The hidden cost of NHS reform

These commercially-driven changes to our health system will be the worst of all worlds.

Last year the NHS paid out nearly £800 million in damages and costs for clinical negligence claims. Although part of an upward trend, it was not an exceptional year. In fact, some £15 billion is held in reserve against current potential liabilities: that is, existing claims or those which are anticipated but where no payment has yet been made. Even in a world inured by the financial crash to the mention of astronomical figures, these are significant sums of money.

We should, therefore, all be interested in the effect that the coalition's radical restructuring of the NHS is likely to have on the incidence of clinical negligence litigation. Thus far, however, the focus has been elsewhere. Unfortunately, both theory and experience say that there is much in these proposals which should concern us.

Whatever the sophistry of its proponents, a scheme in which of the provision of clinical care is outsourced to "any willing provider' can, in reality, mean only one thing: that the potential provider of that care will primarily be judged not on how good that care will be but on how cheaply it will be given. Even leaving aside the additional pressures on costs which apply uniquely to private healthcare organisations (the generation of profit and the payment of dividends to its shareholders), the need to undercut its competitors in the NHS will inevitably impact on their primary item of expenditure: their staff. Fewer doctors and fewer nurses will have to work longer shifts: in other words, the very environment in which mistakes are most likely to happen. Good news for the lawyers: less so for the patients and for the taxpayer who has to foot the bill when a claim is made.

If it were necessary to test that theory against experience, one would need to look no further than the provision of out of hours GP care. Until April 2004, this service was provided in-house by Primary Care Trusts and/or GP practices. Since then, it has been possible for this to be out-sourced to independent commercial providers (a concept which should sound familiar to those examining the current NHS proposals).

In the event, such concern was generated by the succession of adverse events which followed that change that in June 2009 -- and prompted by the tragic death of a patient in February 2008 after he was administered a gross overdose of diamorphine by a locum doctor from Germany -- the Care Quality Commission began an investigation into the provision of out-of-hours primary care services. Its interim statement on this investigation, in turn, prompted the Department of Health to commission its own inquiry. That report, published in June 2010, should have made uncomfortable reading for the evangelical proponents of the Coalition's plans. There is no indication, however, that anyone, from Mr. Lansley down, has ever read it -- or, indeed, seen any of the countless stories in the media about the failures of out of hours care in the years since 2004.

I am a clinical negligence barrister. According to the popular stereotype of the lawyer, I should be willing the Coalition's bill to be passed. I am, however, not only a lawyer: I am a taxpayer and a human being and I have seen too many tragic accidents and appeared at too many inquests not to implore the government to think again.

These proposals are patently driven by commercial imperatives rather than by consideration of patient wellbeing. Even on those narrow terms, and ignoring their human cost, they will not succeed if any money saved on the provision of care is simply spent on compensation for those who suffer as a result.

John Whitting is a QC and member of the Labour Party.

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Theresa May’s stage-managed election campaign keeps the public at bay

Jeremy Corbyn’s approach may be chaotic, but at least it’s more authentic.

The worst part about running an election campaign for a politician? Having to meet the general public. Those ordinary folk can be a tricky lot, with their lack of regard for being on-message, and their pesky real-life concerns.

But it looks like Theresa May has decided to avoid this inconvenience altogether during this snap general election campaign, as it turns out her visit to Leeds last night was so stage-managed that she barely had to face the public.

Accusations have been whizzing around online that at a campaign event at the Shine building in Leeds, the Prime Minister spoke to a room full of guests invited by the party, rather than local people or people who work in the building’s office space.

The Telegraph’s Chris Hope tweeted a picture of the room in which May was addressing her audience yesterday evening a little before 7pm. He pointed out that, being in Leeds, she was in “Labour territory”:

But a few locals who spied this picture online claimed that the audience did not look like who you’d expect to see congregated at Shine – a grade II-listed Victorian school that has been renovated into a community project housing office space and meeting rooms.

“Ask why she didn’t meet any of the people at the business who work in that beautiful building. Everyone there was an invite-only Tory,” tweeted Rik Kendell, a Leeds-based developer and designer who says he works in the Shine building. “She didn’t arrive until we’d all left for the day. Everyone in the building past 6pm was invite-only . . . They seemed to seek out the most clinical corner for their PR photos. Such a beautiful building to work in.”

Other tweeters also found the snapshot jarring:

Shine’s founders have pointed out that they didn’t host or invite Theresa May – rather the party hired out the space for a private event: “All visitors pay for meeting space in Shine and we do not seek out, bid for, or otherwise host any political parties,” wrote managing director Dawn O'Keefe. The guestlist was not down to Shine, but to the Tory party.

The audience consisted of journalists and around 150 Tory activists, according to the Guardian. This was instead of employees from the 16 offices housed in the building. I have asked the Conservative Party for clarification of who was in the audience and whether it was invite-only and am awaiting its response.

Jeremy Corbyn accused May of “hiding from the public”, and local Labour MP Richard Burgon commented that, “like a medieval monarch, she simply briefly relocated her travelling court of admirers to town and then moved on without so much as a nod to the people she considers to be her lowly subjects”.

But it doesn’t look like the Tories’ painstaking stage-management is a fool-proof plan. Having uniform audiences of the party faithful on the campaign trail seems to be confusing the Prime Minister somewhat. During a visit to a (rather sparsely populated) factory in Clay Cross, Derbyshire, yesterday, she appeared to forget where exactly on the campaign trail she was:

The management of Corbyn’s campaign has also resulted in gaffes – but for opposite reasons. A slightly more chaotic approach has led to him facing the wrong way, with his back to the cameras.

Corbyn’s blunder is born out of his instinct to address the crowd rather than the cameras – May’s problem is the other way round. Both, however, seem far more comfortable talking to the party faithful, even if they are venturing out of safe seat territory.

Anoosh Chakelian is senior writer at the New Statesman.

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