Supplementary written evidence from Dr
Jonathon Tomlinson (COM 128A)
RESPONSE TO
MEETING
I thank the Health Committee very much for the
opportunity to speak.
There are just three comments.
1. One of the last questions from the committee
was on the cost of commissioning. The questioner referred to the
cap on administration costs.
Presently my PCT receives £33 per patient. We
have been told that our commissioning group will receive just
£9 per patient.
My reply informed the committee that the administration
and transaction costs of running a market are higher than running
a non-competitive system. Not only will we (City and Hackney GPs)
have to take over PCT functions on a fraction of the budget, but
we will be expected to take on the significant, additional costs
of managing a competitive market. This is not recognised in the
White Paper.
2. Efficiency is aimed at maximising profit.
It's essential that we don't confuse maximising efficiency with
responding to clinical need. If Dr Charlson sets up a blood testing
enterprise on the doorstep of my surgery he may well be enterprising
and efficient (blood tests are easy to organise efficiently),
but he's not responding to patient need, because we already do
our own blood tests. Our patients need more drug and alcohol rehab
provision, but under the proposed system it is not going to be
provided unless it is profitable, in spite of the desperate need.
3. The other speakers objected to my comparisons
with the US system. In my defence I will explain the similarities
and I include the quote I read out and a reference.
The White Paper proposes that NHS services become
social enterprises and hospitals become foundation trusts. These
processes will allow the transform of the NHS from a publicly
owned service into privately owned businesses. Secondly the intention
to remove practice boundaries and allow patients to register with
commissioning consortia is based on the US Health Management Organisation
(HMO) model. Thirdly the conversion of the NHS into competitive
markets converts medical care into a commodity in trade. Finally
and most importantly, the major private companies competing to
provide services to the NHS (like United Health) are US health
care companies. It is for these reasons that I believe that comparisons
with the US are vital if we are to understand our future prospects.
QUOTATION
"The US devotes a much larger fraction
of its GDP to health care than other advanced countries—nearly
twice their average. We spend, in US dollars per person, two and
a half times as much as our counterparts in Europe. The most important
reasons for the uniquely high costs are its commercialization
and the effects of business incentives on the provision of care.
The US has the only health system in the developed world that
is so much owned by investors and in which medical care has become
a commodity in trade rather than a right." Health Care: the
disquieting truthhttp://www.nybooks.com/articles/archives/2010/sep/30/health-care-disquieting-truth/?utm_medium=email&utm_source=Emailmarketingsoftware&utm_content=
229811853&utm_campaign=September302010issue&utm_term=HealthCareTheDisquietingTruth
November 2010
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