Will Competition Improve the NHS?
#lsenhs
Twitter responses after the LSE NHS event on 12th March.
https://twitter.com/#!/search/realtime/%23lsenhs
Tweets
13 Mar Jos Bell @Jos21
@HarryLangford every panellist at #lsenhs last night was strongly against Bill - even those you would expect to support it. Dangerous mess
13 Mar William Wong @3become1
@Paul_Corrigan Good to see you at #lseNHS last night.
In reply to Paul Corrigan
12 Mar Navin @NavinSewak
Will competition improve the NHS? #lsenhs After the debate and discussion, the jury is very much out on this one-perhaps that's the problem?
12 Mar Clive Peedell @cpeedell
#lsenhs 11. Promotion of market competition in healthcare based in neoliberal philosophy, economics & politics http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/Peedell-The-politics-of-NHS-Market-reforms.pdf #NHS
12 Mar shabbir gheewalla @shabbirghewalla
RT @cpeedell : #lsenhs 10. MORI poll of doctors: competition biggest threat to care http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp#.T16F66NYCSM But primacy of competition is key...
12 Mar Clive Peedell @cpeedell
#lsenhs Ham on clinical leadership/followership: "without doctors, NHS reform is doomed to fail". Yet doctors reject market competition!
12 Mar Clive Peedell @cpeedell
#lsenhs 10. MORI poll of doctors: competition biggest threat to care http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp#.T16F66NYCSM But primacy of competition is key to Lansley bill
12 Mar Clive Peedell @cpeedell
#lsenhs 8. Unwarranted practice variation is inefficient, but market competition will worsen this problem. Destroys population denominator
12 Mar Clive Peedell @cpeedell
#lsenhs 7. Doctors want to build good local services for local populations. Needs collaboration and cooperation to achieve
12 Mar Clive Peedell @cpeedell
#lsenhs 6. Market competition encourages citizen-consumerism and requires excess capacity to work. It will bankrupt single payer system
12 Mar Clive Peedell @cpeedell
#lsenhs 5. When patients feel unwell, they don't want to travel & want to be close to relatives and support networks.
12 Mar margaretmccartney @mgtmccartney
@cpeedell #lsenhs indeed, because we have a duty to the evidence, and the evidence is that markets are harmful
In reply to Clive Peedell
12 Mar Clive Peedell @cpeedell
#lsenhs 4. "Patients just want a good local service". le Grand used BSA to counter this, but it was survey of public, not patients!
12 Mar Clive Peedell @cpeedell
#lsenhs 3. Market competition fundamentally undermines medical professionalism & strikes at heart of dr-patient relationship
12 Mar Clive Peedell @cpeedell
#lsenhs I agree with Prof David Marquand that public service professionals are "in a profound sense, not just non-market, but anti-market"
12 Mar Alexander. @alex_mjs
@beardysocialist I believe there was a consensus that the reforms are toxic and/or have dropped the previous radical edge #lseNHS
In reply to Bearded Socialist
12 Mar Bearded Socialist @beardysocialist
@alex_mjs @JonB_89 as the panel pointed out, who in their right mind supports lansley? #lsenhs
In reply to Alexander.
12 Mar Clive Peedell @cpeedell
#lsenhs 1.Elephant in room of this debate is medical professionalism, which is rejected by market (public choice theory - Knights & Knaves)
12 Mar Bearded Socialist @beardysocialist
#lsenhs good event, wish there had been more on the evidence rather than morals and some random thoughts
12 Mar Jonathon Tomlinson @mellojonny
@atm0spheric a debate about healthcare without carers is like a debate about funding without economists #lseNHS
In reply to Edmundo Ventolera
12 Mar Edmundo Ventolera @atm0spheric
@mellojonny #lsenhs My wife chose a doctor who would not be judgmental about her underlying problem - a doctor with the same problem.
In reply to Jonathon Tomlinson
12 Mar Edmundo Ventolera @atm0spheric
@mellojonny #lsenhs I chose my doctor because he spoke even more sense than the garage I take my car to. I trust him with my person.
In reply to Jonathon Tomlinson
12 Mar Mark Littlewood @MarkJLittlewood
@alex_mjs shame. I'd have loved to have been there. Vital issue #lsenhs
In reply to Alexander.
12 Mar Sharon Avraham @Sharonavraham
Zoe Williams very busy tonight. On panel at @LSEpublicevents discussing #NHSBill and on #skypapers at 11.30 #lsenhs
12 Mar John Appleby @jappleby123
"@profchrisham : @HSJEditor can Zac explain how competition causes performance to improve?" In theory, yes! #lsenhs "
12 Mar Dr. Douglas Noble @DouglasNobleMD
RT "@HSJEditor : Zack Cooper says Frank Dobson's attack on NHS competition is similar to climate change denial #lsenhs " >>> how extraordinary
12 Mar John Appleby @jappleby123
@ijgreener #lsenhs yep, gd q ( is comp cost effective) but not wot zc et al set out to answer
In reply to Ian Greener
12 Mar Dale Mary Sandberg @dalesandberg
Heated debate tonight: competition in the NHS. It did feel like there was more of shouting down than engaging, though. #lseNHS
12 Mar Ian Shaw @Prof_ian_shaw
@ijgreener #lsenhs or they drop clinical workload to minimum for re-cert then they have insight and cred with clinicians
In reply to Ian Greener
12 Mar Chris Ham @profchrisham
@HSJEditor can Zac explain how competition causes performance to improve? how comp impacts decision making is opaque at best #lsenhs
In reply to Alastair McLellan
12 Mar John Hully @PutneyDebates
Choice forced on people in illusion they maximise their utility and thus cause competition. Economics inverting cause and effect #lsenhs
12 Mar John Appleby @jappleby123
"@AJO1169 : @jappleby123 @hsjeditor Which US system?" just quoting a speaker at #lseNHS
12 Mar Alexander. @alex_mjs
@MarkJLittlewood bad form them then! Was a great debate too #lseNHS
In reply to Mark Littlewood
12 Mar Axel Heitmueller @axelheitmueller
@ijgreener great thing is that competition among clinicians works in most clinical areas also those where ppt choice doesn't #lsenhs
In reply to Ian Greener
12 Mar Mark Littlewood @MarkJLittlewood
@alex_mjs nope. I accepted and was told my email had not been received or went into their spam folder. They thus stood me down #lsenhs
In reply to Alexander.
12 Mar Jonathon Tomlinson @mellojonny
Evidence is that patients remember very little of each consultation incl. choice. Why is more choice the answer? #lsenhs
12 Mar Jonathon Tomlinson @mellojonny
@doctorpreneur What is the point of patient choice? #lsenhs http://abetternhs.wordpress.com/2011/09/29/point/
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12 Mar Jos Bell @Jos21
@AndrewGeorgeLD check out @Sharonavraham at #lsenhs - NOBODY on the panel supports the Bill - even Cooper.Ask her more....
In reply to Andrew George
12 Mar Ian Greener @ijgreener
@axelheitmueller #lsenhs Competition between clinicians diff from competition between services. Better way forward?
In reply to Axel Heitmueller
12 Mar Axel Heitmueller @axelheitmueller
@ijgreener depends on service. Also transparency of performance data may drive ppt choice but mainly competition among clinicians #lsenhs
In reply to Ian Greener
12 Mar Fi McKenzie @fkmckenzie
This is what I was trying to say/question but got diluted by similar qs and arguments between panel members https://twitter.com/axelheitmueller/status/179298854192168960 #lseNHS
View tweet
12 Mar Anthony Woodhead @ant_woodhead
#lseNHS NHS bad at tendering timely. lots dont happen, just run a "trials" then dont allow all companies to see results (or dont measure)
12 Mar Ian Greener @ijgreener
@axelheitmueller #lsenhs Question is - would costs of extending competition be better spent on care? Surely that is crucial health econ q?
In reply to Axel Heitmueller
12 Mar Axel Heitmueller @axelheitmueller
In practice impact of #competition through ppt choice on outcomes is small compared to tariff changes & competitive tendering. #lsenhs
12 Mar Anthony Woodhead @ant_woodhead
#lseNHS I work in Pharma and don't think we compete all that much really, doubt there could ever be enough providers to make comp work here
12 Mar Chris Mason @Do0g1e
Wowser. Err, ok... no wait, WHAT?!? MT "@HSJEditor : Cooper says Dobson's attack on NHS competition similar to climate change denial #lsenhs "
12 Mar Jonathon Tomlinson @mellojonny
@jappleby123 @AllysonPollock anybody at the debate have to work out complex healthcare choices with real patients? #lseNHS
In reply to John Appleby
12 Mar Ian Greener @ijgreener
@Prof_ian_shaw #lsenhs Problem is that research on clinician managers suggests they find role impossible - no time to do managerial role
In reply to Ian Shaw
12 Mar Mark Saxon @DrMSaxon
#lsenhs "Disruptive innovation"? I'd be happy if nhs got round to making the easy obvious innovations that could improve things
12 Mar Alexander. @alex_mjs
Finishing on sound bites - how about NHS stands for NATIONAL not anti anything but #lseNHS
12 Mar Ian Shaw @Prof_ian_shaw
@ijgreener #lsenhs Clinician managers can - not clear distinction between the two :o)
In reply to Ian Greener
12 Mar Emma Stanton @doctorpreneur
Disruptive innovation has limited applicability to NHS says @HSJEditor but YES to competition on outcomes #lsenhs
12 Mar Alexander. @alex_mjs
Another comparison to schools... completely different in context & set-up #lseNHS
12 Mar Ian Greener @ijgreener
@doctorpreneur @LSEGovernment #lsenhs Problem is Cooper can't explain what good management is - black box in research (again).
In reply to Emma Stanton
12 Mar Alexander. @alex_mjs
If you want an example of faulty computer systems try working in Parliament... #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs If ascribing fault, need to be clear about what. #NHS is low cost, fair. Needs to improve clinical outcomes. Can managers do that?
12 Mar Emma Stanton @doctorpreneur
Good predictors of good management in health care--> 1. Competition 2. Doctors as leaders via Zack #lsenhs from @LSEGovernment research
12 Mar Alexander. @alex_mjs
The fault hasn't been the monoply but the managers #lseNHS
12 Mar Alexander. @alex_mjs
I don't think I've ever seen my official GP. I'm just given the next available at the time #lseNHS
12 Mar Mark Saxon @DrMSaxon
#lsenhs and agree with audience member that good management therefore remains crucial
12 Mar Ian Greener @ijgreener
@DrMSaxon #lsenhs Yes - depends how much it costs, what it achieves for whom. No governance structure improves care - we must focus on that.
In reply to Mark Saxon
12 Mar Mark Saxon @DrMSaxon
#lsenhs competition good? Surely answer is it depends? Agree with frank dobson that finding way to spread of innovation is key
12 Mar Ian Greener @ijgreener
@ant_woodhead #lsenhs 'Opp cost' perhaps too technical. Concerned about transactions costs specifically. Competition expensive…..
In reply to Anthony Woodhead
12 Mar Alexander. @alex_mjs
"Conversation tonight too focused on hospitals & not patient-GP relations" #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs No point in arguing what would have happened 60yrs ago if private involved then. We are starting from 2012!
12 Mar Anthony Woodhead @ant_woodhead
@ijgreener #lseNHS think opportunity cost of competition is real question here, all we're doing is avoiding the rationing elephant, again
In reply to Ian Greener
12 Mar Alexander. @alex_mjs
If the private sector was involved in the NHS from its inception would this debate have the same loaded connotations? #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs Why doesn't Cooper talk about cost of competition - do they dwarf benefits claims to have found? Cost of p-p split huge over 20 yrs.
12 Mar Jonathon Tomlinson @mellojonny
@ijgreener #lseNHS Every consultation contains about 3-6 treatment decisions, so that's about 100 today for me & my patients
In reply to Ian Greener
12 Mar Alexander. @alex_mjs
"Choice already in the NHS - patient asking 'well what do you think Doctor?'" #lseNHS
12 Mar Lisa Trigg @lisatrigg
#lsenhs RCN person next to me says nurse awards for innovation are still going on - Nurse of the Year Awards
12 Mar Anthony Woodhead @ant_woodhead
@mellojonny #lseNHS why doesnt Zack Cooper discuss opportunity cost of competition in paper, even if some effect is tiny
In reply to Jonathon Tomlinson
12 Mar Alexander. @alex_mjs
Reform the NHS? OK, let's pay nurses the same as bankers #lseNHS
12 Mar Ian Greener @ijgreener
@jappleby123 #lsenhs Do you really think teachers think about competition? About league tables - but does that lead to better education?
12 Mar Alexander. @alex_mjs
Did a panelist member just mention NHS shouldn't be rolled back to the 19th century???? Only invented in 20th century!! #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs Interesting how evidence for competition appears second-hand - no real people observed or spoken to. And claims to be empirical?
12 Mar Genevieve Edwards @GenEdwards
I can confirm that we health charities compete in the most charming way @zoesqwilliams #lsenhs
12 Mar Alexander. @alex_mjs
Abortion services in the NHS SHOULD be praised #lseNHS
12 Mar Jonathon Tomlinson @mellojonny
Why does't Cooper observe patients & GPs to see how they make treatment choices? #lsenhs
12 Mar Lisa Trigg @lisatrigg
#lsenhs McLellan would be surprised if any of the panellists would be in favour of the bill as it stands
12 Mar Alexander. @alex_mjs
"Public sector commission WAS competition" #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs Yes - defining principles of Lansley reorganization lost. So time to drop #nhsbill completely. Waste of money and huge disruption.
12 Mar John Appleby @jappleby123
@ijgreener and how get teachers to do good teaching? #lsenhs
In reply to Ian Greener
12 Mar Alexander. @alex_mjs
"Defining principles of Lansley reforms have been lost" #lseNHS
12 Mar Genevieve Edwards @GenEdwards
Do you think that hospitals can improve without challenge? Julian le Grand #lsenhs
12 Mar Alexander. @alex_mjs
"Everywhere in the world - people want to know what's going on in the NHS" #lseNHS
12 Mar Jos Bell @Jos21
competition may improve schools #lsenhs but a child only attends one at once & the objective is quite different. Pupils educated not mended
12 Mar Ian Greener @ijgreener
#lsenhs . Labour as inept on competition as coalition. But got funding up to sensible levels. Cause of improvements?
12 Mar Alexander. @alex_mjs
AT LAST "The other hate figure in the room - not just the US healthcare system - the previous Labour Government" #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs . No competition does not improve schools. Good teaching improves schools! Must show causal links……
12 Mar Broken Arrow @Lala_Lansley
#lsenhs Two questions from Twitter! Zack.. can I see you in my office at the DoH TOMORROW? You RULE! .. @ijgreener ....Can you FARK ORF?!
12 Mar Ian Greener @ijgreener
#lsenhs . We absolutely MUST use info to improve services. Question is whether choice is best means of doing so. How would that even work?
12 Mar Richard @a6ruled
#lsenhs #choice #competition #healthcare #interpretiveflexibility #mytwocents
12 Mar Alexander. @alex_mjs
From the (neutral) CHAIR - "competition improves schools" #lseNHS
12 Mar Alexander. @alex_mjs
"Gospel of despair NOT to use NHS information to improve services" #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
Allowing people to access info on hospitals & gps doesn't mean that they will #lsenhs time & info asymmetry = #opportunitycosts
12 Mar Alexander. @alex_mjs
I don't see why we had to compare the NHS to China, another low level of debate #lseNHS
12 Mar Alex Marsh @ShodanAlexM
Totally absurd. Low tactic. Losing argmt >MT @HSJEditor : Cooper says Dobson's attack on NHS comp is similar to climate change denial #lsenhs
12 Mar Ian Greener @ijgreener
#lsenhs . Choice in healthcare ENTIRELY different to Uni access. In latter good information, can change. In health differentiated, complex
12 Mar Alexander. @alex_mjs
Passions are starting to show on the panel... #lseNHS
12 Mar Alexander. @alex_mjs
NHS compared to University admission over access... #lseNHS
12 Mar Robbie @rmfergusson
#lsenhs cooper just coming off smarmy and pompous. Style over substance. Unsurprised about this; its a fair summary of his position
12 Mar Ian Greener @ijgreener
#lsenhs did Zack Cooper really just claim his research was as reliable to that on climate change?
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs back to lala land - fruitless bashing between Cooper & Dobson. Back to the topic please.
12 Mar Alexander. @alex_mjs
NHS waiting times splits the panel! #lseNHS
12 Mar Alastair McLellan @HSJEditor
Zack Cooper says Frank Dobson's attack on NHS competition is similar to climate change denial #lsenhs
12 Mar Ian Greener @ijgreener
@alex_mjs Keep tweeting! We can't all make London on a Monday night #lsenhs
In reply to Alexander.
12 Mar Alexander. @alex_mjs
Been told to stop tweeting from an audience member - no. it's called open debate #lseNHS
12 Mar Lewisham SOS NHS @LewSOSNHS
examine the real impact of competition http://www.scribd.com/doc/81678939/Breaking-the-Nhs #lsenhs
12 Mar Alexander. @alex_mjs
"In US the Insurance market has become anti-competitive" #lseNHS
12 Mar John Appleby @jappleby123
@SAFCBOB #lsenhs not meant patronising at all; he didn't understand some pts re analysis..
In reply to Bob Hudson
12 Mar Ian Greener @ijgreener
#lsenhs Q from twitter! Can advocates of competition, if scientific, make a prediction about which city's health will improve met this year?
12 Mar Alex Marsh @ShodanAlexM
#lsenhs Must assess strength of evid on competition. Claims relate to impact on simple indicators in narrow circs. Incautious generalisation
12 Mar Alexander. @alex_mjs
Google Doctors...WHAT?? #lseNHS
12 Mar Dean Jenkins @dean_jenkins
Naieve as in the technical meaning not the derogatory one of course. #lsenhs
12 Mar Tristram Wyatt @TristramWyatt
RT @ijgreener : #lsenhs . Advocates of competition completely fail to show exactly how it works - or even if it exists. #nhs #dropthebill
12 Mar Robbie @rmfergusson
#lseNHS procedural point but I have no idea why more than 1 q taken at once, makes no sense and points get lost but everyone does it
12 Mar margaretmccartney @mgtmccartney
q should be - improve for whom. Health inequalities increasing is real unintended harm @doctorpreneur @HSJEditor #lsenhs
In reply to Emma Stanton
12 Mar Dean Jenkins @dean_jenkins
Why is panel the way that it is? Surely those that have published criticisms of Cooper's empiric, naieve approach should be there? #lsenhs
12 Mar margaretmccartney @mgtmccartney
real choice is embedded in everyday GP - what treatments, what degree of uncertainty - it has nothing to do w Politics @ijgreener #lsenhs
In reply to Ian Greener
12 Mar Ian Greener @ijgreener
#lsenhs Gwyn Bevan from LSE said last week in relation to competition 'the evidence is very weak and contested'. Should have been invited?
12 Mar Alexander. @alex_mjs
@clarercgp 'Will Competition Improve the NHS?' at the LSE #lseNHS
In reply to Clare Gerada
12 Mar Robbie @rmfergusson
#lsenhs first questioner is off his rocker comparing meritiocracy with health and wellbeing.
12 Mar Broken Arrow @Lala_Lansley
#lsenhs GOD I wish I was there. I really hope Cooper is giving Dobbo and Williams a pasting. Anyone got the scores on the doors?
12 Mar Ian Greener @ijgreener
#lsenhs We have to look as US system because LSE researchers keep claiming competition has improved things there!
12 Mar Jos Bell @Jos21
competition zaps co-operation & collaboration. Patients suffer as a result. Rivalry does not make patients well. Joint working does #lsenhs
12 Mar Bob Hudson @SAFCBOB
@jappleby123 Rather patronising? Does Cooper understand politics and patient perspectives? #lsenhs
In reply to John Appleby
12 Mar Emma Stanton @doctorpreneur
Does choice make hospital quality improve? Answer from @HSJEditor is "Yes,it can" #lsenhs but evidence base is narrow & ther is overclaiming
12 Mar Alexander. @alex_mjs
"Entirely narrow evidence based on competition available" #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs Mclellan: "let's learn more languages & look to other countries' systems w competition" Am offering my services for Germany :-)
12 Mar Ian Greener @ijgreener
@doctorpreneur @HSJEditor #lsenhs Not just about choice - before we can choose, we need info to be presented in a form to make comparisons
In reply to Emma Stanton
12 Mar Alexander. @alex_mjs
If the answer is legislation - you've asked the wrong question #lseNHS
12 Mar Dean Jenkins @dean_jenkins
@jappleby123 yes I have, and read the critique. Interesting number crunching but argument seems tenuous. #lsenhs
In reply to John Appleby
12 Mar Jos Bell @Jos21
why should one patient be cherry picked over another? who would like to have a complex condition & not be able to access care? #lsenhs
12 Mar John Appleby @jappleby123
Stop being obsessed w US system; we all know it's screwed! @HSJEditor #lsenhs
12 Mar Broken Arrow @Lala_Lansley
#lsenhs I'M WITH COOPER! COMPETITION RULES! AND HES BETTER LOOKING THAN DOBBO. COOOOOOO-PEEERR! C'MON LSE!!
12 Mar Emma Stanton @doctorpreneur
for @DouglasNobleMD --> MT "@jappleby123 : @dean_jenkins #lsenhs yes. Go to zack cooper's site at lse for refs"
12 Mar Alexander. @alex_mjs
"US healthcare is screwed - no one should be copying that!" #lseNHS
12 Mar Emma Stanton @doctorpreneur
For Choice to work properly requires information and advocacy --> such systems do not currently exist in NHS via @HSJEditor #lsenhs
12 Mar Alexander. @alex_mjs
"We're obsessed with the US in healthcare as the US is obsessed with the NHS" #lseNHS
12 Mar Jonathon Tomlinson @mellojonny
#lsenhs I don't see evidence that researchers have understood the contexts in which patients make choices
12 Mar Alexander. @alex_mjs
My mentions for #lseNHS has exploded
12 Mar LSE Government @LSEGovernment
#lseNHS Alastair McLellan. We need to define competition in the NHS. Private sector has played a role in NHS. Can competition work? #LSE
12 Mar Alexander. @alex_mjs
"Competition in NHS is NOT just about hospitals" #lseNHS
12 Mar John Appleby @jappleby123
@dean_jenkins #lsenhs yes. Go to zack cooper's site at lse for refs
In reply to Dean Jenkins
12 Mar Ian Greener @ijgreener
@alex_mjs #lsenhs . Good point! What is private sector for if NHS has to pick up care when private fails/leaves? Or if no basis for choosing?
In reply to Alexander.
12 Mar Alex Marsh @ShodanAlexM
But DiD is a black box method. Correlational not causal > MT @jappleby123 : Not sure dobson understands cooper's methods re DiD #lsenhs
12 Mar Jos Bell @Jos21
as Lord Owen said ' the poison in this Bill runs very deep - is privatisation to the core' #lsenhs No safeguards for patients. No comeback
12 Mar Alexander. @alex_mjs
"The private sector in healthcare is tiny, limited & has real trouble in investing for new services (b/c of risks)" #lseNHS
12 Mar Emma Stanton @doctorpreneur
The private sector has played a critical role in NHS since it began-not least the GPs & mental health medium secure. Via @HSJEditor #lsenhs
12 Mar Ian Greener @ijgreener
@jappleby123 @HSJEditor #lsenhs . I agree with John. What kind of competition? What kind of choices?
In reply to John Appleby
12 Mar Alexander. @alex_mjs
"People in the NHS are nervous of competition - of course they are" #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
more rationality from Mclellan. What type of competition are we talking about? Quality? Price? For what? Service improvement? Cost? #lsenhs
12 Mar William Wong @3become1
Alastair McLellan (#HSJ ): Competition in the #NHS for what and between what? #lseNHS
12 Mar Alexander. @alex_mjs
"Elephant in the room - private sector role in the NHS" #lseNHS
12 Mar Alexander. @alex_mjs
Good to see the neutral panelist highlight the end of the sentence - competition 'for/to what'? #lseNHS
12 Mar John Appleby @jappleby123
@HSJEditor what type of comp we talking about? #lsenhs
12 Mar Ian Greener @ijgreener
@rmfergusson #lsenhs . Problem bigger than that. How can competition exist with next to no good information and big hospitals can't fail?
In reply to Robbie
12 Mar Dean Jenkins @dean_jenkins
@jappleby123 not sure many people do. Has it been published? #lsenhs
In reply to John Appleby
12 Mar Ian Greener @ijgreener
#lsenhs . Advocates of competition completely fail to show exactly how it works - or even if it exists.
12 Mar Alexander. @alex_mjs
YES - Competition on quality or competition on price? #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
At least Dobson mentions cooperation over competition. #lsenhs #nhsbill not clear on how comp & coop can work parallel. #paradoxmachine
12 Mar Robbie @rmfergusson
#lsenhs doesn't this all basically come down to whether you think improvement is zero sum or not? If it is, competition is inherently false
12 Mar Alexander. @alex_mjs
"US healthcare costs twice as much per head & lower life expectancy" #lseNHS
12 Mar Alexander. @alex_mjs
"Cooperation & pooling of risk & cost are the fundamental aspects of the NHS" #lseNHS
12 Mar cluedo @whosgotnoclue
Critics of paper overlook that reduction in heart attack mortality can be indicator of overall efficiency of hospital #lsenhs
12 Mar Alexander. @alex_mjs
I don't think the panelists all get on... #lseNHS
12 Mar Ian Greener @ijgreener
@alex_mjs #lsenhs I agree. Labour as silly about choice as coalition. Time to ditch p-p split and spend on something more useful - care?
12 Mar John Appleby @jappleby123
Not sure dobson understands cooper analysis methods re DiD and cf ami and los #lsenhs
12 Mar Veronika Thiel @VeronikaThiel
Spurious debate in some ways as methodological nitpicking & not resulting in clear debate. #lsenhs
12 Mar Ian Shaw @Prof_ian_shaw
@ijgreener #lsenhs AGREE! but.. needs to be a political consensus on NHS 1st. Whoever is in next there will be another reorganisation...
In reply to Ian Greener
12 Mar Dan Smith @Dan1763
@ijgreener #lsenhs choice in reality, Clinton with unlimited money and access to info, has MI goes to hospital with poor record,
In reply to Ian Greener
12 Mar Ian Greener @ijgreener
#lsenhs . What happens when providers fail? Can't let big hospitals fail. Do they pick up bill for private failure? Is this competition?
12 Mar Alexander. @alex_mjs
"Hospital efficiency has slowed down since competition was introduced in 2006" #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
Ah, the lse paper on competition - Dobson stirring controversy, cooper looking bemused. #lsenhs
12 Mar AESTHETiKA @AESTHETiKA
"@ijgreener : #lsenhs Choice did not lower death rates. Choice led to some patients making a choice. Death rates lowered by better care."
12 Mar Alexander. @alex_mjs
A mention for Pol Pot...high level of debate there #lseNHS
12 Mar Alexander. @alex_mjs
SOMEBODY PLEASE TELL FRANK DOBSON LABOUR LOVED COMPETITION UNDER BLAIR #lseNHS
12 Mar Alexander. @alex_mjs
Tory Competition finally being shown its true colors... #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs NHS may survive, but isn't it about time we tried giving it some stability rather than reorganising it every five years (or less)?
12 Mar LSE Government @LSEGovernment
#lseNHS Frank Dobson says anyone can choose their GP. Since markets introduced choice became restricted and had to be restored. #LSE
12 Mar Alexander. @alex_mjs
"ANYBODY can chose & unchose their MP" #lseNHS
12 Mar William Wong @3become1
Paul Corrigan: the #NHS is not a command and control institution; it has command without control. #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs . Not about capability of choice, but simply saying what it what entail seems impossible. What information? Who makes decisions? How?
12 Mar Lisa Trigg @lisatrigg
#lsenhs Paul Corrigan says there's no choice between GPs. News to me, chose mine. Used NHS Choices and everything
12 Mar Alexander. @alex_mjs
"Best health service in the world - THAT's choice" #lseNHS
12 Mar Alexander. @alex_mjs
"NHS is not a delicate flower...NHS is an incredibly powerful institution & can withstand many things...it won't fall to its knees" #lseNHS
12 Mar Emma Stanton @doctorpreneur
"NHS is a command centre with no control whatsoever;the NHS has a lot of shouting & not much control" via @Paul_Corrigan #lsenhs
12 Mar Alexander. @alex_mjs
"What you get in the NHS is a lot of shouting & not a lot of control" #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs . Perhaps choice has never taken off in primary care because patients just choose docs nearest to them? No real appetite for choice?
12 Mar Alexander. @alex_mjs
"We don't think you're capable of choice in NHS? - Patronizing rubbish" #lseNHS
12 Mar Ian Shaw @Prof_ian_shaw
#lseNHS @alex_mjs shades of poor law. If GP of choice close to work then they responsible for care if ill at home and bill sent to GPs CCG!
In reply to Alexander.
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs in health care, this would mean high quality universal services needed. Q if competition only way #incentives
12 Mar Ian Greener @ijgreener
@mellojonny Hashtag has to be #lsenhs to appear in debate…..
In reply to Jonathon Tomlinson
12 Mar Alexander. @alex_mjs
"NHS has largest labour market - labour markets are run through compeition" #lseNHS
12 Mar Richard @a6ruled
@ijgreener also if NHS 'free' services are moved to paid-for, presumably those advocating choice will be against that..? #lsenhs
In reply to Ian Greener
12 Mar Ian Greener @ijgreener
@DouglasNobleMD #lsenhs . Cooper has published two papers based on outcomes data. Long story - on LSE blogsite (where I dispute findings)
12 Mar Axel Heitmueller @axelheitmueller
No government had the nerve to take on lack of competition in primary care says @Paul_Corrigan #lsenhs
12 Mar Alexander. @alex_mjs
"Implementation of choice at primary care level has never been taken on because of fear of BMA" #lseNHS
12 Mar LSE Government @LSEGovernment
#lseNHS Paul Corrigon says Drs have constructed a monopoly and this has impact on primary care.Good cannot take over bad. #LSE
12 Mar Richard @a6ruled
@ijgreener in future i guess we'll only have the choice of providers our CCG has contracted with..? #lsenhs
In reply to Ian Greener
12 Mar Emma Stanton @doctorpreneur
been waiting since the NHS first began to "First choose your GP" via @Paul_Corrigan #lsenhs --> due to fear of BMA?
12 Mar Ian Greener @ijgreener
#lsenhs - choice is not about information in healthcare. We can't even say what information we'd want to make choices!
12 Mar Salma Patel @salma_patel
Will Competition Improve the NHS? Follow #lsenhs where this is being discussed: http://www2.lse.ac.uk/publicEvents/events/2012/03/20120312t1830vWT.aspx #nhssm #NHS
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs problem is that choice seems to serve wealthy better, but poor would benefit from individualised services - but too expensive
12 Mar Alexander. @alex_mjs
"NO mechanism within system where the good take over the bad because there is no competition at primary care level" #lseNHS
12 Mar Alexander. @alex_mjs
"Crucial moment of NHS is leaflet 'choose your GP' - we're still waiting for that choice" #lseNHS
12 Mar Cristian Herrera R. @cristianhr
Z.Williams (The Guardian) talks about the morality of making profits with people's health. Competition in health may not be good #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs . So, even if I wanted to choose provider (and I don't), how would I do so? Based on what? How am I meant to be making this decision?
12 Mar Dr. Douglas Noble @DouglasNobleMD
"@doctorpreneur : Introducing competition to the NHS reduced mortality. Via Zack C #lsenhs " >>> what was Zach's evidence? is he on twitter?
12 Mar Emma Stanton @doctorpreneur
If you are not incentivised to share information it doesn't mean anything. Via @zoesqwilliams #lsenhs
12 Mar Alexander. @alex_mjs
Health statistics. So so many... #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs choice also problematic bec of info asymmetries & information bias - variant of inverse care law
12 Mar Ian Greener @ijgreener
Debate about competition in #NHS at #lsenhs . Join in the fun!
12 Mar Alexander. @alex_mjs
"Fighting over patients is NOT cooperative" #lseNHS
12 Mar Alexander. @alex_mjs
Trust doesn't derive from choice #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
#lsenhs choice is not levelling playing field as long as living conditions vary as greatly as they do. Geography often overlooked
12 Mar Ian Greener @ijgreener
@Prof_ian_shaw Follow debate at #lsenhs
In reply to Ian Shaw
12 Mar Magapanthus Smith @magapanthus
"@ijgreener : #lsenhs . lots of obfuscation about what 'choice' means. People want choice of time of treatment, not of provider."PRECISELY
12 Mar Alexander. @alex_mjs
"Endless choice scenario in NHS is a little unrealisitc" #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs . Lots of natural monopolies in health. Competition doesn't improve care in big hospitals which are too big to be allowed to fail.
12 Mar Alexander. @alex_mjs
"Some hospitals will soar & some hospitals will end up with much more patients" #lseNHS
12 Mar Emma Stanton @doctorpreneur
Quoting "Mirror, Mirror" study per capita spending in US $7000 per annum via Zoe Williams @LSEGovernment #lsenhs
12 Mar Alexander. @alex_mjs
"Poor people are under-treated" #lseNHS
12 Mar Alexander. @alex_mjs
"Too much choice is not a good thing" #lseNHS
12 Mar LSE Government @LSEGovernment
#lseNHS Patients trust their Dr if no profit to be made. Massive over-treatment of the rich in US says Zoe Williams #LSE
12 Mar Ian Greener @ijgreener
#lsenhs What choice is it we are talking about? Lots of confusion here. Without using the word 'incentive' explain how choice improved care!
12 Mar Alexander. @alex_mjs
"America has worse outcomes than anybody - costs a lot of money" #lseNHS
12 Mar Axel Heitmueller @axelheitmueller
Zack Cooper "monopolies don't improve services for patients" - unless they are natural monopolies of which there are many in health #lsenhs
12 Mar Alexander. @alex_mjs
Believing in the market is nowhere near as less ideological as it is moral #lseNHS
12 Mar Ian Greener @ijgreener
#lsenhs Choice did not lower death rates. Choice led to some patients making a choice. Death rates lowered by better care.
12 Mar Alexander. @alex_mjs
"Lansley reforms are a mess AND improved choice. But dare not a mess because they offer choice" #lseNHS
12 Mar Emma Stanton @doctorpreneur
Introducing competition to the NHS reduced mortality. Via Zack C #lsenhs
12 Mar Ian Greener @ijgreener
#lsenhs . Sounds like lots of obfuscation about what 'choice' means. People want choice of time of treatment, not of provider.
12 Mar Alexander. @alex_mjs
"1 study is not a rationale for a sweeping change" #lseNHS
12 Mar John Appleby @jappleby123
@ijgreener u don't trust frank dobson/zoe williams to put up decent counter arguments? #lsenhs
In reply to Ian Greener
12 Mar Alexander. @alex_mjs
"Choice lowered death rates" #lseNHS
12 Mar LSE Government @LSEGovernment
#lseNHS monopolies don't improve performance. Patients must have choice. Choice exists for rich. Dr Cooper speaking at debate on NHS. #LSE
12 Mar Emma Stanton @doctorpreneur
71% patients treated by the NHS say they want a choice. Less wealthy people want more choice than wealthy people. Via Zack C #lsenhs
12 Mar Alexander. @alex_mjs
"Choice improves outcomes for the poorest" #lseNHS
12 Mar Alexander. @alex_mjs
"Choice already exists for the rich who can AFFORD better care" #lseNHS
12 Mar Alexander. @alex_mjs
"71% of patients in England who use NHS want more choice" #lseNHS
12 Mar Emma Stanton @doctorpreneur
"If we don't have a choice then there is no consequence for competition" Zack C #lsenhs
12 Mar Alexander. @alex_mjs
"Mediocrity plain & simple can't be acceptable" #lseNHS
12 Mar Alexander. @alex_mjs
"Monopolies don't improve performance" #lseNHS
12 Mar William Wong @3become1
At #lseNHS and sitting next to John Appleby no less in packed LSE Wolfson.
12 Mar Ian Greener @ijgreener
Hello #lseNHS . Any danger you might invite an academic who doesn't agree with Zack Cooper next time? :)
12 Mar Alexander. @alex_mjs
"When we know there are good & bad hospitals it is wrong not to give patient choice" #lseNHS
12 Mar Alexander. @alex_mjs
"There are hospitals I wouldn't send my parents to - likely to kill you " #lseNHS
12 Mar Emma Stanton @doctorpreneur
Excited to be @LSEGovernment debate #lsenhs with @HSJEditor @axelheitmueller @markharris83 @Paul_Corrigan "will competition improve the NHS?
12 Mar Alexander. @alex_mjs
"We all fundamentally want to see healthcare improve - as debate becomes more toxic this is what we've forgotten" #lseNHS
12 Mar Ed McRandal @EdmcRandal
First up at #lseNHS is Dr Zach Cooper then @zoesqwilliams , @Paul_Corrigan Frank Dobson then @HSJEditor
12 Mar Alexander. @alex_mjs
There's a reception afterwards! #lseNHS
12 Mar Veronika Thiel @VeronikaThiel
Shiny new building for #lsenhs panel, but microphones more old school - ie. Not working. #somethingsneverchange
12 Mar Alexander. @alex_mjs
"Is it possible to be neutral in this debate?" asks the Chairman #lseNHS
12 Mar Fi McKenzie @fkmckenzie
Good to see @HSJEditor taking photos moments before #lsenhs begins.
12 Mar Alexander. @alex_mjs
PAUL KELLY SPOTTED! @LSEGovernment #lseNHS
12 Mar Alexander. @alex_mjs
Philip Collins, Clare Gerada & Mark Littlewood all pulled out of the event #lseNHS
12 Mar Edward Larkin @EdwardAndLarkin
Will competition improve the NHS? Packed house for panel discussion at LSE #lseNHS http://pic.twitter.com/YwUYbA59
View photo
12 Mar Alexander. @alex_mjs
Very adversarial set-up... #lseNHS
12 Mar Robbie @rmfergusson
#lsenhs this is the lse. Any imbalance will be down to a typical conservative don't need to explain ourselves attitude, not inherent bias
12 Mar Veronika Thiel @VeronikaThiel
At #lsenhs panel on competition. Should be interesting (or even heated) debate.
12 Mar Alexander. @alex_mjs
The title is somewhat misleading 'Will Competition improve the NHS?' - presents this debate as an either/ or only scenario #lseNHS
12 Mar Navin @NavinSewak
Is competition in the health service a British problem? About to find out #lsenhs
12 Mar Cristian Herrera R. @cristianhr
About to begin... "Will competition improve the National Health System in the UK?" #lseNHS
12 Mar Alexander. @alex_mjs
@JonB_89 already made this observation! I expected more balance #lseNHS
In reply to Jon B
12 Mar Alexander. @alex_mjs
Somehow this debate doesn't quite seem politically balanced in its line-up... #lseNHS
12 Mar Alexander. @alex_mjs
Line-up: Zoe Williams is a regular columnist in The Guardian and New Statesman #lseNHS
12 Mar Alexander. @alex_mjs
Line-up: Alastair McLellan is editor of the Health Service Journal #lseNHS
12 Mar Alexander. @alex_mjs
Line-up: Frank Dobson MP is a Labour Party politician who was Secretary of State for Health from 1997 to 1999 #lseNHS
12 Mar Alexander. @alex_mjs
Line-up: Paul Corrigan CBE is a Labour politician & was health adviser to Tony Blair #lseNHS
12 Mar Alexander. @alex_mjs
Line-up: Dr Zack Cooper is a health economist at the Centre for Economic Performance at the London School of Economics #lseNHS
12 Mar William Wong @3become1
Long night ahead: will competition improve the #NHS ? at #lseNHS , followed by #anthropology class on cultural tourism and what it means.
12 Mar Alexander. @alex_mjs
If any Labourite makes a claim about privatization I will scream at them that THEY set the precedent #lseNHS
12 Mar Alexander. @alex_mjs
Could make a joke that the queue for the event is symbolic of NHS waiting times #lseNHS
12 Mar Alexander. @alex_mjs
#lseNHS already a queue stretching far back
12 Mar Fi McKenzie @fkmckenzie
Off to #lsenhs to hear collection of speakers on competition in the health service. Question at the ready on denial of patient choice.
12 Mar William Wong @3become1
Can't wait to hear the stellar lineup for #lseNHS this evening: http://www2.lse.ac.uk/publicEvents/events/2012/03/20120312t1830vWT.aspx
11 Mar Alexander. @alex_mjs
#NHSBill #savethebill #dropthebill I'll be live tweeting @LSEpublicevents 'Will Competition Improve the NHS' tomorrow from 6pm #lseNHS
10 Mar homegardenidea @homegardenidea
oh my god Will Competition Improve the NHS? Monday 12th March, 6:30-8. Wolfson Theatre LSE. #lseNHS http://goo.gl/lDwDE?14 Uganda
10 Mar LSE Government @LSEGovernment
Will Competition Improve the NHS? Monday 12th March, 6:30-8. Wolfson Theatre LSE. #lseNHS http://www2.lse.ac.uk/government/research/resgroups/BGatLSE/Home.aspx#NHS
10 Mar Jonathon Tomlinson @mellojonny
@axelheitmueller @Paul_Corrigan @HSJEditor that's not a debate, it's a group-hug #lseNHS
In reply to Axel Heitmueller