Tuesday, 24 March 2015

You Are Next in Line for Ideology

Spotted this the other day - it must be good:

Overheard at the Sort It Centre:

Chairman: "Hey look - a woman driving a bin waggon."

Hay: "Heavens above - they'll be wanting the vote next."

Hay called Tivium yesterday about a free boiler for her dad under the Green Deal (Tivium have had a bit of bad press lately and there's some debate as to whether they are scammers). She was in a phone queue and, from the time it took to get from 2nd in line to next in line, it was obvious they have just one person manning the so-called 'call-centre'.

Been having a debate with some friends about the outsourcing of NHS contracts which stimulated me into doing some research through the auspices of The King's Fund, which is a highly respected independent charity that reports on all things NHS. Until recently I adhered to the popular perception that the NHS is being sold off piecemeal, but I have since changed my mind, being persuaded by asking some pertinent questions of myself and looking for the answers.

It transpires that the 2006 level of outsourcing was just under 3% of the NHS budget. Today it is just under 6%; admittedly a doubling, but surprisingly the rate of increase has been slower under the coalition than under the last Labour government, at least to 2014.

In the final analysis, it's not the government that places the contracts, it's the HHS Trusts themselves, using government policy that allows it.

Arguments against outsourcing of contracts cite a number of high profile cases where patients were not getting the best attention or being put at risk. Yet in 2013 some 14 NHS hospitals were put into special measures because of systemic failings, and just recently the largest NHS Trust, Barts, has also been put into special measures. Ergo the potential for disaster is not limited to the private sector alone.

I'm not in favour of government policy being developed on the basis of pure ideology, much preferring it to be evidence-based (medicine itself, after all, is evidence-based). That's why I'm no longer fundamentally opposed to the outsourcing of NHS contracts. If outsourcing can be shown to provide benefits in terms of patient care and reduced waiting times, then why not? It doesn't cost the NHS any more and the NHS isn't physically able to reduce the waiting lists anyway without a large time-lag until resources are in place. It's pragmatic expediency, but it shouldn't go too far, else it undermines the whole concept of the NHS, which is fundamentally a good thing for the disadvantaged.

Contrary to received wisdom, the NHS currently has its second highest ever patient satisfaction rating. To listen to the unions and the anti-outsourcing brigade you'd think it was going to hell in a handcart - this simply isn't true.

The ideology that says public services should have no commercial input whatsoever will result in massive inefficiency (we learned that lesson  from the nationalised industries, which were under no pressure to innovate and became bloated and uncompetitive as a consequence) and longer waiting lists, which is tantamount to saying the NHS itself is more important than the patients it serves, which is patently absurd.

Outsourcing should be used to:

  1. Address temporary or seasonal peaks in demand, thus maximising resource utilisation within the NHS (and giving the taxpayer value for money),
  2. Give patients improved access to services (as has been done by giving GPs control of their budgets and decisions on where to purchase patient-centric services, such as testing), and
  3. To stimulate innovation through a healthy degree of competition.
It should not be used where continuity of care is essential; however, that said, the NHS model for mental health services is based on a one-size-fits-all model of CBT, which does not necessarily work for all mental disorders. Continuity of care in mental health, is one area where outsourcing should not be used, but due to the NHS' focus on CBT, much of the therapy is outsourced, but sporadically, as it's the poor relation of the NHS and has very little budget.

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