Tuesday, 9 April 2013

Spending My Children's Health Care Inheritance to Gamble with Ladbrokes

I have reproduced in what follows, with most of the typographical errors corrected, my answers to a consultation survey that started here: 

I felt a lot better after doing it than I did before. I think "Something off my chest" is the medical term. Being a medical service dunce I felt uninhibited by any direct knowledge of day-to-day work in a busy medical practice so I guess I am on a par with the Tory Policy Wonks who dreamt up the whole farrago. It's all about my putative "Personal Health Budget" - the magic key to my kingdom of sunlit uplands in flower-decked NHS Wards and discount heart tablets.

Questions 1 and 2 wondered who I was and what my "organisation" was. So the questions and answers start at Number 3
3 Do you agree that these are the right criteria to be used to determine eligibility for a personal health budget? Should they be prescribed in regulations?

I simply disagree with the concept, so any questions about how to implement a fanciful pseudo-market discipline on health care is a non-question. All means of attempting to do so are based on a flawed model and a gross over-estimate of the ability of most people (including me) to decide on complex resource allocations in fair or morally congruent ways.

At heart, this suggestion seems to be a slightly mad attempt to make people behave as if they were the rational actors assumed by primitive economic models.

That model, having failed, should simply be discarded in favour of practices and experiments that reflect what we already know about how people and communities create their own lives.

4 Do you agree with our proposal to separate out clauses in respect of children and adults who lack capacity? Are there any other capacity related issues you would like to see addressed?

Lacking capacity is universal. Within the range of incompetence and partial understanding, the degree and consequences of such incapacity will be, to some degree, structured by patterns of power and access. A bit like "school choice", the choice is almost entirely hypothetical. In real situations some will have wide knowledge and genuine alternatives - in most others the simple reality will be that individuals have little idea of what the choices are or of what choices might be hidden or unavailable in the real context of the consultation they are engaged in.

Choosing a car is one thing - a mistake can be written off. "Choosing" a health plan is closer to being irreversible - most patients are exceptionally vulnerable to hints or suggestions that might steer them towards more readily available treatments that suit the expert they are talking to.

Again, solving a problem in a badly conceived programme is none of my business. Those whose ideologies point to this kind of silliness need to have their own strategies for making them less bad and not look for endorsement through having "widely consulted".

5 Do you agree that personal health budgets should not be allowed to be spent on the services listed above? Are there any other services which should be excluded?

The whole idea has created this dilemma. Don't go through with it and this question becomes irrelevant. Implicitly the perpetrators have acknowledged that once a complex new system is in place some kinds of people will exploit the possibilities to get even more of what they already have. This is a real inverse of the mythical "welfare dependency". Asking the public to suggest things you have forgotten is a bit rich.

6 Do you agree that the list of information, support and advice that patients are entitled to ask their CCG or the Board for should be supplemented with the items above?

The absurdity of these questions gets richer as the questionnaire goes on. Given the obvious fascination the perpetrators have with "free markets" it is ironic that they are struggling at this point with the obvious non-existence of a key aspect of the free market model - the perfect knowledge of buyer and seller. I foresee careers in health advocacy in which (for £250 pa) an individual can have all their care plan options evaluated by a qualified expert (whose medical training has been diverted from treating patients to discussing abstract costs and benefits of broadly equivalent treatments.

I am starting to wonder if this whole consultation isn't an elaborate joke.

7 Do you agree that there should be the option of paying one-off direct payments for healthcare into an individual's personal bank account?

It sounds like a great idea for maximising misuse of funds while rationing the bureaucracy.

8 Do you agree that local authorities should be included in the scope of the regulations for direct payments for healthcare?

The massive unasked question here is "Am I happy with the way that Local Authorities have been given huge responsibilities for social care while resources provided to them have been reduced for ideological reasons?"

So my answer is no.

9 What are your views on friends or family members being paid for managing complex or large healthcare packages? How should this be defined, for example should it be linked to the size of the direct payment?

It would be simpler for parents of a needy child to get a part-time job with the local authority care department that was adequately funded to manage all support services. Again, the market fallacy is the problem. Distribution of scarce resources, in some circumstances (and in the non-real models of classical economics) can be achieved by letting each participant make decisions in their own interests. Such a model, when it extended by compulsion into real life, fails to solve the problem of distribution while adding to the inefficiency of health providers who now have complex rules and recording to cover for the lack of professional autonomy and trust that made things less bad in the past.

The madness of this question should have alerted the scheme's perpetrators to the folly of what they are doing.

10 Do you agree that these regulations should remain the same? If not, what would you like to see changed?

I have now lost the will to read. Please be assured that having got this far I will do my best. Please note that I now fear for the sanity of any health professional I might need to rely on for advice in the future. When you say "enough to cover all the services that have been agreed in their care plan" I assume you mean "the fixed amount that is insufficient, but which can't be changed given the restrictions we are faced with"

11 Are there other areas that you would wish to see in regulations? If so, what are they?

I have no wish to see any regulations at all. I would rather like it if those who were really expert and acknowledged in their fields made wise consensual decisions that could be evaluated and adjusted in due course. I have a strong sense of highly articulate recent postgraduate scholars inventing stuff as they go along with precious little insight or experience in how organisations actually and normally don't work very well.

12 Could the proposals have any perceived or potential impact on equality including people sharing protected characteristics under the Equality Act 2010?

A lifetime in education and research suggests to me that anything that comes from career politicians backed by Health Corporation lobbyists is going to increase the social, .economic and welfare gaps between rich and poor. Only on a different planet could the change go the other way. 


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