Opinion: Lib Dems should support the NHS reforms to secure its long-term future

Listen to the Labour spin, the media furore, or the special interests in the healthcare unions, and you’d think that the Health and Social Care Bill had been crafted by the evil Tories and naive Lib Dems to maliciously snatch all hope of critically needed health and hospital care from the poor and vulnerable, dooming great swathes of the population to lives of miserable illness and suffering, all to help the ‘rich and profiteering’ private healthcare companies milk every last penny and drop of human decency out of society.

Left leaning voters are angry – indeed opinion polls show that a majority of voters are fearful and opposed to the government’s NHS reforms.  Leading Lib Dem politicians from Simon Hughes to Tim Farron, to the Clegg –Williams letter circulated to party members, and jumped on by the Bill’s opponents, have been lining up to appear against the government’s proposals and to be concerned and critical about the dangers of competition.

Some in the party no doubt see now as a chance to make the headlines, and start a recovery amongst the tactical and protest voters we’ve had support from in past elections. This is understandable politics, but, I believe, potentially damaging both to the party’s credibility and to the country.

I worry because the spin and anti-Bill protestations are false – the reality somewhat different, the threats to the NHS more challenging to accept and hard to fix. Facing up to and solving these challenges is an important obligation of a responsible government, and what I would expect of the Lib Dem government that I voted for.

Recent reviews and research, including under the previous government, have shown that, unreformed, the prognosis for the NHS, is not too healthy – a smaller economy following the financial crisis still stubbornly refusing to grow, an ageing population, an expensive and draining management bureaucracy, and the stagnancy and declining return of a complacent provider monopoly ever more demanding of ever greater funds.  Barely heard for all the noise and hyperbole, these are the real threats to our health service.  The reality few want to face is that staying the same means accepting a future of foreseeable and terminal decline. Defending the NHS means accepting the need for change.

The principles at the heart of the government’s proposed reforms are Liberal ones – of increasing transparency and information, of devolving power to as local a level as possible, of challenging monopoly, of free trade without barriers to everyone’s benefit, and of universal access and protecting the vulnerable.

The government wants you, and your doctor, to have options and choice about what treatment you want to pursue; for providers (both public and private) to compete to offer services, for your doctor to advise and help you choose whichever service and whichever provider will offer you the best service and best potential health outcomes achievable, and for the state to pick up the tab – getting more out of the budget by enabling innovation and efficiency, ensuring you (and everyone else) can get the quality care you want and need, not just now, but for the foreseeable future.
So Lib Dems should embrace the Bill and its stubborn focus on long term necessity at the expense of short term pain.  Lib Dems should support the core Liberal principles and see through our arguments made over the last two years.  Lib Dems in the Commons and in the Lords should live up to the high standards we expect of them when voting.
Abandoning these principles, the logic and evidence, dooming the NHS to predictable failure, simply for headlines and potential short term political advantage – that would be unforgivably disappointing. As I said to Tim Farron’s earlier this week – I’d be dismayed. And I suspect that those reformers who’ve stuck by us so far, or who were considering giving us their vote, might not be too impressed either.

* Andrew Tennant is a Lib Dem member in Loughborough.

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  • Foregone Conclusion 1st Mar '12 - 12:32pm

    Ironically, we seem to be focussed on the policy far more than the politics.

    On the substance of the Bill? There’s nothing too dreadful now, although why we have to have a massive shake-up now I don’t know.

    On the politics of it, it’s dreadful us (and for the Tories). Dreadful, dreadful, dreadful. Kill it now, maybe introduce legislation later in the parliament introducing the good bits, but don’t tie us to this rotting corpse any longer. This could crucify us as a party, and I plan to vote for the motion on those grounds.

  • jenny barnes 1st Mar '12 - 12:39pm
  • mike cobley 1st Mar '12 - 1:01pm

    Hilarious, is one word I could use to describe these farrago of boostery waffle. The actual-existing consequences of involving private sector providers and market mechanisms are as plain as the nose on your face – money will be siphoned away from frontline necessity and towards company profits, exec salaries, bonuses and shareholder dividend. This is undeniable, except of course to those who are singing from the songsheet of 19th century, steam-powered Liberalism.

    The NHS that comes out the other end of these ‘reforms’ may well be still free at the point of use, but they’ll probably also be crap at the point of use.

  • Andy Thompson 1st Mar '12 - 1:11pm

    Someone once said to me that there are three sides to every story and I fear that this is true in this case.

    On one hand you have the pro reformers who point to the implosion of the NHS if nothing is done. On the other hand, there are those who believe that the introduction of competition will lead to falling standards of care as profits are put before patients.

    For me the reality lies somewhere in between. I don’t know how I will vote if this goes to conference. I just hope that the quality if debate reflects the importance of the vote.

  • @Dave Page
    ” I wonder if those people frothing so heavily against it will show any shame for what they have done – or whether they’ll have found a new set of lies to leap upon?”

    Those frothing at the mouth will indeed move on to a new issue. However, those who work within the NHS, the members of the Royal Colleges and various Faculties who oppose the BIll cannot. These are not the idiots at Unite trying to wreck the Olympics, these are the very people who should be listened to. Ignore the extremes of the arguments from both sides, neither of their scenarios will happen, but ignoring the experts, many of whom supported the broad thrust of the Bill but oppose it’s details, is just plain stupid.

  • You refer to “evidence” but don’t actually provide any facts or links. I put little store in assurances by ‘either side’ that competition or co-operation, respectively, are what’s most needed unless backed up with historical, global or piloted experience.

    One genuine question: Suppose my local clinical commissioning group (which will surely retain an essential expensive management bureaucracy, only now run by KPMG or similar) wanted to pick and choose patients, or to unreasonably redefine what services it covers and perhaps offer top-up insurance schemes for those it doesn’t. Would local councillors – via the Health and Wellbeing Boards? – be able to stop or limit them if that’s what their constituents wanted?

  • Many Lib Dems on the left and centre of the party oppose this bill because it is a bad bill, not as an attempt to win back lost voters (as an aside, I think the party has lost far more than “tactical and protest voters” and that this is actually a very serious problem).

    There are several reasons why the bill is fundamentally flawed, to go through them all would be an essay so I will just mention a few key things (i.e. not relating to competition et cetera, though there’s a lot to say there). The core concept of GP commissioning is, in my view, misguided.

    Firstly, GPs see what is a relatively cheap part of the NHS operations. Most of the truly expensive procedures and treatments would go on in hospitals and would be difficult or impossible to use outside of that context. Moreover, as someone whose background is in the biological sciences I can assure you that this trend is only due to increase – there is a lot of extremely exciting (but extremely and inherently expensive) stuff in the works which will probably be impossible to use outside of a hospital setting. I don’t think it is at all sensible to give the purse strings to the group of doctors who are likely to be the least aware of how much the NHS can actually cost.

    In fact I would go so far to say that if a commissioning system is to be used if anything it should include hospital staff and explicitly exclude GPs. I’m not at all convinced about commissioning even under those circumstances to be honest, and would prefer just to staff the PCTs with medical professionals, but I would consider it worth attempting as an experiment. As a side note, any shift towards giving medical staff control over running the NHS should be taken in conjunction with hiring some more doctors so that the workload of any individual doctor isn’t increased too much. They aren’t exactly underworked individuals.

    Secondly, and this point actually comes from me from a GP (albeit through another person). There is a substantial conflict of interest going on. GPs have a duty of care to their patients and must recommend whatever procedures or treatments are best for them. People in charge of the budget have to balance the books as an absolute priority. If a patient requires some very expensive treatment then surely the issues with the situations of GPs being the money-men should be fairly obvious. Massive conflict of interest, very concerning, very bad idea.

    However, the most fundamental flaw with the bill is simply that it is attempting to fix a problem that isn’t there and not attempting to fix a real problem.

    There is a lot of rhetoric about increasing efficiency in the NHS and this actually completely ignores the fact that the NHS is already efficient. Okay, not in absolute terms as anyone with a cursory knowledge of the budgets can tell you, but in relative terms it is in fact one of the cheapest healthcare systems to run in the developed world. Other systems abroad, despite some involving far more of the supposedly efficient private sector, are in fact substantially less efficient than the NHS. Efficiency savings aren’t likely to do much good as we are already exceptional at that game, and we do it without any of the dirty tricks that some healthcare systems use (e.g. de-prioritising rural areas).

    However, what IS a long term problem is an ageing population and the associated costs that will bring. The most obvious solution here is to have more integrated social and health policy, to have a focus on preventative medicine and to encourage anything which doesn’t absolutely have to be based in a hospital to be done at home or in smaller, cheaper health centres. I don’t see any of this in the bill and these are issues which will have to be addressed at some point.

    So, to conclude, the NHS needs reform. However, no reform is better than bad reform and the proposed reform is absolutely terrible. Even if we ignore the misguided focus on competition (that will hopefully be axed anyway) the fundamentals of the bill are not addressing real problems and involve a massive restructuring of the NHS in a way which, quite frankly, doesn’t seem beneficial. The real problems facing the NHS, and healthcare systems around the world, are not even mentioned.

    Let’s not forget that the medical profession spent most of the Labour years clamouring for more say in how the NHS is run. They are getting it in this bill, yet they still by and large oppose it. If the medical profession opposes a bill, even when it contains something they have wanted for years, then surely that indicates a substantial problem and it should be listened to. I sincerely hope that conference votes to axe this ill-conceived bill, as quite frankly there’s no hope for it to be made into something workable.

  • Andrew Tennant 1st Mar '12 - 1:44pm

    @Mike Cobley & Andy Thompson
    The bill does not impose an obligation to obtain health services through the private sector, it merely creates a framework in which using a non-public sector provider is an option. If the public sector service is superior then the public sector service should be the one which is bought. Where the public sector service is inferior, then the patient and doctor can choose the higher quality provider. Unless you believe your doctor to be malicious or incompetent then your experience will be the same service or one that is better.

  • “opinion polls show that a majority of voters are fearful and opposed to the government’s NHS reforms.” Yes they are. With very good reason – it’s known as ‘democracy’ or rather lack of democracy. Before the last general election, I cannot recall anyone from any political party mentioning the merits of introducing competition into the NHS. This huge reorganisation has no mandate; it was never voted on. It seems to me that Mr Tennant knows what is best for the NHS, more in fact than the British electorate and the various Royal Colleges combined. If the government is so sure of the wisdom of what it is doing then put it to the electorate. Simple. But that won’t happen. The health Bill has now become simple political expedience for the Parliamentary LibDems. Vote it down and face a possible general election now (unthinkable!), or back it and hope that in 3 years’ time voters will return. A no-brainer.

  • David Evans 1st Mar '12 - 2:14pm

    “Lib Dems should support the NHS reforms to secure its long-term future.”

    Or alternatively,

    Lib Dems should support the NHS reforms to ensure its long-term demise. The only thing I’m not sure about is whether the ‘its long term future’ refers more accurately to the NHS or the Lib Dems themselves.

  • I stopped reading after “special interests in the healthcare unions”.

  • The NHS really ought to be named the NIS (Illness). Dun Khan hits the nail on the head when he says there is far too little focus on moving provision away from hospitals and into home-based preventative mention. Partly this is a perception issue; people feel better about a problem that is fixed than about something that doesn’t happen.

    More widely, as the population ages, the demands on the NHS will increase. There is already rationing. This will have to increase as the balance between taxpayers and tax consumers changes over time. Society will have to ask itself some hard questions about providing services with no questions about responsibility.

  • This will lead to more A4E’s, this time in the health sector. Billions in tax paid to private companies intent on increasing their profits over health of patients.

  • patricia roche 1st Mar '12 - 3:45pm

    you would all do well to remember that every time there is a story about bed blocking by private patients, doctors running out of money, and charges accruing for health treatment, the lib dems will be blamed.

  • “The NHS as it stands has some of the worst health outcomes in Europe and, indeed, the OECD area. ”
    Any evidence for this? The Tories have made a number of claims about the NHS which have been shown to be misleading or bogus. For instance Cameron has told us that if the NHS operated at the level of the average European country 5000 fewer britons would die of cancer per year. However what he neglected to mention was this claim was based on data from 1985 – 1999. Yes, seriously, the case for Tory reform of the NHS is based on how poorly the NHS performed when the Tories were in charge.

  • David Allen 1st Mar '12 - 4:37pm

    One thing which always fascinates me in politics is how people can fundamentally disagree on who has got the facts right, irrespective of their opinions as to what should be done about them.

    Thus, FC and Mike Cobley in the comments above are united in wanting to kill the bill. Yet FC believes that the amendments have got rid of most of the things which would have caused real harm to the NHS, while Mike Cobley clearly thinks that nothing of significance has changed. Who is right?

    Well, perhaps we should all be a little more careful not to claim too much knowledge in a confused situation. Similar arguments still rumble on about the tuition fees fiasco. To try to be objective about that, it would be fair to say that a lot of the detailed “facts” advanced by the supporters of fees and by people such as MoneySavingExpert do seem to stand up. What the opponents of fees are still entitled to claim is that this is to miss the important point, which they may see as being: to stick to your promises, and/or to abolish debt culture, and/or to avoid the marketisation of education, and/or to avoid increased social inequality.

    So to bring this rather rambling post to a conclusion: Sometimes it’s the detailed facts that matter, but this time, it really isn’t! This Bill, if passed, is going to be judged in terms of whether the public perceive that it has made a mess of the NHS and replaced honest bureaucrats with grasping private contractors. Well, maybe it will do, and then the public will pillory us. Then again, maybe it won’t do too badly because of all the wonderful amendments we have brought in, but, the cuts will still have to be made, the stories will be bad, and some private contractors will assuredly do terrible things and get pilloried. And again, we shall be pilloried too. So (got there in the end) – let’s Kill the Bill!

  • Ruth Bright 1st Mar '12 - 5:26pm

    What exactly is in this bill to tackle the issue of an ageing population? The bill clearly creates another opportunity to integrate health and social care (an opportunity that was there anyway) but it does not actually DO anything about merging health and social care. DunKhan is absolutely right.

  • Foregone Conclusion 1st Mar '12 - 5:53pm

    @Tom Papworth,

    Some of us don’t find the idea of nobody being accountable for the health service via the ballot box particularly comfortable. The incredible centralisation of the health service under the Secretary of State is obviously bad and in practice something of a fiction, but this isn’t much better. The man in Whitehall doesn’t necessarily know best, but neither do GP consortia. What we need is more localism and more democratic accountability – the bill delivers one, but not the other.

    Also, I wouldn’t anticipate any end to politicians being blamed for what goes on in the health service. We have a free market economy, but it doesn’t stop the government being blamed when everything goes wrong!

  • Andrew Suffield 1st Mar '12 - 6:21pm

    Broadly agreed on the policies, afraid it’s now politically impossible.

    There is a very real chance that the outcome of all this will be Labour going down in history as the party that died out after destroying the NHS without even being in government.

  • Dave Eastham 1st Mar '12 - 7:00pm

    part 1)
    First of all, I don’t think anyone involved in the debate has ever claimed that the NHS should not continue to develop and adapt to changes in needs and develop in caring for the Health Care needs of the population. Nothing is or has ever been set in aspic. There always has been and always will be disagreement on the precise way to do this. The question remains, is the current HSC Bill the vehicle to do this?.

    However, for Andrew to open this LDV contribution by suggesting effectively, that all contrary opinions regarding this Bill are motivated by special selfish vested interests in some way, is shall we say?. Not a great start to the piece. Following it up, by dismissing those in the Party are counseling that, the Bill is still fatally flawed and should be dropped, as being motivated by some sort of wish for political atonement after the Tuition Fees fiasco, is also a rather inadequate analysis I think.

    (Especially after the Party has fully engaged in the Parliamentary process and contributed many amendments, which have gone a long way to meet the challenges of the comprehensively amended motion passed at the 2011 Spring conference).

    So, having avoided the kind invitation to breach the guidelines of posting a comment on a contribution in this forum with a brief but somewhat robust reply, I would like to draw attention to the following points.

    Simon Hughes, in the television interview given on Sunday morning last (posted elsewhere on LDV) claimed that the Lib Dem amendments to Part 3 of the Bill would sort it out and allay concerns that the Bill, far from damaging the NHS will be fine after the Lib Dem amendments. Having now seen the said amendments I’m afraid I have to differ. It was said that the Lib Dems would remove the competition aspect from clause three, thus protecting it from EU competition law (it was claimed).

    As I understand it (see briefing note 15, dated 28 February 2012.) , Part 3, Chapter 2, Clauses 70-81 deal with competition. What has been proposed by the Lib Dem amendments is the deletion of clauses Clauses 78-80. Which removes the Competition Commission duty to carry out reviews. It leaves intact the rest of the competition chapter. For example Clause 73; allows the Secretary of State to make regulations regarding procurement, patient choice and competition. Plus investigating anti-competitive behaviour by the NHS Commissioning Board and clinical commissioning groups. Go look at the rest.

    Whilst undoubtedly traveling in the right direction, the recent letter from Nick and Shirley announcing “no government will once again be able to favour the private sector over the public sector like the last Labour government” is perhaps over optimistic.

    It remains a concern that the Bill would establish the legal basis for providing fewer NHS services, for introducing charges for services that are currently free under the NHS, and for excluding people from health services through secondary legislation. This is not waving shrouds.
    Before I leave this bit there are three short points. Firstly, it is not without significance that Lansley is letting it be known that he regards that the amendments are not of any significance and secondly that Earl Howe, despite the will of the lord’s being clearly expressed, has not brought back the amendment to preserve the responsibility of the Secretary of State to be accountable for Health Care as under the 2006 act but has brought back a clause which does no such thing. Finally, the refusal to allow a debate on the Bill following the successful numbers achievement of the Chand petition. The back bench committee felt that as it was a government measure as it was being debated, the subject had been adequately covered. It was pointed out that the debate was on the detail of the Bill. What was being requested for debate was the actual need for this particular bill. It was also the fact that no Conservative was willing to appear before the committee and support the call for the debate. I think that this refusal is an unfortunate mistake.

  • Dave Eastham 1st Mar '12 - 7:11pm

    (Part 2)
    Whilst the cry of “Privatisation” has been inevitably raised in these debates. It should be recognised as a”shorthand” term referring to some level of commercial involvement. Hospitals, for instance have always been built by Private Sector organisations, whether funded directly by Government or procured by other fiscal mechanisms such as PFI. Services historically have either provided by “in house” provision, or have been “outsourced” to a third party provider (“privatised”). Generally with very mixed results. That however is not the aim of these few words.
    The concern is for the effects of the HSC Bill is not the warm words and mood music and talk of “Liberation”. It is the actual direction of travel and implications thereof.
    Whilst many things about this Bill “trouble” me, it is a few years hence and the likely outcomes that concern me. For instance, it is acknowledged that the GP consortia will need support training etc. These Commissioning support groups CSG’s are being set up now to provide “leadership training”. These are being supplied by the likes of McKinsey and other favourite management consultants I’m sure you have heard of. As the Commissioning Support Organisations (CSO) develop no doubt drawn from the staff of the abolished PCT’s . The private sector organisations won’t have much to teach them re actual commissioning. But by April 2016 these organisations will be required to be “Standalone enterprises” becoming financially and commercially viable and a market established in selling services to GP commissioning organisations and that’s when the management advisors get in. If I have got this wrong and I have missed this being deleted from the Bill, then please enlighten me but the old adage about walking and quacking like a duck rather comes to mind.
    The great tragedy of the formation of the NHS is the project was never completed. Lib Dems have always had a vision that integrated Health and Social care that should be the aim. Not one free at the point of use and the other charged. Despite it’s name, my conclusion is that this Bill is very little to do with Health and Social Care. We are in danger of losing a real opportunity to really reform and integrate Health and Social Care.
    We are now told that many changes have already been implemented already and it cannot be reversed and thus the Bill should be passed. Apart from the wider implications of that, my reaction is that argument (if it can be described as one), is like Patriotism, when displayed in this manner, the last refuge of a scoundrel.
    Last minute amendments about integration et al are window dressing. It is time the Party recognises this Bill is not what it says on the tin and withdraws support. Not as an act of political grandstanding but because the Bill really is not fit for purpose.

  • Another pro-reform piece lacking any actual evidence.

    It seems to be taken as an article of faith that competition always increases quality and drives down cost.

    But this isn’t good enough for me, I want evidence. Show me the system with better outcomes for lower costs than the NHS. There isn’t one as far as I am aware. There are cheaper systems with worse outcomes, and more expensive systems with better outcomes. But no system outperforms the NHS.

    Why not take a more scientific approach and just test the system somewhere for a period of years, and if it succeeds apply the model elsewhere?

    You wouldn’t allow a doctor to whip up some concoction in a lab and say “right instead of the MMR we are going to inject all babies with this” so why are we allowing the whole NHS to be reshaped without some trials?

  • Good to see an article making the case for NHS reform. While I support NHS reform in principle, I’m still not certain whether or not I should support this particular reform.

    But again, good to see a defence for liberal reforms.

  • Stuart Mitchell 1st Mar '12 - 8:17pm

    “Listen to the Labour spin, the media furore, or the special interests in the healthcare unions…”

    Sadly this article consists mostly of ad hominem attacks on the bill’s opponents and the usual coalition cry of “we must do this because the current situation is unsustainable”.

    The various medical colleges have produced very detailed and convincing analyses of what exactly is wrong with this wretched bill. The quality of the response from the government’s apologists really says it all. I echo Steve Way’s comments about the need to listen to those who work in the NHS. Doctors are not opposed to the bill for the sake of kicking the government. Anybody who knows doctors or who has followed medical issues in recent years knows that most doctors utterly despised the Labour government and had a great deal of goodwill for Lansley when he took office. The fact that it has all gone so horrendously wrong should tell you something.

  • Richard Dean 1st Mar '12 - 8:20pm

    Stuart: “The various medical colleges have produced very detailed and convincing analyses of what exactly is wrong with this wretched bill”

    I am an ignorant person. Could you posibly provide some web addresses where these are available? Just the simpler ones. Thanks!

  • Why not take a more scientific approach and just test the system somewhere for a period of years, and if it succeeds apply the model elsewhere?
    They tried this – on a small scale – and the Doctors involved don’t back these reforms, but the Tories are trying to push ahead with them anyway.
    Today I travelled (mainly standing, a snip at £40) on an overcrowded commuter train, privatized disasterously by the Tories the last time the country had the pleasure of their expertise. With “competition” we got falling safety standards, increased overcrowding, some of the highest rail fares in Europe and subsidies spiralling upwards. The Tories have a track record of messing up major reforms, whether it be the rail service or the original marketisation of the NHS which massively increased costs. Our duty is to act as quality control. This bill is of poor quality, despite the best efforts of many. Our MPs should remember – first do no harm.

  • Richard Dean 1st Mar '12 - 8:32pm

    Dunkan: “There is a substantial conflict of interest going on. GPs have a duty of care to their patients and must recommend whatever procedures or treatments are best for them. People in charge of the budget have to balance the books as an absolute priority. If a patient requires some very expensive treatment then surely the issues with the situations of GPs being the money-men should be fairly obvious. Massive conflict of interest”

    Please can you help me with this choice. I have $100. I can cure two of my patients at $50 each, leaving the other 10 to suffer, though not too much. Or I can cure ten of my patients at $10 each, but unfortunately the other two will then suffera bit. In this situation, is it actually better to allow me to take account of the costs of treatment in deciding which patients to treat? Or should I simply treat them on a first come fiurst treated basis?

    By the way, one of them is your mother, the other is your son. One will cost $50 and the other $10, but I am not telling you which.

  • Stuart Mitchell 1st Mar '12 - 8:59pm
  • Daniel Henry 1st Mar '12 - 9:26pm

    This post didn’t do much to change my opinion. It simply attacked the bill’s critics af claimed that the reforms would help the NHS with no evidence supplied.

    One of our members has done a better job on me on Facebook. By pointing out some of the amendments we’ve made, some of the manifesto promises it delivers (health and wellbeing boards, integrating physical and mental health etc), the safeguards we’ve put in, the fact that many complaints about this bill (e.g. Private sector involvement and EU competition law) are already in the NHS due to Labour’s reforms and that this bill will actually tone them down and lessen their effect. I’m trying to persuade him to write an article on here.

    I’m really finding it hard to have a clear view on this bill. David Allen above compares it to tuition fees, but that was an easy change to understand. With a few button presses on a calculator I could see that our changes to the loans system would allow the poorest to pay less while the richest paid more. Getting the truth about this bill, let alone the consequences, seems to be nigh impossible!

  • Daniel Henry 1st Mar '12 - 9:29pm

    I think we need a LDV article from Shirley herself, listing all the good points of the bill, all the safeguards we’ve put in, how it improves from Labour’s last reforms and where she still has some concerns.

    If anyone can stave off a membership rebellion it’s her.

  • Richard Dean 1st Mar '12 - 9:48pm


    Thanks very much. While I am no expert, here are some comments on the document by the Royal College of GPs. I’m afraid you may strongly disagree with how I see it.

    Section 1.1 of the document claims that the changes will be difficult to implement, because of simulatneous changes relating to efficiency that are presently being developed, and because staff morale would be adversely affected. The first reason is not a reason not to accept the bill – it is an argument (some might say a plea) for extra funding to assist with the changes. The second reason looks a little like sulking to me!

    Section 1.2 raises concernes about who will be responsible for providing a comprehensive NHS. I raised this concern myself in a different discussion on LDV. The Department of Health provided what looks like a reasonable response to this (). In a nutshell, the practical reality is that the duty specified in the 2006 Act is shared anyway at the present moment, and this bill simply recognizes that practical reality.

    Section 1,3 is on competition. We learn that the RCGP is not averse to cpmpetition at all. Instead, they appear to have some objections only to clauses 73 and 97 of the bill, plus some concerns about training people to understand how competition, choice and integration cxan work together. I don’t see this as sarcasm, I see it as a simple request for training. The last two paragraphs of this section raise some rather vaguely defined concerns which I think the Department of Health should be able to address without scrapping the bill – probably without changing it at all

    Section 1.4 is on education and training, and expresses concerns about whether the arrangements in the bill will ensure the same quality of training as is presently provided. This again seems something that should be relatively straightforward to fix.

    Section 2 presents an alternative re-organization of the NHS. That alternative re-organization will raise again all of the objections that the RCGP have identified in their Section 1, except that the objections will now be made by other non-GP workers of the NHS.

    Section 3 presents the amendments that the RCGP would like to the present bill. One of their major requests is that clauses to do with Monitor having a policing role regarding competitive tendering be removed. They claim that these clauses will damage coopertaion, but give no detailed argument to support that claim. My feeling is that a policing role is absolutely essential, because otherwise corruption can very easily set in – and I think many examples of this can be fond in developing countries where policing of government contract tendering is weak. Futher, without effective policing, the general public will continue to be skeptical of the honesty of the medical profession in relation to money!

    In summary, I don’t see the RCGP document as offerring any convincing case to scrap the bill. Some of the concerns raised in Section 1 look like they could be fixed without changing the bill at all, or by making relatively minor changes. Section 2 is a waste of time – it;s just another proposal which will create objections of the same sort from non-GP parts of the NHS. Section 3 looks too much like a crook asking that the government sack all the police!

    I will try to have a look at your second link soon

  • Tony Dawson 1st Mar '12 - 10:33pm

    @Daniel Henry:

    “I think we need a LDV article from Shirley herself, listing all the good points of the bill, all the safeguards we’ve put in, how it improves from Labour’s last reforms and where she still has some concerns. If anyone can stave off a membership rebellion it’s her.”

    You may be right, although the reason is not particularly logical. Shirley is an icon for Lib Dem concern for public services, she is not necessarily the greatest technical expert on this Bill, ‘improved’ or no.

  • Richard Dean 1st Mar '12 - 10:43pm


    This document (http://www.bma.org.uk/images/nhsreformbriefingbmaopposesbilldec2011_tcm41-210946.pdf) is scrappy and inconsistent – for instance the Introduction lists four primary concerns which it says will be explained in detail later, and then four quite different concerns are explained later! Here are the second four key objections:

    > change is too fast
    > change is too complex
    > knock-on effects have not been thought about (but the BMA give no specific examples of knock-on problems)
    > mismatch of rhetoric and reality

    The first two are very important, but only if the people who will be implementing the changes feel harrassed or powerless. The document does not seem to present any evidence of this as a widespread feeling in the health sector. But anyway, there are surely ways of resolving those issues to everyone’s satisfaction. The third is also potentially important, but is just a vaguely defined worry by the BMA – no actual examples or scenarios are given to support the claim. The fourth one smply claims that government can’t be trusted, giving no credible supporting evidence.


    The BMA and RCGP are professional bodies – unions whose job is to fight for their members’ interests. These two documents (the RCGP one is http://www.rcgp.org.uk/pdf/12-02-06%20RCGP%20HoL%20Report%20Stage%20Briefing.pdf) look tactical to me. They are part of the bargaining process. Tactical documents don’t necessarily mean what they say – sometimes a negotiator will say just about anything if it gets the particular selfish interests they represent satisfed)

    As a political party, we need to fight for the country’s interests, and these are not necessarily the same as the BMA’s or RCGP’s . We need to grow up and make the hard decisions that the country needs. I am always open to changing my mind, but my conclusion from these two documents is that we should go ahend and vote the bill in.

  • Richard Dean 1st Mar '12 - 11:08pm

    Stuart, Sorry to go on a bit, but we need to interpret things correctly. Here are my succinct suspicions, based on the two documents you listed:

    > The RCGP are primarily worried that others will be allowed to compete with the RCGP in training doctors
    > The BMA are primarily worried that others will be allowed to compete with the BMA in representing physicians

    If this is the reality, the issues involved are completely different to what they have seemed to be to date.

  • There is one good political reason why this Bill is so important for LibDems – it is forcing us to decide if we’re in this coalition to be in government, or to be the in-house opposition…

    We need to deliver what we actually want, not just how we can moderate tory ideas.

    That this all comes during the build-up to spring conference means that is where the decisive action will take place – a lot may depend on the speeches.

  • Jayne Mansfield 2nd Mar '12 - 8:49am

    So the ‘spin’ and anti bill protestations are false are they Andrew Tennant.

    Is this the ‘spin’ and anti bill protestations that caused Mr Clegg and the Lib Dems to modify their support for the original bill, or the ongoing ‘spin’ and anti-bill protestations that recognise that this bill is even more of a dog’s dinner?

    The bill is your bill Mr Tennant, it is a government bill that has been supported from the outset by your government. I hold my hand up as an anti-bill protester, and admit that the bill was in my opinion, ill- conceived, muddled and did no in its original form not in its present form , address the problems facing the NHS in the future.

    I have to ask you, Mr Tennant, why was this massive top- down reorganisation discussed before the last election so that we the electorate could think through the issues whilst we still had the power to influence what happens to our NHS?

    It is no good pointing to some page in a manifesto. How many of us read a manifesto before we vote, we take what we are told on trust. You know, ‘I will cut the deficit not the NHS’. ‘ There will be no top down reorganisation of the NHS’.

    Like Lansley, the Liberals ( after voting LibDem at every election by one, think that you can patronise voters like myself with the ‘there, there dear,you just don’t understand what we are doing on your behalf, take the medicine and leave things to your betters’

    I believe that the NHS like the rest of society, works best when there is collaboration and co-operation. The marketisation of our NHS fills me with foreboding.

    If one wants to examine how ‘spin’ works, one should examine the current demonisation of GP’s and health workers who oppose the bill.. If health workers are that craven or stupid, why does Lansley claim that he wants to give them greater power? Why are the GP’s being offered the lions’ share of the NHS budget to do with as they wish ?

    As someone who has voted Lib Dem because they seem ‘nice’, I am having a belated political awakening.

  • Andrew Suffield 2nd Mar '12 - 9:28am

    If one wants to examine how ‘spin’ works, one should examine the current demonisation of GP’s and health workers who oppose the bill..

    Erm. No. This has got nothing to do with GPs and health workers, but rather the trade union bureaucrats who purport to represent them.

  • Andrew Suffield, how can you type that last comment with a straight face? Most of the Royal Colleges have shifted to oppose the health bill after intense opposition to it from their members despite the leaders being more willing to consider it.

    It is also grossly insulting to the intelligence of everybody to keep implying that these organisations are trade unions, they are professional bodies, representing the interests of their respective professions. The interests of those professions being the provision of cost effective and quality healthcare.

  • Dave Eastham 2nd Mar '12 - 10:05am

    @Daniel Henry
    What your contact says is true, there is a lot of stuff about Health and Social care in the Bill that have been added in by the Lib Dems. Unfortunately there is a disconnect between the theory and actual practice on the ground.. For instance the rapid retrenchment in early years speech and language therapy in the community as a result of the pressure on local authority budgets. Yes the Labour Party do have a lot to keep quiet about regarding introducing markets into the health service and I personally campaigned against that too. (As well as their totally dishonest campaign around Tuition fees).
    Regretfully I have come to the conclusion that Nick and Shirley’s letter rather overstates the effects on the Lib Dem amendments to Chapter 3 of the HSCB and much else in the Bill. Although as a partner in Government it cannot be said the Lib Dems have not engaged in the process of positive engagement with the Bill.
    Competition as a positive driver for health care provision remains unproven assertion. Just to show that I am not merely substituting one unsubstantiated assertion for another a couple of references for LDV consideration.
    Firstly, a somewhat brutal but relevant de-construction of Nick and Shirley’s letter can be seen at http://www.healthpolicyinsight.com/?q=node/1350. (although why the author of this blog seems to think that it was in some a “secret” document that had to be “obtained” by the Policy Home website, when it was freely available on the Lib Dem website, is beyond me)
    Secondly, a report on the Bill and the genesis of Lansley’s thinking and a critic of competition in the provision of healthcare. A well referenced document http://abetternhs.wordpress.com/2012/02/28/cc/ (also elsewhere on the blog can be found some interesting comments on some possible effects of HSCB on public health)

  • Stephen Jones 2nd Mar '12 - 10:10am

    We have GP comissioning here in Cumbria and have had for 18 months….this is also the part of the world where Tim Farron is an MP. Lansley uses Cumbria as a model for the rest of the Cumbria. Can I suggest the author talks to Tim about how the ‘trial’ has gone????

  • Stephen Jones 2nd Mar '12 - 10:13am

    Oops meant to say Lansley uses Cumbria as a model for the rest of the country to follow. I’ve been in presentations where he does it!! But seriously I’d ask Tim how he thinks GP led commissioning is going up here!

  • Richard Dean 2nd Mar '12 - 12:21pm

    In partial support of Jayne Mansfield,

    Many people will understand the worry or “foreboding” that Jayne describes, that things might not go well under the arrangements proposed in the bill. But worry is not the same as certain doom. Worry is the thing that maintains quality! Change always causes worry, but we still change, all the time in many ways in our lives.

    Would training help to reassure? Both the BMA and RCGP seem to suggest this. For instance, people might be unsure how to integrate competition with collaboration while not compromising on quality. Training could help. This particularr question has exercised minds in the commercial world for many years, and reliable, tried and tested solutions do exist.

    Training could perhaps be designed under the joint guidance of the MoH, RCGP, BMA, and others, and it could be organized and delivered jointly too, Training would not need to be a top-down imposition. Would this sort of thing help to re-assure people, and allow people to support the bill even while continuing in the valuable activity of worrying?

  • Richard Dean 2nd Mar '12 - 3:16pm

    All this stuff about being blamed seems specious to me. Here’s another scenario …

    Labour actually support quite a bit of this bill, to such an extent that, if LibDems announce they will all vote against, Labour whips will instruct 57 Labour MPs to break ranks and vote FOR the bill. The bill will then be passed. Labour will be in mild disarry but they’re used to that. LibDems will be laughed at – as the party that makes no difference.

    Our role is to do best for the country. We will survive and prosper if, and only if, the country sees us doing that!

  • Jayne Mansfield 2nd Mar '12 - 5:03pm

    So people like practicing GP Dr Clare Grada head of the RCGP are trade union bureaucrats are they Andrew Sutton.

    Add a few sneers about Ed Miliband’s looks and a paen to Mrs. Bone’s observations about the Lib Dems and your attitudes would not look out of place amongst the Dorries /Bone contributors on Conservative Home. .

    Is Dr Charles West a trade union bureaucrat, or Dr Dr Graham Wynyard?

    People voted for this government on the basis of a lie . ‘ That there would be no top down reorganisation of the NHS.

    If Lansley’s bill offers such a wonderful l idea, why didn’t the government share it with the electorate before the election.
    It might have given the Tories an overall majority!

    Is Lansley still parrotting the ” No decision about me without me”, slogan?,

  • Stuart Mitchell 2nd Mar '12 - 6:48pm

    Jayne: “If one wants to examine how ‘spin’ works, one should examine the current demonisation of GP’s and health workers who oppose the bill.”

    Quite right, and the response you got was a perfect example.

    The coalition has decided that “trades unionist” is just about the worst smear you can daub on anybody these days without falling foul of discrimination or obscenity laws. The government’s main strategy now is to stick the “union” tag on anybody who happens to oppose the bill. Watching John Redwood, Jo Swinson and David Starkey last night on QT laying into the doctors for having the temerity to organise themselves into associations and colleges was like watching a trio of early 19th century judges chomping at the bit to transport uppity peasants to Australia. (The sight of Swinson smiling coquettishly at Redwood after a particularly unsavoury Starkey rant was a striking illustration of just how far the Lib Dems have travelled these past two years.)

    The various professional bodies and royal colleges opposed to the bill are NOT trades unions, though it shouldn’t actually matter even if they were. At what point exactly did Lib Dems stop respecting, and giving a fair hearing to the views of, people who happen to be a member of a union or a professional body? It would be nice to see the health bill apologists spend more time responding to the arguments (as only Richard Dean seems interested in doing) instead of just dismissing their opponents with inaccurate labels.

  • Jayne Mansfield 2nd Mar '12 - 7:49pm

    Thank you for your post Stewart Mitchell.

    I was worried that I was going mad.

    This blog is supposedly for activists and Lib Dem supporters. I have voted Lib Dem on all bar one occasion.

    It seems that on the matter of the NHS and Social Care bill, no one, particularly Lib Dem activists on here want to listen to to those like myself who will be affected by these changes.

    To be honest, last night, I looked up the history of the Liberal Party on Wikepedia. I should have done it years age before I voted for the party. The Laissez -faire roots of the party offer a belated explanation of the current behaviour of the Liberal Democrats in power.

    My working class parents have a lot to thank the trade unions for, as by extension do I . I am shocked by the comments relating to Trade Unions on here. You articulate my feelings on the matter far better than I can.

    My project for the night will be to analyse how much of the anger I feel at being so royally deceived over the Tory plans for the NHS before the last election is a projection of the anger I feel towards myself for so foolishly voting Lib Dem.

  • Andrew Suffield 2nd Mar '12 - 7:54pm

    The government’s main strategy now is to stick the “union” tag on anybody who happens to oppose the bill.

    Rubbish. It’s just that most of those organisations you keep talking about opposing the bill, with fine medical-sounding names – take a closer look, they’re trade unions.

    It is in no way a smear to describe a trade union as a trade union. Sorry, but your argument is incoherent.

    The various professional bodies and royal colleges opposed to the bill are NOT trades unions

    In this statement you are simply incorrect. Example:


    We are a voluntary association with over two-thirds of practising UK doctors in membership and an independent trade union dedicated to protecting individual members and the collective interests of doctors.

  • Andrew Suffield 2nd Mar '12 - 7:56pm

    I am shocked by the comments relating to Trade Unions on here

    The only comment made so far is that they are trade unions.

    I do not find your claims of shock very convincing, as this is not a very shocking statement.

  • Jayne Mansfield 2nd Mar '12 - 8:22pm

    Andrew Suffield,
    The sub- text is clearly that as such their opinions is in some way of lesser importance orbiased. That may be the case, but then again it may not be the case.

    Doctors, particular GP’s on the CCG’s are likely to make money from this bill, thanks to the ‘Quality payments”.

    Could you please explain to me why a group who are likely to benefit financially from these changes is opposed to it?

    Could you please explain why Dr Sam Everington, who was an advisor to Lansley, is acknowledged as an innovative GP and a member of a CCG is opposed to this bill?

    Are you Nick Clegg?

  • Richard Dean 2nd Mar '12 - 8:25pm

    The “various professional bodies and royal colleges” form a system of quality control of the maintenace of national health. Their objections all seem to come down to complaints that they will not have the same standing in the new system.

    Dismantling a working quality system and setting up an untried new one (is this Moniitor?) is certainly a very serious step to take. I do not see at all why the bill requires this to happen. Unless the underlying judgment is that this quality system is failing to deliver adequate quality.

    It is certainly possible that such a system is performing badly, even corruptly. It likely has issues about democracy. It is certainly possible that the system can pull the wool over people’s eyes – after all, it is the teacher who teaches people how people should judge them.

    If this is what is happening, then the issues are completely different from almost everything anyone has been complaining about so far! For example, it would mean that the instututions are not objectiing to “competition” because of anything about GP or hospital operations, but because they are expecting to have to compete with new institutions; they may face modernization or demise!

    This suggests that almost everything said on LDV about competition has completely missed the point.

    An explanation from the institutions, and from Mr.Landsley, would seem to be appropriate. Based on the new statement by the Royal College of Radiologists, none of the institutions now seem trustworthy. It would be helpful to be able to assess whether Mr Landsley is fully conscious too.

  • Stuart Mitchell 2nd Mar '12 - 8:52pm

    Andrew: So when you referred to “trade union bureaucrats who purport to represent” health workers, you meant this in a neutral sense? Apologies if I misread your signs. Perhaps you could name some of these bureaucrats, and explain why you think they only “purport” to represent their members.

    I suppose you would also have me believe that the slogan “Not paid for by trade unions” at the top of every LDV page is another entirely neutral statement of fact and is not intended in any way to imply that trade unions are a bad thing, no siree.

    Whatever else they may be, the BMA is an association and the various royal colleges are, well, royal colleges. Why call them something different?

  • @tom papworth

    Profits are the result of attracting custom by providing a superior quality service, and of driving down costs through innovative technology and business practices…..

    Ah, the ever lasting faith in the market to provide for us. I expect that the banks all had that written in their mission statements too.

    I’m afraid that profits are also made by monopolising decision making (still not sorted out by the bill’s amendments), cherry picking areas of the market to increase profits (still not enough safeguards), awarding IT contracts to fellow private sector business sector (they will be licking their chops right now) that end up in a mess, and involving business practices to determine health needs.

    The sight of Swinson on Question Time not even bothering to challenge Redwood when he said they he didn’t know what all the fuss about because the health professionals in his constituency ‘were getting on with implementing the proposals’, spoke volumes about how horribly wedded the Lib Dem leadership has become to the Conservative’s plans.

  • Stuart Mitchell 2nd Mar '12 - 9:06pm

    “Based on the new statement by the Royal College of Radiologists, none of the institutions now seem trustworthy”

    Disagreeing with the government is enough to qualify an organisation as “untrustworthy”?

    Andrew Suffield take note: The RCR leadership has always been extremely reluctant to call for total withdrawal of the bill and asked its members not to insist upon taking this step. The resposne of the members, through an EGM and subsequent survey, was to force the RCR to adopt the position they have announced today. This is the very opposite of “trade union bureaucrats” failing to represent their members. This is a case of ordinary radiologists telling their college, in their thousands, that the bill is wrong and must be firmly opposed.

  • Foregone Conclusion 2nd Mar '12 - 9:15pm

    @ Stuart Mitchell,

    The banner at the top of the site also says we aren’t bankrolled by millionaires. Do we evil Orange Tories hate them as well? The fact is that we’ve been proudly asserting our independence from the trade unions and big business for about fifty years now, so it’s not some kind of horrid new development in the process of our metamorphosis into Thatcherite yuppies.

    Personally I think that health service groups – both professional organisations – should be taken with a pinch of salt. Ultimately the interest of these groups is to defend their members, which doesn’t always coincide with the interests of patients (although they no doubt do care deeply about patient care). I should say that GP commissioning makes me nervous for the exact same reason…

  • Richard Dean 2nd Mar '12 - 9:50pm

    No, Look at their statement. Their complaint is not motivated by a desire to save the nation’s health. They are motivated by saving for themselves the lead role in managing the radiography and oncology professions.

  • Richard, why are you accusing all these health workers and their professional bodies of being self serving? Are you totally discounting the possibility that people that spend all their working lives liking after the health of others might have genuine concerns about the wider systems in which they operate. I am ashamed to see this piece and some of the responses to it on this site.

  • Stuart Mitchell 3rd Mar '12 - 8:13am

    You actually have it completely the wrong way round.

    It was a desire to maintain their influence and position that caused the RCR leadership to RESIST calls to oppose the bill. They made this very explicit in their special bulletin for members before the February EGM:-


    The members’ response was to basically say, “we should call for withdrawal of the bill, even if it threatens our influence in future, because the bill is so bad”. The total opposite of what you claim.

    Foregone: “The banner at the top of the site also says we aren’t bankrolled by millionaires.”

    Which certainly raised my eyebrow when I first saw it, given some of the news coverage of Lib Dem funding in recent weeks!!

    “Ultimately the interest of these groups is to defend their members, which doesn’t always coincide with the interests of patients (although they no doubt do care deeply about patient care). I should say that GP commissioning makes me nervous for the exact same reason…”

    I agree, and therein lies the problem with the government’s current strategy of playing the man, not the ball. If the doctors are really such a bunch of self-serving so-and-sos as is being suggested by the government (and some posters here), then why on earth should we trust GPs with commissioning?

    The critics here can bad-mouth the medical colleges as much as they like, but I suspect the public at large would trust these colleges more than the government any day of the week.

  • Jayne Mansfield 3rd Mar '12 - 10:45am

    If I were a doctor or a nurse, I would join a ‘Trade Union”.

    Look what happened to surgeon Dr David Nunn when he tried to impose hygiene standards during Nick Clegg and David Cameron’s cynical photo – opportunity. The NHS lost the services of a surgeon for several months.

    Look at the way Professor John Ashton, Director of Public Health and `county Medical Officer for Cumbria was called to
    explain his actions when he signed a letter defending the chair of the RCGP. along with co-signatories.

    It seems that all opposition to the NHS bill will be silenced, individuals working in the service will need a trade union to fight for their rights to free speech.

  • Brief point, there was something on the news the other day about how (if I recall) Network Rail have admitted liability in a derailment. The derailment was caused by faulty track, due to substandard track maintenance, on a section of track that Network Rail were contracted to maintain. The entire process took 5 years. But yeah, fragmenting the health service will be fine, I’m probably just some militant trade unionist or something.

    I’m certainly an ex-Lib Dem voter though. Not making that mistake again.

  • Jayne Mansfield 4th Mar '12 - 10:43am

    In my opinion, people should be concerned about the findings of the Bureau for Investigative Journalism’s findings of the number of GP’s on commissioning groups that have links to Private healthcare companies, in particular Assura.

  • Richard Dean 4th Mar '12 - 1:07pm

    As liberals, we celebrate freedom and diversity, so how can we complain if doctors choose to join private healthcare organizations? As democrats, we need to adapt to people, rather than force them to adapt to us.

    Everone tries their best, everyone can be confused, everone sins, and everyone is self-inconsistent sometimes. So shouldn’t we be trying to develop systems – laws, contract arrangements, and monitoring and policiing systems – that recognize these realities, and that also ensure that competition and self-interest are drivers of increasing quality and value for money, not of skimping and wage restraint?

    The offshore energy industry is one of several industries that already has systems that do this. Why not see if they can be adapted to healthcare?

  • Stuart Mitchell 4th Mar '12 - 2:06pm

    “The offshore energy industry is one of several industries that already has systems that do this.”

    Two-letter response: BP.

    Jayne: You are absolutely right. The government has no mandate whatsoever to part-privatise the NHS the way it is doing.

    Those who blithely accepting the advantages of crypto-privatisation should take a moment to consider the incredible revelations in recent weeks about A4e’s involvement with various welfare-to-work programmes. Five directors scooped multi-million-pound payments while the schemes they were paid to deliver had lamentable results. If the coalition gets its way with the health bill, we will have many thousands more Emma Harrisons out there waiting to do the same.

  • Jayne Mansfield 4th Mar '12 - 2:44pm

    Richard Dean, if doctors want to jon private healthcare organisation , it is , as you say, up to them.

    What I am opposed to is the number of doctors on Care Commissioning groups who are already working and profiting from their association with private healthcare groups who are likely to profit even more so when they have the mass of the NHS budget at their disposal.

    I am sorry, but I do not think that a register of interests will make the slightest bit of difference to the conflict of interests that these doctors face.

    It seems that there is already a divide between those more ‘entrepreneurial’ doctors who favour the ‘reforms’ and the GP’s who actually want to give medical care to their patients based on the needs of their patient’s not the size of their wallet.

  • Richard Dean 4th Mar '12 - 4:15pm

    @Stuart. May I offer some letters too … NHS ? Some call it a daily car crash, so I am told. Others call it smash and grab! You perhaps do not appreciate some of the truly sad things it hides.

  • Jayne Mansfield 4th Mar '12 - 4:19pm

    I made my comments on the divide amongst doctors after reading an article in the Guardian last year,-‘ Fear and loathing in Lansley’s new GP consortia’.

    I also live not a million miles away from Haxby, York:- and an article about a local GP practice was the subject of the national news. I have found the original story on the internet,’ GP practice under fire for offering NHS patients private treatment.’ It was in Pulse magazine although I read it in the Yorkshire Post.

    I have to say, the more I hear ( last week on the Politics Show), and whose opinions I read in articles such as this one, the more I admire her.

    I really do feel that the NHS and social care bill is fraught with conflict of interest and the risk of profiteering and I still don’t know in what way it will address the problems of the ageing population and ever more expensive treatments.

    It is a reckless dismantling of the NHS that no one voted for and it would appear the majority are opposed to.

  • David Allen 4th Mar '12 - 4:37pm

    Stuart Mitchell, Foregone Conclusion,

    The full slogan at the masthead of this site is, of course:

    “The most-read website by and for Lib Dem supporters. Not paid for by trade unions or millionaires.”

    On the principle that the clearest thing about any political statement is usually what it leaves out, should we assume that LDV is partly funded by business interests?

  • Jayne Mansfield 4th Mar '12 - 6:46pm

    It really is a puzzle isn’t it?

    The Government support for this bill , and that includes and has always included that of Nick Clegg and the party claims that this is about patient choice. There seems to be selective deafness to what patients are actually saying.

    The Closing of the Camden Road surgery is a case in point. The Practice was put out to tender by the Local PCT. The contract was won by United health who according to the patients, group that was formed undercut popular local GP’s and despite vociferous opposition from patients.. The Practice was then handed to The Practice PLC.

    A couple of weeks ago patients were informed that the Practice will be closed on the 13th April, 2012, and that they must now find a local GP themselves or they will be allocated one.

    Members of the patient group complain that there was a rapid turnover of GP’s and they have begun a campaign against the privatisation of the NHS in this manner.

    As patients it is important that we make our voices heard. Not that we believe that anyone in government is listening. If David Cameron now says that ‘reform’ of the NHS is’ unavoidable and urgent’, why didn’t he tell us before the election what his plans were?

    What is it about democracy that this current government does not understand?

  • Richard Dean 4th Mar '12 - 7:14pm


    That story is perhaps not quite as straightforward as you tell it, see http://www.camdennewjournal.com/news/2012/feb/gp-surgery-was-sold-us-health-company-set-close

    What seems to have happened is that The Practice PLC bought the practice (it was not “handed to” as if it was something of no value). After four years operating successfully at lower cost to the community than local GPs, under United and then The Practice, the service was prevented, by others, from continuing to operate. This is rather different from an arbitary choce to leave. There is no implication that The Practice PLC puled out willingly or arbotrarily, On the contrary, it means that their attempts to assist with placing patients with other GPs is aresponsible action that we should support.

    Who did the preventing? The owners of the site chosen not to renew the lease, seemingly because they may have felt “ousted from their own surgery”. A less charitable interpretation might be that local GPs lost out because of the better service proivided by The Practice PLC, and pressured the site’s owners not to renew.

    This less charitable interpretation seems fully consistent with the facts. If true, it provides clear evidence of the need for private practice to replace cosy, self-serving NHS monopolies that deliberately distort local perceptions to maintain or regain a position where they can exploit local needs and trust.

    Perhaps none of us have any unchallengable idea of what the truth is. Maybe someone should investigate, but who would we trust? Frank Dobson? Come on !

  • Stuart Mitchell 4th Mar '12 - 7:17pm

    “Some call it a daily car crash, so I am told. Others call it smash and grab!”


  • Stuart Mitchell 4th Mar '12 - 7:31pm

    @Richard: A practise is sold to a private company, who sell in on three years later. The new buyers keep it open another year before closing it down, firing all the staff and forcing all the patients to find another practise. The secretary of Londonwide Medical Committees, Dr Paddy Glackin, says: ““I don’t think there is a single private operator that has seen out the full length of its contract to run a GP surgery in inner London.”

    Baffled how you can draw from this shambles the conclusion that “it provides clear evidence of the need for private practice to replace cosy, self-serving NHS monopolies”.

  • Richard Dean 4th Mar '12 - 7:49pm


    If you look at the story, you will see that the private service “undercut” local GPs. No-one in the community was forced to use the new service. They could have chosen to go to those other local GPs. They chose not to, perhaps on the basis of price, perhaps quality or both. But certainly they had the freedom to choose, and choice is one of the things that we as LIBERALS should be supporting. They chose to NOT use those local GPs.

    You will also see that the the new service did not choose to stop operating. They were forced out. Who forced them out? A local GP! One of the group that the local community preferred not to go to for their healthcare! That group of GPs was operatng against the expressed interests of the local community – expressed in their choice to NOT used those local GPs. That person had every right not to continue the lease, of course, but if the pressure I suggest was used, then that group of GPs acted in a way that fundamentally clashes with our beliefs as DEMOCRATS.

    But everything I say and probably everything we are all saying is conjecture based on partial information. It would be nice if there was a good, streetwise, and credible investigative journalist on the case. But do such people exist? As LIBERAL DEMOCRATS, we recognize the diversity of people and the variety of their motivations and actions. Let us also be REALISTS. Let us not be fooled, by others, or even by ourselves!

  • Jayne Mansfield 4th Mar '12 - 8:01pm

    Richard Dean, I have been remiss.I should have put the words ‘handed to’ in quotation marks because they are the words used by the patients who formed a patient’s group in letters to the press.

    These changes are supposed to be about the patient, or so we are expected to believe. Lansley’s ‘ No decision about me without me’ have a rather hollow ring to me.

    The Patient’s group are not only angry about the closure of the surgery. Did no-one question whether the Private Healthcare group could continue to practice from the premises until the expiry of their contract?, they are also, according to reports because of the lack of continuity and commitment. According to a report that I cannot verify, there was a time when only one permanent doctor for 4.500 patients.

    As a patient, the NHS is important to me, especially now I am at the age where I am likely to start having health problems. One can rely on the opinions of doctors, and I would trust Doctor Clare Gerada with my life, literally, or academics from the social sciences such as the co-signatories of ‘Orwellian language of NHS reform’., but ultimately, I trust the experiences of patients.

    The findings of Professor Allyson Pollock et al. ‘ The end of the NHS as we know it’. Fills me with foreboding, because she has shown herself not to be politically partisan when it comes to the NHS.

  • Richard Dean 4th Mar '12 - 8:27pm


    I’m afraid I have to admit that … I was once an academic. I know, oh yes I know, how Professors and others can be so wrong. I don’t know whether your professor is right or wrong, her “non-geographic” argument is too hard for me to follow at this time of night, I just ask, everyone really, to remember that everyone is fallible, even professors. I know this in part because I am personally very fallible indeed.


  • Jayne Mansfield 4th Mar '12 - 8:36pm

    Richard Dean, may I take up your point about the GP services being operated at lower costs than if the contract had been offered to local GP’s.

    I refer you to an article in Pulse the doctors magazine 7th February, 2012.’ Private firm flagship GP practice closes flagship GP practice in North London’.

    I refer you to the statement,

    ‘The decision to award the APMS contract to United Health in 2008 attracted vehement opposition from anti-privatisation campaigners after NHS managers snubbed rival bids by GP’s DESPITE THEM BEING JUDGED TO OFFER SUPERIOR CORE SERVICES’ ( my capitals).

  • Jayne Mansfield 4th Mar '12 - 8:40pm

    Sleep well Richard Dean,
    You are one devil of a devil’s advocate.

  • Even amended, the NHS Bill is STILL not fit for purpose!

    Kill the Bill! DNR!

  • Stuart Mitchell 5th Mar '12 - 6:05pm

    Re. Camden Road. The fact that patients “chose” to stay with the practise was hardly a ringing endorsement. The vast majority will have stayed put for the simple reason that few people change GPs very often. Some would have stayed because the practise was the most conveniently situated, especially if they were old or infirm (at least one of the comments on the article is from just such a patient). Many probably didn’t even know that anything had changed. Anyhow, any patient who DID actively choose to be a patient there ended up all at sea with no GP at all, so that’s hardly a demonstration of the power of privatisation to give patients what they want! Privatisation has led to LESS choice for people in that area.

    You are also factually wrong to state that, “the new service did not choose to stop operating. They were forced out.” They may have been unable to renew their existing lease (a problem which can arise for any business, and often does) but they were perfectly free to relocate. It is reported that they made no effort whatsoever to seek alternative premises – they simply threw in the towel and left their patients in the lurch, their staff jobless. Nice.

    This bill should be junked, and the enormous effort being expended on trying to flog it diverted to thinking of ways to improve the NHS while still running it on the social basis that most people seem to want. Ploughing ahead with the bill in the face of virtually universal opposition would be deeply – and I use this word after much consideration – authoritarian.

  • Jayne Mansfield 5th Mar '12 - 6:38pm

    I suppose that I would be defensive about the bill if my leader had signed off on the bill before reading it. The bill should have been strangled at birth.

    It must be dropped.

    There is no democratic mandate for this bill.

  • After the probelsm at Stafford, Maidstone and Thurrock I think it is time to realise there are problems with the NHS. However, noone is looking at Europe where there is extensive private insurance, many in France work for the health ervice in a self employed capacity and charitable hospitals( often RomanCcatholic ) provide alternatives/ competition/choice to the state run ones.
    When it ome to medical equipment , drugs and building hospitals , the activities are undertaken by private companies.
    The reality is that the BMA and RCN are unions and neither organisations raised alarms about the problems at Stafford, Maidstone and Thurrock hospitals.
    I suggest people readthe report on the C.Difficile Outbreak at Maidstone NHS trust Hospital to realise some of the problems in the NHS.

    Spending on the NHS has practically doubled in the firs decade of the 21 st Century while , pay for nurses and doctors has greatly increased . Doctors in the UK are some of the best paid in Europe and doctors from other countries fly in to do weekend work.
    Gery Robinson in his documentary on a hospital even when an orthopedic surgeon came up with a procedure to increase the number of operations, the system defeated the new approach.

    Millburn under labour, with the support of Blair realised the NHS had to be improved in order to deliver far more healthcare for the money spent.

    It is time all the health professional showed how they would prevent the disasters at Stafford, Maidstone and Thurrock and deliver far more healthcare for the nearly doublingin NHS expenditure. Health care staff complain about managers but appear unwilling to obtain the project management skills required to run in a cost effective manner , one of the largest organisations in the World. Doctors have some of the best science A levels of any profession, so a few weeks of study, if that should enable them to obtain the project management skills( see most engi neering degree courses) . If resources are used in a cost effective manner, then more healthcare can be delivered.

  • Richard Dean 6th Mar '12 - 12:55am

    @Jayne – Thanks! I told the boss and she’s promoted me! I can now spell my name with a capital D!

    @Stuart, Charlie, Jayne,

    Nice to read your comments. Interesting. I hope you don’t feel this rude, but I am amazed at how people use their own preconceptions to invent support for their arguments.

    I feel that the Camden story is obvious from the information in the article I quoted. The local GPs found a way to force the private healthcare providers out. The private providers weren’t providing a worse service that the local GPs had done, so the only available explanation is that the local GPs acted out of their own self-interest, not for the interest of the community.

    Might we at least agree than some doctors are quite capable of damaging healthcare if they don’t get what they want? Let’s take off the rose-tinted glasses for a moment or two, how about it? Here’s more evidence …

    In the beginning, Bevan is reported as saying that he had to pay the doctors a fortune to get them to agree to be part of his NHS. Now, doctors are essentially threatening strike action or similar over a pension that is 5 times the maximum pre-retirement wage of a geriatric nurse, or so it seems from another thread on LDV. Frankly I was rather disgusted when I learnt how poorly those nurses are paid. And like Jayne. I may need them soon in person!

    GPs are generally good people as medics, but they are capable of Machiavellian tactics when things don’t go their selfish way. Indeed, one of the main objections to privatised care is the idea that doctors will make excessive profits! At the poltical level, may I suggest that our task is to find a way to manage them that produces an effective and affordable health service? May I also suggest that the hard evidence seems to be that the present arrangements are not doing that?

    So, at the very least, the new system is worth a try! But more that this – the proposed arrangements are reasonably well thought out and should work fine, and at parliamentary level the objections are a lot more minor than people seem to think. Labour are just doing what an opposition is supposed to do – oppose, because that is what makes good final decisions, but they were intending reform along the same lines anyway. My guess is that LibDem parliamentarians were too, and if we have to trust anyone, why don’t we trust them?

    Best, D 🙂

  • Michael Parsons 6th Mar '12 - 2:16am

    How soon memories fade! The struggle to give citizens the basic right to health care free at point of use was hard fought, and rich consultants were among its strongest opponents. What could be sillier than arguing that private care need NHS sanction and participation to be available?
    In a democratic state freedom means “freedom to”, it means empowerment by a universal service; not “freedom from” i.e. freedom to do whatever because you will not be stopped if you can pay. Monetarist worship of bank-credit ignores the diminishing marginal utility of money – a thousand pounds means less to a millionaire than ten pounds to a man on the dole. The trivial pleasures of the rich outweigh the needs of the poor in any market system. That is why we need to put free health provision as the first.duty of our elected ministers.

  • Richard Dean 6th Mar '12 - 6:54am

    In terms of public health, does “quality”refer to averages, such as cutting average waiting times for some operation to 8 weeks or less, or does it refer to extremes, such as cutting everyone’s waiting time to 8 weeks or less? Should we aim for every individual to get the best treatment possible, or should we aim for a poulation to get the best treatment on average? Is there an “absolute” standard of quality, or does it depend on other things?

    Camden Road might help to explain what I am asking. Perhaps all the original bidders satisfied the government’s quality criteria, but perhaps the local GPs price was higher because they offerred better than what the government judged was needed? What was the right thing to do in the present economic circumstances? Who was right about quality? And remember – this happened under the present system, so killing the bill will allow this to happen again!

    I do agree. But back in those days, the health of the people was generally poor, partly because of the ravages of industrialization and wars. It must have been clear that, as well as all the moral arguments for an NHS that was free at the point of use, a national organization would be the only way to address the problems, and an NHS would be affordable in the sense that a healthy population would also be able to pay through its greater ability to do work and pay tax. Nowadays, affordability seems to be the issue that is causing the problem, in an NHS that tries to provide far more than its founders would ever have imagined.

  • Jayne Mansfield 6th Mar '12 - 10:00am

    Richard Dean, the people to judge the quality of the service, are in my opinion, the patients.

    There was rising satisfaction with the Health service with satisfaction being the highest ever before the current Government decided to inform us of what they had been planning for several years.

    Much is made of the inefficiencies of the NHS. Where is your evidence of these inefficiencies when compared with other Health care systems?

    As an academic , I would be grateful if you could put me straight on an important point. I have already mentioned DrProfessor Allyson Pollock , the professor of Health Policy and Health Services Research at London University , in this thread. She and another leading academic Professor Colin Leys,emeritus professor of Political Science at Goldsmith are reported to have said in an article published today, ‘ We have two weeks to save the NHS’.

    Professor Leys claims that he was surprised to see the White paper on Health Reform , sprung on us shortly after the coalition came to power because there was nothing of it in the manifesto of either party’.

    This contradicts Nick Clegg’s statement sat the time that the reforms were a Liberal Democrat idea. I seem to remember that when asked about the huge changes that were coming down the line and whether this was in the Liberal Democrat manifesto, he said’ Funnily enough it was’ etc.

    As I have already said, I do not read manifestos before voting, and I suspect other ordinary voters behave like myself. On this point could you tell me whether had I read the manifesto, I would have been warned of what was in store for our NHS?

    I would like to agree with you that some, not all GP’s have been extraordinarily rapacious ( The GP contract), so why are they being entrusted with the bulk of NHS money?

    This is a massive top down reorganisation and the only outcome that I can see is that health care, which will always have to be rationed in some form, will not be done on a rational and fair basis. It will all come down to the decisions of multiple CCG’s, causing e a post-code lottery with commissioning GP’s given ‘Quality bonuses’ for saving money by rationing services.

    Which brings us back to what we mean by the word ‘quality’.

    This bill has the stench of corruption about it. There are too many people who will make a financial killing making decisions about the health and well being of patient’s like myself.

    And by the way, the decision for The Practice PLC to leave the premises when their lease was up was described as ‘ a mutual one’. Did they try to negotiate an extension to the lease on terms that were unacceptable to the owners? Why didn’t they find alternative premises?

  • Richard Dean 6th Mar '12 - 10:33am

    @Jayne, I imagine there are opportunities for GPs to be rapacious while working for the NHS, and perhaps fewer opportunities when working for a large company like The Practice PLC, whose website shows it to be operating at many locations.(http://www.thepracticeplc.com/index.jsp) . I think the profesors said it at a literary festival – I will find out more and try to give you a different viewpoint designed to explore their argument. I suggest that the statement that the decision was “a mutual none” is their polite way of saying that a negotiaton failed, that they don’t think it was their fault, and that they are leaving the door open if the other parties wish to come back to the table.

  • Jayne Mansfield, I suggest you read the comments mad by patients and those of the relatives who died and suffered from C. Difficile at Thurrock, Stafford and Maidstone Hospitals. Under Construction Design and Management Regs 2007 , all those involved with a construction project – the client, designer and contractor have responsibility for safety. So why did the members of staff, especially doctors and nurses not raise concerns before hundreds of people died at Thurrock, Maidstone and Stafford Hospitals? If one turns a blind eye to bad or unsafe practice is this not negligence? Under Heath and Safety legislation ignoring unsafe working pratices can be a criminal act. A.Burnham refused an inquiry into Stafford, is this not negligence?

    When you say “Financial killing ” please substantiate because you could prevent it happening . When considering in efficiencies, staff pay needs to be considered. The NHS provides some of the highest salaries for doctors in Europe. Doctor fly to the UK from other European countries during weekends to earn money. By definition all government expenditure is rationed becaue it is not infinite. If one pays £100, 000 to a GP, then 3 cost £300,000 which is the same cost of having 4 but paying them £75,000. Therefore salaries can have an effecton how many people are employed because government expenditure is not infinite.

    Your mention of academics. Do thy speak and read French, German, Dutch , Danish, Swedish , Norwegian andFinnish fluently; because if the do not , they cannot understand how healthcare systems work in other European countries. One aspect you do not mention are various nationalities attitudes to looking after themselves. In many European countries, a higher proportion of the country ensures they are careful about what they eat and take up exercise in order to prevent obesity ad therefore reduce related diseases.

    The present NHS reforms may be a poor imitation of Millburn’s. However, we need to consider all aspects of the the health of the nation( especially personal responsibility) and look at what happens in Europe.

  • Jayne Mansfield 6th Mar '12 - 11:49am

    Richard Dean, the professors did indeed say it at a literary festival.

    I look forward to you responding to my question. I will however, be using my senior rail card to travel to London for the anti. NHS and Social Care bill rally in the morning.

    It was interesting to see Andrew Lansley being chased down for corridors of the Royal Free (or as one wag put it the soon to be Royal Fee hospital)l when he made a carefully choreographed visit.

  • Malcolm Todd 6th Mar '12 - 12:04pm

    “when he made a carefully choreographed visit” — you think Government ministers should just turn up unannounced? Do you suppose this ever happens? Choreography isn’t a sin, you know.

  • Jayne Mansfield 6th Mar '12 - 1:48pm

    No, I know that choreography isn’t a sin, Malcom Todd, I am a fan of Strictly Come Dancing.

    The Guardian is dong a rolling blog on the reforms and from this we learn that a reporter from the Camden New Journal was told that he would not be able to gain access to the hospital to report on the visit, neither would any of the written press. There was to be just one TV camera on the orders of the Department of Health.

    ( A press release will be released today)

    The reporter points out he was born at the Royal Free hospital and- ‘ I still believe that for now that it is a public building . I don’t like the idea of our elected representatives hiding in it’.

    The Government could not use more spin on the issue of the NHS and Social care bill. They were only too happy to have the press around for previous choreographed photo-opportunities. It is only now, when the effect of the biggest top-down re-organisation of the NHS is becoming clearer, and the health minister is seen through the window to be ‘berated, hustled, shouted at, etc. that we the public are excluded from what is really happening.

    Can we look forward to soviet type photographs where Andrew Lansley has been airbrushed out ? Didn’t that happen to a photograph of a group of Bullingdon boys?

    What is the point of e-petitions? What is the point of a Freedom of information act? What is the point of a press if it is excluded from reporting on potentially difficult situations for our elected government representatives?

  • Richard Dean 6th Mar '12 - 2:00pm

    @Jayne. It looks like a non-story. All ten links to it on the first page of Google lead to the Independent’s story, which is at http://www.independent.co.uk/life-style/health-and-families/health-news/we-have-two-weeks-to-save-the-nhs-say-leading-academics-7537774.html.

    The :”leading health academics” Colin Leys and Allyson Pollock simply stated their anti-bill opinion, but gave no explanations of why they had come to the opinion. They said, for instance “This is, a crucial fortnight. The Liberal Democrat conference is a last-chance opportunity to stop the Lansley reforms.” There were other things, but the nearest they came to an explanation of why they were against the bill was this

    “Lansley and his team are moving us to a mixed-financing system similar to that in the US … I foresee community care will contract and decline, everyone who can afford to will go private and all we’ll be left with is a much-reduced service for the poor.”

    This seems to be inconsistent with the “non-geographic” objection made previously to the parliamentary committee. I feel that they are insulting us by asking us to take action wthout any explanation except that they predict something bad – no explanation of how they arrived at their prediction, maybe they asked the Oracle, or flipped a coin, or spotted a selfish opportunity of some kind.

    Good luck with your demonstration. I can’t afford the train fare, but then I might be going to both sides’ parties! The cops will be there to help you exercise your right to protest. What a nice place is the UK! D 🙂

  • Jayne Mansfield 6th Mar '12 - 3:24pm

    The two professors have written extensively on the subject of the NHS , privatisation and the NHS and Social Care bill and its amendments in academic tomes. They are simplifying the consclusions of their research for non- academics like myself.

    The Guardian has an interesting piece by former Liberal Democrat, Dr Graham Winyard. I have written of him before and apologise for the discourtesy of mis-spelling his name as Wynyard.

    I await an answer to the other questions that I posed about the Liberal Manifesto and whether this massive top-down reorgnisation was in it. On the Andrew Marr show, Mr Clegg said that funnily enough it was or words to that effect.

    I have been informed that in the coalition agreement on the NHS there is a promise that says the partners will.’Make the PCT’s the patients’ champions’. Is this the case?

  • Jayne Mansfield 6th Mar '12 - 4:45pm

    @ Charlie.

    The care given at Stafford and the places you mentioned was disgraceful? Do you think that disgraceful care is not given at privately run healthcare institutions? Could you tell me in what way the NHS and social care bill will ensure scandals like Stafford never happen again?

    As the publishing of the roll call of our elected representative who have links with private healthcare companies increases, the suspicion that they are ‘in the pockets’ of private healthcare companies rises. There is now a blog keeping an up to date list and their links to and payments from private healthcare companies.

    After the MP’s scandal, I tried not to became cynical about our elected leaders, not all of them abused the system, in fact the majority did not, but I am having a real problem maintaining trust in any politician after the downright lie we were told that there would be no top down reorganisation of the NHS.

    I refer you to a Guardian article of 7th April, 2011,’NHS amongst developed worlds most efficient health systems, says study’.

    Or an article in Politics.Co.uk in the same month.
    ‘ Surprise report: NHS ‘most efficient healthcare system in the world’.
    I refer you to these articles because the research was conducted by a Professor Prichard of Bournemouth. Andrew Lansley quoted to a previous piece of the Professor’s research to justify his health reforms so he obviously holds the man’s research abilities in high esteem.

    The research refutes Andrew Lansley’s claim that the NHS needed competition and choice to become more efficient.

    Briefly, using data from the WHO, he found that under Labour, UK spending on health rose to 7.9% of GDP. This is less than Germany 10.7% and the US 15%. What is more care, is not only cheaper, it saves more lives when compared with countries like France and Germany.

    The US has a system which the coalition seems to be moving us towards , yet the report points out the’ relatively high bureaucratic system needed to administer costs, behaviour, risks to patient’s as well as immense legal costs required to control payment’.

    The good professor points out that even Adam Smith thought that the state was probably better at heath and education ( ouch).

    I take Richard Dean’s point that even academics do not operate in a neutral environment. As for the rest of us, when mounting an argument, we all choose the research that supports out own particular perspective. As I said earlier, I chose these two articles dealing with research from the Royal Society of Medicine because Andrew Lansley chose to quote from previous research by the self same authors to justify his health reforms.

  • Stuart Mitchell 6th Mar '12 - 6:38pm

    “I feel that the Camden story is obvious from the information in the article I quoted.”

    I thought what you were saying was “conjecture based on partial information”?

    “The private providers weren’t providing a worse service that the local GPs had done”

    You made that bit up yourself. Can you find a single source who agrees? A practise which closes down and dumps all its patients does not seem to me to be providing a good service, or indeed any service at all come to think of it.

    Criticising the freeholder is, I feel, really out of order. You claim to be a liberal who “celebrates freedom” and yet you criticise a freeholder (and even ascribe malevolent intentions to him which you cannot possibly know) simply because he exercises his right to use his own private property for whatever purpose he wishes (in this case, returning it to residential use). It is ludicrous to blame the freeholder for the closure of the practise. The people who bought the practise woud have known full well that the lease only had a year to go and they should have planned for that well in advance. With 10% of shops in Camden empty (2011 figures) they could have easily relocated if they had wanted to. Giev me one good reason why they couldn’t. Perhaps such a move would not have been profitable enough for them so they just closed the practise. That’s what happens when you try to mix short-term private profit motives with a social health system.

    If you read the article and the comments beneath, you will find that the freeholder is highly respected locally and is not being blamed by patients for what has happened. In fact they have a great deal of sympathy with him.

    By the way, why are you in favour of handing over NHS commissioning to people who you describe as “Machiavellian” and “selfish”?

  • Richard Dean 6th Mar '12 - 7:08pm

    I’ve acted as an examiner of academic PhD tomes and they’re sometimes not as good as people make out. I think you may mean this article by Dr Graham Winyard, which I found a little more rational than the professors, but still lacking persuasive evidence – too much judgment, so requring too much of my trust. If I must trust someone, why not Clegg?

    I suggest that Nick’s remarks on the Andrew Marr show be taken at face value

    I got a copy of a thing called “The Coalition: our progammme for government” from the main LibDem website. It has policies arranged in 31 sections, Section 22 is called “NHS”. The section starts like this “The Government believes that the NHS is an important expression of our national values. We are committed to an NHS that is free at the point of use and available to everyone based on need, not the ability to pay. ….”

    This is followed by 30 bullet points, and you might be particularly interested in the following three:

    > We will stop the top-down reorganisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.
    > We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf.
    >The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs. It will also take responsibility for improving public health for people in their area, working closely with the local authority and other local organisations

    I wonder if LDV might like to invite the professors to present their views and allow them to be debated on LDV?

  • Richard Dean 6th Mar '12 - 7:12pm

    Stuart, Be realistic! If the Pra ctice PLC pulls out, there’ll be another health centre there very shortly afterwards. The freeholder will be all smiles.

  • @Jayne Mansfield

    Re “Post Code lotteries”
    Do you think it is a good idea for health services to be more accountable and responsive to local people? If you do then surely the result will be what you refer to as a post code lottery, but what others may call responding to our local needs?

    “On this point could you tell me whether had I read the manifesto, I would have been warned of what was in store for our NHS”
    Well, the manifesto (which is still available online btw at http://network.libdems.org.uk/manifesto2010/libdem_manifesto_2010.pdf) said:

    “Giving Local Health Boards the freedom to commission services
    for local people from a range of different types of provider, including
    for example staff co-operatives, on the basis of a level playing fi eld
    in any competitive tendering – ending any current bias in favour of
    private providers.”

    So yes it was clear that private providers could enter the system (they were already there of course, or there wouldn’t have been talk of a current bias) and it was also clear that it would be competitive tendering. It also says:

    “Empowering local communities to improve health services through
    elected Local Health Boards, which will take over the role of Primary
    Care Trust boards in commissioning care for local people, working
    in co-operation with local councils. Over time, Local Health Boards
    should be able to take on greater responsibility for revenue and
    resources to allow local people to fund local services which need
    extra money”

    Which also covers your “post code” point I think.

    Finally, we have:

    “Sharply reducing centralised targets and bureaucracy, replacing
    them with entitlements guaranteeing that patients get diagnosis and
    treatment on time. If they do not, the NHS will pay for the treatment
    to be provided privately”

    So again, we see that there was a commitment to use the private sector.

    So, if you had read that would you have considered yourself “warned”?

  • Jayne Mansfield 6th Mar '12 - 10:52pm

    @ Chris-sh
    I will indeed read your manifesto, but in my own good time. This issue has politicised me and reading when one only has peripheral vision is tiring and tiresome.

    Could you please explain to me how introducing competition into the NHS will make the service more responsive and accountable to local people?

  • Stuart Mitchell 6th Mar '12 - 10:57pm

    ” If I must trust someone, why not Clegg?”

    Now we know you’re joking.

  • Richard Dean 6th Mar '12 - 11:04pm

    @Stuart, I am always joking, But occasionally words come out that seem to make sense. What doesn’t make sense to me, and perhaps to the electorate, is the distrust between Clegg and his party. It does not bode well for 2015.

  • Jayne Mansfield 6th Mar '12 - 11:11pm

    Richard Dean, If I must trust someone, why not Nigel Farage?

    I can’t fault his honesty. In my opinion, he has never pretended to be anything other than a plonker.

  • Richard Dean 6th Mar '12 - 11:19pm

    @Jayne, We have found a point of agreement at last – Farage! Let’s all live in a yellow submarine, yellow sub ,… 🙂 Have a nice demo, tell us all about it!

  • @Jayne Mansfield

    “I will indeed read your manifesto”
    It’s not actually my manifesto Jayne, I don’t belong to any political party, I only put the info up for you as you asked for it earlier. The question wasn’t supposed to be a dig either, I was just wondering if you would have been informed (or in your language, warned) had you read it first.

    If it makes life easier though, there is an audio version at:


    “Could you please explain to me how introducing competition into the NHS will make the service more responsive and accountable to local people?”
    Once again, I would point out that this wasn’t my policy. But my question to you was about local choice and how they are bound to create postcode lotteries. As to competition, well the LDP management obviously decided that this was the way ahead after some deliberation. I’m not a Lib Dem so I’m not certain of the next bit, but from what people say on this site, the manifesto would have been voted on at their conference by delegates and must have been passed as it was in there (any LD members, feel free to correct me if I got that bit wrong).

    So again, I would ask:

    1. Do you want health services to be more accountable to local people?
    2. Do you accept that if that happens then that is bound to create a variation of priorities between areas and lead to what you call a “postcode lottery”?

  • Jayne Mansfield . NHS expenditure increased from £60B in 97/98 to £120B in 09/10 yet over 1000 people have died because of C.Diff due to poor hygiene at Maidstone , Tun Wells, Basildon and Thurrock , Mid -Staffs and Stoke Mandeville Hospitals . A Burnham resisted inquiries into Mid-Staff Hospitals. Perhaps those who caught C.Diff and the relatives and friends of those who died would have liked an alternative choice of hospital? Not all hospitals have suffered from D.Diff and surgeons have different survival rates so we already have a post code lottery. I would suggest , there always has been a post code lottery with the teaching hospitals invariably offering better medical care .

    If a company had ignored health and safety legislation which led to the deaths of over 1000 people , the directors would have been prosecuted for criminal negligence. The poor hygiene at the hospitals is surely a case of bad health and safety practices. The Chief Executive of Maidstone Hospital received a £175k pay off.

    I think it is time the country looked at the performance of the NHS and compared results with NW Europe.

  • Jayne Mansfield 7th Mar '12 - 9:39pm

    @chris- sh. I didn’t think that you were having a ‘dig’ at me, and I thank you for the link to the audio.

    The point that I have been making is that as an ordinary voter I have never read a manifesto before voting for a party. I have taken on trust what politicians have pledged or promised to do, (or not do) if they are voted into power. Perhaps I and people that I know are unusual in that respect. I have attended hustings and I have listened to politicians before making my choice. I also enjoy listening to political and current affairs programmes like the Daily Politics, the Andrew Marr show , Question Time etc. I would have expected to have noticed that we are about to have the biggest top-down reorganisation of the NHS just from listening to the promises of politicians. I have learnt the hard way.

    I will answer your question but for me it is not an either/ or question. I do not believe that local services will be more accountable to ordinary local people. The people who make the decisions will be the commissioning groups and given that those decisions are to be made in the context of £20 billion of cuts, I think it disingenuous that price is not going to be a deciding factor.

    At the moment I already have a choice of GP, hospital and Consultant. I already hold the health professionals accountable for my care .There are mechanisms to complain through the PCT ( which has representatives fro the different professions such as nurses, physiotherapists, pharmacists etc, and of course GP’s who already hold a great deal of power in decision making about local services.already hold a great deal of power. There is Pals.

    Appointing a few councillors and a few members of charities to oversea local services is not in my opinion going to going to increase local accountability.

    I believe that there will be a post code lottery because if my CCG does not commission particular services, people might have to move to a different area where the local CCG does commission those services. People may have to travel to hospitals a long way from home. All very well if one is mobile, has access to transport, and the financial resources etc.

    I believe that central control is important to ensure an acceptable standard of care in every part of the country. For that reason I support the National Institute for Clinical excellence. Local bodies who are appointed to oversee the accountability of the CCG’s and services are may well be people with special interests or members of pressure groups . That is why the role and duties of the Minster of Health is important to me, I believe that we need a single figure that we as the electorate can hold accountable for the standards of healthcare across the whole of the country.

    This government is selling this bill as a bill that will increase patient choice and arguing that choice will drive up quality. It is my belief that this is in fact a smokescreen for their true agenda, that is, the privatisation of the NHS. and the introduction of aspects of care that will have to be paid for which is currently free.

    I foresee a health service that reduces access to care and increases the already dreadful inequalities in health that are suffered by different demographic groups.

    Given that the bill is about to become law, we are about to find out who is or is not right. I hope that I am wrong.

  • Jayne Mansfield – at the heart of what you’re saying is the age-old expectations vs. reality conundrum that is at the heart (excuse the pun) of the NHS:

    – as individuals we all want the best healthcare possible, now immediately and forever
    – as taxpayers we’re not prepared to pay the infinite amount of funding this would take for everyone

    So – we are always, always going to end up with rationing.

    That can either be decided centrally. Or it can be decided locally.

    Liberals tend to believe in the latter because a) its the right thing to do and b) it tends to be more efficienct to take decisions closer to the point of need – with the obvious caveat that things like procurement are far better done centrally if price is a major concern.

  • Jayne Mansfield 7th Mar '12 - 9:53pm

    @ Charlie, Patients have had the legal right to choose their hospital since April 2009. If having made that choice they are unhappy with it they can discuss their dissatisfaction with the GP and choose a different one.

    Travel expenses can be claimed through the Healthcare Travel Scheme . I do not know what the rules are concerning this scheme.

  • Jayne Mansfield 7th Mar '12 - 10:00pm

    I guess I’m not a Liberal, Tabman.

  • Richard Dean 7th Mar '12 - 10:12pm

    @Jayne, “I believe that central control is important to ensure an acceptable standard of care in every part of the country.” But that is surely what the first few clauses of the bill are – central control for just the purpose you mention? You can find the whole bill on http://www.parliament.gov.uk , in its latest form.

  • Stuart Mitchell 7th Mar '12 - 10:48pm

    Why do we need a new bill to give us what we already have?

  • Richard Dean 7th Mar '12 - 10:56pm

    @Stuart. The new bill is more than just its first few clauses. See http://www.parliament.gov.uk

  • Jayne Mansfield – well, even by your own terms, are you seriously saying that centralised diktat is the best way to run anything? That way tractor production statistics lies …

  • @Jayne Mansfield

    “Perhaps I and people that I know are unusual in that respect”

    I would say that you are probably very normal in that respect, a lot of people do seem to decide who to vote for by the cut of a politician’s jib rather than the content of the manifesto. Others, like yourself, rely on a politician to be truthful when on politics/news shows etc (although I would say that you’ve probably done more than most by going to hustings etc). I wouldn’t condemn that as the alternative can be a cynical distrust, which probably defines people like myself who like to see what has actually been written and compare it to what is being said.

    Having said that (and at the risk of upsetting the locals), as you yourself have found, the sudden bump of reality can be quite disconcerting – “luckily” the Lib Dems have the umbrella of the coalition to fight this particular civil war and can blame it on the Tories. However, if I was one of the Tory GE Team at CCHQ I think I’d be planning a strategy along the lines of “we agreed that they could put all of this into practice, but their own side did everything possible to thwart it – they are a disunited and disorganised party”.

    We all know that manifesto promises get broken and a lot of the public shrug their shoulders about it (a sort of “welcome to the new poitics, same as the old politics”), but I think they have a tendency to distrust parties that spend more time on internal bickering than running the country, so I would be pushing hard for it. Just my humble opinion you understand 😉

  • Jayne Mansfield. The dead have no choice. If staff in a hospital cannot see dried blood and faeces, then a politician in Whitehall will not have better vision. The reality is there are some hospitals where the staff lack the ability to keep them clean. How many patients become ill from aquiring infections in hospital? We have a NHS where it is possible for staff to evade responsibility for their mistakes. So far , I have not heard the BMA and RCN providing an explanation as to why their members failed to recognise the problems at Maidstone, Mid-Staffs, Thurrock and Stoke Mandeville. If medical staff cannot recognise the problems at a hospital, how can they advise their patients? If medical staff fail to recognise problems , then there is no control.

    Comments on Basildon and Thurrock Hospitals
    The Care Quality Commission (CQC) rated the trust as “good” overall in October.
    But a new report from an unannounced inspection team carried out by the CQC found evidence of sub-standard care.
    The inspectors saw:
    • Floors and curtains stained with blood
    • Blood-splattered on trays used to carry equipment
    • Badly soiled mattresses in the A&E department with stains soaked through to the foam filling
    • Items that should only be used once still in use
    • Equipment in the resuscitation room that was past the use-by date
    • A children’s blood pressure cuff heavily stained with blood
    • Suction machines contaminated with fluid inside and out with what looked like mould growing on the equipment

  • Stuart Mitchell 8th Mar '12 - 7:14am

    Charlie: “I have not heard the BMA and RCN providing an explanation as to why their members failed to recognise the problems at Maidstone, Mid-Staffs, Thurrock and Stoke Mandeville.”

    Haven’t looked in to the others but there were several nurses at Stafford who raised concerns over a number of years. They were ignored by senior management.

  • Jayne Mansfield 8th Mar '12 - 12:04pm

    a Charlie. I agree the dead have no voice That is why we must speak up on their behalf.

    The families and friends of those who died must live with their grief but what can we do? The only thing that I can think of is to make sure that this does not happen again.

    We are told that choice and privatisation will be the answer. We are told that local democracy will solve theproblems.

    I have just looked up the hospital that you mention and it seems that it was a Foundation Hospital. I have looked up Foundation Hospitals on the internet an see that these hospitals were hospitals that were created to devolve decision making from central government to local organisations and communities.

    They are different from from normal NhS Trusts because amongst other things:
    They are accountable to their local communities ,

    Their commissions through contract
    Monitor is their regulator.

    I’ve looked up Monitor because the name crops up so regularly in discussions about the new NHS and social care bill.

    On a website , ‘Monitor. Independent Regulator of Foundation Trusts’ II find the same warm, words about ‘ responsiveness to local needs and wishes of their local communities’ that I read in pro NHS and Social care bill.I am informed how I can become involves as a service user etc. etc .

    I would be interested to know whether the appalling standards of cleanliness and hygiene was provided by ‘ in house’ cleaners or a private firm of contractors, given that we are told that privatisation is going to be a panacea for all current problems in the NHS.

    I keep promising myself that I won’t come onto this website anymore and I definitely won’t make any contributions— but like a moth to a flame!

  • Richard Dean 8th Mar '12 - 12:13pm

    MONITOR seems to be one of the main subjects of Part 3 of the bill – and it is this part that has been subject to so much recent controversy. People do need to understand this if they want to critiise these aspects of the proposals.

  • Stuart Mitchell 8th Mar '12 - 6:57pm

    “I have just looked up the hospital that you mention and it seems that it was a Foundation Hospital.”

    It’s always the same Jayne. When local managers screw up, who ends up having to sort it out? Big bad central diktat…

  • @Jayne Mansfield

    “I keep promising myself that I won’t come onto this website anymore and I definitely won’t make any contributions— but like a moth to a flame!”

    I’m glad you are moth like Jayne, I’m finding it quite intriguing plus,as the saying goes, it’s good to talk. I’m also glad that the whole thing has politicised you as you are now part of the debate and not just an onlooker, it’s just a shame that more people don’t follow your example.

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