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Betting the NHS

Nick Robinson | 11:35 UK time, Monday, 17 January 2011

The prime minister told the Today programme this morning that he hadn't taken a bet in years. Maybe not with his own money but he's proving to be quite a gambler when it comes to using taxpayers'. A man once attacked for his political caution has not just created the first peacetime coalition since World War II committed to the biggest austerity programme in decades. He is now embarking on the most ambitious proposals to reform public services seen in years.

A surgeon and operating team

 

This morning he argued that he had no choice since "doing nothing could end in tears" - producing a financial "crunch" in two or three years' time. David Cameron insists that "modernisation" is not just about value for money but also about better service given the fact that survival rates for cancer and heart disease are lower here than in other European countries. He had, he said, learnt from previous PMs - for which read "Tony Blair" - who had wasted their early years in office.

Much debate on this government's NHS reforms has focused on the complex detail - abolishing Primary Care Trusts (which few people have heard of, fewer understand and fewer still care about) and giving the £80bn they spend to GPs. Some have focused on whether the Tories have misled people by promising no "top down reorganization of the NHS" while appearing to do just that. (although this article by an editor at the British Medical Journal backs the government's claim that the reforms were well trailed before the election and are an evolution of changes made by the last Tory and Labour governments.)

More important, in my view, is the philosophy - or ideology if you prefer - underlying these proposals. David Cameron made clear his view that "Choice, competition and diversity drives up standards." That is his gamble. He is counting on groups of GPs to drive down management costs and - often in partnership with private companies - to drive a harder bargain with hospitals. He believes that increased patient choice will lead to higher standards.

His critics claim that costs will actually increase as the newly created NHS bodies want their own buildings, logos and well-paid management and as the system has to keep up with new more complex accounting procedures.

All this happens at a time of an unprecedented squeeze in the NHS finances. The budget may be increasing in real terms (just) but to do so the NHS has to find £20bn in efficiency savings. Compare this with Margaret Thatcher's period in office. She was attacked for cutting the NHS but its budget increased on average by 4.3% in real terms year by year.

Now her successor's taking a gamble she never dared to take.

Comments

Page 1 of 3

  • Comment number 1.

    Okay, BBC, don't bother with any of the other arguments that we are already spending as much of our GDP as other nations but getting worse outcomes, so the real issue is we should start getting better value for money.

    Just carry on spinning the labour party line.

    It's grim up north London...

  • Comment number 2.

    A dishonest policy which will have the NHS in turmoil for years.

    The NHS is heading for a very tricky time due to tory stealth cuts. At the same time as they tout localism they then impose the biggest top down re-organisation the NHS has ever seen, against the wishes of every major medical and health care organisation.

    This has little to do with local needs or efficiency.

    How convenient for the tories to be able say 'nothing to do with us, ask the local GP consortium' as a response to every disaster.

  • Comment number 3.

    "Now her successor's taking a gamble she never dared to take."

    What an odd thing to say. You are implying that Mrs Thatcher WANTED to cut the NHS yet you admit she increased spending year on year by 4.3% in real terms. What is you basis for saying that Mrs T wanted to cut the NHS?

    You're also saying that Cameron is taking a 'gamble' with increased spending and wanting increased efficiencies. You make it sound like he's doing something bad.

  • Comment number 4.

    I think the 'gamble' is trying to reform the ridiculsouly inefficient bureacracy of the NHS in one fell swoop. The NHS is huge! It's one of the largest organisations in the world. Unfortunately it just isn't possible to dramatically cut funding and expect the NHS to become more efficient overnight (or over the next year or even over the next 4 years)

  • Comment number 5.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 6.

    Lest we forget WHY there is the need for the " austerity " measures ,let us all ,including the well paid in the media,remind ourselves of the last thirteen years and just which party held the purse strings and just which party sent our troops off to bomb a country back into the middle ages on a big fat LIE.
    Then let us indulge in speculating what those in oppositon now, would be doing to save the country from bankruptcy.
    I have heard the noises off made by the ex chancellor on how "cuts would have to be greater than those of Margaret Thatcher" but somehow those are forgotten by a complicit media and not even Mr Marr bothers to question the oppositions position.
    So perhaps Mr Robinson ,you could attempt to ascertain, on behalf of the great unwashed ,just what exactly Labour plans to do - should the great unwashed suffer from the media imposed amnesia and vote Labour next time?!

  • Comment number 7.

    Can you ask the PM "Should patients ask a GP when recommended a NON NHS service 'Have you received gifts from them?'"

  • Comment number 8.

    You are cheeky, Nicholas...

    "...that he hadn't taken a bet in years. Maybe not with his own money but he's proving to be quite a gambler when it comes to using taxpayers'."

    Conjecture. Pure conjecture.

    "A man once attacked for his political caution has not just created the first peacetime coalition since World War II committed to the biggest austerity programme in decades. He is now embarking on the most ambitious proposals to reform public services seen in years."

    I carry no card for Cameron, but dont all incoming governments do this? Seek to reform services in their own image?

    A speculative comment.

    "This morning he argued that he had no choice since "doing nothing could end in tears" - producing a financial "crunch" in two or three years' time. David Cameron insists that "modernisation" is not just about value for money but also about better service given the fact that survival rates for cancer and heart disease are lower here than in other European countries. He had, he said, learnt from previous PMs - for which read "Tony Blair" - who had wasted their early years in office."

    Again, are you implying he shouldnt be doing this? Leave it as it is, keep on pouring billions in, and continue to put up with diagnostic and survival rates that are, considering the expenditure, embarrassing? Not to mention the fluff-up over flu jabs and people still being exposed to the risk of MRSA, C-diff, et al? Dont you think we deserve better considering how much this leviathan costs?

    "Much debate on this government's NHS reforms has focused on the complex detail - abolishing Primary Care Trusts (which few people have heard of, fewer understand and fewer still care about)" - more fool them, ignorance is no excuse - "and giving the £80bn they spend to GPs."

    "Some have focused on whether the Tories have misled people by promising no "top down reorganization of the NHS" while appearing to do just that. (although%20this%20article%20by%20an%20editor%20at%20the%20British%20Medical%20Journal%20backs%20the%20government%27s%20claim%20that%20the%20reforms%20were%20well%20trailed%20before%20the%20election%20and%20are%20an%20evolution%20of%20changes%20made%20by%20the%20last%20Tory%20and%20Labour%20governments.)"

    Right... so who are the "some" then, flying the "Misleading" flag? Oooh, let me guess...

    "More important, in my view, is the philosophy - or ideology if you prefer - underlying these proposals. David Cameron made clear his view that "Choice, competition and diversity drives up standards." That is his gamble. He is counting on groups of GPs to drive down management costs and - often in partnership with private companies - to drive a harder bargain with hospitals. He believes that increased patient choice will lead to higher standards."

    Right. At last we get to the point. And he'll have to stand or fall on that, as well as a great many other things. One thing's for sure. Apart from the shiny new PFI'd buildings, I would venture that the distance we have travelled, the "improvements" we have seen are nothing like at all in proportion to the amounts spent over the last decade. My stepfather is still having to wait until February for a hernia repair. My brother in law was killed by MRSA. Another brother lost his life due to a misdiagnosis of a grumbling appendix at an A&E department that led to fatal peritonitis within 48 hours.

    "His critics claim that costs will actually increase as the newly created NHS bodies want their own buildings, logos and well-paid management and as the system has to keep up with new more complex accounting procedures."

    Which I have no doubt that if the boot were on the other foot that Labour would have quite happily have given them. It is upto the coalition to resist such frippery. Given that all three main parties are largely cut from the same cloth, I somehow doubt that it will happen. But for you to use this as a stick, attributing it to un-named "somebodies" is a bit weak. If its your opinion for gods sake man, just say so.

    "All this happens at a time of an unprecedented squeeze in the NHS finances. The budget may be increasing in real terms (just) but to do so the NHS has to find £20bn in efficiency savings. Compare this with Margaret Thatcher's period in office. She was attacked for cutting the NHS but its budget increased on average by 4.3% in real terms year by year. Now her successor's taking a gamble she never dared to take."

    Ah, the Gargoyle of Grantham gets dragged out of her crypt yet again, to be waved like a corn-doll in front of the frightened, simple natives. Just to make sure the message gets through, eh? Sheesh....

  • Comment number 9.

    Can anyone see the synergy here: Chamberlin (Peace in Our Time), Cameron (NHS Safe in Tories hands) PS Don't get sick, old or unemployed in good ole' UK. We are heading towards the USA template for a great many things! And the DEM part of the CONDEMS will play their parts well!

  • Comment number 10.

    I've just thought of something else Nicholas...

    "She was attacked for cutting the NHS but its budget increased on average by 4.3% in real terms year by year."

    Kind of makes the "Twenty four hours to save the NHS" soundbite of 13 years ago ring a little hollow, doesnt it? Arent you guys always trotting out how She-Who-Must-Not-Be-Named was responsible personally for the slaughtering of all first born's north of Watford and personally responsible for the savaging of the NHS?

    Lies, damn lies and statistics, eh?

  • Comment number 11.

    There is a simple reason Mrs Thatcher didn't try to reform the NHS: the British people were in a state of emotional utopia about it. Wrongheadedly, perhaps, but none the less strong for that.

    The NHS has had an unprecedented amount of money thrown at it in the past decade, which has reduced waiting lists, built new hospitals, mostly at high cost on PFI which will be sucking money out of front line treatment for decades to come and on increased salaries. The brutal facts now? Either large cuts happen elsewhere, or the NHS needs to change. Because this country can't afford the price any more.

    Mr Cameron's Coalition is proposing an organisational restructuring, when what is, in my opinion, required is a fundamental cultural change in the NHS. Doctors are smug and self-satisfied social climbers far too often in my opinion. And they live like Kings in their Castles, expecting to be deferred to far too often. The public won't wear that any longer.

    What I see is a shift from SHAs to GP coalitions and I really do question what that will achieve. It'll make a few GP coalition managers rich, for sure.

    The more important question is whether it will actually improve patient care in a financial sense.

    It will all depend on whether the NHS is moving toward a profit-driven organisation or not. If it is, you will see focus on services which make a profit, not those which benefit health. If not, then you may see some genuinely visionary new managers improving local responsiveness radically.

    I don't know which will happen, perhaps a bit of both will happen, but the NHS can't go on the way it has been. And that's final.


    Because doctors are not superior beings, and the culture of the NHS has manifested a false sense that they are.

    They chose to work 120 hours a week. And they are free to do something else if they don't want to. But they refuse to, so they trash others who see through their control freakery and choose a different lifestyle.

    Working 80 hours a week doesn't abrogate from doctors the requirement to behave with decorum outside of work. But they think that it doees.

    Refusing to do private work 'on principle' doesn't grant the right to doctors to stop others earning more money than them. But cryptofascist doctors think that it does. Trust me, I know.

    Refusing to register with Arsenal FC for Club Level tickets doesn't grant them the right to muscle in on the tickets of others. But cryptofascist doctors think that it does. Trust me, I know.

    Paying £500pcm for a luxury 2 bed apartment in Hampstead does not grant doctors the right to tell others who pay their way where they can live in this country or anywhere else. But cryptofascist doctors think that it does. All it grants them is a visit from HMRC for tax evasion........but when their landlady is a retired FCO spook, it's unlikely to.

    Expecting others to be their free ski guide is not part of the social contract of the NHS, any more than 20 year campaigns to destroy all independent activities of members of society is. But cryptofascist doctors think that it does/is. The only thing it entitles them to is a disciplinary hearing from the GMC, which the mafia of medicine would refuse to undertake as too much disgusting behaviour of senior doctors would be exposed if they did.

    Spying on others, whilst expecting to steal all IP from scientific researchers for their own benefit, is not acceptable behaviour by consultant doctors, but the fascists amongst them think that it is. A root and branch expulsion of all doctors who work for MI5 and MI6 is what is required as such doctors use emotional thuggery to break the spirits of people who refuse to bow to their fascist wills. I'm sure the health outcomes of that are entirely inconsistent with the Hippocratic oath.........and it is time that the BMA, GMC and all the Royal Colleges were regulated in a manner which requires that to take place........

    I hope you are beginning to understand the sorts of root and branch reforms of the NHS which are required.

    They must face up to doctors who don't believe in healthy human beings, they believe in crushing and controlling.

    They must face up to doctors who cannot allow independent will to thrive.

    And they must face up to doctors for whom spying and bullying is more important than the emotional health of others.


    In other words, the NHS is completely sick at its core.

    And until this country both faces up to that and gets rid of the canker, then this country's health will remain as poor as it is.


    Not very PC to say all this, but absolutely imperative for the future health of the nation.

    Sad, isn't it????

  • Comment number 12.

    Cameron and Lansley are taking the NHS into to privatisation. They are radicalising and extending a process managed by the Labour Government where micro privatisation of auxiliary services and the creation of foundation trusts provide the platform for the Tory onslaught. Bureaucracy- just wait until the GP's start constructing their consortia (PCT's II) and filling posts with either themselves or recycled PCT management and paying inflated salaries and bonuses. Just remember where with GP's we are staring from - £100K pa to write prescriptions for the worried well and the walking wounded.

  • Comment number 13.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 14.

    I come into contact with NHS consultants in all disciplines on a frequent baisis. All of them think that the NHS needs reform yet, I have not heard one that thinks these reforms are the right ones and will deliver the savings the Government wants.
    Their views to a person are that this will lead to a huge increase in private practice because waiting lists will rise and go back to where we were under the Major government. All of them feel that there will be huge business opportunities for Doctors in private practice. Thus those people that can afford it will have really good care -those that can't will just have to wait their turn.
    From a business perspective no large company saves money by decentralising purchasing -just the opposite in fact. I think the getting rid of the PCTs will prove to be a costly mistake. Private companies will set up loss leaders with GPs to see off the competition then increase fees -this is how business works and if DC and GO had real business experience they would know this.

  • Comment number 15.

    Back in the 80's a particular northern town had one health authority running the two general hospitals, the ambulances, the mental hospital and everything else. They had a chief exec, director of finance, director of HR etc etc

    Then the tories brought in 'purchaser/provider.'

    Now the same town now had an "NHS trust" for each of the general hospitals, the ambulance service, the mental hospital and the community services. They also had a purchaser - the health authority - giving a total of 6 organisations. Each of the 6 organisations had a chief exec, director of finance, director of HR etc A whole army of lesser bureaucrats had to be set up to account for the shuffling of dosh between all these new organisations. All these staff then spent endless hours setting up meetings so that they could 'work in partnership' to solve the real issues of patients which often involved more than one of the trusts. They even set up yet more organisations to help coordinate the working together on specific projects.

    Since then we've had fund-holding GPs, strategic health authorities, primary care trusts etc etc - all adding to the bureaucratic frenzy generated by splitting one NHS into ever more seperate organisations.

    Now the tories want to replace 150 PCTs with up to 500-600 GP run consortiums. Unless you want your GP spending all day with their head down over a budget spreadsheet or typing up a service level agreement then each one of these will need it's own army of bureaucrats.


    This one has echoes of the so called 'bonfire of the quangos' - the disruption is obvious but will it actually save money? Or cost even more?

  • Comment number 16.

    "...Paying £500pcm for a luxury 2 bed apartment in Hampstead...'"

    Blimey, thats a bargain. I had to pay 600 a month for a one bed flea-pit in Chesham. Thats the bargain of the century.

  • Comment number 17.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 18.

    Quite right Nick.

    Cameron is gambling with our lives and wellbeing as he will not be on the receiving end when it goes wrong - being a multi millionaire he can buy in what he wants.

    He also ignores the huge costs of making the changes, making people redundant. The new GP led organisations will require staffing with managers and accountants to make them work - all of which costs money.

    In view of their unquestioning support isn't it time the Liberal Democrats renamed themselves Liberal-Conservative as they did in the 30's whilst supporting a Tory regime?

  • Comment number 19.

    11 rjaggar

    There is a simple reason Mrs Thatcher didn't try to reform the NHS: the British people were in a state of emotional utopia about it. Wrongheadedly, perhaps, but none the less strong for that.

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>.

    This is very true and some politicians use it to prevent rational debate about healthcare in the UK. This is the reason why we are seeing policies which have not been debated in public during the elction.

    You know the sort of thing:

    "...dismantle the NHS.."
    "...privatise the NHS.."
    "...NHS in turmoil.."
    "..the poor won't be allowed to get sick.."

    I wonder which party prefers this type of approach to a rational debate on the subject?

  • Comment number 20.

    Nick spot on -

    If we ignore the typical right wing zealots on this blog.

    The point you make is really good.

    Camerons massive gamble is almost certain to fail. Leaving aside the fact that he lied about not reforming the NHS, or whether it is needed or a good thing, or just about free market anarchy -


    This is a gamble because he expects there to be no unfortunate mistakes - embarrassing anomalies etc when the conservatives are transferring 80bn of expenditure in a very short period of time, to multiple consortia. Any decent management consultant will tell you mistakes will be made.

    Camerons big error is now he has backed it he is closely associated with it - he has no distance, he has no one to fire- but himself.

    This was not in anyones manifesto they have no right to do it we really should call an election.

  • Comment number 21.

    the NHS is by far the biggest drain on public money in the UK today. It has long enjoyed protection as an electoral tool as our MP's must say the correct thing about the NHS as it falsely put forward as some kind of 'jewell' of British society and the envy of other nations around the world. Let's all stop reminiscing about good old blighty and acknowledge the NHS drains money faster than a Northern Irish Water Authority loses it's H2O. A complete overhaul is long overdue and this comfy existence that elements of the NHS enjoy require a real shake-up.

  • Comment number 22.

    It has always struck me that every time Mr Robinson posts anything remotly critical of David Cameron a wave of tories come out to accuse not only him but the whole of the BBC of labour bias. I would refer these people to the excellent bio of Mr Robinson in wikipedia which begins.......Nicholas Anthony "Nick" Robinson (born 5 October 1963) is a British journalist and political editor for the BBC. Robinson was interested in politics from a young age, and went on to study a Philosophy, Politics, and Economics degree at Oxford University, where he was also President of the Oxford University Conservative Association... Does not sound like the history of a rampant leftie to me. There is of course another reason why people may question tory policy, it could be maybe...just maybe... like the poll tax, they have got this one wrong and all those professionals from many disciplines who have dedicated their lives to the NHS are correct.

  • Comment number 23.

    The NHS definitely needs reform but it is going to be a massive task considering the number of people who will oppose these due to "vested interests". It is as bad as Whitehall in embracing change and efficiency. I like the principle of putting GPs in charge but I do think some will be better than others. Every reform that has taken place from GP fundholding in the 90s and then Primary Care Trusts under labour have carried their own spin then the other lot get in after 5 or 10 years and change it all again. If it leads to less beaurocracy and better outcomes as Cameron says then all credit to him. It will depend on how many of the health professionals get on board as to whether or not it will be successful. In the meantime I think we will maintain our private health insurance.

  • Comment number 24.

    Stop wasting money on managers for every department.
    Go back 30 years to when Matron was in charge. The NHS was an Institute of excellence. Now it is second rate to most of the worlds medical institutions.

    It was like a army base.

    GP's cannot run the NHS, why? Because nowadays you can't make an appointment, you have to phone up and hope you get lucky that a GP is actually working that day. If they can't run their own practices, how the hell are they going to run the NHS?

    Mr Cameron has obviously not seen how the NHS runs for us Joe Bloggs.
    People dying through poor care, very poor food. I have seen how life is on the inside for over 22 years, it is far from safe and if Mr Cameron thinks this reform is going to change anything, he is a complete idiot.

    Nursing used to be a vocation, now to many of them, it's just a job.
    How sad is that!

    We don't need outsourced companies giving advice, we don't need outside companies delivery frozen food to be reheated for patients.

    We need an NHS that has the same social care & attitude it did 30 years ago. until that is in place nothing will change.

    The lack of trust between a Doctor & patient has dropped by 50% according to some reports.
    Elderly patients mistreated, left to fall out of beds and hurt themselves or even worse die.

    Wake up Mr Cameron, come with me on a walk though the NHS in the real world. You will not see the pretty image you paint of it's future. Not until you go back to the past when it meant something and start fixing the problems that affect patients every day.


  • Comment number 25.

    I'm a little alarmed at the number of accusations of a 'pro-labour' line from NIck. One has to quite straightforwardly read the wikipedia article of 'blue Robbo' to see that he is actually taking the line that makes the BBC what it is, a line critical of the current government. If you don't like his approach, read another blog.

  • Comment number 26.

    14. At 12:45pm on 17 Jan 2011, wirralwesleyan wrote:

    From a business perspective no large company saves money by decentralising purchasing -just the opposite in fact"

    Unfortunately, the problem with the NHS is that it's so big. This means that they have to have suppliers who can deal with that size of customer. There are VERY few of those, and most of those suppliers know they have a virtual monopoly on this scale of customer, so they overcharge and give poor advice & service.

    Once you start splitting the NHS up, then suppliers are easier to find, so while a smaller company will have no chance supplying an organisation with over a million employees, it can reasonably supply an organisation with a thousand or so employees. More choice of suppliers (should) increase competition, bringing down supply costs and improving the quality of the supplies.

    This is why you hear the stories of expensive laptops and paperclips in the public sector.

    (FWIW, the same applies in other public sector organisations - we recently had someone contact us to see if we were willing to supply IT support services to schools - we were, until they said 'you need to support all of your region's schools'. As a small company we could easily provide good support to the 5 or 6 schools around us and would have been cheaper than the big companies, but asking us to support hundreds of schools puts it way out of our league. It wouldn't have been hard for schools to be given the details of a local support company, but they wanted a single company to support everyone).

  • Comment number 27.

    If the NHS are delivering worse outcomes for the same amount of money when compared to other nations with similar demographics then it seems logical that something needs to change/improve. I don't profess to be a NHS expert so can't comment on whether these changes are the right changes.

    The coalition has at least protected the NHS from the level of cuts seen in other departments. Labour has previously stated that the NHS would not have been ring-fenced. It is not surprising that the unions are anti, they are anti-change and live in a parallel universe of make-believe.

  • Comment number 28.

    Nick Robinson's figure of 4.3% growth under thatcher might be using the GDP deflator. This article from York University suggests that growth in NHS budget under Thatcher was only 1.5% per year if the specific costs inflation in the NHS is taken into account:

    http://ideas.repec.org/p/chy/respap/113chedp.html

    I recall that for many years under Thatcher it was less than 1% in real terms. I also think most voters that deserted John Major did so because they recognised the need to spend more on public services. This may happen again at the next election.

  • Comment number 29.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 30.

    3 Andy

    It doesn't imply anything of what Thatcher wanted to do but gives the actual facts of what she did do i.e. increase the spending on the NHS in real terms every year.
    This is at odds to the perception which remains especially for the left that she actively sought to destroy the NHS but cutting it to shreds, it is a provable fact that she did not actually do this - she did not increase the budgets to match the increase in medical (as opposed to national) inflation or cover the increased demand as we lived longer and new technologies came along.

    Actually repeating the facts to me tends to negate the myth that still remains a feature of the less enlightened lefts rants on the NHS topic.

    I think it fair comment to highlight that this is very much a gamble - medical inflation (caused by increased demand due to age, new drugs and procedures for currently untreatable or poorly treatable conditions etc.) typically runs at significantly higher than the headline inflation rates by which the budget has to increase to meet the real terms increase (stupidly) promised by Cameron. The scale of efficiencies required even with the planned increases are truly monumental 20billion or 20% ish of the current budget in effect.

    The public have a very high opinion of the NHS and change to anything is a risk - politically if the service is percieved to have got worse even if factually or demonstrably more money is spent or outcomes improved, then it is a political problem. Which returns to Thatcher - she spent more and is still widely held to have committed wholesale destruction upon the service. A risk Cameron has now taken on.

    May he have success where others have not.

  • Comment number 31.

    Well, the NHS has to change. The problem is that people have been spoilt by an NHS which is unaffordable and has been paid for by investment companies in China and elsewhere. So, any attempt to bring it back to a realistic level will be met with cries of 'dismantling the NHS'.

    In my view, the NHS service desperately needs to be cut back. No more 'lifestyle' treatments for 'free'. Start looking at what is 'needed' and what is 'nice to have', and treat them differently.

    Also, the NHS should start providing 'premium' services at an extra cost, and even possibly have their own premium health insurance scheme. (While some would scream about that, any profits would go back into the NHS funds rather than a shareholder's pocket)

    I'm not sure that the proposed way is the right way, but I'm not sure what is. All I know is that Labour's way over the past decade has been the WRONG way (throw more and more money into the bottomless pit).

    A big problem with trying to increaase competition within the NHS is that it's not that sort of organisation (like utility companies, rail companies etc). The only competition there could be would be between NHS and private treatment, and that doesn't work at the moment because the NHS don't lose out if someone goes private.

  • Comment number 32.

    Fubar @ 8 wrote:
    "I carry no card for Cameron …"


    >>

    Good one.

  • Comment number 33.

    20#

    If only it was possible to ignore the left wing shills...

  • Comment number 34.

    hopefully this 'gamble' will be more succesful than that of the last government when gambling on the price of gold (or mine on the outcome of yesterdays football)

  • Comment number 35.

    The PCT I work for as a nurse have given 200 of us our redundancy notices, how many are managers? Only 3, about 40 are admin & clerical, and the rest are Nurses, OT's & Physiotherapists.

    Rightly or wrongly this is privatisation by the backdoor, the problem I see is that the public are being sold a vision of an NHS being liberated from the shackles of beuracracy, however who decides where savings and efficencies are to be made? The beuracrats of course. Who pays the price? The health professionals and more importantly the public.

    I don't agree with this governments policy on the NHS reform, but they are the ones democraticlly elected, and ultimatley will live or die by the decisions they make. However once the NHS has been privatised, their is no going back.

  • Comment number 36.

    25#

    Like he was always very critical of the previous incumbent wasnt he?


    (JOKE!)

    Why should we go and read another blog? We're licence payers. We pay for it. We fund the lunches with Eric Pickles and others. Why the hell shouldnt we make our opinions known, just because they dont suit you?

  • Comment number 37.

    Harry @ 25

    The right-wingers on this blog always moan about BBC bias. It's more of an involuntary noise than an opinion - like football managers moaning that the ref was against them.

  • Comment number 38.

    22#

    Quit making excuses for him. He's big enough to stand up for himself. He's about as Conservative as John Bercow is.

  • Comment number 39.

    11. At 12:39pm on 17 Jan 2011, rjaggar wrote:
    There is a simple reason Mrs Thatcher didn't try to reform the NHS: the British people were in a state of emotional utopia about it. Wrongheadedly, perhaps, but none the less strong for that.

    ==============================

    Mrs T did try to reform the NHS - she pioneered the internal market model which because it was done internally and privately did not work as intended. Just began the process of adding the layers of bureaucracy now widely derided.

    The public is wrongheaded about the NHS, you are correct I believe. They believe that the vast resources committed to it are sustainably earned as a nation - sadly this is not the case, it has been bought and maintained on tick by successive governments and through collective failure to grasp the nettle that the whole entitlements culture prevalent in our nation is unaffordable currently.

  • Comment number 40.

    Isn't the problem with all of this that private companies will cream off the easy and profitable stuff leaving the tricky costly procedures to the NHS and the latter may then disappear as the NHS is unable to fund them due to losing out to private companies who are undercutting them on the former.

  • Comment number 41.

    I am far from convinced that GPs are the right people to be commissioning health services. When getting a 5 minute appointment can be a major issue, and misdiagnosis is not uncommon, why should one trust them to make a decision on something as complex as competitive commisioning of services for a diverse patient base. Is this skill to be added to their specialist training, or is the function to be passed to managers on their behalf? I am sure I am not alone in receiving a variety of levels of service from GPs. I would much rather attention was paid to improving this level of medical care than giving them an additional role in order to satisfy some as yet unproven political strategy.

  • Comment number 42.

    Every Government of recent years has struggled with the problem of the NHS. It has lost its original purpose, which was to prevent people dying from illnesses which could have been prevented, if proper care was available. Now everyone, from those with a sore thumb, dislike of how they look, wanting to have children they cannot have in the normal way and those who have contributed nothing to the system, can use the NHS. If this was not the case and the population of Britain had not risen so high, it may have been a manageable service, as it is, it is not. Therefore drastic change is needed. You can tinker, as the Coalition is about to, but until the public accept that some kind of private service needs to be set up, that is all Government will ever do.

    If I had been the Coalition, I would have encouraged through tax breaks for companies and for the better off people, to use private health care, thus lifting some of the burden from the NHS. At the moment this is a taxed benefit. This of course would only be a temporary measure. Some agreement has to be reached between the public and Government that the NHS can no longer go on like this, it is unaffordable.

    At the moment the NHS and GPs serve some of the public well, but most of the population badly, especially those with serious illnesses and the elderly.



  • Comment number 43.

    "David Cameron made clear his view that "Choice, competition and diversity drives up standards.""

    Doubt it - just means money talks.

    More resource devoted to Lucinda's bunion than to Doreen's hip replacement.

  • Comment number 44.

    You're right about PCTs, the only time they're visible is when something goes badly wrong like Stafford. So instead of PCTs we will have GP consortia, what's the betting that it will be the self same managers hired to do the same job on the same outlandish salaries that they had as PCT managers only this time as the consortia managers.
    Regards, etc.

  • Comment number 45.

    Whistling Neil @ 39
    They believe that the vast resources committed to [the NHS] are sustainably earned as a nation - sadly this is not the case.


    >>
    The total cost of healthcare has to be met somehow. If it isn't through general taxation, then it will be through insurance premiums, with the worse off penalized twice - firstly because they struggle to afford the insurance, and secondly because their overall health is worse.

  • Comment number 46.

    Sagamix @ 43

    Your comment hasn't cleared yet, but … bang goes your New Year's Resolution. Still, 17 days is pretty good.

  • Comment number 47.

    37. At 2:06pm on 17 Jan 2011, pdavies65 wrote:

    Harry @ 25

    The right-wingers on this blog always moan about BBC bias. It's more of an involuntary noise than an opinion - like football managers moaning that the ref was against them.
    -----------------------------------------------------------------------

    On the contrary, dear chap, that would suggest it is institutionalised. If it was possible for the Met to be "institutionally racist", it is certainly possible for the BBC to be institutionally biased...

    "But we were not just anti-Macmillan; we were anti-industry, anti-capitalism, anti-advertising, anti-selling, anti-profit, anti-patriotism, anti-monarchy, anti-Empire, anti-police, anti-armed forces, anti-bomb, anti-authority. Almost anything that made the world a freer, safer and more prosperous place, you name it, we were anti it."
    Antony Jay, Telegraph, July 2007

    "..the final answer, frankly, is the vigorous use of state power to coerce and repress. It may be my Presbyterian background, but I firmly believe that repression can be a great, civilising instrument for good. Stamp hard on certain 'natural' beliefs for long enough and you can almost kill them off."
    Andrew Marr, The Guardian Feb. 1999

    "But the bigger question is whether the BBC itself has a future. Working for it has always been a bit like living in Stalin’s Russia, with one five-year-plan, one resoundingly empty slogan after another. One BBC, Making it Happen, Creative Futures, they all blur into one great vacuous blur. I can’t even recall what the current one is. Rather like Stalin’s Russia, they express a belief that the system will go on forever."
    Jeremy Paxman, The James McTaggart Memorial, 24th August 2007


    "The BBC is not impartial or neutral. It's a publicly funded, urban organisation with an abnormally large number of young people, ethnic minorities and gay people. It has a liberal bias not so much a party-political bias. It is better expressed as a cultural liberal bias",

    Andrew Marr Oct 21st, 2006.

    "It's not a conspiracy. It's visceral. They think they are on the middle ground",

    Jeff Randall former BBC Business Editor, Jan 15th, 2006.


    "People who know a lot more than I do may be right when they claim that [global warming] is the consequence of our own behaviour. I assume that this is why the BBC's coverage of the issue abandoned the pretence of impartiality long ago",

    Jeremy Paxman, Media Guardian, Jan 31st, 2007.

    "I do remember... the corridors of Broadcasting House were strewn with empty champagne bottles. I'll always remember that"
    Jane Garvey

    BBC Five Live, May 10th, 2007, recalling May 2nd, 1997.

    "We need to foster peculiarity, idiosyncrasy, stubborn-mindedness, left-of-centre thinking."
    Ben Stephenson, BBC Drama Commissioning Controller, Guardian, July 16th 2009

    Enough examples?

  • Comment number 48.

    What is the labour plan?

    On anything?

    On the deficit there is no plan. On education they ruined standards with twice as much money. On health they showered it with cash but clinical outcomes have fallen below our developed world peers.

    All this bunkum about what great things they did. They did absolutely nothing or made things worse almost everywhere at a time of abundant cheap money.

    Listening to the BBC and Miliband banging on about the same tired old stories is just showing their utter failure to recognise defeat and move on.

    Read this:

    http://www.thisislondon.co.uk/standard/article-23914724-ed-miliband-is-wooing-us-in-earnest-but-does-he-have-a-plan-yet.do

    Ed Miliband hasn't a clue what he would do or how he would pay for it.

    And Alan Johnson appears to have the numeracy of a five year old child.

    We are in a mess. A newlabour mess. It needs to be sorted out and all the BBC can do is sit on the sidelines and carp. If it's so easy to carry on the way we were why did we have to stop? Labour were already cutting NHS spending way before the election..ask anyone who works for it.

    But I suppose for now we have to endure the tiresome attempt to resurrect the labour dialogue (monologue more like) suggesting that 'things can only get better' I suppose they are right in a way - but under four more years fot he coalition.

    It's grim up north London...

  • Comment number 49.

    If you 'listen-again' to the interview it is clear to me that John Humphrys needs to shup-up and allow the Prime Minister to answer. Being Devil's Advocate is all very fine, but I'd like to hear more of the PM and rather less of JH.
    Why do the BBC keep mentioning Thatcher? The Left have demonised her to such an extent that anyone under the age of 30 could be forgiven to believe we lived under a dictatorship during the late 70's & 80's.
    She won 3 general elections and set-up a fourth. You may disagree with her politics, but she had a mandate.
    She has also been out of office for over 20 years, it is time to move-on Nick et al and stop re-writing history from a left perspective.
    Now the NHS - the general reporting of this institution by the BBC is anti-democratic. Any sort of reform, be it Labour, Liberal or Conservative has to get pass the cries of "they're dismantling our beloved NHS for a system similar to the USA's".
    Hopefully this coalition Government is brave enough to continue with their reforms - because reform is needed to save the NHS in the long run.
    The BBC needs to step back and remember that it is not a 'political party' - it is there to report and encourage debate.
    Stop setting the agenda wrt the NHS.

  • Comment number 50.

    "Choice, competition and diversity drives up standards."

    Apply that to the labour market, and it's an eloquent argument for an open-door approach to immigration.

  • Comment number 51.

    Fubar @ 47
    Do you have those comments printed out and taped to the wall in your anti-BBC control room? And a notice saying "Caution! This is a tin foil hat area"?

  • Comment number 52.

    I've recently seen a recruitment advert for a Finance Director at a Social Enterprise set to take over commissioning for a budget of £55million. Salary offered £100k,but the employee structure shows another 5 directors at this level plus a CEO. That is approx. £1million in salaries which equates to approx £1.2 billion on directors salaries just for starters.Then add recruitment costs, new IT, new offices etc. etc. there'll be very little left over for health care.

    Change costs BIG money so why in this age of austerity?

  • Comment number 53.

    The Tories plans to 'improve' the NHS are nothing of the sort, they are privatisation by the front door. The NHS is not broken and doesn't need fixing and Cameron's call for urgency is simply more Tory scare propaganda to slag off the NHS so that it can be handed over, in all but name, to the American and other corporations who have been itching to get their greedy, grasping, profiteering hands on it.

    Any organisation the size of the NHS can always be improved, which was exactly what Labour's investment in it was doing. The vast majority of patients who have used the NHS in recent years will confirm that the service and treatment they have received is light years ahead of that when the Tories almost destroyed the NHS when they were last in power. A prime example is hospital cleaning, which was handed over to the private sector and as a result, the hospitals became dirtier and dirtier with many patients losing their lives as a result of MRSA.

    Those who know the 'nasty party' of old can expect this sort of behaviour from them but the Libdems ought to be ashamed of being part of this Demolition Government which is about to decimate our public services, including the NHS, for purely ideological reasons.

  • Comment number 54.

    I have listened to David Cameron’s interview on the BBC this morning. His forthcoming speech comes as NHS reform plans for England face increasing criticism from medical groups, not least Nick Robinson.
    My and my wife’s experience of the UK National Health Service, compared with service received in Australia and Norway during two holidays in the past 6 years fully supports an urgent need for change.
    Our experience shows this country is far below the standards elsewhere – the NHS is, if anything, less than second rate.

  • Comment number 55.

    Re 20 above

    I don't expect NR to agree with the Coalition, nor do I expect him to propogate their views uncritically. My problem is that issue after issue NR seems critical.
    That said even that would be O.K., I suppose, if he was similarly critical of Labour and the mess they made of things over 13 years.

  • Comment number 56.

    rjaggar has clearly never spoken to any NHS doctors about their job and the running of the NHS. Every one of his/her extraordinary allegations is the opposite of reality. I think most doctors wish they had half the influence he or she thinks they had, because all too often their good ideas for improving efficiency, throughput and quality of care are not acted on because of the financial short-sightedness of (some elements of) senior management.

    I'm quite surprised that the mods approved this stream of unsubstantiated bile.

  • Comment number 57.

    The NHS struggles because of its all encompassing remit.
    If you want a health system based on general taxation, then the present model is about as good as it gets, so to compare it with other sorts of healthcare provision and criticise it because it isn't the best in all ways is a bit dishonest.
    The proposed form of healthcare will result in other providers cherry picking the pathologies which are amenable to easy (and relatively cheap) treatment leaving the good old NHS, or whats left of it to retain the long term problems such as diabetes, asthma, major tumour surgery and the like.
    As to 'patient choice' this will of course end up as provider choice but with the added excitement of fewer local providers for anything more than dispensing with the added frisson of much more of a postcode lottery as budgets are cut and rationing is blamed on your friendly local GP instead of the Government.
    As a further note of caution, having been a diabetic for more than 50 years, with constant improvements in all aspects of diabetic care during that time, I recently had reason to try to re-arrange my annual check-up appointment due to work commitments.
    Upon explaining that the mid-December date was difficult for me, I was told that the next available was in August - some 20 months after my previous 'annual' appointment.
    Enquiries revealed that because the centre was popular, choose and book had resulted in such an influx of new patients that all appointment flexibility had been lost.

  • Comment number 58.

    What annoys me about this type of shallow reporting is that the spending figures and analysis are at Whitehall level. This bears no relation to what happens at the coal face. I have had recently undergone Physio at my local Amersham Hospital and have been reliably informed that management over the last decade or so have annually demanded cuts/savings to the budget. Whether Brown's NHS spending at Whitehall went up 1 or 10 percent each year, these increases do not necessarily filter through to local department level.

    Add in the extra PFI repayments for certain Trusts and even less money will be available to spend on care and services. What would be useful would be a transparent audit of where the money really goes from Whitehall to each NHS Trust.

    Whether these initiatives will reduce the appaling quality standards of care variations in our Post code lottery of an NHS remains to be seen. The care I have received in the NHS in Edinburgh, London and Bucks have been markedly different over the last 15 years - it should not be like this.

    PS If a primary Care trust (to be abolished) has a PFI debt who or what takes responsibilty for that debt?

  • Comment number 59.

    50#

    Arguably so. And look where that has got us.

    51#

    I dont use tape. Its ecologically unsound.

  • Comment number 60.

    #49 Jesoal_Kotarohe

    If you 'listen-again' to the interview it is clear to me that John Humphrys needs to shup-up and allow the Prime Minister to answer.

    --

    You and me both, I thought he was not only incredibly ill-mannered but unprofessional too. Politicians are often accused of not answering questions but the PM didn't even get the chance!

  • Comment number 61.

    Cameron in the opening statements identified this was NOT a spending problem as we are 'nearing' the European average, this is an outcome problem, a value for money issue as the NHS (which he 'cherishes'), is not getting the same cancer treatment success rates etc. having paid nearly the average. Nick you have correctly identified this to be a political and real gamble (to those without another option), and Cameron accepts that if nothing is wrong then he is gambling. However, he believes in 2-3 years the crunch of aging demograhics will drive up costs - presumably over the average. Accepting this is potential political dynamite one has to congratulate him for thinking ahead and beyond his own term, for surely this will all end for him if those dreaded NHS satisfaction surveys fall from their record highs. Especially if older people, who need to be kept satisfied and who are the same people he believes will drive up the costs, think it is failing. Students and OAPs offside will not look pretty at the next election. So he is backing himself and his ideologies. Well done. Shame he has not bothered to ring Diamond of Barclays directly, as he confesses in the interview, and talk about limiting bonuses, rather he has talked to some others in the organisation. As the PM, call the boss, not some high level board committee. Hence I am concerned he may be all hat and no cowboy, not as politically astute as I had thought - why confess to that foolish omission? Anyhoo, back on track, is this just all propaganda for the privatisation of the NHS? Lots of downside, not much upside for Cameron on this policy, very much a gamble, but then surely he will make sure this works - right?

  • Comment number 62.

    15. jon112dk wrote:

    Now the tories want to replace 150 PCTs with up to 500-600 GP run consortiums. Unless you want your GP spending all day with their head down over a budget spreadsheet or typing up a service level agreement then each one of these will need it's own army of bureaucrats.
    ----------------------------------------------------------------------

    Step forward another army of “Consultants” to fill the gap & more jobs for the boys.
    Cost down, what cost down?

    Result: It will probably cost more.

    Cameron is taking a gamble, but he’s not gambling the lives of his family or chums; they have enough cash to see them through no matter what.

    Remember folks “we are all in this together” LOL.



  • Comment number 63.

    "A prime example is hospital cleaning, which was handed over to the private sector and as a result, the hospitals became dirtier and dirtier with many patients losing their lives as a result of MRSA."

    BULL. You lie, Jack. MRSA killed my brother in law 3 years ago in a central London hospital. TEN YEARS AFTER YOUR LOT CAME TO POWER. You cant pin that on anyone but the government of the day.

    A disgraceful revisionist lie and an insult to anyone who has lost a family member to such an avoidable disease.

  • Comment number 64.

    #62 Forgottenukcitizen wrote: "Remember folks 'we are all in this together' LOL."

    http://www.bbc.co.uk/news/business-12205690

    ...some deeper than others it would seem :o) Can't wait till these revelations are announced!

  • Comment number 65.

    When the USA spends 20% of GDP on health services and has the best health servioes in the world for those who are eligible.
    When France spends 12% of its GDP on health services and has the best health services in Europe.
    When the UK spends 7% of its GDP on health dervices and has good health services.
    What does that say about NHS efficiency as opposed to - you get what you pay for.

  • Comment number 66.

    Q. What do you call someone who ignores his doctor's advice?

  • Comment number 67.

    52. At 2:35pm on 17 Jan 2011, fionamcke wrote:
    I've recently seen a recruitment advert for a Finance Director at a Social Enterprise set to take over commissioning for a budget of £55million. Salary offered £100k,but the employee structure shows another 5 directors at this level plus a CEO. That is approx. £1million in salaries which equates to approx £1.2 billion on directors salaries just for starters.
    ================

    Here's a simple question for the tory cheerleaders ....

    Do you think it is LESS bureaucracy to replace 150 PCTs with 500-600 GP run consortiums ?

  • Comment number 68.

    #63, I am sorry about your loss, but one case of MRSA is insufficient 'data wise' to be able to come to any conclusions regarding privatisation of cleaning services and whether this is causing a degredation of service.

  • Comment number 69.

    "#66. At 3:08pm on 17 Jan 2011, Dodo56 wrote:

    Q. What do you call someone who ignores his doctor's advice?"


    ...Unwell?

  • Comment number 70.

    "48. At 2:27pm on 17 Jan 2011, rockRobin7 wrote:
    What is the labour plan?

    On anything?"

    To say as little as possible.

    Then, nearer the election, to promise everything to everybody.

  • Comment number 71.


    "No more top down reorganisations of the NHS" to "We've been working on these plans for five years" in eight months...

    More interestingly,

    "John Nash, the chairman of Care UK, gave £21,000 to fund Andrew Lansley’s personal office in November.
    Mr Nash, a private equity tycoon, also manages several other businesses providing services to the NHS and stands to be one of the biggest beneficiaries of Conservative policies to increase the use of private health providers."

    Daily Telegraph
    14 Jan 2010

    New politics indeed.

  • Comment number 72.

    "70. At 3:14pm on 17 Jan 2011, AndyC555 wrote:
    What is the labour plan?
    To say as little as possible.
    Then, nearer the election, to promise everything to everybody."

    Good plan, it certainly seems to be working for the present government. Let's hope they don't decide to forget their promises straight afterwards though, like the present government.


  • Comment number 73.

    Jackturk

    Labour's 'investment' in the NHS (what a joke already) involved saddling multiple Prmary Care Trusts with PFI contracts set with a 17% return over 25 years.

    If you're worried about nasty US companies geting their 'greedy,grasping hands on it' you're a bit late, they already have it by the short and curlies, thanks to the newlabour party.

    '17% guaranteed returns? Are you serious? We'll take a dozen of those babies...'

    Labour posters need to keep up. It's not enough to come on these posts and act holier than thou about the NHS anymore; you already destroyed it with PFIs and your targets. Ed Miliband needs to understand this... the public are a lot smarter than he gives them credit for and they know his government blew every opportunity it had while in power.

    Someone had to clear up this mess and it's the 'tory-led government' ..and even here Ed Miliband has managed to replace the one word 'coalition' with three.. this is fast becoming his leitmotif... an unfortunate desire to strangle the language and never use one word where fifteen will do.

    It's grim up north London...

  • Comment number 74.

    "The prime minister told the Today programme this morning that he hadn't taken a bet in years. Maybe not with his own money but he's proving to be quite a gambler when it comes to using taxpayers'."

    Praise be the Lord for a chance to gamble the whole of the NHS budget. Now lets spin that wheel... In for a penny in for a pound. Are we feeling lucky?


  • Comment number 75.

    The public desperately need the media to do their job properly and investigate and explain the detail of the Government proposals. Abolishing the PCTs that "few people have heard of, fewer understand and fewer still care about" is not to be dismissed lightly. There is no evidence that the Government will remove the requirement for the work that they do and so it is unlikely that the service will become leaner. Secondly, the public need to be clear that GPs are not NHS employees but private small businessmen and businesswomen who work under a contract that rewards them handsomely from the tax purse.

    GPs are not going to do the jobs currently undertaken in the PCTs, they will simply replace the boards. There are currently 152 PCTs in England. Mr Lansley is proudly stating on the BBC today that there are already 141 shadow consortia covering almost 50% of the poulation. Are we really to congratulate the Health Secretary for a proposal that doubles the number of commissioning bodies in the system? Does it make sense to create a vastly higher number of commissioning organisations than there are clinical providers? Is it wise to put so much power into the hands of small private businesses? What regulatory framework will be put into place to ensure that the consortia are equitable, transparent and efficient? What will happen if your local consortium decides not to commission a service that a neighbouring consortium does?

    In addition to these and many other questions that the BBC and other outlets should be asking, consider the realities of how GPs work. They do not compete for patients with one another. They cover an area and generate a list size that meets their financial needs. Neighbouring GPs often do not routinely cooperate with one another and they like their existing business model because it rewards them so well. Most of us can't easily get to see a GP outside of office hours or on a Saturday. Yet on average the outdated service model which is not at all customer focussed rewards each GP to the tune of £100k per annum.

    Whatever the political philosophy behind the proposals, there are definitely questions to be asked as to whether they will create a leaner and more cost efficient NHS that provides equal access to helathcare. There is a very real risk that by the time the White Paper is law it will in fact have created an even more bloated and inefficient bureaucracy that far from delivering choice (which it is valid to question whether most people wanted anyway) and security of treatment to patients, costs us more and returns us to the bad old days of massive waiting lists and postcode lotteries.

  • Comment number 76.

    The main problem with the NHS is the amount of beaurocracy.

    While I hope that the decentralisation will encourage effective service I doubt it. The only real cure for the NHS is to sack two thirds of the admin staff and use the money to hire doctors and nurses.

    Far easier said than done unfortunately.

  • Comment number 77.

    "Betting the NHS' is the title of Nick Robinson's blog.

    Unfortunately, the announcements by David Cameron today on the NHS are NOT what the 'front man' David Cameron will be soiling his hands with.

    The Minister, David Lansley, who has a long history under the last Conservative administration, is the hired 'instigator', with already firm templates and negotiated discussions with private providers, years before the 2010 election.

    Naturally, we are not surprised by that. However, what we should certainly be informed about is who, and how many, of these new NHS 'providers' are UK companies benefiting from UK tax-payers to create UK jobs?



  • Comment number 78.

    Can't help but notice the change in RockRobin's exit line. Could it be it's no longer a "great time to be a tory"!!!!!!!! but then again it is grim north of london, especially if you are the Tory candidate in Oldham.

  • Comment number 79.

    RockRobin7 @73

    The actual cost of PFI to the NHS is about 1% a year...check it out.

    This morning your hero called for "more elevated public debate" and for people to "grow up"....why don't you follow his advice ?

  • Comment number 80.

    68#

    I'm not trying to convince anyone of the validity or otherwise of what Cameron is planning for the NHS. My strongly worded post in this particular case, to this particular poster was in direct response to what I see as a flagrant untruth. Theres a hell of a lot of misinformation in the public arena about MRSA and for it to be used as yet another blame the tories exercise is below pathetic.

  • Comment number 81.

    Fubar, Andy and Friends [sounds like a show on CBeebies!]...predictably supporting any new policy put forward by the Tories, no matter what. Fair enough: to each his own; and let's face it, there are plenty on the left that do the same (or the reverse, or whatever...).

    I know you lot work in accounts, but there's honestly more to "improving efficiency" than simply slashing budgets. And when it comes to the NHS, this is one area where I really struggle to see how anyone could be in favour of reducing resources - unless you personally opt for private health care, and somehow begrudge those who use the NHS.

    I mean, I'm all for efficiency, but in Tory speak efficiency = cuts and/or privatisation, rather than actually making money go further per se.

    No matter... fact is, this is something that Dave C will have to handle very carefully, or risk the Oldham and Saddleworth reaction spreading beyond the North...there's no prize for third place, after all.

    ----------

    PS: this simply made me laugh:

    Dave C leading the charge: "I don't think we should put up with a second rate - with coming second best. We should aim to be the best."

    Dave C backpeddlng: "I speak often quickly. I don't just have a pre-arranged order of saying things and sometimes you can get a little word out of place and I immediately said, if you listen to the clip, we shouldn't settle for second best, that was the point I was making."

    ^ Clever old Dave; he used to be a PR man, you know?

  • Comment number 82.

    Manningtreeimp..

    PFI contracts were signed to the NHS (and elsewhere) with a guaranteed 17% return. You check it out.

    Even the marvellously inappropriate opening day of the newlabour party's election campaign was held in just such a hospital.

    alexpo..

    Keep up.... north London.. Glenda Jackson majority 42.. north London home of all the champagne swilling, social justice preaching, out of office for a generation facing labour party members..

    It's grim up north London..and a great time to be a tory...

  • Comment number 83.

    As labour's Liam Byrne said " there is no money left". Costs have got to be reduced. Even the most ardent left wing labour supporter must realise this fact.
    I was going to carry on but Yvette Cooper is speaking in parliament and I have just lost the will to live.................

  • Comment number 84.

    63. At 3:04pm on 17 Jan 2011, Fubar_Saunders wrote:

    "BULL. You lie, Jack. MRSA killed my brother in law 3 years ago in a central London hospital. TEN YEARS AFTER YOUR LOT CAME TO POWER. You cant pin that on anyone but the government of the day.

    A disgraceful revisionist lie and an insult to anyone who has lost a family member to such an avoidable disease."


    Calm down Fubar, who was supposed to be doing the cleaning in the hospital where your brother in law unfortunately contracted MRSA?

    Please tell me where I lied.

    By the way, I am no supporter of New Labour and 'my lot' as you call them has never been in power. Don't let your prejudices lead you into incorrect assumptions.





  • Comment number 85.

    At 12:26pm on 17 Jan 2011, Diabloandco wrote:
    Lest we forget WHY there is the need for the " austerity " measures ,let us all ,including the well paid in the media,remind ourselves of the last thirteen years and just which party held the purse strings and just which party sent our troops off to bomb a country back into the middle ages on a big fat LIE.
    Then let us indulge in speculating what those in oppositon now, would be doing to save the country from bankruptcy.
    I have heard the noises off made by the ex chancellor on how "cuts would have to be greater than those of Margaret Thatcher" but somehow those are forgotten by a complicit media and not even Mr Marr bothers to question the oppositions position.
    So perhaps Mr Robinson ,you could attempt to ascertain, on behalf of the great unwashed ,just what exactly Labour plans to do - should the great unwashed suffer from the media imposed amnesia and vote Labour next time?!
    --------------------------------------------------------------------
    A tad intemperate. Try not to let unreasonable anger take control of you.
    First there is no need for 'austerity' measures only a need to pursue sensible economic policies.
    Second if you're as disgusted by the Iraq war as I am you need to remember that a far larger percentage of Tory MPs voted for it than Labour ones. The vote on the war was only passed with the help of tory votes (One of which was D Cameron).
    Thirdly the current opposition would be pursuing sensible economic policies to make the required adjustments. Some of them very similar to the coalition's. The only difference would be the speed and depth of cuts because they would be spread over a longer period.
    Fourthly, Margaret Thatcher never faced a financhial crisis and recession of the magnitude of 2008-2010 and wasn't that averse to high spending or a large public sector. (The headcount in the public sector in 1990 was slightly larger than the one left by Labour in 2010.)
    See. No need to spit the dummy. Never mind making outrageously silly accusation of bias against the BBC or some of its presenters.
    BTW referring to potential Labour supporters as the 'great unwashed' is not a great way of getting their support.

  • Comment number 86.

    I thought promise everything, sign pledges,then renege on every thing was exclusive to Cleggy. Better to say nothing than be a renegate.

  • Comment number 87.

    Well said Rob at no. 75.
    We also need to know the financial figures e.g.
    1. Costs of redundancy for NHS staff (80,000 I believe)
    2. Costs of closure of PCT premises
    3. Costs of introducing new administrative and finance systems including presumably new IT
    4. Any costs related to changing existing contracts etc.
    5. Costs of setting up recruitment to new (untried) bodies
    6 Total costs of all these commissioning bodies

    Anyone like to add any. I'm sure Mr Lansley has all these figures to hand, has a detailed cost/benefit analysis etc.

    Or could this be another 'Bonfire of the Quangos' writ large? (See parliamentary report)


  • Comment number 88.

    81#

    If you happen to extract your head from that dark and dingy place in your body where you've had it lodged, Skol, you would have noticed that I make no comment either way about what Cameron is planning to do with the NHS, or not.

    Can we at least get that clear?

    My posts in this case, have been about the way the story has been reported and the angle that the BBC has used. Geddit?

    That doesnt make me a tory supporter, except in the eyes of cranially deficient, myopic, goldfish-memoried, useful idiot left wingers.

    And, no disrespect to Andy or Robin or anyone who is in the Accountancy (or other related professions) game, but its not my bag. Never has been, never will be.

  • Comment number 89.

    Oh Dear RockRobin, i get your point, now the champagne swilling, social justice preaching, out of office for a generation facing labour party members have been replaced by one term restaurant wrecking champagne swilling Bullingdon boys

  • Comment number 90.

    Sadly, this will like the 'coalitions' many other poorly thought out policies, destroy a system that almost all believe has improved massively BECAUSE OF INCREASED INVESTMENT!

    This ideological PRIVATISATION of the health service is the first step towards David Camerons ultimate goal of a two tier health service.

    One for those that can pay and a second rate service privatised in stealthy ways beginning with the management of the GP's 81 Billion pounds.

    Anyone can see that it is going to be a disaster and the truth is this coalition SIMPLY DO NOT CARE!

  • Comment number 91.

    RockRobin7 @82

    I know the return is 17%. My point is the actual cost is 1%.

    I'm no defender of PFI by the way. However,there are some studies that conclude its not quite as bad as some make out if you for example factor in say 30 years of maintenance etc...depends on the deal signed.

    But don't let that stop you seeing everything in black or white...or indeed red or blue.

  • Comment number 92.

    73. At 3:19pm on 17 Jan 2011, rockRobin7 wrote:

    "Labour's 'investment' in the NHS (what a joke already) involved saddling multiple Prmary Care Trusts with PFI contracts set with a 17% return over 25 years."

    To deny that New Labour invested in the NHS is just plain silliness and weakens your argument. However I completely agree that PFI's were and are a mistake. Let's see if the Tories allow them!

  • Comment number 93.

    I see the army of CCHQ ataff are on here to stand up for Dave.

    The NHS seems to be the big red button with 'do not press' written underneath it that the Tories cannot help but push as soon as they get the chance.

    Let's be honest about this, Dave & Co would quite happily see privatised health in this country. They have had no personal need to rely on it in their lives (beside the stage managed PR stuff they need to get elected), and so they simply don't have that gut instinct and awareness of how important it is that the rest of us do.

    Dave says people don't care if health provision comes from private companies or the public sector - but normal people have seen what a mess private companies have made of other public services, and how much more it costs us, and the profits being made at our expense, and have quite rightly ruled that the NHS is a step too far.

    Its the I'm-alright-jack, free market at all cost, Ronald Reagon, scrap the BBC loons who want to get rid of it.

  • Comment number 94.

    Whilst being a great supporter of the NHS, I cannot deny that reform is necessary; much of the increased funding has gone straight into increased wages and maintaining infrastructure instead of patient care.

    No-one appears to address the basic problem of elderly people bed blocking hospitals because of the lack of community/family support. There is no grown up thinking about this issue, maybe the budget should follow the patient so that social services are incentivised to take on the responsibility for people currently kept in hospital because of their lack of a support mechanism.

    Short termism often results in treatment for chronic conditions being delayed until they are acute and sometimes beyond the point where full recovery is possible further burdening the DSS budget, when this results in permanent disability.

    The manipulation of targets and funding has become a full time occupation within the NHS – I wonder how much money would be saved if we just provided treatment for people when they needed it.

  • Comment number 95.

    ------------------------------------------------------------------
    At 3:04pm on 17 Jan 2011, Fubar_Saunders wrote:
    "A prime example is hospital cleaning, which was handed over to the private sector and as a result, the hospitals became dirtier and dirtier with many patients losing their lives as a result of MRSA."

    BULL. You lie, Jack. MRSA killed my brother in law 3 years ago in a central London hospital. TEN YEARS AFTER YOUR LOT CAME TO POWER. You cant pin that on anyone but the government of the day.

    A disgraceful revisionist lie and an insult to anyone who has lost a family member to such an avoidable disease.

    -------------------------------------------------------------------------

    Sorry for your loss but what you are failing to understand is that (like so many of the changes Thatcher's government made) it would have been very hard (not to say expensive) to undo the changes made.

    As for the current shower, they are trying even harder to dismantle our institutions and hand profits to their friends. Again, they will be done in such a way that it is virtually impossible (certainly uneconomic) to undo the changes. Would you like a list?

  • Comment number 96.

    81 Skol303

    I mean, I'm all for efficiency, but in Tory speak efficiency = cuts and/or privatisation, rather than actually making money go further per se.

    >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

    What if greater involvement by the private sector was expected to produce efficiency gains?

  • Comment number 97.

    45. At 2:22pm on 17 Jan 2011, pdavies65 wrote:
    Whistling Neil @ 39
    They believe that the vast resources committed to [the NHS] are sustainably earned as a nation - sadly this is not the case.

    >>
    The total cost of healthcare has to be met somehow. If it isn't through general taxation, then it will be through insurance premiums, with the worse off penalized twice - firstly because they struggle to afford the insurance, and secondly because their overall health is worse.

    ===========================

    If you have to have a one size fits all solution then that would very much be the outcome for the poorest if you went to a private only premium based solution. However that is only what would probably occur if you let the system reach breaking point before actually doing something about it.

    As it stands you will have the other side of the argument pointing out that whilst paying taxes nominally for healthcare, the wealthy tend to pay for private healthcare in addition (or even not so wealthy through work schemes and top-up schemes) which relieves some of the burden from the current system.

    This pushes to a "conventional" left/right discussion. Private good/bad or public good/bad depending on which position you prefer to take.

    Fundamentally we have a situation where as we live longer due to advances in medical care the cost of healthcare (and social care and pensions - all related) will increase as a proportion of national expenditure (however you choose to measure it, GDP, HMG budget %, cash equivalent).
    We can choose to spend less on other areas, piece by piece, a bit less education, a bit less police, a bit less army, a bit less disability and out of work benefits etc etc. and these will never fill the gap in the NHS or pensions spending being created. Always will these other areas predominantly affect the poorest more since they cannot buy their way out. Ignoring real economic issues will always damage the poor most - it is the largest political failure of Labour not to realise this is an inevitable outcome of failing to strive for efficient service provision.

    Both pensions and the NHS have built up such toxicity in politics that governments have feared to tread the path of dealing with them rationally and still to some extent do.

    The situations which lead to poorer health in poorer people are largely due to poor personal choices. You do not need to be able to afford to join a gym to remain fit and do not need to be paying higher rate tax before a healthy diet is affordable.

  • Comment number 98.

    As the Chairman of the BMA and the Trade Union leadership are all against such reform of the NHS, in the patient interest, then surely it MUST be a really good move.

  • Comment number 99.

    84#

    I dont know whether the cleaning services at the two London hospitals concerned were contracted out or not. What I did see, repeatedly, were personnel going from room to room in an isolation unit delivering meals and collecting plates without using the handwash when entering and leaving rooms, I saw a urine bottle on the floor of the room that had been there for two days and I saw Infection Control badge wearing nursing staff who couldnt care less if they possibly tried.

    To reduce such ill-managed slack behaviour by employees and retained service providers to a party political point when it is not possible for any party of any colour to micromanage outsourced cleaning services in any institution frankly leaves me lost for words. These two institutions are far from being isolated cases. Anyone who uses outsourced services in any field, be it medical or otherwise HAS to manage the contract and ensure that the standards are delivered against and this is what, if there is any realistic blame to be attached to PFI at all, is what should have been done from the outset.

    The NHS are not alone in being institutionally incapable of managing outsourcing contracts. The whole of the civil service is riven to the core with this paralysis, which has made the outsourcers extremely profitable and reduced the level of service to the end user. So we went from apathetic & jobs for life to no improvement in standards (that wasnt precipitated by a national outcry) but triple the bill.

    What has been proven far more than "It all began with the tories and PFI" is that there have been significant other factors that can only be influenced by local - or "command-wide" NHS management and doctrine - prescription of antibiotics, segregation of patients, amongst others - that resulted in the high incidences of hospital borne infections in the last decade. Such an all encompassing blame-attribution exercise is not only factually incorrect, it is also highly misleading.

    Maybe you should have chosen your words more carefully, Jack. If you post like a duck, waddle like a duck and quack like a duck, you're highly liable to be mistaken for a duck.

  • Comment number 100.

    I work for the NHS and I can say that the moral in my hospital is unbelievable, I believe a shake up of directors that do little and get paid loads they should be replaced by management that know what they are doing, these are the people which waste money and throw it down the drain not the front line staff plus you have directors under directors (Associates) why not get rid of the associates and just have one director instead of 2! how many frontline staff would be saved if they did this, the plans which Cameron has spoke of have already been discussed with our unions and they haven't gone down well industrial action is a strong possibility and I believe a protest is on the cards for the 20th March in London not, the NHS employers are meeting with the Unions on the 20th Feb so we will have to see what the outcome of this will be!

 

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