“In a shock U-turn yesterday, Sports Minister Mr Andrew Lansley removed all references to bare-fist fighting in the ‘free-fights-for-all’ Boxing Bill currently before Parliament. Earlier drafts of the Bill had allowed ‘any willing contestant’ to fight ‘with or without gloves’. Critics of the Bill, including the British Medical Association, had pointed out that the wording ‘or without gloves’ provided an opportunity for contestants to fight bare-fisted if they so wished, a practice known to increase serious injury and fatalities.
My Lansley has insisted he never envisaged bare-fist fighting. Speaking in the House of Commons yesterday, he said: ‘I understand that references to ‘or without gloves’ in the Bill can be taken to mean that we want to allow bare-fist fighting. This was never the intention. I have therefore removed all references to ‘without gloves’ from the Bill.’
The announcement comes only days after Gordon Bennett, head of national fight regulator Monitor said: ‘an amount of bare-fist fighting will be appropriate’.
Critics of the Bill welcomed the amendments, saying they were a step in the right direction, but pointed out that the changes only affected about half of all fights.”
Politicians have a bit of a thing about U-turns. While the rest of us will quite cheerfully U-turn when we find ourselves up the wrong street, any politician worth his or her salt always insists he or she doesn’t ‘do’ U-turns. Or when they do – as Mr Lansley appears to have done – they simply deny the U-turn, by saying they were never pointing in the wrong direction in the first place.
Just as any political hack is always on the look out for politicians caught U-turning, reversing up one-way streets, backing out of alleyways, even going the wrong way around roundabouts, indeed any manoeuvre that might suggest a want of steadfastness of purpose or lack of direction on the part of politicians.
And so it was that the other Mr Lansley, the Secretary of State for Health, charged with a U-turn, insisted that he had never envisaged introducing price competition into the NHS, and the media erupted with cries of U-turns. Dr Hamish Meldrum, Chief Pongo at the BMA, while distancing himself from tacky journalese, said much the same thing, welcoming the fact that ‘health secretary Andrew Lansley had listened to and acted on the views of doctors’.
Dr No is unimpressed by this so-called U-turn. He suspects it may turn out in time to be an S-turn, or a Z-turn. In the light of history, it may even stand revealed as an I-turn – a turn without a turn; in fact, no turn at all.
For let us not forget that what we now have is effectively a Tory government. The Lib-Dems are now so clogged up that one more pull on the political loo chain will see them overflow, and run down the drains of history, leaving a Tory government implementing Tory policy. And in health, that means, as it has since the late 1980s when Mrs Hacksaw and BATman first introduced them, markets and competition.
However loudly Mr Lansley may protest today that the market and competition will be on quality not price, it seems he may protest too loud, for it remains an inescapable fact that all the antecedents and coincidents point to competition not just on quality, but also on price.
We have the weight of Tory history and ideology, seen not just in health, but in the utilities and railways; and the embarrassment that a market where the prices are fixed is not a market. We have the threat of the imposition of competition law, both our own and European, that will argue that price fixing is anti-competitive. We have the earlier drafts of the Bill, with clear provision for competition on price, and the current Bill, which still leaves much provision of healthcare unfettered by the price-fixing national tariff.
And lastly, but by no means least, we have – quite remarkably – Mr Lansley brazenly closing one door while opening another:
‘You are entirely right in observing that, whilst the government’s intention not to introduce a general policy of price competition is clear, it is a possibility that Monitor could in future seek to pursue a different approach, subject to agreement with the NHS Commissioning Board.’
Further and better particulars on what such a ‘different approach’ might be have been helpfully spelt out by David Bennett, the newly appointed boss of Monitor, the NHS economic regulator:
“‘I understand why people are nervous about price competition,’ he said. ‘But over time there will be areas where it is useful.’
Mr Bennett, who has ‘experience in sectors that have gone from monolithic public providers to market-type arrangements’, including gas and electricity provision, said price competition was likely to be introduced slowly in the NHS.
‘It is more likely to be at commodity level rather than specialist services,’ he said. ‘Monitor and the NHS Commissioning Board will be very careful about where we introduce it.’”
From where Dr No sits, it appears all the media – and BMA – hullabaloo about U-turns on price competition is a little premature. The ‘different approach’ may be softly-softly – but make no mistake – competition on price is still very much alive.
Mr Lansley may have achieved widespread headlines declaring he has U-turned on price competition. But in his head, Dr No suspects, the mantra remains the same: ‘U-turn if you want to. The Lansley’s not for turning’.
Dear Dr No,
I too forsee the destruction of the Liberal Party as currently constructed. They are so unprepared for the discipline of government.
It is notable that there is no mechanism for adjusting for inflation in the current tarrif structure. With the seemingly willful inflation of 4%+ there will be a squeeze on us all. In the private sector the BUPA tarrifs have been frozen for many years so the lesson may have been taken from there.
Still with the dumbing down of medical training, we hold all the aces. If they want it done right they have to cough up. Of course if they do not care if it is done right the great british public will be on the receiving end of some really bad service.
For a market to function there has to be a multiplicity of providers, not a state/private monopoly. As I posted “any colour you like…” commissioning is the polar opposite of choice and markets.
Dr Phil
Boots – Dr No sees very little evidence that they want it ‘done right’. The professional regulator, the GMC, has been turned into an unelected quango, appointed (at arm’s length) by the Government, which means that when push comes to shove it is the government not the profession which decides professional standards (because the Council is now answerable not to the profession but to Government – which is why for example they are steam-rollering through revalidation despite professional objections). They (they being both this government and the last two – they are on the same hymn sheet on this) pushed through MMC and MTAS, effectively wrecking training. They have overseen the rise of noctors and quacktitioners, and ‘pathways’ that carry patients through healthcare without ever seeing a doctor. And they are setting up managed care organisations – which is what the consortia will become, ably assisted by American ‘cousins’ who know just how to employ doctors and keep them under control.
In many ways this is a reflection of society’s move away from professionalism. The grocer from Grantham (and since this is about professionalism, the epithet is apposite) and BATman started it, by deciding the NHS was no longer a health service, but a health industry. At a stroke doctors moved from being professionals to commercial operators, just like any other commercial operator…so beginning that sinister and very much ongoing process of commercialisation and commodification of healthcare.
It was of course the threat of being turned into civil servants that gave rise to the independent contractor status for GPs at the birth of the NHS. In those days it seems medicine was still a profession, and we stood our ground. Nowadays we have all but capitulated – and for that we have not only our worthless leaders to blame, but each and every one of us who stands idle while great great harm is done. As Burke is said to have said: ‘All that is necessary for the triumph of evil is that good men do nothing’.
For some years now I have found myself becoming far more irritated by the medical profession, than by non-medical managers, administrators, civil servants, and governments for allowing MMC/MTAS and the commodification of healthcare to happen at all. Successive governments have planned this “change” cleverly and carefully presumably as a means of boosting the economy and creating employment by regarding illness and wellness as a substitute for the now largely defunct manufacturing industries. Governments will keep their fingers crossed that patients are treated adequately as a result of the “change” but they will expect the main beneficiary to be the economy.
If you do a word count on any government or health quango document, you will find the words “doctor” or “medical practitioner” rarely appear nowadays. “Health Care Worker” or “Health Care Professional” are the acceptable terms to describe what was once a learned profession. In my view this terminology is now widely used in an attempt to prime patients’ attitudes that they should not routinely expect to see a doctor. I predict another word will soon appear… the ‘Health Care Volunteer” ….. these people will be trained in a few tasks using “skills” acquired in the newer universities which were formerly polytechnics and will now downgrade to “Skills Centres” that will charge no fees, or a token fee, for a few weeks of training.
When will doctors realise that they and their families are themselves “The Great British Public” and that they too will be on the receiving end of bad service?