The greatest enemy of truth is not the lie but the myth. This could have been written with our health proposals in mind. Let me start with the myth that our plans are ‘revolutionary’. The ‘revolutionary’ label embodies neatly what many people wrongly envisage to be untried and untested changes to the NHS. Swamped by all the myth, misunderstanding and mistruths, the facts have struggled to get heard. So let me give you a few of the facts.
Under the previous Labour Government healthcare spending increased significantly. But where Britain spent big, other countries spent better. That is why Britain has some of the worst survival rates for cervical, colorectal and breast cancers in the OECD; the highest number of deaths per 1,000 live births in Western Europe; and why around one in four cancer patients are only diagnosed when they turn up as emergencies. Satisfaction levels in the NHS have reportedly never been higher, but if that is truly the case why were there also a record number of complaints made last year?
With so many lives at stake, the NHS cannot afford to stand still. That is why we are updating the health service by building on the best of the NHS. On Foundation Trusts we are completing the changes started by the last Government. GP fundholding, first started in the early 1990s; total purchasing in the mid-1990s; and practice-based commissioning in the mid-2000s. All of these reforms were started under previous Governments, but will now be completed by the Coalition.
One ‘revolutionary’ charge that I am more than happy to accept is that the Secretary of State will no longer have the power to interfere in NHS organisations. Unlike the last Labour Government, we want an NHS that is free from political interference. Services should not be decided from behind a desk in Whitehall. Instead we will trust family GPs, patients and local government to decide what matters and design the services that deliver world class results.
Under Labour Primary Care Trusts (PCTs) were effectively left to stand by the supermarket till, holding the credit card, waiting to see what GPs had put in their shopping trolleys. At a time when one in every four pounds we spend is borrowed, we can’t afford a go-between. That is why we are abolishing PCTs and giving GPs their spending powers; putting the credit card in the same hands as the shopping list, making sure every pound spent delivers the best for their patients.
It is also important to bear in mind that GPs are not being forced to do paperwork and administration. GP commissioning consortia will be resourced, as PCTs are now, to secure the support and expertise they need to undertake the managerial and administrative functions needed to discharge their duties. Labour’s campaign to save the PCT is indicative of an opposition party caught in the past defending a failed status quo. Instead of giving trust and control to GPs and patients, Labour have made it their mission to save a costly layer of management.
While all the attention has been focused on GP consortia a big change has gone largely unnoticed: the new role for local government. That role includes democratic accountability for health, integrating health and social care services and responsibility for public health. All of this will come together in councillor led Health and Wellbeing Boards and Health and Wellbeing Strategies. These reforms will bring the NHS and local government closer together than ever before creating the opportunity to really tackle the causes of ill health not just treat its consequences.
On the charge of privatisation, our message is absolutely clear; we will never ask people to pay for their healthcare. We are not changing the fundamental basis on which the NHS is funded – out of general taxation. We have no ideological preference for private sector provision over the NHS – in marked contrast to the previous Government, which set a target for the number of NHS procedures it wanted to see undertaken by the private sector. In addition, the reforms we are implementing will prohibit the possibility of any preferential payments to private sector providers, and ensure that the private sector does not make any undue profits from delivering NHS services. This, again, stands in sharp contrast to the position of the previous Government, which paid the private sector substantially more than the NHS would have been paid for the same work.
The final myth to expose is the idea that patient choice is built on a surplus of good hospitals. It isn’t. It is built on choice of care and choice of treatment. Under Labour this option was denied to patients under their “preferred provider” model, which prevented many innovative charitable providers from competing on a level playing field.
One such example, which was excluded under Labour’s model, is the drugs charity Addaction and their ‘Breaking the Cycle’ programme. Seven months of Breaking the Cycle support for one family costs £1,700. Within eight months, that is likely to have saved the state £20,000. Under our proposals to introduce an “Any Willing Provider” model, we will ensure that all providers can compete on a fair playing field, making this kind of choice of treatment possible for all patients across the country. Compete yes, but a competition on quality and outcomes, not price.
The proposed changes announced today in the publication of the Health and Social Care Bill will lead to better quality care, more choice and improved outcomes for patients, as well as long-term financial savings for the NHS, which will be available for reinvestment to improve care. Over £5 billion will be saved by 2014/15 and then £1.7 billion every year after that – enough for over 40,000 extra nurses, 17,000 extra doctors or over 11,000 extra consultants every year.
The NHS will always be free at the point of use and fair to all who need it. By trusting patients and carers to make the best choices, we will make the NHS focus on delivering high quality. Our goal is simple: we want to free the NHS to innovate, to liberate the talent, experience and dedication of NHS staff to deliver the right care, at the right time in the right place.
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127 Comments
Almost every health group and related organisation opposes the speed and scale of these changes – from the Kings Fund, to the NHS Confederation, BMA, Nuffield Trust, Royal College of Nursing, the Health Select Committee, Unite, the most senior GP in the country and even some Tory MPs.
The one campaign that GPs have been trusted to manage – flu jabs – is now being revoked, and yet Lansley is going to steamroll this one through.
Please, Lib Dems, at least attempt to think this one through. Not every doctor is a secret socialist – they just don’t want to see the whole thing come crashing down.
The only people happy about all this are the American health care companies set to gain from it all… and it’s unbelievable that we are using the US system as a model?? It’s broke, it’s unfair and – crucially – its hugely inefficient – unlike the NHS, as the Commonwealth Trust points out every year.
Incidentally – these are the facts of the US health care system:
http://etonmess.blogspot.com/2010/08/healthcare-inefficient-expensive-and.html
The biggest myth of all is that change for changes sake must automatically be a good thing and have been well thought out. If it was that brilliant an idea then why wasn’t it in the Conservative manifesto ?
Government plans for radical reform of the NHS in England were today branded “potentially disastrous” by leaders of doctors and nurses.
In a letter to The Times ahead of Wednesday’s publication of the Health and Social Care Bill, the heads of six health unions, including the British Medical Association and the Royal College of Nursing, warned of their “extreme concerns” about plans to create greater commercial competition between the NHS and private companies within the health service.
The speed and scale of the reforms proposed by Health Secretary Andrew Lansley risks undermining the care of patients by putting cost before quality, they said.
“Our goal is simple: we want to free the NHS to innovate, to liberate the talent, experience and dedication of NHS staff to deliver the right care, at the right time in the right place”.
TRANSLATION:
“Our goal is simple: we want to privatise the NHS, to allow these private companies to employ staff on terms and conditions preferable to their bottom line and to let the service be delivered by for-profit international health care congolerates at a time and place that suits them… I didn’t mention the patients, of course, but let’s not get into any more inconvenient discussions”.
p.s. ” if you don’t like these reforms it’s (rather like those pesky students) because YOU DON’T UNDERSTAND THEM”
p.p.s “If you want to discuss any of this with me further, please write to me next year in my new position at Deluxe HealthCare Services Inc., PO BOX 315, Bermuda”
Just to be balanced, not all Doctors and Nurses are oppossed to the changes. I have heard several recently on TV who are for the changes as well as some who are against. I have no significant view other than that Health care must remain free for all and as far as i can see that is not under threat. If as Mt Burstow suggests health care will be run more locally then that would be a good thing.
I have one major issues with health care and that is the provision of affordable dental care. I am now paying for private treatment because when i went to a dentist on the NHS basis the treatment was rushed and poor and all the time i was being told ‘we can do this that and the other for you’ if i was a private patient. This is a scandle that needs to be addressed!
Some of the points you make, Paul, reassure me. I have to say it would have been good if you’d been saying this stuff since last Summer rather than giving Labour the chance to get into the public consciousness the idea that the Coalition is dismantling the NHS.
I still have some concerns, though. Increased local accountability is definitely a good thing, but I do think there’s need for national democratic accountability – political interference is not always a bad thing, if it’s proportionate. We need to be sure that the service is of the same standard and quality across the country while balancing the benefits of making decisions at the lowest practical level.
And how much choice is there really going to be? Like schools, there will be “popular” hospitals which will quickly become over subscribed. How do you allocate these services.
I like the points you are making about private provision, though, and paying a fair rate, rather than over the odds as Labour did.
I have to say that I’m far from completely convinced about these reforms, but I won’t be listening to anything Labour or the unions have to say as their scaremongering is often inaccurate and can only upset.
Paul,
Ignore the hyperbole from some more hysterical commenters. However, do not ignore the RCN, BMA, Kings Fund et al who are telling you to slow down and be mroe considered in your ‘revolution’. Also, piece of advice from one LD to another, do not be the one that is wheeled out to defend this policy – let Lansley and Burns and Milton do it – do not let even the smell of this policy touch you. Unless of course, you really believe in it, in which case we’re all f***ed.
oh, and what do you think of abolishing NICE’s role in regulating what drugs are paid for from taxes and letting GPs decide? Given that they will ahve no infomation or resources to test drugs, don’t you think they’ll be at the mercy of drugs companies?
Obviously some GP’s are for the proposals, they should radically increase their earning potential, no small feat concidering the average is around £102,000 pa
Has anyone had a decent answer from the Tories as to why this 5 year in the making plan was completely absent from their manifesto and the coalition agreement? Strange no, especially when Cameron was saying no reorganisation during the campaign.
The party needs to be very very careful about blindly supporting these plans.
I’m sorry, Paul, but this doesn’t even remotely convince me.
I support the coalition, I think our ministers are mostly doing a great job under very difficult circumstances and I fully understand that compromise with the Conservatives is both necessary (given they have about 5 times more MPs than us) and democratic (since many more voters backed them than us last May).
I even accept that, however painful and damaging our breaking of the tuition fees pledge was, our MPs were backed into a corner and the leadership did at least manage to wrestle some significant concessions that made the changes better and more progressive.
But these reforms risk being disastrous for the NHS and the thought of our MPs voting them through appals me. They weren’t on the coalition agreement, they’ve been mostly greeted with horror by health professionals, and they risk undermining the very foundations of the NHS.
And your comments about complaints and survival rates are disingenuous at best. Complaints in all areas of life are on the rise because people are more likely to make official comments than before (and the complaints procedures facilitate this in the interests of patient feedback). And of course our survival rates are lower than elsewhere in Europe – we’ve been spending at European levels for a few years, they’ve been spending at those levels for a few decades. Patient satisfaction – measured by a highly reputable polling company who have been conducting the sane survey for a long time – are at an all time high. This is no time to put the NHS through another upheaval.
Even if the proposed reforms were likely to be beneficial, they should still be introduced far more slowly and NOT at a time of spending squeezes. But even apart from the ridiculous timing, the substance of the reforms is very worrying. I don’t doubt that it follows on from some of the spasmodic pilot projects started under by Blair, but that’s hardly a justification for continuing and greatly expanding on them – Blair tried to bring in 40-day detention without trial too, are we going to hop on that bandwagon saying ‘we’re just continuing where the last government left off’?
Dominic – Totally agree about NICE. It was not popular with some of the press, and certainly unpopular with the major Pharmaceutical companies, but at the end of the day it did something that most people would struggle to disagree with: provided independent, medical advice on the efficacy and therefore relative value of drug treatments.
The only winners out of its neutering will be big pharma, and the only losers the taxpayer.
Paul
Surely the best way to avoid a myth taking hold is not to wait a week before presenting your own side of the argument, isnt it?
Does the party actually have a communications strategy, or at least someone pointing out to ministers that if they dont sell the positives of controversial reforms then the only voices that will be heard are the special interest groups, the unions and the Labour Party?
If we dont sell government policies energetically we shouldnt be surprised if morale amongst the party membership disappears and the public sees no reason to support us.
The one thing that is guaranteed about these massive reforms is that their effects will be utterly impervious to any kind of spin once they take effect. If they are as dangerous and damaging as so many doctors and nurses are telling us then the public will notice. The public uses the NHS day in and day out and if this private competition model spawns more Stafford style catastrophes, as the equally foolish Foundation Hospital reforms did, then the public will not just be well aware of it but never forgive those who supported this ill judged marketisation of healthcare.
There will be no dodging the blame as these reforms have to be voted through.
The names of those supporting it will join the names of those who voted to treble fees in ignominy.
Always remember the man ramming this through, Lansley, has already been caught taking money from a private healthcare provider.
Andrew Lansley bankrolled by private healthcare provider
Andrew Lansley, the shadow health secretary, is being bankrolled by the head of one of the biggest private health providers to the NHS, The Daily Telegraph can disclose.
http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lansley-bankrolled-by-private-healthcare-provider.html
These are the type of people Nick has placed his absolute trust and the future of the NHS in.
This issue is going to be second only to the economy and it may well rival that if it all falls to pieces.
I don’t suppose Paul Burstow will ever see these comments, let alone respond, but the question I should really like an answer to is this.
The LIb Dem manifesto contained a pledge to put the running of the NHS into the hands of elected authorities:
“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.”
The Coalition Agreement watered that down, but an element of democratic representation was retained:
“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed …” And of course there was a promise that there would be no more “top-down reorganisations.”
What I simply cannot understand is why the Lib Dems afterwards voluntarily agreed to scrap those parts of the coalition agreement, and to embark on another wholesale reorganisation of the NHS, abandoning the democratic element altogether and putting GPs in charge instead. No one forced them to do that. They had secured partial Tory agreement to a Lib Dem policy, and they simply threw that away. Why?
Mike Hartley,
Thanks for the link. People do like knocking the NHS but it isn’t justified. The NHS is, on balance, very good. Sure, it’s not the best in the world at everything but it is the fairest health system in the developed world and one of the cheapest per head. Clinical outcomes are good but perhaps patchy (I heard on the news yesterday that it is the best in Europe for heart surgery).
Perhaps people need to know that in the US, 1/3 of people have no heath insurance or inadequate insurance and that the other 2/3 pay between 2.5 and 3 times what we do here. Perhaps they need to know that 85% of people with health insurance there don’t get their prescriptions paid for and that the subsidised rate here is actually very cheap for most things. Perhaps they should be told how much income tax would have to go up to match the spending on health most othe developed countries pay. Then let them decide wheterh the NHS is quite so bad.
I’m sorry, Paul, but this doesn’t even remotely convince me.
I support the coalition, I think our ministers are mostly doing a great job under very difficult circumstances and I fully understand that compromise with the Conservatives is both necessary (given they have about 5 times more MPs than us) and democratic (since many more voters backed them than us last May).
I even accept that, however painful and damaging our breaking of the tuition fees pledge was, our MPs were backed into a corner and the leadership did at least manage to wrestle some significant concessions that made the changes better and more progressive.
But these reforms risk being disastrous for the NHS and the thought of our MPs voting them through appals me. They weren’t in the coalition agreement, they’ve been mostly greeted with horror by health professionals, and they risk undermining the very foundations of the NHS.
And your comments about complaints and survival rates are disingenuous at best. Complaints in all areas of life are on the rise because people are more likely to make official comments than before (and the complaints procedures facilitate this in the interests of patient feedback). And of course our survival rates are lower than elsewhere in Europe – we’ve been spending at European levels for a few years, they’ve been spending at those levels for a few decades. Patient satisfaction – measured by a highly reputable polling company who have been conducting the sane survey for a long time – are at an all time high. This is no time to put the NHS through another upheaval.
Even if the proposed reforms were likely to be beneficial, they should still be introduced far more slowly and NOT at a time of spending squeezes. But even apart from the ridiculous timing, the substance of the reforms is very worrying. I don’t doubt that it follows on from some of the spasmodic pilot projects started under by Blair, but that’s hardly a justification for continuing and greatly expanding on them – Blair tried to bring in 40-day detention without trial too, are we going to hop on that bandwagon saying ‘we’re just continuing where the last government left off’?
And totally agree with what others have said re abolishing NICE – a role that GPs can’t hope to fill nearly as efficiently and independently.
Finally, for your sake and that of our whole party, please take Dominic’s advice and stop allowing yourself to be wheeled out on TV to slap lipstick on these proposals…
You can always make savings and be more efficient in any large organisation/ No one dispoutes that.
But the NHS has been doing that in recent years in any case.
But it now appears that of the NHS ‘managers’ who were going to be shed in this top-down reorganisation to save money – according to the Tories – up to 70 per c ent of them are going to be re-employed in the new admin structures that will become necessary. So sack them and give them redundo and they move over into the same job – that makes a lot of sense.
I regard myself as highly intelligent but I haven’t a hope in hell of being able to ‘shape’ the health services which are best for me because I don’t have the specialised knowledge required. I would guess that 99 per cent of the population are in the same boat.
I also wonder when GPs turned into supermen and women – it has long been my experience of GPs that most are pretty swamped by keeping on top of their existing job and are hard-pressed to keep up with medical advances in all its myriad fields.
So how much real expertisde will they have in being able to purchase services at a hospital consultancy level which again has a multitude of sub-specialities run by very experienced and knowledgeable consultants, doctors and technicians – will they be able to corerectly evaluate between the offers from the varying providers.
And I was shocked last night when I heard that these ‘private’ providers will be able to hire operating theatres and other NHS facilities. It’s just the same a Eoyal Mail having to carry letters from competing private companies and hand the 2.5pence for every letter for the privilege. Once again the taxpayer wiull be subsidise big business.
And make no mistake this is what this is all about – BIG BUSINESS and PROFIT. This scheme is aimed at fragmenting the NHS into bite-sized chunks that will be swallowed by private companies interested primarily in profit for their shareholders and not patient health.
And by the time the public waken up to what is going on it will be too late to reconstruct the NHS and the poor will be back in the position they were before the NHS was founded.
Oh happy days – and the LibDems will now doubt be enthusiastically marching through the Tory lobby to bring this about.
I notice a few posters say that the LibDems should listen to the voices of dissent coming from the Health Community professionals. Oh really – college heads all over England lined up to paint the picture of what EMA withdrawal will mean to their poorer students – did the LibDems listen – of course not they’re too busy backing Cameron’s cuts and savage attack on education. And now Gove wants to take us back to a 1960s syllabus.
Gove prattles on about education states from other countries – well Mr Gove, stats can prove anything depending on how they are presented. There can be many political reasons why a country might influence the stats that are published and the same goes for universities.
A look on the internet will show the massive arguments taking place about how international uni rankings are tweaked by some unis to ensure their financial success. I remember Psychology 101 which dealt with the wide variations in suicide rates in different countries and dredging my memory it comes back that the rates weren’t that different – what was different was how deaths were reported and that very much depended on religious or social attitudes to suicide which prevailed in different countries.
So it always makes good sense to beware of how stats are collec ted and interpreted.
Colin Green – your comments on the US system are absolutely right. Not only are vast swathes uninsured, but even the insured have problems securing treatment.
And, before anyone goes on and says that this comment is off-topic, it isn’t. The US system has been quoted by Tory ministers a number of times this year as being the model for GP commissing. In fact, the system is broke, unfair, inefficient and, basically, a massive cash cow for private companies out to make a proverbial killing.
Why are people not more angry about a staggering piece of reform NOT ONCE mentioned in either the Tory or Lib Dem manifesto… and more importantly, when are the Lib Dem ministers that are worried going to stand up for themselves? They are turning into an embarrassment.
Paul – a party political broadcast supporting Tory-led NHS reform on a Lib Dem website? Utterly unbelievable.
You claim to present facts, but then go on to present paragraph after paragraph of Coalition propoganda.
“The NHS can’t stand still…Labour failed to…One in every four pounds spent…Trust GPs and patients…Given the credit card…opposition party preserving the status quo…” It then goes on to read like a solliloquoy to the free-market. When even the Tories question Andrew Lansley’s plans, surely the Lib Dems must stop being cheerleaders for it, no?
You fail to provide facts to answer any questions at all.
NHS Satisfaction high but complaints high? Why? Any corporate customer satisfaction department will answer why. Satisfaction + complaints always rise as one. It’s a sign that the organisation is a) listening and b) approachable enough to hear complaints. If one rises as the other falls, it’s generally a sign that the data is false.
Why are you spending £1.4bn on re-organisation in a fiscal year when your in-cash-terms NHS budget protection amounts to a real-terms budget cut – and without a real-terms 3% increase year-on-year this problem will only compound?
Where in the proposals does it state that Local GP commissions will be barred from charging for services previously delivered under NHS services? Can you guarantee that such services will not invoice patients, allowing them to circumvent the “free at point of use” maxim?
GPs are private businesses. What legislation will there be to avoid practices profiteering – and how transparent will there incomes be?
How will you prevent private providers selling services under cost to enable them to win long-term contracts at the expense of NHS providers who will then go under – leaving the private sector free of competition?
If your aim is to avoid privatisation, can you detail how you will avoid EU competition law (which the NHS is now for the first time ever subject to) from allowing it to happen?
Your system is forcing PCTs to merge (Ealing…Hounslow etc) across larger geographical areas. How does this aid localism?
Are you comfortable with telling us how many hospitals you are forecasting will go bust under this scheme? Will you share government projections of which local hospitals will go bust?
How are you dealing with the current PCT debts to avoid them rolling into the new consortia?
How will you monitor the role of huge companies like Atos, Capita and United Healthcare in their express desire to favour other private providers?
recent polls of the profession point to only 25% of GPs being supportive of the changes, yet to plough on regardless. Why? What is the logic in denying professionals a voice?
Can you guarantee that waiting lists will not rise? Your leader expressly failed to answer this in PMQs this week.
The Labour government inherited a “post-code lottery” NHS system. How, specifically, do these proposals avoid this certainty from arising again?
Remind me again, how much money did the Tories receive from private healthcare companies? Looks like they are getting payback. What do the LibDems get for their supine support?
Paul, you really should ask the NHS chief information officer why she is about to sign a £2.7 billion contract with BT and CSC for the National Programme for IT in the NHS. The coalition was supposed to have brought this contract under conrtol at the very least. There is a disconect between what politicians say and probably, what theyare told by civil servants, and what is happening. You are decantralising the NHS and still signing these massive central contracts that do not deliver.. http://ht.ly/3H5tD Get a grip.
If you want to know what is going on with NHS IT and IT in the wider public sector, follow Tony Collins’ blog on ComputerworldUK.com,.
tony collins blog
Paul it isnt possible to be both accountable to local politicians and free of political interference. But the Health and Wellbeing Boards you describe will not have authority over the GPCCs and GPs will undoubtedly be a powerful force on the boards. This is just one confusion in what is growing into a bterrible mess. I heard Lansley yesterday tying himself in knots on Radio 4 trying to justify the free market approach when Cameron had said he would fight a bare knuckled fight to save small hospitals
This is just a way the Tories have constructed o get the NHS privatised. They will allow private companies to work at a loss to compete with NHS hospitals. The law will be changed to ensure that we have to take the cheap offer and then when the NHS facility closes the private multinational companies will just put the cost up and there will be nothing we can do about it. This is my fear anyway and there is no protection to stop it happening so I believe that this lack of forethought is deliberate and calculated rather than accidental. Clegg actively supporting it seems to show that he has decided which side his bread is going to be buttered (and it isn’t on the side of liberal values or what is best for the country/us as a party).
Meh. Another Lib Dem minister trying to sell a Tory policy. There’s no way we’d be doing this if in government on our own.
I’d expect this from the Conservatives… it’s a shame that the LibDems are so keen to go along with it all.
Here’s a new slogan for you:
“Education and health care are for those who can afford it.”
I hope it works… Because if it doesn’t it’ll be 60 years before we have another liberal MP.
EcoJon
Oh happy days – and the LibDems will now doubt be enthusiastically marching through the Tory lobby to bring this about.
See my comments at 9.15 am today on
https://www.libdemvoice.org/opinion-sharing-maternity-leave-our-most-popular-policy-since-the-coalition-was-formed-22790.html
I cannot take seriously criticism from someone like EcoJon who says he is a “socialist” but spouts Thatcherite rhetoric and cannot even see the prime cause of the huge economic mess our country is in, which is the Thatcherite attitude to home ownership and unearned profits and people getting into debt and the whole “housing ladder” which serves just a conveyor belt passing money from the poor to the rich, on which he is so keen.
“Another Lib Dem minister trying to sell a Tory policy. There’s no way we’d be doing this if in government on our own.”
But on top of that, there’s no way the government would be doing this if the Lib Dems hadn’t voluntarily agreed to modify the coalition agreement to allow it to happen!
This isn’t part of the post-election compromise. Apparently it’s something the Lib Dems actually wanted to do.
The Conservative Party, despite getting the votes of fewer than 4 in 10 people, is drunk on power, and is wasting no time in radically changing the NHS. And our role in this orgy of revolution is to be the enabler to the alcoholic Tories, handing them a glass full of political cover – with a parliamentary arithmetic top – every time their warped, booze-addled minds dream up a new scheme to hollow out the state.
My fear is that every time we defend the Tories’ policies, just as Paul does above, we are in effect giving them more time to keep drinking. Instead of saying ‘this isn’t acceptable behaviour’, we are saying ‘ok, you can abolish council housing, but promise you’ll let us have an elected Lords’. The Tories faithfully promise that we can definitely have it, and then do their damnedest to make sure it will never happen. I don’t blame them for acting like that – just as the scorpion kills the frog while crossing a river, it’s in the Tories’ nature to favour rich over poor, private over public, and brutish over caring. Frankly, they’ll never sober up. But we should know better.
Generally supportive and positive about proposals, but conscious about the expense and support consortia will need to support informed and efficient buying; I hope we learnt from Philip Green that fragmented buying can drive up costs & wastage and will pool our buying power to get the best terms and price.
People would be reassured that this model has been tested successfully if there are other courtier with effective functional and affordable healthcare systems already operating it; what evidence is there internationally of these conceptual models panning out as we hope?
Countries, not courtier!
Damn you iPhone!
Can I say that, whilst I agree with the comments that this is an ill-judged (to say the least) set of proposals that, more even than tuition fees will be a toxic issue for a generation after they are implemented, at least we now, finally, have the opportunity to discuss them.
This is probably the most crucial long-term change to the UK that the Coalition proposes. They have to be thought through properly and debated properly, and if they are found to be wanting – as I believe they are, Lansley has to be stopped. Not should – *has* to be. The public expected the Liberal Democrats to intervene on exactly this sort of issue.
You all need to read this if you haven’t already.
http://www.bmj.com/content/342/bmj.d7.full
It saddens me to hear that Paul Burstow all along was a closet far right economic’liberal’ who believes that only the voodoo magic of the market can improve our services.
Some intruiging quotes in there Paul
“Unlike the last Labour Government, we want an NHS that is free from political interference.”
Are you saying that the Democratic process has no role in how we spend our hard earned taxpayers money here , and appear to have the belief that the free market can replace democracy ”
“On the charge of privatisation, our message is absolutely clear; we will never ask people to pay for their healthcare”
The fact that people will or wont pay is irrelevant to the point of privatisation why such an effort to misanswer the question .?
GPs are in the main hard working dedicated people as are most workers I know, but to give these unelected self employed people total discretion on how to spend tens of billions of pounds of our money shows a belief in vodoo free market economics that is downright scary ”
What happened to paul burstow when did he change his beliefs ? Why did he never tell people he had this beliefs before ???
You state that Britain under llabour spent big, but Europe spent better. However, the spending of the UK on NHS in the last decade has been below average spending of Europe. Therefore we can only expect below average performance on Healthcare.
Cutting budgets to 80% and reworking the NHS will not improve these health outcomes.
I am not a public member about to be bought by Spin on “myth” when the truth is largely in the budgeting and balance sheets.
Neither will putting labour Squeeze in every paragraph incite me to agree to a move which is already distracting heathcare staff. The methodology in Lib Dem approach is for the people, not nodding along with Tory squeeze when the figures do not add up. WIthin my own trust, I have witnessed commissioners pulling service improvement groups on the basis they don’t know if they have jobs so why should they consult with the public to develop care pathways if it’s all being handed over to GPCs. As a result, public facing research on patient experience. PSCQC requirements and need are being obliterated before consortia are in place. Because of this white paper.
If GP Consortia will outsource administration and management costs (conviniently putting them in the category of commercial sensitivity and therefore outside of public scrutiny) why are you abolishing PCTs at all? Why not simply change the command structure so that PCTs are accountable to GPs on a locality basis and save jobs, health and health outcomes? By abolishing a structure, you are putting staff in line for redundancy, you are risking the health of people who the staff serve and you are creating a period where all care is delivered poorly during the transisiton.
You talk of pillars of democratic accountability. Studying the responses to the DoH white paper consultation, one has to accept that the majority of respondents do not want this transition. Therefore the very basis of the white paper is flawed in concept, before initiating that concept.
And there in lies further irony, by transferring GPC management structures to commercial environments, their role is protected by commercial sensitivity and as such, no comparabe data can be analysed under FOI, therefore they cannot be held accountable by their actions. This is neither liberal or democratic.
The principles of the NHS are universal healthcare. There is nothing universal about competitive rates for consortia. The only universality in the proposals is the cutting of funding and refusal to bail GPCs out. Therefore people will be un-universally maligned where major disasters occur, or where predictions on budget forcasts are wrong. This will put more lives at risk than the current system.
You discuss avoiding the privatisation of NHS. However, privatisation is a significantly vaster issue than paying for healthcare. Providing funding to private and commercial funds to deliver NHS services is simply a transferrence of privatisation.
Choice in provider may indeed create competition which will drive up the levels of service. For those who can wait for the time to get into the better hospitals or access the better consultants. But this again undermines the very basis of universal healthcare. If I break a leg, I don’t care where I go, just that the care I receive, whereever I am, is universal accross the NHS. I see nothing in the proposals to underpin this integral value of the NHS.
Ultimately, choice negates the very basis of healthcare, the consultation process is a fait accompli yet used to underpin the proposals and there is nothing in the economic assessments to inprove the health outcomes for the forseeable future.
@Paul Burstow
Thanks for the post.
Health policy has been really worrying me, mostly because I don’t think it’s been sufficiently explained to party members, so more posts like this would be appreciated. And, if you have time, it would be good if you or a colleague could give replies to some of the concerns expressed in this thread.
I don’t understand the proposals sufficiently to comment in detail, but I have some specific concerns:
(a) Using NICE to determine which drugs are good value for money may be unpopular with the tabloids, but it seems to me to be very sensible. Giving GPs discretion to prescribe expensive drugs which aren’t good value for money sounds, potentially, very expensive, and may mean worse, not better health outcomes. I don’t understand the rationale for this change.
(b) Who are the GPs accountable to? They will publish annual reports on their performance, but if one of the 500 GP consortia is not performing properly, what is the mechanism for correcting this? GPs are, in the main, admirable people, but there will be the occasional bad apple and the occasional bad consortium. If a consortium of GPs is unable to handle the responsibility, will the Independent Board have the power to take over?
And has enough time been given for the pilot programmes, so that, if there are problems, the proposals can be significantly modified?
“The NHS will always be free at the point of use and fair to all who need it.”
Paul – these words of yours sent a cold shiver down my back. How are they to be interpreted. Who will assess the need. If we are going to be moving closer to the US model, with care provided by many insurance companies will it be they?
Is this what we are moving towards? I quote from Wikipedia:
“The U.S. Census Bureau reported that a record 50.7 million Americans—16.7% of the population—were uninsured in 2009.[1] More money per person is spent on health care in the USA than in any other nation in the world,[2][3] and a greater percentage of total income in the nation is spent on health care in the USA than in any United Nations member state except for East Timor.[3] Despite the fact that not all people in America are insured, the USA has the third highest public healthcare expenditure per capita, because of the high cost of medical care and utilization today.[4][5] A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses.[6] Since then, health costs and the numbers of uninsured and underinsured have increased.[7]”
Please consider the above as you walk through the lobby.
Sorry – I should have also asked:
Do you foresee a times when the NHS becomes purely a safety net service for those that are means tested as being unable to afford private health care? I so – hence my comments regarding the American Health model.
@George Kendall
a) The rationale is simple: large pharmaceutical companies, who resent having to prove the efficacy of their drugs, have been lobbying for this for years; the Tories are happily supportive.
b) It is – as a poster above pointed out – not about democratic accountability. It’s about whether you ideologically believe that ‘the market’ is more democratic than public structures – there is no point searching for where the democractic structures are, as they are being abolished.
Finally, on your last point, the legislation is being advanced regardless… PCTs are being wound up in 2013. So even if the pilots are a mess, there is no going back.
Incidentally, if the Lib Dem leadership blindly waves this through, then there is no going back for them either.
Dear all,
Thank you for your comments, I will do my best to answer as many as I can as quickly as I can, but I just wanted to put to bed once and for all the idea that the proposals will abolish NICE. This is absolutely not true. In fact we will be strengthening the role of NICE by establishing it on a formal statutory footing, to clarify its role and functions, secure its independence and extend its remit to social care.
Paul
Oh dear, another Lib Dem wheeled out to oblige as cover. Oddly, Paul does not explain why this non Coalition agreement policy is being pursued. This is exactly the type of policy the public expected us to moderate not promote.
@ paul burstow
Thanks for responding. I don’t think anyone was suggesting that NICE would be abolished. The specific concern is that the drug regulatory function will be hived off to gps, who won’t have the resources or inclination to test every drug like NICE do. This means no one will do value for (taxpayers’) tests of drugs, leaving gps having to trust big pharm.’s word on the efficacy of their own drugs, leading to poor value and I’ll informed purchases. Can you confirm or deny this policy?
I’m sorry Paul – thats not good enough. I have a lot of respect for you – in fact when I lived in nearby Kingston I came to help…. .but today I have decided to leave the Party over this issue. While nobody would argue that there are things that need to change these plans will not bear up to scrutiny. I manage a small independent private medical service – so not coming from a vested interest group – therefore I have experience at an operational level. Already there are many ‘good’ people leaving the PCT depleting their experience and expertice. Those demoralised who are left are expected to guide throgh these changes and are likely to want to be involved in the consortia.
I was about to write a full critique about the faultlines …. but I’m sorry I am tired with making excuses for our involvement in the sort of policies I have opposed along the our party for 30 years … I am tired trying to think of reasons why I should stay and I’m tired with squirming when I watch how comfortable our ministers look sitting next to the Tories , not least Nick Clegg’s incessant nodding with Cameron’s proclamations from the front bench.
Sorry guys but I’m out of here
Ian – a brave man, standing by your principles. I left months ago – I can only applaud your bravery.
Paul – your comment on NICE is rather odd. No-one suggested it was disappearing. However – you failed to mention that you’re removing it’s most useful function – that of drug regulator.
I’ve said this before – my wife is a GP. Why say it again?
She has never been approached by so many drug reps (6 in one day), Pharma companies + outsourcing companies as at present. There is a bear-pit of feverish private-sector companies smacking their lips at the potential they now have to take over how and what we get prescribed to us.
Who would you rather have Paul monitoring drug efficacy – NICE or the Big Pharma companies who will profit? Have you asked your customers, sorry, your patients/constituents/GP practices who they would rather have doing this role?
We’re close to being like the US – watching adverts for statins on daytime TV, being advised to approach our healthcare providers to get a prescription.
Well said Ian, and Cuse.
Ian – would you be willing to talk to a newspaper about your views? I think they carry a lot of weight given your background and expertise.
This is simply offensive – if you wanted to do all this ideologically driven crap why wasn’t in your – or there manifesto? what is the relationship between these private provider and the conservative party including Lansley – it appears to be a financial one that i seem to recall Lib Dems criticising before the election.
When this goes wrong it will be the Lib Dems as well as Tories who get the blame for an ill thought out ideologically driven piece of incompetence and another way in which you will lose votes in the next election.
Why did Cameron and Lansley introduce this policy by stealth? Why did they not mention it in the General Election campaign or in the coalition agreement? Clearly, because they did not dare be honest about their intentions. What did they have to hide?
Paul Burstow points out that Labour allowed the private sector to compete on favourable terms. What that primarily demonstrates is the relentless pressure from private providers to muscle in on an opportunity to make money, and their success in capturing politicians as their agents and promoters. All three parties are now entrenched in their positions on this gravy train. But the Coalition can move faster than Labour by riding roughshod over internal dissent – if we let that happen.
Why did Clegg accept this massive change in Coalition policy, announced just a month or so after the coalition agreement was signed, without a murmur? Because he was too stupid to notice, or too cowed to protest? Or because the “coalition agreement” was a bogus document, put there only to fool the public and the Lib Dem conference, and known by Clegg to be a pack of lies? Let the reader decide.
How do we know that this policy will fail the public? Because the stated motives of its promoters, to improve efficiency, are simply lies. The motive is to change the ideology, help business make more money, and get in on that act.
Why is it largely irrelevant that the NHS will (or may) remain free at the point of use? Because the excess profits will in any case have been made further back in the supply chain to the eventual detriment of the taxpayer. And because the first step is for the healthcare business to gain power, the second is to drop the promise of free treatment in dribs and drabs once they have the power to do so.
How many more mistakes can Clegg make before our ostrich activists, frantically trying to look on the bright side, catch up with our voters and recognise our desertion of principle? Were it not for our ostrich tendency, our leader would not have survived the major disaster that was tuition fees. How about chaos in healthcare next?
If the coalition goes ahead with this and voted it through,
I hope the British Public grows a pair of balls on this one and take a firm stance once and for all.
I hope the people take to the streets and do “whatever” is required to bring this government down.
We can not allow the Tories to destroy the NHS in just 2 years of office.
These reforms and marketisation of the NHS absolutely stinks, The Tories have no Mandate to do this, There was no mention of it in their election campaign or manifesto.
Such a radical change to our healthcare system should require the support of the majority of the public.
No party, would ever win an election, if this was part of their policies.
as I said earlier this activist and ex councillor has decided to hand in his membership card and go back to his constituency and prepare for a strange life without the Party I knew and loved. I thought it might work out but I am fed up with having to justify the unjustifiable……….
There was an article on here the other day complaining that Labour wanted to call the coalition a Tory led government, if ever there was evidence that it’s a Tory led government it’s this, not in the coalition agreement, not really in the Tory manifesto, but out it comes bold as brass and they have Lib Dems rallying around to defend it.
Shameful, as someone earlier said, this is the sort of issue the Lib Dems should be moderating, not promoting.
@Paul Burstow MP
“I will do my best to answer as many as I can as quickly as I can, but I just wanted to put to bed once and for all the idea that the proposals will abolish NICE. This is absolutely not true. In fact we will be strengthening the role of NICE by establishing it on a formal statutory footing, to clarify its role and functions, secure its independence and extend its remit to social care.”
Paul,
I’m delighted you’re going to engage in the debate in this thread.
On the issue of NICE, when I said: “giving GPs discretion to prescribe expensive drugs which aren’t good value for money sounds, potentially, very expensive”, it was based on articles like following:
http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4127560
“Last month the Government announced that NICE drug appraisals are to become advisory, with the decision about whether a patient receives a particular treatment to be taken at a local level by GPs instead.”
I’d be delighted if it turns out that that article is incorrect, or if there has been a shift in government policy.
If you were able to provide a link which goes into more detail of what exactly the changes to NICE are, that’d be really appreciated.
In asking this, I’m not writing as a critic of the coalition. I think the party did exactly the right thing in entering the coalition, and I’m proud of many of things the party is doing in government, not least in sorting out the catastrophic financial mess we have been left with. But I am concerned about proposals like these.
The motives to bring the NHS into a new parity line with provision in Western Europe, in terms of better survival rates for breast ,cervical,colorectal cancers and for live births per 1000 are laudable and should be supported.
More patient choice in terms of the expanding and innovatory market of new and revolutionary pain relieving drugs,treatment outcomes for patients and choice in hospitals that show the best survival rates for operations are all welcome and can only do good.
However, as a former member,over 8 years, of my local Community Health Council, until abolition in 2000, by the previous Government,without any consultation, I would like to see local people empowered again to sit on Local Health Boards sought by patient `action’,`watchdog’ and voluntary health groups including disabilities and the elderly.
There is now clearly a massive gap and vacuum in local `checks and balances’ brought about by the abolition of the bureucratic PCT`s.
So surely as part of an honest approach to good localism it is now `Fair’ to appoint an open door approach to health enquiry and consultation with patient groups, to make their timely comments and views felt, on the grass-roots function and workings of the new GP `Fundholders’ and their teams of health commissioners?
The proof of the pudding of the new GP Fundholders methodology, however well targeted and altruistic the health aims,will be tested by statistics and personal experience betterment of treatment outcomes in patients waiting times and survival rates.All will be closely scrutinised against the experince of patients themselves.
The NHS was put in place to offer free at the point of need Healthcare and it is the best practice model for the best patient outcomes that is the most desirous and important.
@Patrick – the motives are to allow rich people to make a lot of money out of us.
A few thoughts if I may.
As a GP and Exec Member for Care and Health on Liberal Democrat Bristol City Council you may be surprised to hear that I think these reforms CAN deliver much more cohesive, integrated, responsive, locally accountable NHS and social care services.
Why am I so confident?
(1) I have seen many health service reforms and seen the responses of all the organisations that Mike Hartley cites to each of those reforms. They urge caution because that is what they do.
(2) These are (mostly) not new changes. They are built, logically, on the work of Conservative Government in the 80s and 90s and the Labour Government in the 90s and 00s.
(3) They do draw on Conservative and Liberal Democrat manifestos. Most obviously forging closer links between health and social care, between NHS, Public Health and Local Authorities, and between councillors, patients and doctors working together.
(4) They improve and strengthen local scrutiny.
(5) They support GPs and their patients to ensure services are tailored to meet local needs. This has been happening for 20 years (GPs were involved with Fundholding and Locality Commissioning back in 1990, not because we wanted to earn more money, which we (generally!) didn’t, but because we wanted to see locally driven, accessible and responsive services for our patients. It is a great feeling as a GP when you know that you can get the right treatment for a patient, quickly and reliably.
This afternoon, by coincidence, we had a meeting of Bristol lead GPs, Patient organisations, commissioners, council officers (including senior health and social care, health policy and children and young people services), Labour, Conservative and Liberal Democrat councillors, chief executives of Bristol City Council, NHS Bristol, The Care Forum, directors of Public Health, etc, etc
We met to start to scope how the Health and Well Being Board would operate, work with others and support the excellent services that Bristol residents expect.
It was a positive meeting. We talked of the opportunities, the partnerships, how to build on the best we have, how to encourage culture change, how to develop trust and understanding, how to clarify roles and responsibilities, minimise bureaucracy but encourage accountability and scrutiny.
We did not underestimate the challenges, but there was palpable excitement as people acknowledged what was possible.
i will try and pick up and answer some of the other points in due course.
Jon Rogers
Can you tell me precisely how GPs will be “more locally accountable” than the elected health boards advocated by the party at the election would be?
@ Jon Rogers – how much will your income increase under this scheme?
@Jon Rogers
Thanks very much for sharing your thoughts, it’s nice to hear from someone with a good overview position. I’m still not persuaded of the merits of these proposals. I’m sure they contain some good ideas like more integration with social care, but alongside that sit some very worrying things and if you have time to address some specific points then along with the comments made by others above, your insights on the following would be very welcome:
1 – The NHS has been through various reforms in recent years and is currently undergoing a period of belt tightening. Of all moments you could choose, isn’t this the worst time to instigate yet another rapid and far-ranging reform package?
2 – If I go to my GP with a serious illness that might need expensive treatment, I want to feel s/he is 100% on my side in terms of advocating for my treatment. I don’t want him/her to be mentally doing a cost-benefit analysis to decide whether it’s worth giving me the best treatment or not. Obviously, someone has to do that analysis, but the whole point of giving that responsibility to NICE is that removing it from the arena of GP-patient relations makes it a) more objective and b) more efficient. According to many news reports, the reforms propose to remove that decision-making power from NICE and give it instead to GPs. Are you confident GPs will have the time to keep abreast of all the latest research in order to make well-informed decisions on the cost-effectiveness of different treatments? And aren’t you concerned about the effect of this on your patients’ trust in you?
3 – There is a concern that private firms may initially offer very attractive prices which GP consortia will find it hard to refuse, then having squeezed out competition will put up prices later once public facilities have closed down, ultimately leaving taxpayers out of pocket and patients with lower-quality service and treatment. Are you satisfied there will be sufficient protection against this outcome? Are you confident taxpayers can trust GPs to have enough business-savvy to get value for money? I don’t want to insult GPs – I’m sure they’re mostly highly competent, committed and decent people – but their expertise is in medicine not markets.
4 – With so many new responsibilities, are you confident you will still be providing your patients with the sane quality of medical care? Will you have time to keep up with the latest medical developments, as well as becoming well-versed in drugs trial research, financial administration, and techniques for extracting the best deal from hard-nosed salespeople? I’m sure you’re very multi-talented, but there are only 24 hours in the day.
‘same’ not ‘sane’ – bloody iPhone!
“We will never ask people to pay for their healthcare.”
“The NHS will always be free at the point of use and fair to all who need it.”
Are you absolutely mad Paul, or just a desperate fraud? What about the tens of thousands of sick and chronically or terminally ill elderly who are ALREADY being forced to pay for their healthcare in its entirety?
Can you explain, please, what you plan to do to provide free healthcare for all those currently – and illegally – being denied full NHS funding?
Don’t bother, I think I know – under new legislation they’ll simply be removed from the equation altogether, with their illness and suffering finally rebranded forever in law as a mere social concern.
You have made some disgraceful statements here, Paul, and I hope you are thoroughly ashamed.
Depressed Ex Lib Dem asks, “Can you tell me precisely how GPs will be “more locally accountable” than the elected health boards advocated by the party at the election would be?”
Hope you can be less “depressed” and less “ex” by working with your local councillors and GPs to ensure that things work well locally.
I am not saying this is “more locally accountable” than the elected health boards, but it is definitely more locally accountable than the current system, which is under central control, with unelected PCT boards implementing central directives. We will have health and well being boards with elected councillors on them. The scrutiny is enhanced by councillors. I agree that GPs are not stricly elected, but in cities they are chosen by their patients, and certainly in Bristol, the GPs directly involved in commissioning are elected to those roles by GPs.
David Clayton asks, “how much will your income increase under this scheme?” – I expect to be personally worse off under the scheme. I took a large pay cut to become a councillor, but money is not everything – I enjoy my work in the practice, in the council house and on the doorstep. Problem solving is great fun!
@jon rogers …….. so these proposals build on the policies of previous Conservative and Labour governments…… thanks for that… thank you for that view ….NOW I know why they stink as much as they do!
It’s like the NHS is treated as a set of LEGO….. build it up, knock it down and rebuiild it using the same bricks. At one point its centralised at the next it’s devolved. Each reorganisation fails to deliver in one or more areas. Here we are again – a reorganisaion to fill a vacuum of a thought through cohesive policy. These proposals have nothing to do with individual party manifestos, Coalition agreements or Cabinet Government… it’s been cobbled together by Andrew Landsley during his years in opposition, suddenly and inexplicably put forward and then supported (unbelievably) by Paul Burstow without the benefits of party policy groups and road testing.
This way of building probably the most important bit of legislation of my lifetime is not why I have belonged to the Liberal Party ?Liberal Democrats for 30 years striving for a liberal and democratic inclusive society.
It is a guaranteed recipe for a guaranteed disaster; and one other quanranteed thing is that I am not going to remain a member of a party that turns it’s back on it’s principles and traditions (Beveridge WAS a LIberal, I know that Landsley isnt…. but I thought our MPs were)
I’ve held my nose since May, not any more
Catherine asks, “isn’t this the worst time to instigate yet another rapid and far-ranging reform package?”
Never an ideal time. My personal view is that this is neither rapid and nor far-ranging. We are asked to set up shadow GP commissioning organisations by 2012 and go live in 2013. In Bristol, we expect to start shadow form in 2011. GPs have already been running GP consortia and have been for well over a year as these organisations were already Labour Government policy.
In Bristol, the roles currently carried out by the PCT are being assessed to see where they might sit in future, (perhaps within GP consortium, accountable organisation, local authority, NHS commissioning board or partnership board) and my own expectation is that we will see retention of many of the current teams, albeit in different organisations.
Catherine asks, “someone has to do that [cost-benefit] analysis”
Indeed. NICE will still be doing the work it is currently doing, but it will be for local clinicians to decide if they accept those recommendations rather than having the decision centrally imposed. I see the decision on such treatments to be considered by the GP consortium in much the same way as they do know, working with other health care practitioners, patient groups, hospital clinicians etc to decide on appropriate care pathways that fit with the skills and service attributes available locally.
As for trust, GPs have always been involved in what we are calling in Bristol “micro-commissioning” – that is we decide on the various treatment options, and reach a decision, with the patient on the best option for them. Cost does come into it as a factor, but our medical ethics require us to act in the best interests of our patients.
Have a look at the GMC web site for further details, but for example, we must “provide effective treatments based on the best available evidence” and “make good use of the resources available to you“
Catherine asks, “private firms may initially offer very attractive prices”
GPs must also “recognise and work within the limits of your competence“! GPs will get help from trusted managers – in Bristol I would not be surprised to see some of the same people who hold knowledge, skills and experience taking posts in the new arrangements.
I see little enthusiasm locally to use private firms although it is not ruled out. Under the Labour Government the PCT was told that they couldn’t spend all the money locally, as requested by Bristol GPs, but had to purchase a percentage of private services, top slicing money from local NHS. In Bristol these services are under-used as our patients prefer the local NHS trusts. That said, GPs will want to have the option of looking elsewhere for particular services if local trusts are failing to deliver at quality, quantity, speed or cost. In 1990 I was not a fundholder, but we commissioned orthopaedic services for 11 local practices that reduced waiting times from over a year to 6 weeks. These commissioning processes are well established.
The new scrutiny arrangements will I understand allow elected councillors to scrutinise all services provided under the NHS, including private services.
Q. What do people who have not got a clue how to improve the NHS?
A. Re-organise. The buzz of the dynamics of the revolutionary change is magnificently-distracting from the reality of the service.
Seriously, 95 per cent of GPs neither want to perform, have the skills to perform or the time to perform the procurement task. They vastly prefer to take their over-inflated (thank you Labour) salaries and enjoy a quiet life which no longer includes out of hours duties. You can have a really comfortable life as a 25 hour per week part time GP.. If this responsibility is passed to GPs they will end up hiring the same managers who presently run the PCTs to do the job (also grossly overpaid).
If we do re-organise, the Northern Ireland model is far more sensible. Bringing in some form of ‘Healthwatch’ also makes sense.
Catherine asks, if GPs will “still be providing your patients with the same quality of medical care?”
Yes. I hope better. I expect to see a return to closer and more cooperative working between GPs and consultants, improved scrutiny of GPs decisions on referral and prescribing as care pathways are introduced and refined.
The work of “macro-commissioning” will take a few GPs away from their practices for a few days a week. This is already happening as GPs tend to lead “portfolio careers”, with special interests, etc. Fewer GPs are now working solely as GPs 5 days a week. Some take on clinical assistant jobs, special interest jobs, perhaps NHS management jobs, commissioning roles, perhaps child care activities or even branch out into politics as I have done! GPs still need to complete appraisals, continuing postgraduate education and training.
@Matthew Huntbach
Anyone who reads my posts in the thread mentioned and reads your posts will wonder what world you actually exist in as it seems to be a parallel universe where everyone is out of step except you.
Carry on with your laughable diatribe as your preferred view of life seems to be that everyone should be united in equal misery.
Not my socialism mate – I want ordinary people to do be able to do better,
“I am not saying this is “more locally accountable” than the elected health boards …”
Good.
But are you saying it’s more locally accountable than the policy in the coalition agreement, which involved introducing elected representatives on to the PCTs?
If so, please explain exactly how it is. And please let’s have any waffle about GPs being “not stricly elected.” GPs aren’t elected. Full stop. They are just about as publicly accountable as the executives of railway companies or utility companies, in that the public may in theory be able to take their custom elsewhere, but in practice they are running what are effectively monopolies.
Ian is concerned that he NHS is like LEGO blocks being switched around “At one point its centralised at the next it’s devolved”
It has never been devolved. It has always been the subject of top down command and control. One size fits all.
The main changes between now and what has gone before are (1) properly recognising the link between health and social care, (2) removing centrally driven targets and bureaucracies and (3) encouraging and supporting local leadership, partnership and engagement. Other aspects have mostly been there before in similar or even identical forms.
“We will have health and well being boards with elected councillors on them”
Was curious about this, therefore looked it up. Apparently each board will have AT LEAST ONE COUNCILLOR on it. My God.
Depressed Ex Lib Dem asks if “elected representatives on to the PCT” as per original coalition agreement would be better than what is proposed?
Probably not a lot of difference, but PCTs in a few areas were pretty much laws unto themselves, failing in some areas to work effectively with GPs or with local authorities (or even I hear sometimes with both!). This change places the responsibility for developing strong, local organisations that work well with GPs, Public Health and Local Authorities firmly on the GPs, and require the PCTs to assist in that process, prior to winding up in 2013. Just putting an elected rep or two onto the existing PCTs would not, in my view, necessarily allow the shift of power to local communities that this reform promises.
“each [H&WB] board will have AT LEAST ONE COUNCILLOR on it.”
We had quite a lively discussion on this in Bristol this afternoon at our scoping meeting. This local flexibility allows each H&WB board to be set up to reflect local circumstances. We talked about the role of the H&WB board and the membership. Opinions were voiced on various options, including having Leader of Council, Exec Members for Social Care and Children and Young People, etc. . Form should follow function.
Jon Rogers,
If it’s all as marvellous as you claim, why did it have to be introduced by stealth? Why didn’t Cameron and Clegg tell the voters last May how marvellous it would be?
@jon rogers “Ian is concerned that he NHS is like LEGO blocks being switched around “At one point its centralised at the next it’s devolved” ”
No Jon you either misunderstand or simplify my concerns by pulling out one sentence – I am concerned that this ill thought through Conservative Policy that has not been through a manifesto scrutiny, the coalition agreement scrutiny, or a party policy scrutiny will be just like all ill thought through Conservative Policies…. more to do with the ego of the tory who ill thought it up.
But this time it will be made much much worse because the very people the public are relying on to restrain the excesses of the Conservatives in this Coalition (ie us Liberals) are going along with it rather than demanding a brake at worst, and a stop at best.
Not one of your apologist postings have persuaded me that this policy is sustainable or deliverable or will provide a tiny proportion of the benefits you repeat.
I’ll make you a wager of the party subs from the next five years that I will be saving now I have resigned over this debacle.
I bet you at the time of the planned election after 5 years of the Coalition (if it makes it that far!) that the NHS policy will have been a total disaster and an electoral noose around the coalitions parties necks through public unpopularity.
So are you willing to put your money where your mouthpiece is?
David Allen asks, “Why didn’t Cameron and Clegg tell the voters last May ”
I guess because these NHS reforms are a product of listening, analysing and thinking that has gone on since the coalition. The desire for localism, the desire to bring health, social care and public health together, the desire to remove top down bureaucracy, the desire to get elected member input, to get increased involvement by patients and voluntary and community sector.
I would strongly encourage readers to find out what is happening in their area. Talk to the GP leaders. Talk to the relevant Exec Members, the officers at Local Authority or in the NHS and talk to public health. Discussions will be going on everywhere about how best to use this opportunity and improve patient care.
The NHS remains free at the point of use.
The “NHS free at point of use” comment was to lead into AC comment about “the tens of thousands of sick and chronically or terminally ill elderly who are ALREADY being forced to pay for their healthcare in its entirety
I am not aware that anyone in England is forced to pay for their health care under the existing (Labour) system, or the proposed (Coalition) system.
Are you referring to the costs of personal care, which has always been means tested in England? Economist Andrew Dilnot chairs a Commission set up by Government as an independent body to make recommendations on how we can achieve an affordable and sustainable funding system for care and support, for all adults in England, both in the home and other settings.
Thousands voice concern over Government’s NHS reform bill
The pressure group NHS Support Federation said 10,000 members of the public have backed an online statement to voice concerns about the Government’s health reforms.
The statement says: “At the heart of the NHS should be patients, but business motives are cutting deeply into the fairness, quality and value that we have come to expect.
“The NHS has public trust because it puts the public first.”
“Its commitment to giving all of us access to safe and effective services, to treating us fairly and providing good value are some of the reasons why the NHS is the country’s most popular asset.”
Earlier the health service chief said that Coalition reforms to make the NHS more productive will mean “significant” reductions in the number of hospital beds
David Nicholson told MPs that making better use of the NHS budget will mean reducing the number of patients who stay overnight in hospital.
More patients will be treated and sent home on the same day, he said. Fewer people with chronic conditions like diabetes and asthma should be taken into hospital for emergency care.
Ian, I am not a betting man!
I am also not the only enthusiastic person – this from a GP in Bury today, ““I think I can speak on behalf of all the local GPs appointed to these important roles. The opportunity for GPs to be so closely involved in shaping services for local patients is an exciting one. We will be seeking patients views and working closely with clinicians and professionals to ensure that the developing GP Commissioning Consortia, that will replace the existing Primary Care Trust, has the local knowledge and expertise required to enable us to achieve the best possible health gains for Bury people.”
What part of the country are you from? How are GP consortia progressing in your area? I think GP consortia are running in all areas now.
I think the GPs have a vested financial interest in this change and their already overly large salaries are about to receive a hefty boost. Also what about the relationship between the Conservative and private “health care” companies does it not make you feel at the very least a little uncomfortable?
@jon rogers
I note your lack of belief in these proposals to the point of taking a risk with your own money rather than the county’s health service!
All I will say about ayour GPs comments – in all my years of management I have met many people at the ‘front end’ of service delivery who believe they could run the business better than the managers because their perspective is limited to their limited knowledge of all that is required.
I wonder if this GP will see the benefit when his practice is surrounded by protesting patients that feel denied a drug on cost grounds by the consortia and are blaming him. HIs shiney new BMW in th ecar park a reminder of the apparent disparity to his protesting patients…?
Or how he will feel once the (privately owned and distand) management from th econsortia make a decision that he personally disagrees with… he used to be able to blame NICE or the PCT (as they often did) now he will have to accept corporate responsibility for a decision he has either had nothig to do with or has been overuled by other practices.
Or how about a patient who is unhappy that his GP (because of a consortia decision) does not offer a service or treatment that they require / desire. The pateint has been told there is choice… but where do they go? they live in a rural community and all local and regional GPs belong to the same consortia.
Three tiny micro examples and there are dozens of them……. and although they are practical examples … my opposition is fundamental and philosophical – these proposals are wrong.
Ian, I have no “lack of belief in these proposals” I just don’t bet. I am investing my time, my energy, and even my money in seeking improvements to Bristol. That does not involve me “running the business” which will continue to need excellent managers. I seek clarity, fair priorities, local involvement, local flexibility and a move from central micro-management of the NHS to devolved decision making.
Yes, that will raise issues, but all you describe is that it is better to be able to blame someone else, rather than being tasked, openly and transparently to explain the situation. Most GPs don’t drive BMWs, (Many of us now ride bicycles!) most are motivated not by greed but a genuine desire to improve the lives of the people in their area.
Oh Jon – you have my sympathy if you truly believe that those benefits will result. Fund holding was meant to do all those things, but soon dealt up another set of problems that needed to be addressed …. and what happenend? fundholding was ‘reorganised’ out of existance
I’m guessing you are a young person who didnt live through the last few reorganisations? I’m also guessing you haven’t looked in many Doctor’s Car Parking spaces!! and if they ride a cycle to work … the BMW is probably at home in the garage.
I don’t doubt your motivation I just disagree about these proposals having the ‘legs’ to deliver (m)any or the gains you hope to see.
I stand by my contention that for something as important and as big as this the policy should have gone through Party policy development, manifesto visibility for the electorate, coalition agreement process and then a full public consultation. It feels like a board meeting where some minor department head pulls out a folder to distribute to an unsuspecting board with proposals to completely reorganise the whole company, and rather than laugh and smile everyone goes ‘oh ok then’. Come on even Cameron had little idea of Landsley’s proposals. Once again rather than rattle the foundations of the Coalition everyone on the LibDem membership bites their tongue and searches for ways to argue for something that they have spent years fighting.
I’ve decided to leave the Party that I love and have represented because I can’t bite my tongue any more.
Ridiculous
These proposals were not in the Conservative manifesto, they were not in ours and they are not in the coalition agreement. The government has no mandate for them
It seems to me, therefore, that our MPs are under no obligation to support them, so I trust that they will not be whipped into doing so.
Jon Rogers.
I am baffled by you.
You have already published a piece on LDV fully defending and admiring the Coalition proposals. You can see on this thread + in national press coverage that many, many people – of a Liberal, Conservative + Labour hue are hugely concerned about these proposals.
Rather than listing again and again and again why in your local area of Bristol they’re going to be so perfect – could you not start to listen, and answer – and understand that your Coalition-supporting propoganda is not convincing anyone? One line in a manifesto on health does not justify these changes! Cameron even said this week “they took him by surprise”. If they took him by surprise, why are you saying we planned this all along! The Lib Dems are quickly descending into the role of Tory cheerleaders faster than anyone dared think.
You’re a GP – my wife is a GP. You ‘re part of a commissioning discussion – she is. You don’t like PCTs – she had a fully supportive PCT. You 100% support these proposals – she is 95% against them. You’re a Lib Dem councillor – she isn’t affiliated to any political party.
Spot the difference?
You could start by being more transparent about the issues this re-organisation will undoubtedly cause, as well as the huge trust issues it will lead to as soon as a patient + GP disagree about a course of treatment – instead of religiously sticking to the Coalition script. “No decision about me, without me”? Great soundbite – but it means nothing.
Be honest – this will undoubtedly change forever the role of the GP as trusted partner to the patient. You will from now be seen as a budgetary gatekeeper. To be honest, that’s already happened. You may not have been asked to stop referring operations to surgeons in your area on budgetary grounds, but it is well documented that this has already happened since May.
Jon
After all that, I still don’t understand why you think putting GPs in charge of the NHS – rather than PCTs with elected representatives – will increase “local accountability.”
Can you tell me what precisely the mechanism for that accountability is? If local people are unhappy with the way things are being run, what will they be able to do about it? Under the coalition agreement they could vote off the elected members of the PCT. What can they do under the new system? Phone up to complain, and be put through to a call centre in India?
It is obvious that there is absolutely no public mandate for the NHS proposals which is a disgrace for Democracy.
Obviously there have been secret talks and policies being built for years involving private sector medical providers and leading Tory politicians and perhaps medical personnel ‘key’ to their objectives.
That’s not a conspiracy theory – that’s just what Tories get up to – anything to earn a quick buck for their shareholders. I thought, once-upon-a-time, that the LibDems weren’t from the same mould. It really is time that you forced your MPs to stand up and be counted on this one.
If they don’t they wouldn’t be betraying just students but every man, woman and child in England who can’t afford private medical care. If you don’t a legacy of shame will haunt you and your party.
Dear all,
Thank you for patience.
Here are some answers to some of the questions you raised.
POLITICAL ACCOUNTABILITY: The Secretary of State and the Department of Health will continue to retain overall accountability for the NHS; the Secretary of State will set a ‘mandate’ for the NHS Commissioning Board which sets out key priorities and outcomes for the NHS, this will be produced annually and will be subject to consultation and reporting to Parliament; our aim is to make political accountability more transparent ensuring that Ministers will no longer be able to micromanage the system in the way the last Government did.
NICE: As I posted earlier, NICE will be put on a statutory footing to secure its independence. NICE is currently a creation of the Secretary of State which could be abolished at the stroke of a pen. The Coalition is placing NICE on a statutory footing to ensure its independence. NICE has never had any powers to “ban” the use of drugs in the NHS, so suggestions that this is a role that will be removed from it are based on a misunderstanding of the position. NICE will continue with what matters most – advising clinicians on clinical and cost effectiveness of treatments and quality standards – rather than making decisions on whether patients should access drugs that their doctors want to prescribe. In addition NICE’s remit will be extended to cover social care as part of the Government’s commitment to promoting greater integration.
MANDATE FOR THE REFORMS: Nearly all of the proposals were in the Lid Dem and the Conservative manifestos. Those that weren’t, eg abolition of PCTs, giving local government responsibility for public health and the establishment of Council led health and wellbeing boards, are a logical consequence of putting together proposals from the two manifestos. For example: Abolishing SHAs, increased competition, stronger local democratic input in the NHS and greater integration between health and social care are Liberal Democrat policies. GP commissioning, creating NHS Commissioning Board, changing the role of Monitor are Conservative policies. Overall they are a blend of Liberal Democrat and Conservative plans.
US HEALTHCARE PROVIDERS: The ‘Any Willing Provider’ (AWP) model does not mean competitive tendering (compulsory or otherwise) – it is quite the opposite. Competitive tendering means identifying a single provider, or limited number of providers, to provide a service exclusively. AWP means setting out the service the commissioner wants and allowing patients to choose from any provider that meets the required quality standards and price. What we are doing is rejecting the approach the last Government took in setting up Independent Sector Treatment Centres. We are not setting an arbitrary percentage of services run by the private sector, with guaranteed volume levels. Instead, any willing provider means that patients will be able to choose on the basis of quality, but without guarantees for providers. Private providers will not be able to “cherry pick” services, as suggested. The less complex the procedure, the less someone-including in the private sector-will be paid. Unlike Labour, we will not rig the market in favour of the private sector.
POSTCODE LOTTERY: On the contrary, the reforms introduce a stronger national framework for driving quality improvement than ever before. That’s one of the key objectives of the NHS Commissioning Board. And it will be reflected in the commissioning outcomes framework, in national tariffs and best practice tariffs, in model contracts, and in commissioning guidance.
While there should not be a postcode lottery services should fit the needs of the people living in the postcode they are being delivered to. At the moment there is no requirement on PCTs to take account of identified population need in their commissioning, in future GP consortia will have to take identified population need into account. The Council led Health and Wellbeing Boards will also agree a strategy for commissioning health, social care and public health services that GP consortia will have to use in their commissioning activity.
I hope this answers are useful. Please keep the questions coming.
Paul
Paul
I can only repeat the same question I’ve already asked.
The LIb Dem manifesto contained a pledge to put the running of the NHS into the hands of elected authorities:
“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.”
The Coalition Agreement watered that down, but an element of democratic representation was retained:
“We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). The remainder of the PCT’s board will be appointed …” And of course there was a promise that there would be no more “top-down reorganisations.”
What I simply cannot understand is why the Lib Dems afterwards voluntarily agreed to scrap those parts of the coalition agreement, and to embark on another wholesale reorganisation of the NHS, abandoning the democratic element altogether and putting GPs in charge instead. No one forced them to do that. They had secured partial Tory agreement to a Lib Dem policy, and they simply threw that away. Why?
Hi paul. Thanks for the replies. You have managed however to not answer a single question I’ve raised I’m afraid. This follow on from a similar set of questions I raised with Jon Rogers on LDV who similarly failed to answer a single question. While this strategy may allow you to present these reforms in the best possible light in the short-term – it only diminishes them in the medium term when people begin to see the damage you are wilfully causing.
ACCOUNTABILITY. Not good enough. You know and I know that these reforms will allow Ministers to say over and over again “That is a local issue”.
What about Consortia accountability? How will they be dealt with? You claim choice is good but if I live in an area with a poor consortium providing poor service – I will be powerless. Especially once you factor in my relative wealth.
Your system is forcing PCTs to merge (Ealing…Hounslow etc) across larger geographical areas. How does this aid localism or accountability?
BUDGETS Why are you spending £1.4bn on re-organisation in a fiscal year when your in-cash-terms NHS budget protection amounts to a real-terms budget cut – and without a real-terms 3% increase year-on-year this problem will only compound?
Where in the proposals does it state that Local GP commissions will be barred from charging for services previously delivered under NHS services? Can you guarantee that such services will not invoice patients, allowing them to circumvent the “free at point of use” maxim?
GPs are private businesses. What legislation will there be to avoid practices profiteering – and how transparent will their incomes be?
On a National level, how will you monitor the role of huge companies like Atos, Capita and United Healthcare in their express desire to favour other private providers?
COMPETITION. Again, not good enough. You didn’t answer my questions. You also mis-represent competition law and how you have allowed this to run freely through your proposals. How will you prevent private providers selling services under cost to enable them to win long-term contracts at the expense of NHS providers who will then go under – leaving the private sector free of competition?
If your aim is to avoid privatisation, can you detail how you will avoid EU competition law (which the NHS is now for the first time ever subject to) from allowing it to happen?
Are you comfortable with telling us how many hospitals you are forecasting will go bust under this scheme? Will you share government projections of which local hospitals will go bust?
How are you dealing with the current PCT debts to avoid them rolling into the new consortia?
MANDATE You claim “nearly all of the proposals were in our manifesto’s”. Nonsense. You then go on to list the ones that weren’t and denigrate their importance. These are the ones that people are up in arms about!
Recent polls of the profession point to only 25% of GPs being supportive of the changes, yet to plough on regardless. Why? What is the logic in denying professionals a voice?
OUTCOMES Can you guarantee that waiting lists will not rise? Your leader expressly failed to answer this in PMQs this week.
The Labour government inherited a “post-code lottery” NHS system. How, specifically, do these proposals avoid this certainty from arising again?
Jon Rogers
“David Allen asks, “Why didn’t Cameron and Clegg tell the voters last May ”
I guess because these NHS reforms are a product of listening, analysing and thinking that has gone on since the coalition.”
So, for four years while Cameron and Lansley were in impotent opposition they didn’t bother to listen, analyse and think out a major new policy, but in one hectic month after writing the coalition agreement, they did it all? Don’t make me laugh.
All organisational “reforms” create winners and losers in terms of power and influence. As a GP, you are obviously excited about gaining power and influence, and I don’t doubt that you genuinely believe in your own ability to be a force for good. If that sounds like an unalloyed compliment, perhaps you might reflect that Tony Blair had a similar belief in his own abilities and rectitude in the matter of Iraq.
OK, a sincere belief in the rightness of your cause looks like a better motivation than the greed of some of your future private business partners. It’s also more dangerous. Witness Blair. Crooks often make quite good politicians because they know what they are about, they don’t blind themselves to facts which might scupper them, so they tend to get pragmatic decisions right. Zealots generally make lousy politicians, because they always know that what they are doing is “the right thing to do”, they don’t self-criticise, and their attitude to bad news is to double their bets. Which is what you’re doing with the NHS.
What really bothers me is, there are already some treatments, that should be totally free to the patient, but these treatments are already being contracted out to private companies, which offer limited sessions, then expect to charge the patient after this.
One such area where this happens, is in mental health.
There is a massive demand on Mental Health services, But a serious lack of resources within the NHS.
Some People can be waiting Months, even up to 12 months, to be able to get into therapy, And even then, some people are only offered 10-12 sessions, due to the high demand in the service, These patients are then signed off, even though there has probably been no significant improvement in their mental health, They are then abandoned to the GP’s who just carry on prescribing their medications, without the patients ever really being given proper access to care and trying to treat the cause, and not just the symptoms.
Some G.P’s are now Bypassing NHS Councillors and Therapists altogether, and instead use companies like Mind, Who will offer 6 sessions for free, then if the patients wishes to continue, they are expected to pay £25 a Hour.
This to me is disgraceful, If a GP thinks a patients medical condition is severe enough to be prescribed antidepressants or other antipsychotics, then surly that patient also warrants free therapy as well.
I fear that these reforms to the NHS could see many more treatments and therapies, that should be free for the patients, being contracted out to private companies, who will then charge after been giving a number of free sessions.
Ian speculates, “I’m guessing you are a young person who didnt live through the last few reorganisations? I’m also guessing you haven’t looked in many Doctor’s Car Parking spaces!! and if they ride a cycle to work … the BMW is probably at home in the garage.”
Er no on all counts! I am a GP aged 56, and was secretary of Avon Local Medical Committee (Local GP committee) in 1990, I was a GP and involved in developing NHS IT systems in 1996-2002 – so closely involved in 1990 Fundholding (fighting against), 1990 Locality Commissioning (helping create effective 11 practices sharing information and working together to get best for our patients) 1996 various TPS Total Purchasing Schemes and the Practice Based Commissioning, etc, etc. None of the cycling GPs have a BMW in our garages…. I don’t even have a garage!
Sorry you are leaving the party. I don’t agree with everything, but I do appreciate that the Liberal Democrats are by far the closest to my political outlook. That is true now and goes back over many years, particularly on fairness and civil liberties. The coalition has some unfortunate compromises, but these NHS changes will really make a positive difference here in Bristol, and I hope everywhere else.
cuse points out “You’re a GP – my wife is a GP. You ‘re part of a commissioning discussion – she is. ”
Agreed
“You don’t like PCTs – she had a fully supportive PCT.”
No. I not only had, but still have a fully supportive PCT. GPs, public health and local authority officers and members are working constructively with the PCT to ensure we build on the best of the PCT, but also recognise the strength of strong GP commissioning.
The local GP Consortia are aiming to set up shadow running, probably from April 2011, working closely with the PCT and I expect sharing staff, planning what functions are transferred to which organisation and how best that can be done. I expect a significant number of the staff to be retained through the changes, as they have been in all the previous reorganisations.
Its difficult to go into Burstow’s elaborate self-justification (oh, all we need to do is EXPLAIN and everyone will go, ‘oh, right, now I see!’), as it fails on so many counts and levels.
There seems little point in arguing with the Whig-Liberals who have taken over the party. I will only say this – the NHS exists to take care of the health and wellbeing of the nation – it does not exist to provide profits and revenue streams for the private sector.
If the progresives ever take power in the country again, I promise you that the reset button will be pushed and the bloodsucking corporations will be shown the door.
Depressed Ex Lib Dem: The plans establish Health and Wellbeing Boards in local government. These Boards will be led by councillors and will set the strategy for health, social care and public health for their area setting the context in which GP consortia commission. This brings the NHS and local government closer together introducing local democractic accountability. On top of this the legislation will give local government responsibility for public health and joining up the way health and social care are designed and delivered.
Mike Cobley points out that the “NHS exists to take care of the health and wellbeing of the nation – it does not exist to provide profits and revenue streams for the private sector”
Absolutely. Under the last Labour Government we had an outrageous, centrally enforced, top-slicing of NHS money specifically to pay for private services that local patients and local GPS did not want. As Paul Burstow said, “What we are doing is rejecting the approach the last Government took in setting up Independent Sector Treatment Centres“. Patients and GPs wanted more services from our local NHS hospitals, not expensive and poorly utilised private companies that were guaranteed money whether they were used or not.
Here in Bristol the PCT has said we can offer patients free taxi journeys to encourage them to use the private facilities that the PCT was forced to purchase by the “command and control” Labour Government.
I am passionate about the NHS, free at the point of use. I want that NHS to be responsive, meeting the needs of my patients, not dancing to the tune of Whitehall bureaucrats.
There are many challenges, and I really don’t dismiss the concerns raised here and elsewhere, but these changes, with elected councillors working with patients, with GPs working with residents, with encouragement to commission coordinated services across health and social care, with closer working between NHS, Public Health and Local Authorities can realise the NHS we have been trying to deliver for over 20 years.
@Jon Rogers
I wondered if you could tell us, whether your practice, or you are aware of other practices who also uses private clinics, to treat mental health patients, instead of sending them to NHS mental health clinics. like the one I posted at 21st January 2011 at 6:41 pm?
Matt asks if I know of “practices who also uses private clinics, to treat mental health patients, instead of sending them to NHS mental health clinics.“.
I think so. Not sure if it qualifies for your definition of “private”, but in Bristol we have commissioned a service called “Rightsteps” which can be used before or instead of an NHS Mental Health referral. You can see more details here:
http://www.bristolpct.nhs.uk/patients/all_services/mentalhealth/rightsteps/service.asp
The service is run by a company called Turning Point http://www.turning-point.co.uk which describes the organisation… “Turning Point is a social enterprise reinvesting its surplus to provide the best services in the right locations for those that need them most across mental health, learning disability, substances misuse and employment.”
It is fairly new, but initial patient feedback seems good. The service is locally based and they claim to respond to patients within 2 working days.
@Jon Rogers
“I think so. Not sure if it qualifies for your definition of “private”, but in Bristol we have commissioned a service called “Rightsteps” which can be used before or instead of an NHS Mental Health referral. You can see more details here”
But my point was, do they charge the patient, after offering a few free sessions?
In My home town, G.Ps are referring patients to Mind
http://www.norwichmind.org.uk/index.php?page=36
Who give patients 6 free sessions, Then expect them to pay £25 for any sessions after that.
That surly can not be right, If a Patient is prescribed medication to treat a mental illness, then surly they should also be entitled to free access to therapy as well?
I
Paul Burstow + Jon Rogers.
I and others will take your point-blank refusals to mine + others specific questions as evidence that the answers are unpalatable. You can’t keep hiding behind this Tory-hugging self-justification, hoping that the electorate will move on. We’re not that stupid.
However, unfortunately, you’re not alone. When my wife has raised them locally – she has not been answered. When Andrew Lansley has been asked – he has refused to answer.
After tuition fees and EMA – this Lib-Dem supported privatisation of the NHS will be the final nail in the last shreds of credibility the party has left with the majority of the population. That your answer to this is line after line of Tory-pandering propaganda is truly shameful.
I don’t know the service in Norwich, and suggest if there are concerns then contact the local practice or the local NHS.
We do have something similar in Bristol with help for people with a weight problem. I can “prescribe” a maximum of 12 sessions with Slimmers World. We decided to commission the course of treatment as it had been shown to be more cost-effective, with better long term outcomes, than prescribing anti-obesity drugs. I am not sure that evidence for NHS paying for long term attendance is better than the short course, but the money is only there for the 12 week maximum. If people want to attend for more than 12 weeks they have to pay themselves.
In Bristol, if someone needs longer term mental health follow up and counselling then that can be provided by standard NHS facilities including the GP practice (or perhaps a further “longer term” contract commissioned with “Rightsteps”?). These challenges have been part of the NHS for 20+ years. They are becoming more explicit and open.
Don’t forget, what you are describing is the current NHS, developed most recently under Labour.
Cuse, I have tried to answer your questions. I have also stated, “There are many challenges, and I really don’t dismiss the concerns raised here and elsewhere”
You ask good challenging questions. I am not dismissing them. I am trying to point out amongst a sea of negativity that there are good Liberal Democrat benefits in these NHS changes.
Let me try and tackle the first of your concerns…
ACCOUNTABILITY. Not good enough. You know and I know that these reforms will allow Ministers to say over and over again “That is a local issue”.
Paul Burstow, the Liberal Democrat Minister of State for Care Services has said in a comment above, “The Secretary of State and the Department of Health will continue to retain overall accountability for the NHS; the Secretary of State will set a ‘mandate’ for the NHS Commissioning Board which sets out key priorities and outcomes for the NHS, this will be produced annually and will be subject to consultation and reporting to Parliament; our aim is to make political accountability more transparent ensuring that Ministers will no longer be able to micromanage the system in the way the last Government did.”
Currently the PCT is unelected and has limited scrutiny from the Local Authority, variable relationships with LAs and with GP practices and the first elected person with any NHS responsibility is the Secretary of State.
Under the new proposals, the Secretary of State is still ultimately responsible, but in addition, as our Minister says, “The plans establish Health and Wellbeing Boards in local government. These Boards will be led by councillors and will set the strategy for health, social care and public health for their area setting the context in which GP consortia commission. This brings the NHS and local government closer together introducing local democractic accountability. On top of this the legislation will give local government responsibility for public health and joining up the way health and social care are designed and delivered.”
This is a major strengthening of democratic accountability in my book, and makes explicit the relationships and the partnerships required.
@Jon Rogers
“These challenges have been part of the NHS for 20+ years. They are becoming more explicit and open.
Don’t forget, what you are describing is the current NHS, developed most recently under Labour”
I was not saying that the coalition was to blame for this. Indeed some of these problems existed under Labour.
What I was suggesting was, That the Coalitions proposals to reform the NHS, could see more GP’s using Private companies, that offer a limited number of Free therapy sessions, then expect patients to pay privately after that.
I understand that your particular surgery has a contract with Rightsteps, but you still have not mentioned whether the patient is given a limited number of sessions, then is expected to pay privately with them, or whether it is supplied free of charge, for as long as the patient needs it.
I understand, that practices vary all over the country. However you appeared to be well informed and supportive on these reforms in the NHS, And how they would effect services, all over the UK.
That’s why I assumed you would know, If other GP’s refer patients to organisations like Mind, That only offer limited therapy, before charging the patient.
My fear is, this practice already exists, due to the complete lack of resources within the NHS, and will only worsen under reforms.
“Under the new proposals, the Secretary of State is still ultimately responsible, but in addition, as our Minister says, “The plans establish Health and Wellbeing Boards in local government”
Just Curious, is the Wellbeing Board, going to be the ones, who carry out Cameron’s happiness Surveys?
Matt worries that, “My fear is, this practice already exists, due to the complete lack of resources within the NHS, and will only worsen under reforms.”
There really is no “complete lack of resources within the NHS” – to Labour’s credit they have funded (with money they didn’t have!) the NHS to a level commensurate with European levels. There is no major shortage of money in the NHS (though I accept there are pressures with a wonderfully ageing population, and with impressive technical advances and money not spent wisely in the past).
The Tories (unlike the Lib Dems!) promised in their manifesto to maintain NHS funding in real terms over the length of this parliament (I know that NHS inflation is greater than RPI inflation, but still the NHS is not facing the cuts that other sectors are facing).
The challenge is to best meet the needs of NHS patients. That challenge will fall on GP consortia. It is a challenge that they have been helping PCTs to deliver for 20_ years. This is not a new challenge, but now it is scrutinised by elected members and the overall, integrated strategic direction is set by elected members.
Jon Rogers.
I’m really not trying to get into a slanging match – despite my dogged attempts to get answers. I’m normally such a calm, mellow man…
I raised 15 questions. You have pointed to councillors as being an answer to one of them. It is unfortunate that this is a tactic adopted by all who support the Coalition in their answers to justified questions about this unnecessary re-organisation.
It looks, feels and appears to be the case that you don’t want to answer them. I and people like me aren’t against change in the NHS. We’re fearful and rightly suspicious. We pay for this service and are having our concerns ignored in the obfuscation of Paul Rogers, Andrew Lansley and David Cameron. This Coalition prefers not to answer concerns – it prefers to hide behind outrageous hyperbole and political grandstanding – all tactics employed by New Labour that we hoped were long dead.
@Jon Rogers
“There really is no “complete lack of resources within the NHS””
I have been talking about mental health care. Are you really going to tell me that there are not a lack of resources within the NHS for mental health care, Counselling, CBT Therapy e.t.c.?
There is a huge demand for this service and severe lack of resources, Patients are waiting Months to be seen, and only then being given limited amount of sessions, due to the high demand.
That is why GPs are using other companies, like Mind, as I said previously.
Also
“There is no major shortage of money in the NHS”
That does actually quite annoy me, As I was talking about a Lack of Resources, Not a Lack of money
There is a huge Difference.
Lack Of resources can mean, Not enough staff in the field working for the NHS,
Not enough medical centres offering the Clinics and therapies.
It’s not all about Money.
Cuse, no slanging match here! Most of the questions you raise are common to all systems of NHS Governance, including PCTs. Your local PCT may chose to merge with another. locally a number have already done so. GP practices themselves make the majority of “micro-commissioning” decisions for individual patients – that is as local as you can get and doesn’t change from Labour Government policy.
“macro-commissioning” of services remains with large local organisations, not PCTs but shadowing PCTs. Both old and new arrangements need public health support, commissioning and procurement skills, information skills, performance management, accounting, reporting, communication etc.. This is not major change. Your questions and concerns apply to old and proposed structures. Some are knotty problems. They are old problems. In my view, but I accept not yours, these new arrangements offer a way of addressing these issues better.
Perhaps I can turn the questions around and asked you how the current system addresses them?
Paul Burstow
“The plans establish Health and Wellbeing Boards in local government. These Boards will be led by councillors and will set the strategy for health, social care and public health for their area setting the context in which GP consortia commission.”
I’m sorry, but from what I have read this is completely misleading. As discussed above, so far from these boards being “led by councillors,” the only requirement in the proposals is that each one will include at least ONE councillor (who will be nominated, of course, not elected).
And even then the role of the boards is only to give advice and encouragement. The power will lie in the hands of GPs, who are unelected and unaccountable.
This is in flat contradiction to the policy you were elected on last year. I’ve asked you twice why you voluntarily scrapped the provision in the coalition agreement to introduce elected representatives on to PCTs. Obviously I’m not going to get an answer to that question.
All I can say is thank goodness we still have the power to vote out MPs!
Interesting debate on twitter this morning on “scrapping PCTs” with Evan Davis from Radio 4 following Nick Clegg’s strong showing on Andrew Marr BBC1.
http://twitter.com/#!/search/evanhd
I wouldn’t say it was a strong showing for Nick Clegg.
It was more, another very weak piece of journalism by Andrew Marr.
I have no idea why Andrew has been so weak of late, He used to be really good at grilling politicians in interviews
Depressed Ex Lib Dem asks, “I’ve asked you twice why you voluntarily scrapped the provision in the coalition agreement to introduce elected representatives on to PCTs. Obviously I’m not going to get an answer to that question.”
The debate on Twitter with Evan Davis prompted me to look again at the Lib Dem Manifesto NHS commitments http://bit.ly/9jrVlG . So many of them are delivered in this White Paper. A quick skim through spotted…
Emphasis on prevention, cutting central bureaucracy, scrap SHAs, integrate health and social care (at last!), encourage independence and staying in own homes, develop proposals for long term care of elderly (Dilnot report due July), ban on low cost selling of alcohol (?coming), cancel third Heathrow runway, etc, etc – so may real achievements already!
The next section covers more control over the health care you need which perhaps starts to address Depressed Ex Lib Dem and other concerns. It states, “Liberal Democrats believe that one important way to improve the NHS is to make care fl exible, designed to suit what patients need, not what managers want. And we believe that care would improve if local people had more control over how their health services were run.” and goes on to describe how this change will be delivered…
… including “ 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.”
Now, the question which seems to divide us is whether the proposed “Health and Wellbeing Boards” are the same as “elected Local Health Boards”? I agree that the strict answer is “No”, but can we deliver the local accountability, involving elected councillors, ensuring that GP input is transparent and in their patients’ interest (as I believe it generally will be, at least in Bristol which I know very well)
also “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 field in any competitive tendering – ending any current bias in favour of private providers”
The bias currently in place to force PCTs to commission private services when local patients and GPs (and councillors?) don’t want them is perverse.
These changes are not without risk, but those risks can be mitigated by strong local involvement and understanding by councillors, patients, GPs, vol sector orgs, health service and local authority managers and public health teams.
People have talked about the NHS being privatised since 1990 and the flawed but innovative “Fundholding” scheme. It hasn’t happened because nobody wants it to happen.
“Now, the question which seems to divide us is whether the proposed “Health and Wellbeing Boards” are the same as “elected Local Health Boards”? I agree that the strict answer is “No”, …”
I’m sure a lot more than that divides us. But I had hoped the principle of having elected people running things would be sufficiently clear-cut that it would be possible to get some straight answers.
But I’m noticing a pattern in your comments. Earlier in the thread you admitted that “GPs are not _strictly_ elected” (!). Now you say that an appointed board with a purely advisory role, including at least one appointed councillor, isn’t _strictly_ the same as a fully elected body taking over the role of the PCTs.
Well, of course it isn’t strictly the same. It could scarcely be more different! I despair.
GPs are not elected, but they are the subject of local choice and local community scrutiny. People change GPs and GP practices and it is often described as people “voting with their feet”!
The Health and Well Being Board does not have a “purely advisory role” – my understanding is that it sets the strategic direction and priorities for the health and social care delivery in the area. The GP Consortia have a commissioning role, but the context within which they work is set by national outcomes and the local strategic partnership.
The use of the word “strictly” for me is where I believe that the intended consequence (more local accountability, improved joint working, better alignment to meet the JSNA, clearer lines of responsibility) can be delivered by what is being proposed, but we do need to push for it locally.
Many continue to prefer a centrally driven NHS and change is always difficult, but I genuinely believe that these changes can deliver a more locally responsive NHS. Proof of pudding of course.
@Jon Rogers
A Pharmacist, spends 5 years at University, Taking 4 lectures a day, 5 days a week
That’s 20 lectures a week. 20 Lectures * 40 week School year = 800 Lectures a year * 5 years = 4000 lectures.
4000 Lectures on medications, advances, Best forms of medications for treating which illnesses, Alternative medications for those who suffer from side effects of certain active ingredients, e.t.c. e.t.c.
Then of course a pharmacist job means he is kept constantly up to date with new medicines.
When you where at University, studying to become a G.P, Could you please tell us how many lectures a G.P has on Medications?
And why, when choosing medications, GP’s tend to refer to the book and dare I say “prices” on determining what to prescribe, and why they will usually go for the cheapest option.
Won’t putting budgets entirely under the control of GP’s, encourage them to go more for the cheapest option, rather than what maybe best?
GPs are skilled at assessing patients, differentiating problems and identifying management options, including prescribing. They are skilled at discussing those options with patients and families and at using information sources to inform best practice. We are required under our doctor ethics – see my comment above – search for “GMC”
The cheapest option is not necessarily the best option, so for example, the cheapest option in prescribing statins in heart disease is not to prescribe, but that will be much more costly in the long run as people experience more cardiac events, increased morbidity and mortality.
PS I am surprised that you think that a pharmacist has such a narrow education 🙂 In Bristol we shared much graduate and post graduate training and education with pharmacists.
@Jon Rogers
You never answered my question, how many lectures does A GP have on medication, during his university training?
“PS I am surprised that you think that a pharmacist has such a narrow education”
And I do not think that all, I pose the question to you, after having a conversation yesterday with my own pharmacist. 😉
“GPs are not elected, but they are the subject of local choice and local community scrutiny. People change GPs and GP practices and it is often described as people “voting with their feet”!”
This is exactly what I asked above – whether the GPs would be “accountable” in any way other than the same way supermarkets and utility companies are accountable. The answer is “no,” apparently. If people are unhappy with the way a local “consortium” is running things, they are supposed to take their custom elsewhere. It would be laughable if the subject wasn’t so serious.
“The Health and Well Being Board does not have a “purely advisory role” – my understanding is that it sets the strategic direction and priorities for the health and social care delivery in the area.”
Well, what I have read is that the role of the board is to provide “advice” and “encouragement”. If you’re claiming otherwise, please can you quote some kind of authoritative source, rather than referring vaguely to your “understanding”? If these boards are going to have any real powers, precisely what will those powers be? If the GPs don’t go along with their suggestions, will they have the power to compel them to do so?
matt repeats “You never answered my question, how many lectures does A GP have on medication“?
I don’t know. I studied pharmacology, cellular biology, biochemistry, physiology, epidemiology, etc, etc. All had elements on drug actions, examinations, vivas, practicals, etc, etc.
In addition I have spent 20-50 hours per week assessing indications for prescriptions, prescribing, explaining modes of actions, possible side effects, likely therapeutic benefits, monitoring, discussing with colleagues (including pharmacists), etc, etc. I have been a GP for 30 years, so by your calculation that is 30x50x20 = 30,000 hours! So your point is?
Depressed Ex Lib Dem is concerned “whether the GPs would be “accountable” in any way other than the same way supermarkets and utility companies are accountable“?
Er yes. They are already accountable to the patient, to their practice, to their Consortium/PCT, and ultimately to the Secretary of State. Additional to the law, to the complaints process, to the General Medical Council.
The proposals potentially add “Health and Well Being Board” and NHS Commissioning Board. On a personal note, I would also add that I am also accountable to my conscience.
There remain lots of ways to address GPs who are struggling. In addition, these reforms will make it a requirement that all NHS GPs must be part of a consortium.
You go on to suggest my “understanding is “”vague” and you suggest that the “role of the [Health and Wellbeing board is to provide “advice” and “encouragement”” only.
http://healthandcare.dh.gov.uk/democratic/
suggests it is, as I suggested, significantly more than that, “We will introduce real, local democratic accountability to health care for the first time in almost 40 years by giving councils the power to agree local strategies to bring the NHS, public health and social care together. This will give an unprecedented opportunity to integrate health, social care and other services for people and to support them to stay well”
I have tried to answer these questions as best I can. My comments are my own, based on what I have heard and read and the work we are doing here in Bristol.
I would again encourage people to explore the opportunities in their own areas.
well that is Rather odd Jon Rogers,
As the pharmacist that I was talking too, said, GP’s only take 1 day of lectures on medication.
What He was telling me, was the way in which Pharmaceutics is taught, was so that Ideally, All doctors surgeries would have their own Pharmacists on site, to help the doctor to decide the best course of treatment, after the GP has treated and diagnosed the Patient.
Unfortunately for whatever reason,that didn’t happen and we didn’t get any further than that, but he said he would tell me next week, why it was going to be a complete mash up, giving GPs total control over all the budgets.
So I will check in with you then 😉
‘ But where Britain spent big, other countries spent better. That is why Britain has some of the worst survival rates for cervical, colorectal and breast cancers in the OECD; the highest number of deaths per 1,000 live births in Western Europe’
Utterly over simplistic. Trotting out stuff like this does nothing but damage your credibility with anyone who knows anything about health.
In fact, we do have a pharmacist working part time in our practice. She reviews our prescribing against recommended care pathways, suggests cost-effective repeat prescribing changes and invites patients for review. Additionally, our GP information systems include sophisticated decision support and associated information systems, as well as offering links to the internet for further investigation.
My understanding is that GPs won’t have “total control over all the budgets“. There are discussions on what services should be commissioned at national level and regional level. Logically that will be the more specialist tertiary services, but also GPs themselves, and I think pharmacists, dentists, midwives and others.
Isla Dowds suggests Paul Burstow is “Utterly over simplistic when he gives comparative survival rates for cancer and perinatal mortality rates.
Can you explain your thinking? For example, a quick Google on cervical cancer reveals…
“12th November 2010 – The UK had the highest cancer death rate for women among European Union countries, according to official figures. Statistics gathered from 25 out of the 27 EU countries reveal that only Hungary, the Czech Republic, Ireland and Poland had a worse record. The findings come from the latest Social Trends report published by the Office for National Statistics which compares UK health, education and lifestyle with other countries.“
Jon
“Er yes. They are already accountable to the patient, to their practice, to their Consortium/PCT, and ultimately to the Secretary of State. Additional to the law, to the complaints process, to the General Medical Council.
The proposals potentially add “Health and Well Being Board” and NHS Commissioning Board. On a personal note, I would also add that I am also accountable to my conscience.”
This is getting ridiculous. You must know that we are discussing local accountability, because it was your phrase in the first place! What I keep trying to get you to explain is what mechanism there will be for local accountability in these proposals – considering that the party has voluntarily abandoned the policy of putting elected members on to the PCTs, which was in the coalition agreement.
And of course we are talking about the accountability of the GP consortia which are going to run the NHS, so for you to talk about individual GPs being accountable to the consortia is irrelevant. As for GPs being accountable to the PCTs, those are going to be abolished, for heaven’s sake! And when people are reduced to invoking their accountability to their consciences to redress the lack of other forms of accountability – well, that’s probably a more eloquent comment in itself than any I could make.
As for the new proposed boards, of course there’s nothing in the paragraph you quoted that says they will have any power of sanction against GPs consortia that do not follow their suggestions. Unless you can provide some evidence to the contrary, they clearly will be purely advisory bodies.
May I suggest that we continue this thread under David Rogers’s article?
https://www.libdemvoice.org/opinion-health-social-care-bill-a-local-government-perspective-22867.html
Meanwhile, what I was trying to say in my answer on accountability was that GPs will be no less accountable than they are now, and potentially more accountable if the right Health and Well Being and GP consortia arrangements are defined. I realise that you want detailed central definitions – what we have is local flexibility and accountability, including elected councillors – In my opinion, this is much more powerful than the current, top down approach.
There is no sense in which GPs will be accountable to the health and Wellbeing Boards. As for the Strategy, I have known local government long enough to know about the value of strategies when others are holding the purse strings. They are not worth a lot as they dont tie the decisions of local GPs to anything at all. I am sure that GPs are the best placed people to know what people want and need. What I am not convinced of is that that then means they are the best at commissioning, procurement, contracting and management of the supply side. I dont think that necessarily means that they know what local authorities do and how best to work with them, And I dont think they necesarily know best about the wide range of medical and non medical support services that are available to the patient. There is a world of difference between demand side purchasing and supply side commissioning. Will GPs be studying OJEU and TUPE regulations and other considerations in commissioning practice, or would they be better off treating patients
“That is why Britain has some of the worst survival rates for cervical, colorectal and breast cancers in the OECD; the highest number of deaths per 1,000 live births in Western Europe; and why around one in four cancer patients are only diagnosed when they turn up as emergencies.”
Did anybody notice the debunking of this claim earlier today by someone who knew what they are talking about. Using the same figures he showed that there has been a massive improvement over the last ten years and, on currebt trajectory we will overtake France performance wise in the next year or so. Not a great reason to radically overhaul the system as is claimed here. The only other evidence is that satisfaction levels are at an all time high.
Dear lib dems, what on earth are you doing supporting what is happening to the NHS. When plans were first announced I said that this was a resigning issue regardless of everything else that is going on.
Am I being thick, but weren’t “Public Services” originally intended to be non-profitmaking “services” that were deemed too important to be left to the rich landowners and other philanthropic barons to manage, e.g. education, health, transport, utilities? And is it just me, or does anyone else get quite exercised when tax payers’ money is handed on a plate to giant companies and their shareholders? If there is a profit to be made, surely it should be ploughed back into the service, or, now then here’s a thought, congratulate the thrifty service for coming in under budget and pass the excess back to the exchequer to offset some of the debts we’re supposed to be paying off at breakneck speed. The current government will bring this country to its knees, but I suppose they won’t care because they’re all millionaires already and don’t pay tax whenever possible. And they’d like to revert to the good old days when the above mentioned landowners and barons had the power, literally, of life and death over their serfs and underlings – and the right to de-flower any bride on her wedding night before the bridegroom did. Ah, happy days……