February 2009, National Health Executive
Top-ups are welcome next step on road to privatisation by Helen Evans
Following the recent government review on the rules concerned with private top-ups for NHS patients who want to access innovative treatments, Nurses for Reform (NFR) is delighted that ministers have started to embrace the next level of partnership working with private medicine. That said, they should have gone much further and avoided an array of impractical, bureaucratic and unworkable rules that are doomed to failure.
Top-ups in context
In 2009, it is important to put the issue of top ups in context and to take stock of just how far the NHS has already come on the journey of partnership working with the private sector.
In 1948 the government sent a leaflet to every home in the country promising in black and white that ‘the NHS will provide you with all medical, dental and nursing care. Everyone – rich or poor – can use it’. Today, below the radar screen of political spin, there are already seven million people with private medical insurance. Moreover, six million people have private health cash plans. Eight million people pay privately for complementary therapies. More than two hundred thousand people privately self-fund for independent acute surgery each year. And many millions more pay privately towards long-term care. This is not to mention the collapse of NHS dentistry in many parts of the country or the fact that more than 56 per cent of trade unionists now use some form of private health coverage that in principle stands in opposition to the promises of 1948.
Indeed, the 2000 Concordat with independent sector hospitals, the rise of independent sector treatment centres, the push for foundation trusts, the patient choice agenda and in social care, the arrival of top ups and social enterprises, all illustrate the fact that what appeared to be utopian in the 1940s no longer chimes with fundamental reality.
The idea that state can do it all, on its own - for everyone - is dead. Today, the NHS is already working alongside the independent sector and following the direction of cash strapped politicians it will go on harnessing ever more economically market driven incentives over the years and decades ahead – irrespective of which party is in power.
On the frontline
With this background in mind it has been clear to most observers that NHS could no longer ‘ban’ people from paying privately for those innovative medicines that the state is no longer able to fund. For front line nurses, doctors and other professionals including health managers trying to care for seriously ill patients across the state and independent sectors, what matters is that the rules that have precluded all but the rich from accessing new and innovative medicines have rightly been scrapped.
In line with the egalitarian spirit of the 1940s it is no longer acceptable that only the wealthy should have access to innovative medicines that invariably buy them, as dying patients, a few extra years or months of life. That is why ministers are right to allow people with more modest means the opportunity to privately top-up their treatment and care without stigma or prejudice from the NHS.
That said, now that ministers have accepted this fundamental right it is a shame that they have only done so in a typically statist and overly bureaucratic manner: for top-ups are only to be allowed under ludicrously regulated and impractical conditions. With top-up medicines to be administered ‘away from NHS wards’ and patients to pay for any related tests and scans, how will things really work in the hustle and bustle of daily hospital life?
While NFR supports top-ups and campaigns for the privatisation of UK healthcare provision and funding, the desire of ministers to keep the top-up aspects of care out of NHS wards will in practice inevitably unravel. It will simply not occur. For example, what will happen to a patient who is admitted to a critical care unit when they are due for another course of top-up drugs? Will they be denied their additional medicine or will it be given while other patients who are not paying look on? Quite correctly ministers have actually devolved responsibility for these decisions to those on the front line by asserting that such problematic cases will have to be “assessed on a case-by-case basis”.
Maintaining the moral and intellectual high ground
Sixty years on from the inception of the NHS, British patients, voters and politicians are rightly moving away from the calamity of fully nationalised healthcare. Overwhelming public support for private tops-ups is not only moral and good but it is the sign of a society that is fast turning against the dystopian realities of unsustainable Soviet-style medicine.
NFR believes in fundamental change and in telling the truth. It believes that only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands in a genuine market that health professionals and managers will find themselves working in a sustainable environment with the incentives, resources and encouragement to deliver a truly responsive, popular and high quality service.
For NFR, America does not represent either a desirable market model or the way forward. The US has a highly planned, regulated and government funded healthcare system that takes - through state programmes such as Medicaid and Medicare – a historically greater proportion of GDP than the NHS.
Valuing healthcare
Today, NFR believes that the government should openly re-cast the NHS as simply a minor – but not sole – funder of healthcare services. It believes that the state should set free – through a range of full blown for and not-for-profit privatisations – all NHS hospitals. Moreover, it believes that all hospitals should be allowed to openly compete with each other. If a hospital fails in this market it should either close or be taken over by a more successful organisation. Similarly, NFR believes that all hospitals - as independent entities - should be allowed to pick and choose from a dynamic and fluid labour market. The totally counter-productive idea of national pay agreements should be scrapped. Finally, the organisation passionately believes in the many social benefits of commercial free speech. Hospitals, doctors, and other healthcare providers must be allowed to openly advertise and in so doing pro-actively inform consumers of where the best deals are to be found. Combined, this initial package of reforms would not only improve efficiency and the experience of consumers but it would start to build a better world for UK healthcare.
More top ups needed
Overall, the recent move by Professor Richards and the government to grant the most seriously ill NHS patients the freedom to privately top-up for innovative medicines, not formally approved by NICE, is not only humane and to be welcomed but it helps to shore up what little moral credibility the state sector can now muster. For to have done otherwise would not only have been an impractical denial of an already existing reality (the rich can always buy healthcare) but it would have dramatically debased the NHS further by forcing the system even deeper into the quagmire of eugenic decision making.
The government and our political class are increasingly aware of this reality: which is why the future is clear. Ultimately, private top-ups are simply a welcome next stage for public private partnerships as we all slowly drift along a long and bumpy road towards eventual privatisation.
August 2008, Independent Nurse Magazine
‘Privatisation can save our healthcare’ by Helen Evans
The Institute of Economic Affairs last week published my book, Sixty Years On: Who Cares for the NHS?
Containing a series of devastating blows to the NHS, the research shows that when speaking off the record a substantial majority of Britain’s health elite no longer believe in nationalised healthcare. Instead, an overwhelming majority accept a much greater role for private provision - including private hospitals, clinics, GP services and dentists.
While the NHS is now charged with being “inequitable”, “two tier”, “rationed” and “costly”, a majority also believe it is too “monopolistic” and want to see a much greater role for private funding arrangements. Looking at private funding versus the state, an overwhelming majority of the respondents surveyed (65%) believe that because people’s healthcare is unpredictable, some of its costs will increasingly have to be covered by private sources: “government arrangements such as taxation cannot do it all”.
One of the most telling responses to the survey was a question about statutory restrictions on advertising. An overwhelming majority of the sample - 81% - regarded Treasury Ministers as having the most to gain from the statutory restrictions on advertising because its promotes consumer ignorance. The banning of advertising of pharmaceutical products is perceived as a measure designed to keep patients in the dark so that they do not demand expensive drugs.
Overall, the results show that the world has dramatically moved on from the 1940s. As people’s expectations increasingly outpace what the state can deliver, behind the scenes, opinion formers are starting to seriously consider market alternatives. Already, in many of their minds, the NHS is dead.
While in 1948 the NHS promised to provide “all medical, dental and nursing care”, today some 25 million people are again going private for various forms of healthcare. 7 million people have private medical insurance. 6 million have private health cash plans. 8 million people pay privately for complementary treatments. More than 250,000 privately self-fund each year for private acute surgery, more than one 1 million people during the life of a Parliament, and many millions more pay privately towards long-term care. This is not to mention a whole raft of other NHS services - such as NHS dentistry - that are collapsing before our eyes.
If, as looks likely, the Government now allows private top-ups for medicines and treatments without precluding people from the NHS, they will only do so because they are playing catch up with what the public have long come to accept as reality. The NHS is no longer a dearly loved British institution. It is a nationalised embarrassment.
7 July 2008, Daily Telegraph Blog
Back to the Reality of the NHS by Helen Evans
Following the recent publication of Lord Darzi’s white elephant, the bizarre spectacle of a special service at Westminster Abbey to celebrate the NHS’s sixtieth birthday, and an endless stream of propagandistic bunkum from the political class on how marvellous nationalised healthcare is, today it is time to get back to reality.
For all the hype, the NHS still has one million people on waiting lists and around another 200,000 people trying to get onto them. In NHS hospitals, more than 10 per cent of patients still pick up infections and illnesses that they did not have prior to being admitted. And, according to the Malnutrition Advisory Group, up to 60 per cent of NHS hospital patients are under-nourished during inpatient stays.
Recently, a major study revealed that the NHS now causes more than 17,000 unnecessary deaths a year. Using data from the World Health Organisation and statistical techniques promoted by the British Medical Journal, the TaxPayers’ Alliance analysed the NHS’s performance since the 1980s. Significantly, Wasting Lives: A statistical analysis of NHS performance in a European context since 1981, concluded that in 2004 - the last year for which data was available - the NHS needlessly killed the equivalent of more than five times the total number of people who died in road accidents and more than two and a half times the number of people who died of conditions related to alcohol. The report’s author, Matthew Sinclair, commented:
“Thousands are dying every year thanks to Britain’s health service not delivering the standards people expect and receive in other European countries. Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. We need to learn lessons from European countries with healthcare systems that don’t suffer from political management, monopolistic provision and centralisation.”
What I want to know is when Prince Charles attended the service at Westminster Abbey, why he and the rest of the congregation did not commemorate the hundreds of thousands of lives unnecessary lost because of the reality of the NHS?
3rd July 2008, Daily Telegraph Blog
The NHS is not fit for purpose by Helen Evans
The Institute of Economic Affairs last week published my book, Sixty Years On: Who Cares for the NHS?
Containing a series of devastating blows to the NHS, the research shows that when speaking off the record a substantial majority of Britain’s health elite no longer believe in nationalised healthcare. Instead, an overwhelming majority accept a much greater role for private provision - including private hospitals, clinics, GP services and dentists.
While the NHS is now charged with being “inequitable”, “two tier”, “rationed” and “costly”, a majority also believe it is too “monopolistic” and want to see a much greater role for private funding arrangements. Looking at private funding versus the state, an overwhelming majority of the respondents surveyed (65%) believe that because people’s healthcare is unpredictable, some of its costs will increasingly have to be covered by private sources: “government arrangements such as taxation cannot do it all”.
One of the most telling responses to the survey was a question about statutory restrictions on advertising. An overwhelming majority of the sample - 81% - regarded Treasury Ministers as having the most to gain from the statutory restrictions on advertising because its promotes consumer ignorance. The banning of advertising of pharmaceutical products is perceived as a measure designed to keep patients in the dark so that they do not demand expensive drugs.
Overall, the results show that the world has dramatically moved on from the 1940s. As people’s expectations increasingly outpace what the state can deliver, behind the scenes, opinion formers are starting to seriously consider market alternatives. Already, in many of their minds, the NHS is dead.
While in 1948 the NHS promised to provide “all medical, dental and nursing care”, today some 25 million people are again going private for various forms of healthcare. 7 million people have private medical insurance. 6 million have private health cash plans. 8 million people pay privately for complementary treatments. More than 250,000 privately self-fund each year for private acute surgery, more than one 1 million people during the life of a Parliament, and many millions more pay privately towards long-term care. This is not to mention a whole raft of other NHS services - such as NHS dentistry - that are collapsing before our eyes.
If, as looks likely, the Government now allows private top-ups for medicines and treatments without precluding people from the NHS, they will only do so because they are playing catch up with what the public have long come to accept as reality. The NHS is no longer a dearly loved British institution. It is a nationalised embarrassment.
5 February 2007
Independent Nurse Magazine
Helen Evans is director of Nurses for Reform, a pan-European network dedicated to consumer-oriented reform of healthcare systems. A former senior nurse with nearly twenty years experience in the NHS, she was recently awarded a PhD in Health Economics from Brunel University.
As frontline practitioners, nurses know only too well that we have to find new and better ways of organising, delivering and funding healthcare. In an age of fast moving consumerism, people are no longer prepared to tolerate unresponsive, inefficient and uniform nationalised services.
Too many nursing trade unions and representative bodies fail nurses because they invariably stick to old and out dated agendas. Instead of championing substantive reform - and in doing so, championing the rights of consumers - they default to short-term platitudes such as demanding more taxpayers’ money or new forms of legislative favour. Such an approach is not only disasterous for nurses but in playing the political game it is also catastrophic for patients.
Nurses for Reform (NFR) is a growing pan-European network of nurses dedicated to consumer-oriented reform of British and other European healthcare systems. In Britain, NFR rejects bland egalitarianism in favour of contestability and it believes in people not politics. Above all else, we believe that greater partnership with the private sector is to be actively welcomed and that the independent sector’s contributions are good news for patients and healthcare professionals alike.
Only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands in a market that nurses will find themselves working in a sustainable environment with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.
The RCN and Unison should be more realistic about nurse pay and stop living in cloud cuckoo land. If such groups really want nurses to be valued and paid appropriately they have to stop arguing such incoherent nonsense as ‘healthcare is so important it is beyond monetary consideration’. In the real world, all healthcare has a monetary dimension and the nursing profession has to accept this. As long as we stay in denial of this we will continue to be exploited by politicians driven by their vote motive.
NFR believes that the government should re-cast the NHS as an important, but not sole, funder of healthcare services. The state should set free all NHS hospitals through a range of for-profit and not-for-profit privatisations. Moreover, NFR believes that all hospitals in Europe should be allowed to openly compete with each other. If a hospital fails in this market it should either close or be taken over by a more successful organisation. In addition, all hospitals, as independent entities, should be allowed to pick and choose from a dynamic and fluid labour market. The counter-productive idea of national pay agreements should be abandoned.
Finally, NFR passionately believes in the benefits of commercial free speech. Hospitals, doctors, and other healthcare providers should be allowed to openly advertise their wares and in so doing pro-actively inform consumers of where the best deals can be found.
Together, this initial package of reforms would not only improve efficiency and the experience of consumers but it would start to build a better world for nurses.
The Times
4 January 2007
Dear Sir,
It is clear from Nigel Hawkes article ‘Operations cancelled as NHS runs out of money’ (4 January 2006) that the ‘tractor production is rising’ view of the NHS is finally running out of fuel. As our nationalised healthcare system implements swinging cuts and delays countless operations it is increasingly clear to me that nurses should no longer sign up for careers in public sector healthcare only to find they are unable to access the resources and autonomy they need to do their chosen work.
Today, too many nursing trade unions and representative bodies fail nurses because they invariably stick to old and out dated agendas. Instead of championing substantive reform - and in doing so, championing the rights of patients as consumers - they default to short term platitudes such as demanding more tax payers’ money or new forms of legislative favour. Such an approach is not only disasterous for nurses but it is catastrophic for patients.
In 1948, the British government promised: “The NHS will provide all medical, dental and nursing care. Everyone - rich or poor – can use it”. Yet, sixty years on from the end of the Second World War, Britain is a very different place and increasing numbers of people recognise the limitations of what the public sector can offer.
Nurses for Reform (NFR) believes in fundamental change and in telling the truth. It believes that only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands in a genuine market that nurses will find themselves working in a sustainable environment with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.
Yours sincerely,
Helen Evans
Director
Nurses for Reform
Nursing Times
5 November 2006
Dear Editor,
I was delighted to read Karen Lamb’s comments, ‘Starting Out’ (31 October - 6 November 2006), that “in the real world” of private hospitals, evidence based practice is not just encouraged but it is actively embraced, good hygiene practice is “carried out regimentally” - and where “a new treatment is introduced nurses are encouraged to research the treatment and condition”. Pointing out that the nurse-patient ratio is 1:3 in a private hospital compared with 1:8 in the NHS, Karen is right to conclude that working in the private hospitals sector has “restored [her] faith in the nursing profession”.
Today, nurses are increasingly recognising that nationalised healthcare is not only disastrous for their professional standards but it is catastrophic for patients. This is why Nurses for Reform believe (NFR) it is no longer acceptable for nurses to sign up to careers in public sector healthcare only to find they are unable to access the resources and autonomy they need to do their work. NFR rejects bland egalitarianism in favour of contestability. Above all else we believe that greater partnership with the private sector is to be actively welcomed and that this sector’s contributions are good news for patients and healthcare professionals alike.
NFR believes in fundamental change. It believes that only by putting patients and consumers interests’ first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands that nurses will find themselves working in a sustainable environment and with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.
Yours sincerely,
Helen Evans
Helen Evans
Director
Nurses for Reform
Nurses for Reform launches blog
Immediate Release: Wednesday 1st November 2006
Contact: Helen Evans 07739 390087
Email: helen@nursesforreform.com
Today, Nurses for Reform (NFR) the nurses campaign group launched a blog at www.NFRblog.com Heralding the new site NFR director Helen Evans said:
"I am delighted to be launching the Nurses for Reform blog today. The purpose of NFR is to campaign for more consumer-oriented and sustainable healthcare systems in Britain and Europe. From now on the blog will be updated regularly by me and by my other NFR bloggers. I hope that our readers enjoy the site as it develops and that they will be inspired to send in your comments."
NFR believes it is no longer acceptable for nurses to sign up to careers in public sector healthcare only to find they are unable to access the resources and autonomy they need to do their work. NFR rejects bland egalitarianism in favour of contestability. Above all else we believe that greater partnership with the private sector is to be actively welcomed and that this sector’s contributions are good news for patients and healthcare professionals alike.
NFR believes in fundamental change. It believes that only by putting patients and consumers interests first will healthcare improve. It is only when healthcare is opened up to real consumers and trusted brands that nurses will find themselves working in a sustainable environment and with the incentives, resources and encouragement to deliver a responsive, popular and truly high quality service.
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Editor’s Notes: Nurses for Reform (NFR) is a growing pan-European network of nurses dedicated to consumer-oriented reform of European healthcare systems. Its director, Helen Evans, is a senior nurse with nearly twenty years experience in the National Health Service. Over the years her career has seen her work in some of Britain’s leading hospitals including Senior Infection Control Nurse, Princess Alexandra Hospital NHS Trust; Infection Control Nurse, the Royal London Hospitals NHS Trust; Operating Theatre Sister, St. Bartholomew’s Hospital. Helen trained at Whipps Cross Hospital in London’s East End and holds a degree in Health Management from Anglia Ruskin University. A Ph.D student in the final stages of her thesis in Health Economics at Brunel University she has also been a guest lecturer at Anglia Ruskin University.
