The Health Bill- the government’s case ( as requested)

1.     It shifts power to GPs so they can get the best health care for their patients

The Bill abolishes two layers of administrators (PCTs and SHAs) and the money they now spend on health care will go directly to groups of GPs. GPs will decide how to spend that money working with other health professionals like nurses in what are called Clinical Commissioning Groups.

2.     GPs will be able to get health care from the NHS and other organisations. They must get the best treatments, not the cheapest and the Bill encourages GPs to give patients more choice

So, if you have a stiff shoulder you could go to an NHS hospital for physiotherapy or to your more local group of self employed physiotherapists. Your GPs can give you a choice between the two – or even more choice of where to go to fix your shoulder.

In Eastbourne some nurses left the NHS to set up a specialist wound healing clinic. It has a fantastic record of healing people who have suffered from serious problems like leg ulcers for years. GPs will be able to get treatments like this from other not-for-profit organisations, charities and organisations offering health care.

In Broxtowe people in need of help to control pain used to travel to specialist clinics at hospitals in Nottingham. Now their GPs have set up their own award-winning  local service – so no more trips to hospital as the service is now nearer to home.

3.     It  joins things up at a local level

Based on shire or unitary authorities one body called the “Health and Wellbeing Board” will bring together local health and social care services and public health. This Board will be a mix of doctors, other health workers, councillors and patients – all coming together to make sure there is a joined up way of keeping people healthy and making people better.

4.     It stops the current system that favours the private sector

The last Government discriminated in favour of private health companies doing work like knee operations. The Bill puts the NHS, not-for-profit organisations, charities and health companies on the same footing.

5.     For the first time there is a statutory duty on the NHS to reduce health inequalities

In 2005 the British Medical Journal commented. “The difference between the life expectancy of the richest and poorest in our country is now greater than at any time since Queen Victoria’s reign’ and under Labour the gap grew. The Bill makes it law that the NHS must work together to make sure people everywhere get the same great level of health care.

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73 Comments

  1. Posted February 29, 2012 at 5:18 pm | Permalink

    Yes all good like motherhood and apple pie, but it isn’t just producer interests which are anti-, is it?
    There is an argument missing here.

    • Posted March 1, 2012 at 7:54 am | Permalink

      Indeed – the argument which is missing is the pragmatic argument – the stage of the debate where intentions meet reality.

      John asked the other day why people were expressing their concerns about this bill now.

      The reason is that the proper processes of consultation which are designed to force idealogical proposals to be analysed by those who understand their potential consequences in reality was bypassed by this government.

      It takes time and effort for people to come to understand the consequences of ideologically motivated proposals and that time and effort is usually put in during the proper processes of consultation – where all the representative experts come together to explore each others concerns. Because they did not happen we, as a society, are implementing policy blind – unaware of what is real consequences will be.

      Hence lots of fears being expressed and hence those fears remaining as a top-line idealogical argument between politicians. Nobody knows what the specific issues are or can debate them properly because they were not explored.

      Reply: It was all fully set out in the original White Paper, and there were two extensive consultation exercises.

      • Posted March 1, 2012 at 12:25 pm | Permalink

        Rebecca

        Interesting short (too short) discussion last Night on Newsnight, Union leaders, Doctors, Social Charity representitives, Private health providers (through the NHS), Government Ministers all agreed on one fact.

        The NHS cannot continue in its present form, as it will eventually bankrupt us.

        This was interestingly the first time I had seen/heard all admit this would be the case (other than some politicians), and was I guess a bit of a milestone in the argument for the need to change..

        Thus change is not political ideology, it simply is needed.

        Now I agree that you can argue the terms, fit for purpose and all the other arguments, but the fact is agreed by all taking part.
        The NHS cannot continue in its present form, and whilst some consider it the best in the World (with no statistics to prove their case) others who cite examples of many other countries, suggest its record is not anywhere near the top.

        • Posted March 1, 2012 at 4:08 pm | Permalink

          I’m also getting the message that key changes have already been enacted Alan.

          But we are in a horrific mess policy wise because of the early lack of coherent consultation.

          I’m going to go to the Libdem Spring Conference (or at least as much of it as I can get to). I suspect a heavily amended version of the original bill is probably the only vaguely coherent way forward but I also suspect it’s going to be extremely hard to sell because so many people have lost confidence in the politicians driving it due to their own incompetence. I will be engaging with the discussion with a view to allowing those with the relevant insight from the LibDems to convince us that the amended bill is coherent should they be able to do so.

          For more details as to what ‘consultation’ has been like under this government see my post below. It’s important we all learn from the mistakes which have happened in our political process. Obviously at present Gove and co are still trying to convince people that they ‘got it right’ by shoving their massive reforms through in the first few weeks of the parliament during the school summer holidays. Only smaller policies (like his National Curriculum Review) have imploded so far. The real horrors are yet to come. Let’s hope those horrors are contained by coherent policy reversal rather than that we see the horrifice consequences of what’s being done which are so obvious to those with the relevant experience.

        • Posted March 1, 2012 at 7:54 pm | Permalink

          The NHS delivers a similar result to most European healthcare systems but costs less as a percentage of GDP. The American model the Conservatives are trying to copy not only costs twice as much as a percentage of GDP but delivers worse results.

          These changes will end up costing much more and bankrupt the UK.

      • Posted March 1, 2012 at 2:18 pm | Permalink

        There have been extensive consultation session in education policy. However they have not been functional. The politicians involved have been on a march energised by London bubble hubris and empowered by their control of media spin.

        They have systematically ignored and actively attacked through the media all those with expertise. If you remember I described aspects of what was going on last year as it was happening:
        http://johnredwoodsdiary.com/2011/09/27/5-tory-mps-write-a-book/

        Once Gove had been successfully prosecuted for not consulting we did get some supposed ‘consultations’ but the constructs on which they were based and the subject matter were so profoundly ignorant I remember I simply couldn’t stop crying all the way through one of htthem and it was accepted by all involved that they were completely pointless.

        It seems to have been pretty much the same in health. Hence the four weeks of questions which are top line. No-one with credibility understands the realities because they have to be hammered out by all the stakeholders and they never were. They were explored by individuals or small groups and that kind of exploration simply isn’t good enough.

        • Posted March 1, 2012 at 7:57 pm | Permalink

          Hear, hear. MP’s like to pretend that democracy is real but in the end they just ignore it and follow party ideology. Most MPs prefer to win favour with their donor than their constituents.

          • Posted March 2, 2012 at 6:04 pm | Permalink

            I think they generally get better as they get more political or general life experience uanime5.

            It’s very unwise for an extremely inexperienced government full of very young people who can’t see the wood from the trees to shove through massive legislation in the early days of their term.

  2. Posted February 29, 2012 at 5:26 pm | Permalink

    Rather wish you had been in charge of Health – you would have been able to put over the main points succinctly and convincingly.

    • Posted February 29, 2012 at 6:15 pm | Permalink

      Power needs to go to the patient I suppose the GP is second best but not the real solution.

      “The difference between the life expectancy of the richest and poorest in our country is now greater than at any time since Queen Victoria’s reign”

      Sounds like PR nonsense, a typical confusion of cause and effect so often used the governments.

      Which is more likely: being in very poor health makes you unable to work much and thus makes you poor or the other way round? Anyway not being unable to buy cigarettes, eating too much food and alcohol & getting ones entertainment and food down at the allotment, going fishing or taking the whippets for a walk is surely good for your health is it not?

      It is rather like saying people who go to the doctor (say 20 times a month or more) are far more sick than those that never visit. So we are going to stop ban doctors as they are clearly so dangerous!

      • Posted February 29, 2012 at 6:18 pm | Permalink

        Very good speech today John but only about a dozen? attending and most on your side anyway?

        • Posted February 29, 2012 at 8:16 pm | Permalink

          And not reported at all as far as I can see.
          Whyever not?

      • Posted February 29, 2012 at 8:31 pm | Permalink

        I doubt that many patients have sufficient medical knowledge to make good choices themselves in many situations.

        • Posted March 1, 2012 at 12:12 pm | Permalink

          Clearly they need to make the decision but taking expert advice on the pros and cons from doctors and consultants as needed. Just like other complex purchases they may make.

        • Posted March 1, 2012 at 2:19 pm | Permalink

          Irrelevant whether it’s a good choice or a bad one – it’s theirs to make and not the doctor’s.

          The doctor/medic should give advice, but never pressure one way or the other.

      • Posted March 1, 2012 at 11:48 am | Permalink

        I don’t think I have confidence in GPs, but I think it is a better choice than patients. If one views the patient as a customer, most would not buy particular treatments from particular suppliers (except perhaps forcosmetic surgery), they would be looking to buy policies from providers. This leads to competition first acting at the level of insurance policy (as in US) and not directly on health provision. Rather then seeing the patient as a customer, or indeed product as now, perhaps the metaphor is to see the patient as a client of the GP, and the GP is the customer of the potential suppliers. As I said I like this conceptually, but I am uneasy about GPs given the rewards they negotiated themselves under the last Govt, and their attitude to pension reform now.

        (More generally I don’t see why under this system that there are still national tarrifs, but Icould just be not understanding).

      • Posted March 1, 2012 at 6:44 pm | Permalink

        Many ill people are working poor. You live in wonderland if you think that the poor, because they have less money do not smoke/drink and walk their whippets down to their allotments.
        The idea that life expectancy differences because of income is just, as you put it, PR is laughable. Do you get out much?

        • Posted March 4, 2012 at 8:34 am | Permalink

          Surely it is more likely that poor health leads you to be poor in income than the other way round.

          • Posted March 4, 2012 at 9:54 am | Permalink

            Health is often neglected due to a lack of income. There is little to live for so escape is sought in drink/drugs/fast food/gambling and housing is often crowded sub standard. No amount of spin and fantasy will put this cart before the horse.
            Do they deserve to be ill because they are to lazy to work is what you are trying to say and should just come out with if you believe this, but if you do will then be out in the open and it will be open season.

  3. Posted February 29, 2012 at 5:54 pm | Permalink

    Ok John, thank you for that. I do have to ask; is that it? What is all the fuss about? Who is going to lose their job? Are the nurses working privately, providing a service that the nhs uses dangerous? How? Mr. Lansley done a pretty horrendous job on promoting the reforms. I’ve barely seen him on the news – oh hang on, that’s my fault I’ve pretty much given up watching the news on tv, and only listen occasionally on the radio. Unlike you, how is he to connect with me?

  4. Posted February 29, 2012 at 6:01 pm | Permalink

    This kind of “executive summary” for people who don’t want to dig into the nitty-gritty is very useful – thanks.

  5. Posted February 29, 2012 at 6:02 pm | Permalink

    John

    Does this mean that the post code lottery of drugs and treatment no longer exists.

    That GP’s can now choose from the whole range of drugs and treatments which are licensed, or does it stretch even further and allow drugs to be used which are not licensed as well.

    In the past we had individual PCT’s having different criteria for old age care.

    Do we now have the same set of rules for everyone Nationwide.

    Sorry its more questions, but these are fundimental to a NATIONAL HEALTH SERVICE if that is what it is to be at last.

    Reply: GP purchasing decides what treatments to buy. There will still be NICE testing and approved lists.

    • Posted February 29, 2012 at 10:00 pm | Permalink

      Reply – Reply

      Thanks and thanks again for taking the trouble to find out.

      Just out of interest, why is the government so bad at explanation of its policies and dare I say it PR.

    • Posted March 1, 2012 at 8:12 am | Permalink

      Will NICE ever stop the NHS doing “alternative” medicines or do the people at NICE think such quack treatments are “cost effective”. If so how did they come to such an interesting conclusion, were they perhaps high on homeopathic drugs at the time?

      http://www.senseaboutscience.org/pages/letter-from-professor-baum-and-other-scientists-to-nhs-trusts.html

      • Posted March 1, 2012 at 12:30 pm | Permalink

        Lifelogic

        I suppose it depends on what you call “alternative” types of medicine.

        I was rather more concerned that we had a truely National Health Service, with the same guidelines for all, and not the postcode fiasco and rationing of drugs and treatment of recent years.

        • Posted March 1, 2012 at 9:17 pm | Permalink

          By “alternative” I mean all the treatments that can not be shown to work and are clearly pointless or mad.

  6. Posted February 29, 2012 at 7:10 pm | Permalink

    When does the government intend to address the opposition put forward by those representing groups who will not be abolished, such as the Royal Colleges and the BMA? If the government cannot convince these organisations or alternatively refute their arguments, then they should not proceed with this bill.

    There have been far too many disastrous ‘reforms’ in the past in so many areas under the direct control of politicians for a reasonable degree of scepticism not to be appropriate. Granted politicians have demonstrated excellence at throwing this country away to foreigners and Brussels bureaucrats and going to war on behalf of other foreigners as well as building up large property portfolios, but that does not demonstrate any capacity for acting for the benefit of the English people at all.

    • Posted February 29, 2012 at 7:32 pm | Permalink

      Will these commissioning groups be commissioning the training of future doctors or would they be equally happy that foreign ‘qualified’ doctors be imported, saving the training costs in the UK and reducing the overhead costs of provision? If health provision were to fragment, there might be no place at which trainees might receive a comprehensive education.

  7. Posted February 29, 2012 at 7:33 pm | Permalink

    What about saving money ?

    • Posted March 1, 2012 at 3:17 pm | Permalink

      Money will be saved by giving patients the cheapest treatment available or by denying treatment on the NHS. That’s how the market reduces costs.

      • Posted March 1, 2012 at 4:52 pm | Permalink

        Or by organisational improvements that reduce costs.

      • Posted March 1, 2012 at 8:54 pm | Permalink

        Money can be saved by giving cost effective treatment that reduces recovery times. For example, 50 years ago most lung surgery required sawing through the rib cage, requiring 6 weeks or more for the rib cage itself to heal afterwards often in an iron lung. Today, most lung surgery is keyhole, and patients can be released a few days after their operation. Such innovations are very much market driven – they reduce costs with better health outcomes.

  8. Posted February 29, 2012 at 7:58 pm | Permalink

    John

    I live in France and know that the last place on earth I would go for health treatment is an NHS hospital. Why?

    If I go to see my doctor I pay him 23€ for as long a time as the consultation requires, of the 23€, I am reimbursed partially or totally by the state depending on the illness and an insurance makes up the difference. No free drugs for illnesses not covered by the life threatening illness for which drugs are totally reimbursed.

    If I need to see a consultant, 28€, I am immediately given his phone number to make an appointment, if urgent this is usually the same day, if non urgent in about 2 weeks, but if he has a slot free, he fills it immediately, no patient equals no money, and always at a time and date that suits me, thus avoiding missed appointments! I always see the same consultant, so I get a consistent diagnosis, not a variety of registrars changing the diagnosis.

    If I need an operation, this is usually in a clinic, operated by a group of consultants, the one whose patient I am and surgeons, across a broad spectrum of specialities, they also have a consultant responsible for infection control, remember an infection will cause patients to go elsewhere and that is a very big financial incentive. The clinics locally to me claim a 33% reduction in operation costs compared to the state hospitals as well!

    Even more importantly I know the cost of every medicine and doctor/consultant visits and operations. This is surely important for the patient to know as he /she will think about missing an appointment or getting an excess of very expensive drugs and understand where the health budget is going, is this drug costing pennies or hundreds of pounds?

    Xrays are taken and then the doctor gives his verdict immediately before leaving, especially important for ladies and mammograms an immediate result saves weeks of worrying and even they are sent with the previous results to be double checked.

    It is my body that is being treated and I am not something for the medical profession to play with. I am responsible for keeping any xrays, heart scans etc. I take the relevant items to each consultant visited, this saves multiple visits to be told that the necessary documents have not been delivered to the consultant or even worse simply lost, my body is my responsibility. The next appointment is usually made after the consultation, it does not matter if it is the next day or a year’s time and I have never had an appointment changed by the consultant, I do admit to changing times myself, but always with plenty of notice.

    Here much more emphasis is placed on prevention rather than recovery from problems caused by delays, it is far cheaper to fix a problem sooner than wait until it is severe and costly to correct.

    Finally a visit to an NHS hospital is a superb experience, if you can remember Green Shield Stamps, except that for single stamps you get MRSA and double stamps you get c-diff as the bonus, if you are very lucky, they have run out of stamps.

    • Posted March 1, 2012 at 9:19 pm | Permalink

      A similar £20 charge for visiting the GP would be a very good thing for all but the very few who cannot afford it.

  9. Posted February 29, 2012 at 8:17 pm | Permalink

    Thank you for bothering to explain something which, quite frankly, is about as clear as mud to most of us.

  10. Posted February 29, 2012 at 10:48 pm | Permalink

    Fluoride is introduced in our once pure water in some parts of the United Kingdom against many people’s wishes yet it has not-to the best of my knowledge- ever been included in a ‘Health Bill’ before. Yet in section 87 (fluoridation of water supplies at request of relevant authorities), in the Health and Social Care Bill, is ‘Fluoride,’ so it obviously must now be classed as a ‘MEDICATION’.

    Yet in the Convention for the protection of Human Rights and Dignity of the Human Being with regard to the application of Biology and Medicine: Convention on Human Rights and Bio-medicine and other sites, it makes quite clear in Article 5, “An intervention in the health field may only be carried out AFTER the person concerned has given FREE and informed consent to it”. Not one person in this Country has been asked if they actually want Fluoride in our Water supply.

    Although many other Country’s have signed the Council of Europe’s Convention on this matter, the UK Government has not. I do have the complete analysis for Fluoride from the Irish Government, and I believe if the people realised its contents, they would be appalled that their MP could agree to accepting having fluoride in their drinking water.

    EU Commission Report.

    http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_122.pdf

  11. Posted February 29, 2012 at 11:10 pm | Permalink

    Thanks for this – very prompt. Has it been sent to the others too?

  12. Posted March 1, 2012 at 8:10 am | Permalink

    My personal opinion is that the NHS is broken – typical ‘lions led by donkeys’, with hard-working, dedicated nurses working all night for a low salary, and struggling to get, say, bandages supplied to their ward. At the same time you have the PCT, SHA, NICE, NHS Trusts, etc. Massive buildings in Central London stuffed with hundreds or thousands of ‘consultants’ all on 100k plus per annum, and at any one time they all have about 10 ‘consulting’ programmes with the big five, projects that all cost millions, many are duplicates, seldom achieve what is required and most will overrun on time and budget.

    So I like everything you say above, John, and I want to re-iterate, the Tories do not have a chance, because the average voter does not know when you are trying to help, they switch on the radio and the BBC tells them the Labour line which is that ‘the Tories are bad and are trying to hurt you’.

    I think that the Tories are unbelievably naive if you think you can achieve anything at all while the media criticises everything you do, and takes the Labour party line on everything, your every attempt is doomed.

    • Posted March 1, 2012 at 3:23 pm | Permalink

      Well under the new bill nurses will get even less money so the private sector can compete with the NHS. After all you can’t pay people a living wage and make profits for your shareholders.

      Also in medicine a ‘consultant’ is an experienced doctor or surgeon. They get a high salary because they’re needed to assess the patients’ condition to ensure the treatment is working and perform complex surgery.

    • Posted March 1, 2012 at 6:46 pm | Permalink

      Maybe more control of the media is needed including the internet and the press?

    • Posted March 3, 2012 at 12:10 am | Permalink

      “Dedicated nurses working for low salary”

      ?????????

      Nurses are not low paid.

      http://burningourmoney.blogspot.com/2010/03/public-sector-pay-who-gets-what.html

      and I think their “dedication” is at best uncertain.

      http://blogs.telegraph.co.uk/news/cristinaodone/100131793/visiting-a-patient-in-a-british-hospital-then-take-them-food-and-water-just-to-be-safe/

      Nursing is just another public sector career path now, rather than a vocation.

      • Posted March 3, 2012 at 4:43 pm | Permalink

        I appreciate that everyone should in fact work for nothing except you, but £30k a year for being a nurse is raking it in? You must have some dedication to do this work for about £400 after tax
        ???????
        The fact that some patients water and food intake is not monitored close enough is not conclusive proof that they cannot be arsed with their jobs. If I put such a generalisation forward for your favorite career. You would dismiss the idea outright, but like many on this site live cushy lives in easy jobs. How is this possible when you are so thick? I think I know. Ram it.

  13. Posted March 1, 2012 at 8:40 am | Permalink

    An interesting discussion on the Health proposals on Newsnight last night.

    A rather more balanced discussion than I had seen for some time, or come to think of it, at all on this subject.

  14. Posted March 1, 2012 at 8:59 am | Permalink

    my GP is useless, the system does not currently allow me to move GP, how does this new bill help me?

    Reply: i thought you could ask to change GP within a practice, or even to change practice.

    • Posted March 1, 2012 at 11:58 am | Permalink

      You can ask, and if you’re an MP or a multi-millionaire like David Cameron I daresay it would be a cinch, the bureaucrats would be falling over each other in their desire to help you. A different story out here in the real world.

      In my practice I (in reality my wife) just get landed with whatever doctor is available, so you’re never seeing the same doctor twice in a row or if you do insist on seeing doctor x you get told there are no appointments apart from ’emergency appointments’ (you need to call at 0830 for one of those, and have to accept any doctor they give you) for another 2 weeks with that particular doctor.

      So theoritically you can, but not if you want the appointment to be of any practical use.

      My wife, who is an immigrant, has been verbally abused by a doctor complaining about immigrants and people coming here with poor English skills (which is rich considering some of the ad-hoc doctors we get from Europe to cover weekends) but we’ve no choice but to carry on using her if she’s the appointed doctor.

      And moving practices is a no-go, we tried but were told the other practice (there is only two where I live) was full and that as we were already registered at the other there was no other recourse available.

      Thank goodness our NHS is the world’s best health care system or I’d resent all the cheques I send off to HMRC.

      • Posted March 1, 2012 at 12:02 pm | Permalink

        Oh, and I guess I could complain about that doctor but it would be blown out of all proportion as anything involving an ethnic minority always is, and it was probably just a throwaway remark made by someone stressed out at the end of a busy day fed up dealing with a bunch of malingerers and time wasters so I would never do that, even if was upsetting at the time.

      • Posted March 1, 2012 at 2:25 pm | Permalink

        Sounds like you’ve got a bad practice.

        Where I used to live you could see whichever doctor your wanted at the practice or change practice without cause.
        If you wanted to see a specific doctor, you might have had to wait longer but that’s life.

        Remember – if you don’t want a particular doctor, you don’t have to let them anywhere near you and you don’t have to give a reason why. That’s why they have to ask your permission before they do anything – it’s assault/battery otherwise.

    • Posted March 1, 2012 at 5:17 pm | Permalink

      Not out here in the real world the only way to change gp is to move house

  15. Posted March 1, 2012 at 9:27 am | Permalink

    It is hard to understand how anyone could be opposed to these changes and yet we are given a daily recital in the media of growing opposition from within the NHS. The main reason I have picked up is that there is a belief that the NHS is being privatised and that is a bad thing. This assertion is seldom questioned or explained but it is portrayed as a bad thing and I think is deliberately meant to make the public feel that they will have to pay and therefore oppose the bill. The word competition seems to be an anathema in the NHS and no doubt its use will soon be banned in the interests of political correctness. I don’t suppose that those same people who oppose competition in health service provision would be too enthusiastic if it were suggested that all supermarkets would in future be owned by, say, Tesco. Competition is ok as long as it doesn’t affect them. This has become a propaganda battle between the government and vested interests. A battle which the government has so far been losing.

    • Posted March 1, 2012 at 8:05 pm | Permalink

      The problem with privatisation is that for the same service you have to pay more so the shareholders can make a profit. This is why the cost of trains and energy increased after they were privatised.

      The problem with competition was that GPs always had to choose the cheapest providers, not the safest or closest one.

      • Posted March 3, 2012 at 12:12 am | Permalink

        In the case of trains, the quality of service increased dramatically.

  16. Posted March 1, 2012 at 9:31 am | Permalink

    Thank you John for a clear exposition of the Government case.

    I do wish there was an alternative to “Punch and Judy” politics where both sides were required to make their cases, in writing, for or against, in less than 500 wards. I for one would then have some understanding of the issues.

    All I know from the media about NHS reform is that; “The Government wants to destroy the NHS”, “Labour wants to save it from Privatisation”, and the Medical Professionals don’t like any change, ever.

    Wish we could be treated as grown-ups.

    David Ford

  17. Posted March 1, 2012 at 10:09 am | Permalink

    My experience of the NHS is that it has deteriorated despite the extra funding received and desperately needs change. But tone of objections does make me wonder if opposition is more than simply producer interests at work and if the mechanics of how this will work are sound.

    Will there be any piloting of these changes before they are implemented in full or is the government going for a ‘Big Bang’ approach.

    • Posted March 1, 2012 at 8:07 pm | Permalink

      The Conservatives will implement it in full so the healthcare companies, which donate large amounts of money to them and senior ministers, can start making money. Expect it to go supernova at election time.

      reply: Do you have any evidence for these donations?

    • Posted March 3, 2012 at 12:17 am | Permalink

      It certainly sounds like NHS workers trying to protect a closed shop.

  18. Posted March 1, 2012 at 10:18 am | Permalink

    The Bill abolishes two layers of administrators (PCTs and SHAs)
    But I expect like all quangos, they will reappear in some other form.
    For example, I have no doubt another group of administrators will be set up to check that the doctors are providing the care correctly as envisaged by the government, and of course, where money is involved, we will need auditors. At the GPs’ practice, there will undoubtedly be the need for more staff to administer the scheme, and I expect the GPs will be spending more time dealing with administration previously done elsewhere.
    I am not impressed by the proposed changes, I believe that much the same could have been achieved by slimming down the existing NHS ans making those administrators legally responsible for their cations.
    With this government being so pro-EU, I’m surprised that they haven’t looked at how they run their health services in some of the EU countries such as France and Germany, particularly as recent reports suggest that we are now spending one of the highest sums per capita on health care, but that the outcome, particularly in terms of cancer treatment, if far from being the best.

    Yes, we need major changes to the NHS, but I’m far form convinced that what is proposed will make much difference as far as the patient is concerned and it does nothing to reduce the huge administrative overhead.

  19. Posted March 1, 2012 at 1:45 pm | Permalink

    Is there a danger that individual GPs will spend their annual budget in 10 months then spend their last 2 months delaying treatments? Or, possibly worse, under-treat and under-prescribe all through the year then have money left over?

    GPs will still need support and help in making their decisions and planning their budgets through the year. We don’t want them spending all their time doing budgets and auditioning potential new suppliers. They will need support. Why were they not just put on the boards of PCTs instead and could take on commissioning from them?

    But why are GPs considered to be the right people to run the NHS at this level? They are not even inside the NHS! They are small businesses and practices attached to the NHS. It is a bit like asking newsagents to regulate the newspaper industry based on the idea that they know what their customers would like and are better than the PCC.

    • Posted March 1, 2012 at 8:14 pm | Permalink

      Don’t worry under the new system GP’s can’t spend any money without the approval of a consortia of private companies that control the budget for them, so expect under-treatment and under-prescription through the year.

      GPs are considered the best people because private health companies can make a lot of money selling their services to GPs who don’t know how to control a massive budget. Also it removes control of the NHS budget from the NHS, making it easier to bankrupt NHS hospitals and force NHS staff to join private hospitals (saving a fortune on NHS pensions).

    • Posted March 3, 2012 at 12:14 am | Permalink

      Moving decision making closer to the patient is good thing.

  20. Posted March 1, 2012 at 2:40 pm | Permalink

    Your article bares a startling similarity to this one…

    http://www.claireperry.org.uk/working-for-you/campaigns/a-plain-english-guide-to-the-health-bill/295

    is she copying you? Or, are you copying her?

    Reply: As I stated at the top of it, it comes from the government!

  21. Posted March 1, 2012 at 3:28 pm | Permalink

    I’m surprised the Government was able to tells so many lies in so few words. Have some facts about this bills.

    1) This statement is contradictory; is it the GP or the Clinical Commissioning Group who decides who the money is spent? What happens if they disagree? Also can private companies influence these decisions or is it only made up of NHS employees?

    Let me explain what this bill will actually do; create several consoritas which will rations the NHS budget. So if your consortia doesn’t approve of your treatment you won’t get any treatment unless you go private. Worse still the consortia can refuse treatment for any reason and there’s no right of appeal. Expect the disabled, elderly, and mentally ill to get very little medical treatment.

    2) This point is an outright lie. Unless the GP has an unlimited budget they can’t give every patient the best treatment and will be forced to choose whichever is cheapest. The same thing happened when cleaning hospitals was outsourced to private companies; the cheapest cleaners were hired and infection rates greatly increased.

    Also the NHS cannot offer the best treatments to everyone while the Government is demanding they make £20 billion of savings.

    3) So all the people legally required to shut down a hospital will be available in one place. Do they have to publish their decisions or will they wait until it’s too late for local people to oppose them?

    4) No this bill allows private companies to ‘cherry-pick’ the most profitable operations, while the more costly and long term ones will have to be done by the NHS.

    Hypothetically speaking if a private company performs surgery, botches it, and sends the patient to an NHS hospital where they need months of treatment will the cost of saving the patient be charged to the private company of the NHS? If it’s the NHS then expect private companies to take major risks knowing that the state will fix all their problems for free.

    5) How is this going to work with regards to the private sector which isn’t part of the NHS? Will all private companies throughout the UK be bound by this statutory duty? If not then expect private companies to be used as a way to circumvent this duty.

    Also why hasn’t Andrew Lansley publishing the NHS risk register? Doesn’t Parliament need to know the risks of the new bill to make an informed decision?

  22. Posted March 1, 2012 at 6:23 pm | Permalink

    Your explanation as not convinced me this bill is for one thing only, to fragment the NHS and eventually bring in private practice. The Private sector may be brought in to run certain services, but when they start complaining they can no longer afford to do it, charges will be introduced. This is the way they are trying to break up what we have had for over 60 years. My Doctor is hopeless, you can’t get referals now without a fight, often you have to visit several times to get the complaint sorted, and the receptionists they employ are like little (Autocrats-ed|). Dictating what we should do, so choice is limited and to argue gets rebukes. They won’t make home visits at all unless they are forced to, you have to be dying before they do that. Referrals are often made to places outside ones locality, where getting there is difficult especially if you have no car like us; where they could send one direct to the local hospital the often go round the wreken, so them holding the purse strings will be a disaster in waiting. We can expect funds to disappear abroad from the many foreign doctors we have, they are after all human beings like us and have failings.
    I’m not happy at all with this bill, and the Tories didn’t say they were going to do it, that was decieving the voters. For me that’s enough, NO VOTE off me then and many others. Drop the bill before it’s to late, I forgot Cameron hasn’t the courage to do that.

  23. Posted March 1, 2012 at 7:55 pm | Permalink

    I’m not sure that I like 3 ‘It joins things up at local level’. The nasty stalinist monopoly will widened if not deepened. The thinking reminds me a bit of Richard Crossman’s gigantic Department of Health and Social Security. It is possible to be ill without being a basket case. There are far too many people in this country whose livelihood depends on creating as many ‘things’ as possible – ‘things’ have have got to be looked after and can be bossed around. The epicentre of this culture is in Bootle, Merseyside, where 50% of the population is either ‘curring’ or being ‘curred for’.

    Point 5 is very well meaning but it won’t work. As long as you cannot afford to drive (and park!) at the best out of town hospitals, your care won’t be as good. If a free ambulance service were to be offered, that might make a difference.

  24. Posted March 2, 2012 at 1:22 pm | Permalink

    Your 5 points puts the governments case across very well. There has been so much on this I often wonder how much is the usual ‘vested interests’

    Its long been clear that GPs unlike A&E and other hospital clinicians do get paid an awful lot of money for normal working hours so its time they took on more responsibility to match what their earnings – you can see why many won’t support this.

    I dont know much about the NHS but I have heard this from the mouths of other medical professionals that many GPs have become lazy and overpaid, so it seems clear that the govt is placing the burden of the PCTs onto this group does seem the right thing to do.

    And what is the problem with using private providers? Its a service thats funded by taxation which comes from private money so I why the socialist worry about using private providers for services? As long as the best provision is provided and remains at no cost to the end recipient it shouldn’t be an issue.

    I still think we should be looking at other health provision models like in Switzerland and maybe France cos ours as many have said seems to cumbersome and expensive.

  25. Posted March 2, 2012 at 2:42 pm | Permalink

    Sorry John but “5. For the first time there is a statutory duty on the NHS to reduce health inequalities” is, as they say a bug not a feature. It imposes an additional goal over what one might expect – eg “give the best treatment for the patients in front of you” – which can apply at all levels. As a matter of fact you can reduce inequality but cutting off the best treatment – absurd, but in a target-led, bonus driven managerialist culture it will happen, because the goal of such targets is to force behaviour, however absurd, that reaches them. In addition we will (continue to) have bureaucracies to define ´healthcare inequalities´, measure them, and feedback the findings as interference to operational decision-making.

    Fail

    Reply: This as I headlined is the government’s view, not my view.

  26. Posted March 2, 2012 at 6:30 pm | Permalink

    You list a couple of examples of innovative projects that are working well for patients, but there are many more. Why isn’t the Health Secretary publishing a comprehensive list of these? We need to be presenting the positive aspects of this legislation to counter all the criticism.

  27. Posted March 2, 2012 at 7:19 pm | Permalink

    Can anybody help? I asked my local MP James Arbuthnot how, and using what input parameters, the GP budgets are to be determined? ‘Don’t know, it’s not my subject.’ Fair enough, Mr Arbuthnot is a defence specialist.

    So who does know? John Redwood is an expert on financial matters. Or there may be a knowledgeable GP among my fellow bloggers. It’s a question that does need an answer.

  28. Posted March 2, 2012 at 11:16 pm | Permalink

    In principle, I agree with a Bill to reform the NHS, what worries me is why now ? It is going to cost millions to implement and our finances and borrowing are in a dreadful mess. The other worry is GPs do not have the qualifications or time to do the research and accounting so they will have to employ all the people who will lose their jobs as the 2 top layers of beaurocracy disappear – this seems idiotic to me. The NHS is SO VAST and unwieldy that it should be broken up into Cottage Hospitals and specialist units with a few general Hospitals kept to deal with minor stuff, otherwise it will just go on and on swallowing huge amounts of money without anything to show for it.

  29. Posted March 4, 2012 at 1:52 pm | Permalink

    When all other possibilities are exhausted the one remaining however improbable must be true. The NHS Bill is complex; it is poorly understood by everyone; it is unwanted by the NHS. So what is its purpose? It must be designed to fail. It is a means to dismantling the NHS by a political class who know it can never be done honestly and openly.

    What the NHS needs is a return to Health Authorities and the abandonment of competition. There are just some things which need to be kept simple, in house and not for profit. When most an NHS Trust’s time is devoted to self congratulation and the promotion of LGBT, BME and other such political agitation something is very amiss.

  • 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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