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NHS reforms- anyone else as disbelieving as I am?

319 replies

nowwearefour · 17/01/2011 22:10

What on earth is going on here? Privatisation by stealth? I know what- let's take the focus off the patients and the healthcare and put it on re-organising ourselves.AGAIN. how brilliant. anyone care to help me see what the benefits are of this?

OP posts:
byrel · 20/01/2011 22:51

Whats wrong with the NHS getting KPMG to help them see how efficiency could be increased, its common corporate practice

Hammerlikedaisies · 20/01/2011 22:54

It looks to me as if KPMG are competing with, or even trying to take over the NHS, not helping them.

edam · 20/01/2011 22:59

byrel - how about starting by looking into the probity of the former head of commissioning at the Dept of Health, AND his deputy, walking straight into lucrative jobs at KPMG just as, entirely coincidentally, KPMG gets awarded this massive contract?

How does KPMG winning a massive contract covering all of London square with the claims in the health bill and white paper that this is bottom-up reform, led by local GPs, rather than the government privatising the NHS?

Why did the Department of Health refuse to publish the report that KPMG produced? It's taxpayers' money spent analysing a public service that is paid for and used by taxpayers.

Why is anyone paying KPMG vast amounts of money, anyway? If we want to learn from outside the NHS, how about asking some of the people who run successful healthcare systems in other countries - systems that do well on access and quality, such as Kaiser Permanante, or the Veteran's Health Administration? Or even some of our own home grown health think tanks such as the Kings' Fund?

Hammerlikedaisies · 20/01/2011 23:07

Wow, Edam. Shock

I thought I was over-reacting when I wrote my last post. This really is shocking. How can we have even a drop of trust left in this government?

We need to shout about getting that report published, imo. Where's the Guardian when you need them? Or Wikipedia?

medicalmum · 20/01/2011 23:08

Shananiah and Semirural life - yes, we do need to make a huge fuss about this and yes, it is time to have a mumsnet campaign. No idea how to go about it, but could be linked into many other campaigns running

If patients don't stand up and complain long and loud then La La Lansley will just push this through and after the contracts are signed with the private sector it will be too late to reverse it.

As for KPMG, the scandalous thing is that Mark Britnell, former Head of Commissioning at DoH went over to KPMG in 2009. Then Gary Belfield took over as Director of Commissioning at DoH and left in 2010, also to go to KPMG. It's the revolving door between the public and private sector which is explored more here if you are interested
www.lobbyingtransparency.org/content/view/55/1/

byrel · 20/01/2011 23:08

I don't know the answer to your first 3 questions as I'm not party to the plans of either KPMG or the GP consortias.
The point I was making was that getting consultancy firms to assess and improve efficiency is common practice and every large firm does it so it would seem sensible for the NHS to do the same.

Hammerlikedaisies · 20/01/2011 23:19

Thanks, NiceCage and Medicalmum for the links. I'm going to look at the video again in the morning. Great report- really illuminating.

Just heard George Galloway on Question Time making the point that GPs won't have time to do all the commissioning themselves, so they will have to bring in private companies to do it. So it will be private companies commissioning services from other private companies. = a private health service.

edam · 20/01/2011 23:19

The NHS is NOT a business, that is the whole point. It does not exist to make a profit for shareholders.

Businesses are free to spend their money how they choose, as long as the shareholders approve.

The government, on the other hand, is dealing with taxpayers' money and life-saving public services. It should not be wasting money on dodgy deals with expensive consultancies. It should not be keeping those deals secret. Especially when those consultancies who are dealing in insider info from highly paid individuals who have designed the system in the first place.

ThisIsANiceCage · 20/01/2011 23:21

I hope the Guardian will forgive this large quote from that article:
[QUOTE]
NHS London said: "The KPMG Partnership is designing and delivering individual and team leadership development and organisational development for GPs in the first eight pathfinder consortia in London.

"This will develop a leadership and organisational development approach to support all consortia in London, with an organisational development model and diagnostic tools that can be used by consortia to ensure they can become effective commissioners in the future."

But Dr Richard Vautrey, deputy chair of the British Medical Association's GP committee, said his organisation is concerned about the use of private sector providers by GP commissioners.

" The advice that we have been giving is that consortia should develop their own organisations, rather than become dependent on external organisations, which over time could become more dominating over the consortia, rather than the other way around.

"I think it is important that consortia have the necessary core skills to be able to deliver their statutory functions and don't become dependent on external organisations, potentially multi-national organisations.

"There is also a potential problem where conflict of interest starts to develop where those that are giving advice, in terms of commissioning advice, are also potential providers."
[ENDQUOTE]
KPMG to aid London GP commissioning groups

ThisIsANiceCage · 20/01/2011 23:34

Becoming dependent on external organisations is called Client Capture in management-consultant-speak.

It means the client (here the health service) becomes so dependent on the specific private company (here the management consultancy) that it can no longer sack it, because the client simply can't do its core job without that particular company.

In some cases, the client loses even the ability to assess whether the external organisation is doing a good job. It no longer has specialist in-house staff. The more complex or technical the service, the more likely this is to be true (everyone can tell whether the canteen is good or not; no one can tell whether the giant new computer system is any good until it's waaay too late).

I'd say KPMG are well on their way to client capture with the NHS in London.

TigerseyeMum · 20/01/2011 23:57

Client Capture is happening in education too. Partnership working within a wider framework is one thing, piecemeal private provision aimed at garnering profit in a fragmented industry is another.

Angel1210 · 21/01/2011 00:06

cerealqueen Thanks for mentioning Complaints I work in a team consisting of PALS and Complaints in PCT land. Everyday we help people with questions they have, mostly about GP practices and dentists, and explain how to complain. I understand the new Healthwatch (being commissioned by local authorities) will have a complaints advocacy role, but am not sure where NHS Complaints will sit. If it is with the GP Consortia there could be a conflict of interest.

ATM PCT staff are greatly reduced as a result of MARS and the encouragement of 'natural wastage' forcing several PCTs to have to join forces to cover their obligations. There are still two years to go before PCTs finish!

ToxicKitten · 21/01/2011 09:08

Thank you to all those people here who are finding and posting the information about how all this is coming about.

I'm Shock because although I am regarded as articulate and intelligent I do not understand most of it until some kind soul comes along and translates it into "laymens" terms.

Many good points are coming out of this thread on a basic level regarding the way we are "blinded by science" and how it keeps driving us away from the core issue, which is how best, as a compassionate and civilised society, do we care for our sick and disabled, and help those who love them to participate in that care without becoming understandably overwhelmed and facing huge crises.

I keep coming back to "money". I feel like we are all running a race, with the starting point of what we instinctively feel is right, and the care I mention being the finish line. We start running, because it will only take me a second to get there, it's not a long distance and it simply requires focussing - we want to run the race, because the race needs to be run. However, the race organisers realise that if we win the race, they will have to share their prize. For them, the winning line is money, because they believe that money is the key to winning, not focus, or determination, or attitude, or actions inspired by those things. For them only money can solve the problems. So they keep putting hurdles in the way.

The hurdles start small, and we have a go at them. We manage the first few, because we are determined to reach our goal. We do the hurdles to prove our committment to the goal, not because we believe in the hurdles. But we think if we go along with the hurdles the race organisers will let us reach the finish line. But it's not enough, and before long we feel we have to focus more on the hurdles than the winning line, because we start to believe one is dependent on the other, when really, it doesn't have to be.

Before long we don't know if we are running the race to get to the finish line, or to allow the organisers to build hurdles, which they believe are important. We get distracted because we start wondering if the hurdles could be improved. We try to get to the winning line and co-operate with the hurdle builders, even though it's a contradiction, because we want to believe that really we are all trying to get to the winning line together, and we know we have to listen to each others ideas and respect them, and try them out.

When we get close to the finish line, we can see people suffering. We feel bad, but we believe we have tried our best. We have been hurdling to get there, and trying to improve the hurdles to make it easier. But there is always another hurdle.

We apologise and ask for the patience and understanding of those suffering. They are close to death maybe, or unable to do things we all take for granted for many reasons, and only want to spend their life in peace. The hurdles, and our attempts to get over them mean very little.

Because we feel embarrassed and ashamed at our failure, and we don't want to feel those emotions, we start to try and spread them around, because misery loves company, and eventually we even hit out at the suffering. We try to examine if the reasons they are suffering are "their own fault". This upsets them.

So some of them give up, and take control of their own destiny. They commit suicide. This causes the people around them to suffer from the loss, many more reasons for the loss than should be necessary, and perpetuates the need for more care. Some people have their last moments filled with the strife generated by their loved ones having to fight for their care. We demand stoicism, though as we are not "suffering" ourselves we have no actual idea what it entails perhaps.

Then we decide to start a new race, but we start with the hurdles in place, hoping they are the right hurdles. But they breed. We try again. And again. Suffering and dying doesn't change. Only the hurdles do.

People who are running the race lose heart and start to suffer themselves. But now they believe there have to be hurdles. That's just the way it is.

Of course the only answer to removing the hurdles is money. You can buy off the organisers of the race. If you have enough money you don't have to attempt the hurdles. Even if deep down you know this is not helpful to people who are suffering who have no money, you only know how to live in the context of enough money. You can't see a different way. You are scared of trying a different way because money is absolutely necessary, even though we have learned how to feed, clothe and house ourselves and now can have luxuries too. We don't put suffering people ahead of luxuries though. We believe that the money generated by luxuries will be put into the race to get to the suffering, and other people will do that and we have to trust them. They have money, and power, and control. We trust them to do the right thing. They believe they are doing the right thing, maybe are trying to do it too. But because they believe they have to hold onto their money in one hand, they can only do half the good.

Because of money, truth and trust have to be tempered with holding onto it. So there is none.

We still don't understand why we're suffering, and we don't like to talk about it out loud in simple terms, for fear of being accused of naivety and then we start to express our frustration in anger. People mistake anger at suffering with other people wanting their money. And maybe we do believe that we need the money. We have been brainwashed, in the name of alleged civilisation and alleged intelligence. We are too sophisticated for such simple concepts as treating each other equally. We even encourage people who think differently to suffer, and push them out of society and try to punish them when they come close to hitting on truth and trust.

If you have read all the way to end of this thank you.

If you agree with any or all of it, thank you.

If you agree that we could make a difference if we explained things over and over again in real peoples language, avoiding the issue of money, then I would like to try, and would like to try in conjunction with other people who feel similarly.

If it feels like taking a risk, well, if you are able to take the risk of getting up everyday and hoping that things will get better, then it's only as big a risk as doing that.

Have a beautiful day because you are. :)

semirurallife · 21/01/2011 10:32

medicalmum, thanks for the link - haven't managed to watch it all yet (DS needs me to play cars with him!) but its brilliant, and very useful for anyone wanting some clarity on what is definitely a complex playing field... see www.lobbyingtransparency.org/content/view/55/1/

My guess is anyone with a LibDem MP has a chance to getting them to asbtain, but who knows what deal they have struck over this?
I am really scared - 2 babies and one major operation on the NHS and all I have ever known personally is kind and effective service... I grew up in the USA and when you get to A&E there the frist thing you have to do is get out your credit card! how a private monoploy is going to provide imporvements is beyond me - look how fantastic our trains are! :(
a good read on the broader picture is Ill Fares the Land by Tony Judt, great analysis of cost of trains (normally boys' stuff but quite interesting when you see how much taxpayers money is going in private pockets while the passenger pays moer and more... )

pascoe28 · 21/01/2011 12:36

What you are experiencing (fear) is the result of New Labour's policies.

The current government are going to change things for the better

Would you prefer them to stay as they are?

ThisIsANiceCage · 21/01/2011 13:03

I am, today, experiencing fear and rage as a result of the Conservatives' policies, in which they may be abetted by the LibDems (but may not, if there's a revolt).

Labour were up to something similar but slightly less rushed. However, they are not currently in power, and I credit the people who actually sign the deal with ultimate responsibility for it.

wubblybubbly · 21/01/2011 14:00

Do you really believe that pascoe? Even Portillio accepts this is a huge gamble. A leap in the dark I think he called it.

semirurallife · 21/01/2011 18:46

mm, which new labour policies Pascoe? agreed that the nhs suffers from interference gone mad, but DC and AL haven't even explained what specific problem they are trying to fix, NOR why privatising the whole thing is a solution. there is simply no evidence that privatisation and competition can work in the imagined "market" for health services. This is just ideological nonsense, absurd at best, deadly most likely. We are not 'consumers' shopping around for the best surgical experience, we are people who want to trust those giving us care, have an operation [or whatever] and be done with it. and by and large the infrastructure of medicine in this country and knowledge is good - training is tough and the drs i know all work ridiculously hard... and have a huge ethic of care and public service which simply doens't fit the Tory world vision in which money and profit are the be-all and end-all.

edam · 21/01/2011 22:08

pascoe, in what way exactly will the government's policies make things better? Do tell. I can't see it.

edam · 21/01/2011 22:11

(And Angel, sorry if I'm repeating anything anyone else has already said - long thread - but Health Watch is going to be funded by local authorities while supposedly holding local authorities to account for their new 'health functions' (public health). Yeah, right, no reverse incentives there at all... and of course at the same time as local authorities are facing swingeing funding cuts. Of course they are going to protect the budget of Health Watch while slashing services for disabled children - the voters will understand, won't they? Hmm

Hammerlikedaisies · 23/01/2011 18:08

Has anyone been listening to this programme? Radio 4 File on Four.

www.bbc.co.uk/programmes/b006th08

It explains how under the government's proposals to cut legal aid, no-one will be able to sue drug companies if the drugs have side effects which are too harmful (eg epilim, seroxat).

ThisIsANiceCage · 25/01/2011 09:46

There'e a vote on all this in the Commons on Monday 31 Jan. It's the Health and Social Care Bill.

You can email your MP asking them to vote against it. More info and coherent campaign here.

Btw, reorganisations are jaw-droppingly expensive. Even if this were a good idea long term, we shouldn't be doing it now.

nowwearefour · 25/01/2011 17:44

brilliant. i totally agree cage re the actual cost of the reorganisation at a time when we can apparently not afford anything at all. horrendous. worse that it isnt even a good idea long term! thanks for the link

OP posts:
ladyloretta · 25/01/2011 21:34

Until the present government got in, my husband and I had received excellent care from the NHS over the last 10 years, both from our GPs and our local hospital. However at my last hospital appointment 10 days ago, I was there for three hours; the actual tests took just one hour, the other two were spent just waiting around, which was very frustrating.

The last Labour Government is much criticised and are never given enough credit for the way in which the NHS improved during ther years in office. My brother and his wife, both doctors, agree.

Hammerlikedaisies · 25/01/2011 22:25

Thanks, Cage. It's a great website and it shows what's happening in your area if you enter your postcode.

I really hope the Scottish MPs will vote against the cuts in England.

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