The Witch Doctor is supposed to be in repose at the moment but in her absence she keeps asking me, her ever obedient Black Cat, to re-blog posts that she put up a long time ago.
This re-blog was precipitated by the fact that Clare Gerada (Royal College of General Practitioners) and Chris Skidmore (conservative MP) were sparring in Monday’s Daily Politics show over privatisation of the NHS.
The Witch Doctor is of the view that regarding healthcare, it is often best to stop thinking of private or public services and instead to consider the various marketplaces, old and new, within the UK healthcare sector.
This is what she said a long time ago:
SEVEN HEALTHCARE MARKETS
Mr Cameron, Mr Lansley, Mr Clegg, many other individuals, governments and politicians of all shades, please listen to this witch!
The reforms are not just a Tory thing. They have been going on for years. All political parties have two problems.
1. How to keep UK healthcare safe, fair, and finacially viable.
2. How to stimulate the economy in a threatening global market.
You have intertwingled them, you stupid, stupid Humankind! And because of that you are becoming confused and making everyone else confused too!
Firstly this witch believes the majority of politicians want to do what is best for patients in this country. There will be a few scoundrels among you who will not possess even a vestige of altruism, I’m sure, but for the most part The Witch Doctor believes that most of you, most of the time, in all government parties are all pretty genuine in the matter of seeing patients properly cared for.
So for the moment, just concentrate on healthcare.
Forget about the economy and the worry of global markets and the balance of power spreading from west to east.
At least just now.
Forget in the meantime too about GP’s being private businessmen and the fact that some consultants do private practice (Paul Corrigan is getting his underpants in a twist about this at the moment). These things are red herrings that can be considered later.
MARKETPLACE NUMBER 1
VALID TENDERING FOR CONSUMABLES ETC.
There has always been a competetive market in healthcare. Of course there has. We all know that. We are not stupid. The companies that supply paper towels, toilet rolls, needles, syringes, bedpans, drugs, surgical insturments, beds, scanners, specs, hearing aids, ……. you know what I mean – tens of thousands of things. Commodities too – gas, electricity, telephones, internet connections. It goes on for ever.
This market uses taxpayer’s money.
Some of it is of great value to the patient but some will be a waste of taxpayer’s money.
Generally, we accept this market place. Just ignore it meantime. This is not the issue.
MARKETPLACE NUMBER 2
FUTURE VALID TENDERING
There will be a new competetive market place emerging relating for example to advanced surgery and investigations, telemedicine and other advances – devices for home measurment of BP, diabetic control, arrhythmias and a huge number of other things not yet even thought of. There will also be a market that involves data collection and distribution.
There will even be a market in training, management, continuing professional development of doctors and their revalidation.
This market will use taxpayers money.
Ignore this new marketplace of the future. Some of it may be wholesome, some dubious, some will be a waste of taxpayer’s money.
MARKETPLACE NUMBER 3
THE FLUFFY MARKET
This is where things start to get seriously muddy. It is the Marketplace of intangible touchy-feely soft practices. It is also the marketplace that is not evidence based. You may find many opportunistic entrepreneurs in this marketplace. Some of the things they produce will be flouncy contributions to healthcare of little or no practical value. Some of their “products” and “activities” will be a complete waste of taxpayers money and a complete waste of time for those employed within the NHS.
This market uses both taxpayers money and personal money.
This fluffy market is already drip, drip, dripping money out of the NHS and into private companies but most of The Humankind have not given much consideration to the fact that this is happening. This market generates business and employment but decreases productivity and increases waste within the NHS.
MARKETPLACE NUMBER 4
PRIVATE COMPANIES USING THE NHS KITEMARK FOR CLINICAL CARE
This is the marketplace that The Witch Doctor, My Black Cat, most doctors and nurses, and most patients too are opposed to in various degrees. However, now that the new Health and Social Care Act has completed its journey through parliament, this is the market that will creep and will slowly become integrated into the “norm.”
This is The Market Place inhabited by Clients, Customers, Consumers, Businesses, Bonuses, Incentives, Multinationals, the Stockmarket, and the healthcare entrpreneurs. Patients too, if they can get a foot in the door.
It is the Marketplace where private companies are involved in the hands-on diagnosis, investigation and care of patients, and to this end are employing medical, nursing and other personnel. The companies fund their staff and activities from NHS funds i.e. from the taxpayer. They will clamour after cheap labour and require to use a service driven by competencies and protocols rather than judgement and expertise. Some of the profits may be distributed to directors and shareholders although different arrangements are appearing by using Charities and a new breed of businesses called Social Enterprises.
Forget Charities and Social Enterprises for now – they just add confusion to the picture.
The Witch Doctor is not against the Stock Market, shareholders or Capitalism. She is however against Capitalism when it loses its sense of responsibility and proportionality and generates greed and recklessnes. She is not against entrepreneurs either. Indeed she has always known she is basically an entrepreneur herself (all witches are) and she considers she has the innate skills plus the knowledge acquired through training that could easily have been used within the private healthcare sector to make her seriously rich and ensure the family she leaves behind her will have no financial worries. She could have been trained in the universities and NHS hospitals and then in due course, when the time was right, walked away and cleverly generated her very own market. She thinks she would have been good at it. With the new NHS in England she could have positioned herself carefully so that her entrepreneurial services could have been purchased using NHS money. However, she did not go into medicine to make loads of money, she will always resist becoming a healthcare entrepreneur, and consequently her family will have to make their own way in life.
That’s all you’re going to find out about The Witch Doctor!
The Witch Doctor acknowledges the NHS has many faults – over the years she has experienced most of them, but she still believes it could become the envy of the world once more. Otherwise she would not bother blogging. In essence she believes the NHS needs to simplify itself as knowledge and procedures become more complex.
This Fourth Market is the marketplace of sharks who swim silently and dangerously ready to grab and dismember; and monkeys too who are for ever trying to reach the highest branches on the tree. And yes, a few of these sharks and monkeys are medical practitioners, nurses, and others who currently work in the NHS but will happily default into more profitable activities when they feel the time is right, and they can justify what they are doing while retaining a degree of respectability.
The Fourth Market is where clients are given priority over patients because they are cheaper and easier to treat. If the NHS continues to be wholly funded through taxation and free at the point of use then an expanding Fourth Market, being part of the NHS family, will lead to the suffering of patients. It is simple arithmetic. The kind taught at primary school.
The Fourth Marketplace will be cleverly advertised and marketed by individual companies even if there is a fixed tarrif for each procedure for those private companies clever enough to ensure they are able to use the NHS Kitemark. Indeed, Dr No is currently in his bath thinking over ways the Fourth Marketplace will get round a fixed tarrif in order to gain more sales and so boost profits. (Later on he came across further interesting observations on gaming the fixed tariff).
In The Witch Doctor’s opinion it is The Fourth Marketplace that will lead to the downfall of the NHS and so if you believe in the principles of the NHS, it is the one that should be given most attention right now and should be resisted at all costs.
The Third Market is very suspect also and much of it should be abandonded in times of need. It is the dubious sugary icing on the NHS cake. But if the cake itself is made of cardboard it has to be spat out, sugar and all. But the NHS cake IS baked, the recipe just needs improving.
MARKETPLACE NUMBER 5
TRULY PRIVATE INDEPENDENT HEALTHCARE
These are the private providers that are more or less detached from the NHS. They will NOT normally carry the NHS Kitemark although they may do from time to time. Clients, patients and customers may choose to use these markets but they will normally pay for them out of their own pockets or separate insurance. However, it is likely that the activities of the fifth market will be selective and will in various ways introduce an extra burden of patient care into the NHS.
So, five healthcare markets!
All purchases and activites need to be designated into one of these markets. Some will straddle more than one market.
There will be two more health care markets of course. This is because The Witching Number is always seven. At the moment The Witch Doctor with her ageing brain has misplaced the last two.
No doubt they will turn up again somewhere…..
You think they are the charities and social enterprises which will need to be given due consideration later, My Black Cat?
I suppose they are.
Seven Markets. The Witching number.