In a twist

We have just come out of a silly season; that time of year characterised by sales, resolutions, kissing under the mistletoe, office parties and the usual increase in unplanned pregnancies among the under-16s. Welcome to festive Britain.

It wasn't all bad though. In the year of the credit crunch you have to admire the ingenuity and entrepreneurial initiative of Sheena McMillan. Apparently, Sheena has been selling knickers on the internet. She admitted to punting clean and soiled underwear on eBay under the strap-line: 'Naughty Knicks'. The listing read: 'Hi there, the options are for you to own clean knickers £20, worn knickers £23 and for those smelling of sex, ie worn just after sex £25'. Happy bidding!

So knickers worn after bonking carry a £5 premium. I thought it would have been more. How does one establish the value of such an item, knowing that a pair of knickers in Primark costs less than a pound? This seems like a good return for a small deposit...so to speak. Perhaps this is the answer to getting the economy going again and stiffening the resolve of the bankers.

Anyway, there was a little problem with Sheena's venture and that is the fact that she is a nurse. It seems she overlooked her employer's tedious rules about the use of the internet for personal matters. Sheena worked for Plymouth's Derriford Hospital and, in her advert, understandably mentioned the fact that she was a nurse. Well, it works for me! (And, so it seems, for a lot of other people).

I'm not sure of the upshot of Sheena's hearing at the Nursing and Midwifery Council. No doubt they were overcome at her little bloomers.

Under the weather
While we are on the subject of the internet, what does Google know that we don't? Apparently, the internet's favourite search engine compiles a lot of data. It knows who we are, what we search for and ipso facto what we are worried about and what we really think.

It captures what is referred to as 'spikes' in searches. Google says spikes in searches for 'flu' consistently come a fortnight ahead of peaks in influenza, recorded by the US Centre for Disease Control. This is public health information that is not to be sneezed at.

If we do feel a bit under the weather, we could ring NHS Direct, the NHS's much-abused information source. It refers 60 per cent of all callers to GPs and secondary care which, considering it is there to take the pressure off NHS demand, is about as useful and a chocolate solar panel. NHS Direct has been refused leave to apply for foundation status on the grounds that, in the event of a national emergency, it has to remain under the direct control of the Department of Health (DH). Presumably that includes a flu pandemic? It might be cheaper for the DH to do a deal with Google.

Insiders tell me the boss of NHS Direct, Matt Tee, is to take up a civil servant role at the DH. My guess is we are likely to see a scaling back of NHS Direct. It might even be a target for privatisation. Despite what anyone says, the DH needs the money. I doubt NHS Direct will be around this time next year.

That said, we have to wonder just what the NHS will look like this time next year. The landscape could be very different.Netcare, the South African outfit specialising in independent sector treatment centres, saw its share price fall 42 per cent. Care UK, provider of residential social care services saw pre-tax profits fall by 89 per cent. Assura, primary care provider and landlord to NHS activity, saw pre-tax losses widen to £40.8m, from £26.6m in the same period last year.  

Alliance Boots, the pharmacy chain, saw like-for-like sales revenue growth flat at 0.5 per cent. Corin, medical device makers, said full-year profits would be "materially below current consensus estimates". Their shares fell 47 per cent. Four Seasons Health Care is trying to do a debt for equity swap with the Royal Bank of Scotland. I think they have two chances; slim and none. Phillips, the international health technology giant, will cut 1,600 jobs from its healthcare division as it looks to maintain profitability.

All of these companies have explanations and cogent reasons why these statistics are just blips. Nevertheless, like Google searches on flu, there is a pattern developing here. Things ain't healthy in healthcare.

2008 saw more policy initiatives than there are balls on the Christmas tree. Some quick operators were caught out. Babcock and Brown (B&B), the specialist fund and asset management group, snapped up a major stake in Ashley House – NHS property specialists. B&B moved on news that the NHS was into building 150 polyclinics with a hint that many more would follow. The policy now seems to have been kicked into touch. The clinics cost a fortune to run and, without closing existing services, would put too much strain on local health economies. The plan for the first London Polyclinic, located in UCL Hospital, Bloomsbury, has been dropped.

The NHS is sitting on a £1.7bn surplus, but the Treasury will only allow £400m to be spent and the government is seeking to impose a 2 per cent growth cap for 2010 onwards. Beware of doing long-term deals with the NHS. 

The government plans to re-boot the economy by 'reprioritising' public projects; £300bn will be spent, almost none of it in health. Indeed, Chancellor Darling has all but said he expects the NHS to come up with half the £5bn savings he wants across the public sector. The NHS faces a downward pressure on the cost of providing services. The NHS's latest fad, World Class Commissioning, a way to improve quality and value for money of patient pathways, is likely to become World Class Cost-cutting.

The NHS has its knickers in a twist – where's Sheena McMillan when you need her?

The Author
Roy Lilley is a (sometimes controversial) healthcare author and broadcaster.
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