care to smokers. A University of Washington survey published last year found just under one in 10 smokers hid their tobacco use from doctors, often because of stigma. In a survey of smokers and ex-smokers soon-to-be published by the UBC group, respondents talked of being refused access to city buses after they were spotted smoking at a bus stop, harassed by strangers in public and otherwise treated as pariahs. "You really are labelled as a bad person if you smoke," said one person. Tobacco policies also now disproportionately affect the poor, as smoking rates are almost twice as high amongst those on low income as the highest income group. Katherine Frohlich, a public-health expert at the University of Montreal, said studies found that poorer smokers feel the policies have discriminated against them by, for instance, restricting their social interaction and isolating them at home.
Cynthia Callard of the group Physicians for a Smoke-free Canada rejected the notion, however, that smoking is now a predominately low-income phenomenon. The rates may be higher among the poor, but the sheer numbers are still much larger in middle-and upper-income groups, she said. But evidence proves otherwise, as yet another minority are increasingly marginalised and discriminated against; that smoking is a choice should be completely irrelevant. I've been smoking for five years this summer, and have no wish to quit. I know about the many health risks. I know about how much it's costing me, and how much it makes my clothes smell. I know how it could potentially cut my life expectancy considerably; my grandmother died aged just 51 from a heart condition possibly exacerbated by her heavy smoking habit. Despite all this there's a certain pleasure I receive from smoking - as do most of my friends evidently. One mate of mine lets me smoke in the house, and we are forever scrounging for a cigarette from each other, or anyone else we can manage to convince to give one up. I go through about fifteen fags a day, but I refuse to be looked down on by the health Nazis attempting to stop me from enjoying a few minutes every now and then to spark up. It's relaxing, and it helps me to concentrate. Why should anyone take those benefits away from me because they disagree with smoking? What makes it alright for them to claim their moral high ground whilst increasingly forcing us to quit smoking or suffer as second-class citizens?
Wednesday, 9 December 2009
Health privatisation is truly sick
A damning report into hospitals last week claimed many were so sub-standard that over 5,000 patients had died in their care, despite being admitted with low-risk conditions. But the report, by the Dr Foster quality inspectors, is more than an indictment of the hospitals named as failing. It also calls into question the government’s strategy of privatisation and part-privatisation of the NHS. Four out of 12 hospitals deemed to be failing to meet basic standards of patient care are “flagship” NHS foundation trusts; under a scheme brought in by New Labour in 2002, bosses at these trusts are exempted from many normal health service rules, and are free to run their hospitals like independent businesses. Foundation trust status was supposed to be a reward for those hospitals that were deemed to be providing “excellent” patient care and financial management.
The report also deals a blow to the government’s Care Quality Commission (CQC) watchdog, set up this year to take over the monitoring of hospitals - the commission was supposed to be a new broom after the scandal of excess deaths at South Staffordshire NHS trust. This revealed that “self-regulation” of hospitals by their own managers had failed to identify even the most basic failings. Despite this, the majority of hospitals deemed by the Dr Foster organisation to be the “worst 12” were praised by the CQC in its annual health check last month. Among those rated “good” was Basildon and Thurrock University Hospitals NHS Foundation Trust. This manages a hospital that was condemned by Dr Foster inspectors who found “blood-spattered” walls and filthy conditions.
Accident and emergency units at a number of London hospitals are again under threat as the government plans to “rationalise” services. The department of health is rehashing plans to replace emergency services at four London hospitals with services provided by semi-privatised polyclinics. The scheme would involve downgrading the King George’s hospital in Essex, the North Middlesex hospital in Edmonton, and Whittington hospital in Archway. It has already been decided that Chase Farm hospital in Enfield will lose its emergency and maternity units. A huge public outcry greeted similar plans three years ago. Marches, many several thousand strong, forced the government to retreat. Ministers said that in future they would consult more fully. Local Keep Our NHS Public groups must be reformed and rejuvenated in order to force the government to backtrack on these proposals.
The report also deals a blow to the government’s Care Quality Commission (CQC) watchdog, set up this year to take over the monitoring of hospitals - the commission was supposed to be a new broom after the scandal of excess deaths at South Staffordshire NHS trust. This revealed that “self-regulation” of hospitals by their own managers had failed to identify even the most basic failings. Despite this, the majority of hospitals deemed by the Dr Foster organisation to be the “worst 12” were praised by the CQC in its annual health check last month. Among those rated “good” was Basildon and Thurrock University Hospitals NHS Foundation Trust. This manages a hospital that was condemned by Dr Foster inspectors who found “blood-spattered” walls and filthy conditions.
Accident and emergency units at a number of London hospitals are again under threat as the government plans to “rationalise” services. The department of health is rehashing plans to replace emergency services at four London hospitals with services provided by semi-privatised polyclinics. The scheme would involve downgrading the King George’s hospital in Essex, the North Middlesex hospital in Edmonton, and Whittington hospital in Archway. It has already been decided that Chase Farm hospital in Enfield will lose its emergency and maternity units. A huge public outcry greeted similar plans three years ago. Marches, many several thousand strong, forced the government to retreat. Ministers said that in future they would consult more fully. Local Keep Our NHS Public groups must be reformed and rejuvenated in order to force the government to backtrack on these proposals.
Sunday, 6 December 2009
Health Reform Makes America Stronger
In a nationally televised news conference dominated by the health care issue, Obama delivered lengthy statements in response to Republican attacks on proposals he favors. He also attempted to ease the concerns of people left confused by the fierce debate in Washington. He repeatedly emphasized that the spiraling costs of the current system would bankrupt the nation while denying coverage to millions more Americans. Asked directly if he could guarantee that an overhauled health care system won't change how people receive treatment, Obama said no. "The whole point of this is to try to encourage what works," Obama said, addressing concerns that reform would take away the ability of people to choose their doctors and treatment. "The government is already making some of these decisions," Obama said. "Insurance companies are making some of these decisions."
The reform proposals he backs would have experts make decisions based on the best medical treatment, not accountants attempting to save money or doctors prescribing treatments that bring the highest fees, Obama said. "This will require patients ... to be more discriminating consumers," he said. "I think that's a good thing. Ultimately ... we just can't afford what's happening right now." Republican opponents of Democratic bills in the House and Senate said earlier that most Americans like the current system, which they said must be made less expensive and more accessible. Republican opponents of Democratic bills in the House and Senate said earlier that most Americans like the current system, which they said must be made less expensive and more accessible. Obama and Democratic leaders say the problems are deeper and systemic, and the president spent all of his seven-minute opening statement at the 52-minute news conference outlining the challenges and his proposed solutions. "Even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before -- and health insurance reform is central to that effort," Obama said. "If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket."
As he laid out the list of benefits that health care reform offers, he dropped a direct reference to a government-funded public health insurance option. Until now, Obama has consistently touted the government-funded public option as competition for private insurers in expanding access to health coverage.
It was unclear if Obama changed the wording to avoid a label opposed by Republican supporters, or if he was signaling a policy shift toward a compromise being negotiated by the Senate Finance Committee to have health insurance cooperatives rather than a government-funded public option. Republican Sen. Charles Grassley of Iowa claimed on Wednesday that the Finance Committee was not considering a public option. Later in the news conference, Obama responded to a question about the public option by saying it was intended to "keep the insurance companies honest." He noted that some insurance companies recently reported record profits, and said offering a competing government-funded health plan would require private insurers to offer less-expensive coverage. Speaking about the benefits of his plan, he said it would offer "security" and "stability" to sick and healthy Americans. "It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money," he said.
He also said his program would not add to the deficit over the next decade, addressing concerns from Republican opponents and fiscally conservative Democrats over the costs of the program. "Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over $100 billion in unwarranted subsidies that go to insurance companies as part of Medicare -- subsidies that do nothing to improve care for our seniors," he said. Obama also chided opponents of his health care reform push for making the issue purely political. "I've heard that one Republican strategist told his party that even though they may want to compromise, it's better politics to 'go for the kill.' Another Republican senator said that defeating health reform is about 'breaking' me," he said. "Let me be clear: This isn't about me," Obama said, noting that he and every member of Congress -- including those trying to scuttle health care reform legislation -- "have great health insurance." Instead, he said, the debate is about people lacking health insurance because they can't afford rising costs, get denied due to a pre-existing condition, or lose their jobs. "This debate is not a game for these Americans, and they cannot afford to wait for reform any longer."
Obama also confirmed an agreement with fiscally conservative Democrats to create an independent group of doctors and medical experts empowered to eliminate waste and inefficiency in Medicare. Obama said he backed adding such a panel to health care reform legislation. Such a panel could both save money and "ensure the long-term financial health of Medicare," Obama said. So-called "Blue Dog" Democrats questioning the costs of initial health care bills said Obama gave a "verbal agreement" Tuesday to including the independent panel in health care reform legislation.Earlier Wednesday, Obama worked the phones, urging lawmakers to embrace health care reform, White House Communications Director Anita Dunn said Wednesday. It follows the president's Tuesday meeting with Democrats at the White House, dubbed a "serious working session" where "major progress" was made, Dunn said. Officials said Obama will be taking a more hands-on approach with members of Congress in the days and weeks to come regarding the health care debate.
White House aides say the administration is concerned about three centers of serious opposition from House Democrats: the fiscally conservative Blue Dog Democrats who are worried about the cost of a public health care plan; the freshmen and other Democrats from high-income districts who are concerned about taxes for high-income Democrats, and the anti-abortion Democrats who are concerned about federal funding going for abortion services, and whether health care providers can opt out of certain procedures. One official said the administration is aware that "if any of these three groups abandon the effort the bill would be impossible to get out of committee, much less pass."Aides say the president and lawmakers also discussed the public option versus a co-op option.
Conservatives may scoff at the outlined plans and accuse Obama yet again of attempting to build a "socialist utopia" but they know deep in their hearts that their fear and loathing for modern politics has lost them their dignity. The faith has gone in right-wing Republicans who hate abortion yet adore the death penalty; the types who are strongly against this egalitarian institution because all they wish to do is look out for themselves and big business. If Barack Obama keeps doing his job right whilst irritating the regressive Republicans, he gets my backing for life.
The reform proposals he backs would have experts make decisions based on the best medical treatment, not accountants attempting to save money or doctors prescribing treatments that bring the highest fees, Obama said. "This will require patients ... to be more discriminating consumers," he said. "I think that's a good thing. Ultimately ... we just can't afford what's happening right now." Republican opponents of Democratic bills in the House and Senate said earlier that most Americans like the current system, which they said must be made less expensive and more accessible. Republican opponents of Democratic bills in the House and Senate said earlier that most Americans like the current system, which they said must be made less expensive and more accessible. Obama and Democratic leaders say the problems are deeper and systemic, and the president spent all of his seven-minute opening statement at the 52-minute news conference outlining the challenges and his proposed solutions. "Even as we rescue this economy from a full-blown crisis, we must rebuild it stronger than before -- and health insurance reform is central to that effort," Obama said. "If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket."
As he laid out the list of benefits that health care reform offers, he dropped a direct reference to a government-funded public health insurance option. Until now, Obama has consistently touted the government-funded public option as competition for private insurers in expanding access to health coverage.
It was unclear if Obama changed the wording to avoid a label opposed by Republican supporters, or if he was signaling a policy shift toward a compromise being negotiated by the Senate Finance Committee to have health insurance cooperatives rather than a government-funded public option. Republican Sen. Charles Grassley of Iowa claimed on Wednesday that the Finance Committee was not considering a public option. Later in the news conference, Obama responded to a question about the public option by saying it was intended to "keep the insurance companies honest." He noted that some insurance companies recently reported record profits, and said offering a competing government-funded health plan would require private insurers to offer less-expensive coverage. Speaking about the benefits of his plan, he said it would offer "security" and "stability" to sick and healthy Americans. "It will prevent insurance companies from dropping your coverage if you get too sick. It will give you the security of knowing that if you lose your job, move, or change your job, you will still be able to have coverage. It will limit the amount your insurance company can force you to pay for your medical costs out of your own pocket. And it will cover preventive care like check-ups and mammograms that save lives and money," he said.
He also said his program would not add to the deficit over the next decade, addressing concerns from Republican opponents and fiscally conservative Democrats over the costs of the program. "Already, we have estimated that two-thirds of the cost of reform can be paid for by reallocating money that is simply being wasted in federal health care programs. This includes over $100 billion in unwarranted subsidies that go to insurance companies as part of Medicare -- subsidies that do nothing to improve care for our seniors," he said. Obama also chided opponents of his health care reform push for making the issue purely political. "I've heard that one Republican strategist told his party that even though they may want to compromise, it's better politics to 'go for the kill.' Another Republican senator said that defeating health reform is about 'breaking' me," he said. "Let me be clear: This isn't about me," Obama said, noting that he and every member of Congress -- including those trying to scuttle health care reform legislation -- "have great health insurance." Instead, he said, the debate is about people lacking health insurance because they can't afford rising costs, get denied due to a pre-existing condition, or lose their jobs. "This debate is not a game for these Americans, and they cannot afford to wait for reform any longer."
Obama also confirmed an agreement with fiscally conservative Democrats to create an independent group of doctors and medical experts empowered to eliminate waste and inefficiency in Medicare. Obama said he backed adding such a panel to health care reform legislation. Such a panel could both save money and "ensure the long-term financial health of Medicare," Obama said. So-called "Blue Dog" Democrats questioning the costs of initial health care bills said Obama gave a "verbal agreement" Tuesday to including the independent panel in health care reform legislation.Earlier Wednesday, Obama worked the phones, urging lawmakers to embrace health care reform, White House Communications Director Anita Dunn said Wednesday. It follows the president's Tuesday meeting with Democrats at the White House, dubbed a "serious working session" where "major progress" was made, Dunn said. Officials said Obama will be taking a more hands-on approach with members of Congress in the days and weeks to come regarding the health care debate.
White House aides say the administration is concerned about three centers of serious opposition from House Democrats: the fiscally conservative Blue Dog Democrats who are worried about the cost of a public health care plan; the freshmen and other Democrats from high-income districts who are concerned about taxes for high-income Democrats, and the anti-abortion Democrats who are concerned about federal funding going for abortion services, and whether health care providers can opt out of certain procedures. One official said the administration is aware that "if any of these three groups abandon the effort the bill would be impossible to get out of committee, much less pass."Aides say the president and lawmakers also discussed the public option versus a co-op option.
Conservatives may scoff at the outlined plans and accuse Obama yet again of attempting to build a "socialist utopia" but they know deep in their hearts that their fear and loathing for modern politics has lost them their dignity. The faith has gone in right-wing Republicans who hate abortion yet adore the death penalty; the types who are strongly against this egalitarian institution because all they wish to do is look out for themselves and big business. If Barack Obama keeps doing his job right whilst irritating the regressive Republicans, he gets my backing for life.
Saturday, 5 December 2009
Privatisation is sick, not the NHS
THE LATEST report on safety standards in our hospitals lays bare some shocking examples of safety failures in some NHS hospital trusts. The Hospital Guide, compiled by a joint private/public body known as "Dr Foster", highlights 12 trusts that underperform on patient safety measures. The report highlights foreign bodies being left in patients after surgery, operating on the wrong body part and 5,024 patients with low risk conditions dying in hospital. Predictably the media headlines blame the national health service, trying to weaken support for the NHS and its hard working staff. But these problems are mainly caused by the privatisation and cuts to our NHS that New Labour has instigated. Many of the hospitals in deepest crisis were Foundation Trusts, initiated by Labour Health secretary Alan Milburn in 2002.The criteria for hospitals to become Foundation trusts included getting their finances in order and meeting targets, regardless of the consequences.
Foundation hospitals represent a further move towards privatisation as they have more financial autonomy than other hospitals (though patient care is not always a priority).They are supposed to involve the local community but the real decisions are made at the top. Before privatisation and PFI there was at least some local accountability for health services through the community health councils. We now need local health services that are run and planned by democratic committees with representatives of NHS workers and the local community. One big incentive for hospital chiefs to obtain foundation status is to secure a fat pay rise. The salary of the chief executive of Blackpool, Fylde and Wyre NHS Trust rose 32% from £125,000 to £165,000 on gaining foundation status. The Royal College of Surgeons' President explained that: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."
Unison (the largest trade union in the health service) calls for Basildon and Thurrock Foundation Hospital to be taken back under NHS control, and calls for a public enquiry into patient care at the hospital.They explain that the hospital's privatised cleaning contract has been inadequate for many years with too few cleaners and not enough training. This is the direct consequence of private companies inside our hospitals ensuring fat profits at the expense of patient care and of staff wages and conditions. Public money fills the pockets of companies who make huge profits from building hospitals under the Private Finance Initiative (PFI). As interest rates for private borrowers are rising, it now costs £6.3 million more to finance a £100 million deal than it did two years ago. And it costs £23 million more to fund such a deal through PFI than using money borrowed from the government. In consequence, less money is available for patient care. While supporting Unison's demands on bringing hospitals back into NHS control, the health unions should also call for an end to all privatisation and cuts in the NHS. And they should stop paying huge amounts of their members' money to the Labour Party who are responsible for the cuts and privatisation of our health service.
Foundation hospitals represent a further move towards privatisation as they have more financial autonomy than other hospitals (though patient care is not always a priority).They are supposed to involve the local community but the real decisions are made at the top. Before privatisation and PFI there was at least some local accountability for health services through the community health councils. We now need local health services that are run and planned by democratic committees with representatives of NHS workers and the local community. One big incentive for hospital chiefs to obtain foundation status is to secure a fat pay rise. The salary of the chief executive of Blackpool, Fylde and Wyre NHS Trust rose 32% from £125,000 to £165,000 on gaining foundation status. The Royal College of Surgeons' President explained that: "Too many hospitals are too concerned with meeting financial targets at the expense of clinical standards, and we are seeing patients suffering as a consequence."
Unison (the largest trade union in the health service) calls for Basildon and Thurrock Foundation Hospital to be taken back under NHS control, and calls for a public enquiry into patient care at the hospital.They explain that the hospital's privatised cleaning contract has been inadequate for many years with too few cleaners and not enough training. This is the direct consequence of private companies inside our hospitals ensuring fat profits at the expense of patient care and of staff wages and conditions. Public money fills the pockets of companies who make huge profits from building hospitals under the Private Finance Initiative (PFI). As interest rates for private borrowers are rising, it now costs £6.3 million more to finance a £100 million deal than it did two years ago. And it costs £23 million more to fund such a deal through PFI than using money borrowed from the government. In consequence, less money is available for patient care. While supporting Unison's demands on bringing hospitals back into NHS control, the health unions should also call for an end to all privatisation and cuts in the NHS. And they should stop paying huge amounts of their members' money to the Labour Party who are responsible for the cuts and privatisation of our health service.
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