Andrew Lansley's Health Reforms.

This is about the 13th reorganisation I’ve seen in my 3 decades as a GP. Up till now I’ve put it all down to the fact that politicians can’t resist “fiddling”, and if we called all managers administrators instead, they’d administer rather than think they too have to introduce change for change’s sake or to prop up their egos. This “reorganisation” is far more sinister however as the label “NHS” will not be in any way applicable afterwards.

This White Paper ( WP ) represents the Coalition Government’s proposals for legislation to privatise the NHS. It is the next logical step in the seamless acceleration of the policies of the last Government. Tony Blair was elected in 1997 on a platform of abolishing the NHS market , but a few years later reversed this without a mandate from the electorate. The present Secretary of State gave a pre-election pledge that there would be no more major reorganisations in the NHS. And why wasn’t the NHS a “hot topic” in the election campaign ? Because all three main parties are in agreement that commercialisation is the way forward . Those believing in the founding principles of the 1948 NHS were disenfranchised. Now the main aim of the WP Mr Lansley has introduced is to hand over the provision of NHS care to private companies. This policy is called “ patient choice” To enforce this change, commissioning in England is to be privatised.

GPs have no choice but to amalgamate into consortia (GPCC) which have the task of commissioning the bulk of the NHS care under the control of a National Commissioning Board ( NCB ).
The GPCCs and the NCB are open to be largely run by private interests. The appointed NCB would contain figures from large health corporations. GPCCs in some areas are at risk of being dominated by a clique which would turn to the private sector to do the commissioning for them. There is a real danger of damaging conflicts of interests when “GPs” are both service providers and service purchasers
The present commissioners, the Primary Care Trusts and Strategic Health Authorities are a publicly run bureaucracy and would get in the way so are to be abolished by 2013.
This plan to privatise commissioning is skilfully hidden by saying that GPs will be in control of 80% of the NHS commissioning budget, through GPCCs. But these GPCCs would take over the debts of the PCTs and then have to ration care on a massive scale as they would be held responsible for cutting the NHS budget by £20bn ( a fifth of the NHS budget )
The nominally responsible GPs would then be blamed for the withdrawal of care and treatments and for closing hospitals.

The publicly owned infrastructure of the NHS is continuing to be closed down, sold off and privatised as the cuts proceed and the private companies such as BUPA and the US company UnitedHealth move in ( e.g. PFI and LIFT buildings, privatisation of NHS procurement, IT contracts, privatisation of ambulance and pathology services, ISTCs etc.). The new commissioners are instructed to carry out “patient choice”, by ending the present position of
“ NHS as preferred provider” and changing to an “any willing provider” policy.
The new “market” of competing providers would be regulated by MONITOR, which would also introduce price competition by abolishing national tariffs, and deciding “ best practice” tariffs. The new commissioners are instructed to continue the “reconfiguration” of NHS care by driving down GP referrals of patients to hospital, and removing hospital care.

The aim is to “liberate” the NHS from the structures founded in 1948
* Publicly owned hospitals and infrastructure,
* Publicly provided service by staff on national terms and conditions and pensions
* National system of education and training
The three parts of the NHS are all to be privatised.
-- Community care is to be outsourced by April 2011.
-- Primary care is increasingly owned and run by private health companies employing APMS general practitioners.
-- The hospitals are to be denationalised. They must all become Foundation Trust businesses and then convert to “ social enterprises”. The latter are the transition stage to fully-fledged private hospitals. Hospitals must make money or go bankrupt and fail and must not be ‘bailed out.’

The consequences for NHS staff are the loss of thousands of posts through cuts, and the forcible transfer of employment to private companies with removal of national terms and conditions and NHS pensions.

The consequence for patients is the rapid and drastic removal of care provided; fewer hospitals miles from home, and the withdrawal of all types of treatments and care.
The WP demands increased individual patient budgets, which together with provision by private companies, paves the way for charges and private insurance.
The vision of the future is one in which corporate interests will be given incentives to select patients, time-limit care, sell top-up insurance, and introduce charges for some elements of care no longer provided by the NHS. The Government will then want to see the development of practices competing against one another for members (patients), just like US health insurers. That’s a chilling prospect for the elderly, those with chronic illness and people with mental illness and long-term needs, who are often of no commercial interest to the corporate because of their high healthcare costs.
The WP proposals will inevitably lead to the end of the NHS as a publicly owned and provided system of healthcare funded by taxation, with the right of every citizen to have access to comprehensive, high quality healthcare, free at the point of need. “NHS” will be nothing more than a title. Just as the USA is waking up to the inefficient, unfair, corrupt and discriminatory health care system they have, we are being driven in that direction— for ideological reasons.
The danger is that without careful and informed debate one of the best-loved and most successful public institutions of the last 60 years will go down undefended.
Dr Paul J. Hobday MB BS FRCGP DRCOG DFFP DPM

No conflicts of interest

FAO of Andrew Lansley
The inconclusive general election result did not give the government a legitimate mandate to implement the changes that are presently being proposed. The Prime Minister promised not to undertake any major reforms to the NHS. The Health Secretary is playing lip service to the concept of public consultation and rushing blinkered into untested and ideologically driven changes. The aims highlighted in the White Paper are laudable but the speed and scale of the proposed changes are high risk and divisive.
The constant reorganisation of the NHS by successive governments has prevented the cooperation and collaboration between the government, NHS staff and patients that we should be all aspiring to in order that we can develop and integrated and equitable health service.
I would readers to Clive Peedle’s letter in the British Medical Journal and the numerous responses in support
Open letter to the BMA about the health white paper Clive Peedell and cosignatories BMJ 2011; 342:d7 (Published 4 January 2011) https://www.bmj.com/content/342/bmj.d7.full

Julian Law BM MRCGP MRCGP DPD

These reforms are based on Adam Smith Institute proposals published in 1988 in a report called 'The Health of Nations'. They were always intended as a first step toward privatisation of the NHS and were largely rejected by the Thatcher government as a politically dangerous reform too far.

These reforms weren't in the Tory manifesto, in fact the Tories promised no more far-reaching structural change. The proposals certainly weren't in the LibDem manifesto and were not a feature of the coalition agreement. If there is one thing coalitions should be good for it is the prevention of extremism in government and a brake on policy making being overly driven by ideology. If there's any issue on which the LibDems can demonstrate their influence in government and the true value of coalition to good governance then this is it. Let's hope they step up to the plate.

If Andrew Lansley plans to involve GPs as commissioners in future why did he ignore them and his own code in Maidstone area by permitting transfer of consultant-led maternity and children's services from Maidstone Hospital?
His four tests for hospital reconfigurations included GP support. He has seen the results of five GP surveys, including one by the local NHS, and all show overwhemling opposition to this move. They do not believe his decision will meet another of his tests - clinical safety - as women in labour must make difficult journeys of 15/18 miles along mostly rural lanes to reach the new hospital at Pembury. He also sought 'genuine engagement with public, patients and local authorities' but this was not possible because all were so massively opposed. He called for patient choice - and has taken away the only choice Maidstone area paients want. He said he depended for his decision on advice from the Independent Reconfiguration Panel. But the only report he had was from the chairman alone commissioned by his predecessor and out of date because it did not consieder his own four tests - he should have commisssioned a full local hearing by the panel. He said he also depended on a report by a small Kent County Council Committee. But KCC's own statutory overview and scrutiny committee, after that report, first voted to refer the issue to him and then voted decisively against the reconfiguration. Maidstone's MP, Kent County Council. Maidstone Council and others call on him not to implement the decision until the GPs are empowered - saving money and much grief among 250,000 population.

Well!
Peeps, some food for thought there

Dr Hobday (1)

Thank you for your clear insights and informative information in your post. The NHS will not go down while people like you are speaking up for it. I would like to echo the vast majority of your post. If what you state is true, there can be no doubt that these reforms are lead by a narrow, polarised, ideologically lead mind set. I would go as far as to say that Mr Lansley is little more than a political stooge for the private health industry and associated intrests. You only have to look at his historical ties, directorships, and donors to see where his influences come from. I suggest the health service unions get together (if they haven't been brainwashed yet) with the GPs and all other interested parties to form a united stand against these so called reforms. Big business has no intrests in public well being, a fair and equal society, a health service where everyone receives the same level of care millionaire or poor, theres no money in such principles for them and their share holders. I agree with and support your stance. The NHS has a history based on the highest qualities of humanity and social cohesion. We must not let these things be lost to the interests of a few ideologically driven people at the top who see nothing wrong with one health service for those that can afford it and the rest take their chances with whats left.

Andrew Lansley and others before him (Lord Darzi et al) have spoken ad nauseaum about "evidence-based" medicine etc.

What worries me is the lack of ‘evidence-base’ for the original White Paper, issued so precipitously in July 2010.

The WP had a mere 33 references in the endnotes, some were out-dated. Astonishingly few pieces of evidence for a reform of this magnitude, and its impacts on a £102bn budget and '000s of employees.

I have searched in vain for evidence of consultation, prior to issuing that document.

Not to mention, the reversion of control over patients to paternalistic GPs...

Could we demand a judicial review of the WP, or is it a fait accompli?

I really hope this week that the producers of PM can help the ordinary Radio 4 listener appreciate the extraordinary level of disquiet in health professional circles at the imposition of the Lansley 'reforms' but as the programme tends toward 'comment' rather than 'insight' and based on national media coverage of this issue so far, I'm far from hopeful

It should strike anyone who has been following the debate about the new NHS White Paper that Andrew Lansley's appearance every day this week on PM to discuss this 'done deal' that has no mandate nationally as no more than an opportunity for him to spout his well rehearsed rhetoric to what has to be one of the most historically unpopular, untenable and least well thought through domestic policies in modern British history, a clandestine privatisation of what this country holds dear. Why else would he agree to such a stunt after determining that the proposals in the White Paper should proceed unaltered, despite the scale of the resistance to these so-called reforms.

It's clear to anyone sampling the reaction to the White Paper that hundreds of prominent GPs, their representative and health policy academics,etc who have been openly and vehemently opposed to the pace, scale and sheer impracticality of delivering quality health service within the proposed new system, that there is no willingness within any quarter of the health service to deliver on this agenda.

And yet despite how poor these proposals are, their coverage in the media has to date been appaling. Let's hope in the interests of real balance, i.e. not the kind of balance that gives equal time to poorly defensible positions as it does to rational ones, that PM allows the White Papers numerous, prominent detractors (such as Dr Paul Hobday who opened this thread) to interrogate Andrew Lansley, which is the near-inevitable outcome of being interviewed by any 'hack' (no specific offence to Eddie or his team otherwise intended)

Here are links to the numerous prominent professionsal I referred to who have openly spoken out in the media against these proposals...
1) 119 doctors BMJ - https://www.bmj.com/content/342/bmj.d7.full?sid=e76d8a2c-fa07-4826-8eac-603df72b7073
2)Jonathon Tomlinson 10 things wrong with the White Paper https://abetternhs.wordpress.com/2010/12/09/10-things-wrong-with-gp-comissioning/
3) 206 plus medical professionals write 'Government plans will destroy NHS' thetimes.co.uk/letters
4) Superb critique of NHS White Paper by Dr Jacky Davis of BMA Council on https://www.youtube.com/watch?v=i2m99U9ocbg
5) Allyson Pollock and David J Hunter Public Policy experts BMJ, 341, 228-231
6) Clare Gerada, chairman of the Royal College of GPs predicts trouble for doctors from a public angry at Conservative NHS reforms - https://www.guardian.co.uk/society/2010/nov/19/doctors-warned-expect-unrest-reforms?intcmp=239

Thank goodness for all the well-informed posts above and the fact that there are still people in this country prepared to stand up and fight for what is morally right rather than kowtow to capitalism with our most precious public good.
I thought Humphries did a fair job with CallMeDave this morning mostly by focussing on how often Dave says "I want" and how he avoids committing to do anything. It was utterly obvious that Dave does not understand one iota of the science and statistics behind the cancer outcomes. He is uninformed and unthinking on the topic. So, PM team, please: demand evidence-based logic from Lansley and don't let him slither away from providing it; ask him to guarantee that there will still be an NHS totally state-provided at the end of his reforms; ask him to guarantee that private concerns will NOT have access to data or be able to influence decision-making; ask him to explain completely without omission of relevant facts the whole story on cancer outcomes - if he can do that, it will be obvious that Dave's view is illogical at best and may even lead to fatal outsomes in the cause of populism.

I've got a question for Mr Lansley.

As with any massive reorganisation there are bound to be mistakes made, would he be willing to put a profiteering clause into his proposal specifying that:

No organisation or individual is allowed to make more a £500,000 profit from providing commissioning services or health care for the NHS.

This might help to allay fears that his proposals are driven by a desire to increase the profits of his friends in the American health care industry, rather than the wellbeing of the people of this country.

I, too, was extremely disquieted by the interview this morning with Mr. Cameron. Mr. Humphrys worked hard to hold a slippery eel, but when you are dealing with someone who exaggerates in order to create a semblance of substance (for example. when Mr. Cameron asserted that he has employed Andy Coulson for "many years" - Since when did three and a half years constitute "many" years?) it is extremely difficult for interviewers to hold such people to account.

As Monday's Today programme is as yet unavailable on iPlayer, it is difficult to recall all the inaccuracies and exaggerated assertions that were made this morning, but I would implore Eddie to employ his best footwork when interviewing Mr. Lansley so that the latter is not allowed to duck, dive, or perform illegal actions during this series of programmes.

I recently joined the NHS from private industry and would like to make a couple of observations.

1) There is no NHS. There is a central funding body that gives money to local health care bodies. Some guide lines are offered for spending that money but each body can spend pretty much how they want - including re-inventing things. Very little is mandated and there is little central control. Not many private business can operate for long on this model.
2) In private business when costs need cutting two things are done - management layers are axed (SHAs) and control is centralised. Here the government seems to be doing the opposite. Control is being decentralised and management is being increased - each GPCC will need its own admin / strategy team.

If the Government is serious about saving money it needs to turn the NHS from an anarchy to a dictatorship, mandate and impose solutions, reduce duplication. The government paid Sir P Green to produce a cost saving report - the NHS reforms seem to fly in the face of much of his recommendations.

It would be interesting to ask Mr. Landsley how he is going to stop consultants taking NHS consumables for their own private consultancies or, in a case I heard of, for their partner's consultancy? This goes on and people within the NHS are too scared for their jobs to whistleblow. The loss of such consumables is hidden within the overall budget of the hospital or Trust.

May I also say how good Wirral NHS Trust has been in my dealings with it for my mother, my father, auntie and, now, a cousin. Arrowe Park and Clatterbridge Hospitals fall over themselves to give the support needed and the in-patient care is very good. My experience of this Trust extends from 1997 to the present.

I have found a link to this morning's interview and am in the process of 'listening again'.

https://news.bbc.co.uk/today/hi/today/newsid_9363000/9363655.stm

Two minutes in and I am struck again at Mr. Cameron's ignorance concerning the NHS. He waffles on about objecting to reorganisations and rebrandings, and refers to Primary Care Trusts being rebranded as Primary Health Authorities. I am beginning to wonder if he is living on a different planet ...

Big Sister - thank you for taking the time to monitor and scrutinise. The more one focusses on the detail level with Cameron, the more obvious it becomes that he is vacuous.
It is outrageous arrogance to take the post of Prime Minister of this country and approach it with a louche, droit-de-seigneur sense of entitlement without getting off his rear end to knuckle down to the detail. I am also appalled at his ill-manners and sneering evasions at PMQs. His behaviour is disgusting!

Dave Robson - Very good point - PM team please make sure he is thoroughly interrogated on what money he received directly or indirectly from private health businesses.

Oh, and following Digby J's outrageous whopper on Financial Services tax contribution last week, please ask Lansley what the NHS tax contribution is to the coffers!

The argument about giving poorer people more choice.

There is a fundamental flaw at the heart of this argument, namely, as GP surgeries are private enterprises, it will be impossible in practice to force GPs to take individuals onto their lists. This will undoubtedly lead to those in the greatest need of good care being forced onto the lists of the less popular (i.e. less effective) practices.

For Mr. Cameron to insist that his proposed reforms will lead to fewer health inequalities and better health outcomes is, therefore, glib and will in all probability prove to be wrong.

16. Big Sister

Big Sister, I think you're right. It always seems to me that these arguments (NHS, schools) about choice depend critically on the continuation of poor services. This morning Cameron says the proposed NHS reforms will provide a 'route out of poor services', and we know by heart the Tory mantra's about choice. BUT - people I talk to don't want choice - they just want a decent service (GP, school, hospital, police force) - they DON'T want to be able to choose between a good service and a bad one.

Throughout the 80s and 90s and up to a few years ago I was installing and servicing analytical equipment in hospitals throughout the UK.
I saw behind the doors where the general public were not permitted. During this time, the Tories pledged that the health service was safe in their hands. It was a lie then and they cannot be trusted now, no matter what Cameron says. I can assure you that the NHS during the governments of Thatcher and Major was being broken down; it was a death by a thousand cuts. They did this strangulation by not keeping up spending in line with inflation bearing in mind that healthcare inflation runs at a higher level than the CPI. We saw massive waiting lists with patients dying before they got treatment, we saw elderly people spending hours on trolleys in corridors. The buildings were left to deteriorate, I saw lab technicians using chewing gum to block a hole in the joint between a window frame and wall.

The current set up works, it may be made more efficient but it does not need to be destroyed, only tweaked.
This proposed change appears to be a result of Tory party dogma and will lead to a worsening of the service with private companies creaming off profits. The Tories cannot be trusted with our NHS as so many of them do not use the service and they have spoken up in America against Obama’s modest reforms. These reforms will be expensive to implement and any savings, if any, would take years to come through.

That’s my opinion based on my observations of the past Tory NHS reforms. It took a mountain of cash to rebuild the hospitals, to pay doctors and nurses properly, to train sufficient numbers, to open new medical schools, to replace the old worn out equipment with the latest technology. Just as the increased spending is about to pay off the Tories throw it all in the air. Improvements in health take time to come through and to say as Cameron says what he says regarding medical outcomes shows that he is ignorant as to the facts.

Under this new system, who is responsible for planning ?

If my local hospital decides to close it's ANE department because the management has decided it's no longer profitable, who can I complain to ?

The Hospital is now a partnership, my GP works for a limited company , my MP can do nothing.


If I cut my finger and turn up in ANE, who pays for it if I am one of the large number of people who isn't registered with a GP ?
If I don't know who my GP is does that hospital have to try to track down my GP ?
Will the ambulance service have to get my GP's details,
Will I have to sign a receipt for any treatment I recieve.
Who will cover the costs of billing and debt recovery.
what happens if my GP run's out of money ?

Do I need to bring my credit card with me to Hospital just in case my GP won't pay ?

For a non-Tory or Lib/Dem view of Cameron's NHS plans.

https://www.mirror.co.uk/news/politics/2011/01/17/david-cameron-accused-of-destroying-nhs-with-privatisation-plans-115875-22854652/

From the article "But a report by the NHS Confederation which ­represents doctors, ­administrators and medical groups, said the reforms were ­“extraordinarily risky”."

"Extraordinarily risky" this is my health, my Mothers health and my childrens health that they are putting at risk.

20. Looternite

You obviously didn't read this bit: "Lib Dem Andrew George also attacked Mr Cameron’s planned changes. He said: “The structures the Government is putting in place put at risk the public sector ethos of the NHS.”'

21. Sid
So Clegg, Cable will also fight to stop these reforms. Or is Andrew George a lone voice!

Re evidence-based decision-making.
Eddie, can you please ask Lansley, in your trust-engendering Scottish accent, why there is a different approach in Scotland?
Is it a) because the evidence is different? or b) because it's actually a political decision rather than a medical one?

23. MadnessOfCrowds
Of course your are right, as you say, if the reforms are for medical reasons then they will be taken up in Scotland.

I never thought I'd be fighting to keep the PCTs and SHAs but actually I am.

In this wonderful idea of moving the budgets to the GP they are forgetting some of the work that is carried out by the PCTs. They are the bane of my life - I currently work in an environment where 3 PCTs are commissioning work from us and all are ensuring that we conform to national safety alerts (NPSA, MHRA) in subtly different ways. None of them will accept each others and all 3 are different from our Corporate compliance monitoring forms. But at least I know that the commissioners are checking that we are running a safe service and that they understand the work that is required. I cannot fault them for chasing me if something is delayed and querying something that they don't understand in my returns.

Our most local PCT is looking like it is going to split into 3 commissioning groups which is where we were 6-7 years ago. Are each of these going to be making the same safety and quality checks? Will they have the same expertise and resource to check in the same way? How has this saved money? Has this not just potentially trebled my workload in compliance tasks and reduced my patient contact time?

Who is going to be making sure that the less than very local priorities are met for a region? Are we not heading back to a postcode lottery? Within our region there are a few areas of particular health inequalities. The SHA and PCT ensure that resources are diverted appropriately towards these areas currently. What will happen in the new regime?

There are inefficiencies in some NHS processes - that's a given - but ask the individuals within these areas how the processes can be made more efficient without impacting on patient care. Flattening the structure is not always the answer.

Surely the fact that Mr Lansley's plans do not find favour from a single one of the informed, intelligent and braod minded individuals above shows the level and roots of genuine public concern.
After listening to the Today interview online, I would ask that someone take Mr Cameron to one side and gently explain to him that trusted or not, GPs are not "people in the NHS". They may (or may not) be the best known or even most trusted providers to the NHS but his (and Mr Lansley's) oft repeated assertions that their planned reforms are being led from the front line of the NHS are, at best, misleading. GPs are independent businessmen, working in businesses whose prime, if not only source of income is the public-purse funding via the NHS.
On the matter of health inequalities, to assume that these can be changed by GPs (or indeed anyone) changing the commissioning of specialist services rather than wide-scale improvement of PRIMARY care (that provided by GPs, Pharmacists etc) demonstrates an insulting ignorance of the English health system.

If this is evidence-based government making evidence-based policy, let's see the evidence.

25 RxKaren - I guess that localism and 'addressing local needs' will indeed make for postcode variations in services and funding. The real challenge for whomsoever ends up running the NHS is to make sure that this variationdoes not include quality.

I have a great deal of respect for GPs - and my own in particular - but they are, as Suziebells correctly states, independent businessmen and women. Whatever their motivation (acknowledging that many regard their work as a true vocation), they cannot ignore financial considerations, yet they are not answerable to us, their patients. There is not a contract that could be drawn up that will change this situation.

How DARE Cameron tell us to "grow up"and stop criticising him! The narcissistic, self-important, vacuous little ******* needs to get his ego in check very quickly or seek help with whatever psychological issues are causing such outrageous self-importance.

A few comments / concerns from my own, uninformed point of view:

* Presumably it will cost a fair bit of money to decommission the SHAs and PCTs and set up these newfangled GP-led consortia. In addition to the staffing costs (hiring and firing), there's also the question of buildings - some of the office space may be taken up by GP consortia, some by private companies, but it's likely some will sit dormant, while rent etc. still continues to be paid. Similarly, some of the GP consortia may need to buy or rent new office space. I assume no extra money is being given to them to implement the changes, so where will it come from? Loans, to be repaid from phantom efficiency savings, some other mystery pot of money, or (as I suspect) taken out of the budget available to front-line services?

* Several decades ago, GPs were probably best placed to understand your needs. However, these days, appointments are generally no more than ten minutes, and trying to get an appointment outside office hours can be difficult. Last time I had an appointment, I reeled off my symptoms, then spend several minutes sitting in silence while the GP searched their computer for the relevant drug and printed off the prescription. There's not much of a doctor-patient relationship when you have a strict time limit and you're effectively treated as another item on a conveyor belt.

* As I understand it, these GP consortia may include GPs from several different areas, and there may be several consortia in an area. Will practices be required to publish which consortia they're a member of, and will consortia be required to periodically publish relevant information on their performance and patient satisfaction?

* If it's all about patient choice, how much say will the patient get in where they're referred to? Can patients choose to be treated at their local hospital rather than, say, the PFI complex thirty miles away which gets regular outbreaks of almost every hospital-acquired infection going?

30. mittfh
"newfangled GP-led consortia"

re the cost of change: the Economist article referred to above has this comment:

"(3) In previous articles the Economist has shown (i) that reorganisation costs 30% of productivity in year one, and shows benefits only after 3 years or more and (ii) that the NHS has been re-organised more than once every three years...so all costs and little benefit. One has to ask whether another rushed reform is really sensible."

Big Sister (28)

For me you have hit on a very important nuance there. Although I have great respect for my local GPs some do have a corporate head on their shoulders in every day matters. As far as patient experience goes the vast majority of patients would not see or recognise this if they tripped over it. However, just on occasion the mask may slip and the independence and corporate image show through. I had a very real experience of this when a young (probably student) lady turned up at my surgery when I happened to be waiting to see the doctor. She was in obvious pain with what I surmised to an ankle injury. She was told to take a seat in the waiting area and the doctor would see her when he/she could. The young girls pain was so acute that she strung two chairs together so she could sit on one whilst resting her feet/ankles on the other to try and gain some relief. After a few minutes of twisted facial expressions from the girl, a passing surgery doctor took a member of the reception staff to one side and I heard him order the receptionist to go and tell the girl that she is not allowed to sit like this in the surgery. The receptionist duly obliged telling the girl what the doctor had said and adding, that she might upset other patients waiting to see the doctor. No other form of pain releiving comfort was offered this poor girl (even though I know there are rooms at the surgery with bed trolleys in them). I saw this girl have to haunch herself up with an outburst of verbal pain and sit like this until the doctor found time to see her. The approach of the surgery seemed nonchalant and unsympathetic. Still they did have their (private) corporate image to think about. Personally as a patient of that surgery, it would not have bothered me if the girl had lain on the floor for all to see if it had relived any of her pain. I almost said something...wish I had now.

Which consortia would you complain to about a consortia? Will there be a comparison web-site? Will there be free hip breakdown cover if you have a hip replacement through certain surgeries? Will they want to sell us double glazing?

33 FjD
Not much use if you're in for cataract surgery.

ld (33)
Yea, but legal assistance will only be 25 quid a year extra if you've been registered there a while...assuming you can produce a medical MOT and five years no claims bonus.

I am really worried about a health minister and a prime minister who can't tell the difference between a public service and a supermarket. I do not want choice, I want excellence wherever in the country I happen to need it. If I have a stroke I will not be asking my GP to shop around for the best bargains or the 'taste the difference' range. I will need the best care, right now, thanks very much.

Why did the Tory manifesto promise no further structural change if Andrew Lansley had spent five years working on such changes?

To 37.lucien desgai
I completely agree. Indeed the conservative manifesto explicitly stated that they had no plans to reorganize the NHS - obviously political speak for "We have no plan we want to show you now (before the election) but reserver the right to finalize one the day after voting that we have been working on for 7 years.

This coalition is doing lots of things they have no Political mandate for.

The ordinary members of society have been effectively disenfranchised since about 1997 when, regardless of their obvious wishes, elected politicians have carried out the agenda of their class (generally public school multi-millionaires) whichever political party they belong to. So Andrew Lansley tonight was quoting actions by "New Labour" to support his position. Where are the Lib-Dems or Labour in organizing opposition to these plans?

Could all the posters here who say that the NHS works please ask the PM team to give me their email addresses.

I'd like to contact them so that they can get me some of this wonderful care. I assume that you will be prepared to put your money where your mouths are, though experience has shown that when I challenge people like this everything goes very quiet.

I currently get no care from the NHS even though people with similar conditions in other countries are able to get treatment. My GP says that this is because "the NHS hasn't found a niche for you yet". I know a number of people here in the UK with my condition who have the same problem getting care so it is not just something that applies to me - it is system wide. That's not a system that works in my book, let alone the wonderful system that you all describe.

At least under Mr Lansley's proposals I'll be able to get to the person who is responsible for providing my care - my GP. At the moment, the decision makers are hidden away and the NHS complaints system allows them to stay hidden and unaccountable.

NCT, UK's largest parenting charity, is concerned that commissioning of maternity services by GP consortia will have a potentially detrimental effect on those services which for a number of years have not been provided by GPs and are essentially and characteristically different to other acute primary care services.

Government policy, based on sound evidence is that pregnant women should have their care managed by a midwife. Additionally, where a woman experiences complications in pregnancy she may require further support and care from other health professionals including obstetricians for example. In providing midwife led care, aims such as providing good support and a continuous relationship of trust with a midwife known to you can be established, which has been proven to have a positive impact on the women’s experience of and outcomes of labour birth and the early postnatal period.

Scottish policy has moved further to ensure that midwives are the lead professional and the first person women are directed to when pregnant, ensuring that relationship starts from day one.

Moving to a radical new commissioning model in England may have a knock on effect on how services are provided. PCTs currently have specialist maternity commissioners who understand how maternity services work and differ from others.

NCT therefore believes that maternity services, providing for an average of 700,000 babies and their families every year, should be commissioned by the NHS commissioning board.

The general election result certainly did not give the government a legitimate mandate to implement the kind of changes that are presently being proposed by Andrew Lansley.
The Prime Minister, talking about The Big Society said “... It’s about saying if we want real change for the long-term, we need people to come together and work together – because we’re all in this together”
In this spirit then, before any action is taken, how about asking us, the public?
a) Do we want this change?
b) If so, do we want this right now, at the height of our worst economic crisis?
We could all be asked by a very simple survey, similar to the NHS Patient Survey Programme. Such a survey would be extremely low cost compared to NHS budgets. If we all voted Yes then Andrew would be justified. If we all voted No then we’d save a lot of money.

Eddie, in that special manner only you have, please ask him, will do this?

On ‘Today’ and ‘PM’

Re the NHS: John Humphreys this morning interviewing Cameron.

JH missed the opportunity to find out from Cameron exactly how the NHS can be improved to European standards.

According to WHO figures, while the uk is “mediocre” at around 17th and France tends to be best in terms of outcomes for patients, surely the interview should have taken this on. I am a green lefty not a Tory but I think Cameron has a point with this.

Humphrys should have concentrated on this sad truth that the NHS ranks so low. I would have asked Cameron that instead of constantly the UK reinvienting the NHS wheel, couldn’t we simply adopt the system of the best lock stock and barrel?

And it could make sense to hire the French to run the NHS for us, as the latest idea of giving it to the Gps to run sounds very worrying knowing some GPs and their performance.

Also in PM tonight Eddie Mair too seems not to have grasped the crucial issue of the NHS ranking so low in EU.

None of my French friends seem to worry about their NHS care and they are shocked when I tell them that here one has to wait to see a specialist.

There is another issue never discussed, France, and other countries I believe, have trained double the number of doctors from their own population while here our NHS and governments have always relied on the cheaper option of ‘pinching’ already trained staff from poorer countries –nurses too - which in itself is a disgrace. Years ago, when I was a trainee nurse, I never saw a single English doctor working at Great Yarmouth General the whole time I was there – except a handful of consultants.

One more aspect is the rate of sickness and disease. Does the UK have the most sick people in Europe? It would be interesting to know if this has been measured. And which EU country has the healthiest population I wonder? Anyone know?

At last we have it - on today's PM the candid admission from Mr Lansley that "I don't know best". You could tell from his hesitation after letting these words slip from his lips that he realised he'd put his foot in it. But that was trivial compared to the damage these reforms will do to our NHS.

As an institution the NHS has, since 1948, translated our society's more enlightened and civilised values into reality. It may not be the perfect organisation but it is an organisation (ie organised), not a free-for-all. Make no mistake, economic events have conspired to give the Tories the opportunity they need to follow their baser instincts and finally destroy this bastion of the post-war Welfare State. It is entirely a matter of ideology. Of course, in the last 63 years the world has changed out of all recognition and I am not arguing for the maintenance of the status quo. However, when you massively reform an organisation which is so fundamental to our way of life, the onus is on you, firstly to demonstrate your case, and secondly to make sure you get it right. The proposed changes are completely untested - a few politically-favoured GPs who have done some pilot work do not amount to sufficient justification for what the Tories are doing. Simply repeating the incantation that the aim is to "improve services" and "deliver both equity and excellence" (The Times, 17 January) does not mean it's going to happen. I can see nothing in the proposals to suggest that the changes will automatically lead to service improvements, nor that equity and excellence will be better served - especially if the committed workforce are not on board and motivated.

Do not believe them that similar schemes have been introduced in the past - in the 1980s, GP Fundholding, for example, was a similarly ideologically driven policy during the Thatcher government, but was so limited in scope (GPs were given small budgets and allowed to buy a number of services such as physiotherapy and counselling) that it bore no relation to what is now proposed. Giving GPs the responsibility for the entire commissioning process makes no sense. Patients want good services where and when they need them. Beyond that the holy grail of patients' choice has no meaning. Most GPs want to be doctors. Simples.
These changes herald the final dismantling of the National Health Service. Instead of a national dimension there will be a collection of fragmented and competing players; the enterprise will attract private institutions making money the primary focus rather than health; and it will no longer be a service in the accepted sense - it will be a business, or rather an array of many small businesses. GPs have always protected their independent medical contractor status, and these changes give every single GP practice the status of a small business.

Possibly the most damning aspect of the changes is that this government has absolutely no mandate whatsoever to do this to our NHS. However, even though Mr Lansley does not know best and does not have the support of the people who use and pay for the NHS, it seems that there will be no stopping him and Mr Cameron from pursuing their destructive policy. "First do no harm" is not a bad maxim.

It appears that I was wrong in my post #3. According to Paul Burstow MP on C4 News the NHS changes were in the LibDem manifesto.

pithywriter- good questions. For a start, the French have paying a lot more tax than the Brits for many years. I'd happily pay more tax. In fact, right now, I'd pay a large sum of money to get rid of the CammyNick's Coalition.

eighty eight - I could give you many, many examples in detail. It sounds to me like your GP is trying to pull the wool over your eyes. Have you asked him exactly what would happen to you when he starts to "commission"? If he's a good GP and he believes you need treatment he will be able to get you treatment under the current system. There is no such thing as "niches" in the NHS. I suspect he doesn't think you need treatment but it is hard to tell from a distance. But please do ask him what treatment you will get if things change.

Doctors and patients work together as ‘co-producers’ of health. Efficiency in health care is therefore a joint effort. My most vulnerable patients need looking after and they choose to see a doctor they know, not a multitude of providers they don't know. Of my last 51 referrals out of 807 consultations over 3 months, not one was interested in provider choice. My patients need a lot more care than patients who are better educated, wealthier, and more secure. Because they do not, cannot behave ‘efficiently’, their GPs and hospitals will appear to be inefficient. And Lansley's market solution for inefficiency is, either to become more efficient, or be closed down or taken over.
For a white paper that promises to put patients first there's been almost nothing about them. Lansley's choice is about market stimulation not clinical decision making. Clinical decisions matter to patients and they depend on a relationship of trust. Something markets are likely to undermine.
Dr Jonathon Tomlinson
https://abetternhs.wordpress.com/

37. lucien desgai

"Why did the Tory manifesto promise no further structural change if Andrew Lansley had spent five years working on such changes?"
... because they were lying.

Dear Eddie,
Please ask Mr Lansley 3 things:
1.If GPs have ordered too few flu vaccines for their patients, what convinces him they can handle commissioning?
2.If he subscribes to the “no decision about me without me” mantra will patients be able to choose whether they have treatment in Primary or Secondary Care? Eg if I have prolonged back pain will I be able to choose to see an Orthopaedic Surgeon rather than a triage physiotherapist?
3.When drawing up these plans did he talk to any hospital doctors? Or even to more GPs than Prof S Field?
Thanks

Oh Mr Lansley, hardly a ringing endorsement is it? I think you've got a lot of work to do here, don't you?

@49 acousticwilli - you are confusing him with someone who gives a damn. Not a single member of the Coalition Collection of Cataclysmic Grunts gives a damn - they are insulated and arrogant.
So, inflation up. Interest rates next.
Anyone else on here remember paying 17% mortgage rates under the last shower of Tories?
Next question for Lansley then: presumably NHS spending will now substantially increase to keep in line with inflation?

Note these weasel words spoken at 17:25 approx on 18th Jan 2011... "that's not my purpose". A bit like " we don't plan top-down reorganisation".
It may not be your purpose, Mr. Paid-by-American-Private-Healthcare Lansley but it sure as heck will be the (un)anticipated effect.
Weasel words.

51. MadnessOfCrowds
Oh yes the Tories are masters of "Weazel" Words.
"We have no plans to ..." or "That is not the intention...." or "Provide the .... to greater competion".

Insert any of the following into the Tory statements above.

Increase VAT, To privatise the NHS, Mortgage market, other statements can be inserted.

Madness - I noted that, too. More disturbingly (imho) was the 'Am I bovvered?' attitude to how these plans are likely to adversely affect those most in need of the services of the NHS.

Disgraceful.

Madness - we've already had this with QoF points. Introduced with laudable aims. I've gone from being "someone with hayfever and a blue inhaler" to "mild asthmatic" because asthma is worth QoF points. Arthritis isn't so my mother wasn't a priority. Meanwhile I'm being called up annually to be told what my inhaler is and how I should use it...

I've also heard a rumour that all of the PCT people locally are being TUPE'ed across to the new commissioning groups so if they're not able to make savings on salaries then where?!

Alyson Pollock is a million times more knowledgeable than I am and has done outstanding research in this area.
Here is her response to the open letter in the BMA. I believe she reveals the subtext of Lansley's public speech.
Allyson M Pollock, Professor and Director David Price, Centre for International Public Health Policy
We also support Clive Peedle's important letter. The Government has signalled the end of universality in child benefits and higher education. There is a serious risk that the same philosophy will be extended to the NHS because current reform proposals abolish the systems and structures that underpin the secretary of state's duty to provide a comprehensive, universal health service. An integrated public health care system is essential for the provision of equal care for equal need. The Conservatives promised before the election to "back the NHS". That promise must not be broken.
You can see it at: https://www.bmj.com/content/342/bmj.d7.full/reply

Note very carefully the removal of the Sec of State's DUTY. Let's not be fooled. Let's stop this duplicitousness NOW!

RxKaren@54 - yes, QoF is a perfect example. And, just to emphasise, I am no supporter of Noo Labour's interventions either. Of course, our old friends from Kaiser Permanente are still hanging around too.
I am more than happy to offer my own time pro bono to help unravel misleading statistics, poorly reported research and misinterpreted 'evidence'. If anyone thinks they can usefully use me, just ask.

And, apologies for @55 - I should have written Allyson Pollock not Alyson.

Well, Well, with the Tories you should always follow the money:
https://www.mirror.co.uk/news/politics/2011/01/19/tory-backers-with-links-to-private-healthcare-firms-give-the-party-more-than-750-000-115875-22859373/

No wonder the Tories are so keen on these changes.

Interesting to hear on WATO that Cammy didn't understand the extent of Lansley's proposed plans - so he's boosting the number 10 staff employed to explain stuff to him. Reminds me strongly of Dubbya's approach - allegedly he used to insist that every policy question was summarised into no more than one paragraph.
Alternatively, Cammy could get OFF HIS WELL-UPHOLSTERED POSTERIOR and do some work - or, admit that he is just not intellectually up to the job.

58 Looter
I think the question is more why the LibDems are supporting these changes (though hardly a question for Mr Lansley). There's no democratic mandate for the reforms and they weren't in the coalition agreement. One LibDem minister claimed on tv the other day that the changes were a part of the LibDem manifesto, but that is clearly an untruth.

60. lucien desgai

The coalition agreement includes this:

"We will strengthen the power of GPs as patients’ expert guides through the health system by enabling them to commission care on their behalf."

It could be argued that this is the central change proposed.

The Lib Dem manifesto includes:

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

And:

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

That may not be exactly what the changes will bring about, but it would not be sensible to claim that there is no relationship between the Lib Dem manifesto and the proposed changes.

Bring back the 'Community Health Council', eh? ;)

60 Sid
So the NHS changes are a victory for LibDem influence within the coalition?

Sid@61, thanks for taking the time to extract those manifesto ideas.
I'm afraid the only justification for supporting would have been a manifesto commitment to wholesale privatisation of the NHS. Anyone who doesn't understand that this is what is happening is allowing themselves to be duped. See my link to Allyson Pollock above.
I am starting to believe that people in this country would not care if Hitler came to power so long as he was wearing a nice suit and had a telegenic smile. If you are not prepared to lie down and ignore it, please go here and sign the petition:
https://www.nhscampaign.org/current-issues-2/e-petition.html

Utterly depressing to hear that clip of Cammy saying that EMAs work (pre-election)juxtaposed to PMQs with him saying they don't. Is he thick or evil or just too arrogant to care?

Thanks for the link, Madness.

61 Sid
These reforms aren't about local health boards or decision making by local democratic bodies. They are about abolishing PCTs and handing £80bn of NHS commissioning to private healthcare companies to spend with other private healthcare companies. They are about introducing european competition law to the NHS, disadvantaging public sector providers and rendering traditional NHS partnerships illegal. Neither coalition party proposed these changes in their manifesto.

64. MadnessOfCrowds

Thanks for the link.

My GP is not part of a group, so how the hell is he going to find the time to manage my health care and the finances when it may involve blood tests at one place and treatment at a hospital far away. He only barely has time to check my blood pressure as it is, let alone listen to my symptoms and work out with me the best place for my treatment.

66. lucien desgai

The Conservative Manifesto has this:

"We are committed to the continuous improvement of the quality of services to patients, and to achieving this through much greater involvement of independent and voluntary providers.

"We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers."

Please note - I'm not saying I agree with the changes (I don't) - but I do think that just dismissing them as not having been in anybody's manifesto/coalition agreement is not really helpful.

In Post 61, Sid wrote:

• "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."

Like Sid, I'm not in agreement with what is proposed but to say it wasn't in the Tory Mainfesto is nonsense.

"We will strengthen the power of GPs as
patients’ expert guides through the health
system by:
• giving them the power to hold patients’
budgets and commission care on their behalf;
• linking their pay to the quality of their
results; and,
• putting them in charge of commissioning
local health services."

70. mittfh

Note - that quote was from the LD manifesto, not the coalition agreement.

This is good, if you haven't seen it yet:

https://abetternhs.wordpress.com/

Re: Post 72 (Sid)

As Eddie will have a very limited time to probe Andrew Lansley with questions on Friday, has anyone got the time / inclination to read the excellent arguments put forward by medical professionals, both here and externally (e.g. the "A Better NHS" blog), and provide a concise summary of them that could be picked up and used in the interview?

The scenario put to Andrew Lansley about "loss leaders" is exactly what happened after bus privatisation where large companies went as far as running free buses to put competitors out of business.

As the onus of these reforms is, apparently, a need to bring in competition, I asked the health dept to show me proof that competition would improve patient quality of care. I was sent references for 3 pieces of what Simon Burns at Richmond House described as research. Only one them contained any research of significance. All they showed was that increasing patients' choice of bricks and mortar lowered waiting times and, therefore, mortality and morbidity stats. Duh. Choice of hospital does not equal competition between providers, as in "any willing provider".
Here's what I have to say about my local set-up -
https://www.thisisgloucestershire.co.uk/news/Stop-NHS-changes/article-3015799-detail/article.html

marytaylor@75. I read your link with great admiration - thank you, thank you, thank you for being a genuine public servant.
It is unacceptable for the rest of us to sit back and not take action. There is absolutely nothing admirable about keeping quiet for the sake of an easy life. EVERY freedom that we regard as precious in this country was fought for by people who made themselves irritating, obnoxious and often threatening to the powerful of the time. We have great challenges today: to counteract the BS of the superficial (my generous version); to destroy the pernicious, duplicitous intent of the lazy, moronic Entitled "Aristocrats" who wish to exploit the people who actually work hard and contribute to society; to build a genuinely better future for our children and other people's children.

75. MaryTaylor and 76. MadnessOfCrowds

I would also like to thank you for your comments and link.

Thank you also MadnessOfCrowds for your comments.

75. MaryTaylor

Did you see Simon Burns on Newsnight? Utterly incapable of explaining why the new set-up would be of any benefit to a patient presenting with cancer to his GP. He's learnt the soundbites, but he lacks any understanding.

There seems to be little difference between New Labour and the Tories with respect to the direction that the country is being taken in. This is not just with respect to the NHS but in other areas too. I have a suspicion.

That suspicion is that the same Management Consultants and Lobbyists have access and for their own self serving interests persuade Governments that re-organisations involving more (usually foreign I suspect) private providers are a good idea.