Editor’s blog Tuesday 16 March 2010: Winding up Telegraph NHS debate, and other bits and bobs

Hello. I didn't get round to washing up the remaining articles from last week's Telegraph series on the NHS, and shall now do so quickly.

The quality of these overall varied widely, but many took a reasonable stab at getting some of the issues into the arena of public attention. The Telegraph deserve some credit for that.

Of the remaining good ones, the feature on Central Surrey Health presented the best-known (and so far, only) example of a co-op that has taken over NHS community provision at scale.

Sadly, much of its impact was dissipated by the journalist's failure to differentiate a provider service from a PCT. Understandable a year ago; a bit of a problem now.

Ali Parsa of Circle was, unsurprisingly, to be found in the mix, with his piece calling for reality as opposed to romanticism about co-operative forms of ownership.

Parsa's view is significant in light of Circle's impressive growth. He writes that "while mutualism sounds great, it is difficult to deliver. In addition to employee ownership, it requires the array of management tools, professional resources and capital markets crucial to the success of any enterprise".

Some are sceptical of the sustainability and profitability of Circle's business model going forwards. Their fortunes are likely to be mirrored by those of their new-build hospital, opened just outside Bath. At their recent annual conference, the buzz of enthusiasm and motivation among their partners was almost tangible (not for nothing did Mark Britnell compare them to Moonies).

It felt quite sad, talking to some of them over coffee and lunch, to find that the NHS had frustrated their attempts to improve the system from within.

Parsa's recipe for making co-ops work goes into more detail: "For employee-owned enterprises to succeed, they need three attributes. First, they must be ambitious. The Circle partnership has the most extensive programme of hospital building across the country, designed by leading architects with the ambition to redefine patients’ experience of health care. Each hospital is controlled and managed by the professionals who provide the services to their patients.

"Second, employee-owned enterprises need to reshape the ubiquitous top-down management system and remove unnecessary bureaucracy. Within a year of taking over NHS Independent Treatment Centres in Burton, Bradford and Nottingham, we had transformed their performance. In Nottingham, for example, we were treating 22 per cent more day-case patients and had reduced costs by over 19 per cent. And we made these gains while maintaining some of the best clinical outcomes anywhere in the country, including readmission rates four times better than national targets and a zero MRSA infection record. In each of the last five months, 99.6 per cent of our patients said they would recommend the facility to friends and family.

"Third, employee-owned organisations need to appeal to outside talent from different sectors of the British economy. Once the talent is attracted, it needs resources to be able to do its best".

Karol Sikora abolishes the NHS (again)
Karol Sikora did his well-known bit about how the NHS is out of time. You've heard it before. Great oncologist; lousy medical politician.

Sikora line about "our health system is in a cul-de-sac; a Galapagos Island of evolution, where the vestigial remains of previous ages abound" brings to mind Nigel Edwards of the NHS Confederation's fine riposte that "if what we've been seeing in some policy of recent vintage is intelligent design, maybe we should go back to evolution".

Jeremy Warner, assistant editor of the Telegraph and an economics commentator, suggests that "the NHS perenially overspends" (plain wrong), adding "there are limits to what publicly funded health care can and should be expected to provide" (no shit, Sherlock), and concludes with the doozy "people are going to have to learn to prioritise their long-term health needs over the rampant consumerism of the recent past".

Oh dear. As arguments for an insurance-based co-payment system go (which seems to be his case), this is a poor one. His article, as many of the worst of the series did, assumes that all expensive high-tech healthcare innovation is automatically good. This is quite an assumption - heroic, really. Many new technologies are not cost-effective: we would not otherwise have developed NICE, which the rest of the world now seems to be rushing to copy. Many of the things that will improve health are as close to free as makes no difference (exercise, adequate diet).

It is intriguing that market fundamentalists, who so oppose having the state as the single payer under a tax-funded system, seem immune to understanding that while healthcare cost-inflation is significant in the UK, it is far worse elsewhere.

The series also featured a series of sketchy vignettes about the health systems of France, Holland, Australia and the US. Interesting as they were, the selection of participants quoted seemed unduly homogenous, making the 'real-life' examples seem a bit 2-dimensional.

Elsewhere online ...
The annual 'Hunt The GP Who Earns Most' competition took roost in the Thunderer, with this story. It's always good to see a Murdoch paper calling for a wages policy ...


GPs want to spend less time with their patients ...

People reckon that those with unhealthy lifestyles should be penalised in NHS treatment, while admitting to unhealthy lifestyles ... oh, and private insurer AXA PPP who sponsored the opinion poll wants a 'debate about what we should pay for"

And fir a contrasting bit of rational sense, Nick Timmins wrote this excellent analysis of the broad successes of NHS reform.