It sounds like heresy but we've got to stop treating the NHS like a national religion

Every healthcare system throughout the world is currently in the middle of a perfect storm.


The deepening crisis engulfing all health services has been caused by three crucial factors: ageing populations, mounting costs in advancing technology and treatment, and well-informed service users who are used to making sophisticated consumer choices.

Yet the problems are perhaps more acute in Britain than anywhere else in Western Europe, not least because our monolithic National Health Service is proving too inflexible, bureaucratic and outdated to meet the challenges of the new era.
Sixty years old this month, the NHS was designed for an entirely different age, when life expectancy was far lower, medicine was less complex and the British population, having emerged from six years of gruesome war, was much more subservient to state authority.

The Labour Government, while adopting an increasingly proprietorial air towards the NHS in the run-up to the 60th anniversary, has recognised the system is in dire need of reform.

The strategy adopted during the years of Tony Blair's rule was to throw vast mountains of cash at the system. Since Labour came to power, NHS spending has more than trebled, topping ?100billion annually.

But real change was not delivered, so the usual problems have persisted, particularly in the rationing of treatment, the differing standards throughout the country and the increasing costs of a top-heavy bureaucracy.

When Gordon Brown arrived in Downing Street last summer, he appointed a leading and very capable surgeon, Lord Darzi, as one of his health ministers and ordered him to conduct a fullscale review of the NHS.

The result is the document launched yesterday under the optimistic and slightly Soviet-sounding title High Quality Care For All.

But it would be wrong to be too cynical. Lord Darzi is a dedicated healthcare professional, not a calculating career politician, and there is much to admire in his document.

For a start, the idea of creating polyclinics in every town is an excellent one, vastly improving access to healthcare, especially for those who have busy working lives and cannot easily get to GPs surgeries during the day.

These new-style polyclinics have been given a bad press by the doctors' professional union, the British Medical Association. As a result of this negative campaign, they have been presented as a destructive alternative to the trusted GP.

Nothing could be further from the truth. Polyclinics are a complement to current services and, if run properly, they will expand the range of the treatments available, thereby reducing the pressure on hospitals and delivering care far closer to patient's homes.

Mind you, for all the benefits of polyclinics, it was this Government that shattered the tradition of GPs providing 24-hour cover through its disastrously botched negotiations of the last GP contract, which allowed doctors to reduce drastically their hours and yet receive more money.

In part, therefore, polyclinics are a solution to a problem created by ministers.

There are other aspects of the Darzi report to be welcomed. The proposed NHS constitution, which legally enshrines patients' rights, should act as a restraint on authorities trying to block certain types of treatment.

Lord Darzi's call for closer working between the various branches of the NHS is common sense, though too often ignored by empire-building bureaucrats who jealously guard their own territories.

Speeding up the procedures by which the National Institute of Clinical Excellence (NICE) decides whether to license a certain drug will also benefit thousands of patients.

But there is also a serious downside. As with so many statist plans, the expansion of bureaucracy becomes a substitute for real action.

Sadly, in failing to learn the recent lessons of history, Lord Darzi has allowed his plan to become littered with yet more extensions of the corporate state.

So we read that he wants a National Quality Board, a new Care Quality Commission, a new NHS Medical Education Service and a new Fit To Work service, as well as vast amount of new paperwork contained in the demands for 'quality accounts' - audits of how well patients are treated - as well as a host of other indicators, targets and box-ticking exercises.

Just as worryingly, there seems to be a fundamental contradiction at the heart of his document. On the one hand, he says he wants to end the ' postcode lottery'.


On the other, he argues that, to improve efficiency, better performing trusts and health centres should be rewarded with extra funding, while poor performers should be penalised.

But in practice, such an approach will only worsen the variation in the provision of treatment. In effect, patients will be hit twice over for living under an inadequate trust. The key is the lack of tangible incentives to drive efficiency.

So we need to admit - and this is almost heresy - that the NHS just can't do everything. We like to be sentimental about it as though it was a religion. It's simply a core service on which to build our own responsibility for health. Service users must make the transition into welcomed customers.

This brings us to the greatest weakness of Lord Darzi's scheme. For all Gordon Brown's talk yesterday of 'the bold vision' of the ten-year plan, in practice it is only perpetuating the failed structure of the NHS.

The fact is that the continuation of the state healthcare monopoly can never meet the needs of the British people in the 21st century.

This is partly because we have reached the limits of taxation on job-holders. Those in work would simply not put up with a further 5 or 10 per cent increase in their income tax to pay for the NHS.

But more importantly, the very existence of a massive bureaucratic monopoly breeds its own chronic inefficiencies, leading to widespread waste, mismanagement, low productivity and lack of pressure on suppliers and contractors.

In my own field of cancer treatment, for instance, many leading drugs are far more expensive in Britain than in continental Europe, for the sole reason that the absence of any commercial competition here means that the big companies can keep pushing up their prices, knowing that the Government will have to pay.

What we really need in healthcare is more competition, with the Government acting as the guarantor of a basic level of treatment for all patients. The NHS should be regarded as a private health insurance company, not a national religion.

Far from leading to injustices, the introduction of a proper market would actually lead to real reform, driving up standards and lowering costs, just as happens in most other Western countries.

A truly radical reform would be to give every individual a health insurance voucher, enabling them to choose to buy their treatment wherever they wanted. That would transform healthcare in this country far more than all the fine words of the NHS constitution.

• PROFESSOR Karol Sikora is a leading cancer specialist and former chief of the World Health Organisation Cancer Programme.

1,600 British early retirees lose their health cover in the Valencia region

The Valencian Regional Health Service say they will no longer treat those British retired residents who have not reached pensioner age.
Spanish newspaper El País has picked up on the policy change from the regional health service in Valencia which means that thousands of pre-retirement foreign residents in the region will no longer be able to obtain free health care.

Until now the Valencian public health service had an open-door policy for the hundreds of pre-retirement British residents in the region who were thus attended to in the region under a category of ‘extensión o demada’.

The Generalitat regional government said that some 3,000 foreigners have been benefitting from the arrangement, 1,600 of them British residents, and that it explained a high number of operations for problems such as cataracts, angina or other heart problems. The costs of these treatments was being met by the regional health service in Valencia which has said ‘no more’.

Pensioners are not affected as the Valencia health service can claim back the cost of their treatment from the British Government, and tourists also have no problems as the E-111 card covers their needs in Spain for as long as a year.
However those who retire early to the Costa Blanca are not covered unless that retirement has been forced by an accident or illness.

Now such British early retirees are obliged to take out private health insurance. The change in practice in Valencia was supported by both the Partido Popular and the Socialists in a move to better control access to health resources.
The move could well be followed by other regional health services in Spain.

Knowlton joins insurance agency

LEWISTON - Allstate Insurance Co. announces that agent Jon Knowlton is expanding an existing agency.

Knowlton has purchased former agent Gerry Dutil's book of business and is now meeting the insurance and financial needs of families in Androscoggin and surrounding counties. Knowlton worked for agent Patti Gagne as a sales producer, and brings solid industry experience with him. He holds his P&C, Life and Health and Series 6 & 63 securities licenses.

The Jon Knowlton Allstate Insurance Agency, located at 400 Sabattus St., is a full-service agency providing insurance and financial service assistance. The agency is open Monday through Friday, with evening and Saturday appointments available by calling 783-7555.

Mills on NDC failures in government: 'I was a bad judge'

Kwabena Amankwah , 20/06/2008

The Presidential Candidate of the opposition National Democratic Congress, John Evans Atta Mills, Wednesday admitted that the mistakes he made while serving in the NDC Government as the Vice President were due to his poor sense of judgment of people.

"I was not a good judge of people when I was in Government,” the Law Professor stated when he took his turn on “The Evening Encounter with Presidential Candidates,” an interactive programme initiated by the Institute of Economic Affairs, under the auspices of the Ghana Political Parties Programme.

Prof Mills was responding to a question about the mistakes he made whiles in government.

When he was reminded of the fact that it would not be prudent to entrust the destinies of over 20 million Ghanaians into the hands of somebody with a flawed sense of judgment, the NDC flag bearer was, however, quick to assure, “I was a bad judge of people when I was in Government, but now I'm not.”

Even though the nation's economy was rendered almost comatose under his watch as the Chairman of the National Economic Management Team, in addition to allowing an American 'businesswoman,’ Juliet Cotton, to walk away with a huge amount of state- guaranteed loans secured for a rice project, Prof Mills insisted that he resorted to “prudent fiscal” measures in handling the economy, adding that he would apply the same measure if he ascended the nation’s presidency.

Prof Mills, who used much of his time to castigate the Kufuor administration, made a lot of promises which some analysts have described as "too lofty and overly ambitious," wondering how somebody who is seeking to rule the nation could make such promises without giving any indication of concrete measures to raise the needed funds to fulfill them.

He promised to provide potable water for all Ghanaians, insisting that "a caring government will not look on unconcerned while people suffer water shortages."

Others include solving the problem of slums being developed in the city; embarking on an irrigation project in the Accra Plains; expanding the school feeding programme to cover all basic schools; providing free uniforms for basic school pupils; expanding access to secondary education and working to progressively make it free; reviewing the National Health Insurance Scheme "to make it more national"; establishing a factory in the Western Region to produce fertilizer; fighting crime and corruption; and restoring the morale of the Police Service.

But, speaking on Joy FM’s Super Morning Show yesterday, Abu Sasraku Foster, a CPP guru, could not understand why Prof Mills could make such promises without providing practical measures to translate them into reality.

Views sampled among some of the electorate across the country indicate that they were not convinced about the sincerity of Prof Mill’s promises.

"This is a man who had the opportunity to serve the nation as the Vice President and also headed the National Economic Management Team. What legacy did he leave to convince us that he will be able to manage the affairs of the nation, if he is given the mandate?" Dennis Kwakwa, a youth opinion leader wondered.

Meanwhile, the Executive Director of the Danquah Institute, Asare "Gabby" Otchere- Darko, has urged the NDC flag bearer to "take Ghanaians serious if he wants to be taken serious."

Commenting on Prof Mills’ presentation on Joy FM’s Super Morning Show programme yesterday, the former Editor-in-Chief of The Statesman observed, "It was the typical run of Mills sort of thing - bash NPP small, praise the PNDC and NDC, give promises, to deceive himself that he can ride on them to power, without telling the people how to pay for the promises."

In the words of Mr Otchere-Darko, "it is not just enough to make such promises; we can all make promises, but you have to cost the promises and tell the people how practical they are if you want them to take you serious."

Spokesperson for the NDC flag bearer, Mahama Ayariga, however, insisted that Prof Mills was sincere about all the promises he made, and that bringing them into reality was not an impossibility.

The MP for Bawku Central yesterday told listeners of Joy FM’s Super Morning Show that a clear-cut plan to fulfill all the promises had been clearly spelt out, and had been indicated by Prof Mills in some of his previous presentations. Mr Ayariga however, failed to add anything concrete to the promises made by his party leader.

'Insurer forced annuity, but we still work'

When dentists Nick and Polly Patsias turned 60 within a month of each other last summer, it wasn't only birthday cards that came tumbling through their letterbox - they also received letters from numerous insurance companies inviting them to turn their savings into a lifetime income through an annuity.

As owners of a thriving dental practice in Beckenham, Kent, the couple had no intention of retiring so they ignored the correspondence.
But one of the companies they had saved with - Abbey Life - took it upon itself to buy an annuity for them.

Abbey Life turned a pension of £57,000 in Polly's name into an annual income - payable once a year in arrears - of just over £3,300 without offering her tax-free cash or any financial protection.