Free Market Oxygen

Some patients with chronic lung disease need oxygen, and rather than keep them in hospital, these patients often have cylinders of oxygen delivered to them at their home.

Until recently it was the pharmacist who supplied these cylinders, but the government in it’s infinite wisdom has decided to privatise the supply of oxygen.  This means more paperwork, which NHS Blog Doc has already covered.

And now a patient has died, possibly due to a delay getting her oxygen delivered.  It drives me crazy that I spend my time in my ambulance going to 23 year old men with coughs, yet apparently no ambulance was called for this woman.

It all comes down to the government wishing to run the health service like a business.

I know that some people believe that the free market will constantly provide superior service to anything run by the government.  Unfortunately healthcare isn’t a ‘market’ and this market view of the NHS  leads towards some very silly initiatives.  It’s why ‘failing’ hospitals get less money than ‘successful’ hospitals, who would want to throw money into a failing business?

Why are hospitals so dirty?  Because of the free market contracting of cleaners to the cheapest supplier – regardless of the quality of the cleaning.

It’s also why, despite increasing numbers of patients, increasing calls, very few new staff and all the other reasons why we may not meet our government ORCON target this year, we’ll get less money to be spent on improving our service.

But what do I know – I’m a van driver not an economist.

24 thoughts on “Free Market Oxygen”

  1. If there are any journalists reading this, please, I beg you, write an article on this.It's about time this government was confronted with the reality of the health service in this country – before it's too late.

  2. Very wry comment about being a van driver. I recall many years ago a cabinet minister referred to ambulance personnel as being taxi drivers. Apparently he thought all the paramedics had to do was put the patient into the meat wagon and make a delivery to the nearest hospital. It shows how out of touch these people are.And they run the country

  3. Add on to that – and all the support staff should be forced to wear deoderant and shower daily and you've got dre's support.seriously though, I don't think i've seen anyone sum up the problems in the NHS better than in this post – especially the cleaning bit. Maybe we should print this out and send it to our tony at number 10. Or maybe we should just arrange a march through London. Viva la revolution!

  4. The 'Taxi driver' jibe sounds like it could have been made by the same type of idiot manager from the Health Board up here who couldnt understand why trained nurses had to be on the wards during the night shift because – “The patients sleep all night so auxilliaries should be left in charge”.

  5. Hi Tom.Yeah, this one is quite extraordinary. Getting O2 via the chemist has always worked well. I think it has been a bit of a pain in the ass for the chemists, but they are highly trained people, they understand the occasional need for O2 on an urgent basis, and they deliver.

    I do not understand why the goverment introduced the private sector in this fashion. It is very Thatcherite and the one of the reasons I voted for Blair (yes, I admit it, I did do the first time, I thought he would make a difference, yes I will now do my 8 years in purgartory, aka the NHS) was to get rid of crap like this. One has to wonder whether the guys who run these private O2 companies are mates of Tony's.

    The paperwork we have to do now to get O2 is beyond belief. I said:

    “A visit from two pharmacists who bring the HOOF protocol. A two page colour document with a complicated flow chart. HOOF stands for Home Oxygen Order Form. When a patient needs domiciliary oxygen, we used to write out a prescription and the chemist delivered it the next day.

    Now we have to complete the HOOF form, and the patient has to complete the HOCF form (that is the Home Oxygen Consent Form). When the HOOF and HOCF forms have been completed they have to be faxed to Allied Respiratory and two additional copies must be faxed to the nurse specialist at the hospital.

    Thank God thats all been simplified.”


    Then this happened:

    Thursday 9th February

    I mentioned the new simplified system for providing oxygen for patients at home last week. We have been filling in HOOF forms all week as requested. Allied Respiratory (must check out who owns them I wonder if they are friends of Tonys?) cannot cope and so we are going back to the old system.

    We received this email today from the new Prescribing Support Team:

    To: All General Practitioners

    All Practice Managers

    Community Nurses

    7 February 2006

    Dear Colleague,


    Due to the current problems the new supplier Allied Respiratory is having with the demand for delivering oxygen supplies and the consistent problems patients and doctors are experiencing with the phone lines, we have been advised of the following arrangement that will assist with the supply of URGENT OXYGEN.

    FP10s can be written for patients requiring urgent oxygen – they will be valid, honoured and reimbursed. This arrangement can be used if needed until 31st March 2006.

    Thank goodness we have the newly funded prescribing support team. This was formed to deal with the complications caused by the simplifications that have been introduced. I am sure the pharmacists and four nurse specialists on the team will all be justifying their salaries.

    This is a microcosm of the way the whole NHS functions under this government.”


    What I am puzzled about is this report that some guy was seen by a GP who wanted him to have urgent O2. It did not arrive, and the poor guy died 6 hours later.

    I cannot understand how someone could be so ill and not be send into hospital.

    As I said on NHS BLOG DOCTOR somewhere in the comments, I had an elderly patient last week who had run out of O2, and was v. SOB – so I called you guys who as normal arrived within 15 minutes, with some O2, and took her off to hospital.

    Frankly, all this could have been avoided (wasting your time and the hospital time) if it were not for the new system.

    But any systme that replaces a two line prescription and a telephone call to the local pharmacist with:

    needs it's head examing. I hope Patricia Hewitt reads Random Acts

  6. “I know that some people believe that the free market will constantly provide superior service to anything run by the government. Unfortunately healthcare isnt a market and this market view of the NHS leads towards some very silly initiatives.”I most certainly do think that free markets improve things. As does NHS Blog Doctor in some of his postings (things like GP Fundholding).

    I also agree that the NHS is not currently a market economy. And ought to be.

    What I think youre missing in the (implied critique) of my views is that I wouldnt describe this as a more free market method of delivering oxygen. Sure, its being provided by a private company….but its a monopoly. Nothing “free market” about that at all.

    Such free markets only work if there is competition. Thats the thing that spurs on the increased efficiency (and it doesnt matter whether its a for profit company, a cooperative or whatever).

    Now, if there were two companies (or more) providing oxygen then the one that used this new method would never have any business. The one that used the old chemists road would have it all as it is obviously more efficient.

    Whats gone wrong here is not “free market” but the stupidity of the bureaucrats at the centre who think that “private company” is the same things as “free market”. Theyre not the same at all.

    Have two, four, 20 suppliers of oxygen and that would indeed be a free market and yes, I would expect to see things being done efficiently.

    A private monopoly? One of the few things actually known to be worse than having government do it.

  7. Getting O2 via the chemist has always worked well. […] I do not understand why the goverment introduced the private sector in this fashion

    The chemists are private sector too aren't they? Unless you're talking about hospital pharmacies.

  8. Why are hospitals so dirty? Because of the free market contracting of cleaners to the cheapest supplier regardless of the quality of the cleaning

    That's exactly it; it's down to the NHS not being prepared to pay for quality – nothing to do with the free market at all. The market can provide good quality cleaning, after all private hospitals manage it well enough. If the NHS spent as little on employing their own cleaners as they do on employing external ones the results would be just as bad.

    NHS buying policy is like doing all of your shopping at Netto – it's cheap, but that's all it is. The market provides options, including quality ones – if you want it you can get it, but you're going to have to pay M&S prices.

    The only difference between not spending enough internally and not spending enough externally is that the latter allows the people responsible to pretend that it's not their fault.

  9. There are four companies supplying oxygen, although like NHSBlogdoc, I wonder if they are 'friends of Tony'.I think the problem with health as a free market is that the NHS is half free market, and half government controlled. The NHS really should be one or the other as this mish-mash doesn't seem to be working.

    Look at how many hospitals are over their budget this year. My local hospital is keeping plastic drinking cups under lock and key, because they have over-spent on them.

    But as I say in my post (and my mention of you Tim was because I wanted to see what you thought) I'm a van-driver, not an economist.

    (I think it was Kenneth Clarke who called ambulance people 'taxi drivers').

  10. I'd like to argue with the folks who think the free market has a place in medicine. As Tim rightly points out, competition is an essential component of free markets. The other fundamental characteristics are equal access to the same information by all (which is why insider trading is banned), and equal choice among all the competitive alternatives, i.e. they must all be equally available.Competition is the only aspect that could be introduced, but even that would lead to a loss of efficiency in some situations. You will not be shopping around for the best O2 cylinder when you're dying of suffocation.

    As for informed decisions and equal access, those are impossible. The only people who could exercise them are doctors and hospitals. However, they don't *necessarily* have the patient's best interests at heart. (The fact that they very often do, says that people aren't as bad as it sometimes seems.) Only the patient *always* has their own best interests at heart, and there is no way most patients can have enough information to make an informed decision. And there is no way any patient, even one with an MD, can calmly weigh all possible alternatives while in pain or dying.

    Those are the fundamental reasons why free market medical care can't work. Then there's an immense slew of practical reasons as well, sprinkled liberally throughout this blog, the news, the US health care system, the Third World, and on and on and on.

    I'm on this big rant because I see the misplaced application of free markets literally ruining our society and our planet. This is huge. It's not just medical care. Free markets work for what can be bought or sold. They don't work for beauty, love, truth, sex, justice, knowledge, the environment, or, for that matter, care of the sick and dying. They're great at what they do, but if we don't learn to limit them to that, and damn soon, too, we won't have anything left to buy or sell.

  11. Militant it may be, but we as professionals need to strike before our voices will be heard.Unfortunately, our 'caring' nature and profession goes against us, and as I have said in a previous post, unless people do die, like this person lacking oxygen did, owing to beauracratic b%ll%x then nothing will change.

    I apologise if I've upset anyone but ….

    As Dr Dre says 'viva la revolution.'


  12. When Kenneth Clarke was Health Secretary he was more concerned to scorn striking ambulance crews as 'taxi drivers' than to settle a dispute which put many lives at risk. This made not a few people hope that one day he would himself need the kind of emergency attention which ambulance crews provide every working day. His imposition of budgets on GPs met with opposition from the doctors, who Clarke dismissed as motivated by their wallets before the needs of their patients. These budgets are now suspected of discouraging some GPs from spending money on treating their more elderly patients – perhaps because worn out workers are not economically fruitful to keep alive.To repeat. These people run the country. Why do the words 'orhanise' and 'brewery' come to mind?

  13. Ahhhh, Privatization. All part of our little plan to re-colonize y'all. Get used to it. We love it over here! Next up: McDonalds in the School cafeterias.Kumachka from across the waters.

  14. Well, the U.S. has a 'free market' health system & I'd venture an opinion that it does not serve us well at all. As many have already observed, lower cost does not translate into improved services via more competition.

  15. Speaking as someone who lives in a nation with free market health care, I can tell you first hand it's an utter disaster. I am not getting better service through competition, I get shitty service essentially all the time.My access to good healthcare is entirely predicated by my ability to pay. Wealthy Americans, I'm sure, get some of the best healthcare in the world. However, most Americans are not wealthy. Many Americans are extremely poor. While any American emergency room would be required to treat me if I was in an acute healthcare situation, they would also be entitled to collect thousands of dollars from me. I in turn would not be able to declare bankruptcy due to healthcare costs, thanks to recently passed legislation in the United States. The collections agency utilized by the hospital could potentially take everything I owned from me as partial payment of my fees. A friend of mine recently lost her house this way.

    Luckily for me, I am among the small percentage of Americans that is insured–I pay over USD 1,000 per month for my insurance, and usually shell out anout USD 800-1,000 in copays in medication costs. (Especially since my insurance provider won't cover prescriptions that are not in the “approved list.” That asthma medication that actually relieves my symptoms? Not in the “approved list,” and USD 500 per vial.) My insurance also won't cover rides in the helicopter–I have to go through a different service for that. (And good thing I have helicopter insurance–my last ride would have been upwards of USD 50,000.)

    However, I do know others without insurance of any kind who have been denied treatment or given very shoddy care. Especially those on Medicare. In terms of preventative medicine, we are all fucked. Medicine here is a hell-infested free for all. It's terrifying.

  16. Word to tony and this cronies. why fit terrorism, they are speeding up the distruction that you are doing.Why the f**K is life sold to the lowest bidder. how much do the goverment think our lives are worth, 1.25 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    im a bit wound up over the whole thing, *BEEP*ing blair *BEEP*

  17. Sorry about that – not quite sure what happened there. Only the quote was supposed to be in italics, and on the preview that's the only bit that was.

  18. The people dying of suffocation aren't the ones who are supposed to be shopping around; the PCT is, and if they're not getting a good service they should go to a different supplier. They won't though – just as with cleaning they'll go with the cheapest option even if it kills people. Why would anyone believe that these same cheapskates would spend enough to get a good service if it was done in house?

  19. If the “free market” isn't working in the US, that's because we don't actually have a truly free market here. The insurance companies are in between the consumers and the doctors, and that messes up the market bigtime. It also messes things up when employer plans give a small copay for drugs; this artificially increases demand by creating an artificially low price for the end user.What happens when you limit the price a consumer pays? Shortages. Look at the gas price cap in the 1970s, and rolling blackouts in CA in the late 90s.

    If you look at something that insurance companies typically don't cover, you'll see the free market at work. Compare, say, the price of LASIK today to the price at its inception.

    The free market works–if you let it.

  20. The problems are still there see the BBC new website. Ambulatory Oxygen does not exists with AP. Ambulatory means walk with. So anyone any news on this.

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