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health reform: more local control « Previous | |Next »
February 16, 2011

The National Health Service (NHS) in the UK is becoming dysfunctional and causing harm to elderly patients. And so we have the market-based reforms from the Cameron Government:

RowsonM NHSreforms.jpg Martin Rowson

A radical argument for health reform is made by Simon Jenkins in The Guardian. His diagnosis of what has gone wrong with the NHS is that it is too big. His solution is that somehow local responsibility must be rekindled and that GPs and their surgeries must regain the initiative.

He says:

Aneurin Bevan was wrong to nationalise it back in 1948. Morrison was right in wanting a new health service based on charitable and municipal hospitals, as almost everywhere else in the world....Bevan wanted "a maximum of decentralisation to local bodies and a minimum of itemised central approval". He got the opposite....It is significant that every attempt to reform the NHS tries to break it up, by denationalising, regionalising, introducing market forces, contracts, choice, anything to reduce bulk. Each attempt fails. The only conclusion no one dares mention is that the rest of the world was right and a "national" health service is too big....Schumacher was right. Big is ugly. NHS gigantism is like the Pentagon. Its interests are too institutionalised, its lobbyists, especially the doctors, too powerful, and its internal controls so pervasive as to seize up the system.

He adds that all arguments about the state of the NHS on the left, are predicated on the maxim that it must have more central accountability and control. The way to improve hospital care is to castigate the minister, shriek postcode lottery and demand money with menaces. Big is best.

The turn to localism is made in Australia by Armstrong, Woodruff, Legge and Wilson in their Putting Health in Local Hands in whoch they propose the establishment of local Regional Health Organisations (RHOs) across Australia, with each responsible for the health care needs of a defined population within their region:

This model proposes that all current health care funding from local, state and federal governments be pooled within a national agency and equitably distributed to RHOs on the basis of evidence about health care needs. Publicly available information on local health needs and health spending (regularly collected and updated in accordance with national standards) would inform decisions by RHOs about the appropriate allocation of services and resources in that region.

This is the opposition of the centralization model favoured by Rudd and which was premised on the Commonwealth having a controlling share in hospital funding and a Commonwealth primary care takeover. Thus the Commonwealth has majority funding responsibility for the entire health sector.

| Posted by Gary Sauer-Thompson at 5:07 PM | | Comments (3)


Australia has a population of 23 million, the UK has a population of 62 million.
The Australian Medicare system has always been blessed with an excellent computer system, the UK NHS started before computerisation and probably they had manual procedures in place they failed to computerise efficiently.

If Australia can't run an efficient centralised bureaucracy for Health then that's because some rampant empire building has been permitted.

Given Australia's population and geographic spread a centralised system should promote more equitable treatment for all Australians.

I live in Victoria in the Alfred hospital feeder zone [inner SE suburbs Melbourne] and I have received excellent care, more than comparable to the Epworth. I have been shocked at the more limited access to health care for people in rural Victoria and the Sydney basin. From my observations I think that decentralised local health boards will disguise the inequalities in health care provision in different parts of the country.

me again. re NHS causes harm to elderly patients.

The statistics for Victoria a few years ago were
average length of stay in a nursing home = 4 months
average weight of female on admission = 60 kg
average weight female patient after 3 months = 40 kg
some establishments budget 70 cents per meal per patient

Used to joke to my mother that elderly nursing home patients starved because they couldn't pull the cling wrap off their packaged food and their dentures fitted to badly for them to chew.

The NHS reforms proposed by Lansley consist of quotas for numbers of procedures like IVF, homeopathy and joint replacement treatments. At the moment in Australia we have quotas on treatments paid for so that if you have a heart attack at the end of the financial year you get a cheap treatment but if your heart attack occurs in August at the start of the financial year you will be stented a simple effective but expensive treatment - the cost is in the patent license payments.

American insurers also set restrictions on the treatments they will pay for that they apply on a patient by patient basis