A friend of mine in the UK sent me this link to an article in The Guardian “NHS plans for credit rating agencies to vet hospitals” – it’s an interesting article and well worth reading.
So, what’s it all about? Perhaps it is my own personal view of politicians being unwilling to accept responsibility but, it seems to me, that this is another one of those “we’re only responsible for the funding and not the quality of the delivery” moves. My guess is that we’ll see hospitals declared to be a financial risk by organisations which Joe Farrington Douglas (an Associate Fellow of The Institute for Public Policy Research) termed “key enablers of the financial meltdown” and then what? Surely the options after such a declaration are few and far between.
(1) The Government could simply say “So what? It is doing an excellent clinical job and we will fund it regardless of the financial risk as assessed by these bodies!” Yes, you can just see that happening can’t you?
(2) The hospital is closed, staff loose their jobs and patients have to travel to a hospital in another town or city. It has to be said this sort of thing has happened before and politicians have ridden out the storm, but then it’s generally just been a department that has closed, such as the stroke unit at Darlington. The headline in The Northern Echo is “Darlington hospital stroke unit closure ignites fresh row“, or residents of Rochdale being told not to go their own hospital in an emergency but to one in Bury, Oldham or Manchester.
(3) The private sector might just be invited to step in and take over the facility along the lines of “failing schools”. This extract from a NASUWT publication is, perhaps, an indication of the way things might also progress in the NHS
“Currently, in the state education service, the private sector is involved in:
• sponsorship of and direct investment in schools and their activities;
• the provision and management of local authority services;
• the provision of services for schools;
• Private Finance Initiative (PFI) and Public Private Partnerships (PPP);
• the management of state-funded schools – Academies”
So, which of these are possible in terms of NHS hospitals? Clearly sponsorship is a possibility. With that sponsorship could well come a specialty within the hospital, such as, cancer, or diabetes or pretty much anything else. Would that be good or bad? As with most things, it may depend, and we should perhaps not make a decision too early. It would, surely, be “a good thing” if there was increasing expertise within a hospital, but if that expertise came at the expense of a reduction in the width of other provision, say the Accident and Emergency facility, would that still be a good thing? Presumably it wouldn’t be a good thing if, like the citizens of Rochdale you have to take your injured child several miles further than you otherwise would, particularly if, as is often the case, time is of the essence in effecting a treatment. Paramedics are very well trained and do an excellent job but they simply don’t have the resources of a hospital available to them as they make the 5 miles journey along the B6222 on a wet February night. Maybe it would be the provision and management of the hospital services themselves, but, isn;t this already something that can happen? The provision of services for the hospital might well an alternative along the lines of “We no longer provide x-ray scans here madam, please take your child to the XYA clinic five miles away”. It sounds ridiculous doesn’t it? Maybe but that’s effectively what my wife’s health insurance policy provides for us. We can use an in-hospital facility but if we do then we are charged significantly more than our co-pay in an in-policy but not hospital facility down the road.
My guess, and that’s all it can be as I am certainly not aware of ongoing government thoughts on this, is that there will be two main possibilities, the first being that the hospital is simply taken over by another provider which charges the NHS for the services it renders, or that expensive services are contracted out and the hospital/NHS is charged accordingly. Is there anything really wrong in this? In one sense, no, there’s nothing wrong with it as might well enable a higher standard of care than the NHS is funded to provide at the present time, but in another sense, yes, there is something very wrong with it, and, until you’ve experienced the wrongness of being told you have a potentially life threatening problem and you should go home, consult your insurance company, the internet and then make an appointment to see a doctor, you probably won’t think of it, but believe me, that scenario is about as wrong as it gets. I couldn’t have done it – well I suppose I could but as a total novice in this system I freely acknowledge that I was out of my depth.
Something of a follow-up
This report by the BBC caught my eye yesterday. It seems to be clearly stating that the NHS got a bad report because only a limited data-set was examined! No-one seems to have been willing to stand up and criticise the original report. I wonder why?
Something more of a follow-up
Here’s a petition you might like to check out http://www.38degrees.org.uk/NHS-petition