Reforming the NHS

 

               This week the changes to the NHS have at last come centre stage in the UK political debate. I am starting to receive emails disagreeing with  the government’s plans.

               There are two common criticisms of the Lansley proposals which I need to dismiss before we can begin intelligent discussion of them. The first is that a very radical reform of the NHS was not mentioned in the Manifesto or before the election, and has suddenly been sprung on the country. The second is that the government’s plan is a way of privatising the NHS.

             The NHS was treated differently to other areas  by David Cameron between 2005 and 2010, because he personally relied on it for his disabled child, and wanted to reassure people that he believes in it. He made Andrew Lansley Shadow Health Secretary and guaranteed his job for the whole of the last Parliament, unlike all other Shadow Cabinet members. He instructed Mr Lansley to immerse himself in the culture and problems of the NHS, and to come up with a way of improving it. He protected the NHS from any future cash cuts by offering to increase spending on the NHS by a little more than prices each year of  this Parliament.

           Mr Lansley energetically got around the NHS over the last five years, and produced detailed policy papers in opposition, setting out the direction of reform he wished to undertake should he become Health Secretary. These papers received very little publicity.  The Manifesto itself confirmed a radical plan for changing the NHS. It said:

          “We have a reform plan to make the changes that the NHS needs. We will decentralise power, so that patients have a real choice. We will make doctors and nurses accountable to patients, not to endless layers of bureaucracy and management”.

             The plan always included the central proposition that GPs should buy in the hospital care and other services their patients needed, removing commissioning from PCTs and phasing them out. Some of us spent time in the election explaining to the few people interested how these radical plans might work.

I also wrote a website piece explaining that the media were wrong to think the education plans were radical and the health plans were not. I suggested that the NHS reforms would prove to be bigger and more important than the schools plans. It is quite untrue to say there was no warning that change was afoot, and untrue to think the main outlines of the reforms were not explained before the election.

Nor is it true to say the aim is privatisation of the NHS. The crucial promise of the NHS that is very popular in our country is the promise that everyone has access to care, free at the point of use, based on medical need.  The Manifesto made clear that that was fundamental to the Conservative party approach:

“As the party of the NHS, we will never change the idea at its heart  – that healthcare in this country is free at the point of use and available to everyone based on  need, not ability to pay”

The NHS has never been a fully public sector owned and run service. From its foundation, GP practices have remained as private businesses, contracting with the NHS to provide NHS services. They often provide private services as well, from innoculations and other paid for items of service through to dispensing and charging for presecriptions. From its opening it has bought in large quantities of drugs from private sector for profit companies. It has put work out under contract to private sector companies of all kinds, from catering and cleaning through to specialist nursing and clinical services. Labour expanded the private sector role, finding some private sector businesses could offer higher quality medical,nursing and clinical service for lower cost.

The Lansley reforms build on this mixed base of provision. Again, the Manifesto was very clear. It said:

“So we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.”

It went on to explain

“We will strengthen the power of GPs as patients’ expert guides through the health system by

giving them the power to hold patients’ budgets and commission care on their behalf

linking their pay to the quality of their results

putting them in charge of commissioning local health services”

I hope following this I will not receive more emails and letters suggesting the Conservatives failed to explain their plans before May 2010, and no more suggesting the aim is to undermine free at the point of use. It is important to grasp that the NHS has never been an entirely state run operation. Tomorrow I will look at the challenges faced by Mr Lansley in implementing all this.

The UK debate as always remains distorted by people who do not understand the numerous hybrids we have between full private sector for profit competitive provison on the one hand, and full scale free at the point of use with all assets owned by the state and all employees employed by the state at the other.

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41 Comments

  1. Tory Torch
    Posted January 23, 2011 at 7:35 am | Permalink

    Superb analysis and mythbusting of the ridiculous campaigns and standard lobbying sent out by the trade unions. Looking forwaard to your next blog on this.

  2. lifelogic
    Posted January 23, 2011 at 7:48 am | Permalink

    The NHS should not be free at the point of use that is the first main problem. It means it is has to be rationed by doctors making it hard to make appointments (could you ring back tomorrow (why should I can I not book now?) or is it an emergency? (No I just need to book an appointment). Then they do not having enough time to see you when you do finally get in or you have to have long waiting lists to deter people.

    Charge £25 to see he doctor each time with some alternative provision for people really unable to pay.

    Then you need a NICE type of organisation (for cost benefit analysis) this needs to decide what the NHS will and will not provide I would suggest no “alternative” Prince Charles type of nonsense and very little plastic/vanity surgery or lots of other nonsense that goes on. You also need to control the doctors to ensure they are not doing things which serve little purpose or are prohibitively expensive for little benefit and control the drug companies to ensure they are not pushing pointless expensive drugs through the doctors or over charging generally. You also need a few specialist “factories” for certain operations knee and hip, eye, heart and the like. There is no real need for every one to have years of medical experience surgeons could just be taught in a few months how to do a knee or eye operations if that is all they are doing. Why spend 7 years training on things you do not need for that particular job anyway?

    Run it efficiently like your clean factory it is after all mainly just engineering mixed with a little communication and social work and follow up checks.

    • lifelogic
      Posted January 23, 2011 at 11:09 am | Permalink

      Regarding Baroness Warsi – Norman Tebbit Puts it rather better than myself on his blog:

      Had Baroness Warsi sought my advice, I would have counselled her not to make the speech which has been trailed in The Daily Telegraph today.
      I would have told her that the Muslim faith was not discussed over the dinner tables of England, nor in the saloon bars, before large numbers of Muslims came here to our country. Then I would have told her to go to our Christian churches and listen to what was said about her religion and those who practise it, then to the Mosques to hear what is said in some of them about the Christian faith and those who practise it (or about Buddhists, Jews, or even those who have no faith at all).
      After that, I would say, she might consider who is in need of her homilies on prejudice.
      Until then a period of silence from the Baroness might not come amiss.

    • A.Sedgwick
      Posted January 24, 2011 at 8:52 am | Permalink

      I agree with all your comments except length of training for anyone operating on me. My reason can be summed up in one word – complications.

  3. FloTom
    Posted January 23, 2011 at 7:51 am | Permalink

    Maybe you should explain to your readers just whom these reforms will affect as there is no National Health Service in the sense the public have come to understand it.

    These are reforms to the English Health Service.

    The Scottish Welsh and Northern Irish Health Services don’t need refom. The English taxpayer props them up with massive extra spending per head every hear under the Barnett Formula.

    Oh as they do in Education to.

  4. Johnny Norfolk
    Posted January 23, 2011 at 8:07 am | Permalink

    Well done for explaing the truth. Its a pity the BBC cannot do i,t as it is totaly opposed to the plan as is its party.

  5. norman
    Posted January 23, 2011 at 9:02 am | Permalink

    The NHS reforms are one area where I have absolutely no idea what the thrust of the argument is. I know that the plan is to give GP’s control over a large part of the budget but how this will help completely escapes me. How a GP will be able to manage complex business decisions better than a competent local business manager isn’t exactly clear.

    On the other hand I don’t know how it can make things worse than they currently are. As Dave said this week (on the Today programme) the NHS is second rate and needs reforming so we must give the government the benefit of the doubt on this one.

    • norman
      Posted January 23, 2011 at 9:17 am | Permalink

      Thinking a little more about this over a coffee, what I suspect will happen is local NHS quango types will be told to go (with redundancy and topped up pension pot), they’ll ring up the newly empowered local GP’s surgeries (who they’ll all be on first name terms with) touting their services and the GP’s will hire them to carry on much as before. After all, if you’re a busy GP (and I would imagine all are) you really aren’t going to want to be laden down with all the administrative stuff that is going to come with this vast amounts of money.

      Far better to simply hire someone with experience in the field to manage it all for you. You’d have to be some kind of idiot not to but instead spend all your spare time meeting sales reps, poring over accounts, examining the minutiae of contracts, etc. The very thought of it sends a shiver down the spine.

  6. Onion
    Posted January 23, 2011 at 9:19 am | Permalink

    I sit on the board of one of the new GP commissioning consortia. You are correct that the reforms were trailed in advance of the election.

    There are many people I know involved in implementation, without a political axe to grind, who are alarmed at how reform is proceeding. GPs were asked to form into consortia without knowing whether or not they’d inherit historic PCT deficits. A panoply of targets will remain via central initiatives like CQUINN and QIPP. The CEO of the consortium – the accountable officer – will (if I am not mistaken) be accountable to the NHS board in pursuit of these targets and budget balancing. This is not much different to the current setup (PCT CEO accountable to central authority)- it would simply be window dressing

    The major problem is important business decisions are being made in an information vacuum. This will set up this nascent new market to market failure before it gets off the ground

  7. Brian Tomkinson
    Posted January 23, 2011 at 9:44 am | Permalink

    I am not surprised that you have received so many e-mails that you regard as ill-informed. This government has been very poor at explaining any of its policies. Each announcement has dribbled out allowing opponents to fill the newspapers and air waves with their own slanted interpretation of what was being proposed. Now that the Director of Communications has resigned perhaps his replacement will address this central part of that role. I have read much about Mr Coulson’s major role as part of “Team Dave”. Shouldn’t the role of the unelected Director of Communications be to ensure that the government’s policies are relayed to the public in a clear and coherent way, not to be part of the inner team developing them?

  8. Iain
    Posted January 23, 2011 at 9:45 am | Permalink

    With NHS trusts the cost of treatment is spread over millions of people, a bit like insurance where millions of policy holders pay out for the people who have accidents. What happens when the NHS budgets is spread over GP practices, what happens when a GP practice gets number of expensive cancer patients? As the GP practice doesn’t have the clientele base over which to spread the costs do the cancer patients not get the treatment they require?

  9. John Bowman
    Posted January 23, 2011 at 10:41 am | Permalink

    Mr Redwood.

    The NHS is on a par with a ComEcon collective.

    In my lifetime so far, every Government since the early 70s has attempted “reform” of the NHS. Every time, apart from some short-lived cosmetic improvements, the “reforms” have only made it worse.

    Why would any reasoning person imagine that yet more “reforms” will succeed, when clearly the whole enterprise was flawed from the start and is unworkable?

    In a recent post you were extolling the virtues of a well-run company.

    Core to any successful enterprise must be efficiency, defined as minimum in; maximum out. To achieve efficiency, you must know, the individuals and the organism as a whole must have intrinsic motivation to aim for it and achieve it.

    This hinges on reward for individuals, both intangible such as pride in their work, good work conditions and tangible, that is money and promotion. Reward for the enterprise as a whole is return on the investment of its shareholders and added value to their investment.

    In the NHS, tangible reward is mostly through length of service rather than merit. Intangible reward is achieved by treating effectively, not at least cost, and just as much by treating one patient as it is by treating several: in other words more work done does not deliver increases reward, either intangible or monetary.

    There is then no efficiency motive.

    The organisation is penalised for treating more patients more effectively, because it increases its costs, uses up budget and means in extreme terms it reaches a point where it has no more funds to carry on. There is then an intrinsic necessity to ration treatment.

    Further, if the enterprise does reduce its costs, this impinges on future budget awards, which will be based on what it spent last time. Intrinsically the enterprise is motivated to spend at least its allocation, over-spend is better.

    There is no efficiency motive.

    Doctors, nurses and other health care professionals are not interested in efficiency, they are motivated by effectiveness.

    Asking them to make their clinical judgements based on sound financial reasoning is a contradiction for them – they will nearly always opt for clinical judgement, otherwise they would have chosen professions in management and accountancy.

    My own experience in involvement working in the NHS and in the supply side, shows that healthcare professionals make poor managers of resources and finance – not a criticism but an observation. Of course these areas are not where their skills, experience or aims lie. Those who reach positions of supervision and management amoung professionals do so for the most part on length of service, not because of innate ability, skills, experience or suitability.

    Being a good doctor or nurse does not make one a good manager or supervisor.

    Hospitals, unlike business enterprises, are multiple fiefdoms each run by its own barons, often in conflict over funding and status, with no single unit of output. There is no such thing as “the patient” because no single patient is at the pinnacle of the enterprise as a whole, being treated usually only in one of the fiefdoms.

    It is then impossible to decide which fiefdom deserves the most funding to make the whole more efficient, or which type of patient treatment is the most “valuable” – how could that be judged anyway?

    How then do the Cleggameron imagine handing funding down to GP’s will bring about the efficiencies that supposedly is required, and change work practice and the internal culture in hospitals oer which GPs have no control?

    True GPs can chose where to send their patients, so in a free market system one would suppose that some hospitals would lose “business” unless they offered a good service and thus have to close? Can you imagine this happening?

    It still remains that a patient is an expense, not a revenue source, so once again clinical decision is in conflict with financial decision.

    In a free market system, the opportunity would have to exist whereby a private or even a mutual enterprise could start up and compete with existing hospitals and services.

    But the NHS is not a free market, it is a monopoly, so once again a Government by keeping it that way, excludes the one factor which drives any enterprise to the benefit of all, the user/customer – as you will.

    The NHS user/customer gets whatever those within the institution decide, which meets primarily their needs and within the constraints of what meets the needs of their political paymasters.

    Of course this may well be the intention of the Cleggameron, “nudging” the population and health workers towards privatisation.

    I find it unlikely the Cleggameron will have either the ability or the guts to do this.

    What is likely is some mix and match, half-way house – not unlike the railways – which retains the worst of the current situation, but enjoys non of the benefits of a free market system.

    In all this; it seems to me, with regard to the NHS the British population is like a battered wife who defends her brutalising husband saying, when he is not kicking and punching her, giving her a black eye and shoving her down the stairs, really he is a good man, a good and loving husband which is why she stays with him.

    I suppose in that sense the British population deserve what they get until they come to their senses and understand, the NHS never worked and never will, because its aims are to meet political dogma not to meet the needs and wishes of those who fund it, which it does, but it does not have meeting the needs of its users as its pivotal aim.

    I wonder why you and the minority of other politicians who seem to have some grasp on the real World do not speak out. Of course you may disagree with what I say and too have battered wife syndrome.

  10. Nick Heath
    Posted January 23, 2011 at 11:00 am | Permalink

    My-god man have a lie-in on a Sunday!
    People don’t seem to understand that the vast, vast majority of NHS encounters are not through A+E, but through routine outpatient appointments, and I think that this skews the debate a bit. I worked for a private organisation that provided GP-commissioned services in GP surgeries, for example Minor Surgery, Diabetes control, that would normally have taken place in a hospital. Patients were delighted that they didn’t have to travel to hospital for a routine appointment, the service was cheaper to the NHS than a hospital appointment, and our waiting time was 7 days, as opposed to 6-8 weeks in a hospital. If we continue to provide evidence that GP-commissioning works, the public will come-round.

    • Nick Heath
      Posted January 23, 2011 at 11:05 am | Permalink

      A referral to our minor surgery service cost £80, a referral to hospital cost £250; naturally the service was stopped by the PCT to save money…

      • Ben
        Posted January 23, 2011 at 4:16 pm | Permalink

        Nick,

        I think you’ve perfectly highlighted one of my major concerns regarding the reforms. Private providers will be able to undercut the NHS on simple surgical procedures (you highlighted one instance, cataract operations would be another). By doing so this may make other, more complex services at the same hospital less cost effective. If operating theatres aren’t being used efficiently because there are few procedures costs per operation will rise. There is also the worry that if NHS hospitals become exclusively about complex procedures then the training of junior doctors will be undermined – they will no longer be able to cut there teeth on simple procedures whilst also observing more cutting edge activity.

        I’ve not seen anything to rebut this argument so far.

        • Stuart Dickson
          Posted January 24, 2011 at 10:37 pm | Permalink

          Ben,

          Surely the opposite is true.

          Consider the NHS budget in it’s entirity, if you can do the minor operations as cheaply as possible that would mean a much larger pot is available for the more complex surgeries.

  11. alan jutson
    Posted January 23, 2011 at 11:14 am | Permalink

    John
    Await to see more of what is being offered as a policy (meat on the bones) before making up my mind.

    Have no problem in principle with GP’s running the show on clinical grounds, as this would seem sensible, but there needs to be some financial controls and accountability in place to avoid mismanagement of funds.

    I well remember some GP’s getting a very high increase in earnings, and some rather swanky surgery buildings when the Fundholding System was all the rage.

    If a mixture of private sector and state can offer a better solution at less cost, then all well and good, but private sector for simply private sector sake no.

    Looks like the new media man at number 10 will have his/her work cut out if press reports in todays papers (Mail on Sunday James Forsyth) are to be believed about Mr Coulson being a eurosceptic check on Mr Cameron, and a check against some of strategy guru Mr Hilton’s views on a number of topics, including the happiness index.

  12. English Pensioner
    Posted January 23, 2011 at 11:57 am | Permalink

    What I find completely unacceptable about the NHS is the poor cover provided at nights, weekends and Bank Holidays.
    I worked in the Air Transport industry, and a large majority of staff had to work shifts, nights, weekends and bank holidays throughout the whole year. Indeed more staff worked weekends and holidays than at other times.
    But Air Transport isn’t an essential service like the NHS; no-one is going to die if, say, there were only emergency flights on bank holidays. However, there’s a fair chance you will die if you have a stroke or a heart attack on Good Friday, with most hospitals having no specialist staff available for another three days. There is something seriously wrong with our priorities,when you can fly of on holiday, go to a supermarket, but not have quick access to emergency medical treatment.
    When my daughter was taken ill in Sardinia, she was admitted to a local hospital (in bed, on a ward in less time than it would take to see the triage nurse in our local A&E) and a specialist called from the other side of the island to see her. This is the kind of service we need, not the vast sums being wasted on administration, political correctness and computers.

  13. Ross
    Posted January 23, 2011 at 12:05 pm | Permalink

    Another day another NHS plan –

    I wish that the British would fall out of love with the NHS.

    While Castro heads Cuba, we’re not the only nation in the world that has a centrally controlled health service

    If our system is so good why aren’t other states replicating it?

    Why do we have some of the worst cancer survival rates in the western world?

    Should we be proud of a service where you’re expected to sit in a casualty department for 4 hours and then be seen by the most junior of junior of staff?

    Mr Blair thought that the solution was to bring NHS spending nearer to European levels of spending – the results didn’t improve proportionately – a lot of it went into pensions

    The last government, naivety, did a deal with GP’s in the mistaken belief that they were Mother Teresa’s under it all – only to find that they grabbed the cash and threw those inconvenient parts of the job overboard. (As would happen in industry if the management were stupid enough) Result more expenditure – worse patient care.

    In many countries – GP’s only get paid if you go – if you use them – no patients no money.

    We need a politician to point out that the NHS isn’t affordable or desirable in its present form

    Why try to reinvent the wheel? Look around the developed world for the best system and copy it.

    Maybe a system of mandatory private health insurance, the government picking up the tab for those who can’t afford it.

  14. Nick
    Posted January 23, 2011 at 12:21 pm | Permalink

    What I don’t understand is why every time a Tory MP is accused of not outlining these NHS reforms in the manifesto they don’t reply “Well actually they were in the manifesto, take a look at page 46.”

    The ability of most Tory MPs to answer “difficult” questions is appalling. It does make me wonder what Andy Coulson has been doing if he evidently hasn’t produced a simple Q&A for MPs to deal with aggressive questioning on “complicated” issues like the economy or health reforms.

  15. Javelin
    Posted January 23, 2011 at 12:45 pm | Permalink

    Red tape in the NHS is often there for many “well intentioned” reasons (1) targets (2) health and safety and (3) compensation (4) data protection (5) drug regulations. You can’t just dismiss these and get rid of them but they can be reformed. For example being realistic about the cost of drug development etc. The public need to hear how these policies will be reduced sensibly.

  16. Peter Turner
    Posted January 23, 2011 at 2:39 pm | Permalink

    Health care is probably the most complex organisation in the country, certainly the largest. It is staffed not just by doctors and nurses but by a vast range of different professionals whose skills and expertise are unknown to the general public and who receive little recognition even within the service itself. Health care exists in a dynamic enviroment where change in diagnosis, change in treatments, change in demographics, change in technical capabilities, change in medical understanding, change in therapeutics, change in pharmacology and so on happen almost every day. Healthcare is provided and sited in different locations from major urban conurbations to rural outposts requiring completely different approaches to the delivery of care. However, the recognition of different needs, different difficulties, different responses and such like do not appear to feature highly in the Services overall planning where there is a continued leaning towards the mantra of one hat fits all.

    It is said that the Government, in it’s manifesto, promised that their would be no major top down re-organisation. What this Government seems to propose will be a major bottom up re-organisation and this is good. The Organisation that we have in place, and have had since the birth of the NHS, is a Bureaucratic Organisation and such an Organisation cannot operate effectively in the dynamic environment described in the preceeding paragraph. And it never will! I wish the Coalition well in its bottom up re-organistion but it will have to think carefully about how it will introduce a new type of Organisational Structure and how that Structure will allow flexibility to flourish. My personal desire is to see the term “simplify” come to prominence.

  17. BobE
    Posted January 23, 2011 at 2:43 pm | Permalink

    Its divide and privatise. First create smaller GP led units and then sell the good ones to the private sector. MediPlan will become similar to DenPlan. The system will slowly become two tier, like dentistry. You will need to take out health insurance in the end. I suppose its inevitable.
    Bob

  18. lojolondon
    Posted January 23, 2011 at 3:21 pm | Permalink

    I do not agree that the NHS spending should be ‘ring-fenced’. In the same way as more money labelled for ‘defence’ is spent on the MOD than on the army, I understand that the vast bulk of NHS spending is on IT, consultants and contractors, ‘initiatives’ and ‘programmes’ and the several hundred upper management that we find in the many trusts that dot around the country.
    Labour doubled spending on the NHS and left us with the MOST expensive and WORST performing health services in Europe. Note this is not the fault of the great front line doctors and nurses and the good people working all hours to deliver services. All the waste and inefficiency comes from the top heavy management and job-creating admin positions that are preventing healing work from taking place.

    Slash the local trusts and replace with a single central management group of limited size and complexity, terminate all the (American and European) consultancy companies, double up the nurse salary scale and enjoy the fantastic and great value service.

  19. JimF
    Posted January 23, 2011 at 4:02 pm | Permalink

    I am a layman insofar as the NHS is concerned. I don’t work in it, and rarely need to use its services, happily. However, cometh the day I do, I really am unsure what my supposed insurance policy covers. I have no policy statement. I pay National Insurance, and have done so for nearly 40 years, but I have no actual statement as to what is covered and what isn’t.

    However from what I can gather the following apply:

    Prescriptions are free to all in Wales, and Scotland (I believe) but not in England. Without looking it up, I wouldn’t like to hazard a guess at NI.
    Treatments given vary between regions, I believe, so that there is no knowing whether if I contracted a particular type of cancer or disease I would qualify for treatment, as I understand this can vary between regions.
    I don’t really know whether my doctor can or will be able to determine whether I have a particular type of treatment on the NHS, or not. I’m a bit unclear as to why some fairly minor or cosmetic operations, and IVF, are treatable by the NHS yet some fairly major conditions are not.
    I suspect that there is a certain amount of ageism in decisions taken about treatment in the NHS by practitioners, but doubt there are any policy guidelines about this.
    For sure I know that dental treatment isn’t covered, unless one manages to find an NHS dentist.

    As a previous contributor has said, it doesn’t actually seem like a National Health Service, when there are so many discrepancies across the Country and between practitioners. I think that until the thing is put on a sound basis, where you contribute X and get a statement telling you what is covered and what isn’t, then people will be confused.

  20. Éoin Clarke
    Posted January 23, 2011 at 4:32 pm | Permalink

    Dear all,

    The starting gun has just been fired on the Irish Election. The Green Party have just walked out of government.

    • alan jutson
      Posted January 23, 2011 at 5:56 pm | Permalink

      Eoin

      Perhaps the Green Party if its anything like it is here, has realised that there is no money left to spend on many of their pet schemes, which without government subsidy of some sort (includes new regulations/increased taxation/enforced change) make them uneconomical to to implement to all concerned.

      Thus without being able to lobby from within, there is no point in being in Government.

      Or

      Have I got it wrong ?.

      What is your take on this ?

      Happy to be advised.

  21. StevenL
    Posted January 23, 2011 at 4:54 pm | Permalink

    “NHS standards” seems to include homeopathy but not chiropracters and osteopaths at the moment.

    Will customers of the NHS be able to change this?

  22. rose
    Posted January 23, 2011 at 5:39 pm | Permalink

    The main problem with the English service is that it is open to the whole world to use. Coming out of the EU and clamping down on immigration from the rest of the world aren’t going to be mentioned in the programme of reform but until something is done about the free-to-the-whole-world-at-the-point-of-use nonsense the NHS is going to remain as embarrassing as Heathrow.

    Your excellent explanation isn’t going to stop you getting silly emails and the irresponsible elements in the Media are still going to egg on the rioters in the way they did over EMA and student loans, by saying the PM has broken his promises. What rioter is going to read this blog and where else are they to get the truth? Bernard Ingham was as robust and clear a press officer as you could get, but even he couldn’t stop the distortions which then appeared. They were always trying to frame him too, and Denis Thatcher – to get at their real target: the Conservative PM. We have just had 13 years without their doing this so they have a lot of steam to let off.

    • Iain Gill
      Posted January 23, 2011 at 11:39 pm | Permalink

      It is certainly true that the families of work visa holders from 3rd world nations clogging up hospitals has got out of hand (as an example of the many and varied foreigners “entitled” to free NHS), often they come here to work precisely because their wife or child needs an expensive operation (so they are disproportionately too expensive to the system compared to their small and heavily discounted contributions)

      Free health care for people with indefinite leave yes, free healthcare for people from a country which would give similar treatment free to a Brit yes, free healthcare to the whole of the population of the rest of the world with one or two nations abusing this kindness to excess is not sustainable

      Not holding my breath that Cameron and friends will sort this out though, it doesnt really affect anyone in their little rich public school bubble does it

  23. BobE
    Posted January 23, 2011 at 5:53 pm | Permalink

    Its divide and privatise. First create smaller GP led units and then sell the good ones to the private sector. MediPlan will become similar to DenPlan. The system will slowly become two tier, like dentistry. You will need to take out health insurance in the end. I suppose its inevitable.
    Bob

  24. Iain Gill
    Posted January 23, 2011 at 6:57 pm | Permalink

    they are not going far enough or fast enough

    turn the NHS into a state backed insurance fund, everyone pays in according to ability, and folk get out according to need, according to some documented rules and not the random charity of some jobsworth in the NHS

    get the state out of being a provider of healthcare, sell of all the providers of care in the state sector

    and absolutley as much as possible give the patients a cheque to take to any provider they choose when they need treatment, give the end customers choice not their GPs!

    current set of reforms will just keep too much of the dross employed and not give the patients enough power

    and in the very short term we need political will for the worst places to shut quickly, we need the hospitals in (list of hospitals withheld but available on request from Iain Gill) to shut – as the worst hospitals in the Western world, we need competitors that will replace them quickly!

  25. Gary
    Posted January 23, 2011 at 9:00 pm | Permalink

    How will this affect the cost of medicines to the NHS ? Are doctors able to procure their own drugs ? There are have been reports of extortionate prices charged to the NHS eg. a pack of 10X 10mg hydrocortisone tablets cost £5 in 2008 and costs £44 today.

    http://www.dailymail.co.uk/news/article-1295610/NHS-doesnt-care-cost-medicine-Drugs-firms-accused-profiteering-raising-prices-ONE-THOUSAND-cent.html

  26. Martin
    Posted January 23, 2011 at 10:29 pm | Permalink

    Surely the fundamental problem with the NHS is the charging model.

    Some parts most have to pay for in full or part (Dentistry & Optical Devices). Others are free.

    The free bits have taken on a sort religious status. No criticism is allowed.

    Take the GP service (the people the government plans to run more of the NHS) – would the average GP practice survive 5 minutes if the public had to pay say the price of a pint of beer or a gallon of petrol for an appointment. GPs cost the public purse a fortune yet they are never subject to the sort of scrutiny that other parts of the public sector get.

    Most Dentists don’t earn as much as GPs, have to charge us patients and yet provide a better service. Us patients appreciate the Dentist more as he has to work for our custom and we pay him. The Dentist tells me to do things that will reduce my future bills and pain!

    Perhaps modest charges for the GP service would help both the GPs and patients have a more professional relationship.

    Dentists rarely refer folk to hospitals, GPs do a lot of the time! Why does the NHS value GPs more?

    In summary I reckon that some modest application of the power of paying would sort out the NHS more than this more GP power business.

  27. Electro-Kevin
    Posted January 24, 2011 at 6:47 am | Permalink

    Firstly – for those of us who pay tax the NHS is in no way ‘free’. In fact it is highly expensive.*

    Secondly – we don’t want ‘choice’. We just want it to work. The last thing we want to be doing when we (or our loved ones) are sick is to be making decisions – and for it to be incumbant on us to make the right decisons (and all the attendant recriminations should we get those decisions wrong.)

    I remember the last Tory government banging on about ‘choice’. Look what it got us on the newly privatised railways. A myriad of different charges to wade through before booking a ticket and endlessly imaginative ways for train operators to charge us more than we need pay.

    And what about education ? The one choice we parents of state educated children really wanted (grammar schools) was – and still is – denied us by the Tories.

    *Politicians make it out as if the NHS is a gift from them to us. ‘Free at the point of use’ sounds deceitful to those of us who pay over half of our wages in taxes and national insurance.

    Reply: Some of us do want choices, and intelligent explanation by Drs of the options available should we need treatment.

    • Iain Gill
      Posted January 24, 2011 at 9:10 am | Permalink

      yep choice is the only thing that will allow patient power to shut the dirtiest places, to stop the all day queues, to reduce the arrogance of providers and so on, but proper choice where you really can walk out and take your money elsewhere at any stage

      • Electro-Kevin
        Posted January 24, 2011 at 6:10 pm | Permalink

        That sounds like privatisation to me.

  28. Brian Curnow
    Posted January 24, 2011 at 8:07 am | Permalink

    Hello John,

    Excellent analysis as usual. It needs a tougher top line though to counter all the inevitable leftist PR bluster they spout in their predictable manner, which is the only thing Labour appears to have thoroughly mastered todate.

    Best wishes

    Brian Curnow

  29. RDM
    Posted January 24, 2011 at 11:25 am | Permalink

    A debate and Reform that is well overdue.

    It will be interesting to see how specialisation develops within such an environment? And how it effects other Health Services near by?

    Best of Luck,

    A WelshTory.

  30. Ellis Roberts
    Posted February 8, 2012 at 2:11 pm | Permalink

    Why do you lie yet again John? You should have know about this plan years ago as you wrote it.

    You really are a vile man. You should be a man working for the people instead you really work for the banks and big business.

    I dont know how you have the stomach to face the people of this country after all the lies you have told them and money you have cost them.

    Reply: I would not allow such unpleasant remarks about anyone else on this site. These comments are so untrue and over the top that I will let them appear. As you can see from the article, I have set out what the Conservatives said about health reform before the election, and how they have sought to carry that through in office. I work for my constituents, not for the big banks.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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