Opinion: Why the Leader’s letter hardened our Health Bill motion

For a year a group of Liberal Democrats who know something about the NHS and the delivery of healthcare have been working to modify Lansley’s Health Bill with the aim of preventing irreversible damage to the NHS.

Until last week our draft motion still offered the hope of amending the Bill. When we saw Nick’s letter we realised that there was no point.

On preventing competition by price the letter is doubly misleading. David Nicholson warned about this in January 2011 and the Government conceded the point in February. However, even now competition on price has not been completely prevented. Government Peers admitted this week that the EU and UK competition law still applies to the NHS. Competition law only recognises two sorts of competition one wholly on price, and the other partly on price. There is already case-law on this matter. Imagine a small group of GPs taking on the financial might of a multinational health provider. The lawyers will make mincemeat of them.

Even the new amendments promised in the letter have not been delivered. Nick said we would remove the reviews by the competition commission. Government amendment 185 does nothing of the sort. It simply changes the words that describe the reviews. He said we would keep Monitor as the regulator of Foundation Trusts. Then Lib Dem and conservative peers defeated an amendment proposing exactly that. Even if they had delivered on that promise it would have be no help. Monitor cannot protect the NHS from competition law.

Nick said we had safeguards against ‘cherry picking’. All we have is words. We have not and cannot prevent ‘cherry picking’. So many of the things we claim to have delivered like ‘making the UK a world leader in medical research’ are just words. Telling commissioning groups buying in a fragmented market that they must remember education and training is like telling someone who’s boat you have torpedoed that they should try to keep their feet dry.

Nick says that “Public health will finally be returned to its rightful place in local government. Integration between health and social care will become the norm rather than the exception.” So how does moving public health from ‘A to ‘B’ guarantee integration between ‘A’ and ‘B’? And why do the experts in public health all tell us that the Bill will increase costs and increase inequalities?

From 1946 to 2006 every NHS Act has required the secretary of state to secure or provide healthcare. This Bill will remove that. In June we were assured that the clause on the duties of the Secretary of State would be reinstated word for word. It turned out that someone had their fingers crossed behind their back, or they were refering to a different clause at the time. In the Autumn Lansley boasted that his Bill had come through the commons unscathed. Last week Number 10 said that the additional changes being requested by Nick and Shirley were insignificant. And we didn’t even manage to deliver those.

So, fellow Liberal Democrats, we decided that Lansley’s Health Bill is not amendable. The time has come for a clear open honest debate. No middle line fudge. No more amendments that could be reinterpreted, misunderstood or half-delivered. Are you for or against the Health and social Care Bill? Conference should now decide.

*Charles West is a GP and chair of Shrewsbury Liberal Democrats

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  • I admire your stand and your integrity Mr West. I happen to whole-heartedly agree with you. I believe, however, that the LibDem leadership will do anything to avoid a serious Conservative/Liberal Democratic split, which in turn (the Leadership believes) could lead to a General Election. The Leadership also believes that such a premature election would be catastrophic for the LIbDems. The LibDem leadership are “playing politic” – they will support this Bill whatever their misgivings.

  • Richard Dean 8th Mar '12 - 7:36pm

    You are a hospital and you want a thousand aspirin 100mg tablets. Supplier A offers them at 10p each, Supplier B offers identical tablets at 20p each. The money will be paid by taxpayers, not patients. Should you just flip a coin?

    You are a population. You want a health centre. Supplier C offers one at 10 million. Supplier D offers an identical centre at 20 million. The money will be paid by taxpayers, not patients. Should you just flip a coin?

  • If politics means compromise,if compromise means doing the wrong thing.Then its about time the Leadership did the right thing.

    Ditch the NHS reform,like it should have the Welfare Reform.

    If austerity means cutting the 50% tax rate,then your definition of austerity is different than mine.

  • You are a hospital and receiving a Budget of £1 million pounds from the tax payer

    You have 10 operating slots available in Theatre

    You have 10 NHS patients all requiring a heart transplant at the cost of £150’000 each

    Treating all 1£ would make the hospital go £500.000 over Budget

    You have 10 Private health care patients which will pay the NHS Hospital £50’000 to use the facilities and the theatre time slots, earning the hospital £500,000

    Now you tell me who is going to go without. The government will not increase the hospitals budget as they are expected to earn revenue from the private sector, meaning NHS patients will be “denied” or “delayed” much needed surgery.

    It’s not rocket science, Kill the Bill not the Patients !!!!!!!

  • Martin Pierce 8th Mar '12 - 8:35pm

    Godfrey – unfortunately I think it goes further than that – much of the leadership actually AGREES with the Bill. The Fixed Term Parliament legislation means the Tories can’t call an election on their own – so that isn’t the reason. Richard Dean – the problem isn’t the straight choice between cheaper and more expensive supplier – it doesn’t need an NHS Bill to enable that. It’s that big corporations will come in and use loss leaders, or artificially low prices that they subsequently have to unscramble, to buy market share – then later they use their market muscle to increase prices and profits, or to reduce wages to do the same. It’s standard capitalism and we’ve seen it often enough as private sector/competition has been mandated into local government – without, I would venture, seeing a dramatic increase in service quality or Council Tax reduction

  • Richard Dean 8th Mar '12 - 8:41pm

    @Matt. I have a couple of stents in my heart, so your question is very well received! I had the surgery in the West Indies, where the public health system pays the private health system to do this type of operation. I was the last patient to be done that day – the eleventh, after a mixture of private and public patients. I was worried that the surgeons might want to hurry the op and get home. But they didn’t.

    You may also be interested in my mother’s story. At 80 years of age, she had an accident in France. It was a day of accidents, and not enough surgeons. She was treated last, because she had less life to lose than all the younger people with less serious injuries, and less chance of survival. She waited eight hours on morphine in a bed in a corridor. That’s triage, and no matter how much equipment and how many surgeosn you have, there’ll always be times it happens..

    I see that your question is about budgets, and about the private/public dilemma, and not about competition. You arevperhaps trying to get me to say that 4 private patients wll be treated first, or ten? But that is not the answer.

    The answer is that the operation does not cost £150,000. Or more precisely, it only costs that if you do 10 operations, That is because the main costs are the costs of the machines, which in this case seems to be about 1.,5 million. If you use those machines more often, you reduce the costs per operation. The medical staff are not such awful people that they will let ten people die. They will do them all, of course.

    In case you think I’ve dodged the issue, let me assure you that I do see that you are trying to make me say the 10 private patients will always get preference. I very much doubt that, because heart surgeons just aren’t like that. I know. I’ve had heart surgery. Not every doctor is a Conrad Miurray, and I doubt that money will affect triage decisions. At the very worst scenario, patients will be triaged on the basis of first come first served, or perhaps on the basis of who they think is more likely to survive, like my mother.

    In the longer view, the managers of the facility that you imagine will soon see that there is demand for heart operations, and that there are profits to be made from the private patients. The managers will therefore enter into appropriate arrangements with a financier to buy the extra equipment they need to treat those patients. It’s the same equipment as for the NHS patients, so the NHS patients will get to use it too.

    So the answer to your question shows that, over time, the dilemma you describe actually leads to an improved health service that serves both the NHS patient and the private patient equally well. What has happened is that the private patients have been tricked into paying for the operations they would have had anyway in the public system. That indeed is more or less the way that the health service I experienced in the West Indies is being continually improved.

    Now, please answer my question. Thanks! Sorry for any typos.

  • Nigel Quinton 8th Mar '12 - 8:46pm

    @Richard Dean

    You take creating straw men to a new level. 🙂

    The arguments are not as simplistic as you suggest. Listen to those who are familiar with the NHS – the vast majority are saying this bill will not achieve its objectives and will create mayhem and lots of unintended (or intended if one chooses to be paranoid about Lansley’s real objectives) consequences.

    John Pugh has put together an alternative vision of NHS reform without this mess of a BIll, and I would urge you to read it. I have put it on Google Docs as I do not know where it resides elsewhere – follow this link https://docs.google.com/document/d/1zfU5MdP32KfAa84y7PoODjzfNQbeKHFUMvIadkTE6no/edit

    I very much hope the party draws back from its support for the Bill. From the several discussions I have had with him, I am sure Paul Burstow’s intentions in supporting this in 2010 were good, and his stated aims of greater integration and greater democratic accountability areexactly what the NHS needs, but from most informed opinion I have been able to read this legislation is not going to achieve these objectives.

  • I can only speak for myself, but I think that your party would gain huge respect and some lost ground if you pull this bill.
    I cannot see Cameron collapsing the coalition over this issue, as he could not get a majority on his own and would not want an election fought on the issue of the NHS.As has been said, it is a fixed term Parliament.
    I have been critical about quite a lot of coalition policy, but know that the numbers were such that coalition with Labour was not possible.Good luck, Dr West, as you have the hopes of many resting on you.
    I have read three different articles on your forum, this evening, on differing interpreations of aspects of competition law and yours is the one I would trust.

  • @ Richard Dean

    The cost of the operation is irrelevant, it was a hypothetical based on the same assumptions as of your previous post.

    I agree that the more operations that are performed reduces the cost of the equipment, but then you also have to consider that everything has a shelf life, and the more that it is used, the more maintenance is required or the earlier it needs replacing.

    You say “The medical staff are not such awful people that they will let ten people die. They will do them all, of course.”

    This maybe idealistically true, however, there are only 24hrs in a day and pre-scheduled operations are only allocated so many hours in theatre in any 24 hours. (the heart surgery transplant was an example not absolute)

    My point was, if the Government will only allocated X amount from the Tax payer, and yet there are X amount of NHS patients requiring the treatment, meaning the Hospital would run at a loss, it stands to reason that, that hospital is going to treat the “private” patients which “earn” them capital rather than spend it, because as the health bill clearly has said, that those hospitals that fail to reach financial targets could either be closed, “or” taken over “entirely” but a private health care provider.

    You also say

    “In the longer view, the managers of the facility that you imagine will soon see that there is demand for heart operations, and that there are profits to be made from the private patients. The managers will therefore enter into appropriate arrangements with a financier to buy the extra equipment they need to treat those patients. It’s the same equipment as for the NHS patients, so the NHS patients will get to use it too.”

    Indeed it is the NHS hospital that would be liable to take on the “finance” of new equipment along with the responsibility of maintaining that equipment as well as the financial commitments in order for “private” patients and “private” health care providers to reap the rewards without the commitments.

    Personally I believe that if people want to go private and use Private health care providers, then those companies should build their own facilities and resources and not the NHS.

    These private medical companies ” like Harley street” who have made Millions of pounds from private patients and boob implants, which have now gone horribly wrong, plead poverty and say they would go bankrupt if they where forced to carry out “reversals” for all those that had non-medical industry standard implants. It’s like everything else that this government and previous governments have done, They privatise out the profits and publicized the losses.

    On a final note, it is my opinion that ALL governments have abused the tax system and the intended NI system.
    Income tax and Indirect taxes should have always been kept separate from National Insurance Contributions, but for some perverse reason the treasure decided to combine ALL tax revenues in order to cook the books so to speak.

    National Insurance Contributions should solely be for paying for the National health and for welfare, if the cost of those rise, then so should the cost of contributions, The rises in NI contributions may have led to a reduction in Income Tax, but as long as the public had coherent information on which taxes where rising and for why, it would lead to much less confusion and animosity.

  • Daniel Henry 8th Mar '12 - 9:26pm

    Isn’t the NHS already subject to EU competition law due to the current reforms?

  • Foregone Conclusion 8th Mar '12 - 9:45pm


    Is it not possible that the hospitals would reinvest the extra money they get from private treatment to expand facilities? Under the current system, individual units within hospitals can have a very high proportion of private patients (the one I’m most familiar with is IVF), and so end up subsidising the rest of the hospital. I’m against the Bill for various reasons, but simply going ‘oh noes! Private money! Everyone will dieeeee!’, perhaps opponents of this particular provision could be a little more nuanced?

  • Jayne Mansfield 8th Mar '12 - 9:52pm

    If Conference does vote against the bill, does that mean that the leadership will have to oppose it?

  • Richard Dean 8th Mar '12 - 10:01pm

    @Nigel. Thanks. I will try to understand what a straw man is.

    I have looked at the Pugh document. Page 2 describes some rather vague concepts, not looking like they constutute any kind of effective blueprint. The next few pages are criticisms of the bill and descriptions of the present system.

    After that, there is a section called “An alternative way forward”. It starts by recommending that w e adopt a proposal that was made over 60 years ago, in 1944. It proposes turning PCT clusters into public authorities. An explanation of why this would be better than the bill is not given, but Pugh deos say that “This proposal is supportive of, and not in any way antagonistic to, the evolution of GP commissioning”. Which is confusing since there already seems to be plenty of objections to GP commissioning.

    Pugh goes on to say that the public authorities would operate on the basis of “best value” – which presumably means competition on the basis of quality and price. These boards would presumably be in receipts of moneys from central government, but it appears they would not be accountable to central government, Instead, accountability would be “ensured” by having half of their boards being clinicians and the other half clinician appointees, with “consideration” being given to the possibility of elections at some later date. The boards would have “discretion” to deliver their unaccountage plans by tariff systems, block contracts, or “any other form of commissioning”. The arrangements are said to “obviate the need” for central control by MONITOR.

    This scheme is ridiculous. Tell me what you like about it! Pugh has not considered accountability, or conflicts of interest, or understood what “best value” means. The scheme has no independent checks on quality, no checks on financial viability, integrity, theft, embezzlement. There is absolutely no realistic proposals for how hospitals – which I understand are the major parts of the NHS – should be intgerated in the mess. The scheme won’t help at all with Matt’s problem, of the heart operations. It will generate at least as much opposition and furore as the present bill. I had to stop reading.

    Please tell me what on earth is good about Pugh’s proposals. If I half believe you, I will read onwards.Apologies for any inadvertent rudeness. I have been dragged through so many hedges I don’t notice them, and tend to be impolite without meaning to.

  • I am not suggesting that other departments could not subsidise others, Like IVF, but as I said previously the dept I referred to was a hypothetical.

    I suppose I can only really comment on are those services within the NHS that I have first hand knowledge and experience from which is mental health and Gastroenterology. I think we all know how massively underfunded and The Mental health service is, which led me to going “private” shock Horror and well as for Gastro, it has been my experience of late that it is full of newly created juniors and waiting lists are being pushed back 12 months even though patients are suppose to be being reviewed every 3..
    Mental health is not something that “private health care patients” will approach their Company health Insurance for, as most people don’t want that kind of medical history to tarnish their career, And believe me, it does, no matter what proposals the government says there are to protect you., once any company gets a whiff of you suffering from mental health issues you can kiss your career progression goodbye, and don’t rely on government subsidies for Disabled workers because they are in the process of abolishing them too, no doubt on favour of more shelf stacking at tesco’s.

    I really can not see anything positive in these health and social care reforms,

    They need rewriting. and putting to the electorate for them to vote on. not slipped by via the back door of no 10 along with his other puppets who have got their hands so far up the proverbial and driving his mouth piece

  • Neil Bradbury 8th Mar '12 - 10:26pm

    I am a board member of a PCT with a family involved in the NHS. I support the public health changes, the Heath and Wellbeing boards overview of the NHS by democratically elected councils, the abolition of SHAs, removal of preferential terms for the private sector, allowing foundation trusts to compete to make money for the NHS instead of it going to BUPA et al, CCGs putting GPs in the driving seat (something GPs have been asking for years – raising their prestige), allowing the voluntary sector to compete on a level playing field, a move to putting primary care first with the inevitable consequence of a squeeze on secondary care and making GPs accountable for their obscene salaries.

    Not so keen on the government centralisation of the national commissioning boards – although in reality the whole of the NHS is centrally controlled in the last vestige of central planning. So I’m for it and I don’t care whether the professions oppose it, they opposed the NHS in the first place. This bill challenges vested interest and inefficiency in the system. Anyone reading the Mid Staffs reports and the many other similar scandals knows the NHS is totally impenetrable at the moment. I want an NHS Beverage would be proud of not the one Bevan botched.

  • Richard Dean 8th Mar '12 - 10:28pm

    @Martin Pierce. Your worries only happen when there is a monopoly situation. But a major achievement of Part 3 of the bill will be to outlaw any such kind of anti-competitive behaviour. So you should be voting FOR the bill – it gives the protection you seem to be asking for.

    Even in the unregulated commercial world, when those nasty capitalists put a price up, they open up the field for new competitors to come in at a lower price. It’s called “umbrella pricing”. It’s not going to do the damage you say.

  • Richard Dean 8th Mar '12 - 10:48pm

    @Linda Jack., No, I do not have the option to go privately for the main things I am likely to need, like prostate removal, knee replacement, hip replacement, another heart op, cancer.

  • Nigel Ashton 9th Mar '12 - 12:14am

    Dan Falchikov has a point. Don’t forget that the BMA opposed setting up the NHS in the first place and only acquiesced when Nye Bevan famously “stuffed their mouths with gold”.

  • @Richard Dean
    “You want a health centre. Supplier C offers one at 10 million. Supplier D offers an identical centre at 20 million. The money will be paid by taxpayers, not patients. Should you just flip a coin?”

    At first sight the answer would be easy. But I see some issues that are not easily apparent.

    Supplier C is a private hospital, it provides excellent treatment and employs well qualified staff. It only has CPD and revalidation requirements for these staff. It provides routine operations, for example hernia repairs under either local or GA. It does not have an ITU but relies upon the nearest NHS Hospital for emergency support.

    Supplier D is an NHS Hospital, it provides excellent treatment and uses well qualified staff. It has CPD and revalidation requirements for it’s staff and also has to provide additional time to it’s consultants to enable them to train junior and registrar level physicians. It has trainee nurses working on it’s wards as supernumeries each of which has to be supervised. It provides routine operations, for example hernia repairs under either local or GA. It also provides complex procedures has an ITU and full emergency support.

    Supplier D is more expensive, but it provides the training to the Surgeons who may go on to work in Supplier C’s hospital. It also provides the emergency support to both outfits and has to ensure there is sufficient capacity to allow support both.

    My issue is that there is no simple formula to judge the two against each other. Without D our standards will fall and the training and experience of junior staff will suffer. There is a place for both but D needs protecting. As yet I have seen nothing that achieves this. If we move all simple hernia operations into the private sector based upon price do we transfer an element of the training required to carry these out to them also. If so who governs this and how are the percentages calculated. A UK trained physician has been training within the NHS for many years before they get to even call themselves Dr. How do we preserve this. These are questions that I have yet to see answered properly and adequate protection built into the legislation.

    I am not anti private or anti public sector. Those who present the argument as polarised as this do it no justice. The last Government did a lousy job in many areas of the heath service and it needs improvement. Supplier C has a place in the mix as does Supplier D, the challenge is to get the balance right – and I don’t think it is there yet

  • @Nigel Ashton
    “Don’t forget that the BMA opposed setting up the NHS in the first place ”

    Actually let’s forget the BMA entirely and the RCN and other Trade Unions. But let’s not forget the Royal Colleges who also oppose the Bill.

  • So much for the Members’ opinions – what about “Party Members make the Policies, not the Leadership”. See my posting on the results of the NHS Reform Survey and elsewhere. This Bill is not fit to be put through Parliament and must be stopped, now! I cannot go to Conference but I appeal to all those who are going, particularly Federal Conference Reps [who, by the way, have not sought my opinion where I live and probably no-one else’s either] please vote this Bill out!

    We, the Members, should have a voice on this – so far we are being ignored.

    @Jayne – I doubt if the Leadership will take any notice like they didn’t with the Welfare Reform Bill

    @Margaret – I agree with you. The Party will gain more respect by killing the Bill right now than if we carry on diddling around with it. No amount of tweaking will make it a good Bill – it is not a “Curate’s Egg” – good in parts, there are not enough good parts to outweigh the bad ones! Stop it now!

  • jenny barnes 9th Mar '12 - 8:52am

    The leadership do, in fact agree with it. There’s an article in the orange book by David Laws suggesting that the best form of public health provision is privately provided, via insurance. Presumably some state, some private.

  • Jayne Mansfield 9th Mar '12 - 9:32am

    @ Steve Way, there are so many convoluted arguments about the NHS and Social Care bill, my hed is starting to explode.

    Why do those who are in favour of the bill keep referring to the trade unions of the professional bodies? Even I have grasped the difference between medical and nursing trade unions and professional bodies that set standards.

    Why is the coalition insisting that they are democratising the NHS by handing power to the doctors and nurses who are best placed to know what is best for their patients, when those very same professionals who are supposed to know what is best for their patients are opposed to his reforms?

    Why is the coalition demonising those very people who will be central in putting the reforms into practice? David Cameron at PMQ’s argues that those professionals who voted against the reforms are a minority. If that is the case why don’t we read more criticism from those professionals who feel that their professional bodies do not represent them on this matter?

    I cant’believe that my confusion is just the consequence of old age. Could someone please give me some answers?

  • Jayne Mansfield . The BMA is the doctor’s union, the RCN became the nurses union 20-30 years ago. Why cannot we look at the continent of Europe where charitable run hospitals ( often Roman Catholic) provide patients with alternative to the state run hospitals. Also many countries have state financed non-profit making medical insurance which gives patients far more choice than in the UK.

    I would ask the question as to why did the doctors and nurses not recognise the hygiene problems at Maidstone, Basildon and Thurrock, Midd-Staffs andStoke Mandeville. Under Health and Safety Legislation all professionally qualified people are responsible are preventing accidents. An engineer is liable if they ignore a gas leak which causes an accident to occur. It is time to stop pretending that the UK NHS is the best in the World and start looking at other NW European countries.

  • Richard Dean 9th Mar '12 - 10:33am

    @Steve Way. There are always complications, yes, but that applies just as much under the present arrangements as they will undre the new ones. WIth appropriate training, all these issues can be readily separated into their detailed parts and sorted out, and the passage of the bill will not change that.

  • Richard Dean 9th Mar '12 - 10:48am

    @Jayne. Here’s an old man’s viewpoint – Other things come with power, including responsibility, opportunities for abuse, systems to monitor and prevent abuse, and opportunities for further changes (including but not limited to improvements) later. People seem to be worried about the responsibility involving in managing the pressures of competition and cooperation, and about whether the systems of monitoring will be too fierce. People don’t trust healthcare professionals because they don’t trust themselves. People want things fixed for ever, but that can never be. And commercial interests add to the fog.

  • Jayne Mansfield 9th Mar '12 - 11:05am

    @ Charlie, but the Royal colleges that have ranged themselves against it, such as the Royal College of Paediatricians and the Royal College of Radiologists etc are not Unions.

    However, what is wrong with Unions? Could someone explain? It seems to me that without the unions fighting for the working class we would still be doffing our caps to our betters as was the case in my parent’s day.

    You obviously feel deeply about the scandals that took place in some of our hospitals. I think everyone must. We obviously differ in how we respond to the scandals. It seems to me that there are two things one can do, one can keep using them as a political weapon or one can make sure improvements take place so that there is no recurrence.

    Since the scandal occurred, have you looked at the statistics on the reduction of the incidence of the bug C Difficile that you mentioned in a previous post?

  • Jayne Mansfield 9th Mar '12 - 11:29am

    @ Richard Dean, there seems to have been little discussion around an article that appeared in the Guardian on the 2nd March, regarding documents that were handed to them by Channel4 . It was headed’ NHS reform could see GP funds floated on stock market’.

    There is so much confusion and doubt thrown up by this bill. T hat in itself should be enough to drop the bill. The bill is such a massive leap into the dark, until we the electorate get some reassurance that our worst fears will not be realised.

    This discussion and analysis should have taken place before the election but we were lulled by David Cameron’s reassuring words about his support for the NHS and his promise of no top down reorganisation of the NHS.

    My husband is , like yourself, an old man. He like myself is starting to suffer the physical degeneration of old age, in his case deafness. There are those on here who for whatever reason seem intent on denigrating the NHS under Labour.

    I have just found a website called Liberal Conspiracy which I assumes was another Liberal Democrat Website.

    It has an article, ‘Why is Lansley so quiet about this NHS good news?’ The answer it seems is that the DOH has published figures showing how waiting times for diagnostic teststhat no longer have to be booked by a consultant have been dramatically reduced under Labour. These include MRI scans and in my husband’s case Audiology.

    I can understand the logic in running down the achievements and improvements that are taking place in the NH S as a justification for bringing in this NHS bill, but it shows a total lack of concern for patients who want truth not propaganda.

  • Richard Dean 9th Mar '12 - 12:36pm


    That is a very interesting article. I certainly find it difficult to see how a company floated on the stock market could put patients first, because the aim of floatation on the stock market is usually to put investors first. However, the article does also mention potential benefits in terms of improvements to healthcare facilities, and these are not small benefits.

    My conclusion is that this makes MONITOR a much more important organization than people may have thought,. Just in case anyone is in doubt, here is part of clause 61 of the bill, which defines the general dutes of MONITOR. Thjis clause is near the beginning of Part 3, and so is one of the clauses that Shirley WIlliams, the Labour Party, and others wanted removed:

    (1) The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which—
    (a) is economic, efficient and effective, and
    (b) maintains or improves the quality of the services.

    It looks rather inept to put “economic” as the first point, and I would have tabled an amendent to switch (a) and (b), but I don’t know whether the order matters. There are other duties in this clause, and many other clauses and chapters. Whether MONITOR would be effective Seems like a different judgment, and one that probably depends on the quality of parliamentary oversight as much as anything else.

  • David Allen 9th Mar '12 - 4:06pm

    Richard Dean said:

    “You are a hospital and you want a thousand aspirin 100mg tablets. Supplier A offers them at 10p each, Supplier B offers identical tablets at 20p each. The money will be paid by taxpayers, not patients. Should you just flip a coin?”

    Well, of course not.

    A public servant, tasked with ensuring best value, will have no difficulty opting for supplier A. This is the public-private interaction working well. Public money, public servant spending it, private suppliers competing for the business in a transparent way.

    However, the new system will put private commissioning organisations in charge of spending the public money. Perhaps the commissioning partnership, let’s call them GeePee International Inc, might just happen to have commercial links with Supplier B, and, perhaps they might just quietly encourage Supplier B to charge on the high side?

    So, to rewrite my previous paragraph for the brave new world we may – or may not – be entering:

    A private commissioner, interested in profit rather than best value, may well have no difficulty opting for supplier B. This is the public-private interaction working appallingly. Public money, one private company spending it, other private suppliers competing for the business in whatever way they think will work for them. Crony capitalism at best, bribery and corruption at worst!

  • Jayne Mansfield. I am NOT against unions , what I against is the present situation where well paid incompetent people people are not being held accountable for several and repeated acts of negligence . The Chief excutive of Maidstone left with a£175K pay off.

    If the doctors and nurses working in the hospitals are not prepared to point out failings in hygiene, then in practice, there is no accountability. I see no evidence of the the BMA and RCN criticising it’s members for failing to notice and act upon dangerous failings in hygiene lapses. We see medical professions accepting authority and pay increase but not accepting responsibility for their mistakes. The BMA and RCN needs to explain how it’s members allowed at Basildon and Thurrock NHSTrust, the following to occur

    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

    Katherine Murphy, the director of the Patients Association, said that the problems were widespread within the health service. “Yet again the regulators’s assessment of a hospital has proven to farcical,” she maintained. “It is nothing but a tick box exercise that didn’t reveal any of these problems. The evidence was there but not acted on. That is completely unacceptable.
    “The system of regulation and supervision needs to be urgently reformed. The new system will not introduce the kind of rigorous on site assessment that is so desperately needed so that the public can have some confidence in what they are being told about their local hospital.
    “Maidstone. Tunbridge Wells. Stoke Mandeville. Mid Staffordshire. Now Basildon. Will this be described as another one off? We’re sick and tired of NHS managers and senior staff walking away unscathed when families are left with a life sentence of grief.”

  • David Allen – “A private commissioner, interested in profit rather than best value, may well have no difficulty opting for supplier B. ”

    A private commissioner interested in profit will screw his profit margins by selecting a more expensive supplier???

    Well … duh.

  • David Allen 9th Mar '12 - 4:51pm


    He could declare that supplier A’s product is unusable for some bogus technical reason. Then he just demands more public money to spend on supplier B’s overpriced product.

  • Richard Dean 9th Mar '12 - 6:18pm

    @David Allen. So, you agree that we do need Part 3 of the bill then? – which says that Monitor must act to prevent anti-competitive bahaviour, including the anti-competitive behaviour that you imagine.

  • David Allen 9th Mar '12 - 6:24pm

    @ Richard, I don’t want to invite a burglar into my home along with a policeman to chase him, I would prefer to keep clear of the whole sorry mess!

  • David Allen – I think you have a rather rosy view of public service commissioning.

    But to go back to your original point, why on earth would he buy a more expensive version of the same product? Being an 3vil capitalist he will be targeted on profitability.

  • David Allen 9th Mar '12 - 6:50pm


    No doubt public servants sometimes make errors. But I hope you’re not saying that private companies should always be both buyers of all services and sellers of all services, and that all civil servants should be dispensed with – are you?

    I did explain in my previous post how it is possible for two private providers to work together and game the system, so I am not sure why you are asking again, if not simply because you like having the last word. There is some defence against that from the nature of the market system and pressures to compete, but it isn’t by any means watertight. Hence the need to involve both burglars and policemen in the brave new privatised world.

    Let’s be objective about this. In many industries (mine, electricity, for instance) privatisation has neither been the disaster many predicted it would be, nor the great leap forward envisaged by the Thatcherites. Then there are other industries, like rail, where it has indeed been disastrous. All the indications are that health will make rail look good by comparison.

  • David Allen 9th Mar '12 - 6:51pm

    Sorry – instead of “two private providers” I meant “a private provider and a private commissioner”.

  • Are the questions which need to be asked?
    1. How do we ensure competence and accountability in near monopolistic suppliers?.
    2. How do we ensure organisations which have been created to protect members interests do not protect members from being held accountable for their mistakes?
    3. How de we enable the public to quickly and easily obtain information on the performance of near monopolistic suppliers such that those who have made mistakes can be held accountable? A Burnham refused tohold an inquiry into Mid-Staffs.
    4. How do we enable the public to quickly and easily obtain information on near monopolistic suppliers such that such that people can make an informed choice?
    5. After all contracts have been awarded , should they be made public and a time of several weeks or months allowed in order for them to be challenged ? If the specification , bill of quantities, breakdown of bid price and final bid price are made public it would enable us to challenge any suspicious figures.

    Sunlight and fresh air are marvellous antiseptics.

  • Richard Dean 9th Mar '12 - 8:30pm


    You could look at the actual bill – on http://www.parliament.gov.uk (you have to click through a cople of thing to get to it)

  • David Allen – I’m sure in your scenario that supplier A would make a big song and dance about corrupt behavior if supplier B was overcharging because of commercial links with supplier A. In any case you can simply apply public sector commissioning rules to the new situation. None argument.

  • Richard Dean 9th Mar '12 - 11:50pm

    Could someone call the fire brigade please? I have been quietly climbing the walls, and am now stuck on the roof. While waiting , I have worked out the correct answer to Matt’s question. The government doesn’t give the hospital a budget of a million. Instead it pays the hospital the same, per patient, as the private patient pays. That’s the theory, anyway, but it’s cold here and I may not be thinking straight.

  • patricia roche 10th Mar '12 - 12:17am

    I know this will not be published but please please look at who is proposing the bill. These are the TORIES. Do I reaqlly need to say more. I remember clearly the Thatcher years.

  • @Richard Dean

    ” I have worked out the correct answer to Matt’s question. The government doesn’t give the hospital a budget of a million. Instead it pays the hospital the same, per patient, as the private patient pays. That’s the theory, anyway, but it’s cold here and I may not be thinking straight.”

    That’s not how it works and I think you know that, unless your not sure how our NHS works and your from another country “like” the united states for example as you seem to more informed and in favour of their kind of health care.

    Our government does not “Pay” the Hospital on a per patient budget, They are given budgets to “pay staff buy supplies, machines, services e.c.t.e.c.t

    The Hospital then has all the responsibility on financing those Machines maintenance etc.

    And the private patient comes along, Pays a fee to let the equipment and the room, then walks away with no obligations for maintaining that equipment or replacements.

    The Cost the Private Provider pays towards the use of the facility is nothing compared to the overall cost the government are paying out in the first place for the facilities.

    It will be the same thing we see time and time again with these governments privatising everything.

    They Privatize out all the Profits and when things go wrong publicize all the losses

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