‘If you want to sell a lie, get the press to sell it for you…’

17/03/2013

Yesterday evening, after working all day to catch up on the infinite amount of backlog, my wife and I went to see the film Argo. At one point in the film, one character begins a sentence, ‘If you want to sell a lie….’ which is then finished by another character, ‘get the press to sell it for you.’

This seems to me to sum up well the role of the Department of Health Mediacentre during ‘selling’ of the Health and Social Care Bill.

More specifically, it is at the centre of the ‘selling’ of the policy to abolish GP practice boundaries. I used to think the politicians involved and the Department of Health were just remarkably stupid. I have now come around to the view that they are not stupid, they are carrying out a deception. What they really want is to deregulate English general practice, to make it boundary-free.

Why? Ask Virgin Care, KPMG, and McKinsey.

For examples of what I mean, read my article on Andy Burnham’s visit to the King’s Fund (and the blog post providing notes to this article), and my article about the press’s striking compliance with Department of Health’s Media Centre.


Message for GPs: Consider signing petition for Health Select Committee about GP boundaries

03/03/2013

The Coalition Government is clearly intent on abolishing on GP practice boundaries: in their Interim Review they recently listed the GP boundary-free pilot as one of three areas that showed that they had ‘Improved the NHS’, by

allowing patients in six trial primary care trusts to register or receive a consultation with a GP practice of their choice. (page 24)

This is a most misleading claim: in reality 2 of the 6 PCTs have boycotted the pilot; of 345 GP practices in these PCTs, 42 practices have opted in to the pilot; at a recent count, 514 patients had registered with a practice, more than half in the London Borough of Westminster. These are small numbers. The DH and Government say they are going to ‘independently evaluate’ this pilot, but I fear that this will mean merely asking those (few) patients who registered with a practice how they found the experience. Of course, they will say they liked the opportunity to choose a practice near work, etc. The evaluation will almost certainly not evaluate or comment on the merits of the policy as a whole.

What can GPs do? I have written a series of articles for Pulse on this issue, and the 6th article addressed this question.

One thing we can do is to put pressure on the Health Select Committee to scrutinise this policy carefully. This would shine a light on the policy, the way it has been promoted with groundless and bogus claims, the way the public and Parliament have been misled, the way in which it will harm primary care in England.

If you are a GP, please sign the petition calling on the Health Select Committee to investigate the policy.

 


GPs refusing to extend their practice boundaries, from Pulse

17/07/2012

Pulse has published an article on the resistance by GPs to extend their practice boundaries. I have posted the following comment to this article:

When a practice decides on its practice boundaries, it needs to be clear about the ecology of the practice’s functioning. What are the outer limits in allowing the practice to deliver good quality primary care, in an efficient, cost effective, and safe way? This should be the prime, and perhaps only, consideration.

GPs should resist firmly policies that undermine the ecology of good quality British general practice.

The policy to abolish GP practice boundaries is, when you scratch the surface, a hollow shell, an illusion, which will introduce all sorts of problems and give only a limited number of resourceful individuals ‘choice’.

If this policy was a financial product, it would be charged with gross mis-selling.

It is very important in the coming months that the GP community become more resolute and clear about this, and refuse to implement changes which will cause the service to malfunction. It is important that this issue becomes more public, and that mainstream journalists gain an understanding of how general practice functions. At present, they rely on press releases from the Department of Health’s media centre.

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For a series of posts on the stupidity of this policy, click here


14. How can they be so stupid? The Plot Against the NHS

05/06/2012

[This is the 14th in a series of 14 posts. I suggest you scroll down and start with Number 1]

The Plot Against the NHS is a book by Colin Leys and Stewart Player; I would recommend it, read it and judge for yourself.

Briefly, their thesis is that a ‘concordat’ was negotiated in 2000 by the Independent Healthcare Association with Tony Blair’s second Secretary of State for Health, Alan Milburn. ‘The Association’s leading negotiator, Tim Evans, was very clear on the ultimate aim of the concordat. He looked forward, he said, “to a time when the NHS would simply be a kitemark attached to the institutions and activities of a system of purely private providers.”‘ (page 1)

The authors document the steps that were taken to further this aim. They call it a plot because it was covert, never made explicit, never debated. ‘Neither parliament nor the public have ever been told honestly what was intended. Misrepresentation, obfuscation and deception have been involved at every stage.’ (2)

Some excerpts:

‘So in spite of it great popularity Britain’s most famous postwar oscial achevement was unravelled through a series of step-by-step ‘reforms’ each creating the basis for the next one, and always presented as mere improvements to the NHS as a public service. They were billed as measures to reduce waiting times, to offer more ‘choice’, to achieve ‘world class’ standards, to make the NHS more ‘patient-centred’—anything but the real underlying aim of the key strategists involved, to turn the health care back into a commodity and a source of profit.’ (5)

‘Each of the so-called reforms involved persistent, behind-the-scenes lobbying and fixing by a network of insiders—inside the Department of Health, above all, but also by a wider network, closely linked to the Department: corporate executives, management consultants, ministers’ ‘speacil advisers’, academics with free market sympathies and a taste for power, doctors with entrepreneurial ambitions—and the House of Commons Health Select Committee, packed with just enough compliant back-benchers and deliberately insulated from advice from expert critics of the market agenda. Not to mention a large and growing corporate lobby.’ (5)

‘Each ‘reform’ needed its own quantum of dissimulation and occasionally downright lies. The culture of the Department of Health was radically transformed. In place of old-fashioned ideas of accountability and fidelity to facts the priority shifted to misrepresentation and spin. This was accelerated by the fact that from the late 1990s onwards more and more private sector personnel were active inside the Department, often in leading roles.’ (5-6)

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These are just a few excerpts. I have bought and read the book. To me it helps make sense of DOH behaviours which are otherwise mind-bogglingly stupid.

If you understand the ‘Choose your GP’ policy as aiming to de-regulate English general practice and open it up to for-profit companies, then it is rather clever, not stupid. But it does rely on the public being duped, and not seeing through the duplicity and deception; and the journalists, and the GPs, and other health professionals.


11. How can they be so stupid? Cognitive Muddle

05/06/2012

At the heart of this issue of patients’ choice of their GP practice there is a significant amount of cognitive confusion and muddle. What I mean is the sentences used are disconnected from reality, there is a disconnect. It is as though if the sentence sounds ok, then just go with it. Don’t actually try to see what it means in real life. There is an ignoring of the paradoxes.

It is as though a potician were to say: ‘I believe wholeheartedly is a strong family life and a lifelong committed marriage to my wife, and also having the choice of which mistress I have on the side at any given time.’

So Andrew Lansley says to the RCGP:’I’m not abolishing practice boundaries…I’m intending to extend patient choice.’

Many do not seem to be aware that there really is no choice, it is illusory. Current GP practices are all working at capacity, there is not significant spare capacity. If the practice area were suddenly to become the whole of England (or just the whole borough), there is no way that the practice could register the patients. This is such a basic reality, such a simple fact, and yet the muddle persists.

Another cognitive muddle is the argument that opening up practice areas will result in competition and improved quality of the poorer practices. But again, this is absurd because of this issue of capacity. Yes, a few patients might move from practice x to y, but it can only be limited. This is not same type of market as hamburgers and mobile phones.


9. How can they be so stupid? Being duped…

05/06/2012

If there is a deception being carried out, then there have to be people being deceived, being duped.

If a politician promises something that he or she knows cannot be delivered, and a citizen believes this, then the citizen has been duped.

If a politician promises something thinking they can deliver it, and a citizen believes this, has the citizen been duped?

In the case of the GP boundary issue, I think it is likely there are some politicians who think it is perfectly practical (in which case they are stupid, and not participating themselves in a deception) and are unaware of the unintended consequences; if they promise their constituent to deliver this is the citizen being duped?

A concrete case: on 30 December 2011 (is there a significance in such a date) the Department of Health launched the ‘Choose Your GP’ pilot. Almost immediately a number of articles appeared in the online press (Telegraph, Express, Oxford Times, and others). These ‘articles’ were essentially all the same, they all repeated what the DOH ‘Media Centre’ told them. They all more or less lifted the text from the DOH webpage. The articles did not say ‘All this content is from the Department of Health as they are giving it out. I cannot guarantee the veracity or reasonableness of the content.’ Nor did any of the articles analyse what was being offered, ‘promised’. They just presented it. A citizen reading the article could be excused for thinking the content, the promises, were reasonable and achievable.

So in this case, the journalist is being duped, and in turn, unwittingly, is duping the public.

(I checked this with one of the journalists, and offered some additional information which critiqued the content of the DOH webpage; the journalist said that he/she had had to rely wholly on the DOH content; and had he/she been aware of what I had told him/her, he/she would have written a different story. There may be more on this in the future).

DOH ‘Media Centre’ Launch

Two examples (there are at least 5 others):

Oxford Times ‘article’

Express ‘article’


8. How can they be so stupid? Duplicity

05/06/2012

Duplicity:Oxford Dictionary of English: deceitfulness; archaic the state of being double.

Andrew Lansley gave a speech to the Royal College of General Practitioners’ annual conference in October 2011. I did not attend but fortunately the speech is available on video, as are the questions and answers after the speech. So I was able to listen to these. What he had to say about GP boundaries was actually not unreasonable, he seemed to have understood the problem (‘Now I’m clear that whatever we do general practice must always remain rooted in local communities and that clinical commissioning builds on this.’; whatever was done had to work, they had to find ways that worked; ‘I’m not abolishing practice boundaries…’). But I was sceptical: let’s see what happens. A few weeks later the GPC signed a contract for 2012-13 which agreed to a pilot on GP practice boundaries, and for asking practices to create ‘outer practice boundaries’ which retained patients who moved from within the practice boundaries. This was not unreasonable, but I remained sceptical: how independent and probing would the ‘independent evaluation’ of the pilot be?

Then came the launch of the pilot, at the end of December 2011:

It allows patients for the first time to choose whether to register with a practice close to their workplace or home, without worrying about practice boundaries.

Health Secretary Andrew Lansley said:

‘Many patients are happy with their local GP practice, but a significant minority have problems registering with a practice of their choice. This pilot will mean patients taking part can access the high quality care they deserve in a place and at a time that suits them.

‘That’s why I believe patients should have the freedom to choose a GP practice that suits their lives, and not be restricted by geographical boundaries.’

He did not really believe what he said to the GPs in October. He was intelligent enough to know what sort of thing he had to say in order not to be eaten alive, but his intention was, and still is, to plough ahead with the abolition of practice boundaries. And this is how it was reported in the press.

In this sense, he is duplicitous, ‘double’, speaks with ‘a forked tongue’. Not to be trusted.

(For text of what he said to RCGP)