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But why?

Nick Robinson | 12:33 UK time, Monday, 31 January 2011

Today the prime minister spells out what, he says, is not true about his NHS reform.

It is not a revolution.
It is not opposed by doctors.
It is not privatisation by the back door.
It is not going to damage patient care.

Maybe - or maybe not. Each one of those claims is hotly debated.

Gp writing prescription next to stethoscope

 

What's curious, though, is that David Cameron did not say why his reforms are needed - save, that is, for one mighty big claim. The PM says that without modernisation the NHS will be unaffordable. What he did not spell out is why.

The health service is being asked to find £20bn in efficiency savings over five years - a figure set by the last Labour government and without precedent. It's being asked to do so at a time when costs are increasing thanks in large part to the fact that people are living longer - the population aged over 85 is expected to more than double in the next two decades. What's more, no political party is proposing to increase health spending beyond the tiny - and disputed - real terms increase the coalition had budgeted for.

So, the government believes it must get more for less. Labour clearly believed that too. The question as to how they think they can do it is rarely spelt out.

The coalition hopes to cut the costs of bureaucracy by scrapping the quangos - Primary Care Trusts and Strategic Health Authorities - which supervise care. Their critics warn, though, that the costs of re-organisation may outweigh savings in the short term whilst private sector providers - once they have a significant slice of NHS business - may start to charge more not less than the NHS managers they replace. Only time will tell who is right.

Ministers believe that giving family doctors more decision-making powers will speed up the process of transferring treatments from expensive hospitals to cheaper alternatives provided closer to home in enhanced GP practices. Labour ordered the creation of more polyclinics to achieve the same goal. David Cameron used to attack what he called top-down bureaucratic decisions to close hospitals. Let's be clear though there is bound to be pressure for more hospital closures which will now be blamed instead on patient and doctor choices.

Finally the government thinks, but rarely says, that GPs will ration care - in other words decide what the NHS can and cannot afford. Those decisions are currently taken by unelected and unaccountable Primary Care Trusts or quangos like Nice. In future they will be taken by large groups of GPs locally - with ministers again (they hope) getting less of the blame.

In other words, more for less must mean more closures and more rationing. That would be true however the NHS was run. The debate is whether the government's reforms will lead to more of it or less, and whether they will lead to decision making which is more or less in the interest of patients.

Comments

Page 1 of 3

  • Comment number 1.

    It's clearly privatisation by the back door. That's what "modernisation" means to the Conservatives:

    A) Companies want to make money
    B) because of A) then companies will introduce changes
    C) Profit...
    D) ... at the expense of the end-user. In this case patients.

    Look what happened to the energy industry (posting record profits), the rail industry (still needs propping up in parts), water etc...

    Cameron is not saying why because his only reason is ideological, here's hoping Clegg and his band of merry men will grow a backbone and stand up for what they believe in

  • Comment number 2.

    There are 3 economic approaches in the UK:

    1. The Coaltition wants to remove the deficit in one parliament
    2. The Labour government wants to remove the deficit in two parliaments
    3. The New Keynesian approach, which John Sopel tried but failed to quiz George Osborne about on Sunday, when he asked the Chancellor why George Soros and Martin Wolf didn't agree with the Coalition's ability to bring growth. Interestingly, Ed Balls has twice mentioned Paul Krugman's name, first to Bloomberg on August 26 2010 and again to the Independent on Sunday 30 Jan 2011. Krugman has been at the forefront of articulating the New Keynesian response to the bursting of the housing bubble. An excellent summary of his position can be found in two linked articles at the New York Review of Books:
    1. The Slump Goes On: Why?, September 30, 2010, Paul Krugman and Robin Wells
    2. The Way Out of the Slump, October 14, 2010, Paul Krugman and Robin Wells

    There is no need for NHS reform or bond market panic if you cross the New Keynesian Rubicon.

  • Comment number 3.

    What's curious, though, is that David Cameron did not say why his reforms are needed.

    Does he really need to?

    The health service is being asked to find £20bn in efficiency savings over five years - a figure set by the last Labour government and without precedent.

    Of course it is without precedent! Sacred Cows don't get slaughtered every day or even, in this case, bled a little.

    The NHS budget is > than 100 Billion (try googling to find out how much!) So the NHS is to save something less than 4% a year in efficiency savings? Does anybody, outside of the Left and the Public Sector, think that this is a difficult task?

    Here are some ideas.
    Move away from national bargaining and set wages locally.

    Do the same for terms and conditions - start with pensions

    Cancel the expensive and ultimately wasteful and useless grand IT projects.

    No doubt the 'let's not bother figuring out how we can live within our means Left' and their fellow travelers will respond in their usual negative ways but I am sure that more money saving ideas could flow from this site.

  • Comment number 4.

    I think you've answered you're question without realising it.

    As you state in the article, decisions about whether a particular hospital should closed will be driven by the choices of patients and doctors based on clinical need rather than be driven by politicians for reasons of political expediency.

    To ask why this will lead to improved outcomes is a bit like asking why I would be better off being able to decide what food to buy, what clothes to wear and where to live rather than having Ed Miliband decide for me. You'd have to be a lefty to ask such as daft question, or at least not to know the answer.

  • Comment number 5.

    More for Less?

    That's a nice soundbyte, but I think I can be forgiven for wondering if it's referring to the Doctors rather than the NHS.

  • Comment number 6.

    It is a fact that the money that was sunk into the NHS did not deliver improvements in proportion.

    Therefore it would appear that this money can be taken away.

    Because the NHS is funded out of taxation, there is a limit to how much can be spent on it, essentially how much tax the British people will stand paying.

    This is why we spend less as a proportion of GDP than the other major European economies.

    If we are to spend more, then perhaps we should adopt the continental model, which is a mixture of state and private sector provision.

    Oh, and stop Unison and their ilk dictating government policy at the barrel of a gun.

  • Comment number 7.

    This thread is shortly to descend into a "Labour says Tories will privatize the NHS while Tories say we won't" affair. Is there any chance that we could have the sort of considered debate about whether or not the NHS model created in 1946 is appropriate to the needs of the 21st Century? The NHS that was created by Bevan is nothing like that set out in Beveridge's original report, he foresaw healthcare being administered through a network of regional authorities largely under the control of local authorities. However Bevan ploughed ahead and nationalised the whole system under direct Whitehall control simply "because I can!"

    Bevan's NHS was by modern standards a modern efficient organisation and for it's first 15 years it worked well and it's this romantic vision of the NHS protrayed in shows like The Royal that causes Britons to get dewey eyed. The problems began in the 1960's with the growth, under successive governments of the managerial classes with layers of beauracracy soaking up resources that could be spent on the front line. The NHS is too big and unwieldy and personally I would try to get back to Beveridge's vision and break the NHS up into regional authorities while retaining universal health coverage.

    Countries like France, Germany, Canada and Singapore have markedly different health systems than us and they perform much better in international, so why can't we have a version of their systems here?

  • Comment number 8.

    The coalition hopes to cut the costs of bureaucracy by scrapping the quangos - Primary Care Trusts and Strategic Health Authorities - which supervise care. Their critics warn, though, that the costs of re-organisation may outweigh savings in the short term whilst private sector providers - once they have a significant slice of NHS business - may start to charge more not less than the NHS managers they replace. Only time will tell who is right.

    And of course these 'critics' provide no real costing for their assertions.

    So why are they given space to comment? Too much attention is paid to these self-interested groups. Because that is what these 'critics' are. The BMA, Nursing unions, ancilary workers unions and the TUC. How about applying some journalistic vigor to their pronouncements such as asking them to document and specifically qualify their claims. Then we can see if they are founded on fact or froth.

  • Comment number 9.

    150 PCTs replaced by 500-600 GP consortia.

    The GPs are self employed health professionals with no training or experience in management/finance/administration. Their need for administrative support will be considerable if disaster is to be avoided.

    Will all this cut admin costs? Let us see - I am still waiting to see how much the bonfire of the quangos saved.

  • Comment number 10.

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

  • Comment number 11.

    Finally the government thinks, but rarely says, that GPs will ration care - in other words decide what the NHS can and cannot afford. Those decisions are currently taken by unelected and unaccountable Primary Care Trusts or quangos like Nice. In future they will be taken by large groups of GPs locally - with ministers again (they hope) getting less of the blame.

    Given the changing demographics, does anyone seriously doubt that state-provided health care will have to be rationed.

    At some point the GDP cake will not be big enough to feed the ever increasing NHS appetite.

    Hard choices will have to be made and personally I would rather they are made by a qualified medical doctor than by a Whitehall civil servant or even worse, an MP. I would have qualms about the civil servant's independence and about the MP's focus - would he/she be thinking of the issue or wondering how to present an ever so slightly dubious expense claim?

  • Comment number 12.

    Just in case it isn't clear from my earlier posts, I have never subscribed to the notion that the NHS should not be subjected to spending reductions just as is other government expenditure.

    I have spent parts of my working life, overseas and know that there are lessons that the NHS could learn from other systems but fear that instead of doing so they will simply expend energy (and tax payers money) on fighting these reductions.

    I would recommend the Norwegian health system as providing some innovations that could be successfully applied in the UK.

    Also, consider a change to the benefits in kind system and actively encourage people to take out private health care or for employers to provide same without it being a taxable burden on the employee. If my employer provides me with private medical insurance, I am taxed on this benefit. Think for a minute though. If I use this benefit, I will not be using the NHS (which I will have already paid for through NIC and personal taxation) but the only recognition I receive is a higher tax bill. Those on the left will see a logic in this, anyone else will see how crazy that is.

    I am a UK taxpayer, not a banker and not in the public sector.

  • Comment number 13.

    Visualise.
    A Road Traffic Accident. The soon to be privatised ambulance service arrives and asks or searches for the injured parties ID card (has to be one). The medics at the scene have to contact the doctors of the injured to find out what hospital to send them to. It stinks to high heaven.
    As an ex employee of a hospital as a tradesman I witnessed the contractors arriving, they make botch-up after botch-up then lie, deceive and cheat their way out of trouble.
    United Kingdom--------NEVER….A disjointed isle filled with hatred of each other.

  • Comment number 14.

    It could be that the coalition believes reform of the current system is impossible - successive governments have thrown more and more money at the NHS, we now have some of the best paid doctors in Europe but the end user feels little improvement in the services.

    I am a passionate supporter of the NHS but I do feel the present system is not always run for the benefit of the patients and maybe a radical approach is required to shake things up.

    However I do worry about their ability to carry this through, I would worry more about their competence than their motives.

  • Comment number 15.

    If 99% of the admin staff went , the NHS would be solvent over night .

  • Comment number 16.

    "So, the government believes it must get more for less. Labour clearly believed that too. The question as to how they think they can do it is rarely spelt out."

    The last time we had a period of underfunding it resulted in the Labour promise to raise National Insurance to pay for spending to reach the EU average. In four years time Labour will make this pledge again, to clear the huge waiting lists and queues of people on trolleys in corridors that Lansley's policy will cause.

    That is, of course, if Cameron doesn't decide to do it himself when the NHS financial crisis predicted by Prof Bosenquet at Imperial occurs this November.

  • Comment number 17.

    The NHS does need to be reformed.
    The Labour Government started this reform process. They were keen to encourage competition in the health & social care market.
    What the NHS does not need is far reaching reform on a broad platform, undermining service delivery and without regard for the legal responsibilities of PCTs and SHAs in the interim.
    Fix what needs fixing (such as centralised supply chains and micro management of clinicians), leave what works (service delivery, resilience in major incidents and shared business service approaches to HR and corporate functions) and stop trying to mis-sell the cost saving element disguised as patient choice!

  • Comment number 18.

    Cameron's argument is deeply flawed. It basically goes like this:

    The NHS in its present form is unsustainable.

    Therefore, something must be done.

    The NHS reforms as proposed in the current bill are something.

    Therefore, the NHS reforms as proposed in the current bill must be done.

    I think most sensible commentators agree that the NHS is unsustainable as it is. But that doesn't mean that any old reform will do. Reforms need to be carefully thought out and have at least some chance of being an improvement on the current system. It's that last part that Cameron doesn't seem to have grasped.

  • Comment number 19.

    @11 obritomf
    "Hard choices will have to be made and personally I would rather they are made by a qualified medical doctor than by a Whitehall civil servant or even worse, an MP"

    Such decisions need to be taken with reference to a revamped patients charter, GPs should not be allowed to discriminate against patients who happen to be old, slightly overweight or incapacitated.

    My GP is fanatical is some of his prejudices [he may be the exception] and safeguards would need to be put in place to ensure the patients rights.



  • Comment number 20.

    I am continually amazed that some people complain at any change. If spend on the NHS nearly doubled, over perhaps 10 carefree Summers, then maybe the odd Winter is a good thing. Its like eating pie for 10 years, then having to do a little exercise. Its necessary.

    The NHS needs to cut back, if for no other reason that it hasn't over the past 10 years. It needs to address if it is getting value for money, and this will not happen without cuts.

    What the key aspect is, is to change without throwing away good things learnt over the last 10 years, and as so many managers instantly spout out it will be the patients who suffer, with the implication that they always run tight ships, then I for one tend to think that if they say this, then perhaps they should be the first casualty. If they had 10 years of cuts then perhaps it might be true, but 10 years no cuts, then sadly, I am inclined to disbilieve most of what else they say.

    You always need winters as well as summers Nick, for the garden to do good.

  • Comment number 21.

    @1. At 1:05pm on 31 Jan 2011, SuperSonic4

    "here's hoping Clegg and his band of merry men will grow a backbone and stand up for what they believe in"

    Little chance of that. In 2005 Indy article Clegg said

    "One very, very important point - I think breaking up the NHS is exactly what you do need to do to make it a more responsive service."

    "I don't think anything should be ruled out. I think it would be really, really daft to rule out any other model from Europe or elsewhere. I do think they deserve to be looked out because frankly the faults of the British health service compared to others still leave much to be desired."

  • Comment number 22.

    It's not a radical change. It's a throw-back to the late 1980s. Then the Tory Government wanted GPs to be commissioning agents for hospital services.
    But it didn't work well and the system had to change because of all the wasteful bureaucracy GP commissioning created. Moreover, some GPs referred patients for particular conditions and others didn't. And other GPs ran out of money and sought to postpone necessary treatments. It was chaotic.
    But Cameron was a boy then and probably didn't use the NHS much anyway. So he probably doesn't know about that disastrous episode of GP commissioning.
    History repeating itself? Is this just the farcical repeat of history or the historical tragedy coming up?

  • Comment number 23.

    The NHS needs reform because it is inefficient and wasteful.
    There is no more to it than that.

  • Comment number 24.

    @3

    In real terms (2008/09 prices) the NHS (England) budget is:

    2009/10 100.2
    2010/11 100.9
    2011/12 101.0
    2012/13 101.1
    2013/14 101.2
    2014/15 101.3

    (src HoC briefing SN/SG/724)

    > Does anybody, outside of the Left and the Public Sector,
    > think that this is a difficult task?

    Yup, anyone that knows anything about the NHS. As NR says, during this period of flat funding there will be more people needing treatment (unless there is some kind of govt endorsed euthanasia), plus inflation is showing signs of getting out of control at a time when the economy cannot withstand a base rate rise. If inflation goes above the current rate then the "real term" figures will end up being a real terms cut. The NHS has never withstood a real terms cut for four consecutive years. In the past the result of a single year's cut has resulted in such a public outcry that the government increased the budget in subsequent years.

    Osborne has not learned from history. He had better have a big pile of cash to pump into the NHS in his 2012 budget.

    > Move away from national bargaining and set wages locally.

    Already the case. Foundation Trust hospitals can have local pay bargaining, but so far only one does.

    > Do the same for terms and conditions - start with pensions

    ditto

    > Cancel the expensive and ultimately wasteful and useless grand IT projects.

    Already done. have you been hiding under a rock for the last year?

    This Bill will be the end of this government, if it ever gets passed. My prediction is that it will be made an election issue in the local elections and when hundreds of Tory and LD councillors fail to get elected in May and say that the NHS bill was the most talked about on the doorstep, Cameron will stop the Bill saying that it is taking too much parliamentary time.

  • Comment number 25.

    With more years than I care to mention working in health, any argument you want to make about the Health Service will have an element of truth in it some where. It is such a vast structure and has and will always have inefficiencies. Vast sums of money have been invested in recent years resulting in improvements. There has also been a significant increase in waste and burdensome bureaucracy. My colleagues and I spend increasing hours on administrative duties and fewer hours on clinical work.
    The report into the Mid Staffordshire NHS Trust makes interesting reading and the final paragraph from Robert Francis QC in his letter to the secretary of state and I quote

    "If there is one lesson to be learnt, I suggest it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented."

  • Comment number 26.

    Why does everyone seem to want to protect one of the worst healthcare systems in Europe?

    YES, I am in favour of an NHS - one that WORKS and (preferably) doesn't cost more than GDP, but I do agree that change is absolutely essential - whether the coalition version will be an improvement remains to be seen!

  • Comment number 27.

    But the Conservatives have a poor record of dealing with such national institutions. Lansley worked for one of the Accountancy Big 4, they see this as a bonanza in fees and consultancy. That is why it will fail, it is not about reform but about giving their mates a lot of profits and the loser will be the person that needs treatment. Labour were mugged by the doctors and the Tories will not dare take that money back, the massive increase in funding paid for the doctors' salary increases. I do not trust the private sector as they are in it for profit not for public good. The NHS funding s another issue, how much of the Country's income do you wish to spend on health?. That is what a referendum should ask.

  • Comment number 28.

    Nick, You obviously didn't listen to the Health secretary Andrew Lansley on "Marr on Sunday" answering precisely these points.

    One of the main points he makes is that in spite of record amounts of money the NHS still fails to give healthcare outcomes for patients which compare well with most other Western European health services across many aspects of care.

    The point being that if you keep doing the same things the same way then you are unlikely to improve. Not making changes is not an option, that is a decision to stand still when you are obviously not yet as good as your peers.

    He was at pains to say he wasn't deciding for patients or doctors what the most effective and acceptable solutions were for them nor dictating that they should choose private over NHS care. In fact he was very complimentary to many aspects of the NHS and felt that in many areas it was will able to compete for patient and doctors choice.

    I think that rather than knee jerk criticism of the coalition for daring to think outside the box you should be asking Labour why all their massive increase in tax and expenditure hasn't brought about the scale of improvements they promised when in office.

    Its not just about tax and spend it must be about quality of healthcare outcomes achieved as efficiently as possible.

  • Comment number 29.

    @7

    "Countries like France, Germany, Canada and Singapore have markedly different health systems than us and they perform much better in international, so why can't we have a version of their systems here?"

    OECD figures (per capita, % of GDP)

    Fr $3696 11.2%
    De $3737 10.5
    Ca $4079 10.4
    Si (not available)
    UK $3129 8.7%

    Does that answer your question? To get a French/German/Canadian system we have to spend a lot more (~£30) not less. Or will you now say that their systems are too expensive for us?

  • Comment number 30.

    From my long experience with GPs, there a are a few extremely good ones, and many, many very poor ones. They are the last people in the NHS whom I would trust with any decision making power, let alone the purse strings. And it's unlikely they'll even get to do most of that, when the consortium farm out the contracts to private firms, whom I would trust even less. Private firms have a legal requirement to act in the best interest of the Board, and no body else. That means profit, and profit alone. That profit has to come from somewhere, and it will be money that could be spend on patient care.

  • Comment number 31.

    Nick

    The reason for the need to reform the NHS should be obvious to everybody who bothers to think about it. It was (and is) a wonderful ideal to have treatment for all, free at the point of delivery. The problem is that this ideal was established at a time when treatment was largely confined to nursing care, bed baths and straightforward medical procedures. Fast forward to today, when hugely complicated and expensive treatments are the norm, drugs cost a fortune, virtually any organ can be transplanted, and elective treatments like IVF, cosmetic surgery and the like are freely funded. To cap it all the population (partly but not exclusively because of these medical advances) is aging at an alarming rate. Put simply, the nation (even in good economic times) can't afford the NHS in its present form. Not only does the structure need serious reform, but also the range and scale of treatments that the NHS is expected to undertake. This is a nettle which successive governments have been terrified to grasp, but unless something is done the NHS will either cease to exist entirely, bankrupt the country, or both.

    The NHS has been a scared cow for long enough. The people who work within it on the whole do a commendable job, and it is easy to see why the public view any reforms with apprehension, but if we really do value the NHS, which is, after all, at its most basic about saving life, then we all need to recognise that we have to cut our cloth according to the size of our wallet, and not the form of our dreams. Serious reform to not just the structure, but the ambition of what it is called upon to do, is long overdue. This is too important to be used as a party political football.

  • Comment number 32.

    As previous posters have said those of the left will oppose these reforms because idealogically they believe in top down beaurocracy and large organisations. Personally I do not believe large organisations manage change particularly well so I can foresee difficulties ahead. This does not mean they should not try to reform. David Cameron is right when he says that GP's are better placed to decide on treatment than Whitehall civil servants or some overpaid beurocrat in a PCT somewhere remote from the patient. He is also right to say that if we do nothing we will be in deep problems later on with an ageing population and ever more expensive drugs and treatments.

    Labour has always believed in layers of beaurocracy and personally I would rather the money went into the front line. Andrew Lansley says the reforms will cost £1billion but overall the lifetime of this parliament the savings will be 5 times that. I think he is being optimistic but I do not believe the NHS works well as it is at the moment. I think those on the left who believe just sticking with the status quo are just burying their heads in the sand. Even Blair knew the NHS needed reform just that he was not brave enough to tackle it probably due to the dinosaurs in his party.

  • Comment number 33.

    @11

    "Hard choices will have to be made and personally I would rather they are made by a qualified medical doctor than by a Whitehall civil servant or even worse, an MP. I would have qualms about the civil servant's independence and about the MP's focus - would he/she be thinking of the issue or wondering how to present an ever so slightly dubious expense claim?"

    Do you know anything about healthcare or are you just ranting? Let's pick that apart:

    "made by a qualified medical doctor"

    Under lansley's plans GPs wont be making the decisions, the consortium will. The law does not mandate that the consortium board has any clinical representatives. It is perfectly possible that the board will not be GPs since they will make business decisions not clinical decisions. The GPs will then be handed the list of acceptable treatments and a list of hospitals where treatments can be provided. The GPs and their patients will have a restricted choice.

    "than by a Whitehall civil servant"

    Doesn't happen now. If you are referring to NICE, they are clinicians who use research data to make evidence-based decisions. It is the best way to decide on what treatments should be acceptable, since it means that patient in the country will have the same treatment and there will be no postcode lottery.

  • Comment number 34.

    JPSLotus79 @ 7

    You say that countries like France, Germany, Canada and Singapore have markedly different health systems than us and they perform much better in international {benchmarks}, so why can't we have a version of their systems here?

    I believe that professional politicians are often looking at how politicians in other countries do things and sometimes try to replicate them in their home country e.g. the 1980's Thatcher privatisations were replicated in some other countries.

    However, there is no guarantee that what works in one country will be successfully tranplanted to another, for a whole bunch of reasons.

    Possibly one reason why England has remained mired as a place where 'nothing works as it should' (an American lady journalists complaint to Tony Blair) is that the country has suffered decades of low-level political civil war between the Labour and Tory Parties, who selfishly thinking of themselves rather than us, have pulled us this way and then that way, which has had the overall effect of getting us nowhere.

    It would be good to think that the Con-Lib-Lab Coalition will put all that into an unhappy past but old habits are hard to break so the jury will be out on that for some time to come.

    with respect to the Health Service in England (there are four separate Health Services in the so-called UK), I think that the English public would broadly accept a mixed-model, that is a mixture of private, public and charity sector involvement, especially at the local level.

    The problem is more political inasmuch as the mainstream political parties have all, in the past, promoted the NHS as some sort of sacred token and now find it difficult to admit that it must be recast.

    Let us face it, there is something very odd and not quite right about a small country on the edge of Europe running the third biggest public sector organisation in the world i.e. the NHS (after the Chinese Army and the Indian Railway).

  • Comment number 35.

    There can be no more inefficient organisation that one run by a government. The largest such organisation is the NHS. So, the more privatised it gets, the better return on government (i.e. our tax) investment will be. I am all for cutting the NHS down to size provided the level of care becomes better.

    Having been a civil servant in the past I can vouch for the fact that it is very wasteful in the civil service and badly run on the whole. If the government can get the same operation elsewhere for £1000 that the NHS would charge £1500 for, then why shouldn't it? Don't you want better service and lower taxes?

    Those who think the NHS is full of angels should wake up and smell the roses, those days are largely gone although there are exceptions. It is hugely inefficient and badly run and needs to be sharpened up. We can't support such a huge inefficient organisation forever, it has to change!

    I don't suppose the coalition will get the reforms perfectly right, but it has to be better than letting it just go on as it is.

  • Comment number 36.

    I can see why this sort of fearful rhetoric has occurred - the government simply haven't well enough explained how the new system would work - but really, it's worth looking at closer: no-one is saying that it is simply a case of "saving money", although clearly it is an agenda. The issue that is being tackled is that the NHS is a catastrophically badly managed business. In all seriousness, if the NHS was a trading entity, it would have gone out of business decades ago. It's only because of its assured income (i.e. the tax payer) that it still exists at all. The current system of PCT's is unjustifiably top-heavy - far too many middle and senior managers - who simply aren't up to the job - don't understand the pressures of the health service, GPs, patient expectations, hospital management, etc. It can’t carry on as it is, and a campaign to “preserve the NHS” in its current form would be almost criminally short-sighted.

    A personal friend of mine is a GP practice manager, and 2 years ago was elected onto an executive that operates in the way that the new plans would work: he represents a collective group of GP practices who have been given the control of the budget for their area (approx. £92million), against which the new plans have been modelled and, as such, is now operating as a pilot for this scheme. He and a few other people work in conjunction with the GP practices that they represent (including the Practice for which he is the business manager) and they allocate resources as any well-managed business would. They have found that their surplus cash is so great that they have been able to open up far more specific centres (a pharmacy, a travelling eye-clinic for schools, an osteopathy clinic) simply because they manage their funds properly. The current PCTs simply aren't in a position to do this - if they were, they would have done so by now. They represent an additional layer of bureaucracy that simply isn’t required – certainly considering their performance.

    I can see the concerns (GPs are doctors, not business managers; various hospitals are going to have to be more competitive in the arena in which private hospitals will also be allowed to compete) but these fears are not born of fact. The GP practices would employ a business manager (rather than a whole committee of PCT managers) to co-ordinate the funds properly – most already do in some form: there's no need for GPs themselves to have to learn fiscal policy. And, for the most part, why shouldn't the NHS have to be more competitive? Isn't this what a democratic (and democratically funded) organisation should be about? Let’s not forget that the funding for the NHS has been ring-fenced, so there is no talk or “saving money over saving lives”. This is a plan to get better care for the same money. From what I’ve seen, it will work.

    If the Unions could stop being deliberately, lefty, obstructively obnoxious about it, then maybe some progress could be made: surely it doesn’t matter WHICH side of the political divide you are on – shouldn’t we all want the best?

  • Comment number 37.

    But why?

    ...because not everyone believes in God and not everyone has the evangelistic addiction to the NHS that is regularly aired on these posts.

    Dare to criticise and one is bombarded with such arrogant piffle as "just wait till you get ill" or "I hope they've closed your hospital next time you have an accident".

    The NHS has gone the way of all state owned behemoths when showered with cash... it has become wildly inefficient and seems to now pride itself on having over paid, over qualified staff in every part of its superstructure.

    Name me the country trying to emulate the NHS? There isn't one because it can no longer claim to be the 'envy if the world'. Clinical outcomes are now worse than in many OECD countries after the thirteen years of newlabour spending... they took it backwards.

    So the real question you should be asking is not 'But why?' .. the real question is 'But why did this take so long?'

    It's grim up north London...

  • Comment number 38.

    Most doctors oppose the proposed NHS changes. GPs have been told that they have to sign up to the Pathways to GP Consortia as there is no alternative under the present government- this does not mean that the GPs agree with the changes- they have no option but to sign up.

  • Comment number 39.

    I'm not a doctor, but three of my close friends are - and they're all opposed to Cameron's plans for the NHS (despite two of them being Tory voters...!). Why? Primarily because they believe it will take their attention away from patient care.

    To me, it's just more of the same old pantomime of politics and PR that is the Tory party:

    David, Ms Lansley seems keen on privatising the NHS, while taking back-handed payments from those who are set to gain from this...
    Response: "Oh no he isn't!"

    David, Mr Osborne seems to be making a mess of our economy and refusing to even discuss a Plan B...
    Response: "Oh no he isn't!"

    David, your former communications officer seems to be at the heart of an illegal phone tapping scandal...
    Response: "Oh no he isn't!"

    David, Ms Spellman seems to be wanting to privatise our woodlands, despite 85% of those polled being opposed to this move...
    Response: "Oh no he isn't!"
    David, she's a woman...
    Response: "Oh no she isn't!"

    The tactic: simply deny whatever is put to you, even if there is clear evidence to the contrary.

    I guess that's what you get from an ex-Carlton TV PR man! Just deny everything, till you're quite literally blue in the face.

    PS: "He's behind you!!" Oh yes... he really is. And worryingly so.

  • Comment number 40.

    Is it not time for some honesty from politicians. The Tories were not elected direct nor were the lib dems but hey, it’s not a perfect world. But never the less, both these parties went to the electorate with clear proposals as to what and what would not be done if they came to power. We now have both these parties reneging on promise made so what are we to believe. Reading between the lines I believe this to be a back door to moving the NHS into the private sector much in line with the American system where by if you have medical insurance you will be covered; if not you will rely on the charitable organisations for treatment. This must never happen and I don’t think the majority of people in the country would like to see this type of health care. If we are to save the NHS we should be looking at breaking the strangle hold pharmaceutical companies have over us by over charging for the medicines we need. This would save billions of pounds year in year out with out having to make massive cuts to a service we as a nation are proud of

  • Comment number 41.

    @15

    "If 99% of the admin staff went , the NHS would be solvent over night ."

    Indeed, because there will be no patients because there will be no appointments sent out.

    A few months ago I was in my local hospital and chatted to the guy next to me. He said the same thing, so I asked him:

    Me: who? the receptionist, the appointments clerk, the people who manage the patients' notes
    Him: no, we need them
    Me: then who? the procurement clerks who make sure that stocks of medical equipment are kept full and that the hospital pays a cost effective price?
    Him: no, we need them
    Me: so who?

    The issue is that it is very easy to say "cut admin" but when you look at the system you realise that admin is needed to keep costs down and to keep the hospital safe.

    Oh and before anyone trots out Cameron's election statement "remove targets and you will remove admin" (not heard that for a while, eh? I wonder why?) Remember that targets like 18 week RTT comes from stats generated to implement the Internal Market. Of course, if you are advocating abolishing the Internal Market then I am willing to listen further...

  • Comment number 42.

    The NHS is an excellent , good value service. Soon it will be fragmented and district hospitals will close, with expanding private sector, profit-making services, which won't necessarily be very local. I suspect that the Tories longterm aim is to make the NHS a second-rate safety net system with services much reduced from the present. The Tories will probably encourage more and more people to take out private health insurance in order to avoid the future downgraded and more basic NHS. The coalition's plans for the NHS spell the end of a generally excellent, value for money NHS, focused on the needs of the patients rather than on private companies' profits or Tory tax cuts for the rich.

  • Comment number 43.

    If the coalition continues with its terrible plans for the NHS, all blame for any problems in the service will be put on GPs, which is exactly what the coalition intends.

  • Comment number 44.

    "Finally the government thinks, but rarely says, that GPs will ration care - in other words decide what the NHS can and cannot afford. Those decisions are currently taken by unelected and unaccountable Primary Care Trusts or quangos like Nice. In future they will be taken by large groups of GPs locally - with ministers again (they hope) getting less of the blame."

    May I just point out that the "large groups of GPs" will be unelected and unaccountable, just like the quangos they'll replace in this commissioning function.

    Also, anyone who thinks the involvement of their own GP will made any difference to their personal healthcare is living in cloud-cuckoo land. With maybe 70 GPs in a consortium, each with hundreds of patients to consider, many of whom will not have presented with their conditions when the decisions are made, how could it possibly be any different.

  • Comment number 45.

    The siren voices on these posts beginning 'I'm a doctor' ... 'I voted tory' ...but these pointless reforms blah...

    This is the standard newlabour publicity mnachine in operation again.

    I've lost count of the number of stooges on Question Time who begin their questions these days with 'I voted tory, but....'.

    Get a life.

    It's grim up north London...

  • Comment number 46.

    "28. At 2:11pm on 31 Jan 2011, yewlodge wrote:
    .... The point being that if you keep doing the same things the same way then you are unlikely to improve. Not making changes is not an option, that is a decision to stand still when you are obviously not yet as good as your peers."
    ===============================================

    No argument with that. Similarly, no argument with the PM's repeated assertion that his aim is to improve healthcare for all.

    The problem is that, just because a system needs to change doesn't mean that any change will improve things. It is possible to change something, even something already very bad, and make it worse.

    Yes, the NHS needs change. These changes will make matters worse not better.

  • Comment number 47.

    #29

    "Or will you now say that their systems are too expensive for us?"

    Er no, those systems are ones that work a lot better than ours. A big difference between the British and French systems is that in France the costs are borne by the patient who can then claim most of that cost back. This allows for extra revenue to be raised which supplements that provided for out of taxation. Interestingly only 65% of French hospital beds are provided by public hospitals with another 20% being provided for by profit making companies.

    As their system seems to, by general consensus, work an awful lot better than ours perhaps we should seriously consider looking at it.

    http://en.wikipedia.org/wiki/Health_care_in_France

  • Comment number 48.

    #24
    Richard
    This 20 billion is being saved over just England or the total NHS? I ask to see if it is around 4% or something less.

    How many Foundations Hospitals are there?

    Does anyone expect Unison and the nursing unions to sit back and see changes made to their salaries and pensions?

    These 'carers' care so much that they would be out on strike in a heartbeat.

    The year on year increases that New Labour lavished on the NHS (and on other state industries such as education) largely went on salaries for its paymasters rather than in improving service delivery. Please don't mention all the new hospitals and schools - they are funded through PFI and that particularly ugly bird will continue to come home to roost for many years to come.

    There probably is an element of rant - as a UK taxpayer who works in the private sector I see
    Waste in the Public sector and poor value for money.
    Public sector workers cosseted with pension arrangements that private sector companies don't offer because they are unaffordable.
    Public sector workers continually insisting that in spite of all evidence to the contrary they have no fat to cut.
    An NHS service which simply doesn't deliver - what is the point of a free at point of delivery service, if you can't get to see a doctor for 10 days?

    Those on the left and in the unions simply don't get it. The folks in the private sector have had enough. The Public sector must be made to feel the cold winds of reality that always buffet the private sector.

    Bleat all you like. I hope that the government reduces and reduces the public sector and I will vote for any politician (save a racist one) that proposes that at national or local level.

    Oh, and if you are wondering, I am posting on my own time. My workday starts at 03.00 AM so now I am on my own time. Can the same be said for all those 'lefties' who regularly seem to post here during the normal working day?

  • Comment number 49.

    At a recent stay at a large NHS hospital in the Home Counties I was surprised that the majority of front line staff were from agencies, from cleaners, nurses through to doctors and surgeons. In any business agency staff are always the most expensive and are used sparingly if at all. One nurse I spoke said that she used to be employed by NHS, but it was more rewarding to become an agency worker with less responsibility as the pay was better.

    Many of the agency workers are over qualified, but the high pay attracts medical staff from all over the world. It is a classic "throw money at the problem" rather than deal with what caused the shortfall in the first place. Meanwhile it falls to western charities to provide basic medical to the Third World...

    As to Cameron not saying why:

    The coalition's track record on communication is appalling, whether with Coulson or not. They are obsessed with the soundbite a la Blair, but it worked with Blair because the big change programme was shelved. As change is on the agenda the spinners need to be kicked into touch and ministers need to explain.

    An example is Osborne making it clear what the alternative to the cuts programme was. Economists and other professionals in the financial sectors would know or could figure out what the consequences were if public sector spending cuts were not made. But Joe Public will not have a clue if you do not tell them!

    The government must also front up on what PFI is going to cost the NHS locally and for how long. One efficiency that might save billions is medicine procurement: I wonder what impact a Tesco chain would make.

  • Comment number 50.

    "15. At 1:38pm on 31 Jan 2011, jimbo26 wrote:
    If 99% of the admin staff went , the NHS would be solvent over night ."
    =====================================================

    Absolutely correct. Solvent overnight, and at a standstill by lunchtime.

    Frontline services, provided by medical professionals, may be entirely what the NHS is for, but without the backline services (back office they call it in business), the frontline can't function.

    Doubt it?
    Who will pay the doctors and nurses, or will they work for nothing?
    Then think about medical supplies (stocks thereof), appointments, equipment, food, cleaning, recruitment, vehicles, buildings, etc., etc.

  • Comment number 51.

    These reforms are really important to get through. Those working in the NHS have largely been accountable to no one apart from themselves - not even to patients. And that simply has to be changed. Compare this current level of accountability with what we have in Local Government in the UK where officers are directly responsible to locally elected politicians who in turn can frame direction and policy. Compare it also with the open accountability to shareholders in listed companies.

    There is no doubt that those in the NHS have led a sheltered life for far too long and the sooner it changes the better. There is also no question, from my conversations with many GPs, that GPs are behind these changes - their key issue is about how to effect the change and how to get it to happen in the best possible way that is not subject to being undermined by vested interests in the NHS.

    This is not about privatisation - its about social enterprisation.

  • Comment number 52.


    #36 AJ Wrote

    A personal friend of mine is a GP practice manager, and 2 years ago was elected onto an executive that operates in the way that the new plans would work: he represents a collective group of GP practices who have been given the control of the budget for their area (approx. £92million), against which the new plans have been modelled and, as such, is now operating as a pilot for this scheme. He and a few other people work in conjunction with the GP practices that they represent (including the Practice for which he is the business manager) and they allocate resources as any well-managed business would. They have found that their surplus cash is so great that they have been able to open up far more specific centres (a pharmacy, a travelling eye-clinic for schools, an osteopathy clinic) simply because they manage their funds properly. The current PCTs simply aren't in a position to do this - if they were, they would have done so by now. They represent an additional layer of bureaucracy that simply isn’t required – certainly considering their performance.

    Nick - This is the story. Why doesn't someone check this out and then trumpet what is ACTUALLY working rather than pandering (isn't that a crime in some places?) to those vested interests that simply oppose any change, which will diminish the amount of swill in their trough.

  • Comment number 53.


    #42 Sarah
    The NHS is an excellent , good value service.

    And the evidence for this is??

  • Comment number 54.


    The reforms are just to divert public money into the private sector. it isn't wealth creation as the money still comes from Government. All we'll get is Serco, Asda and Tesco hospitals. They'll probably end up compensating their "pile em high sell 'em cheap" Negligence with Nectar points.



  • Comment number 55.

    Nick, re your comment -
    " Let's be clear though there is bound to be pressure for more hospital closures which will now be blamed instead on patient and doctor choices."
    David Cameron also said on BBC1 this morning the decision as to where treatment takes place will be down to the Doctor and patient.

    I am sceptical my understanding is the decision will be made by the consortium, which will probably be staffed the people made redundant (with redundancy payouts)from the previous system. These people will have a set budget, so my guess is they will go for the cheapest, wherever that is.(Am sure they will argue the cheapest also happens by coincidence to be the best quality)
    The patient may well say I want to go to the local hospital, but if this local hospital costs more than one further away I have my doubts that the patient will get their way. If this is not correct can some one can point to where in the proposed legislation it states the patients wishes are paramount. I do not mean that they must be consulted, but that the patients will have the final say.
    As far as the G.P. consortiums are concerned the fact the patient has to travel further and incur extra costs for themselves and their families will not be big issue, as it will not affect their bottom line.

  • Comment number 56.

    I own a business, and I can tell you without hesitation what the response of private enterprise will be - because it's the response any businessman would take.

    1: Outbid the competition, go in cheap as a loss-leader, and remain cheap until the alternative suppliers are no longer operational.

    2: Once competition is destroyed, cut services and raise costs to ensure dividends grow - the NHS won't have an alternative supply, so you can charge (more or less) what you want to.

    I'd like to say it's naive of politicians to expect otherwise. But I'm not sure it is naive. I think it's idiological, which is worse (in my opinion). Naivity can be educated out of people, but idiology will continue to make idiotic choices regardless of the data.

    I fully accept the need to reform and refinance the NHS. But private enterprise isn't the best way to do it long-term; it will only provide short-term savings. Over the long term - which is the timeline on which we really should be thinking - privatisation will inevitably cost more, or reduce the quality of services.

    Why? Because if you're a director of a company you have a greater responsibility to shareholders than to patients. If the choice is between dividends and treatment, dividends will always win. So inevitably there will be cuts to services.

    I don't deny that in many ways private enterprise can out-perform public services. But surely it's not beyond us to encourage a cost-saving, private enterprise ethos within the NHS. Why not give performance-related bonuses to managers who deliver services at lower costs? Bonuses work for the management of banks - why not for the management of hospitals?

    Alternatively, break up the NHS and make them outsource services - but do the same for banks, and cut banker bonuses too.

    If these decisions are based on logic and data, let's apply the same solution to all areas of public services. But they're not based on logic or data, they're driven by idiology, and that's why it's "one rule for the rich, another rule for the rest of us".

  • Comment number 57.

    Health care, as we live longer and medical science advances, is perhaps the most complex and challenging area of public policy. Balancing the need to spend more with the need to spend less, the need to manage effectively with control of bureaucracy, top-down or bottoms-up, accountability versus competence, state-to-private mix, choice versus guaranteed uniform standards ... all of these actual or potential conflicts come into play.

    The Coalition reforms may or may not be a step in the right direction – I don’t know and nor do they – but they are far-reaching and radical. As such, they are inappropriate at the present time. This is (probably) a one-term government, elected without a particularly strong mandate and with no pre-Election mention of radical health reform - indeed quite the opposite; even its own supporters were taken aback when the plans were first announced - and thus it has no business doing what it appears to be doing. It’s presumptuous and hubristic.

  • Comment number 58.

    In England, the 1% of the population who earn more than £125K per annum should, and probably already do, have private medical care.

    However, private providers cannot justify, for return-on-investment reasons, funding some of the hugely expensive medical equipment that is available today, so even the relatively wealthy 1% may end up in an NHS hospital where they will receive the required treatment.

    I do not know anything about NHS/internal market economics, but in those circumstances, you'd assume that the NHS could reclaim the costs of treatment from the private provider in some way.

    I would be very wary of the medical insurance model, as the example of America seems to indicate that insurance cartels form, sometimes in an unholy alliance with 'big pharma', which can result in the consumer/patient being ripped off.

    Again, I do think there is the scope and general willingness in England for a more mixed-model in healthcare provisioning as opposed to Wales and Scotland, which, in my opinion, are more socialistic countries and where this mixed-model would probably not be acceptable.

  • Comment number 59.

    "The official ministerial briefing for the Health and Social Care Bill states that despite spending the same on healthcare, our rate of death from heart disease is double that in France.

    Although statistics from the Organisation for Economic Cooperation and Development (OECD) confirm that in 2006 the age standardised death rate for acute myocardial infarction was around 19/100,000 in France and 41/100,000 in the United Kingdom, comparing just one year-and with a country with the lowest death rate for myocardial infarction in Europe-reveals only part of the story.

    Not only has the UK had the largest fall in death rates from myocardial infarction between 1980 and 2006 of any European country, if trends over the past 30 years continue, it will have a lower death rate than France as soon as 2012.

    These trends have been achieved with a slower rate of growth in healthcare spending in the UK compared with France and at lower levels of spending every year for the past half century."
    [John Appleby (Kings Fund) writing in the BMJ.]
    The NHS isn't working? No just another Tory Story - used to justify yet another TINA scenario.

  • Comment number 60.

    rockRobin7 wrote:

    "The siren voices on these posts beginning 'I'm a doctor' ... 'I voted tory' ...but these pointless reforms blah...This is the standard newlabour publicity mnachine in operation again." [sic]

    ^ Robin, you really do make me laugh! Especially as just earlier you posted:

    "The NHS has gone the way of all state owned behemoths when showered with cash... it has become wildly inefficient and seems to now pride itself on having over paid, over qualified staff in every part of its superstructure. "

    ^ Not that such comments could ever be perceived as being the "standard new Tory publicity machine in operation again", of course!? After all, your above comment seems to be brimming with evidence and factual understanding.

    Here's your petard back...

    And by the way "It's grim up north London..." - what's that all about exactly?

  • Comment number 61.

    I work in Holland at the moment and all insurance here is private. The government do pay money into the system for children and those not paying taxes. As soon as you get a job paying tax you must get insurance from a private provider - these are regulated by the government and cannot refuse cover under any circumstance whatsoever; or they are no longer in the health care business

    The cost for private health insurance is around 100 Euro per month and I can honestly say the service provided beats the NHS hands down (I have experienced both services, requiring specialist treatment here and in the UK)

    The NHS costs a lot per head and I believe that a public/private system would be a huge benefit to the UK. The government should regulate the costs and provide cover for all residents who are:

    a) Under full time education
    b) Not working

    For lower earners the system should be weighted (it is here, you get a lower premium if you don't earn 17,000)

    Ask most people that have experienced health care outside the UK how it stood up and I think nearly all of them would say it was better - although when I say 'better' I don't mean in the human side of care, just the speed, quality and delivery of care. I got an appointment with a neurologist the same day and was undergoing treatment the same day here - I arrived at the hospital and was escorted directly to see them, the waiting room was totally empty, great service

    I'm a fan of the NHS for it's core beliefs - but it does need to reform and I personally think public/private is the way forward, i've experienced both and know what I prefer

  • Comment number 62.

    Surely the biggest scandal is that the coalition says it has a democratic mandate for such wide ranging reforms, yet the Conservative Party did not spell out any such change in its manifesto; was not brought up in any of the 3 leader debates and public were kept in the dark.

    And for those who thought the Libdems would be a moderating influence, Nick Clegg has declared this was always LibDem policy! See his interview last week with Andrew Marr.

    It is the dishonesty which is so galling. http://bit.ly/gzsZRF

  • Comment number 63.

    When the'Old Etonian Clown', before the election was telling us the Tories had no plans for any major structural changes in the NHS,Was he lying?
    The Tories can't be trusted with the NHS.

  • Comment number 64.

    obritomf @ 52

    That 'good news' story about the GP Practise Manager finding oodles of extra cash for additional services (assuming it is true) is exactly the sort of news which gets published in the Australian media.

    When you go to Oz, as I did a few years ago, it was really notable that 'good news' stories were very prominent in their media, and it was a wonderful change from the dire, miserable, negative fare that is so often served up here in England.

    Our media should lighten up, it is not healthy to feed the natives an unremitting barrage of bad news and indirectly, probably increases the NHS workload.

  • Comment number 65.

    9. At 1:18pm on 31 Jan 2011, jon112dk wrote: and many others.......
    =========================================================================
    It is somewhat a fallacy that GP practices are not financially astute as the majority now have a budget of an SME to deal with and some of the bigger practices or joint practices have a considerably larger budget.

    Now it is not going to easy but it should dove tail well into their current expenditure. Please see the quote from the BMA re the way GP's feel they were being squeezed under the last goverment, dated 28 April 2009;

    "The current situation in General Practice provides an unwelcome dilemma: how to reduce practice running costs without cutting some of the new services or standards introduced since the New Contract. So what has changed? Since 2004, practice running costs such as staff salaries, building maintenance and utilities, clinical and office equipment, and other essential supplies are paid for out of practice income."

    Is it a perfect solution, no the only way that can be done is to have a clean sweep and start again on a clean sheet of paper. Something many health professionals would support but it would be a hard sell to the die hard maintain the old NHS at all / any costs.

  • Comment number 66.

    51. At 2:59pm on 31 Jan 2011, stedmund40 wrote:
    
"This is not about privatisation - its about social enterprisation."

    ----------

    ^ Brilliant! You should go for Andy Coulson's job... only I'm guessing you're probably too upstanding a citizen to qualify (it's not difficult, to be honest).

  • Comment number 67.

    # 61

    I too have sampled the Dutch health-care system and recognise its benefits and inherent fairness. You though, are a voice crying in the wilderness on this blog. It is difficult to see the benefits of alternative systems when one has one's head stuck in the sand. Do you think that maybe these lefties have such large brains that they can't keep their heads up and so they get buried in the sand - couldn't possibly be shame, could it?

  • Comment number 68.

    IPGABP1...


    When Tony Blair said '24 hours to save the NHS' in 1997 the day before he won a landslide did he really mean '24hours before I commission eleven reviews, triple spending and impose targets?'....

    The labour party made a fist of reforming the NHS, now it's up to the coalition to try make soem sense of it.

    Do keep up, you had your chance and blew it.

    It's grim up north London...

  • Comment number 69.

    Russell JOnes

    The usual left wing bilge about the private sector. If what you say is true then why just keep the private sector out of health care provision. Why allow private companies to produce and sell food, houses, clothing, cars, medical equipment etc, etc ?

    GPs and patients will have the say about who provides their health care. Rather that than have it determined for them by some mindless ideologically motivated agenda.

  • Comment number 70.

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

  • Comment number 71.

    #62 Extranea
    Heading for dangerous territory here.

    I seem to recall an explicit promise for a referendum on the EU Constitution which was gotten around by renaming it the Lisbon Treaty.

    If Andy C was still at No 10 he would no doubt be saying things like the books were in a far worse state than we could possibly have imagined (true) etc. and then going on to say that these reductions were anyway in line with New (do we still say New?) Labour's own proposals.

    The coalition's mandate is to govern. That includes making decisions based on today's information and scenarios. Spending must be reined back, way back. The government isn't doing enough but they are at least making a start.

    Perish the thought that we could have had Miliband and Balls - two of the team that did more than others to get us into this mess - in 'charge' of the economy. Hope that doesn't conjure up too ugly an image.

  • Comment number 72.

    63. IPGABP1
    Im afraid the reality will be much much worse than “the tories just cant be trusted”.
    Ive already read a report on the GPs Cameron wheeled out to say how wonderful the reforms were. Apparently a company hoping to benefit from NHS reforms provided the government with GPs to help ministers sell the reform to patients and staff.
    http://www.guardian.co.uk/politics/2011/jan/31/paper-reforms-local-health-budget

  • Comment number 73.

    62. At 3:17pm on 31 Jan 2011, Extranea wrote:

    "Surely the biggest scandal is that the coalition says it has a democratic mandate for such wide ranging reforms, yet the Conservative Party did not spell out any such change in its manifesto; was not brought up in any of the 3 leader debates and public were kept in the dark."

    ----------

    ^ Absolutely.

    Presently, I'm starting to think that:

    Privatisation of NHS + woodlands = Cameron's "poll tax" in the making.

    There are already a bunch of ex-Lib Dems just itching to vote Labour in protest, and the NHS/woodlands issues is already starting to sway "pale blue" Tories too.

    Cameron and co need to be careful if they want to avoid rocking the boat.

    Actually, what am I saying... "Go team Cameron!" ;-)

  • Comment number 74.

    I went into hospital five years ago a confirmed socialist and came out one but I would have sacked most of the nurses employed. Patients were treated with total contempt. With the exception of a mid European girl who was left to work her back-side off they were the idlest group of workers I've ever come across. Their neglect negated the brilliant work done by surgeons and physios and I hope that reforms alter things before I have to be hospitalised again. Yes, I did put a complaint on the hospital website. It responded by thanking me for recommending the services I had received!!

  • Comment number 75.

    #68 RockRobin
    Surely you are mistaken?

    "The labour party made a fist of reforming the NHS"

    What reforms? Hosing it with cash doesn't constitute reform.

    Oh, and by the way it may be 'grim up north London' but at least you have Arsenal to lighten-up your life.

  • Comment number 76.

    "67. At 3:47pm on 31 Jan 2011, obritomf wrote:

    "It is difficult to see the benefits of alternative systems when one has one's head stuck in the sand. Do you think that maybe these lefties have such large brains that they can't keep their heads up and so they get buried in the sand - couldn't possibly be shame, could it?"

    ---------

    ^ Translation: "Blah, blah, blah, lefties, [insert playground insult]" ad nauseum.

    Just thought I'd try to speed up the right-wing argument a little...

  • Comment number 77.

    57. sagamix wrote:
    Health care, as we live longer and medical science advances, is perhaps the most complex and challenging area of public policy.
    -----------------------------------------------------------------------
    Saga; retirement ages are rising, so theoretically people will be working for longer & therefore contributing more money in NI…in theory anyway.

  • Comment number 78.

    But why?

    Just imagine - you've choked on your organic tofu or stabbed a toe erecting a yurt for Jude and Sienna's 5th birthday party and your local A&E has been outsourced by those wretched tories. Now the acceptably below par local comp has been shut down to be replaced by a Toby Young free school, with an ex SAS officer as the Headmaster!

    Last month your sure start centre was closed down for underperformance and to cap it all the council taxes are going up because although you're the third richest borough in the country the labour controlled council still can't make ends meet under those wretched tories...

    But why?

    it's grim up north London...

  • Comment number 79.

    sagamix 57

    The coalition are introducing the reforms because they genuinely believe they are in the interests of the NHS. There are plenty of reasons for them not to do so, including the undoubted political risks they entail, but the coalition put improving peoples health above such considerations.

    The Labour party in contrast would quite happily sell the long term interests of the NHS down the river if they thought there were some short term political gains to be had by doing so.

  • Comment number 80.

    None of the large Public Sector Cuts or State Benefit Cuts are in anyway in the interest of the British Working - Classes, since you only need to see why the Egyptians are currently having a General Strike to advance their cause as being supported by Cameron and his Muppet Coalition Government, while any callings for a General Strike is by Law BANNED in the UK.

    The ONLY interest for Cameron and his Cronies is to hack-up the currently what remains of Public Sector by selling off Cherry - Picking the more profitable parts so that his (Camerons) Elite friends in the Private Sector can legally plunder at random, which will lead to a booming in UK Unemployment for the future, something else namely in(Unemployment) that the Egyptians are also fighting against, while under a Double-Standard in awareness Cameron is supporting the Egyptian stand to create more Jobs in Egypt a Country that already today receives vast amounts by way of Finance Grants for support, from both the USA, and the UK.

    With Cameron, a Man of ALL Style and NO Substance it is of no wonder that he is saying one thing for foreign constumption, while delivering the reverse massage for furure UK un-workability listening, that will end up destroying the UK's Work-Places both in the Public and Private Sectors forever.

  • Comment number 81.

    "why keep the private sector out of health care provision?" - 69

    No problem with the private sector playing a part so long as the ultimate product, medical treatment for the sick, remains free at point of delivery and is provided to a similar (and good) standard to all who need it; personal financial means playing no part. Money buys many things in life ... so it should, so it always will ... but there are one or two core essentials where, in a civilised society, it shouldn’t be a factor. Health care is one of these (education is another).

  • Comment number 82.

    grendad @ 74

    Not all Angels, are they? Not by a long chalk.

  • Comment number 83.

    From the Daily Mail:

    "Cameron admits even his own doctor brother-in-law doesn't trust NHS reforms"

    [...yeah, yeah, my excuse for browsing is "know your enemy"!]

    You know things aren't going well for the Tories when the Mail starts taking sides against them.

    Go team Cameron!

  • Comment number 84.

    The UK spends less in % of GDP and in some cases significantly less per capita than Germany, France, Australia, Norway, Canada and a whole bunch of others.
    Of those countries with a universal health care system the UK is one of the most under funded. Politicians continually criticise the NHS without addressing this fact, the UK spends 8.4% of GDP on health, France spends 11%.
    No matter how many times the management layer is trimmed, no matter how many times politicians re-organise the NHS the UK spend on health is below average.
    The truth is the NHS is great value for money and if Mr Cameron wants to see real inefficiency just look to the US with 17% GDP spend and a life expectancy close to the bottom of the league table for the developed world and below that of the UK.
    I think this is another naive and uninformed move by this Government who are clearly not thinking before they act.

  • Comment number 85.

    "The coalition's mandate is to govern." - 71

    No, their job is to govern - in accordance with their (overt and implied) mandate. The mandate is to cut public spending too hard and too soon (being the main thing we voted for), but it most certainly isn't to radically reform the NHS. Back of fag packet stuff, not shared with the electorate pre May 6th.

  • Comment number 86.

    Nick, you are wrong again. Cameron has said why the changes are needed.
    To improve quality and save money!
    Just like the coalition should do with the BBC. Even the repeats aren't advertised as repeats - why?
    The BBC is spread too wide with too much duplication.
    Nick, can you justify the BBC in it's present format and can you also justify the high salaries.
    I await your blog with interest.

  • Comment number 87.

    People forget that GPs are private contractors and their practices are private businesses. Yes they derive the majority of their inoome from the NHS for the contracts they have to deliver General Medical Services. But giving GPs control over a large part of the NHS budget is a 'de facto' privatisation of the NHS.

    Andrew Lansley, the Health Secretary, has visited the USA to see how 2 States attempted a similar scheme with their publicly funded health services. Both were abandoned as too complex to manage. Yet he is proceeding with what can only be decribed as a 'massive experiment' with the NHS, a much larger health care system. His motivation like much Tory policy at the moment is pure ideology. They haven't got the faintest idea how this will work.

    The question we need to ask is 'Do you want your GP to be a Doctor or do you want he/she to be a Manager, Commissioner of Health Services, Administrator, Health Care Planner, Finance Manager and local Public Health Expert..'

    I am not arguing that the NHS is sacrosanct and shouldn't be touched, but there are better ways. Giving GPs stronger roles on existing PCTs is one way that would also be a lot cheaper.

  • Comment number 88.

    The naivety of many of these posts beggars belief. PCTs have always included GPs on their Boards, and involvement in decision making processes and along with many other range of clinical staff. They also hold public board meetings, make Board papers available to the public,and have to consult widely with the public over any significant change in service. None of this is required by the proposed changes, and indeed the private consortiums will not even have to answer Freedom of Information requests- ie all the decisions to stop services / close hospitals etc can be done in private and the public / patients only find out afterwards. There is HUGE conflict of interest in having GPs in control of the budget, and appears to be no proper planned oversight of GPs contracts for the provision of primary care services. These changes are totally ideologically driven and are all about privatisation leading to a very poor safety net NHS and private health insurance.
    This is not to say that the NHS could not improve- but this is absolutely not the way to do it.
    How many of us are in a position to choose which hospital to go to at our road accident / heart attack etc?
    If private hospitals cream off all the easy elective surgery by offering cut price deals the cost at NHS hospitals for the complicated care will increase. Moreover many hospitals are locked into ludicrous PFI costs (benefitting the private sector including the banks).
    I don't have time to find the links, look at John Appelby from Kings Fund recent report for eg - but NHS expenditure is only just reaching EU average, France spends significantly more. Outcomes for cancer etc, take years to change but the trajectory has been steady improvement for the last several years.

  • Comment number 89.

    "What's curious, though, is that David Cameron did not say why his reforms are needed"

    So what you're saying, Nick, is that Cameron hasn't said why reforms are needed?

    "- save, that is, for one mighty big claim. The PM says that without modernisation the NHS will be unaffordable."

    Oh, he has then. That without them the NHS will be unaffordable.

    "What he did not spell out is why."

    Oh, I see, he DID say why reforms were needed but didn't give a full explanation.

    "The health service is being asked to find £20bn in efficiency savings over five years - a figure set by the last Labour government and without precedent."

    OK, so both major political parties are agreed at the size of the efficiency savings needed , but still no reason why, eh Nick?

    "It's being asked to do so at a time when costs are increasing thanks in large part to the fact that people are living longer - the population aged over 85 is expected to more than double in the next two decades."

    OK, so costs are increasing, we've an increasing population and an increasingly elderly population which, in itself creates additional costs.

    "What's more, no political party is proposing to increase health spending beyond the tiny - and disputed - real terms increase the coalition had budgeted for."

    And no party is saying that they could fund increases is health spending.

    "So, the government believes it must get more for less. Labour clearly believed that too."

    So both main parties are saying roughly the same sort of thing.

    So, Nick, you're still saying that Cameron hasn't said why reforms are needed beyond there being no more money and an increasingly elderly population which is going to cost more to look after.

    Yeah, it's a mystery to me too, Nick. Why ARE those reforms needed?

  • Comment number 90.

    "I am on my own time. Can the same be said for all those 'lefties' who regularly seem to post here during the normal working day?" - obrit @ 48

    You mean "Lefties" like perhaps the four most prolific during-working-hours posters on this site - Robin, Andy c555, Fubar Saunders and Susan Croft?

  • Comment number 91.

    I think this is necessary start of reform to truly empower the citizen. This reform has a number of shortfalls in as much as there is no democratic accountability of the GP consortia. However this is better than nothing. Next step should include finding ways to elect a Health Commissioner just as there are plans for electing Police Commissioner. They should have the power to licence the GP consortia and set priorities for the area. GPs are not above human failings of greed, corruption and incompetence.

  • Comment number 92.

    sagamix 81

    A reasonable point of view, not shared by pretty much the whole Labour movement.

  • Comment number 93.

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

  • Comment number 94.

    why does everything on the nhs have to be free.

    if i go out on a friday night and drink so much that i pass out, get taken to hospital to have my stomach pumped and have an overnight stay, i would expect a £2000 bill.

    Make changes like these not just squeeze everyone else

  • Comment number 95.

    81 - "but there are one or two core essentials where, in a civilised society, it shouldn’t be a factor. Health care is one of these (education is another)."

    There you go again.

    You just can't get your head round the concept of public and private systems operating side-by-side with no detriment to the other.

    You believe in personal freedom I assume? Yet you want to take that away from those whose political views are not the same as yours.

    Suppose Doctor Jones decides for personal reasons that he does not want to work for a government (of any persuasion). It's against his beliefs. He sets himself up in private practice and offers to give such services as he can to those who wish to pay for them. What, exactly, is your problem with that?

  • Comment number 96.

    "The BBC is spread too wide with too much duplication."

    You're not wrong there.

    Do we really need Nick Robinson AND John Pienaar?

  • Comment number 97.

    The world can see what is going on. Every move by this rabble of right-wingers and craven pseudi-Liberals is designed to do one thing. Follow the logic - a significant amount of financial support for the Labour Party comes from Union Members - many Union Members are employed by National and Local Government - sack as many of them as you can and there is less financial support for Labour - Labour in difficulties financially means no opposition - no opposition means that the right-wingers can sack the craven pseudo-Liberals who then become the Opposition - right-wingers take over. This is not about the National Health Service, that is just a smoke-screen. Come on you Tory Grandees, come out from behind this very plausible PM and show yourselves.

  • Comment number 98.

    forgotten @ 77

    Yes, I guess this is inevitable. If we're going to live to, say, 125 then it makes sense for a normal working life (if there is such a thing) to shift from 18/65 to 25/90, something like that. Will mean you're just getting going (!) at 60 ... quite a thought.

  • Comment number 99.

    No68 RockingRobin,
    Are you too politically thick to realise that I have no interest in Labour Party politics.
    It appears you agree that the 'Old Etonian Clown' did lie over major plans for restructuring the NHS.
    You can't trust the Tories with the NHS, I am pleased you recognise the facts.

  • Comment number 100.

    The country is bankrupt. It is borrowing vast amounts of money. But if you do a little online research, you'll see that we were borrowing heavily way before the banking crisis. So for most of the last 10 years we have borrowed money and lived way beyond our means. When you add PFI costs, it is even worse. The NHS is one of our biggest expenditures.
    Question. Is it morally justifiable to borrow money to spend on our own health and leave our children to pick up the bill? Or should we in fact live within our means?
    It is hightime the NHS found different and cleverer ways to do things, just as have the rest of us. But whether the government's scheme is the right way is very unclear. I suspect they have squandered an opportunity.

 

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