In praise of Mr Lansley


                  This week-end has seen numerous briefings against the Health Secretary. I have found him to be one of  the best informed, and  most accessible of Cabinet Ministers. He knows his brief well, is aware of the problems of piloting through change to the NHS, and has already secured the support of the overwhelming majority of GPs to his new proposals for commissioning.

            The first criticism made of him  is he has come up with radical reform proposals that were not explained to the public before the election. I have quoted liberally before on this site from the Conservative Manifesto to show this is wrong. The Manifesto on pages 44-49 went into considerable detail explaining the changes. It said administrative costs would be cut by a third by taking out layers of bureaucracy. It said GPs would be put in charge of local commissioning and would help patients by purchasing their care from a variety of providers. It said “We will give every patient the power to choose any health care provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers”.

               The second criticism is that these changes are somehow against the spirit of the NHS, and different from the kind of reforms Blair initiated. Again, this is wrong. All three main political parties and a large majority of the UK electorate strongly support the central idea of the NHS, that care should be made available free at the point of use on the basis of need. The care should be paid for by all taxpayers through their contributions to general tax revenues.

             All three parties have long accepted the role of the private sector to help supply the free care for patients. The NHS presided over by Labour, Lib/Labour and Conservative governments have in the past relied heavily on for profit companies to supply all the drugs and other medical supplies  used in the NHS. They have employed contract cleaners, caterers, management consultants, legal advisers, advertising agencies, recruitment consultants, property experts and the rest from the private sector to assist in managing the large service. The NHS has offered contracts to many doctors whom also run private clinics, or charge for additional services provided to NHS patients. The doctors were not nationalised when the NHS was set up. Much elderly care has long been provided in private sector nursing and care homes.

                   Labour also strengthened the idea that parts of the medical and clinical workload could be contracted out to private clinics and hospitals. They reasoned that if a private clinic could perform cataract removals or knee joint repairs to a high quality standard and the same or lower price than the NHS, they should increase NHS capacity by letting such contracts. Labour also used private finance extensively and often very expensively to build and rebuild hospitals and other facilities.

                     Like so many public services in the UK, the NHS is not entirely nationalised, though often misunderstood by its employees and some patients. It has never been the case that all the NHS assets are state owned, all the employees are on the state payroll, and all the supplies and services are provided by public sector suppliers. Some of Mr Lansley critics are trying to make out that there was some kind of golden age when the NHS worked well because everything was done in house by public sector staff. History tells us otherwise.

               Some critics cry foul at the thought that the private sector might do what it can do best and at lower cost. Taken to extremes, that judgement would end all private contractors currently working within the NHS.  Some argue that the Lansley reforms are back door privatisation, whereas the PFI/PPP/private sector contract regime of Labour was somehow not privatisation.  These criticisms are not thought through.  Healthcare in the UK is under the umbrella of free care at the point of use and will remain so. Beneath that umbrella there has always been a lot of mixed working between public and private sectors. Instead of being ideological about it, why  not let patients decide where and how they want to be treated with the advice of their GPs. Haven’t we got beyond the yah boo of public/private, in a service which has many interactions and hybrids between the two?


  1. foundavoice
    April 4, 2011

    “The first criticism made of him is he has come up with radical reform proposals that were not explained to the public before the election. I have quoted liberally before on this site from the Conservative Manifesto to show this is wrong. The Manifesto on pages 44-49 went into considerable detail explaining the changes.”

    This is true. However, there has not been (to my mind) a consistent loud message coming out before the election and since the election. This is indicative of the Govt. where the good ideas (e.g. IDS’s social reforms, Gove’s school reform and Lansley’s plans) are not being communicated well or consistently or for any frequency over a length of time that it becomes common knowledge.

    And yes, it is all there if you *really* look for it, but did the Tories learn nothing whilst in Opposition about communication, about setting the agenda and framing the argument? Labour managed to pin an entirely disproportionate amount of their economic mismanagement on the banks by simply repeating their ‘viewpoint’. You are going to keep being on the back foot until you learn to crack this.

    I complete agree with the rest of what you wrote, mind.


    1. alan jutson
      April 4, 2011


      Agree with your points about communication.

      The biggest failure of this government, is its lack of ability to communicate any of its policies, in any form of sensible and understandable manner.

      This failure will result in failure to win a second term, guaranteed.

      It also seems to have a problem with being able to think through proposed polices clearly before they are launched, and then a certain amount of back tracking seems to take place.

      The biggest failure of all Governments (for decades) appears to be the lack of ability to tie up any Purchasing/building/services contract with the Private sector in a sensible, commercial and business like manner to ensure real value for money.

      The taxpayer always seems to pay through the nose, even on failure.

      Cost over runs, maintainance, design changes, work paid for (number of operations agreed, but never asked to complete) are all extra costs which seem to be the norm rather than the exception.

      Where are the payment by results, penalty clause type contracts which should be the norm.
      Where are the regular inspections to make sure contract terms and performance is being met.

      You would have thought the civil service with all of its expensive staff, all of its so called expertice, would be able to write or advise on a form of a tight contract, but it appears that they are happy, along with government ministers of the time (many of whom have absolutely no commercial negotiating experience at all) to allow us taxpayers to be fleeced on a regular basis, by those who are in actual business to make money.

      John those ministers who are up to speed with their brief are being let down by those who are not, and by lack of support from the system. I have blogged before about the Government needing an enforcer (or a team of enforcers) who will make sure things actually happen, that policies are followed through, and that the yes minister employees of this world are put in their place.

      I have no problem with contracts being put out to private organisations, as long as they are, and give, value for money and meet performance criteria which is better than the NHS or any other department can provide. The fact that in addition they make a profit, is evidence if any was needed, that the state run organisations are not only inefficient but expensive.

      1. alan jutson
        April 5, 2011

        Oh Dear

        Just heard that the newest NHS proposals are now being put on hold pending further clarification.
        Mr Clegg has been interviewed both on TV and radio and said that there will be substantial alterations to the original proposals.

        Yet another bloody farce.

        The second farce of the day:
        A new simple better paid pension scheme for everyone (without means testing), but it will not include the millions of present pensioners, or any that are due to retire up to 2015 -16.

        So there you have it, those of us who have paid in for 39 years or more get nothing extra, those who will only pay in for a short period, but who will retire in 5 years time will get the larger amounts in full.

        Why not make it simple, put everyone on the same basis, and close all of the departments related to additional pension benefits, which millions are on, to help pay for it.

        Think you need to do a “U” turn on the second farce, if you do not, then be prepared to lose many, many millions of voters who have paid into the system all of their lives, in 4 years time.

        Just seen Mr Cameron on lunchtime TV news, seems we are giving £650 million to Parkistan for educational purposes.
        In return we may get our secret info on how we defuse IED’s leaked to the Taliban via their supporters who have infiltrated (parts of -ed) Parkistan.

        Just had AV info through the post, another £500 million waste of money.

        Thought we had no money ?

        Oh yes, forgo we have enough to pay the EU £40 million a day.

        With all this moey sloshing around why do we even need to talk about cuts, let alone fail to implement them.

        It is not looking good today John is it.

        Mixed messages all around again from a goverment who do not seem to have a clue where they are going or how to get there !

        Thats my rant over for the day, now for a coffee.

        1. alan jutson
          April 5, 2011

          Almost forgot

          Earlier in the week the government announced a rise in prescription charges for England, on the same day Scotland announced they would be free there. Wales and Ireland already free.

          Income from prescription charges is reported as £450 million per year, as only 10% seem to pay the full amount.

          The £650 million we are just about to give Parkistan, would have paid for free prescriptins for everyone in England for a year and a half, then you could have scrapped a whole department who has to administer the expensive system with all of the non payers having to be recorded etc, etc, and saved further £ Millions each year.

          Do we know/does anyone know what the full administration cost is with regard to prescription charges for everyone concerned ?

          1. Acorn
            April 5, 2011

            Prescriptions: The NHS in England spent £8.2 billion on prescription drugs in primary care in 2006, which represents around a quarter of the total expenditure on primary care. Ninety-eight per cent of these drugs were prescribed by GPs (National Audit Office 2007)

  2. lifelogic
    April 4, 2011

    Why should people have to pay for glasses, prescriptions, the dentist, food, parking, a hair cut and nearly anything else but not have to pay to see a doctor if they can afford it?

    The effect of this is that NHS GP’s uses back door methods to ration visits by making it hard or inconvenient to book appointments and having too short appointments, particularly for people who work. Free at the point of use is mad for those who can afford to pay. It and a lack of choice is the heart of the problem with the NHS.

    1. Electro-Kevin
      April 4, 2011

      It must be galling for working taxpayers to be unable to arrange visits to see their GPs in advance.

      This is a service which they are paying through the nose for.

      1. REPay
        April 4, 2011

        I have never been able to see my NHS GP in central London. I wanted to deregister as I objected to the fact that they are paid money for my inclusion on the register. I was advised against this as possibly being injurious to any need for NHS care. The fact that I always have to wait a week means I have normally gone to a private doctor – I then have to pay full price for any medicines…

        I remember Dr. Theodore Dalrymple opining once that the NHS is superb at its primary role of supplying employment and pensions for a large number of people…no wonder Labour is against any reform of this situation.

        1. lifelogic
          April 4, 2011

          I agree there is a sort of contempt for the |”customer” as they already have his money and they want to do to deter him/her from bothering them.

          Two examples I needed some antibiotics for a very severe throat infection needed 30 seconds of a doctor to look at my throat and 50p of drugs. I could not get a doctors appointment after ringing several times so had to wait in casualty for 3 hours no good pointing out I only needed antibiotics they have s system to deter so you will wait three hours. It should have cost next to nothing.

          Secondly appointment arrived with a set time and date – not a phone call to agree a convenient time or any check that the card was actually received. I ring to rearrange no answer on the number on the card and an answer phone left three message no return call. I ring switch board they cannot find right department in the end I had to go the the hospital to rearrange the appointment.

          And that is before you get me on to quack treatments, vanity surgery and virginity reconstructions they do.

    2. waramess
      April 4, 2011

      @ lifelogic, I used to pay to see my GP and it cost £15 per session. Hardly likely to impoverish but not very socialist. The downside was that I had to pay market prices for medication. I now see my GP on the NHS because none of the doctors locally are willing to take private patients.

      1. lifelogic
        April 4, 2011

        Absolutely – a monopoly – you have already had to pay for it so it is rationed by making it inconvenient and unpleasant. Also managed and run mainly for the convenience and enrichment of the staff and managers.

    3. wab
      April 4, 2011

      Personally I think that dental care should be part of the NHS. And most of the things lifelogic mentions are subsidised in some way by the state (including food, because there is no VAT). But let’s not quibble.

      I hope Tories on the whole agree that we do not want an American-style health service, where people can literally go bankrupt trying to pay for health care. That is the major distinction between health care and the other things you mention. The bills can easily become catastrophic, and to some extent it is a lottery whether or not this happens to you or your family.

      Before the last election the Tories endlessly whined about all the major changes that Labour brought in over the previous 13 years, and claimed they would bring in an era of stability. Funny how that didn’t work out.

      One thing that is key with these so-called reforms is that the incentive should be obviously set up so that GPs look after the best interests of patients, not their own best interest (i.e. their bank account).

      1. norman
        April 4, 2011

        Not sure if this is trolling (which I’m guilty of myself sometimes) or an outstanding example of leftist mentality – something that isn’t taxed to the hilt is subsidised by the state.

        I remember hearing a speech by President Obama (or a part of it) a few months ago and he said he had already made hundreds of billions of spending cuts. The reasoning he used was that he had continued the ‘Bush tax cuts’ so was depriving the state of that money – he viewed this as a spending cut.

        That’s the leftist mentality – all our money belongs to them and they decide how much of it we are allowed to keep.

      2. lifelogic
        April 4, 2011

        Not having VAT on food is hardly a subsidy – many counties have no sales tax at all on anything and free trade unlike the EU which pushes up the price of food and much else hugely through CAP and duties.

        Subsidy no indeed quite the opposite in the EU.

    4. A.Sedgwick
      April 4, 2011

      Agreed. From anecdotal comments I would say many GPs are frustrated at not being able to spend more time and give quicker appointments for those really needing their help. £10 a visit would redirect some to Boots, deter timewasters and maybe GPs could start emulating dentists (now mainly private thanks to Blair) with more emphasis on prevention and early diagnosis.
      On the broader front there are numerous areas in the NHS that should not be financed by the taxpayer, conversely the complete and early availability of treatment for serious illness should be automatic e.g. life prolonging cancer drugs.

    5. lifelogic
      April 4, 2011

      Radio 4 had Shirley Williams on who seemed to be strongly against Mr Lansley’s so he must surely be working on the right lines.

  3. Bill
    April 4, 2011

    yes, but I think – if you took a poll – most people just don’t understand the change – me included

    1. acorn
      April 4, 2011

      Spot on Bill. We are about to get a pamphlet on the AV voting system. I can’t remember seeing one for a much greater changes to the NHS. The White Paper was as enlightening as the clarity of Lansley’s signature on the document.

      “Free at the point of use leads to abuse”. If you read the King’s Fund report you get a better idea of the size of the problem. “The estimated total number of consultations in general practice in England rose from 221.8 million in 1995 to 299.3 million in 2007, an increase on average from 3.9 to 5.4 consultations per person per year”. So are we getting sicker?

      When the state is both “purchaser” and “provider” of a service, discovering what the free market price of any part of that service, is near impossible.

      1. Bill
        April 4, 2011

        Free services are abused (Mr Lansley’s change won’t change this)

        I return from a business trip to Egypt – ill with opposite of constipation (can’t spell it) and feverish – ring GP for appointment – 10 maybe 15 times engaged – rang next morning engaged again – took to bed got better after 3 days no medication.

        I ring up for a vet – its fine – bring the dog in ½ hour

        Why don’t GP’s get paid like vets – when you go to them?

        Chronically sick and old – state pays

        1. lifelogic
          April 4, 2011

          A perfect illustration of the problem. And does not just apply to a vet – anything else you pay for directly a florist, builder, boiler man, electrician, optician, and does not have an almost state monopoly.

      2. lifelogic
        April 4, 2011

        5.4 consultations per year!

        I have been to the doctors in my 50 odd years or so on average about once every 4 years. And five of those were for them to misdiagnose appendicitis (so they could have been avoided) some of the other were for antibiotics on which they have a state enforced monopoly.

        Perhaps I have spent a total of 2 hours with a doctor in my life and had my appendix out. So benefit received perhaps £3000 total and may be £200 worth of inoculations and the odd drug (would have been less had they not failed to diagnose correctly) actual tax and NI paid so far perhaps £1.5M.

        Is this good value?

        1. K.W.Chesterton
          April 5, 2011

          The majority of NHS costs per person are incurred in the final years of life or during one final major illness so it is likely that you will get better value in future. Your figures may be correct & represent poor value to date though.

  4. Electro-Kevin
    April 4, 2011

    “The Manifesto on pages 44-49 went into considerable detail…” etc

    There were lots of things The Manifesto went into detail on.

    When it comes to the next election it’s quite clear that we should take the Tory party promises with a pinch of salt.

  5. StrongholdBarricades
    April 4, 2011

    I am all for reform of the NHS, as it is long overdue.

    My only concerns are:

    1/ No public accountability for a tax funded, they work for us body

    2/ No ring fencing of budgets for patients to stop gerrymandering of personal salaries by GP’s

  6. Richard1
    April 4, 2011

    the Government must stick to its guns on these and other reforms. The public sector unions have a hugely disproportionate share of airtime & we must expect them to resist all reforms which challenge their power and privilages. But the silent majority of taxpayers in the UK want value for money and know the explosion in the size of the state under Labour is unsustainable. The Government must expect to get a tough time in the media, especially with the BBC as the effective voice of the public sector vested interests. In 4 years time at the election if the Government stands firm it will reap the benefits.

  7. Michael Read
    April 4, 2011

    You quote the Conservativce manifesto. Fine. But the electorate didn’t give you a majority for that manifesto. The coalition agreement, the quasi manifesto, contains no mandate for the changes Lansley wants to implement.

    Why do you persist in this sleight of hand?

    You are engaged in an exercise which if it were done by the EU – which it often is – you would complain on each and every occasion.

    What is this: Wokingham rules OK.

    Reply: There is no sleight of hand. The Manifesto set out the reforms. The Lib dem had some similar bits in it about cutting brueaucracy and more patient choice. What is your problem with that?

  8. waramess
    April 4, 2011

    I really do find the options a puzzle. The Health Secretary proposes a radical restructuring in order to replicate as far as possible the private sector, where supply is determined by customer demand, and determined by those closest to customers and there is considerable disquiet. No doubt there is disquiet because any radical reform is a great risk and clearly vested interests can easily use the fear to their own ends.

    The puzzle is that we are invited to chose between bread and cake when there are a whole raft of other options.

    There are trillions of pounds invested by the taxpayer in our socialist inspired health service that yield us not one penny in return.We bravely sell off one prison to release a quarter of a billion of badly invested resources and yet it would appear we will willingly give away bits of the health service, when the baying of the socialists is not too loud, but we will resist “selling the family silver” no matter how impoverished we become.

    Every hospital represents a huge investment in assets, including its people, and each has a high value in the private sector, but is being poorly managed in the public sector. Why on earth take on the huge risk of trying to radically reorganise the Health Service along private sector lines, and along the way giving away valuable assets to the private sector for free, when the least risky course would be wholesale privatisation?

    The government would still protect the poor but would not I suspect pay for free visits to the GP by millionaires

  9. Susan
    April 4, 2011

    I do hope this is not going to be another U turn, if it is, the Coalition will start to lose all creditability with the public.

    I agree with the reforms for the NHS as far as they go, but they are not a long term solution. I also agree with many, who oppose the reforms, that there is a lot of scope for things to go wrong, unless careful planning is put in place. However, with or without the reforms proposed, the taxpayer will still continue to throw money at a service which is not fit for purpose. The NHS has become the sacred cow of Politicians, the public and those work for it, which makes it very difficult for any Government to bring about true reform. Many in the NHS worry that what is proposed will bring competition between the NHS and private firms. This, though, is surely what we want to improve standards.

    The facts are, that patient expectation, new expensive treatments, obesity levels and an increasing aging population, has put the NHS under pressure. This would require massive sums of money from the taxpayer to just keep the NHS going in the future. Labour pumped money into this service over their 13 years, increasing the budget substantially, yet productivity went down. Most of the money was spent in staff getting higher wages, very little filtered through directly to the patient.

    An insurance based model such as other Countries have would be the right way forward, this apparently increases quality and efficiency.

    A taxpayer funded NHS is not only inefficient it is unsustainable and ring fencing its budget was a poor decision. Still I suppose, like everything else, it will only be the failure of the service in time to come, after vast amounts of money have been wasted that people will come to realise this.

  10. Gammidgy
    April 4, 2011

    With respect, Mr Redwood, there is another criticism of Andrew Lansley that you do not mention: he has continued to claim there is evidence to show that his proposed policies will deliver the desired outcome, even after it has been pointed out that there the evidence says no such thing. At the next election I shall vote not for the party with the ideology that most closely matches my own but instead for the party that is most able to base policy on the available evidence. On current showing that is unlikely to be the Conservatives.

  11. Hugh
    April 4, 2011

    “In war Truth is the first casualty”

    There are, it seems, some very unscrupulous people about, and they work hard to ensure that Truth is indeed the first casualty because they have a political axe to grind.
    What can be done do you think to improve this John, apart from making regular reading of your blog mandatory.

  12. Lindsay McDougall
    April 4, 2011

    I suspect that many GP group practices have not thought through how they would negotiate with central government about determining their overall budget and how they would allocate it to individual doctors. I imagine that group practices would get bigger so that they could carry the overhead of someone who was financially savvy enough to do the budgetary calculations and negotiations. My GP says that in principle the budget calculation is simple enough – based on population catchment, demographic profile, stress levels (low incomes, single mothers, smokers etc). The difficulties are the extent to which future changes can be predicted and how to handle competition. The existing PCTs must have dealt with these issues and no doubt some of their existing staff would be employed by the enlarged group practices.

    To me the main benefit of GP group practices holding budgets is the hospitals may be run for the benefit of patients rather than the benefit of staff. If you have a condition that requires a number of diagnostic tests to be carried out, it is convenient to the patient that all the tests be carried out on a single day that is convenient to the patient. NHS hospitals don’t work like that. They have departments and you are summoned by the hospital to attend different departments on different days. That works out at 4 lots of petrol costs for return journeys and 4 lots of NHS car parking charges – and the longer that you have to wait the greater the parking revenue accrued by the hospital. Don’t you dare to tell me that this is a service that is free at the point of use. The patient’s TIME is worth something; doesn’t the NHS EVER take that into account?

  13. Popeye
    April 4, 2011

    I would hazard a guess that most of the complaints are from the Unions and Union members who wish to maintain the status-quo complete with all the restrictive practices that goes with it.
    Kep up the good work Sir!

  14. Mike Stallard
    April 4, 2011

    The way it is presented to the Public is that Mr Lansley makes all the wrong decisions.
    What happens is that the Civil Service, the Unions and the Media decide what they want to happen and then bang on and on about it. Of course,( surprise!), what they want is what hepld them, not what is good for us the public.
    The more risks we can apportion to risk takers – with rewards commensurate – the better. But the groups that are standing in the way loathe risk, personal responsibility, courage and doing the right thing. What they want is to cover their backs.

  15. forthurst
    April 4, 2011

    I hope that Mr Lansley has spent a lot of time visiting our continental neighbours before attempting to diagnose what is wrong with the NHS.

    It is well known that our continental neighbours experience far better medical services in far better conditions at much less cost than in our own much vaunted, but third rate and very substantially third world staffed NHS. In fact, only about a third of doctors practising
    in the NHS are what I would class as British. Our reliance on foreigners who cannot speak English and those whose skills, intellectual abilties and qualifications are rightly questionable raises the issue of the competance of the GMC to be the arbiter of our medical profession.

    I do not see that it should be the function of GPs to commission services. GPs are currently constrained to refer locally. If a GP would like a patient to attend at a centre of excellence outside of his local area, that should be allowed as it used to be.

    There is no reason why hospitals should be incorporated into an enormous hierarchy presided over by a Minister and some idiotic Spad vapouring in his ear but it is wrong to put GPs in the driving seat as replacements for layers of existing bureaucracy. They are not equiped. Futhermore, the NHS cannot br run entirely like a business unless we are prepared to treat people as motor cars.

  16. David Thomas
    April 4, 2011

    You’re quite right to suggest that private provision forms an integral part of current NHS secondary care, and has been instrumental to shortening the waiting times for certain common procedures and works well for all concerned. The NHS employed private companies to fill the gaps it couldn’t do itself as cheaply, while still retaining control of the market to ensure that less profitable and complex patients would continue to be looked after. The private sector served the NHS.

    Lansley’s plans bring a very different sort of private sector involvement, where a free-market of sorts will allow them to choose the treatments they focus on, the NHS providers will have to compete with the rest, and who in such a market is going to want, or be able to afford to, treat the less profitable cases? You’ll be spoiled for choice if it’s hips and knees you’re after, but if your child has a long term chronic condition, and particularly a rare one, that requires frequent hospital care you might be a bit restricted. Especially so if your local foundation trust hospital has closed because it couldn’t compete.

    If we are to allow freer competition, then it’s going to need to be regulated and before you know it we’re back to the maddening bureaucracy everyone loves so much!

  17. Catherine in Athens
    April 4, 2011

    Brilliant, John!

  18. REPay
    April 4, 2011

    Thank goodness one bright MP spotted what the purpose of the reforms are!

  19. James
    April 4, 2011

    This bill is shocking and will be the downfall of the coalition government. If Redwood listened to his constituents he would not support it.

  20. Stephen W
    April 4, 2011

    Thank you, Mr Redwood, Thank you! For making a clear defence of the bleedingly obvious amidst a vast see of nonsense and total inaccuracy. Thank you for such a clear and accessible defence of the NHS reforms. You manage to say in plain English what so many have totally failed to do up until now.

  21. BobE
    April 4, 2011

    This is a simple case of divide and privatise.
    MedPlan will be in place similar to the now DenPlan.
    Tis fairly obviouse that this is what they are doing.

  22. Bazman
    April 4, 2011

    Norman Tebbit seems to think differently and the main point is that if there is billions to be freed for private companies to cream off, and cream off they will, then the NHS should be changed so these billions can be helped improve the healthcare of the nation. How soon before medicine is the new banking? Not very long. The railways are a fiasco, the utilities are a scam, Sky is expensive and rubbish, motorway toll roads are not used, many companies like banks are just legal cartels subsidised by the taxpayer. People will not tolerate rubbish healthcare depending on wealth and do not need ‘educating’ on this any more than they need educating about not having a job. The NHS is one of the few levellers in the massive inequality in this country where most of the wealth and land is owned by a very few of the population. It is also a very large employer providing a living for millions of people. What do all the middle class fantasists do for a living as I doubt it pays enough for unlimited healthcare?

    1. lifelogic
      April 5, 2011

      You say “The NHS is one of the few levellers in the massive inequality in this country” I want to see good treatment for all not a “levelling” which will mean bad treatment and poor service for all as now.

      But it is true that the state have trouble buying anything efficiently off the private sector due to self interest, political interference and often corruption.

      1. David
        April 5, 2011

        There’s good and bad in all services, and indeed industries, private and public, but you can’t reasonably generalise that the NHS means…

        ‘bad treatment and poor service for all as now.’

        That’s somewhat harsh on the majority of healthcare professionals I’m sure. 72% of patients were satisfied with their treatment in the last survey I believe, the highest levels for a long time, things have come a long way since the 1990s.

  23. BobE
    April 5, 2011

    It won’t matter because it will all be run by the EU.
    Britain is over.

  24. stred
    April 5, 2011

    I pointed out to Lansley that GPs have ghost patients on their list who have left the area years ago. I have not heard of any interest in this or plans to check that lists are kept up to date and accurate. As mentioned above, GPs are paid to keep patients listed.

    A friend was recently charged £20 for a photocopy of a diagnostic test by his GP. These were foreign and I think it is odd that this country, in which many professionals are underpaid by international standards, has increased GP’s pay to a level which attracts doctors from other wealthier countries. Are these people really to be trusted to run the budget. As posted above, many of them cannot even run a satisfactory appointments system. The last time they were given the key to the moneybox, some used fundholder cash to build new premises.

    This is not to say that the PCTs should not be abolished- without giving huge redundancy payouts. If we had a system like the French, the patient has the power and the doctors and hospitals have to give a good service. And GPs are paid less.

  25. Sarah
    April 5, 2011

    It seems to me as an observer of the system that there is a (deliberate) confusion between the NHS and free health care. As a society and as individuals we should be interested in the latter and be testing the former to see if it is the best method of delivery. Methinks this confusion persists because it suits all kinds of vested interest groups. I cannot see why a distinction cannot be drawn. I personally do not care about who delivers the health care ( state or private) as long as it is free at the point of delivery. I do not believe that most others care either. It is issues relating to quality of delivery which should interest us. I do not understand how the NHS is being allowed to be such a sacred cow .

  26. sudesh
    April 10, 2011

    i can’t belive conservatives. i mean cant you guys go back to thatcherism . rather then attack nurses , professionals or the organistaion ,

    why not just give tax incentives for ppl not to use the nhs. more ppl will take out private healthcare insurance then, private companies will still benefit , employement created taxes generated and ppl that are poor will still get a good excellent service from the nhs as the budget is still portected and you will still get better health outcomes.

    until you change ppls behaviour through taxation the system will suck. sometimes conservatives are so stupid.

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