Saving the NHS!

[Undisputedtruth]

Loz Wrote:

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> El Pibe Wrote:

> --------------------------------------------------

> -----

> > Hmm, and whilst some of these are tenuous, taken

> as a whole it begins to hum a little.

>

> Tenuous doesn't even begin to describe some of

> them - I mean, 'has shares in Vodaphone group'?

> Whoopee doo.

>

> I went through the 62 Tory lords listed (couldn't

> be bothered to do them all) and only 18 I would

> count as having anything approaching a meaningful

> relationship with the companies listed, based on

> the information given.

>

> My favourite, which was used twice, was "Shares in

> Diageo plc an alcohol drinks company who have been

> awarded money to teach midwives in England and

> Wales on the dangers of alcohol. No, you can't

> make it up." Ironically, I think that is pretty

> much what the article authors did, if they think

> that is a serious enough link to sway a lord's

> voting intention.

Sneaky Loz, how you define what constitutes a meaningful relationship is neither here or there. The article is very clear on where there are conflicts of interests amongs the Lords.

[Loz]

Undisputedtruth Wrote:

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> Sneaky Loz, how you define what constitutes a

> meaningful relationship is neither here or there.

> The article is very clear on where there are

> conflicts of interests amongs the Lords.

Oh, come on UDT - I refuse to believe that holding shares in Vodaphone or BT constitutes a conflict of interest. I refuse to believe that holding money in Lansdowne UK Equity Fund, one of the UK's largest unit trusts, is a conflict of interest. I refuse to believe that holding shares in Diageo, an alcoholic drinks company, is a conflict of interest. Cutting the list down was pretty damn easy.

This is just a classic mud throwing exercise. You may as well look at all the lords that voted against the motion, find out which ones had ever been, or had a close family member, treated by the NHS and cried 'CONFLICT!!'. It would be as equally pointless.

Now, with the 18 I did find there was some real, potential conflicts. But they were hidden in so much meaningless dross that it devalued the entire exercise.

[Undisputedtruth]

I suspect the conflicts of interest are much wider and deeper than first suggested. A bit like the MPs expense scandal, don't you think, sneaky Loz?

ETA: you have to go to Lords number 34,54 or 60 to see any Diageo or Vodafone references out of the first 62 Lords. So much for your insight, Loz.

[Loz]

OK...

3 - Owns some shares in Marsh Inc insurance brokers and in Zurich Financial Services AG. Whoopee.

4 - Chairman of Chime Communications group, whose companies include Bell Pottinger, and whose lobbying clients include Southern Cross, BT Health and AstraZeneca. Whoopee. Also, a completely unrelated criminal conviction. Eh? Whilst unpalatable, hardly evidence of voting bias. Just some handy mud they found, so they chucked it.

7 - Owns some shares in Reckitt Benckiser. Whoopee.

10 - Owns some shares in Reckitt Benckiser. Still whoopee.

11 - Owns some shares in GlaxoSmithKline. Whoopee.

12 - Chief executive of Huntsworth communications group. Apparently someone from this company once chaired a meeting. Yippee and whoopee.

15 - SHARES IN VODAPHONE!!! You missed that one, UDT. Major league whoopee-doo.

16 - Owns some shares in GlaxoSmithKline. Whoopee.

... etcetera, etcetera.

Really, it's not hard to pick up that the list contains mostly pretty poor and desperate stuff. Had they stuck with the various directorships and paid consultants in there, they might have made a nice little case. But no, they had the chuck mud at any and everything. Poor, poor journalism.

[El Pibe]

I actually agree with you Loz that the scattershot approach undermines their argument where there is a strong case to be made.

You only have to be a regular reader of Private Eye to realise that cronyism and conflicting vested interests absolutely riddles politics across a broad range of issues.

Topically today in the building industry as the plannig guidelines are reduced from a thousand pages to 50 opening the door for my chums to make lots of cash, bye bye the few remaining playing fields and the beautiful countryside outsiude Stevenage growth.

[Huguenot]

UDT, if you have a pension then you have shares in companies that may 'benefit' from the new healthcare blueprint.

According to your own ridiculous logic, that means your opinon has no validity also.

I should point out that companies like Reckitt Benckiser may suffer as a result of the new plans as their own pricing comes under more scrutiny and pressure from healthcare competition.

All you are trying to do is sling shit. It's pathetic. It demeans you and your arguments.

[Chippy Minton]

Now that the Bill is law, someone has been brave enough to leak the risk register (or at least a draft) at last.

It's no real surprise that it's pretty damning given the government's continual refusal to publish it, but it shows the private sector could ?add costs to the overall system;? implementation begins before adequate planning; a disjointed system with NHS moving faster than other areas; ?Financial control is lost? due to restructuring; ?more failures? such as bankruptcies and cuts to services; low staff morale; a system designed ?without taking into account ? patient view;? ?emergencies are less well managed/mitigated;? and ?costs of the future system cannot be controlled.?

[El Pibe]

I think the last one is the most damning.

It looks to me like another half baked move based upon short term pressures that'll saddle the taxpayer with a long term financial burdens that it will be too costly to pull out of.

See trains, tubes, schools, mod purchasing, IT systems ad nauseum......

And as usual lots of people will say I told you say but it'll be far too late to do anything about it.

I wonder how long before Lansley quits for a fat health industry directorship somewhere? Depressing frankly.

[Huguenot]

Chippy, I don't think you know what a risk assessment is?

It's an activity carried out as part of strategic planning to identify worst case scenarios in order to mitigate against them.

It is a deliberate part of risk assessment to include every possible outcome regardless of likelihood.

It is a PREVENTION document.

It is NOT a list of the problems.

Geddit?

It requires no bravery to release it, just stupidity: they know that unfounded shit stirrers with vested self-interest will crop up on forums everywhere and present it as 'proof' that the plan is doomed to fail.

Oh hang on...

 

[Chippy Minton]

I agree EP. It can't be long now before Lansley goes surely?

Although, having said that the government completely ignored the information commissioner's ruling to publish the risk register and this leaked version is only a draft. I can't imagine the latest FOI request regarding the financial links to be treated any differently so may be he can hang on now that the Bill is law and the spotlight on him is less bright?

[El Pibe]

I've worked on two types of projects.

Those with chunks of red on the risk register that remain red because noone is willing to face the political implications of addressing them.

It eventually bites you on the arse to some degree or other.

The other type is where stuff that should be red is massaged to yellow or green because someone isn't willing to face the political implications of admitting to the fact that it's red.

This bites you on the arse every time and heads usually roll.

I am of course the annoying person at the coal face who sits in meetings being ignored as I say 'its red, its red' and ultimately 'i told you so' ;)

It's in the nature of big projects that there are only these two options.

This feels like the latter to me because it is an innately political project.

[Chippy Minton]

Talking of Private Eye and people saying "I told you so," I doubt anyone in the NHS will want to be whistleblowing now the Bill is law!

[Huguenot]

The task with 'risk' is not to eliminate it, but to find a balance between the potential downside and the costs and resources needed to ammeliorate them.

The irony is that attempting to eliminate risk frequently results in spiralling costs and unending projects that miss all their deadlines.

Just the thing that EP and Chippy are claiming they want to avoid.

Risks are a wet dream for people who take great joy in criticising or bullying others. They can be dragged out to prove that 'we knew about the problem and did nothing about it' as a percursor to persistent and vicarious hate campaigns.

In the particular hate campaign that Chippy is waving around like someone who has stolen someone else's lunchbox, the basis of the risk was the claim that something could have been done (by the CEO) to prevent the Baby P tragedy.

Rather than the 'whistleblower' being subject to bullying and harrassment, it's the CEO who is being painted as a callous and deliberate child murderer.

What it doesn't say is that taking such an approach for every child is a catastrophically expensive process that the taxpayer refuses to pay for, and risks destroying families without justification. So the judgement has to be applied subjectively by professionals - and they make mistakes.

[El Pibe]

You may put those words in my mouth if you want Huguenot, but in my experience the risks are based on the goals being unachievable such that they will ONLY result in spiralling costs and missed deadlines (and usually faliure), and though it might be a bitter political pill to swallow someone needs to fess up and start savagely cutting back on what they want to achieve and focus on what CAN be achieved.

Public, private makes no difference, I've witnessed this in banks, in media, in the MOJ and in the NHS appropriately enough, though on a scale far smaller than Lansley's impending debacle.

This NHS exercise smacks to me as archetypal in trying to make the hand fit the glove rather than vice-versa.

Doomed I tell ya, doomed!!

It's funny that you accuse others of of unsubstantive criticism, but your support seems equally so to me.

[Huguenot]

I didn't say your criticisms were unsubstantive - the risks exist.

The challenge is to try and balance these against their likelihood, resources necessary to mitigate, and the potential benefit of taking these risks.

Every project has risks, some of those risks will be realised, and if a killjoy is sufficiently fastidious to remark on all of these before any action is taken they will be able to say 'I told you so' more than once.

This isn't in itself a reason not to embark on a project, and the prophets of doom could wonder whether their warnings went unheeded because they cried wolf once too often. After all, 99% of the problems they cite will go unencountered.

I think your description of the risks of big unwieldy projects is accurate and apposite.

The NHS itself is a huge unwieldy project whose costs and bureaucracy have spiralled out of control as people pull it in different directions, with conflicting motives and poor information flow.

The solution to this problem is self-evidently decentralisation and return of the administrative control to the coalface, where the public can adjudge the quality of service with their feet - competition.

Just what this health bill does.

[El Pibe]

For starters I'm not sure it self-evidently is.

As I've pointed out before, purchasing policy is so decentralised it's often at departmental level.

I worked on a data gathering project which was attempting to find out who was paying how much for what.

Apart from the enourmous distrust with which individual managers met any enquiry into their business, what little we could glean was that even within a single trust there could be huge unit price discrepancies on the same damn product.

If the NHS were to get an overall procurement strategy and leverage the huge economies of scale and negotiating power available to it, I think the savings could conservatively be put in the billions and vastly outweigh anything to be gained by these reforms.

Ironically the quango tasked with the exercise was axed by the incoming tories quangogeddon as a cost-saver.

Whoops!!

[Huguenot]

So in other words the NHS doesn't work because its own employees don't want it to?

If distrust of central bureaucracy is so high that they wouldn't even tell you what price they were paying for goods, then what do you expect their reaction to be of the centralisation of drug acquisition and distribution?

I foresse a complete meltdown of the workforce amidst claims that politicans are using the NHS as a political football and it takes powers away from the clinicians etc. etc.

Regardless of that, there's no reason why group buying power couldn't be executed by a decentralised NHS - it's only requires cartel behaviour - I suspect that in loose affiliations of private companies the politics would swiftly be overcome and a company step in to deliver that role.

[El Pibe]

More the NHS doesn't work because it's balkanised and people are myopic.

"I suspect that in loose affiliations of private companies the politics would swiftly be overcome and a company step in to deliver that role"

I suspect that's cloud-cuckooland wishful thinking. Have you considered a job as a Tory policy maker at all ;)

[Huguenot]

Well perhaps, but then why would the newspapers be full of stories about distributors behaving like cartels to squeeze suppliers - supermarkets for example.

[El Pibe]

That may well be but doesn't serve as an anolgy here where the suppliers are very powerful and know how to play the game far better than the happless procurement managers/GPs et al.

[Huguenot]

But aren't the hapless procurment managers a consequence of a bumbling government bureaucracy with associated HR and performance challenges?

They wouldn't last long in a competitive environment?

[El Pibe]

Again, competitive environment is not something anyone wants to hear when it comes to the NHS as what that really means is privatised.

Hospitals that underperform commercially will simply be shut down, see also high street banks, cash machines, post offices and railway stations (ghost trains notwithstanding).

Having to drive thirty miles for a cash machie is a p.i.t.a., in terms of emergency medical care we're talking dead people.

Plus I'm still looking at the porposed structure and trying to understand why terms like streamlining or minimising beauracracy are being bandied about.

[El Pibe]

and just to be clear on my general position. I'm not against change.

Clearly the NHS can benefit from reforms, indeed the status quo was arrived at following Labours own attempts to 'solve' the NHS.

I just don't think the problems are as intractable as people like to make out or that the NHS is sick.

We'd obviously all like more for less, but ultimately the NHS is something the electorate is willing to pay for no matter how costly, it's the closest thing we have to a sacred cow in this country.

I'm simply of the opinion that reform isn't something applied in an ill thought out manner every 4-15 years or every time there's a new prime minister trying to make his bloody mark. As I've said before there should be a much longer term strategy built into the precepts of reform proposals.

Those proposals, whilst obviously being under a political direction, should be, as much as humanly possible, free of the vagaries, ideologies and political point scoring of party politics and under the direction of cross party/camera bodies with substantial input from independent reviews.

Change should come in small manageable, achievable chunks as part of an evolutionary process of improvement. This will mean meaningful change can actaully be achieved and hopefully without demoralising the workforce and putting patients at jeopardy.

I have little doubt that we will see both as a result of the introduction of the health bill.

[Huguenot]

I'm not sure why competition has to mean privatisation, it simply introduces a link between performance and reward.

GPs already receive 25% of performance related pay - meaning that they 'compete' for patients within their catchment.

The actual compensation structure for GPs is still not fit for purpose, and it's incorrectly audited, but it does demonstrate that competition can exist within public services.

[StraferJack]

GPs already receive 25% of performance related pay - meaning that they 'compete' for patients within their catchment.

You've seen the recent threads about gps medical centres going downhill yes?

That'll be the less profitable patients talking then