24 Comments

• Little Jackie Paper 11th Jan '17 - 9:39am

  ‘In recognition of the scale of these challenges, we join together to launch a campaign to encourage the Government to establish a cross-party NHS and Care Convention to examine the future funding requirements of these cherished services and agree a new, long-term settlement.’

  OK…I’ll stick my head above the parapet.

  What exactly would this convention say that’s not been said already? Successive governments have undertaken fiscal consolidation but protected the NHS (admittedly with ‘efficiency savings’) implying deeper cuts elsewhere to protect the NHS.

  If the aim of this convention is to come up with a number then surely its going to have to grapple with the same problems we’ve had for decades. If the aim is to set out what will and will not be funded on the NHS then fine – but that is a huge set of questions that have been repeatedly asked. Certainly it would be difficult to future-proof against advances in technology. If the aim is to look hard-headedly at immigration and the NHS then its walking into a hornets nest.

  If the aim here is to sort out some new set of priorities then fine. The text is interesting in that it says, ‘ensure millions of older, ill and disabled people.’ That to me tacitly implies some reprioritising in favour of those groups but I fail to see how the convention would easily explain all this to those who lose out in this reprioritising, particularly as some of the winners will likely be those that felt less austerity.

  If the aim is to look at new models of service delivery (like polyclinics) then fine too, but it’s walking into the same controversy that others have walked into. Can patients have a reasonable expectation now of an old-style family doctor?

  If the aim is to look at staffing issues then this convention will find no easy answers and almost nothing that can be guaranteed into the future. Suffice it here to say that glib talkboard lines on this question are little more than cant (I used to work in NHS staffing).

  So if we want this convention then fine. But let’s at least be honest and recognise that it will probably just run into the same issues previous NHS reviews have hit. Treating the NHS as sacred cow does no one any favours if our aim is, ‘a sustainable solution.’

  Anyway I’ll let everyone shout at me now.

• Theakes 11th Jan '17 - 10:30am

  The NHS always needs more money. The country is now as debt laden as2008. The lottery spends a small fortune on the olympics. Divert some or all of that! Does Canada havé our alleged difficulties.
  Also why not no industrial action for staff, . Should we replace the NHS with a better system if there is one, do we moan too much? No doubt this will generate a storm I will retire behind the parapet.

• nigel hunter 11th Jan '17 - 11:19am

  The NHS is a bottomless pit but is vital for ALL . Past govnt’s have chipped away at it over the years, higher prescription charges, dental costs etc. Maybe it is time to put a penny in the pound tax to pay for it but as a stand alone tx way from what we already pay.

• nigel hunter 11th Jan '17 - 11:47am

  How about giving more minor injury problems to pharmacies to deal with,and more publicity and funds for them to take pressure away from the NHS.
  t one time there were no top heavy management posts, bring back matron control.

• Lorenzo Cherin 11th Jan '17 - 2:09pm

  It needs to be said that we are one of the few countries in the world that have both a state based system and a regular crisis in that system.

  Unless people understand that we need radical changes in attitude , we are going to repeat this every goodness knows when .

  We cannot rely on the whim of government to organise and fund directly , without our patient input , or that of independent bodies representing the patient.

  We have a system that has not worked since it was formed. That is a fact. Bevan was someone who , in real situations , was pragmatic. In internal party matters he was nothing of the sort. Whether from principle or not , he was as big a player of the game of politics imaginable. But he said , “socialism is the language of priorities .” He came up with the model of health care we have , as the best on offer or possible in a hurry in a difficult era. Gaitskell, another political operator , pragmatic par excellance, warned , the system could not sustain funding increases needed, and means tested charges for glasses and false teeth . Controversy , resignations , outrage !

  When we, the patient are not in the driving seat at all, but government , managers, companies, it does not work .

  Traditional Liberal Democrat responses have been caring but complacent. More democracy and local council involvement. Fine for democratic and government responsibility , nonsense for patient satisfaction.

  We need a timely , radical mixture of massive funding , training , reforming , integrating liberalising , all at once . A holistic approach.

• David Raw 11th Jan '17 - 3:32pm

  @ Lorenzo Cherin

  With great respect, Lorenzo (and I mean that) when I was on the transplant list six years ago I didn’t want to sit on a patient committee – I wanted a new organ and the skills of the professionals to perform that operation; to care for me (and to give my wife and daughters moral support). They did, and I am eternally grateful.

  To do it I wanted a Government to enable them to do so by adequately funding the NHS – which I contributed to as a tax payer and NIC contributor for nearly fifty years when I was fit. I did not want to fund the profits of Branson’s Virgin care system as introduced by Lansley and nodded through by the Coalition.

  The inspiration for the NHS was the great Liberal Beveridge (one time MP for Berwick). As to the great Nye Bevan, I can remember him and I heard the speech he made in Trafalgar Square during the Suez crisis. He, and the Attlee Government, had the guts to to do it after a destructive war which nearly cost my father’s life and which virtually bankrupted the country to fight evil. Yet Bevan did it and stopped the horror of people avoiding treatment because they could not afford it. Talk of political operators is just that, talk.

  We now have a government that cuts Corporation tax and prefers to fund Trident instead of adequately funding the NHS. Mrs. May wobbled and was on the rocks at PMQ’s today

  As to the patient being in the driving seat – by all means show respect and care – but the rest is what the Scots call blether and sounds like the worst sort of Lib Dem Conference.

• Little Jackie Paper 11th Jan '17 - 4:18pm

  Lorenzo Cherin – I’d be very careful about that line. Patient interest groups are interest groups – no more no less.

  About 12 months ago my Dad died after some years with Cancer. During that time he got some drugs paid for by the Cancer Drugs Fund which, I understand, would not have been routinely available to him without this special funding. Now I’m no expert on cancer medicine or health prioritisation. I’ve no idea whether these drugs made any difference. And I’ll always be grateful for the support.

  On the other hand I wouldn’t want to have to explain why my Dad’s condition is worthy of a special fund whilst another patient’s condition is not. To say as much is to simply recognise that the NHS can not ever be all things to all people. There is no reform that gets around prioritisation – all this convention would do is grapple with the same questions and issues the NHS has grappled with since inception.

  Indeed this petition states, ‘long-term solution to ensure millions of older, ill and disabled people can get the high-quality care they need and deserve.’ Surely that is a tacit statement of priorities (and note the order of those three groups). All the convention does is reheat the same arguments.

  A real plan would ask what are the limits of the NHS.

• Jenny Barnes 11th Jan '17 - 4:51pm

  We could try and stop people getting ill in the first place. Active travel, for example, to reduce population levels of obesity and hence diabetes.

• Fiona 11th Jan '17 - 8:18pm

  Every time there is a discussion of problems in the NHS, comments sections invariably fill with various suggestions on how to fix it, some more credible than others. Let’s face it, we all have ideas on how the NHS could save some money, but ultimately these suggestions are missing the central problem, which is that the NHS is chronically under-funded.

  As a nation, we need to realise that we pay less for our health service than just about every other developed country, and if we want a health service that provides the care we all seem to want, then we need to pay for it. There’s too many people trying to deflect from that central issue by blaming either the public or the NHS for being too flabby.

  Successive governments have shied away from properly funded investment. The Tories almost always reduce funding in real terms, while Labour did give the NHS a much needed emergency cash donation, too much of this came from PFI, which we are paying for now. We really should have paid for more of it then, but the fact Labour didn’t have the guts to raise more of the funding through taxation at the time is as much the fault of the electorate as it is the government of the day.

  The NHS needs sustained funding to make up for the years of under-funding, and there is no quick fix. Many older people, reasonably, talk about how they’ve paid into the system all of their lives, but unfortunately, through no fault of their own, this has not been enough to sustain the NHS they need now.

  The talk of older patients could be viewed as a cynical ploy to appeal to those who vote the most, or it could be an acceptance that we are an aging population, so regardless of any impact we’d like to blame on immigrants, or people getting a sex change/breast reduction/IVF, the NHS has more to do per lifetime, so we need to pay more per person. Successive governments have been in denial about pension age too.

  I support sensible reviews to improve the efficiency and effectiveness of the NHS, but it’s time we let the politicians know that we need a proper increase in funding, and that we’re prepared to accept an increase in tax to pay for it, and if we are living longer, we need to pay into the system for longer too.

• Lorenzo Cherin 11th Jan '17 - 8:19pm

  David Raw

  Thank you for the respect , in the midst of sarcasm and satire , it can get lost , disagreements are not the same as dislike , not in any way , shape or form , respect , herein reciprocated.

  Similarly do not think for one moment my comments on Bevan, who I am less keen on politically than Gaitskell, the latter is someone I particularly like , have lack of respect behind them, far from at ! I went out of my way to explain how pragmatic both were in office , in an appallingly cash-strapped era!

  I do think there is much in what you say above , but your fears re; people like me and what we advocate , are misplaced. Firstly , as I regularly say , I am in the centre of the party , a mix of left and right and neither and both. I share many of your views on economics and corporations. I just happen to be of a different age , and have different experiences.

  I am delighted your life has been extended by excellent NHS care. I think I can safely say my father’s was.

  My wife , ans several people I know , have had often terrible levels of service.

  I do not want patient input as a token gesture , or committee talk or blether excercise !

  Little Jackie , above , also , take note. I want the patient treated as a whole person in a holisitic system. Involved in whatever choices are available , and whatever decisions are made.

  I also want , as I say regularly , massive levels of training in home grown staff, massive levels of funding at all stages, and integration of the best of all that is available.

  You would find little you would find fault in if I were Health Secretary !

• nigel hunter 11th Jan '17 - 10:21pm

  Whilst NHS trusts can learn from ‘good practises’ is it not time that with an ageing population more people will want NHS treatment in hospital or at home. Treatment at home can be cheaper than going to hospital therefore the care system and support of it should be increased Councils can raise more from the precept for 2 years but then what? back to square one?
  In relation to minor injuries etc. (people wanting tablets for a headache or for broken nails other minor injuries)the pharmacy system could take up the slack. The Government should NOT cut its funding but encourage it to take on more.
  They say we should fund it through a strong economy. However I remember a time when we were the 4th biggest economy, the latest info is that we are now 7th. With all other pressures on funds we need a radical reorganisation of the system.One pence in the pound could be taken out of income (both working and otherwise) maybe on wage slips as a seperate item over and above tax and N.I. payments. Equally we could have statutable health insurance again taken out of wages etc.
  We all will need NHS provision sometime in our lives. Governments will have to grasp the nettle of funding, it will not go away.

• nigel hunter 11th Jan '17 - 10:39pm

  Governments do have to do unpalatable things (to them). If a ‘compassionate’ and ‘sharing’ economy/country is to exist ideology should be put aside.

• Cllr Phil Knowles 12th Jan '17 - 3:07pm

  Such good news this step and a clear commitment both to leading direction and cooperation. For many months I have been calling for a full and over arching review of the ‘NHS’. From Ambulance response times and responsibilities to bed blocking, GP care, Social care and so much more. Calling for an over arching review of how each service interacts and impacts on the other services. I have contacted many who are directly involved, from EMAS where I spent time in the control room to Doctors, Nurses and a variety of interested/concerned parties. I contacted the Health Secretary and the Chair of the Health Select Committee. Lets hope that we can see this move forward without delay and this ‘over arching’ cross party review can start sooner rather than later and lets also hope that those charged with the review will include not just health professionals and MP’s but also those on the ground who are at the forefront of many of the local campaigns’ – Cllr Phil Knowles

• Andrew T 12th Jan '17 - 5:04pm

  @Fiona is right. There are always ways of spending money more wisely but the NHS is underfunded. If we actually want an NHS that works in the steady state with regards to population age then we need to pay more for it.

  I feel there are 5 key health issues:

  – Structural NHS underfunding
  – Structural under training of British health professionals
  – Primary care needs reforming
  – Mental health provision needs reforming
  – Care provision needs reforming

• Jenny Barnes 12th Jan '17 - 6:35pm

  Further thoughts on demand reduction:
  1 tax on alcohol to cover all nhs related alcohol expenses – dealing with serious alcohol overdoses is essential,
  2 tax on sugar in anything to cover diabetes related expenditure . Maybe fat too?
  3 increased VED on motorcycles & scooters to cover the costs associated with their RTA

  Hopefully such taxes would reduce demand for such services, rather than actually needing to be paid.

• Jenny Barnes 12th Jan '17 - 6:36pm

  Ps it’s all going to the tory privatisation plan.

• Matthew Huntbach 12th Jan '17 - 8:29pm

  Little Jackie Paper
  
  Indeed this petition states, ‘long-term solution to ensure millions of older, ill and disabled people can get the high-quality care they need and deserve.’ Surely that is a tacit statement of priorities (and note the order of those three groups).
  
  No, it is simply a statement of reality.

  Medical advances mean there are large numbers of people alive today who a few decades ago would have been dead. Conditions that would have killed people no longer kill them. So they stay alive, but are more likely to need care. There are more older, ill and disabled people now than in the past because far fewer people die at a young age than in the past.

  As we get into our 50s, 60s, 70s and so on, little things start going wrong that require care. They wouldn’t be needed if we died earlier on, as many people did in the past.

  So it all costs more money, just to care for people in the same way as they would have been cared for in the past because there are far more of them that need caring for.

  This ought to be the central point of discussion on the NHS, but it is not.

  It ought to be the central point of discussion of politics in general that if you want something provided by government, it has to be paid for by taxes, but it is not. Instead these things are talked about as if they are separate and unrelated. That is just daft.

  So because politics is daft like this, we get all these daft talking, and nothing sensible that hits the real issues.

• Matthew Huntbach 12th Jan '17 - 10:11pm

  Jenny Barnes
  
  Further thoughts on demand reduction:
  
  Er, no, this will just keep people alive for longer, so they will be sick with other things later on, and that will cost just as much.

  If you really want to reduce demand, encourage more smoking, so that people die earlier of the cancer and heart failure it causes.

• Matthew Huntbach 12th Jan '17 - 10:42pm

  Instead of accepting that if you want it, you have to pay for it, all we get in politics is this hand-waving suggestions that somehow there is some magic way to pay for it that doesn’t involve raising money for it.

  So, there’s always some bureaucracy we are told can be cut to pay for it. Or there’s some bureaucracy that can be introduced to pay for it – bureaucrats to set targets and run them to make things more efficient and that sort of thing, or bureaucrats to deal with all the complexity of competition, which we are told will bring costs down.

  Or we can centralise it all, well, you see that saves money by economy of scale. Or decentralise it, that saves money because there is more local know-how so it is spent better. So there we are – every few years centralise then the next few years decentralise, and that will keep on reducing costs and we will never ever have to raise taxes to pay for the inconvenient fact that people are living longer but still pretty much sick and in need of care at the end.

  If competition was the magic answer, as the Tories still like to say, how are costs going in private health care, where surely if there’s easy-peasy ways to cut costs it will be done as that’s all about competing to have the lowest costs, isn’t it? I think you will find that private health care costs have been rising rapidly.

  And what about us LibDems, have we been honest about all this? Er, didn’t we focus our attention in the 2015 general election on how we were a tax-cutting party? Even after we saw what happened when tax cuts meant there wasn’t enough money to pay for universities any more … Daft.

• Glenn 13th Jan '17 - 11:23am

  Matthew.
  Well said.

• Katerina Porter 13th Jan '17 - 4:14pm

  This is has been a very mild winter, till now. Our major crisis is probably at least in part, due to the total restructuring of the 2012 Act. This act removed the 1948 duty of the Secretary of State to provide the best affordable care for every citizen in this country. There are now commissioning boards, contracts, competition and lawyers to pay for, much much more paper work and loss of the local structure. Administrative costs were 3/4% of the budget for decades, our health service was cheap for a reason. Now they are 30/40%. Professor Allyson Pollock, whose field it is, spells it all out in a video. You can look it up. This restructuring is a move to the US model. You reduce the NHS till it is obviously not coping, and then the argument will be that privatiation is the answer.

• nigel hunter 14th Jan '17 - 10:56am

  Yes it is a ploy to become US style but other countries provide good care. We must look at them for ways of improvement.
  One measure to consider. 26 extra beds have been provided at Wharfedale Community hospital (Otley) to take the pressure off NHS trust Leeds. Patients who are awaiting discharge are transferred there with a link to a care service provider for 6 months care after discharge.. Greg Mullholland Leeds West MP can give you information on the system.
  These Community hospitals are an asset and should not be closed but used far more efficiently.The above plan takes pressure off the overloaded main hospitals. With more foresight than spending cuts tragedies can be reduced
  Have a look at your community hospitals and see if they are being used to maximum efficiency, if not bring them back into the system.
  Indeed the top heavy management shoul d be dismantled and the NHS get back to the patient as it was intended.

• Fiona 14th Jan '17 - 11:30am

  So much of the existing NHS waste is itself due to under-funding. There is too much fire-fighting, which is often necessary, but never an efficient use of resources.

  I favour an unashamed increase of 1p to our income tax, making it clear that it is necessary if we want to have quality of care and quality of life as we live longer. We can accept there are “important discussions about what we want” or means to improve working practices, but not allow those topics to be used as delay or diversion tactics. Some people will say “I’m happy to pay it, so long as it is ring-fenced for x, y and z improvements …”, but we need to find a way to communicate that we’re trying to get back to a neutral position to over-come historical, long-term structural under-funding, and that actually, collectively, we’ve been under-charged for the services we all expect. If you are recently retired using the line “I’ve paid in all my life”, well you did what you were asked, but you should have been asked for more.

  I also welcome a carefully considered sugar tax, but this time think it’s right to ring-fence it. Again, it’s easy to be distracted by often legitimate discussions of free choice, or making the application ‘fair’, but at its heart, the Jamie Oliver suggestion of adding a modest charge to soft drinks with added sugar was a good starting point. His suggestion was to ring-fence that money to pay for better food education in schools. I would urge that money raised from any sugar-taxes are ring-fenced for public health and education initiatives.

• Andrew T 14th Jan '17 - 5:04pm

  I think reducing the state pension by at least a third and ending the culture of awarding overly generous pensions to public sector workers combined with an effort to increase the tax take by 1% of GDP would solve the funding problems. We should also look to remove the concept of “retirement age” altogether and replace most current benefits with a UBI (Basic Income).

  This would probably involve gradually weaning people off the present systems while borrowing to fund the NHS in the present.