Norman Lamb writes… The NHS: safe in our hands

The NHS is our most treasured institution; designed by a Liberal it is based on a great British idea – that we will care together, collectively for one another in our time of need. Treatment free, when you need it, not when you can afford it. That’s an idea that must never be undermined.

People want to see Liberal Democrats in government protecting and improving the NHS, and this week we have shown that’s exactly what we are doing. The government is pausing – stopping the clock on its NHS reforms to listen, reflect and improve the legislation – in direct response to concerns raised at our conference in Sheffield and by all the clinicians, patient groups and experts who’ve spoken out about the reforms.

Of course, change is needed in our NHS. Under Labour the NHS became bloated and unaccountable, with more managers than nurses. Too much of the necessary increased investment over the last decade was squandered on a centralised bureaucracy. The NHS is currently the fourth largest employer anywhere in the world (after the Chinese Army, Indian Railway and Walmart!). Labour tried to direct and control this vast organisation from Whitehall. Bureaucracy must go and patients must get more control. As Nick said in his conference speech in Sheffield, ‘We have campaigned for years for an NHS that gives more power to professionals and to patients.’

And change is needed, too, because we must keep up with an ageing population and rising numbers of people with long term conditions like diabetes and alzheimers, and we need to find the money for new treatments and new technologies so people continue to get the world-class care the NHS is known for. Costs are rising for these reasons in every developed country but although we have gone further than Labour by ring-fencing funding for the NHS, we are not in a position to pump in huge amounts of extra cash. This means that in order to safeguard the NHS, to make it sustainable for the future, we have to find ways of making the available resources go further.

Liberal Democrats have always championed opening up our public services and freeing them from the dead hand of Whitehall – and those are the ideas behind the reforms the government has brought forward. Paul Burstow has been working tirelessly to ensure that, for the first time, local government will have a real role in our NHS, holding GP consortia to account and taking on responsibility for public health. By pressing for more personal budgets and ensuring patients have a greater say in decisions about care he has ensured that patients will have more control, and doctors and nurses will have more freedom and responsibility. These are the principles that conference reaffirmed in the motion we passed with amendments and these are the principles that are underpinning our work in government.

But we now have the opportunity to strengthen the reforms so that we can be certain they protect everything that is good about the NHS even as it is brought up to date. We must ensure that there is proper accountability and that the principles of good governance apply to all commissioning decisions. Competition is not an end in itself and it cannot trump the importance of co-operation and collaboration. Cherry-picking by private providers must not happen. Integrating health and social care will be essential if we are to be more effective in avoiding crisis admissions to hospital of those with long term chronic conditions.

The conference motion, as amended, made vital points that the government will be addressing over the next two months – in addition to the changes that Liberal Democrats have already won such as a guarantee that there will be no competition based on price. Nick made clear at conference just how strong our support of these key points is:

No government of which I am part will tamper with the essential contract at the heart of the NHS: to care collectively for each other as fellow citizens. World-class health care for all. Publicly funded. Free. Centred on patients, not profit. So yes to health reforms. But no – always no – to the privatisation of health.

Liberal Democrats in government are committed to spending the next two months fighting in government for the NHS our party wants and that our country needs. A Liberal was responsible for the formation of the NHS – it will be safe in our hands.

Norman Lamb MP is Chair of the Federal Policy Committee and Chief Parliamentary and Political Adviser to the Deputy Prime Minister.

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27 Comments

  • “Under Labour the NHS became bloated and unaccountable, with more managers than nurses.”

    This is utter, utter, unmitigated bilge.

    According to the NHS Information Centre, as of 30 September 2010 the NHS employed:
    * 41,962 managers and senior managers
    * 410,615 qualified nurses

    See: http://www.ic.nhs.uk/news-and-events/news/number-of-managers-and-senior-managers-decreases-alongside-an-overall-expansion-in-nhs-workforce

  • I mean, Norman Lamb. Seriously. Seriously. How many years did you spend as the Lib Dem health spokesman?

  • This is just a cynical ploy by the government to take the heat out of the issue until after the May elections.

  • The UK spends less on healthcare than many other OECD countries, yet has the same outcomes. Why does it need major reform?

    Other than Andrew Lansley says it does and Norman Lamb has as much spine as Nick Clegg.

  • For anyone who doubts how fundamentally Lansley’s reforms will change the very nature of the NHS in England for the worse, it might be a good idea to read this article in the BMJ (no registration or subscription required):

    “How the secretary of state for health proposes to abolish the NHS in England”
    http://www.bmj.com/content/342/bmj.d1695.full

  • “Of course, change is needed in our NHS.”

    Your problem is, most of the public fundamentally disagree with this statement. Most of the public think the NHS is pretty fantastic as it is. Most people don’t care whether the money is in the hands of “bureaucrats” or doctors – we just want good treatment – and we’re getting it atm. We know the NHS is one of the best in the world. You have not made the case whatsoever that there’s anything wrong with the NHS as it is, and what any changes will supposedly improve.

    I frankly am nowhere near knowledgeable enough to understand most of the proposed NHS reforms – but Coalition ministers’ regular lies (about the cuts being fair, about £9000 fees being the “exception”, etc.) have given me no reason at all to believe your protestations that the NHS is safe in your hands – therefore, I will campaign vigorously against these changes.

  • “….designed by a Liberal it is based on a great British idea – that we will care together, collectively for one another in our time of need.”

    Yes, an interesting concept, however, this no longer seems to apply to unemployment (this from the Guardian):

    ‘A week ago, a Department for Work and Pensions whistleblower told the Guardian that he and his colleagues were being leant on to refer a fixed tally of meagre benefit payments for docking, which they can end up doing by rigging the assessment of how hard people are looking for work. The welfare secretary, Iain Duncan Smith, popped up in front of the cameras to dismiss the suggestion as “claptrap”. Now the DWP has conceded that certain offices were indeed interpreting political talk about getting tough on the workshy in precisely this way.

    Other insiders have come forward to the Guardian to detail the discriminatory and very likely unlawful manner in which benefit sanctions were being applied. We must take it on trust that such practices were the exception as opposed to the rule, and were never intended by Whitehall. It now promises they have been stamped out. Although on-the-ground confirmation is awaited, alarmed government lawyers will surely demand no less. The message being sent through the whole system is that its masters are intensely relaxed about making the poor poorer. The consequences will reach far and wide.’

  • AndrewM. Re. The health “reforms”, as far as I am concerned, they belong to Clegg et al. as much as they belong to Lansley. No mandate, no hope.

  • This is the slippery slope downwards that will allow a future government to dismantle the NHS. It is not the end just the beginning of the end.

  • “The government is pausing – stopping the clock on its NHS reforms to listen, reflect and improve the legislation….”

    Yes, but the government has also said that it’s not really going to change anything because it will ruin it’s masterplan. Do you have anything to add to this than wishful thinking?

    What’s more, what happened to ‘and end to top-down reorganisations of the NHS’?

    It’s only the government that are ‘stopping the clock on its NHS reforms to “listen, reflect and improve” the legislation ‘ (ha ha). The reforms meanwhile are going full steam ahead with the loss of 500 staff (125 frontline) at my local hospital and my PCT winding itself up (we campaigned to save the hospital but perhaps it’s just the patients that need saving). Are you not being disinguenous by suggesting that everything has ground to a halt?

    Norman Lamb, it was only thanks to the Party that Clegg raised any objections – as far as we know he was nodding this through happily with Paul Burstow leading. Please explain what was going on?

    Could none of the LibDem ministers see anything wrong with these ‘reforms’?

  • @Simon McGrath

    Err, what? So productivity has been rising since 2005? Don’t suppose the fall in productivity prior to 2005 had anything to do absorbing the impact of previous ‘modernisations’? There have been 15 major reforms of the NHS in the last 30 years. Each time there is a reform there are dips in productivity as resources are devoted to coping with the changes. Trying to justify further reform in 2011 on the basis of a fall in productivity prior to 2005 is really desperate even by your standards.

    Another quote from the same document
    “Health outcomes have improved, waiting times have come down sharply and the public is more satisfied with the performance of the NHS.”

    Now, I’m sure the NHS can be improved but it doesn’t sound like we need the biggest structural reform of the service since it’s inception.

  • Simon McGrath 8th Apr '11 - 10:05pm

    @andrew – I think they only had data up to 2005.
    @Various – the importnat thing is that the NHS is free and well funded. Why should who supplies the service be of interst as long as they are safe and cost effective

  • @Simon McGrath

    What evidence is there that GPs/Other clinical staff/Local representatives will be better at commissioning services?
    What evidence is there that private supply of services will lead to an improvement in patient outcome?

    Given we have a relatively efficient health service providing good outcomes at a low cost (all available evidence shows this) then why the desperation to make a change?

    Just because some liberals and conservatives don’t like the idea of a socially owned, centrally managed health system doesn’t mean it doesn’t work very well.

  • David Allen 9th Apr '11 - 12:35am

    “The government is pausing – stopping the clock on its NHS reforms to listen, reflect and improve the legislation.”

    No it isn’t. If you meant to reverse anything of significance you would be telling us what it is – not just holding a public relations “pause” until after May 5th.

    “Of course, change is needed in our NHS.”

    If that’s so obvious now, why did the manifestos and the coalition agreement say the opposite?

    “Paul Burstow has been working tirelessly to ensure that, for the first time, local government will have a real role in our NHS, holding GP consortia to account..”

    Hang on a minute. The consortia will be entrusted with making professional judgments on medical priorities. Who is a local councillor to argue? The consortia will also operate in a competitive market. How can a local councillor interfere in commercial decisions?

    The answer is surely that the easiest figleaf for Lansley to concede, in order to buy off the feeble challenge from the Lib Dems, is to allow a few harmlessly decorative councillors to pontificate uselessly in the background, while his GP consortia get on with turning the NHS into a free market.

    “No government of which I am part will tamper with the essential contract at the heart of the NHS… no – always no – to the privatisation of health.”

    Oh yeah. £9000 tuition fees will be wholly exceptional. Go and have a good cry.

  • “Liberal Democrats have always championed opening up our public services and freeing them from the dead hand of Whitehall – and those are the ideas behind the reforms the government has brought forward.”

    Yet you all voted for the Academies Act (and are supporting the Education Bill) which removes schools from local accountability (incidentally hugely diminishing parental influence) and hands direct control to … Whitehall!

  • http://www.38degrees.org.uk/page/s/Protect_our_NHS_Petition

    Non partisan campaigning group to save the NHS. They helped stop the Forest sell off as well.

    Sign up and share ! Protect the NHS.

  • Can someone please answer me the question as to how EU competition law will affect the tendering process ? How will bureaucracy be reduced in this way ?

    Also how Charities and small organisations will be able to compete with private health care companies and large organisations in the bidding for contracts ?

    Please stop this bill. Change and improvement needs to be carefully considered and introduced. Start a Royal Commission that involves debate from all sectors and sides of the political spectrum. This is too important an issue to be left to chaotic and rushed policy making.

  • re: The Eu competition laws

    http://www.bmj.com/content/342/bmj.d2071.full?sid=79fa6c23-e73e-4b4c-859d-757939d6a35f

    Very frightening ..

    Call me a cynic, but I fear the two month delay is to get the local elections out of the way..

  • Dr Peter Ashby 10th Apr '11 - 5:44pm

    As a recently retired GP from South London, I would urge you to think again. It is my opinion that there is no chance of improving patient care and freeing doctors from any political agenda if the present PCT structure is not removed.

    During the years that I was fundholding, many hundreds of thousands of pounds were saved in my practice alone and all patient waiting list were cleared. You have to accept that the end result we are all striving for is excellent patient care, and if this seems at times to ride against our personal political beliefs, then so be it.

    Think, don’t be driven by dogma.

    Peter

  • Dr Ashby. I am slightly confused are you for the abolishment of PCTs or against ? If you are against the PCTs questions relating to the EU Competition Law and the threat of legal action, costs of tendering and whether anyone other than big private health care coporations can really compete in the tendering process need to be answered ? Do you feel qualified to answer such questions ?

    Also the question of whether hospitals will be forced to go to the wall. I also feel that the trust that people have with GPs will be broken as patients will see GPs as being more concerned with their budgets and profits than acutal good quality healthcare.

    Lots and lots of questions. The bill needs to be ripped up and started again.

    I would also be more convinced of MP, Norman Lamb’s conversion and threat to resign if he had not voted through the bill already without any comment. A cynical pre local election media move ?

  • North Norfolk Local 10th Apr '11 - 10:53pm

    It is really annoying that Norman Lamb and many other Lib Dem & Tory MP’s do not get their facts right.

    The truth is that the NHS is still massively underfunded compared with other countries such as Germany, France etc.

    NHS management costs are still lower than any other health care system in the western world.

  • Dr Peter Ashby 11th Apr '11 - 10:56pm

    Jack Timms

    Thank you for responding. I am speaking from my own experience, as I was aware of the haemorrhage of funds by the PCT which meant that my patients suffered, both in delays for treatment and sometimes in increased morbidity.

    The layers of administration which developed within the PCT was really sad to see. On one visit that I made with a new young GP to introduce him to the area his comment was “Dr Ashby, what are all these people doing, sitting at their desks reading newspapers, and chatting?” In that area there was not even a single PC display actually awitched on.

    In answer to your question, Yes, the PCT needs to go or be trimmed down to a very basic level, and be replaced with a group of primary care workers who have day to day patient contact. Only then will the right decisions be made as they will be born out of current needs and past experience. Patients are all individuals, their care needs to fit them, and they deserve the best that their doctor can give them.

    Am I qualified to answer these questions? If not, who is? I worked in one health authority area witnout break between 1966 and 2007. At the beginning there was no such mulitlayered administration, and I know that the problems of providing health care have been made worse, not improved with the introduction of such bodies as the PCT. It was such a relief to hold my own fund as I have mentioned in my first note.

    Peter

  • @ Simon McGrath

    My point of view (and I’m sure Dr Ashby will back me up here) is that the best healthcare is evidence-based.

    Where is the evidence that these reforms will be beneficial for the NHS? Where are the studies that tell us the PCTs are bad for patients, and GPs would do a better job of rationing treatment? If all you and the coalition have to offer is a study saying that you don’t necessarily get out of healthcare as much as you put in and a load of empty (and quite weak) rhetoric, you’re not going to convince many people that you’re right.

  • Dr Ashby. Thanks for clarifying your comments on the PCT. It was interesting to read your perspective and hear your view point. I wouldn’t dream of questioning your skills as a professional and manager in your practice. Apologies if you felt I was doing that.

    The questions I think needed answering where you may not have the expertise is whether the tendering process would be subject to EU competition law and the effect this may have. It has not been clearly considered in the white paper – http://www.bmj.com/content/342/bmj.d2071.short?rss=1 .

    What effect would this have on the tendering process. This opens up a whole area of possible litigation and claims from big private companies. If the health service is subjected to full-blown competition law, cost could easily take precedence over quality. Serco or Capita could win a contract with little expertise away from an existing provider. Bureaucracy to the NHS could be massively increased. In terms of the bidding process how will charities, existing providers or smaller units compete with the likes of Serco or Allied Health Care or any of the big providers given the cost of the process?

    There are also issues of hospitals going bust, local nhs services being closed without consultation, no limit on private patients being treated in NHS hospitals, charging for services and accountability.

    All this change without bringing in the issues of producing radical change whilst big cost efficiencies are going on.

    I think it is a worthwhile discussion to have regarding commissioning and how it can be made more effective. PCTs can provide an overview of health strategy in an area, and how services are integrated. Changes to the commissioning process can of course be considered and improved. Changes and discussion needs to be carefully made. There is a real concern about fragmentation of services.

    The BMA also feel that there will be threats to training and a return to the post code lottery.

    http://web2.bma.org.uk/pressrel.nsf/wlu/SGOY-8FGFJ7?OpenDocument&vw=wfmms

    http://www.bma.org.uk/healthcare_policy/nhs_white_paper/moripoll2011members.jsp

    I work with disability and older people and my wife is a nurse (Burns and plastics / surgery / Head and neck / cancer). I am very passionate about a better health system. This current NHS bill needs to stop.

    There needs to be a national discussion regarding improvements. The current bill is a bad bill. I am not against consideration of different ways to commission services but this needs to be done in a way that will bring in Nurses, Doctors, GPs, NHS users and opinion from across the political spectrum. The changes can then be progressive, well thought and innovative. There are too many unanswered questions in this rushed and inept bill.

  • conservative 14th Apr '11 - 9:44am

    It was amazing to see Norman Lamb grow a conscience just days before he was out canvassing with district councillors in North Norfolk who had by all accounts been distancing themselves from Nick Clegg’s right hand man – it was probably a coincidence.

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