I was surprised yesterday to wake to the news that 38 Conservative MPs led by Dan Poulter had signed a short letter to the Sunday Telegraph declaring that they suported the Health Bill. The spin said these were loyalist MPs who wanted to show their support for the Prime Minister’s Health reforms.
I was surprised because at last count around 300 Conservative MPs supported the Health Bill. I had not heard rumours of large groups of disloyal MPs seeking to change the Bill radically or get it droppped. There have been no angry meetings about this, no letters signed by 100 potential rebels, no attempt to table unhelpful backbench motions through the backbench business committee, no pre-emptive summons of Health Ministers to the 1922 Committee to explain themselves. This is no referendum on the EU or powers back from Brussels issue within the Conservative party, where all of these things have been happening, including from some of the same people who signed this letter.
I was surprised because many MPs had not been shown the letter or invited to sign it, so clearly there was no wish to maximise the numbers of signatures. As a result a letter went out with just 38 names on it, running the risk of implying there are almost a couple of hundred Conservative backbench MPs who would not sign it, when I guess most had not been asked. Let me reassure you all further, those who like the reforms or are relaxed about them. As far as I know Conservative MPs will continue to vote for this legislation if asked to so so. If you are against the Bill , you will be relying on Labour and Lib Dem votes in the Lords to force the changes.
The letter makes the fair general point that the aim of the Health Bill reforms is to improve the quality of patient care, partly by offering more control over that care to medical practitioners within the service. The aim presumably was the worthy one to try to get across the high level messages about this reform – that quality and choice are the drivers of the reforms with the aim of better patient care. One of the means of doing this is cutting bureaucracy and leaving more direct control to medics. Unfortunately the absence of any praise for Mr Lansley in the text left the media with the story that the loyal MPs were loyal to the PM but not to the Health Secretary, which no-one seemed to move rapidly to deny. The original White Paper in 2010 was co signed by Mr Cameron, Mr Clegg and Mr Lansley. All three were completely united in recommending their chosen course of action to the public.
What is my view? I favour more choice and more patient power in the NHS. I am happy about effective cuts in overall bureaucracy, as long as the replacement offers better management for less cost. I did not advocate the Bill, but will support the government if they tell me that is the best way of bringing about these general aims. I was asked at the beginning of the government what I thought about proceeding with it. I suggested it would prove difficult as I expected the Lib Dems enthusiaism for it to wane if it ran into criticism. They do need to be careful lest the Bill becomes a very expensive complex measure, with all sorts of new duties and functions for the NHS built into it to seek agreement to it in the Lords. They need to concentrate on achieving that better quality care with more choice that is at the heart of the original proposals.
I would be interested to hear your views on this Bill, and on the government’s approach to it. I have delayed the schools piece until tomorrow, as this is topical today.
February 27, 2012
We hear that many of the changes envisaged by the Bill are already being put into effect, and bringing benefits to patients. If this is true, why is the Bill necessary? It suggests that changes to the NHS can be made by managerial rather then legislative means. – which I am sure is in fact the case. But if the Bill is necessary, this implies that changes being made prior to its enactment are illegal. Which is it?
February 27, 2012
WHatever they do will not be enough because al public services will not be able to cope with the overwhelming demand by the increase in population caused by the mass immigration policy.
February 27, 2012
Ahhh…good to see xenophobic comments based on little real data. You’d be surprised how many doctors, nurses, surgeons and carers are from abroad to service the demand of our ageing population. Ridiculous comment…
February 28, 2012
Xenophobia is defined as “an unreasonable fear of foreigners or strangers (wikipedia).
What is unreasonable about questioning an unpopular and major public policy of mass immigration (net 25ok pa and its potential effects on a major public service?
http://www.personneltoday.com/articles/2005/03/15/28675/bma-chair-slams-nhs-for-poaching-staff-from-africa.html
http://news.bbc.co.uk/1/hi/7215624.stm
http://www.bbc.co.uk/news/health-17187179
If only more facts were available, you should be questioning why they are not ? You have offered none.
February 29, 2012
Thanks for the trusted facts from Wikipedia and newspaper clippings…
What is important to avoid an unbalanced perspective, is to review both positive and negatives of immigration.
The previous comment was saying the immigration was causing ALL of the issues, which is a ridiculous statement.
As for mine, I’ve worked for years in the NHS and without these immigrations our health and social care would be on its knees. Here’s a challenge ask any clinician in the NHS if we should turn away doctors, nurses, surgeons, anaesthetists and midwives…
Here’s a reall reference to get you started : http://www.ic.nhs.uk/cmsincludes/_process_document.asp?sPublicationID=1300712111004&sDocID=6727
I agree we should look after our country!! I’d happily vote UKIP to control our borders. But it’s not the 19th century, people do indeed migrate. We could even talk of the emigration that doesn’t help our country. I’m equally concerned about Brits leaving with their skills and trades to Australia etc.
February 28, 2012
Socialist twaddle. Cameron is on your side, he always caves in.
February 29, 2012
What was meant was I’m passionate for informed statements from all relevant factors not just one sided views. That’s all. Hope that doesn’t scare or offend…
February 27, 2012
To my previous comment, I would add this: however many Conservative MPs do or do not support the Health Bill, if the Conservative Party does not win an overall majority at the next general election, it will be the fault of one man – Andrew Lansley.
February 27, 2012
Apparently Mr Lansley has spent years researching the NHS and working out (like IDS and Michael Gove) what ought to be done. He has prepared a clever plan based on years of scholarly research.
Now he is being hung out to dry by the Daily Telegraph and the Cabinet who ought to be in there supporting him.
The first lesson I learned as a schoolmaster was this: if you try to be popular with the children you will end up very quickly being loathed and despised. The entire Cabinet seem to be falling into this trap far too often. Leadership is what people love. Not being sucked up to and agreed with when we know we are both ignorant of the full facts and probably wrong.
February 27, 2012
And now even Tescos are falling into the same trap too. As if they needed to worry. All they need to do is deliver the service their customers want, and perform any acts of charity on the side that they choose – with their own money.
February 27, 2012
Hiring people should not be seen as an act of charity or as an excuse not to pay people for working at a private company.
February 27, 2012
Unsure how much scholarly research Mr Lansley has done given the large volume of objections from most doctors, nurses, GPs, and other health workers. Consulting the medical profession to create a viable plan should have been the first thing Lansley did, not the last.
February 27, 2012
Like you I have been impressed by Andrew Lansley. However, a bill like this should have been introduced on day 1. Remember the Poll Tax fiasco.
February 27, 2012
No not true. The Tory party will lose because Mr Cameron’s cast iron u turns have less strength than the back bone of a jelly baby. He failed to state what the Tory party stood for at the last election and he has continued to fail in this regard. In fact most think he is a socialist Lib Dem. His failings got the party into this mess with the Lib Dems and he will not be so lucky at the next general election because he will not be standing against the most loathed PM Gordon Brown.
He has not succeeded on any major policy issue. Every single issue that matters has got worse:
Economy.
Borrowing and spending.
The prudent, savers and pensioners worse off through QE- he wants them to work longer because the value of their money will be eroded.
EU still moving toward the pan European state. EU socialist regulation wrecking our lives.
Terrorists cannot be deported through HRA. In contrast European arrest warrants allows UK citizens to be arrested and extradited by EU countries for offences that do not exist here!!
Mass immigration policy continues and has a huge impact on all public services at a time when cut backs are needed.
Natural resources cannot cope with the increase in population, farmers put out of business on a daily basis because of the EU CAP.
Soft on crime Clarke might has made sure there is no longer an effective deterrent in committing crime.
Socialist Coalition are creating an anti capitalist environment where all business people are bashed and robbed by taxation. They need to move abroad ASAP. If there is anything left the EU intends to take the taxation from the City to spend on European infrastructure projects.
Do not wait for Jelly Baby Dave to act.
February 27, 2012
“if the Conservative Party does not win an overall majority at the next general election, it will be the fault of one man – Andrew Lansley”. No.
They did not get one at the last election due to one man Dave Cameron. Failing due to his lefty, big state, pro EU, green wash agenda and his absurd decision to give the LibDems equal billing on TV. If they do not get one at the next it will be due to him continuing with this and his “tax borrow and waste agenda” which will clearly not deliver real growth.
Only three years left.
February 27, 2012
Spot on ,well said.
He has not changed the lefty civil service, councils, quangos or anything else. Complete and utter waste of space. i will definitely not vote Tory while Mr Cameron is in charge.
February 27, 2012
LIFELOGIC – 100% correct! When the voters thought that Cameron had stood up to the EU in December (he hadnt really) he got a 5-7% spike in the polls.
He failed to win the last election because he is a lying Europhile. If you cant win against Gordon Brown after 13yrs of the worst goverment in history then that should you tell you everything.
February 27, 2012
The Bill will make the management of the NHS vastly more complex. It centralises powers that are currently devolved locally. When the first GP is physically attacked for a Commissioning decision, we will then be faced with them walking away from CCG’s or turning surgeries into fortresses. There are structures and functions proposed that no-one knows what they will do, or who should be on them, but they are to be up and running by April next year.
PCT’s are dissolving. The managers who had previously kept patients safe are being made redundant. In a year or so, replacements will have to be employed, when the gaps created by the £25 per head cost cap, start leading to deaths and bad publicity.
The Bill is a shambles, but we can’t reverse out of it- the NHS is already too far down the road. The next Government will have an almighty mess to sort it out.
February 27, 2012
Not to mention all the operations being refused because they’re too costly. I’m sure the outcry from several thousand cancer suffers being denied chemotherapy, elderly people being denied care, and the mentally ill denied treatment all because it’s deemed too expensive will result in the Conservatives becoming a minority party.
Reply: The new system will still provide care free at the point of need as at present. This is scaremongering.
February 28, 2012
Are you saying cancer patients were never denied expensive treatments, available in the US, under the Labour Govt?
February 27, 2012
The problem with the bill is largely one of perception. The average man does not trust private medicine, because he knows that the insurance companies hold the whip hand. Private medicine at present encourages people not to be treated, for fear that premiums will rise and exclusions added to ther policy so that when they need treatment badly, they will be going NHS anyway.
So any mention of private providers by the media will result in fear and mistrust. They suspect that it’s all about helping private businesses at the expense of the working classes, and the government has had little traction in reasuring them because they failed to address the BBC in the first months of government.
But unfortunately, it’s just the same as when the govenment in the 90s changed the rules on chips in car windscreens – most people thought that someone high up had shares in Autoglass. You won’t shift that perception without dealing with the cause – and the cause of most of your problems. The BBC.
February 27, 2012
Yesterday’s Telegraph criticised Mr Lansley and demanded his resignation.
February 27, 2012
You say “most people thought that someone high up had shares in Autoglass”
Perhaps not Autoglass but there was no other rational explanation for the MOT war on tiny glass chips that the government unleashed as yet another way to mug motorists. It is even being used by car rental companies as a nice little earner I see perhaps you are meant to dodge the stones as you drive.
The chips clearly have no effect at on safety what so ever.
February 27, 2012
Given that in the US private healthcare firms seek to make as much money as possible with little regard for those who are ill is it any wonder than people in the UK feel that UK private healthcare firms will act the same way.
Also this view isn’t due to the BBC as many right wing newspapers, such as the Telegraph, are saying the same thing.
February 28, 2012
If you allow proper competition, service providers that do not offer vfm or a good service to customers will lose out to other providers. Under your communist ideology,customers have no choice.
February 27, 2012
You favour “more” choice and patient power in the NHS – indeed that is what is needed they currently have non, they get what they a given and that when the NHS feel like giving it them.
The money does not come from the patient, nor even does it follow the patient. The system is bound to remain inefficient by design.
February 27, 2012
Patients have some control over which hospital they can go to, though they usually choose the nearest one.
Given that most hospitals are required to have 80% or more of their beds in use at any time a scheme where the money follows the patient would have little effect.
February 27, 2012
The money should then come from the patient? Could you pay for major surgery or long term care?
February 27, 2012
John, like many people I suspect, I am a bear of little brain, with no time to absorb the intricacies of the bill. Can you give us a link to a website that lists in simple bullet points the benefit of the bill, and if required for each point an explanation as to why that is beneficial? It’s all to complex to absorb, with the arguments and distortions in the press. I need something that I can quickly and easily understand. Is the bill beneficial? Do I believe that the nhs needs reform? I don’t know, I can probably give it an hour this week if lucky.
February 27, 2012
Bill
I agree with your comment.
The bill has been very, very badly promoted with regard to factual information.
This may be Lansley’s fault, it may be the Governments fault, but given the peoples love for the “FREE” NHS, opposition is very easy.
One thing for sure, the governments stopping and listening policy, which then initiated changes, and Cleggs continued negative statements (for political ends) have completely undermined its introduction, and given the opposition fuel to the fire worries about privatisation.
At a guess I would suggest 90% of the population do not fully understand the details/changes at all, couple that with the fact that 50% of the population are not interested, it leaves the government with a real problem over introducing any change at all.
At a guess it will now be a complete dogs dinner, and a shadow of its original intentions, if and when it eventually makes it onto the statute book.
For a man who is usually slick on presentation Cameron, not Lansley, has failed this one big time.
February 27, 2012
OOps should read.
50% of the population are not interested in change at all .
February 27, 2012
This government is weak on effective communication – the main one being their inability to accurately tell the public what they are doing with regards to public spending – instead they have tried to portray an image of being tough deficit cutters.
They made a decision recently for political purposes on separating the Border Force from the UK Border Agency i.e. to take the heat out of the argument following an adverse report.
I doubt that they have a clue how the reconfigured Border Force will work. The decision was probably made in isolation with little thought to the consequences…..it wouldn’t be the first time.
zorro
February 27, 2012
The purpose of the consultation period was so that the Government could get the views of those working in the NHS and modify the bill to get the support of NHS workers. However the Government didn’t like what they heard, so they decided to ignore most of these recommendations. As a result the medical profession is now actively opposing the bill. This is a failure of the Government, not the critics of the bill.
Had the Government gotten the support of the medical profession then this bill would have passed without any problems.
February 28, 2012
You mean the politicised union representatives of medical staff with vested interests in maintaining the status-quo.
February 27, 2012
Yes, please will someone provide all the coalition MPs with a digest listing the policy’s main points as they don’t seem able to do it themselves. Most of them have blogs like this and it is wasted opportunity. Of course we have a major problem with the BBC and other broadcasters, but we now have the means in the internet to counter some of their daily brainwashing.
February 27, 2012
Bill,
I agree wholeheartedly, the Bill hasn’t been explained. I have no idea of what actual changes will come about aNd why they will improve healthcare. I doubt this would be the case if Michael Gove or Eric Pickles had been the Secretary if State. Mr Lansley has woefully failed to communicate.
The fear about healthcare being privatised and quite extraordinary; the supply of food daily in a safe and healthy environment is arguably more important than healthcare yet no-one has any qualms about food shops. I happen to think that Tesco would make a far better job of running healthcare and I like the idea of their competing with Asda, Sainsburys, Waitrose and Lidl for illnesses.
Unfortunately the one reform that Mr Lansley is not pursuing is the removal of the ‘National’ part. I believe that it is just too big to be managed effectively. The other notion that it is ‘free’ must be addressed. It isn’t and is paid for in part by the ridiculous levels of tax paid by the top 5% of tax payers.
However, I could make the NHS more efficient at a stroke, banish all chairs from nursing stations.
February 27, 2012
The Department of Health has a lot of information about the bill, including several factsheets. However as this is a Government website promoting this bill it should not be consider impartial or free from bias; especially since it does not include any mention of the risks associated with this bill which Mr Lansley is currently refusing to publish.
http://www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/HealthandSocialCareBill2011/index.htm
For the alternative view there are pressure groups who state why they oppose these reforms:
http://www.keepournhspublic.com/index.php
http://www.opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs
February 28, 2012
Keep Our NHs Public is a run by left-wing extremists, with a long history of communist and anti-capitalist activism.
February 27, 2012
The fact sheets summarising the bill are at
http://healthandcare.dh.gov.uk/factsheets/
I haven’t read these so don’t know how good they are.
February 27, 2012
It’s a list of what the Government is telling people they’re trying to achieve. Whether this will occur, if Government is capable of delivering this, or what the risk are has not been included.
February 27, 2012
The UK and Cuba are the only two countries with our type of health care system. None of the ex-communist countries choose our method when deciding what road to go down. Nor does any country, first world or otherwise, contemplate changing to our system.
I think that should tell anyone with any critical faculty all they need to know about the current set-up.
It’s not small reform that’s needed but a health care revolution if we’re to ever see value for money and accountability to the clients / end-users – patients as they used to be called. Which, of course, will never happen in any of our life times, unless things go downhill faster than they already are which looks like a distinct possibility.
Look at the outcry over these measures, which in the end will change precious little and we’ll still be debating how we can improve things from a rock bottom position 15 years from now.
As David Cameron in a rare moment of candour said (before furiously backtracking and praising it as world best, etc.) the NHS is second rate. In truth, it’s not even second rate considering what we spend on it.
But we are where we are so tinker away and expel lots hot air in Parliament if you think it will make a difference. Just remember the public will never be won over by any arguments about it, as far as the press and public are concerned we really do have the world’s best health care system cause that’s what politicians have been telling us all our lives so you’re backing a loser from the off.
February 27, 2012
Just because Cuba copied our healthcare system doesn’t make it communist. Also most ex-communist countries choose to improve their existing healthcare systems rather than adopt a new one.
Given that as a percentage of GDP the NHS is better value than most European systems yet delivers similar results the evidence suggests that it doesn’t need to be reformed.
“Just remember the public will never be won over by any arguments about it”
The public will quickly be won over by any reforms that are supported by those who work in the NHS. The lack of support from medical staff is why the current bill is so unpopular.
February 28, 2012
That is a lie. The UK is at the bottom or near the bottom for all measures of health and well-being in both Europe and the Western World. The monopoly of the NHS is a barrier to people spending money on private health, as they do in all those nations which achieve better performance than the UK. Ex-communist nations are our nearest rivals for poor health outcomes, but as they open up their market they are improving and will soon be better. Just one example.
Survival rates:
Breast cancer: US 84%, UK 70%
Prostrate cancer: US 92%, UK 51%
February 27, 2012
This government may have some good ideas but it displays a total inability to successfully drive the narrative and put its case across in an effective manner. In addition the level of competence in the implementation phase of legislation – could it be sabotage from a disgruntled civil service – appears weak and indecisive – vide the job experience fiasco.
This administration seems to exude a general lack of competence and though no one wants to return to the days of Blairite spin, a little bit more vigour in the area of presentation would seem desirable.
As an aside, if the story in the Times today about service housing has any basis, (and it has not been refuted), I suspect that you will cut a very lonely figure in the next parliament. There is a limit to my – and I suspect many others – tolerance of sheer stupidity, and that limit is getting very close. I received the usual begging letter from the tory party a couple of days ago – I shall be ignoring it this time.
February 27, 2012
The problem with the Government is that certain people believe that they are always right and that anyone who disagrees with them must be wrong. As a result they cannot formulate an argument to support their view because they naively believe that everyone will accept it as being correct. This leads to poorly designed policies and constant u-turns as soon as the policy becomes unpopular.
Blair for all his faults at least knew how to make a bad idea seem good.
February 27, 2012
Are you serious? The people of this country (remember them, you are supposed to represent the people?) do not want this Bill. The doctors and nurses do not want this Bill. The Unions do not want this Bill. The Bill is a shambles that has become more about saving face than anything else. The Bill is not wanted or needed despite Government misrepresentation to the contrary and if Cameron put his arrogance aside, perhaps he would realise it. At least it has shown how untrustworthy politicians are!
February 27, 2012
Yes he is serious. The people of this country, you included, have been brainwashed into thinking that the NHS is wonderful, marvellous, and the jewel of the welfare state. It isn’t, and what is more it never has been. It is no more than deluded nonsense. Even when it was created in 1948 it was the wrong model and was actually opposed by many of those you say oppose this bill. The NHS needs radical reform and above all it needs competition which would drive up standards and drive down costs.
February 27, 2012
Care to explain why in the US competition has driven up costs without any improvement in standards?
February 28, 2012
Check US vs UK survival rates of serious illnesses and cancer.
February 27, 2012
A national healthcare system is far too expensive for every other country in the world to contemplate, not sure how Britain can afford to support it. Actually we can’t, but every government that wants to make it ‘affordable’ is cut down by the media – the taxpayer’s BBC, of all things! Add to that the fact that Liebour doubled spending on the NHS without improving services, and you know it cannot continue.
February 27, 2012
Every other healthcare system costs more as a percentage of GDP than the UK’s. The main reason is that the UK relies on state services, rather than the more expensive private companies.
February 28, 2012
Almost every other comparable Healthcare system produces better results than the NHS.
February 27, 2012
I want to thank you for a very open account of the current state of this bill in parliament at the moment.
As far as I can tell, there is nobody else – newspaper or blogger – who has bothered to do this so clearly and frankly.
February 27, 2012
I’m on Andrew Lansley’s side, I think he should be allowed to get on with something which he outlined reasonably clearly before the election.
I don’t support every last detail of it, but fair’s fair, and given that all the wailing has come from the usual special interest groups, I’m happy to give him the benefit of the doubt.
February 27, 2012
Leaving aside the point that I rather doubt that Andrew Lansley has ever explained anything clearly in his life, what the Conservative manifesto said about GP commissioning, amid several pages of motherhood statements about the NHS, was “We will strengthen the power of GPs… by:
…putting them in charge of commissioning
local health services.” So fair enough, it was there in the small print. But as already noted, this could have been done without legislation, since it is happening now.
But the key point is not what Lansley planned, or even what was in our manifesto. The key point is that the message in the campaign was “No top-down re-organisation for the NHS”. It is pathetically disingenuous for Mr. Lansley to claim that the change he is imposing from the top is not top down because the “bottom layer” is involved, if it is appropriate to refer to GPs as the bottom layer.
It is equally disingenuous to renege on an unambiguous campaign commitment by referring to the small print of page 46 of the ludicrously titled manifesto.
Bottom line – this issue will cost the party many votes.
February 27, 2012
Haven’t read the bill, and haven’t a clue about the NHS or how the NHS works anyway. What worries me about public sector reform in general is that it just turns into an excuse for a fight between government ministers and the public sector trade unionists who bankroll the opposition.
Although I work in an LA, I’ve never been a union member. As soon as the 2010 election was decided, the local UNISON branch suddenly started emailing me on the global address book. They were screaming blue murder (good pun huh?) before any of you had even had the chance to open your mouths anyway and were never going to give you a fair hearing on anything.
I don’t know what the NHS is like, but if its anything like the LA’s, then the union’s bark is a lot worse then their bite.
February 27, 2012
The NHS is in serious need of reform without it the breath and quality of its services will continue to decline. It is highly inefficient, wasteful and is not patient orientated. The current bill as it stands is not reforming the health service in a way that addresses all these problems adequately but it is a step in the right direction as it allows in the future further reforms. What is needed is a complete change in the provision and funding of the NHS a step that no government could take in one go. The problem for Lansley and the Conservative party is that this bill although it will bring improvements eventually it may make things worse in the short term with all the downside implications for their popularity. Doing nothing is as bad as the NHS would continue to deteriorate unless masses amounts of money is thrown at it as Labour did which of course is not now available. Labours strategy did nothing to stop the decline only slow it a bit.
February 27, 2012
“not patient orientated” indeed not after all they have the tax payers money – patients to the NHS are just a liability to them. To be deterred rationed and inconvenienced as much as possible.
February 27, 2012
This is becasue they have the illusion that the patients are getting their services free. So they condescend, and patronise, and keep them waiting. They call them by their Christian names, often with contempt, while the doctors are called by their surnames, with titles respectfully added. As long as the service is free at the point of use this delusion will continue to degrade the patients.
February 27, 2012
You think the dentistry is in good shape now we have all this ‘choice’? Fantasy by fantasists.
February 28, 2012
The bad habits of the NHS have, alas, been carried all too often into the private sector. Deep cultural change is hard to bring about in a generation. Look at Russia.
February 27, 2012
There needs to be a radical approach to mantain a free health service for future generations and these changes at best are minimally beneficial to improving the monolith. Off the top of my head this morning say all new born UK citizens are privately insured by the Government for full medical care whilst they remain residents. The current NHS would slowly disappear effectively in about 80 years and the Government would be out of the day to day management, at which activity most would agree it fails vastly more than it succeeds.
I doubt if the most ardent socialist would object to their new born being given the privilege of private medical care.
February 27, 2012
You say “There needs to be a radical approach to maintain a free health service for future generations” indeed and this radical approach should be to charge for it where people are clearly able to pay and lower taxes so they can.
February 27, 2012
I suspect the majority of people have no idea about what passing this bill will mean. I have mentioned before just how lamentable this government has been in explaining its policies – even with PR men at the top. Vested interests oppose changes to protect and increase their own influence. Politicians are using it as a tool by which they hope to garner votes on the basis of scare stories. Just what the bill will finally be like after all this meddling it is hard to imagine. As with so many things, the government has allowed this bill to be mired in so much obfuscation that it has made it less likely that it will have public support.
February 27, 2012
Paul Peacock,
Since when do you speak for ” The people of this country…”?
I, for one, want serious reform of the money pit that is the NHS.
February 27, 2012
Money pit and inefficient deliverer and rationer of so little of real value as compared to the huge cost.
February 27, 2012
Rather like wind farms but more deadly.
February 27, 2012
Quite right
February 27, 2012
John, to be honest, I am confused about the bill, it seems to be unclear. The opposition has enrolled anyone who is anti-Conservative and they are doing a great job, MAINLY BECAUSE OF THE BIASED BBC AND GUARDIAN. (When, oh, WHEN will you rein in the BBC??)
I personally think that frontline people in the NHS do a great job by and large, but, like the army, probably only 10% of the money goes there, with the vast majority of funds totally wasted on the Trusts, NICE, admin, bureaucracy, and jobs for the boys and Billions for the big consulting companies. All that should go.
Likewise for the police, protect the frontline, and cut all the junk.
February 27, 2012
The Telegraph also opposes this bill. Should they be ‘reined in’ as well?
February 27, 2012
The only relationship in a health service that matters is the one between the medical professional and the patient.
If the service is to be efficient then the patient needs choice and there needs to be competition within the profession. It is impossible to know the true cost, say, of an operation, unless surgeons compete with one another to carry it out. In any other area of exchange – where payment is made for a good or a professional service – this price competition is well established and proven to work. Imagine how complacent the legal or accounting professions would become if there was a set scale of fees and no competition?
Money needs to follow the patient. If a patient can’t afford the medical care that he or she needs, then the answer is to provide the patient with the money.
Therefore the NHS mantra of “free at the point of delivery” needs to be challenged. There is no such thing as “free” – what the NHS provides, inetivably, is bureacracy and inefficiency.
Whether or not the current Bill addresses any of these points is hard to figure out. It has become one of those politcals bones that has been so badly chewed that it’s hard to figure out what it looks like anymore. I’ve lost track of it, and almost lost interest in it.
February 27, 2012
There are but two things that are certain: the first is that the NHS is in need of reform and the second is that the Government (any Government) is incapable of an effective reform.
No matter how much time and good intentions are spent on the reform it is certain to be ineffective so long as it is being conducted by people who have no financial interest in its success.
Maybe these reforms will go ahead in spite of massive amendments but most certainly they will be ineffective and will simply prove to be an embarrasment to those who have initiated them.
Privatisation may prove to be contentious but it will have to happen eventually when this great socialist experiment finally collapses so, let’s hope privatisation happens sooner rather than later rather than drag on to the bitter end like other experiments the socialists have tried.
February 27, 2012
I am against the bill, it seems to be designed to allow private medical company’s to run significant parts of the health service, using the tax payers capital rather than their own. Many companies are lining up to run the commissioning side of things for GP’s.
This whole commissioning thing is not well explained. My view is that it is an unnecessary level of complexity. On the one hand you have GP practices and on the other hand medical providers such as hospitals. The latter are basically charged with carrying out procedures to a NHS price list, a sort of implied contract. What is there to commission. GP practices would simply contact providers directly. Providers might have a few salespersons to keep in touch with the practises. It could be run like any other business arrangement.
I have nothing against private medicine carried out in privately financed facilities. I have nothing against selling a complete general hospital to a private provider for a realistic several hundred million pounds. There would be no guarantee they would get to treat NHS patients, if they provided an efficient level of service at or less than the NHS price, then they would get business. But no guaranteed gravy train.
Part of the bill seems to be pushing for more private medicine in NHS hospitals. This would take us back to the time when you saw your hospital consultant and were told that you could have your operation in 6 to 9 months time, but if you went private you can have it done next week. The long delay, of course, is because the consultants hired a significant proportion of the hospitals facilities for their private operations, a totally unacceptable conflict of interest.
February 27, 2012
“I did not advocate the Bill, but will support the government if they tell me that is the best way of bringing about these general aims.”
What will you do if the government continue to assert that this bill is the best way of bringing about these general aims but every person you talk to who actually as experience in administration in the NHS tells you that the bill will create a completely horrific expensive mess John?
Reply: I will examine the evidence with an independent mind as I always do. That is not the current message from local GPs and hospitals.
February 27, 2012
The message I’m getting from hospital directors and the like is that the reforms are seriously poorly thought through but they have already been forced to implement them anyway.
February 27, 2012
As lifelogic says, the money does not follow the patient, as happens with continental systems. Here, GPs are paid twice the salary of some of their counterparts and the patient is tied to their surgery with little choice. The strongest union in the UK is the BMA and they have been able to improve their position to the point where they see no advantage in change.
Foreign GPs have been drawn to the UK for the high pay. Many practices charge excorbitant fees for copies of tests, which the patients has to beg for. Standards are appalling in some surgeries , with patients whisked through and symptoms missed leading to late treatment, extra costs and fatalities. My friend’s GP is known by staff as ‘Speedy Gonzales’. His cancer was diagnosed in the late stages and 3 cracked ribs missed for 5 months. A faxed request for treatment was missed or not sent for 6 weeks.
GPs have finally been found to be multiple charging for ghost patients but the NHS is still sending out letters to former patients who left the UK years ago. Why ever did Lansley think that GPs could manage the health service any better than the overpaid managers. They struggle to manage appointments in less than half a week.
In a continental system the patient can chose the GP and the diagnostic clinic. Then the hospital or treatment centre is chosen. These parts of the service then do NOT NEED to be managed centrally by large numbers of highly paid managers. Even the Cubans have a less wasteful system.
Why on earth did they not just copy a continental system which works. Before Uan tells us that the NHS is cheaper, these figures must not include all the overheads and not take into account the fact that many patients are not treated properly and die early, removing costs from the system. Is the cost of NICE incuded, with their Kafkaesque system of QUALIS deciding on the allocation of treatments and drugs delayed for approval because of immediate costs?
February 27, 2012
The bill puts the patient and clinicians at the heart of decision making when setting priorities for their local area and is an improvement on the current situation. I am not surprised that the professional bodies and unions are against changing the status quo.
I think that Andrew Lansley is doing one of the most difficult jobs in politics and regret that more of his collagues have not been a bit more audible in their support. The government cannot afford backtrack on this bill.
February 27, 2012
No that’s what the bill is meant to do. What it will actually do is introduce a centralised bureaucracy that isn’t made up of patients or GPs.
February 27, 2012
“The aim of the Health Bill reforms is to improve the quality of patient care, partly by offering more control over that care to medical practitioners within the service.”
This is the major flaw in the bill. The bill is not for the benefit of patients but for the benefit of GPs, although most of them seem to be against it, presumably because they prefer to be doctors rather than accountants and bureaucrats.
Now some people quaintly think that GPs act in the interests of their patients, but they do not, they act in their own interests (like everyone else). Patients will still be at the mercy of someone else to determine what kind of care they will be given. Nothing the government has proposed changes this.
February 27, 2012
This bill is more for the benefit of private companies than GPs, as GPs will need to hire private companies to determine which treatments are the best value for money. So patients will be at the mercy of private companies who are trying to do everything as cheaply as possibly, which usually involves not providing the most expensive treatments on the NHS.
February 28, 2012
Most Practices are set-up as private companies.
February 27, 2012
Two comments: The Bill is not clear / understood by me suggesting there is a failure to get the message over — pity Mr Cameron appointed Mr Patton to the BBC. Secondly I [possibly unfairly] fear the possibility of “my” Doctor placing his business profit before my long term benefit more than I fear the current systems inefficiencies.
February 27, 2012
Off subject. No wonder HMG is enjoying bounty tax receipts. This year I filled my online forms in before the due date and was given a higher amount to pay than my own calculation. I paid it and received an emailed receipt. The forms have a reference number. I complained on the form abount the higher calculation figure.
Now I have received a late payment fine of £100 and threats of £10 a day further fines if I do not pay it. I called the Liverpool (it would have to be wouldn’t it) call centre and , after listening to messages about how to pay and appeal, got through to a human after 15 minutes. I was told that after the filling the form in and getting to the payment section and paying, there is another ‘next, button to click. This is at the bottom and to see it scrolling down is necessary. I did not see it and the actual form did not register.
When submitting, I clicked, ‘save’ to keep the forms, this did not work either as it puts it into some category which ‘windows’ finds hard. So to save it, one has to click and drag the whole lot and then press various control plus other letters, then give it a different title. When eventually today, I managed to save it, I noticed a ‘not submitted’ note at the top of the long form. I had missed this when getting to the bottom of the submission and paying.
Needles to say, the operator said the fine would still apply and seemed unsympathetic. I hope my earful and promise to go to jail rather than pay made a good start to his week. The problem is that the calculation now shows that I have overpaid by £600, so they have it already, and my wife pays my unpaid fines and then we just cancel holidays or the occasional few visits to restuarants. No wonder so many are closing.
February 27, 2012
Stred
Yes and Vat will require manditory submission on line after April of this year as well.
When Oh when will government realise that not everything can be done by computer, and not everyone is happy about their own computer skills.
God knows the government has such a poor record on computer programmes, you would think they could understand that no system is foolproof.
Given many people will fill in forms incorrectly, not be fully completed, or simply do not understand the process, why does not a simple but clear message appear in large letters, before you are able to log off.
FORM INCOMPLETE or ERROR on FORM Please re-submit.
Then a reminder if you ignor the above, and still try to log off.
Your form is INCOMPLETE and has NOT been ACCEPTED.
Again its all so bloody simple, but it seems beyond the capability of government departments to understand that people and businesses are not all experts in tax submission.
February 27, 2012
User friendly programmes !
No chance.
Guilty until proven innocent, without a doubt. Fine you first then you will need to appeal.
Now been going on for a few years, started under Labour.
Continuing under the present administration.
February 27, 2012
This happened to me last year, and I am not even a taxpayer, but Gordon Brown ensured people like me get fined too for not pressing that final inconspicuous button . £100 from every non taxpayer, as well as taxpayers like you – what would that work out at? Or did Mrs Balls think of it?
February 27, 2012
I had a similar problem with the VAT web site.
The common problem is that with HMG products market forces can not act to weed out the bad in favour of the good.
February 27, 2012
Tony E is right – the insurance companies hold the whip hand in private medicine: but then, the purchasing authorities hold the whip hand in NHS purchasing. I am horrified by the thought that my GP may also become the local purchaser – now he is unequivocally on my side in any fight I may face to get treatment, but if he is also the purchaser……?
Competition can only operate within a relatively unconstrained market. A market consists of the numerous individual transactions and the judgements that each side of the transaction makes about the value of the transaction to them. In health care in this country, such a market cannot operate. The consumer does not pay the bill and the purchasers make no judgement about outcome (mark you, such a thing is very difficult – and very expensive – to do, at least at all accurately. Medical outcomes are heterogeneous – many different causes may operate, only one of which is the clinical skill involved). The result is endless distortions of a system which does, by and large, work fairly well – as the last major intervention of outside competition into the NHS demonstrated so appallingly well.
February 27, 2012
John, further to my earlier email, I am serious, if the Tories do not deal with the BBC, they will undo you, as they have before.
I have totally copied this from a post on the Biased BBC – because I could never do a better job of this myself –
“The problem here is the lemons the Tories put up on Newsnight were badly briefed. The BBC as we’ve pointed out here has used unpaid work experience for years and still does today.
The Tories just don’t seem to understand the evil that exists in the BBC, as I pointed out in the general thread EVERY SINGLE POLICY that is announced by the Government is trashed on a daily basis by the combined output from the BBC, I’ve pointed out before how it works.
Newsnight kick it off as it gives a chance for the editors of the Guardian, Mirror and Indy to also run the BBC line the following day. The BBC then go all out on the Toady show followed by Dame Nikki and Vikki Pollard on Radio 5.
Then the main BBC news channel picks it up, we then get Toenails having a go followed by endless sound bites off of MaGuire, Toynbee and Sir Michael. The whole 24 hour cycle is rounded off by Newsnight once again.
It’s like the BBC is punching an opponent so often the opponent doesn’t get a chance ot hit back or if they do it’s just the occasional punch.
But go back to the days of Bliar and Brown and the BBC did nothing but support the Government, remember Marr crawling out of Downing Street as he announced there would be no election? Remember the MP’s expense scandal? Most of the seriouds abuses of expenses were by Labour MP’s yet the BBC STILL only ever reminds people of Tory moats and duck houses (which were never approved) yet ignores the criminal acts of severla Labour MP’s and the troughing of people like Tam Dalziel who tried to claim £18,000 for a couple of BOOK CASES, yes 18K!!!
As I pointed out in the general thread the BBC never went after the Labour Government in the way they do the current one. But I have no sympathy for the Tories, instead of putting Chris Patten in as head of the BBC trust it should have been a someone to run down the BBC for either selling it off or making it self subsidising.
The Tories will suffer at the next election as the BBC will go full out to get Labour back in.
February 27, 2012
lojolondown wrote: “As I pointed out in the general thread the BBC never went after the Labour Government in the way they do the current one.”
Perhaps the Hutton Inquiry set up by the last Labour Government slipped your mind? Hutton’s criticisms led to the resignations of the Director-General and the Chairman of the BBC.
February 27, 2012
Maybe, the irony of the Labour Govt attacking the BBC for being too left-wing is lost on you.
February 27, 2012
It’s natural selection. The Tories don’t deserve to win if they can’t counter BBC propaganda. The BBC is a known quantity but there are other channels. The Tories are just useless at getting their message across convincingly.
zorro
February 27, 2012
In fact, the Tories are so poor at communicating their message in government that even if they had their own channel, they would probably have Kevin Maguire presenting their strap lines!
zorro
February 27, 2012
Thank you lojolondon for pointing this out.
It is even more fundamental than siding with a particular political party; they often go against many of our cultures. The playing field is so tilted that we have forgotten what level means.
The BBC has its own agenda, spin based on dishonesty and oversimplification. For example, why hasn’t this superb lecture by Richard Lindzen on Wednesday 22nd Feb 2012 in the HoC committee rooms been reported:
http://bishophill.squarespace.com/blog/2012/2/24/lindzen-in-london-josh-152.html
Why hasn’t Peter Gleick’s deception been reported:
http://dotearth.blogs.nytimes.com/2012/02/20/peter-gleick-admits-to-deception-in-obtaining-heartland-climate-files/
etc etc/
February 27, 2012
It’s not the fault of the BBC that the Conservatives were badly briefed or that they don’t respond well when questioned.
February 27, 2012
Biased BBC is ran by David Vance who is shall we say a traditional Unionist. He himself might be a little biased I suspect. Certainly not a source to be taken seriously.
February 27, 2012
What do you plan to do with Channel 4 News which is often very hostile to the government?
February 27, 2012
John,
I think that Lansley deserves every support you, and we, can give him. He is the poor fellow who is putting into effect what both Clegg and Cameron signed up to in the teeth of determined producer interest and opportunist socialist opposition.
Tony Blair in his memoir said that he had ” wondered … whether we had been right to dismantle wholesale commissioning int the NHS … (page 211). That surely says all you need to know about whether the changes are needed.
But, nowhere have I been able to read a list of the individual amendments to the Bill alongside the Department’s analysis about what each amendment will do to enhance or deny the objective that Clegg and Cameron signed up to.
Please can you ask Andrew Lansley to get such a list showing at the top of Google’s searches when you put in “Health and Social Care Bill Amendments”. They must have this please please can we see it. I will be most happy to help if needed.
Reply: I have aqsked for more up to date information about the Bill, as several of you are understandably seeking it.
February 27, 2012
Does this help:
http://services.parliament.uk/bills/2010-12/healthandsocialcare/documents.html
February 27, 2012
This is pertinent to a general point I have made before: the public should have access to original source material and not have to rely on a selective presentation by the media. Equally, of course, we also want to see what the media make of issues.
In this context, the “source” is not just government but all political parties. If there is to be further funding of political parties I think it would be reasonable to do so “in kind” by providing an outlet via the BBC, who provide the broadcast technical support, while the editorial control is with the the “source owner”.
February 27, 2012
Dear John,
I do not support this Bill. My reason is that I see it as a vehicle for getting private companies to run the NHS – and not the claimed aim of getting better outcomes for the patient.
Such companies are never given the scrutiny they require because the politicians who put them in place do not want egg on their face (having claimed how much better the private sector is) should the company prove to be a dud.
February 27, 2012
And what is wrong with ‘private companies’ running the NHS ?
Why does the State need to own and staff every damned hospital the length and breadth of the Kingdom ? It doesn’t and until 1948 never did. All you are going is defending a nationalised industry with all its inbuilt inefficiencies and waste. The NHS is set up in the interests of the producers rather than in the interests of those who use it. It badly needs more diversity in provision and much more competition which would drive up standards (presently lamentably low) and should drive down costs. The present Stalinist system simple does not work and I can’t understand why so many people seem so keen to defend it against any sort of reform. The world has moved on since 1948 and it is a pity some of you haven’t.
February 27, 2012
Points to note:
1. Conservative MPs are voted in to represent their voters, not the party. Those wanting clarification of the actual benefits of the biggest change ever to the NHS are therefore not “disloyal” as was wrongly suggested.
2. There are literally a handful of people in the country that 100% completely understand the bill.
3. Health is such a complicated sector and I’d like experts to give their expert views, not career politicians that are advised by “advisors” who tend to be wet-eared graduates.
4. Those informed know that the NHS has been evolving constantly to meet changing demographics, expectations, technologies and policies. A fool would say otherwise.
5. Why is the Conservative party adament of breaking up the NHS? Many studies have shown it to be ONE OF THE LEAST EXPENSIVE health systems in the world (BMJ 2012) , one of the best for quality (WHO 2010) with the highest satisfaction of recent patients (Department of Health) with increasing productivity for the last 10 year (Lancet 2012). Why break it up???
Reply: Conservative MPs are in the main seeking to implement their Manifesto promises on the NHS. They are not out to break it up – the fundamental point of care free at the point of use or need is central to the new as well as the old vision. The comparative studies of cost usually leave out the costs of tax collection, which are part of the costs of the NHS, whilst including insurance costs in overseas systems.
February 27, 2012
You say “The comparative studies of cost usually leave out the costs of tax collection, which are part of the costs of the NHS, whilst including insurance costs in overseas systems.”
Indeed they do also they should include the very large costs inflicted on people and businesses of administering the hugely complex tax system as well.
Far more efficient to “charge at the point of use”.
February 28, 2012
Charge who? How much and for what? A question you seem unable to answer other than for charging to see a GP. Which could be expensive in the long term if many delay consultation and the problem is serious.
The reason you cannot answer is if you do the game will be up. If you think that if you cannot afford to pay you should not get treatment then just say, but again the game will be up. In America many believe this so you will not be alone. The argument can then move forward. If you believe the same in housing or anything else, then crawl out from under your stone to be squashed.
February 29, 2012
Again charge who?
Imagine the extra pressure, extra stress, the thought of having to fund care you individually or as a family cannot afford to help a loved one. The stress on the patient/family,friends and society. It probably would be extremely divisive,counterproductive and a guaranteed election loser.
Indeed sometimes a relatively small cost incurred at an early point is extremely beneficial for all. e.g. Vaccine uptake for at risk groups or control of infections at source irrespective of legal status or wealth.
Charging even a small fee directly can potentially impact a patient, some may not proceed with the prescription using an alternative or none at all.
February 29, 2012
What’s twenty quid these days? Anyone can afford this.
February 27, 2012
“I favour more choice and more patient power in the NHS” me too and with knobs on, if only that had been the over arching theme instead of giving power to GP’s, and if patients really were given real power then a much more powerful message would be behind changing the NHS.
February 27, 2012
The government needs to address the legitimate concerns of the Royal Colleges; in fact the government needs to address all the legitimate concerns expressed about Mr Lansley’s bill. GPs are paid by the taxpayer, but apparently will be able to operate as private consortia to requisition hospital services; there appears to be no exclusion from GPs having personal financial interests in the provision of such services. GPs are trained in medicine; they do not have MBAs. When financial criteria are all important, it may be the sick and vulnerable who suffer.
The criticisms of the poor performance of the NHS is as much a criticism of the performance of GPs and their failures to exercise proper skill and care in referring patients for hospital investigation as of the performance of hospitals in providing services. Many of the problems of the NHS boil down to the malperformance of individuals who are a danger to patients. It is not clear how these problems will be addressed.
A similar consortia system has had severe problems in the US; it would be preferable if we tried to emulate the much better more cost effective systems of provision found on the Continent.
February 27, 2012
When I worked for a pharmaceutical company, I worked closely with Doctors formerly inthe NHS and European qualified medics. We did much of our new drug testing in Eastern Europe because in the UK and Western Europe a much higher proportion of the population were on long-term medication. GPs give out prescriptive drugs far too easily – it should be a last resort, not a patient ‘right’ to leave the practice with a box of tablets.
A German Doctor frequently complained to me about the inefficiency of our GP barrier system, where all patients are screened by the GP. If I have a back problem, I have to visit the GP, who will do the briefest examination, and then refer me to a back specialist. In Germany, so I was told, if you have a back problem, you go directly to a back specialist. Even if you have private medical insurance, you still have to see an NHS GP, to get referred. Its a waste of resources. In a monolithic organisation, like the NHS, all common sense and flexibility is lost. Bureaucracy and inefficiency prevail.
Many people visiting a GP are better off doing self-diagnosis on the internet. GPs often do the same when you visit.
February 27, 2012
It sounds as though this has been gone about far too quickly. Thatcher never grasped the NHS issue in her 13 years, so it was a tough call for the Coalition to do this in 13 months.
Why not put this one on the shelf until a proper Conservative administration can apply normal Tory principles and meantime sort out all the other issues you discuss here?
February 27, 2012
I am entirely happy with the general thrust of these reforms, including GP group practices being budget holders. However, I still want someone to answer the question: ‘By what procedure using what input parameters are the budgets determined in the first place?’ You can draw up a budget on the basis of catchment area and demographics but only if competition between them is limited.
I suspect that a lot of opposition is coming from hospitals who dislike the hierarchy being inverted – they will have to offer their services to GP group practices instead of dictating to them.
Regardless of front bench propoganda, one of the best features of the reforms is that GP group practices will be forced to think about which drugs are costs effective; and about time too.
Incidently, who elected the BMA board? Who elected the spokespersons of the Royal College of Nurses? How do we know that they represent their members? No doubt they will say that there are lots of umbrella organisations that know better than their members – such as the European Commission !!!!!!!!!!!!!!!
February 27, 2012
Why do so many replies to this blog assume that the bill is about privatising the NHS? It isn’t. It is about introducing competition between Branches of the NHS e.g. individual hospitals. This competition will be about quality of service not money.
Everyone is simply giving prominence to views raised by fringe political parties while labour find it suits them to keep quiet and not contradict those views.
Most of what appears to be privatisation is simply inclusion of what already goes on into the bill. This is necessary because the layers of bureaucracy that currently organise these aspects are being removed.
I just wish people would read the bill instead of criticising what they think it says.
February 27, 2012
Anything that gives patients more choice and makes the NHS more efficient has to be good. The NHS is FAR, FAR behind the French system in giving good safe service. There the GPs actually invest in their practices and have scans and Xrays in their surgeries. They are also trained in reading and taking the investigations.
February 27, 2012
My neighbour in France is an excellent GP and earns half the salary of a British couterpart. Small diagnostic clinics are in every town and excellent hospitals in the region. Each are managed independently and do not need highly paid strategic management. The patient has his independence through subsidised reclaimable insurance and any non performer finds themselves out of work, without redundancy costs. The standards are far higher.
February 27, 2012
Most of the vociferous opposition to this bill comes from health professionals, who seem to think that the NHS is there to serve their interests. This naturally worries patients, who are more inclined to trust dctors than politicians. But it is not long ago that doctors were complaining about the excessive bureacracy of PCTs and SHAs. Many were keen to adopt Labour’s Practice Based Commissioning, which was introduced when they realised their mistake in abolishing fundholding. They changed their minds when they realised that they would have to pick up a share of the PCT debts.
It may not have been necessary; it may have been badly handled; the concessions to the LibDems may have reintroduced even more bureaucracy; but to pull the bill now would be a political disaster, and we would never get another chance to reform this cash guzzling dinosaur.
February 27, 2012
You may be interested to take a look at the slog website later, as he has written his views on the NHS.
http://hat4uk.wordpress.com/2012/02/27/memo-to-lansley-wannabe-management-is-the-nhs-problem/
February 27, 2012
Firstly I would say that I haven’t seen any MP explain with any great clarity what the changes are and what impact they would have (beneficial or otherwise). Maybe I’ve missed it, but all I hear are the usual soundbites and platitudes about “patient choice” blah blah blah.
But what I’d really like to say is this. Whoever in the Conservative party strategy team decided to wade into the NHS in the first term of a Conservative government needs to be fired immediately. What on earth possessed them to do this, knowing that public trust in the Conservatives management of the NHS has always been virtually zero ? Now they have done it, and lets be honest its a mess and has done nothing except provide ammunition to the left to say “we told you so”.
I’m afraid John, you need to employ people who have developed strategies before and can see the bigger picture – not these PPE graduate fresh out of university with zero experience.
It was a PR disaster waiting to happen….and its happened !!
February 27, 2012
I think it’s telling when you have to sell it as ‘improving services’ when, in fact, it is about having to save money.
I agree wholeheartedly that we need to be saving money.
To say so is to court the wrath of the Left and the BBC. At the moment general elections can be lost on such issues.
Things need to get a lot worse before people realise what it’s going to take to make things better again.
February 28, 2012
Most people object to saving money by not providing treatment to patients. While South West Essex is saving money by no longer offers hip or knee surgery on the NHS this is not for the benefit of their patients.
February 28, 2012
Rather like council services cuts are sometimes made in spite rather than for economy or efficiency – or for the benefit of the paying ‘customer’.
The Left are like that, I’m afraid.
February 28, 2012
Uanime5 – Do you have proof btw ?
Links ? Docs ???
February 27, 2012
Mr Redwood, I’ve worked, trained in the NHS, have used it as a patient, and these changes are not necessary or wanted by the public. Yes, perhaps reforms are needed, but it can be done within the NHS as it is. Bringing in ‘private systems’ is not what the public want, and after all it’s them who pay for it, so may be they should call the tune.
Lets look to spending by various governments, foreign aid @ some £18 billion and rising, £55 million on health tourists, money which should be spent here on OUR healthe care.
So, we can afford a National Health Care in this country, and most people like what we have, it’s not all what you read in the press. Many people, including myself, cannot afford private health care costs, so what would we do? No, I’m afraid this bill is corosive to the well being of health in this country and most people see it that way. If the Conservatives pursue this bill and implement it they will suffer at the elections the public will see to that. There are some who say, continue, well they must be well off and can afford private health care, but the majority cannot. The NHS is the jewel in this countries crown, people appreciate it very much, mess with it at your peril. Mr Clegg signed the first agreement as you say, so we can take what he says with a pinch of salt, why sign it at all before screening it? Drop the bill for your own sakes if you don’t and it goes through you will regret it big time. This will be Cameron’s ‘poll tax’ moment. I for one do not agree with it. As for doctor’s holding the funds, that again is a big mistake, some of it will find it’s way abroad, just wait and see. Doctor’s don’t see patients now if they can help it I’ve had problems with that recently.What a silly mistake this government is making when they could have made great strides in getting as majority next time round.
February 27, 2012
(I have not studied all 400+ pages, is there any wonder that media/opposition/Lords/weaker back benchers can have fun?).
My concern, hope and confusion lie with exactly the same part of the Bill. So Part 3 Chapter 4 on pricing, Monitor and national tarrifs is where my hope/despair/confusion lie. With comissioning of provision I had hoped that there would be a move away from national tarrifs, I want a system in which expansion of providers of more good outcomes per pound occurs instead of reimbursement system. So the whole national tarrif part disturbs me. Nonetheless I am also hopeful here in that alternative providers will lead to the development of better costing sytems so that eventually a national tarrif system can be removed.
February 27, 2012
One thing I do know about health care is that with an ageing population and improvements in medicine the costs will escalate hugely so savings have to be made to stand still.
I don’t have an understanding of at all of the intracacies of the NHS and expect the bill is complex. I think its lacked the sell from Andrew Landsley, unfortunately he has not seen fit to sell it and appear on programs to defend it. Ian Duncan Smith has done well to sell his complex bill by being willing to appear and defend it.
As Andrew Landsley has not been out on TV selling it I have to work on a hunch. To me yes its a good thing, private enterprise means less influence by the unions who will drive the NHS into history. Politically its a hit but the right thing to do.
February 28, 2012
Don’t worry about the cost of care for the elderly. Under the Health bill this will no longer be provided by the NHS if it’s too costly, saving vast amounts of money every year.
If you’re referring to Ian Duncan Smith’s Work Programme it may have been sold well but it’s still a massive waste of money. At present all people on the Work Programme do is spend 1 hour per week looking for jobs over a 2 years period. Perhaps if the Government tried retraining people, rather than paying private companies to remove them from the unemployment statistics, they might reduce unemployment.
February 27, 2012
The NHS is an infinite sink of resources. This is not a criticism but the nature of the thing, indeed of any health care system.
We have to decide what percentage of available money to spend on the NHS and then endeavour to get best value for that money.
February 27, 2012
“The NHS is an infinite sink of resources. This is not a criticism but the nature of the thing, indeed of any health care system.”
Well, maybe so, but a Beveridge system is a bigger sink than a Birmarckian system. We never seem to recall that along with the railways, steel and coal, healthcare was one of the great nationalisations of post-war Labour. When the NHS is spoken of as a national treasure, it always seems to be assumed that there was just zero healthcare before the NHS. I was born in 1945 in the Royal Free Hospital. The cost? The clue is in the name.
February 27, 2012
As a long-term recipient of NHS medical care, I am perhaps qualified to comment. Whilst praising some of the care I have received, it has to be said, the rest is mediocre and needs to be put right. Despite their fanciful claims, Labour did not leave the NHS in a good state of repair. There is far too much waste and poor governance at clinical level. Neither did Labour get good value for money with the bigger capital projects, when a £600 million hospital ends up costing the tax-payer over four times that amount.
Just last week, I e-mailed Andrew Lansley to say that if he needed anyone to support him in the local press, or on local radio, he may feel free to contact me. I won’t be slow in telling the whole world why these reforms are absolutely necessary. To hell with Labour’s duplicitous and dishonest political dogma, or the windy Lib Dems who, to use Tony Benn’s expression, bend with the breeze like a ‘weather cock’, rather than stick to their intended course like a ‘sign post’. Waste just cannot be allowed to prevail, simply because a perculiar instituon happens to be much-loved and cherished. That is a betrayal of everyone else who pays to fund it.
I have total confidence in Andrew Lansley, and I will stick my neck out and say, after the implementation of his reforms, one noticable change, will be the smaller size of the cheques the treasury has to send out. I also anticipate the service will be better, and if as happened to me recently, a hospital letter takes from the 7th February (the date it was typed), to the 23rd February (the date it was posted), it won’t come a minute too soon!
Tad Davison
Cambridge
February 27, 2012
Doctors are paid far too much in comparison to European colleagues. Why can’t we move to a European model of health insurance, and get some diversity of provision?
zorro
February 27, 2012
Just like the Rail companies, on same inept scale.
Expect more Southern Cross style collapses.
The US model is not one to copy or take any cue from.
This will not give users the power to drive standards higher.
This is an appalling reform that will not address the issues that need addressing.
Shame.
Would be better to pay everyone’s insurance premium centrally, give them a credit card and let people get on with it.
February 27, 2012
As a Conservative voting doctor I support many of the principles of the bill. It has sufferred a death by incoherent ammendment, and is now a mess.
I have read much of the bill and am particularly concerned at the implications for training the next generation of doctors. There is one paragraph on this core part of the NHS, and it is not clear how this can be organised across a multiplicity of competing providers.
Another problematic area is screening. for this to be effective this needs central call and recall with feedback circuits to assess false and true referrals. Once again it is hatd to see how this can be done between multiple providers, without recreating a pct like beaurocracy.
February 28, 2012
I agree with the Bill but am becoming increasingly concerned at the many amendments which is making it all a mish mash. Today, I have read that further amendments will be made by the Lib Dems in the House of Lords. What Labour and the Lib Dems are concerned about is competition. Further, they have whipped up public concern on this matter with people opposed to the Bill who have not read the proposals. I find it all shocking.
Because of all the negativity, I have re read Alan Milburn’s paper on the NHS published in 2000. Fascinating document which indicates that the way ahead is to have all services provided by private contractors. What is also despicable is that Labour made many changes to the NHS in pursuit of privatising the service. They introduced payments by result. They also introduced private companies into the system to provide often acute care and not just routine operations to reduce waiting lists. They introduced Foundation Trusts based partly on the Spanish model. This was to ensure that the taxpayer would not have to bail out hospitals each winter with hospitals having to manage within budgets. They ensured that failing hospitals would be closed unless the Regulator determines they are necessary. Hinchingbrooke Hospital in Cambridge is a classic case when the last government refused to permit the NHS to bid for the hospital and it is now in private hands. This will certainly continue to happen in the years ahead. We also have some 227 GPs paid for by private health companies. Privatisation of many services – some 25% of private healthcare revenue comes from the NHS was introduced by the last government. What is despicable is that all these changes were implemented by Statutory Instruments. If a Bill had been used we would have had the same outcry that we are now witnessing. I think Labour should be reminded of there underhand changes which ensured that medical staff and i am sure some MPs did not know what was happening
I am looking into the future to envisage the outcome of healthcare if the Bill is introduced. There seems little doubt that bidders will undercut NHS Hospitals and hospitals will close. This is no bad thing as we have far too many large and expensive hospitals. (I read that most MPs know that large hospitals exist which are not required but they cannot say this as it may affect their constituents). Much better to have smaller clinics which are common in Europe as they are more efficient, offer speedier treatments and cheaper to run and to have larger hospitals for major and acute conditions. Staff will have to move where the work is and herein lies the opposition to the Bill from many of those employed by the NHS. At the present time clinical services and hospitals are run for the benefit of medical staff in many parts of the country. We only need to look at Dr Foster intelligence to know how outcomes on mortality etc depend on what day you are admitted to hospital. Senior surgeons organise their week to include private patients. We all know many surgeons work three and a half days a week (on full pay) and spend the other sessions seeing and operating on private patients. A documentary on television some years ago pointed up that theatres are inefficiently used and theatres rarely used on a Friday. Despite highly paid management – no one can control powerful medical staff. They have a monopoly – they do not need to change their working habits. The Bill will most certainly change their practices as patients will have their treatment at centres of choice and will be able to question Doctors on their expertise. I can assure you that despite many efforts, patients are not given choice in many areas of the country.
I also think that some services presently offered by the NHS will no longer be available unless one is willing to pay. I personally do not have difficulties with this as over my life time many services have been removed from being free to requiring payment. What we presently have is a system provided by the State which seeks to provide all things and to encouraging citizens to believe that they can do so. We have removed personal responsibility from health to the State. Look at how difficult it is to get copies of medical reports and the ignorance many people have about the cost of procedures and medication. Having lived abroad and with family members presently living in different parts of Europe, I know of no other system which provides food for example without payment. Some systems rely on family members to assist with care too. We are totally unreasonabale to expect to have so many services provided within a limited budget. Further, we are unwilling to pay increased taxes to meet demands on healthcare. I do not want to pay increased taxes as I do not trust the State to be efficient or to use my money wisely in any of the services it provides. I would be willing to pay a fee to visit my GP when necessary. Further, although over aged 60, I should not be exempt from prescription charges. In my opinion, the State should only set the Standards and Regulations in the provision of healthcare. They should not be directly involved in the provision of services.
I am optimistic that for people like me who lives in a rural area, will finally have a choice over the provider of services. I sincerely believe that competition will dramatically improve my local NHS Hospital which totters from crisis to crisis. Reports from the CQC are appalling with trainee medical staff being removed because of lack of supervision etc etc. I am now seeing a small hospital run by a private company being set up – agreed by the last government and this will continue. Surely all this will benefit me as people will be competing for my money…..
As to those medical staff opposing the changes, I am sure many are fearful for the future not opf healthcare but their own personal situations. However, we need medical staff and they will always be in employment. Some weaker staff will not be employed. This too is good for patients.