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The NHS: Where ‘choice’ into ‘value’ doesn’t go

Mrs GogginsGordon Brown has a fascinating plan for the NHS: Increase patient choice, whilst simultaneously driving the cost of healthcare down to deliver better ‘value for money’. The plan is fascinating primarily because its two aims are utterly contradictory.

As any good economist – Gordon Brown included – will tell you, the greatest economies are those of scale. If the more specialist services from seven Anytown General Hospitals can be lumped together at the Bigcity Regional Specialist Unit, and the five GP practices in each Anytown are combined with the remaining General Hospital Services in a Polyclinic, then costs can be massively reduced. Less real estate, fewer administrative staff, and fewer healthcare staff are needed to serve the same number of patients. Economically speaking, it’s a nobrainer.

Yet while the out-of-town model is great for businesses and retailers, it’s crap for healthcare – and also flies in the face of current policy. Which is where Mrs Goggins comes in.

Gordon currently wants to offer old Mrs Goggins a choice of places to have her cataracts seen to – most likely, she’ll choose Anytown General, as it’s closest to her house and more convenient all round. She’s unlikely to be attracted by the lure of Bigcity Regional Specialist Unit, 50 miles away, and she’d rather wait an extra couple of months to have her eyes operated on closer to home. And that’s pretty much all well and good.

In a few years’ time, however, Mrs Goggins won’t have that choice. She won’t be able to go and see her local GP any more, she’ll have to travel all the way to the Health Village on the old Anytown General site, where she’ll be assessed by an economically friendly Nurse Practitioner, who will then refer her over to Virgin Healthcare’s Bigcity Regional Specialist Unit, where she can go and be assessed by another Specialist Nurse Practitioner who can consider whether or not she need make the 50 mile round trip again another day to actually see the consultant, and then a third trip to have the operation done…

When she gets to the Virgin Healthcare Bigcity Regional Specialist Unit, she’ll find she’s on a very noisy, open eight-bedded bay… but this is Virgin, so fear not, she can pay £15 per night to upgrade herself to her own private side-room with her very own TV. She won’t be able to afford to heat her house for the next few weeks, but it’ll be worth it to make her comfortable in hospital.

Her follow-up is, of course, based at the Hospital – disparate community follow-up services are desperately financially wasteful – so she can treat herself to a few more 100-mile round trips before even contemplating having the second eye done.

Of course, Mrs Goggins will still have some choice – she needn’t go to Bigcity if she doesn’t want to – she can go to any of the Specialist Units in the country, she’s not restricted to the nearest.

Or else, she could decide that the whole thing is far too hard, and she’ll just put up with her cataracts – And, after all, that’s the best choice for us, economically speaking.

» Image Credit: Original photograph by Christopher Walker, modified under licence.

This post was filed under: Health.

Diary for 28th April 2008

The Big British Castle has changed the I’d Do Anything video format… So the weekly posts have become impractically time-consuming. Sorry! «

This post was filed under: Diary Style Notes.

Humphrey Lyttelton has died

Humphrey Lyttelton

It was with deep regret that I learned on Friday evening of the death of one of radio’s greatest dry wits, Humphrey Lyttelton.

I’ll always remember him as the wonderful host of one of Radio 4’s best shows, I’m Sorry I Haven’t a Clue, though Radio 2’s The Best of Jazz was the soundtrack to and from the journey to many of my own music lessons in my youth.

His is one of those friendly voices which has been ever-present from my earliest years to the present day: It a voice I shall greatly miss.

May he rest in peace.

This post was filed under: Media, News and Comment.

Diary for 24th April 2008

Lots of folk seem to be chit-chatting about the teachers’ strike today… But no-one I’ve talked to supports them. Not suprising, really. «

Unnecessary, heartsink, pseudo-American NHS neologism of the day: Protocolised. «

This post was filed under: Diary Style Notes.

Confusing ‘simplification’ of rail fares

It is reported that Rail Tickets are to be simplified into three new types: Advance, Off-Peak, and Anytime. Any simplification of over-complex ticketing is to be welcomed, but I’m confused.

Let’s consider the options for a simple return journey, with no changes, from Manchester to York, leaving at 10.57 on 30th April, and returning at 17.58 on the same day. All of these options are for the same couple of trains.

Single Ticket Outbound: Student Getaway C (£3.75), TPE Standard Advance Single D (£3.95), Student Getaway B (£4.75), TPE Standard Advance Single C (£4.95), Student Getaway A (£5.00), TPE Standard Advance Single B (£6.25), TPE Standard Advance Single A (£6.60), Standard Day Single (£12.85), TPE First Advance Single B (£16.00), TPE First Advance Single A (£17.00), or First Day Single (£25.70)

Single Ticket Inbound: Student Getaway A (£5.00), TPE Standard Advance Single B (£6.25), TPE Standard Advance Single A (£6.60), Standard Day Single (£12.80), or First Day Single (£26.30)

Return Ticket Choices: Saver Return (£15.25), Standard Day Return (£15.65), Standard Open Return (£17.80), or First Open Return (£51.40)

To summarise, there are fifty-nine different ticket combinations for the same return journey, on the same two trains.

The cheapest option for this return journey is actually to buy two singles, at a total cost of £8.75 – which would get me exactly the same seats on exactly the same trains as a £12.80 return or singles costing a total of £25.70.

Also note that a Standard Day Return is cheaper than one Standard Day Single – so if buying the ‘standard’ tickets, you’re better off buying a Return ticket for a Single Journey.

When you start to contemplate longer journeys, or journeys involving changes, things become unmanageably complex – especially when you consider that ticket splitting is an issue (which I’ve deliberately omitted above).

Bizarrely, this ‘simplification’ retains all of the above fares. There will still be fifty-nine different ticket combinations available, but now through an extra haze of only three different ticket names. Progress?

We are crap at running trains and it ia all our fault

» Image Credit: Original creation by Tom Goskar, modified under licence

This post was filed under: News and Comment.

Decision making with Gordon Brown

[flashvideo filename=”http://sjhoward.co.uk/video/review2.flv” picture=”http://sjhoward.co.uk/wp-content/uploads/2008/04/s7001616.jpg” /]

Also available on YouTube

This post was filed under: News and Comment, Politics, Video.

Diary for 22nd April 2008

I have a few bits and pieces I really want to post on here, but I haven’t had chance in the last few days. Soon, though, soon… «

This post was filed under: Diary Style Notes.

Diary for Monday, 21st April 2008

I have long enjoyed the fact that Millie’s advertise their celebration cookies as suitable gifts for Slimmer of the Week… «

This government’s biggest claim to success has been the economy, stupid… Yet its biggest downfall may very well be the stupid economy. «

This post was filed under: Diary Style Notes.

An unexpected blast from my web-based past

Daily Saturn: Tilly in Toe-Stub TerrorIf you remember this site six years ago, in the days before the blog when Tilly O’Shea, The Corporation, and TOSSers reigned supreme, then this may be as much as blast from the past for you as it is for me.

Browsing the site’s external archives recently, I’ve unearthed a veritable mine of stuff that I haven’t seen in years – and frankly thought was lost forever. In fact, it came from the old simonhoward.co.uk, in the days before sjhoward.co.uk ever existed…

Perhaps the most startling find is this complete mock red-top newspaper report, which formed part of my A-Level English work, but also formed the centrepiece of a whole website about Tilly O’Shea and The Corporation – some of which still survives via the Wayback Machine. It’s amazing to look back at crap I wrote so long ago – and endlessly fascinating. Though probably primarily for me, I’d guess.

There are a couple of other things I’ve rescued from digital oblivion, primarily for the sake of nostalgia – a small collection of downloadable pub quizzes and lyrics to a few Lazlo Bane songs have both found a new home in the ‘Freebies’ section. And I guess no sjhoward.co.uk nostalgia-fest would be complete without links to the latest So It Goes column by Jason Love, and The View from Here column by Shelley Strauss Rollison, both of which were at one time popularly syndicated by this very site.

If that’s quite enough parochial navel-gazing for you, then you’ll be utterly dispirited to learn that this very blog’s fifth birthday is just a little over two-weeks away, and there’s bound to be more self-congratulatory whooping then. I can’t wait!

This post was filed under: Miscellaneous.

Diary for Saturday, 19th April 2008

Umbrella Watch (especially for Steve): Whilst the umbrella is still working admirably, its string handle has disintergrated. Frankly, I never really liked it anyway. «

This post was filed under: Diary Style Notes.

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