"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Tuesday, 31 August 2010

Dimwitted Dorries

This blog is called Tory Lies because I was incensed when I first heard David Cameron tell the country how he would "protect the NHS" since I had read the Tories NHS plans from 2006 and 2008 that said precisely the opposite.

If there is an embodiment of Tory Lies it is Nadine Dorries. If I was charitable I would say that it is not her fault. She is rather dim and she feels that she has to say something, and hence makes everything up on the spot.

Look at her latest blog post. So here she is castigating the £260 million spent on "management consultants" without explaining who they are. As it happens these are private sector contractors like lawyers, architects and IT consultants. This is very much the "any willing provider" policy that Tony Blair was keen to use in his scheme to get more private sector involvement in the NHS (something I was against), and it is something that Andrew Lansley will make compulsory. But dimwitted Dorries says:
"something Andrew Lansley put a stop to by imposing a consultancy spending moratorium on day one"
Umm tell me, does that mean that Lansley is going to cancel the "any willing provider" plan? No. I thought not. So in fact Lansley will increase the amount of money that will be spent on private contractors.

Then dimwitted Dorries says:
"The opposition have also begun to describe GPs as the private sector within the NHS."
Remember that this woman is a member of the Health Select Committee? She does not know that GPs are independent contractors? She does not know what a "practice" is? She does not know that GP practices make profits which are shared between the partners (or re-invested in the practice)? How dimwitted can she be?

But this really got my goat:
"GPs will no longer have the PCT breathing down their neck, watching every penny they spend and on who, telling them what services they can procure and which they can’t."
This sounds like GPs will have a huge pile of cash and will be throwing it around at every healthcare issue. No. GPs will be under immense pressure to save money in the next few years. Let's take one simple example. At the moment there are 152 PCTs and the cost of their commissioning work is £1.85bn a year. There will be an estimated 500 GP Commissioning consortia (which will inevitably duplicate the work of neighbouring consortia) and they will be paid £1bn to do commissioning. Lansley has not published the reasons why he thinks 500 consortia will be able to do the work of 152 PCTs for 54% of the money and the suspiciously rounded figure suggests that it is a number pulled out of thin air. Moving from 152 organisations to 500 organisations is the opposite of "economies of scale". If GPs are going to to commissioning at the standard of PCTs then they will have to spend more.

GPs will have no choice, they will have to do commissioning. Remember section 5.14 from the White Paper (something that Dorries clearly has not read)?
"the Government will not bail out commissioners who fail"
This means that if GPs do not have enough money to do the necessary commissioning from the management fees paid by the Department of Health then they will have to dip into their budgets for providing healthcare. Or worse, (and this is a real fear expressed by many GPs) they will not do all the required work like risk management and performance management. The GP consortia will provide "commissioning lite" which means that the large hospitals will dictate to a consortium the fees it will charge and that they will pay rather than negotiation between the consortium and the hospital. GP consortia will be too small to have any clout against the large hospitals (which, remember, will also be private-sector businesses and duty bound to maximise their income). Inevitably this will make costs rise.

Yes, many GPs dislike PCTs but most GPs appreciate the fact that they are there. Why? Well, up until now the Hippocratic Oath that defines the work that GPs do says that the GP must give the patient the treatment they need based on their clinical judgement. In fact, by law they have to do this because it is enshrined in their contract. But the White Paper says (4.4)
"bring together the responsibility for clinical decisions and for the financial consequences of these decisions"
This says that GPs will no longer make decisions purely on clinical grounds, they will be duty bound to make decisions based on the financial consequences. In the past it was the PCTs who handled the financial side, it was the PCT who had to find the money to allow GPs to make their decisions based purely on clinical decisions, but under Lansley the GPs will no longer have the insulation of passing the tough financial problems over to the PCTs. In the future a patient will not know whether the decision their GP is making is a clinical one, or a financial one. GPs, understandably, do not like this. Dimwitted Dorries does not seem to realise that this edict from Lansley will destroy the trust that patients have in their GPs.

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