The Lib Dems extensive health reform agenda


        I have dealt before on this site with the extensive  account of planned NHS reform in the Conservative Green Papers and Manifesto issued before the last General Election. I have also quoted from the detailed Coalition policy document issued under the joint signatures of Mr Cameron and Mr Clegg last summer, showing how they both signed up to extensive reform.

            As we are still hearing that these plans are secret Conservative ones foisted on the Lib Dems it is time to remind people that extensive NHS reform was also proposed in the Lib Dems 2010 Manifesto, which said nothing about ending privatisation or ending the Labour cuts to management. Many of the Lib Dem reform proposals are included in  the joint proposals in the White Paper and enacted by the Commons in  the Bill, with the full support of the Lib Dem whips.

            Their Manifesto said they wanted cuts to bureaucracy and management.

“Cut the size of the Department of Health by half, abolish unnecessary quangos such as Connecting for Health, and cut the¬† budgets of the rest, scrap Strategic Health Authorities and seek to limit the pay of top NHS managers so that¬† none are paid more than the PM”

              They favoured the type of devolution of power to front line staff also proposed by Mr Lansley and incorporated in the reforms:

“Sharply reducing centralised targets and bureaucracy….Putting front line staff in charge of their ward or unit budget,¬†¬† and ¬†allowing staff to establish employee trusts giving them real involvement and say over how their service is run”

They sought extensive administrative chanegs, including  the abolition  of PCTs and their replacement by locally  elected Health Boards.

They did not recommend the abolition of private involvement or contracting out, but did favour more contracting out to employee buy outs and the ¬†third sector.¬† “Giving local health boards the freedom to commission services for local people from a range¬†of different types of provider”.

          The so called Lansley reforms are a true amalgamation of two radical manifesto packages  promising substantial NHS reform. Both wanted to cut centralised and bureacratic costs, both wanted to strengthen the front line, both wanted more employee mutuals and co-ops to replace directly employed staff and both wanted budget delegation to GPs and hospital ward management.

           Have the Lib Dems now changed their minds or have they forgotten their Manifesto and their support for the White Paper and the Bill in the Commons?


  1. lifelogic
    May 9, 2011

    So I assume Cameron is going to backtrack fully on the NHS in order to assist the Liberals politically. But will continuing to fund a hugely inefficient, poor quality and free at the point of use NHS really assist anyone at all?

    Certainly not the patients or the tax payers.

    1. lifelogic
      May 9, 2011

      I see that a report by Policy Exchange suggest that the 20% who work for the state sector are getting 35% more than the private sector. How much longer does the private sector, often without any pension provision have to continue carrying these richer over pensioned and pampered.

      Also how many businesses will find they can no longer do this and will stop trading – leaving even fewer to carry the ball and chain?

      We need a government that wants out of the EU and actually represents the 80% private sector for a change.

      1. lifelogic
        May 9, 2011

        As much of what the state does has entirely negative consequences for the economy (by inconveniencing and over taxing the private sector) it does not seem sensible to pay 35% more for these staff than the private sector.

        Surely the cheaper and least efficient such staff are, in these negative positions, the better. As they are likely to cause rather less harm.

    2. Bazman
      May 10, 2011

      Why not abolish the health service and let everyone just take their chances? Serves them right if they eat, drink and smoke to much. Why should I pay for it. They should also pay f0r their own housing and children as well.
      Would the country be better or worse for it lifelogic?

      1. lifelogic
        May 13, 2011

        Far better in the main but some safety net will be needed for a few.

  2. Mike Stallard
    May 9, 2011

    You were up early again!
    I voted, silly me, first of all for free schools. Now they are being buried in a sea of form filling. I was desperate to see the economy restored with low taxes, reduced debt and getting rid of the deficit because I have some (very small) savings. Your blog convinced me that this is simply not happening. I was mildly interested in NHS reforms and respected Mr Lansley’s hard work. Now that is being discussed out of existence. Finally I wanted to see IDS unleashed onto the Welfare State. Who he?
    Now we are beginning to see that, just like Tony, Mr Cameron is kicking everything which his party promised into the long grass.
    Is this personal? Or is it the bureaucracy? Is it the Libdems? Is it the London dinner party set getting its own way?
    I do not know.
    All I do know is that unless something is done pretty fast, my dear little country will continue to rocket downhill faster and faster.

  3. APL
    May 9, 2011

    JR: ” … and the third sector.”

    Ah! the third sector, isn’t that the land of quangocrats that Pickles was supposed to be raising to the ground?

    Not heard much from him lately.

  4. Javelin
    May 9, 2011

    Shocking figures in the Telegraph about public sector pay being 40% above the private sector. All I can say is stand back and feel the resentment and anger from the private sector. It’s clear public sector salaries need to be frozen for at least 5 years.

    1. lifelogic
      May 9, 2011

      The need a special state sector pension tax (to equalise pensions after brown’s private sector mugging tax). A reduction in size of the state sector by about 50% and a cut in wages of at least 30%. They should reduce pay offs to a maximum two months wages too private and state.

      They could set a good example by reducing the circa ¬£50K PA MP’s pension allowance given to say ¬£15K PA.

      Rather tricky to get through parliament though.

      1. Bazman
        May 10, 2011

        Who’s wages do you propose to cut by 30%. The NHS cleaners? What part do you think private companies played in getting Ireland into the position they are in now? And finally do you understand the word ‘exploitation’ because nothing you have ever wrote addresses this and in most cases would further exacerbate this problem. No matter how much profit private companies makes they will not share it with the workforce. The evidence is all around. Redundancy payments are in fact very small for most people and if you think they should get nothing you are wrong.

        1. lifelogic
          May 13, 2011

          I would cut all the ones the majority who are getting far more than the market rate for the job. The the private sector would expand and the market rate would increase as labour demand increased and the economy improved as a direct result.

  5. alan jutson
    May 9, 2011

    So having failed in LOCAL COUNCIL ELECTIONS and having lost the AV vote, the Liberal Demo’s want to influence government policy even more to their way of thinking.

    If the Governments policies were so bad, and if the claim is that people wanted to kick the governent, why did the Conservative Party gain more seats ?

    Contrary to watering down present government policy, perhaps the recent vote was a sign that the government need to complete their original promises FASTER than at present, NOT SLOWER.

    John, cuts in the NHS budget started under Labour in their last year in office (we have family members and freinds who work in the NHS) those cuts have only started to filter through in the last 6-9 months, so long did they take to filter through, that this government is unfairly taking the flack for such under the guise of their proposed modernisation plans. Thus many employees and some of the general public are hearing of Conservative cuts and modernisation, which have yet to be approved and be implemented.

    Once again the explanation of the governments policies has failed, and the media and the Labour Party is having a field day.

    Cameron has to get a grip, and a grip fast if he wants to survive, the electors patience will run out before the end of 5 years.

    Agree with much of Mike Stallards comments, already posted 6.42am

  6. Bryan
    May 9, 2011

    Why are we surprised? They are after all the Libdems who will agree to anything on the basis that they can backtrack as and when it suits!

    If Mr Cameron had any backbone he would remind Mr Clegg and his coalition ‘partners’ that (they should accept what has now happened-ed).

    1. lifelogic
      May 9, 2011

      Clegg has a difficult hand to play his pre-election agenda pro EU, pro green, anti nuclear, Free at the point of use NHS, tuition fees etc. is all clearly mad. As are many of his MP’s and Lords.

      Now he has to do what is sensible without admitting that all his vote for me pre-election stuff was mad.

      Let us hope he tries his best and sees the light the country needs him and Cameron to do the right thing. They still might.

  7. Brian Tomkinson
    May 9, 2011

    The LibDems were trounced in all of last week’s elections and the AV referendum. The main reason for this being that finally they have been seen to be duplicitous, untrustworthy, self-serving and overrated. Why then should anyone want to take a shred of notice of what they now say should be done with regards to the NHS bill which they have until recently supported, or anything else for that matter? It is about time that the parliamentary arithmetic, which will be used to answer this point, is given the weight it deserves when the views of the Conservatives are considered Рalthough they seldom seem to be.

  8. John Bracewell
    May 9, 2011

    The LibDems are doing what they do best. Going back on what was in their manifesto and to ideas that they have signed up to. Why? for political reasons. Having lost the main item of benefit to them when they negotiated the Coalition Agreement, they want to be seen to be reforming the NHS plans despite having agreed to them before the Bill was put to the House originally. Your question on the Today program, Mr Redwood, ‘what do you call significant changes’ is the key. In times of money shortage and the increasing cost as the elderly live longer, effective and substantial change to the NHS is not just required but is a necessity for it to continue to give decent medical care in future.

  9. GJ Wyatt
    May 9, 2011

    As an organisation, the NHS is letting people down in myriad ways but they “cling to nurse for fear of worse”, and Labour and Libdems are tapping in to that, conveniently allied today with the GPs’ union (aka Royal College). I hope Cameron’s Conservatives will have the temerity to challenge these cynical “forces of conservatism”. I concede that he may not be able to fight all battles simultaneously, but if he lets this one go he’d better redouble support for his other radical commanders in the field, i.e. Gove and Duncan-Smith.

    1. lifelogic
      May 9, 2011

      They perhaps “cling to nurse for fear of something worse” because they have had all their money taxed off them. Were they able to retain some they might not feel so vulnerable or dependent on recovering a few scrap of their money – perhaps just 5% – indirectly and very inefficiently via the “free” NHS.

  10. Bill
    May 9, 2011

    It will be a real test of Mr Cameron’s leadership to stand up to the Lib Dems, they wanted a referendum and they got it.

    Dr Cable, Mr Huhne sound sanctimonious attacking the Tories as cause for their defeat, when the no vote was more than double the yes vote.

  11. norman
    May 9, 2011

    It’s a shame that our biggest budget item by a long way, the NHS – third biggest employer in the world – and in need of reform as evidenced by all three parties manifesto’s is now being treated as a political football in order to give the perception to the public that the ‘caring’ Lib Dems are giving the ‘nasty’ Tory party a kicking.

    This ensures that there will be no significant reform of the NHS over the term of this Parliament and the problem will be saved up for someone with a pair to sort out before we go bankrupt. It’s also, yet again, conceding the argument to the left that more money is always better and always equates better service regadless of how it is spent. Absolute lunacy.

    I know the PM has to be gracious in victory(too much to expect the Lib Dems to be gracious in defeat) to placate the likes of Huhne but surely there’s a better way to do it than this?

  12. English Pensioner
    May 9, 2011

    The LibDems are now learning that there is a big difference in promising things which sound good in a manifesto and actually implementing them in government. For years they have made promises that there was no chance of having to implement, now changes are proposed, many of which which as you say were in their manifesto, they are discovering that whatever you want to do, there are always objections from vested interests.
    As I’m sure most Conservatives could agree with what the LibDems proposed in their manifesto, perhaps Cameron should put a LibDem in charge of the reforms with instructions to implement their manifest proposals in full. I’d certainly be happy if they were carried out.
    As I side issue, I note that, according to the Daily Mail, Cameron is proposing to give Scotland another £2 billion in a bid to preserve the Union. When are the English going to have a vote on Scottish Independence!

  13. acorn
    May 9, 2011

    The Electoral Ward is the primary component of all other electoral geographies in the UK. The functional business unit is the primary component of any corporate cost accounts. There must be a similar structure in the NHS; even local government gets this bit correct.

    If you are on a cost cutting / efficiency / productivity drive, you start with the business units. Do we need it; is it a cost; contribution or a profit centre. Does this BU send bills; does it get bills; does it have “customers”?

    Many years back I was a junior on a project that tried to identify business units in a corporate. We ended up getting them all to send bills for there services to other BUs they thought should be paying them. It was traumatic but very effective. This corporate had customers it could send bills to. The customers had choices of supply.

    If I were in Mr Lansley position the above is where I would start; he needs a price discovery and comparison mechanism. For the time being all NHS customers would get invoices and pay for them with a UK-NHS debit card; which, also for the time being, would be 100% paid for by the Department of Health. Down the road, the 100% might change. I can imagine one hospital sending secret shoppers into other hospitals; just like Tesco and ASDA.

    Now Mr Gove, how about a UK-Education debit card with an overdraft facility for the tertiary years?

  14. oldtimer
    May 9, 2011

    I think that the LibDems have gone into headless chicken mode. The best that can be said for this, from their point of view, is that it draws attention to themselves and away from the massive electoral defeat they suffered last week.

  15. jane
    May 9, 2011

    I shall be very angry if the proposed reforms are not carried through. I am tired of not having any choice in the provision of healthcare – a service I have paid for throughout my life and indeed rarely used although havinghad lots of experience based on caring for relatives and being involved in various NHS panels. In my area, the Choose and Book system for hospital appointments was never implemented and necessitated a telephone call to provide details and then await a letter of appointment within three weeks. The only efficient part of the process was a follow up letter asking for feedback! A recent visit to a hospital with a friend pointed up the problems. Another patient looked at their chart and file and was promptly scolded and advised that the documents were the property of the hospital. The nanny state in full operation – very dangerous as many of us are quite able to manage our own healthcare thanks to the web and the countless government projects to educate us diet, exercise etc etc. Look at what we have permitted – huge salary increases in the NHS with less productivity and in the case of GPs less cover.

    Today, I have listened to a GP representative who sounded very much like a posh Bob Crow. They are opposing any form of competition – self interest of course although dressed up as if they were speaking up for my rights. It is only with competition that we can improve the NHS. I am tired of the health system being run on behalf and for the benefit of staff with the customer and those paying having a lower priority. The user often feels powerless in the system and it is time that this changed. How dare any politician put the interests of their political party above the rights of citizens to have a healthcare system which is designed to ensure that patient care is paramount. This care involves patient choice which is non existent.

    1. lifelogic
      May 9, 2011

      ” patient choice which is non existent.” indeed it is – that and free as the point of use is the problem in a nut shell. You have already paid silly taxpayer so shut up and take what ever if anything we can be bothered to offer you.

  16. lola
    May 9, 2011

    Clegg and Lib Dems current newsflow post AV failure demonstrates classic Lib Dem duplicity. ‘You run with the revolution, I’ll drive your Jag.’

  17. Peter Turner
    May 9, 2011

    Thankyou Mr. Redwood, your comments above needed saying. Unfortunately the Lib Dems seem to be in a right mess and, from comments made, seem to care more for the survival of their party than for the welfare of the country.

  18. Magnolia
    May 9, 2011

    Your posts are very good and accurate and you have chosen your words very carefully today but I would like some clarification.. There is the world of difference between all ‘frontline staff’ and ‘frontline GPs’ alone , the latter being just one kind of ‘frontline’ staff.
    Quote, “Both wanted budget delegation to GPs and hospital ward management”
    Hospital ward management isn’t usually part of the ‘fronline’ staff. There are clinical managers throughout hospital specialties but they are appointed by the non-clinical management/admin and their role is often one of only implementing the dictats and orders from on high. No gifted and talented doctor would touch these posts because it would not be their first profesional interest.
    The fatal flaw in Mr landsley’s proposals is that he hands everything to the less well qualified GP kind of ‘frontline’ staff and the rest of the ‘frontline staff’ get nothing!
    The GPs are to become the purchaser or buyer on behalf of the client or customer patient and they will have a finite amout of money which they have to spend wisely.
    This excludes every other kind of ‘frontline staff’ from the reform process and this lack of consideration has put fear throughout the hospitals in the land. I believe that it is already causing paralysis.
    I agree that the Libdems were proposing radical NHS reform prior to the general election but I think I’m right in saying that they did not plan to hand all budget control to the GPs. That was Mr Landsley’s plan alone and also his undoing.

    Reply: GPs and their buying consortia decide where to purchase treatments.Hospital staff spend the revenues their hospital has attracted.

    1. forthurst
      May 9, 2011

      I think it is silly idea to make GPs responsible for purchasing and an even sillier to try to bounce them into that role. GPs will normally refer a patient to a main hospital for investigation with a letter to the Senior Consultant of a speciality. Why would they want for more involvement than htat?

      What will be the position with hospitals liumbered with outrageous PFI contracts from Labour? It seems to me it is more urgent to renegoitiate these contracts to be no more than mortgages for the buildings.

      What will be the position of specialist hospitals that operate at the leading edge of medical procedures in specific departments and undertake the most difficult cases?

      If GPs have budgets, surely they will be looking to avoid taking on old people and those with chronic conditions. Even if GPs cannot pick and choose, they will still have varying treatment costs for their patient lists depending on their age and class profiles.

      Hospitals are not the same as supermarkets. They have expensively trained staff and expensive equipment and the most efficient way to operate is for those both to be fully utilised and without interference from dweebs in Whitehall.

      Reply: If GPs take on more patients they get bigger budgets.

      1. forthurst
        May 9, 2011

        Is it not better to make GPs fully responsible for their patients 24×7 once again and resolve the issue of the provision of specialist treatments separately.

        Incidentally, the GMC needs sorting: they should be made fully responsible for validating doctors training, qualifications, and references on the basis that EU qualifications are transferable, but the issue of English language skills should not be theirs; that should validated separately by the employer.

    2. lifelogic
      May 9, 2011

      “Reply: GPs and their buying consortia decide where to purchase treatments.Hospital staff spend the revenues their hospital has attracted.”

      That is nearly what we want but it should be patients in consultation with GP’s. The buying consortia should be the patient or the patient’s family not the state which should only be a safety net.

  19. javelin
    May 9, 2011

    What’s the point of the LibDems now they know they will never get AV, PR or anything else like that into law?

    Their existence is down to the limbo status of AV/PR. Now we know its status they should (in theory) cease to exist. Does this sound familiar ? …reminds me of “Schr√∂dinger’s cat”.

    I’ll call it “Schr√∂dinger’s Manifesto” …

  20. John B
    May 9, 2011

    Oh dear. Quick nurse! the screens. It’s a bad case of cognitive dissonance.

    Why waste time arguing on the ins and outs of yet another NHS “reform”. Whatever mish-mash emerges won’t work, as all the attempts to tinker and reform haven’t in the last 40 to 50 years.

    Incidentally up to 40 years ago spending was in the hands of “front line” staff, that’s why health expenditure got out of control and spending was taken out of their hands. Still wouldn’t do to learn from past experience would it?

    The NHS is like one of those comical bird-man contraptions of the early 20th Century, men on bicycles with large feathered wings attached to their arms, flapping about, falling over, crashing and never giving up because they can’t or won’t see the obvious.

    Each time they crashed in a heap they “reformed” and spent more on their design: bigger wings; more flapping; longer run-up; faster peddling; higher ramp.

    We all knew it would never get off the ground because the idea and model was flawed.

    Just how many more times does the comical NHS contraption have to crash in a heap before the bears of little brain in the political class, and quite evidently the wider public, figure out – it ain’t ever going to fly.

    Replace it! Privatise it! Copy the French model which consistently appears as No 1 on the WHO best health system list.

    Oooo Matron: what’s difficult about this?

  21. Mark
    May 9, 2011

    After tuition fees, I’m frankly amazed that Lib Dems want to front another policy failure designed by them. Maybe the elections made them truly suicidal.

  22. REPay
    May 9, 2011

    Here is the BBC take on the reform of the NHS from the web site. The pressure is merciless.

    The government needs to rewrite a key part of its health bill which encourages greater competition, the Royal College of GPs says. College chairman Dr Clare Gerada said otherwise the bill risked “unravelling and dismantling” the NHS in England.

    Gerada is straight from central casting…no explanation of how the NHS will unravel – just a straight forward labour scare.

    The BBC is essentially a lobbying organization for the public sector status quo…

    1. REPay
      May 9, 2011

      I just noticed and listend to JR’s excellent performance on the Today Programme.

    2. lifelogic
      May 10, 2011

      You say “The BBC is essentially a lobbying organization for the public sector status quo‚Ķ”

      Indeed I get the impression that, in the main, the government, the political parties, MP’s, the Unions, QUANGOS, charities, the NHS, the BBC, the civil service, teachers, exam boards and school curriculum are all in this state sector lobbying game. It needs a lot of lobbying to sustain this, huge state, tax and waste nonsense.

  23. rose
    May 9, 2011

    Further to the Human Shield spin we are all getting bored with, our Liberal pocket borough and its near neighbours all returned their Liberal candidates with a higher vote than last time. This may be because the Liberal council here has held council tax down and not made politically malicious cuts. The AV vote was still No. So not a good idea to link the two votes if voters themselves don’t. A liberal did get toppled by a Green in one of the central wards but that was a huge effort on their part, and a higher than usual turnout. Only in the marginal suburbs did the collapsed liberal vote let in 3 socialists.

  24. Gary
    May 9, 2011

    Libdems cannot be trusted we are repeatedly told here in the comments. What happened to the two most important promises the Tories made and then broke with us , a referendum on the Lisbon Treaty(I know they fanangled some excuse on the point being moot , or some such excuse) , and properly tacking the debt ? Someone should also ask them why we are still paying for the EU bailouts , and why the bankers bonuses are increasing even as their banks sink deeper into the mire…..
    The best thing the libdems can do is pull out of this tawdry coalition and collapse the govt. We could then hope for a miracle that a thoroughly disenchanted electorate would give us UKIP and we can ditch the EU and the bankers right there. Failing that, the people may have to take charge of things directly.

    Reply: Conservatives kept their promise from 2005 election and voted for a referendum on Lisbon – Labour and Lib Dems voted us down. The promise was not repeated in the 2010 election, as Lisbon had by then be ratified.

  25. Susan
    May 9, 2011

    The NHS is no longer being run for the benefit of patient, it is there for the benefit of the staff who work for this big bureaucratic mess. On the few occasions I have had to go to hospital, mainly with family members, I have found it to be organised chaos. On one occasion even life threatening as the staff were in confusion as to what they were actually supposed to be treating. The hospital in question was also dirty. The nurses were continually ignoring the needs of the patient and behaved in an aggressive manner. This has been my experience, and it has made me very glad that I personally have private healthcare through my company. However, even in private healthcare the prices keep rising as there is no competition as such. The whole system of health in Britain is in crisis and no Government seems to have the courage to do something about it. Therefore, the needs and expectations of the public will continue not to be met and the seriously ill patients continue to suffer.

    I feel sorry for Lansley, because I believe him to be an able Minister who tried to reform the system as much as possible without going beyond the restrictions put on him by public opinion and Government. However the truth is the NHS will continue to decline as a service no matter how much money is wasted on it. Reform is needed from top to bottom in health and a new system introduced. Until this happens the public will continue to receive a poor service which is not fit for purpose and those who work within the NHS will resist reform out of self interest.

    As to the Lib/Dems, I fully expected them to use the NHS reforms as an excuse to flex their muscles within the Coalition after their poor Election results. I expect more of this behaviour to come as time goes on. The Lib/Dems are pure opportunists and have policies that change depending on the audience, this is why I would never have considered voting for them. The public is now seeing this for themselves as the Election showed. Unless the Conservatives want to go down with the Lib/Dems, Cameron needs to start listening to his own party and stand firm on policy that the Lib/Dems have already signed up to. However I know he won’t.

    1. rose
      May 10, 2011

      This is a vivid and accurate picture of what it is like in our public hospitals. I am told that some of the bad manners have been carried by doctors and nurses into private hospitals too, but that infection is less likely there and you will get your own room. Money is not the problem. It is “the culture” which needs to be changed, but it is all very complex, and privatising may not be the way to get back the conscientiousness and sense of duty and dedication which we have lost. These things have to be taught very early in life, and carried on throughout the years of education and thence into employment. People who extol the Germans and the Japanese should look at their education and upbringing, and at their training, rather than their political systems.

      1. Susan
        May 11, 2011


        I very much agree with your points regarding the culture needs to change. How to achieve this, will be very difficult indeed. Britain has moved away from being the caring society it once was, we only have to look around us to see that this is true. It is most evident in our hospitals, as the quality of care has dropped over the years. You are right to say moving towards privatisation may not address this issue. However competition often does push up standards.

        Money is a problem for the future as well, if the UK continue with the NHS in its present form. People are living longer, new procedures, obesity levels etc will all add to costs for the future. Labour poured vast amounts of money into the NHS over 13 years and very little improvement was the result. It is true to say much of this money went to the staff on wages and little reached the patient, but still it proves that money just gets wasted in the system the UK has at the moment. In most private businesses, it has to be proved that money awarded to staff, is based on improvements made, this does not seem to be the case in the public sector.

        One answer, to make the money go further would be to cut some of the services which are at present offered by the NHS. This would entail going back to what the NHS was originally set up for, to stop people dying from preventable illnesses, instead of the plethora of unnecssary work untaken at the moment. Such as IVF, unnecssary cosmetic surgery etc. Stopping health tourist and those that are not entitled to use the service, would also help. As no Government seems to want to do this, lack of money will see the services the NHS provide continue to decline.

        1. rose
          May 11, 2011

          Susan, this is the nub of it: we are trying to treat the whole world free. No other country does that. Even before we did that, the NHS was doomed because medical advances could not be held back, and what was available privately, like hip operations, and then cosmetic and fertility treatments, would soon be demanded on the NHS. So now we are in the ridiculous position where feet, eyes, teeth, and backs have all but gone private, while tattoos etc. are, as you say, attended to by the NHS.

          As a matter of interest, what is your remedy for the police? They used to be, as were nurses, the most respected and trusted strangers one encountered. There was a natural axis between the two, as if they were brothers and sisters in the same family. They were not just slim and fit, but polite, intelligent, and utterly reliable. They managed it all with pencil and paper, and without the cars and helicopters. It was their attitude and inner resources which gave them strength and authority. Now, just as with the nurses, one gets the feeling the police are not looking for work. Pretty well everything which ought to be their business no longer is, and who would now turn to them for help – even if they were visible?

  26. Grant Buckley
    May 9, 2011

    So, the ‚Äėhorse trading‚Äô of the local elections and the AV referendum is now over. My next
    question is when can we see the UK becoming a quality country, such as Germany and
    France? Any intelligent person knows that the Labour party could not organise a drinking
    session in a brewery, without making it bankrupt. The party I support, the Liberal
    Democrats ‚Äď not quite the Christian Democrats, but as close as I can get in the UK, are
    marginalised in the UK and so the recovery of a healthy society is left to the
    Conservatives. Can they deliver or is the UK going to be a third rate European country for
    the rest of my life? Basically the public school boys, who make up the majority of
    parliament, are the failures of that system and so the rest of society has to endure their
    failings as they attempt to manage our Country. How I long for a German system ‚Äď no real
    public schools, a true democracy and a success!

  27. Kenneth
    May 9, 2011

    I believe that when Mr Lansley spent many months working on this policy and adapting it for the coalition with Liberal Democrat approval, he did so in order to achieve the best possible outcomes for patients.

    Anyone who suggests otherwise is either putting out propaganda or is subject to it.

    Doctors have for too long been constantly referring to this specialist and then to the next specialist; the patient is fed into the sausage machine and no longer on the waiting list. Job done.

    What the Left do not acknowledge is that by the doctor taking more responsibility for the cost of all this, the patient’s time IN the machine will be reduced leading to improved outcomes. The Doctor will also be forced to take a more holistic and critical approach at an earlier time in the process: and that should be the doctor’s job anyway!

    At the moment it is all too easy to refer when the clock is reaching the 5 minutes point rather than take another minute to work out what is actually best for the patient.

    Saving money in a sensible way should result in saving lives.

    I hope lives will not be shortened in order to placate a hostile media.

  28. BobE
    May 9, 2011

    If the Lib Dems force a leadership contest and Cleggy looses, what would happen?

    1. rose
      May 10, 2011

      The winner would want to stay in office for as long as possible.

  29. Adam Collyer
    May 9, 2011

    Interesting that the GP’s are opposing this – people often forget that most GP’s are not employed by the NHS but are self-employed. And patients can choose their own GP of course.

    In other words, GP’s are private sector operators, who compete with each other. Seems to work pretty well actually.

    1. Kenneth
      May 10, 2011

      …and not only that, but the NHS is a professional service, not a voluntary/charitable service.

      Each NHS health care worker and other workers work for a profit.

  30. Bazman
    May 10, 2011

    The state would pick up the tab for the patient when the insurance ran out or does not cover that ailment? If they did not what would happen? NHS will always exist in one form or another. To big to fail, so why put money into private companies. If there is money to spare then it should be used for healthcare not private profit.

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