Paul Burstow writes… A few facts about the NHS

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

  • I see no Iceberg 20th Jan '11 - 10:43am

    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.

  • 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!

  • Dominic Curran 20th Jan '11 - 11:12am

    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’?

  • 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.

  • I see no Iceberg 20th Jan '11 - 11:33am

    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.

  • Depressed Ex Lib Dem 20th Jan '11 - 11:36am

    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?

  • 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.

  • 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 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

  • dave thawley 20th Jan '11 - 1:03pm

    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).

  • Darren Reynolds 20th Jan '11 - 1:13pm

    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.

  • Leviticus18_23 20th Jan '11 - 1:18pm

    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.

  • Matthew Huntbach 20th Jan '11 - 1:21pm

    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.

  • Depressed Ex Lib Dem 20th Jan '11 - 1:26pm

    “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.

  • Dominic Curran 20th Jan '11 - 1:28pm

    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.

  • Chris Riley 20th Jan '11 - 1:39pm

    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

  • John Fraser 20th Jan '11 - 1:40pm

    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 ???

  • Disconcerted. 20th Jan '11 - 2:02pm

    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.

  • “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.

  • Paul Burstow MP 20th Jan '11 - 2:59pm

    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.

  • Dominic curran 20th Jan '11 - 3:44pm

    @ 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.

  • Dominic Curran 20th Jan '11 - 4:35pm

    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.

  • david clayton 20th Jan '11 - 4:48pm

    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.

  • David Allen 20th Jan '11 - 5:57pm

    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?

  • 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.

  • Patrick Smith 20th Jan '11 - 7:33pm

    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.

  • dave thawley 20th Jan '11 - 7:40pm

    @Patrick – the motives are to allow rich people to make a lot of money out of us.

  • Depressed Ex Lib Dem 20th Jan '11 - 9:30pm

    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?

  • david clayton 20th Jan '11 - 9:39pm

    @ 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.

  • providing your patients with the sane quality of medical care

    ‘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.

  • @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

  • 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.

  • @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,

  • Depressed Ex Lib Dem 20th Jan '11 - 11:31pm

    “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.

  • Depressed Ex Lib Dem 20th Jan '11 - 11:35pm

    “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.

  • 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?

  • I see no Iceberg 21st Jan '11 - 1:02am

    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.

  • david clayton 21st Jan '11 - 6:22am

    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.

  • 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

  • Nick (notClegg) 21st Jan '11 - 9:06am

    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.

  • Depressed Ex Lib Dem 21st Jan '11 - 9:41am

    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.

  • Paul Burstow MP 21st Jan '11 - 1:52pm

    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

  • Depressed Ex Lib Dem 21st Jan '11 - 2:08pm

    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?

  • David Allen 21st Jan '11 - 5:54pm

    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.

  • mike cobley 21st Jan '11 - 7:53pm

    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.

  • Paul Burstow 21st Jan '11 - 8:15pm

    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.

  • 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.

  • 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.

  • Depressed Ex Lib Dem 22nd Jan '11 - 12:17pm

    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!

  • Depressed Ex Lib Dem 23rd Jan '11 - 12:58pm

    “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.

  • Depressed Ex Lib Dem 23rd Jan '11 - 4:51pm

    “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?

  • ‘ 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.

  • Depressed Ex Lib Dem 24th Jan '11 - 8:56am

    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.

  • 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.

  • Sue Duffield 14th Mar '11 - 10:53am

    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……

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