Question Time last night on BBC1 assembled a panel sure to cause fireworks, and fireworks there were, on a military scale. Lansley spent much of the programme looking like a barrage balloon about to explode, Sarah Sands explained to anyone willing to listen why she should be the next editor of the Daily Mail, and Mark Littlewood previewed the bilateral cauliflower ears that all Lib-Dems will sport, once the electorate give them the boxing about the ears that they so sorely deserve at the next election. But the best and most striking bit was the visceral anger of the audience. At one point, they almost rose up as one, as if to tear Lansley limb from limb. Dr No, pacifist that he is, almost wished they had. At least we would have been spared further sight of that blasted barrage balloon.
When he wasn’t looking bloated, Andrew looked disappointed, like a parent let down by unruly offspring. I have done my best for you, these last eight years, the look said, and this is how you repay me. Goaded intolerably at one point by a miscreant Phil Hammond, who had had the cheek to run a word count on the Testament According To Lansley without actually reading it, the wounded patriarch mask all but slipped, with corporal punishment for miscreants back on the menu. But it was not to be. It was Dimber’s turn to look disappointed. A bust up on QT would have done wonders for the ratings.
The take home message was, or rather appeared to be, that, like his boss Cameron, Lansley simply just doesn’t get it. Daily he stares in the face overwhelming public and professional opposition to his reforms, and yet he sees nothing, nor hears a word. It is quite extraordinary, and Dr No can only think of two possible explanations. Either it is denial on a delusional scale – Lansley really does live in La La Land – or – surely not – it is the deliberate steam-rollering of ideological dogma over the expressed will of the people.
Regretfully, Dr No rather fears the latter. Call him a conspiracy theorist, but he can’t help wondering why the CQC’s latest dossier of despair, which Lansley ordered, was released yesterday, the day after the Lords’ second reading of the Bill. More grist to the no-change-in-not-an-option mill? Another hose with which to sprinkle water on dissident reactionary fireworks? Of course, Dr No can’t be sure – but he does wonder.
“why should the secondary care providers be different” – over time competition and profit motive will have a profound effect on services, starting with a bureaucracy that will grow exponentially as the wheeling and dealing becomes ever more complex and opaque (gobbling up >30% of health costs if we look at the experience in the USA).
Dr P – Southern Cross may or may not be defunct because the market exposed its failing – but let us not forget that it failed because of excessive zeal for what the market had to offer in the first place.
Nor is Dr No overly persuaded that a plurality of general practice exists – all said and done, the vast majority of general practice works (albeit with varying degrees of success) on the small business independent contractor status model. But in many ways, despite their legal status, I suspect many individual GPs think of themselves as virtual NHS staff – and that’s the crux – they work for the NHS and their patients (even though technically and legally they are working for themselves). They consider themselves part of the NHS family. They are therefore naturally (in most but not all cases) subject to the public service ethos. Those in the corporate private sector, on the other hand, be they any qualified provider, or very willing cowboys, work to the beat of a very different drum, to a rhythm that can all too easily find itself out of step with public service.
A&A CN – Dr No is sure we all agree that the ‘tradition of elder abuse is well established in our culture’, but is it getting worse? Dr No thinks there may be indirect (and anecdotal) evidence that it is. Too much to post in a comment so new post here (and it covers all patients, not just older patients, although of course most patients are elderly).