Cake…

Training Primary Care - NHS - GPs - Cake...

Expect to be battered, shoved and pushed around by the lobbyists and the propagandists and the fiddlers and diddlers…

… there’s an election. Your vote’s important and the NHS is a key issue.

Labour are out of the blocks with a lot of stories about the NHS ending up in private hands. Fake news, scare-stories, or real?

The future of the NHS, after Brexit? The insinuation is that we will somehow see the NHS gift wrapped and sent to Washington, in a deal with Donald… thanks very much, a piece of cake.

Is the NHS on or off the table?

Jon Ashworth, the Labour Shadow Health Secretary, is right when he said; ‘… if our NHS is taken over by US corporations, it will undermine it as a free, universal public service.’

Corbyn said; ‘… if there is a trade deal with the US it’ll mean the death of the NHS‘… or some such.

The big word in both sentences is the shortest… if.

May I offer some advice; if you judge, if you claim, if you predict… investigate first…

No trade deal has the power to stop the NHS being free at the point of universal use.

Trade deals are about how trade takes place. They protect outsiders (importers), developing a market, only to have the rug pulled on them, in favour of home-produced products.

Trade deals can’t redesign the architecture of public services.

Australia, among others, has a trade deal with the US and it does not include their state healthcare system.

The confusion may come from the fact that some NHS services can be subject to competitive tendering.

It might be worth pausing a moment, to remember, it was EU regulations that required a purchaser-provider split and the development of the internal market, at the enthusiasm of Alan Milburn, Labour’s health secretary.

A number of US companies already provide contracted services to the NHS. Centene in primary care and Acadia in mental health are big players.

There are a number of UK participants such as Virgin and the voluntary sector like Macmillan. In the scheme of things it’s only about 7% of NHS spending but it’s a tidy sum, around £9bn.

The current punch-up has echoes of the TTIP row… the UK/EU/US trade deal that flopped a year or two ago.

Another row; the ‘secret’ discussions between UK civil servants and US Pharma have added another layer of intrigue. Discussions of this sort go on all the time and not just with the US.

Market access to the English NHS is tight. Tighter than in most countries. There are deliberate hoops and hurdles, including NICE, designed to avoid a free-for-all.

When a company turns up with a new drug, and says; ‘you must buy this’, we say, ‘hold yer horses, let’s find out if it works and is it value for money’.

It is probably true, our system influences price structures in other countries and because of complex arrangements uplift in NHS drugs cost is limited to 2% pa, with a refund triggered if margins are exceeded.

In the US there is no such regulation. State schemes and insurers do separate deals. There is no cohesive national policy. Parma trades one off against the other and it is a free-for-all.

They also argue, if foreign health systems pay less, the US domestic market has to pay more, as big-pharma has to amortise development costs and create dividends for share holders.

EU regulations are clear, member states can set the prices for medicinal products, provided the mechanisms are transparent. There is an enshrined ‘right to regulate‘. After Brexit, we are back in the world of ‘if‘.

The law that enables competition and contracting, in the NHS, is Sec 75, of Lansley’s, Health and Social Care Act 2012.

In the Queen’s Speech, it is on the list to be ended, if Parliament ever gets back to work.

If, if, if… not sure about that word.

Add it and you create mayhem but…

‘if you can talk with crowds and keep your virtue’…

... you’ll find there’s more to Kipling than cake.

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.