Comments on Just Plain Sense: Ten things you'll miss when the NHS has been evisc...

Correct me if I am wrong. As per the new bill, th...

2012-02-14T10:05:49.353Z

Correct me if I am wrong. As per the new bill, the GPs will send a simple straight forward appendicitis to a private hospital known to them or where they have their stake (as in the GREAT MEDIEVAL TOWN OF YORK) while an appendix with perforation and peritonotis ends up in an acute NHS hospital. The former get dischaged in less than 48 hours a while the latter occupied Ward, ICU bed, has multiple CTs with possible re-explorations. The only common thing is that both get paid £2000 !

in addition, the government have no money - only t...

2012-02-14T00:11:46.245Z

in addition, the government have no money - only taxpayers money. they have no authority to spend our money on what they think is a good idea. it is akin to me going into your wallet and extracting money to spend on something that i feel is a good cause. let the market decide on everything.
i wish people would understand that socialism is just as evil as NAZISM(look at the Gulags in the former USSR).

I support complete PRIVATISATION of the NHS. It is...

2012-02-14T00:07:41.757Z

I support complete PRIVATISATION of the NHS. It is the only way the health service will improve and develop. I also believe that the last thing the NHS needs to be funding is sex change operations... humanity has survived hundreds of thousands of years without them.

The key point that underlies "the reforms&quo...

2012-02-13T14:58:52.409Z

The key point that underlies "the reforms" is in what they will enable in the very near future.

Gareth makes the point very clearly that for the NHS to survive at its present scale, and especially if extended as proposed, it will require additional funding from new sources.

There are many who believe that the principle of paying for healthcare through taxation and receiving treatment "free at the point of need" should end.

By invoking private sector involvement (where this principle makes no sense whatsoever) and allowing greater choice to the recipient of treatment (rather than those who presently pay for it), the door to co-payment is opened. The name may be stolen, but our NHS cannot tolerate co-payment.

The argument that taxpayers should not pay for "choices" exercised by others is already well established. Phase II of the reforms will therefore easily be accomplished once the impact of the increased cost of greater choice and the inevitable failure of continuing "efficiency" savings to address general price inflation start to bite.

The "clever" idea is that it will be public demand that leads to the abolition of the NHS in England, which is why this is only enabled, not put into effect, in the bill.

If a service is funded "nationally" then all the necessary controls must be in place at that level to ensure that the money is spent wisely and the benefit distributed properly. If the service is large, then these mechanisms are weighty.

The Bill is effectively taking away the justification for total central funding, thereby preparing us for the end of the NHS in England.

This is what we should be debating.

I'm a patient, not a health professional, just...

2012-02-13T14:36:29.637Z

I'm a patient, not a health professional, just a piece of cannon fodder. I get meds for 2 chronic health issues, not related to smoking, obesity, or dementia. I have signed the ePetition, re-Tweeted various links etc & emailed my MP (who neither replied nor supported the Early Day Motion asking for the Risk Register to be made available to the House of Lords in its deliberations on this Bill). Is there anything else I can do as part of the drop-the-bill movement?

Good point David, badly trained fewer staff, I ha...

2012-02-13T14:06:17.641Z

Good point David, badly trained fewer staff, I had to complain about a local stroke ward on behalf of my friend, it's next to the dementia ward and every night patients come through onto the stroke ward so they barricaded the fire exit to stop it,you couldn't make it up

I won't pretend to have anything beyond a laym...

2012-02-13T13:53:12.984Z

I won't pretend to have anything beyond a layman's understanding of what is going on, beyond I have all the fears which Christine writes about.

So I'll stick to something I do understand, as we know the government have already performed the miracle of doctor training being reduced to 18 months, or at least that's the impression Cameron gave last week.

But seriously, if fewer doctors, nurses etc are going to be trained, how will this be affected by immigration caps, as the NHS won't have been employing or training these abroad?

Completely agree with you, Gareth, I might have to...

2012-02-13T11:45:16.558Z

Completely agree with you, Gareth, I might have to buy your book!

Must get on but just to pick up on the point about the widespread belief that the private sector is more efficient than the public sector, I think that it's just one of those things which has been repeated so often it has the status of fact. The public sector can be hugely inefficient but so can the private sector.

Seems to me that the public debate is currently in terms of 'Who should we believe?'. My response is: 'I don't want to have to believe anyone, I want facts and analysis so that I can make my own mind up'.

Andrew - spot on. State spend should never be mana...

2012-02-13T11:28:32.577Z

Andrew - spot on. State spend should never be managed by any entity other than an elected and accountable one. There is clearly no way it would be safe for commercial companies to hold the purse strings, and I don't think the Clinical Commissioning Groups will allow that to happen. The extent to which they are guided by the McKinsey and KPMG types is another matter however and something that must be watched.

The Bill in its present form seems to me to be about giving further power and profit to big business, despite the big society rhetoric of our leader. That was the reason behind my book, and the changes that I suggest in my blog are actually about calling the government's bluff on that.

If the Bill is genuinely to protect and enhance the NHS they will have no problem with my suggestions, which are in a nutshell to enshrine social enterprise as a delivery mechanism and ensure that we are all equal when treatments and benefits, even pensions, are being handed out.

A Big Society will simply not come about unless there is transparent fairness and equality across society, and that is the glaring omission from the current Bill, standing worryingly alongside the other risks that we can all see.

I don't follow the argument that private sector is more efficient or better than public sector, and I agree with your reservations about PFI and privatisation. They have both been expensive and messy. What is needed however is a more dynamic culture within the NHS and a proper strategy to deal with the challenges ahead. Unless they are built in to the Bill, I can see it ensuring that Cameron is not re-elected, whether it makes it into law or not, and that alone gives me some hope that further concessions will be made.

Apologies for wittering on, but an analogy just oc...

2012-02-13T11:24:01.997Z

Apologies for wittering on, but an analogy just occurred to me.

It would be perfectly possible for our armed forces to use contract personnel, rather than directly employed members of the armed forces. All strategic and operational planning could be handed over to KPMG and McKinsey and the actual fighting to Blackwater, or whatever they're called now.

Of course the private sector already provide a big role in defence - supplying hugely expensive weapons systems, and everything else, for example - but I think many people would be uncomfortable with the idea that all operations should be planned and executed by mercenaries. Ditto the NHS.

Many thanks Gareth, that's very helpful I'...

2012-02-13T11:12:27.564Z

Many thanks Gareth, that's very helpful I'll take a look at your blog later.

Seems to me the devil is in the detail. On the privatisation point, clearly the NHS isn't being privatised in the same way that British Airways and BT were: moved entirely into the private sector, listed as PLCs and owned by shareholders rather than taxpayers.

This feels much more like the British Rail privatisation. As we know, parts of that went horribly awry with Railtrack having to be brought back into public ownership after a number of serious accidents.

Like many I have very little faith in the political process or politicians so I want to see some good evidence - or at least, a priori reasoning where evidence isn't available - that this huge raft of changes won't expose us to another Railtrack. I do think the onus is on those who are pushing through the changes to demonstrate that they've got it right, or at least as right as it's possible to get it in advance, and that where there are risks they've anticipated them and how they will be handled.

The experience of Private Finance Initiative funded projects also casts some doubts, in my mind about whether the private sector good/public sector bad mantra the efficient market advocates believe is really as efficient as it seems. Even George Osborne seems to have his doubts about PFI and announced a 'fundamental reassessment' last year.

Clearly the private sector has always and will always have a large part to play in health service delivery. It's when private sector firms - who, if they're stock market listed, have a legal obligation to maximise shareholder value - are running all/most aspects of delivery that we start to worry.

Listening to Lansley it's easy to get the impression that his main argument for massively increasing private sector involvement is 'Well, so were Labour'. This, of course, isn't an argument at all.

There's no doubt in my mind that how we fund and deliver health services has to change - everything has to change - but I have huge doubts whether the current proposals, which seem to have been rushed by a government which doesn't really have a mandate.

If we have, as you suggest, to accept that the bill will go through will there be anything that we can do to undo any damage that might be done?

I also have major concerns about the role of Mckinsey in all this, but that's another story.

Management summary: if most health service delivery and planning will be in the hands of the private sector, albeit funded by taxpayers, how can we be sure that they won't put the profit motive first and that the interests of patients and taxpayers will come second?

Andrew Cooper is right that we have a highly polar...

2012-02-13T10:33:31.474Z

Andrew Cooper is right that we have a highly polarised, politicised, debate without much in the way of fact to underpin it. Many of the opponents of the Bill don't seem to have a clear idea of why they object, trumpeting phrases like back door privatisation, and many supporters are unable to give a coherent defence of what exactly it is trying to achieve.

For my part I have worked extensively in and with the NHS and in my book, The Unofficial Big Society Green Paper, I included a whole chapter on the subject. Many in the NHS will say there is enough money in the system now, it is the demographics, rising cost of treatment and rising health inequality that concern them. With issues like these they struggle to understand the changes, or at least the current relevance of them.

That said, I can see some merit in the proposals and suspect we will be stuck with the Bill in some form, so we need to make the most of it. I would welcome my GP being in control of the budget for all of my healthcare, and helping to leading community commissioning that ensures high quality local services, and so would she, provided that the provision of funding is fair, equal, transparent and sufficient to ensure no-one is turned away. Also, I don't have a problem with competition provided it is between the right type of providers offering best of breed services. I cover this in more detail in my blog http://bigsocietygreenpaper.blogspot.com/2012_02_01_archive.html

I fully agree about the dangers in the Bill, and see that it is piling change on top of funding issues, but can also see that with a couple of tweaks it could be a positive force for all of us. If we are going to get it anyway, we might as well work to make it as relevant and safe as possible.

Andrew Cooper is right that we have a highly polar...

2012-02-13T10:31:45.282Z

Andrew Cooper is right that we have a highly polarised, politicised, debate without much in the way of fact to underpin it. Many of the opponents of the Bill don't seem to have a clear idea of why they object, trumpeting phrases like back door privatisation, and many supporters are unable to give a coherent defence of what exactly it is trying to achieve.

The NHS is clearly not broken but neither is it in a good position to deliver high quality healthcare with leading edge treatment as the population ages, treatments increase in cost and complexity and those paying tax reduce as a proportion of the population. The huge machine which runs the NHS absolutely does need to be reinvented and slimmed, and the way it is funded needs to get past 1948.

For my part I have worked extensively in and with the NHS and in my book, The Unofficial Big Society Green Paper, I included a whole chapter on the subject. Many in the NHS will say there is enough money in the system now, it is the demographics, rising cost of treatment and rising health inequality that concern them. With issues like these they struggle to understand the changes, or at least the current relevance of them.

That said, I can see some merit in the proposals and suspect we will be stuck with the Bill in some form, so we need to make the most of it. I would welcome my GP being in control of the budget for all of my healthcare, and helping to lead community commissioning that ensures high quality local services, and so would she, provided that the provision of funding is fair, equal, transparent and sufficient to ensure no legal citizen of the UK is turned away. Also, I don't have a problem with competition provided it is between the right type of providers offering best of breed services. I cover this in more detail in my blog http://bigsocietygreenpaper.blogspot.com/2012_02_01_archive.html The blog explores two changes/actions may make the Bill much more palatable and much more likely to do us good.

I fully agree about the dangers in the Bill, and see that it is piling change on top of funding issues, but can also see that with a couple of tweaks it could be a positive force for all of us. As we're likely to get it anyway I think we must try to make it as safe and relevant as possible.

As I noted in my first comment, I'd like to se...

2012-02-13T09:53:07.877Z

As I noted in my first comment, I'd like to see some well argued - and preferably evidence-based - rebuttals of Christine's arguments. We're clearly not going to get those from Londonstatto, whose response is sadly typical of so many of those who support Lansley.

So does anyone else have suggestions about where we might look for the other point of view?

I'm perfectly prepared to accept there is another point of view. Unfortunately, as many including his colleagues have pointed out, Andrew Lansley is a very poor communicator so it's difficult to work out exactly what is going on.

The problem for Lansley is that this leaves the public in the position of asking themselves the question 'Who should I trust? A politician or nurses and doctors?'.

It's not a good question to have to ask but, as I say, in my view it's a result of the Department of Health's poor communication.

"I am not ascribing motives to GPs or saying ...

2012-02-13T08:55:46.134Z

"I am not ascribing motives to GPs or saying that they will do things, but that these are things that people will suspect them of doing because"...

...because you made it up.

Yet more scaremongering. Point 4, to take just on...

2012-02-13T08:54:34.809Z

Yet more scaremongering.

Point 4, to take just one example, fails because the government is continuing to increase the NHS budget (though Labour want to cut it).

And the assertion that the NHS isn't broken is risible.

And, of course, whilst "once the NHS is gone it's gone", this Bill will not remove the NHS. Pure scaremongering. You should be ashamed of yourself.

PS - re the efficient markets hypothesis, I strong...

2012-02-13T08:10:04.678Z

PS - re the efficient markets hypothesis, I strongly recommend Edward Stourton's recent Radio 4 Analysis programme here http://www.bbc.co.uk/programmes/b019rlnv which includes interviews with people on the right who have increasing doubts about the nature of 21st century capitalism.

@andrewzcooper

This is really excellent. I'd like to see a re...

2012-02-13T08:03:54.138Z

This is really excellent. I'd like to see a reasoned rebuttal of each of your points by someone who is in favour of the changes. At present best that the the Conservative and Libdem politicians who back the bill seem to be able to muster in their defence is 'we're right/they're wrong' attacks on the Royal Colleges and the BMA and ad-hominems.

Re. the Mercedes point, it seems to me to be that the best designed management and economic systems tend to fail mostly due to pure and simple greed. It certainly applies to communism and more and more people, even on the right, are arguing that the efficient markets hypothesis, which underpins market driven reforms, is fine in theory but takes no account of how people actually behave.

This isn't about GPs, it's about the human condition. The idea that KPMG and McKinsey - firms whose partners charge thousands a day for their services - will be responsible for commissioning - fills me with horror.

Your point about training is particularly worrying: our daughter is hoping to embark on 5 years at medical school in the autumn. I assume the bill's proponents hope that KPMG and McKinsey will set up medical schools as well as commissioning bodies.

@andrewzcooper

Thanks for your comment Gareth. I'm making it ...

2012-02-12T21:38:18.736Z

Thanks for your comment Gareth. I'm making it easier for people to read it by linking here

However, in response, two points:

Firstly the comment about buying new cars was not to say that GPs would actually be swayed in this way, but to emphasise the motives that their patients might attribute. This isn't about actions but about loss of trust.

Second, although I've read your post I don't think the NHS is served by heaping complexity on complexity. The fact is that the system was already performing exceptionally well before the coalition took an axe to it. Their assertion was that the NHS needed the change they wanted to bring about, but the evidence says the opposite.

The bill could be abandoned here and the NHS would survive. The contraction of PCTs and SHAs into clusters was a plan that Labour had already prepared and it arguably delivers a slightly smaller administration, at the cost of far less local decision making and accountability. However, one could live with that.

And it is false to claim that the NHS Commissioning Board offers something better. It, too, is a layered bureaucracy. However, instead of being accountable to local stakeholders it imposes an iron grip on the organisations that would replace PCTs. The government talks about the importance of localism, yet the NHS CB takes it away, with local tendrils of the commissioning board breathing down the necks of Clinical Commissioning Groups over every decision they make.

The only autonomy for CCGs will be the right to take the blame locally when things go wrong, as they will

Point No. 1 The PM said patients will have more c...

2012-02-12T20:57:22.950Z

Point No. 1

The PM said patients will have more choice therefore if a patient wishes to see a consultant s/he will be able insist they are sent to a consultant of their own choice.

Or

Could this mean that there will be discrimination against patient on grounds of criteria such as age, etc.

I fully agree with your comment but am not sure it...

2012-02-12T19:32:08.673Z

I fully agree with your comment but am not sure it is helpful to suggest that GP car purchases and commissioning budgets are interchangeable. I also know GPs who think the new proposals are desirable in some ways, notwithstanding the obvious flaws. In my blog I have sugggested two 'patches' which would make the bill more likely to help the NHS and more likely to be acceptable to those within it. I would be very interested to know your views on it! http://bigsocietygreenpaper.blogspot.com/2012/02/memo-to-andrew-lansley.html

Definitely the reforms that are making health syst...

2012-02-05T19:42:55.805Z

Definitely the reforms that are making health systems in UK and in many parts of the world are a mess. Now patients are seen as customers, not as people who need of wisdom and knowledge of a doctor to cure their diseases. And worst of all, doctors are losing their professional ethics to make things that are best for the company health or hospital that the patient.

Thanks Christine, and also for the news about Woma...

2011-09-11T12:42:57.665+01:00

Thanks Christine, and also for the news about Womans Hour(a friend on one of the forums has also clocked it, so I shall iplayer it). Two broad brush strokes you highlight are the 'asset stripping' of talent from the NHS in the wake of creeping privatisation(the health pro plunder that will escalate), and the sense I gather that so many people who already receive meds via NHS, or most certainly will in the future, don't understand the grave moves underway. The sleepwalk, despite the valliant campaigning, is strange to behold.

Come on people - wake up.

All the best Oliver.

Oliver, thank you so much for your contribution. O...

2011-09-11T11:17:33.102+01:00

Oliver, thank you so much for your contribution. Oddly enough I was only listening to an item about Thyroid Cancer on Woman's Hour this week. My best wishes for your health.

Your point highlights that so much of what is said about these changes comes from the mouths of those who haven't experienced the system working like this.

Health isn't a commodity. Quality teamwork and learning can't just be 'bought in'. The NHS is more than the sum of its parts .. a point that accountants and private sector investors will never understand.

I can't understand how this Bill is moving ste...

2011-09-10T22:26:57.130+01:00

I can't understand how this Bill is moving steadilly ahead Christine. I have had steady treatment for thyroid cancer for pas 20+ months. When I began treatment Jan '10 I was astounded by the level of cooperation in my local hospital. People have started to mock the NHS here and there, but it's worth reminding them that NHS does teach ALL doctors, and the treatment I received from my PCT was so well integrated that comparing it to friends on a cancer forum who 'went' private, it was clear that I had a 'package' that spotlighted all the failings of the private sector.
It's because consultants at my hospital(note the my)are part of teams treating & teaching, that it was such a great place to get well.
But as the months have passed things are changing. It's almost impossible to get something called Thyrogen(artificial thyroxine) for use during certain scans or radiation treatments(RAI). It would appear having scan is also going to be rationed, and TC is a condition that is only supressed so scans & bloods are crucial for rest of life.
I suppose what I'm saying, what we're all saying is 'don't fix it if it ain't broke', and I know the money, the cost will escalate for the oncoming abandonment of Cooperation.