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The listening cure

Nick Robinson | 13:37 UK time, Monday, 4 April 2011

Where does it hurt? How long have you been feeling this way? Is there anything else I can do to help?


Health Secretary Andrew Lansley (right) inspects a new tool to measure blood pressure

 

This afternoon Doctor Lansley is going to reveal his prescription for curing his ailing NHS reforms. The health secretary is, in short, going to promise to listen. That's right. Not - despite what you may have read - delay or amend or scrap or U-turn - just listen.

The question, though, is what will he and the government do if - when? - they hear that their reforms lack any friends? It's easy to find supporters for individual elements of the reform package - after all, the BMA voted to back GP commissioning, Labour encouraged and expanded the role of private health companies within the NHS, and the Lib Dem manifesto called for primary care trusts to to lose their role in commissioning care for local people. However, taken as a whole the reforms have few if any cheerleaders.

In the long term, that poses a massive political risk for David Cameron, whose modernisation of his party was rooted in his declaration of love for the NHS. In the short term, it poses a challenge when the legislation reaches the House of Lords in the summer - to be confronted by a coalition of Labour peers who want to re-contaminate the Tory brand, Lib Dems who want to an opportunity to reassert their party's independence, and anger from those like Dr David Owen, whose hearts beat for the NHS.

All the signs are that the prime minister has lost faith in his health secretary's capacity to sell this package and was becoming increasingly nervous that his coalition allies were on manoeuvres over health reform (despite having backed it all the way until a few weeks ago). That's why the coalition's Dynamic Duo Cameron and Clegg were due to launch the NHS listening exercise later this week.

Today, though, it looks as if Dr Lansley has decided that he will be the one who will declare: "The Doctor will see you now. I'm listening."

PS - I've only just caught up with Norman Tebbit's article in the Mirror joining their campaign against Andrew Lansley's NHS reforms. That's right - Tebbit in the Labour-supporting Mirror backing the NHS against the man who he helped recruit into the Conservative Party. Andrew Lansley had been a civil servant in Lord Tebbit's department. The health secretary is badly in need of some friends.

Comments

Page 1 of 4

  • Comment number 1.

    I can only hope that when someone says "You're privatising the NHS aren't you?" he will listen to them and realise that, yes, this is exactly what he's doing.

  • Comment number 2.

    VAT man and robbing stepping in should be interesting as they do not have a wonderful record of clanger avoidance. Lansley has been shadow health spokesperson (and now SoS) since 2003/4. Shows how much real interest Cameron took in health if he can be so wrong footed by Lansley's radical proposals (overseen by Letwin at one point) to require a re- branding or listening offensive (Lansley was on PM for a week dont forget). Proposals headed for ITU and prognosis is poor - Shirley Williams administering last rites soon?

  • Comment number 3.

    The problem rests more with a vacillating Prime Minister who is not prepared to back his ministers when the going gets a bit tough and then rapidly distances himself from the fallout. Remember the Forest sale that never was and Caroline Spelman was left holding the proverbial: yet the previous government had sold off many more acres than Spelman proposed with no adverse reaction.

    Cameron wants to be all things to all people - this is not possible, unless he does a Blair and not push any significant reforming legislation through at all. Unfortunately Cameron's stance is symptomatic of modern Britain, take all the credit when things go well and take no responsibility when things go pear shaped.

  • Comment number 4.

    A cure for the NHS? If the NHS were a patient, the doctor would probably advise losing some weight. There is still too much bureaucracy.

    But the latest coalition plans to turn GPs into bean counters is NOT the answer. Doctors are trained to diagnose illnesses, not do book-keeping or administrative work.

    Also, patients want to be able to call their local surgery... not speak to a call centre. This is NOT want people want.

    The real risk for Cameron is that unlike our doctors, he doesn't have his finger on the pulse!

  • Comment number 5.

    I fail to see the problem. We've all known for a long time that the NHS is incredibly wasteful and badly managed. It has been that way for a long time, and small reforms have done little to bring the monster under control.

    It's about time we tried some real reform. I have no idea whether these plans will work, and neither does anyone else - the point is there is a decent argument for them, and a decent argument against them. Give them a try, and see how things change. If there's a positive change, great. If there's a negative one, reign it back in.

    We can talk about privatising as much as we like, but the fact remains that as long as the NHS is free at the point of 'sale' and paid for through collective taxation, it's no more privatised than it is now. The state doesn't produce medicines nor treatments, and does not have the expertise to do so. The public sector outsourcing to a competitive private sector works perfectly well, as long as that competition is allowed to flourish.

    It can't be any other way anyway, as we don't produce medicines. Get over it and give it a try, or come up with an alternative.

  • Comment number 6.

    I think you might be overstating David Owen's position in the food chain somewhat. A has been who arguably is also a never again likely to be.

    "The question, though, is what will he and the government do if - when? - they hear that their reforms lack any friends?"

    They should do exactly what they should do in such a position. Get on with it. Personally, I couldnt give a monkeys if it is privatised or not. It cant carry on exactly as it is, it is fundamentally unaffordable and bordering on the unmanageable.

    It has to change, one way or the other and its about time someone had the guts to at least try to do it.

    As for all the shroud waving and doom-mongering from the left.... its getting profoundly boring and it is only about one thing. Trying to stick one on their opponents when their own record of how they have handled the health service over the last 13 years can be described as anything but glowing. Its got nothing to do with saving the NHS from anything, let alone privatisation and everything to do with scaring the bejesus out of the natives and getting them waving their pitchforks... exploiting weak minds for selfish electoral gain.

    Considering the effect that Shirley Williams had on Education, some of the effects still being felt to this day, she'd be better advised to crawl back under her stone and stay there. Let her anywhere near any kind of organisation at your peril.

  • Comment number 7.

    #1 RYGNB

    Having had experiences in both the NHS and private health systems I can say that my views are that private is better. Way, way better hands down over the NHS

    You could provide excellent cover for the same cost as the NHS or less. My private insurance in Holland is 110 Euro's per month and it provides all the cover I need (dental is separate here though)

    Insurance companies cannot refuse cover to anyone and they have to accept all requests for cover. It also covers you abroad (apart from the USA and a few others) and the hospitals here are incredibly good. The time I needed to see a specialist neurologist I got an appointment within 4 hours and was under treatment the same day

    Everyone gets dewy eyed about the NHS. It's too big, too inefficient and weighed down with management; and it costs way too much for what it delivers for the price

    I would like to see a system like here. The government pays a small amount per person and people on lower incomes get free care and the policies are on a sliding scale after that. Nearly all the insurers are not-for-profit organisations who don't make money and it is well regulated - it's a great system.

    I don't know the figures for the NHS but I reckon it costs a lot more than 100 pounds sterling per month per person! We could get a lot better for a lot less - but we need to seriously look at the NHS and what it is and does (preferably without the blinkers that are always attached when talking about the NHS)

  • Comment number 8.

    Quote on BBC website today: In a statement to MPs, Mr Lansley is expected to announce a "listening exercise"

    We know what that is. WE are expecting to do the listening "because we haven't understood the proposals". They will keep on doing the telling.

    Why do politicians continually patronise us by calling these propoganda events "listening exercises"?

  • Comment number 9.

    4. At 14:26pm on 4th Apr 2011, DistantTraveller wrote:

    "But the latest coalition plans to turn GPs into bean counters is NOT the answer. Doctors are trained to diagnose illnesses, not do book-keeping or administrative work."

    Whilst this seems like an obvious point on the surface, it must be pointed out that GP surgeries are largely privately run, and as such part of the job must include bean-counting anyway.

  • Comment number 10.

    The reasons why this is politically toxic:

    1. Both Conservatives and LibDems promised before the election that there would be no more top-down, politically-driven reorganisations of the NHS. Now, in coalition, they are both doing exactly what they promised not to do;
    2. Lansley has received money from consultancy and towards his private office from organisations which hope to gain from the 'any provider'. His hands are not clean. Lansley also flipped his second home;
    3. There is no evidence that this will work, some weak evidence that it won't, and there have been no pilots;
    4. There are serious concerns that European Competition Law will stop healthcare providers from working together and add a massive new layer of bureaucracy and cost to the NHS. There are concerns that these changes could, by accident, hand control of the health sector to Brussels from Westminster;
    5. GPs, who are not generally NHS employees but private contractors, have, with issues such as their pay rises and the non-provision of out-of-hours cover, shown themselves to have more regard for their own remuneration and reducing hours than patient welfare or the NHS budget. They, historically, have not exactly been the cream of medical school output. Why are we handing GPs control of the NHS budget, especially when they do not even appear to want it?
    6. Evidence on the ground suggests that existing bureaucrats are leaving the NHS with large pay-offs and walking into identical jobs with GP consortia.
    7. The existing NHS efficiency drive is not working: frontline staff are losing their jobs, while the bureaucracy is awarding itself big pay rises and 'commercial' titles
    8. Why do we seem so keen to handover the NHS to overseas companies, particularly US one?
    9. The public does not support these changes, and the LibDems fear, quite rightly, annihilation at the ballot box in May and beyond.

    Lansley won't survive the backlash. Neither will Clegg or Cameron if they don't jettison Lansley.

  • Comment number 11.

    Andrew Lansley has shown himself to be incredibly incompetent in the way he has dealt with NHS reform.

    You would be forgiven for thinking that Andrew lansley had been put in charge of the NHS a couple of months ago having never visited a hospital. He has actually been shadow Health Secretary for nearly 7 years before being Health secretary for 11 months. How can someone who was supposed to have it all in hand and working on reforms for so long get it so wrong? https://bit.ly/hUO3aL

  • Comment number 12.

    Listening? To whom?

    Doesn't it rather depend who the audience is?

    https://www.economist.com/blogs/bagehot/2011/03/ed_miliband_0

    He's not the only one who needs to 'listen' it would appear.

    Perhaps the NHS could now try to 'listen' rather than this knee-jerk clap-trap about re-contamintaing the tory brand.

    The NHS needs reform, not a self appointed liberal elite of north London metropolitan 'progressive' types telling it what to do the whole time.

    It's grim uip north London...


  • Comment number 13.

    Politicians fell over themselves to say they would reduce the paperwork of police officers and get them back out onto the beat. In what way are GPs any different? Why should someone who has gone through several years of medical training waste their time trying to sort out paperwork or shortlist suppliers? Consulting them more would have been a step forward, making them solely responsible is a step backward.

  • Comment number 14.

    4. At 14:26pm on 4th Apr 2011, DistantTraveller wrote:

    A cure for the NHS? If the NHS were a patient, the doctor would probably advise losing some weight. There is still too much bureaucracy.
    -------------------------------------------------------------------------------

    ....I'd suggest a regular colonic irrigation and failing that, a Do Not Resuscitate Notice! :o)

  • Comment number 15.

    Look at the cost of running the NHS compared to the US. The US spend some 15% of GDP compared to the NHS 8-9%. The NHS is very good value for money. We still spend less per head than most of the European countries as well.

    If Cameron forces these changes through then I think it may be the final end to the Tory party. Its always been proven in the past, you can't trust the Tories with the NHS.

  • Comment number 16.

    I would see this as aimed at the LibDem MPs – our best hope for fracture in the ConDem coalition.

    Clegg has sold his soul to the devil for a few years of power. His party can see the writing on the wall: if they don't do something soon they will disappear as parliamentary party at the next election. A leadership challenge is likely, if they dump Clegg and renounce association with the party of evil soon enough perhaps they can rescue something.

    Can back peddling on tory plans to break up / privatise the NHS head off the confrontation between Clegg and his party?

    I don't think so - not if the economy continues to collapse - but it might help Clegg for a short while.

    Let's see what happens at the forthcoming council elections.

  • Comment number 17.

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

  • Comment number 18.

    Yep. I think post 01 @ 14:11pm on 04 April 2011 - 'RedandYellowandGreennotBlue' sums up what I know to be happening in my hospital workplace right now.

    btw - 'RedandYellowandGreennotBlue' please condense your screen name?! Just for the sake of idiots like me who can't cut and paste, nor have the time to learn. Hope you don't mind. Thanks

  • Comment number 19.

    9. At 14:56pm on 4th Apr 2011, Marnip wrote:
    4. At 14:26pm on 4th Apr 2011, DistantTraveller wrote:

    "But the latest coalition plans to turn GPs into bean counters is NOT the answer. Doctors are trained to diagnose illnesses, not do book-keeping or administrative work."

    Whilst this seems like an obvious point on the surface, it must be pointed out that GP surgeries are largely privately run, and as such part of the job must include bean-counting anyway.
    =================================

    Larger practices - primary care health centres - with multiple doctors, nurses, etc employ professional practice managers.

    Doctors have no training in administration, employment matters, finance etc

    Quite rightly so.

    When I go to my GP I want them to have the time to talk to me in depth - not pass me off to the practice nurse. When I am not at the surgery I want the doctor with his head in the British Medical Journal or the Lancet, not scratching his head over the spreadsheet of costs for the wheelchair service.

  • Comment number 20.

    Health care spending in the UK as a percentage of GDP and spend per capita is the lowest in the western world countries. Rather than criticise the NHS for inefficiencies we should be celebrating how the scale of economies within the NHS provides us all with a very cost effective health service.

    Dont believe me here one of many links that you can view the data.
    https://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/

  • Comment number 21.

    Listening. Thats brilliant isn't it? Listening is only the first part of what needs to be done. Listen, consider, then act. Doing just the first bit is a largely pointless exercise. I can listen to my alarm clock ringing loudly at 6AM, but I still have to think "time to get up", then lift myself from bed before I venture into the NHS to work . . .

    "As for all the shroud waving and doom-mongering from the left.... its getting profoundly boring and it is only about one thing."

    I think you have missed the point somewhat. Its not the left that has been doom-monering, its pretty much everyone & the BMA is hardly known for its left-ist sympathies.

    Over £1.5b is being used to reform a system in ways that very few actually want or believe is needed. Pushing responsibility onto people who don't want it, don't understand it, don't have time for it & don't have the time for it.

    A few will grasp the opportunity, some of which run their own private providers, who they will be able to refer their parents to.

    Its a massively flawed bill in so many areas. Ill considered and ill thought through.

    When the listening stops, I'm hoping there will be some positive action and very real courage to change direction.

  • Comment number 22.

    Be surprised if they don't end up backing down on this one. Even their supporters - or the more astute of them anyway - were somewhat taken aback by these 'plans'. This government has enough of a challenge with doing the simplest of things to a halfway competent standard without taking on NHS reform. Not saying it doesn't need reform at some point, but not now and not by these guys. Best to leave it for eighteen months or so, let the next Labour government handle it.

  • Comment number 23.

    Andrew Lansley, to be polite, has a long history, and a 'reputation' regarding the NHS. This is why he was appointed by David Cameron as a quick and easy option for Minister.

    But experience in this area does not make Lansley right. A hacker is still a hacker.

  • Comment number 24.

    Don't forget that the changes have already started.

    PCTs in London have been abolished and have been replaced with a hastily formed patchwork of organisations, that existing NHS staff were given about a month to apply for.



  • Comment number 25.

    I completely agree with NHS reforms are needed but I do worry that these changes are being rushed somewhat.

    As for increasing private sector involvement I really dont see this as a problem providing patient care is not compromised. It will lead to greater competition, improved efficiency and less waste.

    As someone who works in the NHS the amount of waste is utterly ludicrous. For example, about 3 months ago our team threw away thousands of pounds worth of leaflets because they had the wrong logo on.

    There are about 50 members in our team and at most we have 4 hours patient contact a day. What are the other 3 1/2 hours for then I hear you ask. Admin apparently, though this only takes 30 mins tops, so we have 3 1/2 hours just chatting and going on the internet and people who ask for extra work get fobbed off with non-jobs.

    The private sector companies providing the same service simply make their staff work 6-7 hours clinical work a day instead of our 3-4. Under these reforms our team would be forced into being more efficient or we would not be able to compete. Even though this may ultimately lead to unemployment for myself I agree with the principle because we should get value for money as taxpayers and I hate the idea hardworking people are paying for me to sit in the office playing on hotmail, facebook and the BBC message boards.

  • Comment number 26.

    Why is everyone so hung up about privatising the NHS?

    Private companies sell us the water we drink, the food we eat and the clothes we wear for a profit.

    All are far more basic necessities than health care but no one suggests we have state run supermarkets. In fact, the only people who die of thirst or hunger in the UK are elderly patients in the NHS who can't feed themselves.

    For me the reforms don't go far enough - a privately run NHS can still be free at point of use AND offer better value/service to the taxpayer.

  • Comment number 27.

    10. At 14:57pm on 4th Apr 2011, norwici wrote:

    The reasons why this is politically toxic:

    1. Both Conservatives and LibDems promised before the election that there would be no more top-down, politically-driven reorganisations of the NHS. Now, in coalition, they are both doing exactly what they promised not to do;
    ------------------------------------------------------------------------------
    So, how is this top down? Surely, its bottom up isnt it? This line is more than a little sound-bite-y and formulaic.
    ------------------------------------------------------------------------------
    2. Lansley has received money from consultancy and towards his private office from organisations which hope to gain from the 'any provider'. His hands are not clean. Lansley also flipped his second home;
    --------------------------------------------------------------------------------
    Whoopy-do. Who cares? Take a look at the previous incumbents if you want to see serial flipping and that included Balls and Darling as well. Several times. Not a unique enough USP to hang somebody with.
    ------------------------------------------------------------------------------
    3. There is no evidence that this will work, some weak evidence that it won't, and there have been no pilots;
    -----------------------------------------------------------------------------
    References please? Where is this data? Published by whom?
    ---------------------------------------------------------------------------
    4. There are serious concerns that European Competition Law will stop healthcare providers from working together and add a massive new layer of bureaucracy and cost to the NHS. There are concerns that these changes could, by accident, hand control of the health sector to Brussels from Westminster;
    --------------------------------------------------------------------------------
    Well, over the last thirteen years we've given away control of virtually everything else to Brussels for next to nothing in return except free gravy train passes for the Kinnocks, Lord Mandy and Cathy Ashton. That ship sailed YEARS AGO.
    ------------------------------------------------------------------------------
    5. GPs, who are not generally NHS employees but private contractors, have, with issues such as their pay rises and the non-provision of out-of-hours cover, shown themselves to have more regard for their own remuneration and reducing hours than patient welfare or the NHS budget. They, historically, have not exactly been the cream of medical school output. Why are we handing GPs control of the NHS budget, especially when they do not even appear to want it?
    -------------------------------------------------------------------------------
    You tar them all with the same brush. Ask who signed the pay deal that gave them such riches in return for so little. I would venture that the point is meant to be that GP's "buy" services from "providers" (ie hospitals) when and where they need them, having better and more up to date knowledge of their own patients and their requirements, rather than the hospitals becoming self-licking lollipops. Theres nothing fundamentally wrong with the idea, regardless of how badly pearshaped it may go in execution....
    -------------------------------------------------------------------------------
    6. Evidence on the ground suggests that existing bureaucrats are leaving the NHS with large pay-offs and walking into identical jobs with GP consortia.
    ------------------------------------------------------------------------------
    Where is this evidence? Links please.....
    ------------------------------------------------------------------------------
    7. The existing NHS efficiency drive is not working: frontline staff are losing their jobs, while the bureaucracy is awarding itself big pay rises and 'commercial' titles
    -----------------------------------------------------------------------------
    Front line staff? You sure about that? Where? Examples? Data?
    --------------------------------------------------------------------------
    8. Why do we seem so keen to handover the NHS to overseas companies, particularly US one?
    ----------------------------------------------------------------------------
    Like who? And, even if that is true, we've had thirteen years of handing over ownership of key players in industry and in government services to overseas competitors and nobody batted an eyelid. Why the big fuss now? Why is this different?
    ---------------------------------------------------------------------------
    9. The public does not support these changes, and the LibDems fear, quite rightly, annihilation at the ballot box in May and beyond.
    ---------------------------------------------------------------------------
    Data to support the lack of public support? Second part is probably right, but its a bit of a wet finger in the air.
    --------------------------------------------------------------------------------

  • Comment number 28.

    #7 mightychewster

    Interesting to see how different countries manage different health systems. With regards to the example you gave, what is the justification of having these insurance organisations which, it seems to me, act as middle men. Why not just hand the money directly to the health system?

    Is it like car insurance where everyone has to be covered? If not, then what happens when someone who doesn't have cover requires emergency care? I've had and heard of terrible experiences with the NHS, but recognise that it is an organisation which does remarkably well with a large population and comparatively small budget. There are steps to take first before introducing what the government is proposing, until today these steps appear to have been totally ignored.

  • Comment number 29.

    4. At 14:26pm on 4th Apr 2011, DistantTraveller wrote:

    A cure for the NHS? If the NHS were a patient, the doctor would probably advise losing some weight. There is still too much bureaucracy.
    -------------------------------------------------------------------------------

    ....I'd suggest a regular colonic irrigation and failing that, a Do Not Resuscitate Notice! :o)


    And the sad thing is, Daily Mail readers actually believe this kinda stuff.

  • Comment number 30.

    The difficulty for Mr.Cameron is not the merit of change in the institutions managed by the state,but they need the undivided attention of a prime minister who is occupied elsewhere.

    The conservatives want to remodel society on free market principles in as short a time as possible,to do it such a way it would be impossible to reverse like the sale of socialized assets in the eighties.

    This programme however is not comparable to the Thatcher administration which had radical elements like council house sales and privatisation,but otherwise proceeded cautiously.This is more like the Attlee government of 1945 coming from the opposte direction.Not piecemeal trial and error which is the British tradition,but wholesale,root and branch social engineering completing the revolution began by Mrs.Thatcher.

    For change on this scale you need wide public support,otherwise it looks dictatorial and ideologically driven.Mr Attlee had a bloody war and mass unemployment in his radical sails.Mr.Cameron has has to overcome a public prejudice in favour of the NHS as it is with perhaps some tinkering. Patient satisfaction has never been higher so why change,?why now?,why Mr.Lansley?

    That it is driven by demographics is not believed,nor by the cost of new drugs. So Mr.Cameron and Mr.Clegg are listening.But complex policy can only be framed by informed analysis and opinion.When an aircraft or tank is designed,the minister doesn`t drop in on the general public in listening mode.It`s a nonsense,,it`s also a nonsense if you are redesigning a social service on which the public depends.

  • Comment number 31.

    15#

    Not comparing like with like biggles, for a change, plus a side-order of the usual hackneyed left wing soundbites.

    Yawn-a-rama......

  • Comment number 32.

    19 - "When I go to my GP I want them to have the time to talk to me in depth"

    In your case, don't you mean "listen to me in depth"?

    What a dreary prospect.

  • Comment number 33.

    I'm not sure what the fuss is about. If you're not satisfied with the NHS, simply subscribe to BUPA or a similar service.

  • Comment number 34.

    19. At 15:24pm on 4th Apr 2011, jon112dk wrote:

    "Larger practices - primary care health centres - with multiple doctors, nurses, etc employ professional practice managers.

    Doctors have no training in administration, employment matters, finance etc

    Quite rightly so.

    When I go to my GP I want them to have the time to talk to me in depth - not pass me off to the practice nurse. When I am not at the surgery I want the doctor with his head in the British Medical Journal or the Lancet, not scratching his head over the spreadsheet of costs for the wheelchair service."

    Don't we all. Perhaps we'll get more doctors and nurses should any competition be created between providers of healthcare products. I happen to have worked on one company that provides an important instrument to the NHS (I won't say who or what they specialise in). The competition in the market forced them to offer the best price available, expand their product range through investment, become more efficient by outsourcing production to China for a fraction of the price, and still make a reasonable profit.

    This cannot be done within the NHS. The competition could well free up money for more doctors and nurses, and less burden on them.

    Oh, and sure they're not trained in administration or bean counting - but is it too much to ask for them to get together and use their expertise to decide where money is most needed? There is too much employment of people who know nothing of the industry in the public sector; it's especially prominent in the NHS and public transport.

  • Comment number 35.

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

  • Comment number 36.

    "I think you have missed the point somewhat. Its not the left that has been doom-monering, its pretty much everyone & the BMA is hardly known for its left-ist sympathies."

    OK, I should have included "self-interest groups & Lobbyists". There. Does that make you feel better? The BMA is most absolutely, certainly a self interest group.

    "Over £1.5b is being used to reform a system in ways that very few actually want or believe is needed."

    You mean "very few of the self interest groups and politicians who ride on the back of them and figure they can use it for their own ends actually want".

    Has anyone asked the patients? Those who have had to wait the best part of 8 months for a hernia repair? Those who'se relatives were killed by MRSA and CDiff, not to mention incompetent locum practitioners hired from overseas, not to mention those who were suffering from cancer who were told that if they stumped up for their medication that NICE deemed they were not worth, that they would lose all rights to further NHS cancer treatment full stop, based purely on the Health Secretary's schoolboy communist ideology?

    Have you asked them what they think?

    After all, they're the poor saps who are paying hand over fist for it and getting a service which is not as universally good as it should be, given the levels of investment.

    No?

    Thought not.

    "Pushing responsibility onto people who don't want it, don't understand it, don't have time for it & don't have the time for it."

    Empty soundbite. I'm going to ignore that last line. Probably came from the same gob as "too hard too fast" and other such idioms.

  • Comment number 37.

    29#

    Typical spotty student left wing rebuke and phenominally, buttock clenchingly boring and unoriginal.

    Try again duck.

  • Comment number 38.

    RYGNB:

    We have a very similar system in Belgium.

    "Is it like car insurance where everyone has to be covered?"

    Basically. Covers you for emergency treatment, hospitalisation and the such like that your social security payments do not.

    "If not, then what happens when someone who doesn't have cover requires emergency care?"

    You get the care, but you also get the bill. What happens after that, I dont know. I've not had to use it.

    "I've had and heard of terrible experiences with the NHS, but recognise that it is an organisation which does remarkably well with a large population and comparatively small budget."

    Comparatively small? When it employs more people than the Indian State Railways and eats billions per year??? Are you taking the mickey???

    "There are steps to take first before introducing what the government is proposing, until today these steps appear to have been totally ignored."

    Like what? If now is the listening phase, maybe you'd do well to get your views expressed to No10 pronto as to exactly what these steps should be. It would be terrible for us all to miss out on your mass healthcare provisioning insight...

  • Comment number 39.

    Lansley will be the embodiment of Jeremy Thorpe's comment about Harold Macmillan's 1962 re-shuffle. He is a big problem for Cameron and Clegg. A noble sacrifice is in order and Andrew Lansley's career should suffice - at least in the short term.

  • Comment number 40.

    There's a big difference between "reforming" the NHS and privatising it... the former doesn't have to be at the cost of the latter.

    Cut the waste, reduce the middle management and so on - sure. But let's not pretend this requires privatisation. Just about the entire medical profession is saying "this is a bad idea"; it's time to listen to them methinks.

    If the Coalition bungles this one, it will almost certainly become their own version of the Poll Tax. That is: something that will turn even the bluest of voters red with anger.

    It's a bad idea financially; it's a bad idea in terms of public health; it's a bad idea politically. It's quite simply a bad idea. But heh, you heard it here last!

  • Comment number 41.

    "Why is everyone so hung up about privatising the NHS? Private companies sell us the water we drink" - 26

    I consider this more of an argument for nationalising water than for privatising the NHS.

  • Comment number 42.

    So here we are again discussing the sacred cow of services again. The only thing wrong with these reforms is they do not go far enough. It means the taxpayer will still have to face a future where the NHS swallows up massive amounts of money, poured in at frequent intervals, to keep this bureaucratic service on life support. This small amount of reform will save some money but not nearly enough.

    The truth is that patient expectation, more expensive treatment, large population increase and an ever increasing aging population that are living longer, means the pressure for the NHS to provide healthcare for all, will be impossible to deliver in its present form. Just the obesity problem in Britain, will need a vast amount of funds for the future.

    Spending increased under Labour substantially, yet the improvements for the money spent were small. Most of the extra funds went on wages for staff, very little followed the patient. Ring fencing the NHS from budget cuts was a mistake, because managers in the NHS will continue to waste money, instead of trying to provide value for money.

    A taxpayer funded NHS is not only inefficient but it is unsustainable as well. The sooner England moves to a private insurance model for health the sooner money will stop being poured down the drain.

    I think Lansley is very competent, it is hardly his fault that the public cannot or will not understand these reforms.

  • Comment number 43.

    "Has anyone asked the patients?" - 36

    Satisfaction levels are relatively high. Performance and value-for-money aren't too bad. Can be improved of course (silly to say otherwise and the NHS shouldn't be a sacred cow) but there's no mad crisis.

    'Yes' to appropriate, thought-through and mandated health reform at some point in the near to medium term - but not this, not now, and not by these less than bright sparks.

  • Comment number 44.

    The benefit of carrying out wholesale reforms at this time was always questionable.

    Some reform of the NHS is long overdue but with managing the economy, changes to education and military intervention abroad this would seem a step too far at this moment in time.

    Against the backdrop of widespread cuts this will always look like they are trying to renege on their spending pledge on the NHS.

  • Comment number 45.

    andy @ 33

    Hey, hats off for finding the time to comment today on the NHS, Andy.

    End of the tax year - turning fiscal corner - is prime time for monkey business, I would imagine?

  • Comment number 46.

    I am so glad I live in Scotland. The English reforms could have a silver lining for us, as well as the Welsh and Northern Irish.

    Our block grants depend on the amount spent on the devolved services in England. The reforms, even if privatisation is only partial, are likely to increase the cost of providing a decent health service in England. So Scotland, Wales and Northern Ireland can expect more money.

  • Comment number 47.

    34. At 16:02pm on 4th Apr 2011, Marnip wrote:

    I'm sorry but I'm still falling about laughing at the idea of private sector efficiency in bidding for tax payer funded contracts.

    From the £22 light bulb to the multi-million pound cash grab of PFI, the private sector is a massive rip-off of tax payers money.

    I think most people working within the state sector have at times wondered how (example) a two room extension the size of my garage can cost more to build than the price of a semi-detached house, inclusive of the builder buying the land for the house.

    Few of us were surprised when we heard major construction firms were being fined for collusion - 'you put in a bid at cost times three for this one, we'll put in some really silly bids. You do the same for us on the next one'

    "The Office of Fair Trading (OFT) issued penalties to 103 UK companies worth a total of £129.5m after an investigation into bid-rigging in England, but warned that the practice had been “endemic” in the industry."

    Tens/hundreds of millions going straight into the pockets of the tories rich mates, kerching.

  • Comment number 48.

    I am still waiting for that first person who can explain, or at least attempt to explain, why the changes that Lansley is proposing should lead to a better NHS. What is becoming more common is supporters of Lansley's reforms asking for opponents to "prove it will not work" This is becoming a sick joke.

    Oh, before I forget, the Lansley's supporters are now arguing that the NHS needs reforms and any reform is better than no reform. OK, my car needs doing something to. I don't know what to do, so I drive it off a cliff because it's better than doing nothing to it.

    The Tories (and I'm afraid some Labour and LibDem ministers) have always looked at the NHS as gold mine for private money making. Andrew Lansley's ploy was to bribe GPs with GP commssioning, and then go ahead and privatise the NHS. But GPs may not be the brightest brains in the profession but they are not daft. Lansley is exposed.

  • Comment number 49.

    #38 Fubar_Saunders

    "Comparatively small? When it employs more people than the Indian State Railways and eats billions per year??? Are you taking the mickey???"

    The NHS costs less per person than most (if not all?) other healthcare systems. Economies of scale maybe? I wouldn't compare it to Indian State Railways, not sure their average wage bill and overheads match those of the NHS.

    "Like what? If now is the listening phase, maybe you'd do well to get your views expressed to No10 pronto as to exactly what these steps should be. It would be terrible for us all to miss out on your mass healthcare provisioning insight..."

    Here's my amateur mass healthcare provisioning insight with regards to this situation:

    - PCTs should not be scrapped so suddenly. If they have to go, then remove them over a longer time so as to provide sufficient support to whoever is taking over their responsibilities.
    - Remove the dependence on management consultants such as McKinsey who charge exorbitant rates for little benefit.
    - Spend more time consulting with GPs, and with wider participation for feedback (somthing which now appears to be taking place)
    - Fully consider and test the implications of having the NHS compete with private companies for patient care. It may be the case that private companies win out over the NHS in the vast majority of cases. What role, then, for the NHS?

    As for going to No.10 with these ideas, I'm not an expert and so wouldn't expect to be listened to.

    I'm still interested to hear why it is necessary in the Dutch/Belgian systems to have insurance organisations as middle men?

  • Comment number 50.

    Having interrogated my friend and tennis partner who is a GP I was reasonably satisfied that leaving doctors to manage their budgets and allocate health care was a 'good thing' and would not create a new postcode lottery. Then I thought about it and realised that not all GPs are as socially responsible as my chum. That, I think, is why there is public disquiet - some people simply don't trust doctors. Sad but true. Howewver rational the reforms may be, they threaten one of the few civil institutions that people in Britain love - the NHS.

  • Comment number 51.

    "45. At 16:56pm on 4th Apr 2011, sagamix wrote:
    andy @ 33

    Hey, hats off for finding the time to comment today on the NHS, Andy.

    End of the tax year - turning fiscal corner - is prime time for monkey business, I would imagine?"

    Always have a few spare moments to spread wit & wisdom. One of the advantages of being good at what I do.

    I suppose it's the opposite for you. How the long empty hours must drag for you between each of Nick's blogs.

  • Comment number 52.

    "Spending increased under Labour substantially, yet the improvements for the money spent were small" - 42

    The improvements were large. Even Kelvin MacKenzie (rather a bete noir of New Labour) acknowledges this to be the case.

  • Comment number 53.

    42. At 16:38pm on 4th Apr 2011, Susan-Croft

    500-600 GP consortia replace 150 PCTs .... reduction in bureaucracy?

    As posters above (#10) report (from the inside?) the NHS bureaucrats are taking handsome redundancy payouts then moving to the same jobs with the new bureaucracies.

    NHS job cuts are coming mainly in the form of recruitment freezes - young doctors, nurses, midwives, physios etc will be qualifying to find no jobs. The more senior paper pushers are just moving to new posts.

    Reality check: GPs can't run the details of NHS contracting, no one is expecting them to do so, it is not part of the plan.

  • Comment number 54.

    47 - "From the £22 light bulb"

    Hilarious that you can take an example of state waste of money and somehow make it a fault of the private sector. If I was able to charge £22 for a lightbulb abd someone was daft enough to pay it, I'd be a fool not to.

    See if you can find an example of a private company paying another private company £22 for a lightbulb.

    They use lightbulbs as a metaphor don't they? You know, one flashing above your head when you have a bright idea. I guess it's been a long time since you had one of those moments yourself.

  • Comment number 55.

    I see that the ideological lines in the sand have been drawn again. Fubar, Marnip, Susan, Andy, and Robin (please stop using Private Eye's 'It's Grim Up North London', Robin - it doesn't belong to you) are in favour of privatising, and Saga and Jon amongst others defend the public sector. Reminds me of Haig and Foch against Hindenburg and Ludendorff i.e. fighting the same old battles with the same old tactics. Not that I don't enjoy reading what can be extremely stimulating argument (and some quite amusing abuse), but it won't work with this issue and the NHS has got to the stage where something new is necessary.

    Our state-funded health system can certainly be a bottomless pit. Demand will always outstrip supply and taxpayers are not going to be able to fund it indefinitely. People living longer means costs will rise significantly and it is surely right that the individual should take greater responsibility where feasible. This may mean greater use of private insurance but should mean a tax concession for those who do so.

    I don't see how privatisation without true competition can work, however. The water example given earlier is truly fatuous in that there is no consumer choice and we rely on a regulator to ensure we aren't being stiffed. How is that true competition? Railways are another poor example of ideological tinkering that has brought about very little if any consumer choice. If there is to be greater private sector involvement in our healthcare system then it must be truly competitive with a state regulator imbued with statutory obligations and powers to ensure that standards are met. I would also baulk at a situation similar to the US where the bottom 10% or so are jettisoned from non-emergency treatment because they cannot afford it. We are meant to live in a decent, civilised society, and those who are vulnerable should be protected.

    I am no great fan of privatisation in the UK primarily because it has been so clumsily handled. State monopolies have been replaced with private cartels, thanks to the fudges of Thatcher and Major. Now, I am no Rothbardian anarcho-capitalist who believes that the market is the answer to everything. The state should do some things which are too important for the private sector e.g. law and order, defence, but there is no reason why, with true competition that has a regard for dignity inbuilt, a properly privatised healthcare system would not work.

    It shouldn't be done now, though. There is no mandate for this type of major re-organisation and it would be disingenuous of Cameron, Clegg, and Lansley to proceed without one. Referendum, anybody?

  • Comment number 56.

    The question is: Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income? For me it's simple, I prefer my GP to remain a GP.

  • Comment number 57.

    "42. At 16:38pm on 4th Apr 2011, Susan-Croft wrote:
    So here we are again discussing the sacred cow of services again. The only thing wrong with these reforms is they do not go far enough. It means the taxpayer will still have to face a future where the NHS swallows up massive amounts of money, poured in at frequent intervals, to keep this bureaucratic service on life support. This small amount of reform will save some money but not nearly enough.

    The truth is that patient expectation, more expensive treatment, large population increase and an ever increasing aging population that are living longer, means the pressure for the NHS to provide healthcare for all, will be impossible to deliver in its present form. Just the obesity problem in Britain, will need a vast amount of funds for the future.

    Spending increased under Labour substantially, yet the improvements for the money spent were small. Most of the extra funds went on wages for staff, very little followed the patient. Ring fencing the NHS from budget cuts was a mistake, because managers in the NHS will continue to waste money, instead of trying to provide value for money.

    A taxpayer funded NHS is not only inefficient but it is unsustainable as well. The sooner England moves to a private insurance model for health the sooner money will stop being poured down the drain.

    I think Lansley is very competent, it is hardly his fault that the public cannot or will not understand these reforms.
    "

    The US privatised system costs more per head, excludes 20% of the population from care and life expectancy is less than in this country.

    https://en.wikipedia.org/wiki/Health_care_in_the_United_States

    There is no evidence that privatised health care is more cost efficient.

  • Comment number 58.

    How can you trust the Tories with the NHS after what they did in the 1980s. Waiting lists grew dangerously, orthopaedic for instance was around 3+ years in our local hospital. Departments forced to invoice other departments who used their services overstretched staff levels and every year a further 10% was lobbed off funding. Private industry top dogs started taking over the running of hospitals leading to a centralisation of services and break up of departments. They paid themselves hugely and brought in their buddies from the City to advise. When the Chief Executive was thrown our of our local hospital she many millions went with her and her 'business' style accounting procedures. The hospital never recovered the money and there wasn't enough evidence to prosecute her. Her executive team left wholesale and to this day the hospital has debts arising from her stay. She used a conveyor belt mentality in her management and the hospital fell to bits for a while. Labour came in and saved it and now it is thriving.

    Look on the internet and see what the papers of that time said. People were dying in A&E without being seen by a doctor, there were occasions when time passed before they were found. People suspicious of having cancer waited many months for scans and people died before diagnosis. My mother was one of them and her treatment was horrendous. The staff did their best but funding problems had brought the service to its knees. How short the memory is of the general public, but there is evidence of what the Tories did if anyone should care to look for it.

    Cameron promised quite explicitly he would not reform the NHS. There could have been no other meaning in what he said. He didn't win the election because not everyone was convinced that he meant what he said. Having lived under the Tories I never for a second believed that Cameron cared about the NHS. He used his disabled son to try and give the impression he was NHS friendly Cameron, which in itself is contemptible and shows what a ruthless liar he is. I abhor him and his party and by their association, the Liberal Democrats who promised different things before the election but joined in heartedly with the bank-friendly, city-loving multimillionaires now who sat round a table to judge disabled people for having an extra room in their homes, and find ways of depriving them of it in spite of the fact it may be their lives. They show no shame, and I wonder how many rooms they have in their own houses. What a load of dreadful heartless people we have ruling us at the moment. To use Cameron's words when discussing giving the vote to prisoners, he makes me sick to my stomach, and his nasty cronies make me feel the same.

  • Comment number 59.

    "52. At 17:27pm on 4th Apr 2011, sagamix wrote:
    "Spending increased under Labour substantially, yet the improvements for the money spent were small" - 42

    The improvements were large. Even Kelvin MacKenzie (rather a bete noir of New Labour) acknowledges this to be the case.
    "

    True. I remember him saying the same in question time a month or so back regarding improvements to his local hospital.

    You need to remember that private health care spend huge amounts on their lobbyists. There seem to be a few on here!

  • Comment number 60.

    51. At 17:26pm on 4th Apr 2011, AndyC555 wrote:

    "Always have a few spare moments to spread wit..."

    ^ Nice rhyming slang there, Andy!

    On topic: Lansley as quoted in the latest Beeb headline - "There is a job to be done in convincing people of these reforms" - he's not wrong there. But I'd rather he did his job and listened to people, rather than seeing his job as being to convince them.

    I guess that's what you get with an "ex-PR man" running the show...

  • Comment number 61.

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

  • Comment number 62.

    As the Country is broke, so we are told, where is the money coming from to support the cost of these "reforms"

    Also as the NHS is apparently more about business and competition that treatment now a days when will we see ROI for the above?

    The reason the NHS has become so bloated is due to the number of bean counters employed on not insignificant wages to prove that the Tax Payer is receiving value for money and looking after the "internal Market".

    In the Trust that I work at th Director of Finace is paid more than the Director of Nursing... that says it all in my book.

  • Comment number 63.

    Marnip wrote:

    I have no idea whether these plans will work, and neither does anyone else - the point is there is a decent argument for them, and a decent argument against them. Give them a try, and see how things change. If there's a positive change, great. If there's a negative one, reign it back in.

    In other words, let's run around like a headless chicken and make changes pretty much at random, because doing anything at all can't possibly be worse than not doing anything?

  • Comment number 64.

    sagamix 52

    For the money spent the improvements were small. In fact I believe productivity actually went down. As to Kelvin Mackenzie well what can I say, you really are quoting an expert on all matters there. Not.

  • Comment number 65.

    Thanks for the link to the Tebbit article. His advice is straight from the point of experience. I also read his article in the Telegraph on Saturday where remarked that Cameron wanted to be Prime Minister more than he wanted to resolve the nation's problems. I would call that a measured assessment.

    However, generally speaking the NHS needs to be reorganised so that the money goes further, the patients get the care they need when they need it and the ordinary folk, both staff and patients, feel in control and that they matter.

    I have reservations about granting all power to the doctors as I have bitter experience as to the competence of the medical profession who would rather hand out pills than listen to the patient, but at the same time we need to bring decision making into the front line so that the needs of the patient are properly met.

    It is a conundrum that is hard to resolve. Perhaps the government is trying to go too far too fast. We cannot afford the nonsense of the Soviet system set up by Bevan which rewards bureaucrats for failure. But we also we need a system of social medicine that allows free access with the capability of training medical staff, developing new and better treatments and improving its own performance.

    I believe in flat management structures and the empowerment of the people who do the work. The principle of devolved management is correct, the practical issue is who, how and when.

  • Comment number 66.

    Privatisation of the NHS is all about inventing growth at the expense of the taxpayer so that the super rich can generate bonuses on the backs of the invented growth. Nothing more. Nothing less.

    Service will be down as it so often is, costs up, the burden distributed to the many through taxes, health insurance overheads on people and businesses meaning they spend more and the benefits to the banksters and elite running the businesses.

    Anyone who defends the plans are lobbyists, banksters, politicians with a vested interest, businesses interested in grabbing the windfall in supporting their paymasters or the gullible.

    When are we going to stop inventing more ways of borrowing from our future to pay for a brokenbanking system?

  • Comment number 67.

    To 42 Susan Croft - you have no idea and probably not much care either. We all get something from the NHS, would you prefer US style health service where half the population have no health care and which costs a lot more than ours? No large, or small for that matter, organisation is perfect, and there will always be some waste in any situatiion. The fact that you can get rid of every bit of overspend is as ridiculous as the Tories saying that the NHS will always be free at the point of need. If they get away with it, they'll introduce charges, and these charges will gradually increase so they'll introduce insurance to cover the gap, and we'll be in US territory health.

    No one really expects the Tories to keep their word for a second - in this parliament look what they've said, the forests will be better managed under private ownership, and the public saw through that one; £9,000 annual tuition fees would be exceptional and most universities have gone for the higher rate; the school sports saga, and now the EMA debarcle, and that's just the tip of the iceberg. There's Eric Pickles treatment of local councils, the sell off and break up of our armed forces, the broken promises at every level of this incompetent government and of course, that cutting the deficit is labour's fault and nothing to do with the bankers the biggest lie of all.

    One minute they were promising to spend pound for pound of labour's spending, the next day they were all dressed in black with sombre faces saying something different and we're losing so much because of that. They are a lot of liars, they lie easily and comprehensively, and they've been caught out on the NHS.

  • Comment number 68.

    Let's not forget - in spite of Andrew Lansley, every UK citizen has the right to have their operation performed in a UK private hospital since 2007? It's on the Statute.

    Furthermore, as a UK citizen, you are entitled, under EU legislation, to request/demand your operation be performed in France, Germany, Spain, Italy etc., etc. as an NHS patient via your GP and/or UK consultant.

    Do your research. You are entitled. Many UK GPs/Consultants never want to hear about the above. However, it doesn't make them right to refuse your choice under EU Law.

    No, none of the above is about treatment while on holiday in the EU! That's another investigation!

  • Comment number 69.

    55.

    Sensible post but competiton in business with in built dignity that would be something to behold!!!!

  • Comment number 70.

    "How the long empty hours must drag for you between each of Nick's blogs." - 51

    Not at all - I just re-read all the old ones. I'm drawing up a 'Best 50' from all comments posted (by everybody) since July 2008, an exercise (by no means even nearly complete) which absorbs me pretty much 100%. No entry for you yet, Andy, but like I say - not finished.

  • Comment number 71.

    The listening cure.
    Does this mean that no one from the Coalition Government was listening before?
    Prognosis
    1. progressing deafness or
    2. attention deficit disorder or
    3. both.

  • Comment number 72.

    How about sacking Andrew Lansley - or is that too extreme and cheaper than his privitisation and churning up (again) tendencies toward the NHS. Hmmm?

  • Comment number 73.

    Re 58

    Diane,

    I accept fully that everybody has the right to their opinion, hopefully based upon empirical evidence, but I am also aware that political prejudices affect opinions and am therefore reasonably sanguine about that.

    There is no basis whatsoever for you to say such things about the PM and his son, however. I am no friend of the Conservatives (or anybody else, for that matter), but you have gone beyond the pale when accusing Cameron of using his son for political advantage. Unless you have evidence you should think carefully about retracting as this is probably libellous. This sort of attack is what allows the Heffers and Hastings of this world to paint the left as vitriolic and full of bile.

    Unless you have the evidence, shame on you.

  • Comment number 74.

    The NHS is actually a quite efficient organisation by international comparisons - and if you compare it with the US system, it's incredibly good value for money so why is the government which promised at the election not to do yet another throw-it-all-up-in-the-air-and-start-again reform - doing precisely that?

    There is a fundamental belief in the Tory party that market forces are THE answer to everything, so if you swear never to privatise the NHS and always keep it a universal service free at the point of consumption, the current policy of turning GPs into "bulk buying" consumers of services from "any willing provider" is the only way left to marketise Health Care, ostensibly "to make it more efficient".

    The reality is this - GPs have strengths and weaknesses - and the one thing we can be absolutely certain of is that the management of a complex system of healthcare provision is not their MAIN strength, which is the practice of medicine, not lean management techniques, achieving economies of scale or competitive purchasing strategy.

    Firstly, there will massive duplication of effort as each GP consortium has to have its own full structure with personnel covering everything that used to be done by a much bigger NHS regional office structure. Secondly, GPs are only human and tend to have their pet interests and priorities - so they won't be objective in their priorities or dispassionate in their purchasing decisions either.

    The evidence for this not working is there from the last big, bodged privatisation - the railways - which become hugely more expensive to run and had to be bailed out when RailTrack got so cavalier in cost cutting that the network became unsafe.

    And what about the "willing providers"? This will be the story of feast and famine - private companies cherry picking the profitable parts and getting fat, whilst the NHS providers are left to pick up the work that no one else wants, at a loss.

    The NHS providers will therefore become more inefficient as they lose critical mass, economy of scale whilst retaining the high cost work.

    So what's the answer?

    I think we need to recognise that running off to the doctor every time there is the slightest problem is unsustainable. So you've got the flu' - go to bed, take the flu' medicine and get on with it. Cut finger? Clean it up, put antiseptic cream and a plaster on it, and it will heal. I have personally not been to see a doctor for over 10 years and it was another ten before that the previous time when I went.

    Casualty departments are full of people with such minor aliments that they should not be there at all, or should have gone to see their GP practice nurse at very most.

    Failing to take reasonable medical healthcare precautions like using condoms, getting flu jabs for at-risk elderly or incurring expensive-to-treat injuries whilst doing sports or high risk activities should be seen as irresponsible and challenged. IMHO some of them should require private health insurance cover or incur a charge, e.g. sports injuries like skiing or rugby and paying for the care for victims of blameworthy car accidents should come from the insurance of those that caused the accident.

    Those people whose lifestyles cause huge cost to the NHS by using drugs, excessive alcohol or over eating should not just be accepted by society - we should actively discourage these lifestyles and come down hard on those who promote them through taxation of legal activities, punishment for illegal ones and encourage people to change.

    These changes can only be achieved by challenging attitudes and changing behaviour. The Conservatives rubbish this as "the nanny state" - I say we need nanny and most of the time, nanny knows best and it is only by making people take more responsibility for their own health and the amount of NHS resources they seek to use, that we can free up wasted resources to provide good care to those who really need it.

    What is the hallmark of marketised US healthcare? MASSIVE waste for those who are rich enough to afford it through unnecessary tests and treatments, whilst the other half of the population doesn't have access to even basic health care.

    No one is claiming that the NHS is perfect - yes it needs to constantly evolve to meet changing needs and technological progress - atomising it is not the answer.

  • Comment number 75.

    Everytime Ed Balls opens his mouth to criticise the government, does he forget that it was his labour party that got us in this muddle in the first place? Therefore, that is why this government has got to make all these cuts to get us back out of the muddle labour had already put us in.

  • Comment number 76.


    At last - the BBC is finally starting to raise the fundamental issues raised by current NHS reforms ... e.g. rewarding GP's for rationing healthcare (a clear conflict of interest - i.e. profiteering from patients and from not referring patients properly), as well all the other fundamental issues raised by every medical professional body (e.g. British Medical Association, Royal College of Surgeons, Royal College of Nursing etc etc).

    And its worth remembering that the BMA only 'backed' 'GP commissioning' due to private lobbying/voting from 'greedy' GP's. Everyone else is against these reforms, including the vast majority of honest, trustworthy and honorable GP's.

    To push through these reforms the Government are trying to bribe the 'greedy' GP's to take part, by offering them lucrative personal rewards (e.g. fees, bonuses and shares in commissioning groups, as well as lucrative deals in which they can profiteer from rationising healthcare and referring work to themselves). They have also been quietly trying to force those GP's against the reforms into commissioning (which they are still trying to resist), but the Government are now saying they'll let another 'GP consortium' profiteer from doing it instead!

    The Government will still try to press ahead with these controversial reforms, which will be to the detriment of everyone's health and well-being, and which will eventually destroy the NHS.

    These reforms were not asked for, or voted for, by anyone (and were in no party manifesto) ... the introduction of the NHS was a key moment in UK history, and its effective destruction will be equally as dramatic ... we must not lest this happen ... and IMHO the BBC have a duty of care to continue to raise these issues too ... to ensure the public voice is heard!

    IMHO the Government are not 'delaying' to take time to 'listen' ... but to make sure they don't suffer a complete massacre in the forthcoming elections in May! ... only by ensuring the coalition are crushed in these elections will they actually listen to anyone ... and stop the destruction of the NHS, as well as the removal of patient trust in their doctor to act in their best interests!

  • Comment number 77.

    It remains to be seen if the Conservatives will withdraw their plans to introduce competition to the NHS, ie privatisation. It is not possible for the NHS to improve if it is controlled by the market. This is because the needs of shareholders in private healthcare companies will come before the needs of patients. Mr Cameron had a nice scheme worked out whereby billions of pounds of public money would be diverted to private business. He dressed it up as a great handing of cash to our friendly, local GPs. But people realised that GPs would be powerless to choose where the money would be spent when faced with massive private firms ('any willing provider') who can undercut anyone else. So, there is a pause while Cameron 'listens'. Unfortunately, it's just a pause to rearrange the window-dressing. Your NHS will soon belong to those who can make a few bob out of it.

  • Comment number 78.

    Andy 33

    This is a rarity - I think you've cracked it!

    You've cracked it! Get rid of the NHS complely and we all subscribe to BUPA or a similar service.

    Of course, we will have to start by redistribution of wealth, so that we don't discriminate.

    Bit busy this evening, so perhaps I could ask you to put the suggestion to number 10.

    Well done you.



  • Comment number 79.

    jon 53

    The reforms will save a small amount of money. Yes there will be problems if not enough thought out planning is put into the introduction of this policy.

    I have already said the taxpayer will still have to fund vast amounts of money to the NHS at 42, and explained why. I have also said that England must move away from the taxpayer based NHS to an insurance based model, because in the future this is unaffordable, so these reforms for me, will not achieve this aim.

    What I do like about the new policy is that it introduces competition and this inevitably pushes up standards.

    BTW you must stop listening to propaganda jon, that is the department of sagamix.


  • Comment number 80.

    "For the money spent the improvements were small" - susan @ 64

    No - large. Please see post 52 if you doubt this.

  • Comment number 81.

    If anyone can bring down this ConDem gov it will be Andrew Lansley.

    Don't mess with the NHS Mr Lansley - control your ego - the NHS is not about you. If you have something to prove - or justify your Ministerial salary, do it elsewhere, where it personally affects you.

  • Comment number 82.

    ...and once the good doctor has listened. Any bets on a U Turn?

  • Comment number 83.

    56. at 17:41pm on 4th Apr 2011, Dr John Taylor wrote:

    The question is: Do I want my GP to look at me as a patient, with a focus on curing my ailments, or as a business person focused on reducing costs and maximising income? For me it's simple, I prefer my GP to remain a GP.

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

    a fantastic post and I fully agree - this one simple question sums up the problem with these reforms perfectly ... and it highlights how/why the government have been trying to bride GP's to back the reforms ... as he can't do it without them and he needs their help to ration NHS care at source (i.e. before being referred any treatment) - hence they were prepared to offer GP's part of the profits/savings (e.g. as fees, bonuses, shares in commissioning companies, referral work to themselves instead of hospitals)!

  • Comment number 84.

    It is a myth that the NHS is inefficient , of course it needs management and admin staff its a massive enterprise. See this extract from the BBC website 23 June 2010

    "The UK's health care system is the most efficient, says a study of seven industrialised countries.

    The Commonwealth Fund report looked at five areas of performance - quality, efficiency, access to care, equity and healthy lives.

    The US came last in the overall rankings, which also included data from Australia, Canada, Germany, the Netherlands and New Zealand.

    But there is room for improvement in every country, says the report.

    The report, which is an update to three earlier editions, includes patients and doctors' ratings of their experiences in their own health care systems.

    More than 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study, starting in 2007".
    It seems to be accepted dogma that NHS is full of managers stopping the medical staff doing their jobs.
    The facts are different, lets base decisions on facts not dogma - i.e its public service therefore it must be inefficient.

  • Comment number 85.

    Lansley's career is over and this bill, in its current form, is a corpse. Lansley told Parliament this afternoon:

    "I can therefore tell the house that we propose to take the opportunity of a natural break in the passage of the bill to pause, to listen and to engage with all those who want the NHS to succeed and subsequently to bring forward amendments to improve the plans further in the normal way."

    Dead in the water, never mind lame duck.

  • Comment number 86.

    54. At 17:30pm on 4th Apr 2011, AndyC555
    47 - "From the £22 light bulb"
    Hilarious that you can take an example of state waste of money and somehow make it a fault of the private sector. If I was able to charge £22 for a lightbulb abd someone was daft enough to pay it, I'd be a fool not to.
    ============================

    I don't find it at all hilarious that private companies are ripping off the taxpayer during an alleged 'national emergency'

    That case was used by your tory mates in an attempt to trash talk the MoD - look how inefficient they are, we can cut their funds and it can all be taken up with efficiency savings.

    Turns out the bulb was for the back light of a radar equipment. The private company had fitted a bulb only they could supply. Entirely innocently of course, no intention whatever to lock the tax payer into a single source of spares for which they could charge whatever they wanted.

    So exactly what I say - an excellent example of the way in which the private sector rips off the taxpayer.

    Nice of you to confirm that you believe that is exactly what the private sector should do if given the opportunity - that kind of attitude is why many of us don't want the private sector at the forefront of something as serious as health care.

  • Comment number 87.

    I have spent some time today reading about the reforms and listening to Andrew Lansley in the commons. On balance I think his reforms sound sensible and anything that means removing unnecessary beaurocracy is a good thing. I think it indefensible that under labour more managers were employed than doctors or nurses.

    Those who are happy with the status quo should consider that there is a great unease in the nhs about lack of proper nursing care, drugs which are not available as they are too expensive and the growing problem we have with obesity and all its health related issues and alcohol and drug abuse. There is also the problem that many elderly people are in hospital and taking up beds simply because they are not well enough to go home and look after themselves and there are no nursing home beds available. With our ever increasing longevity this is a problem which will not go away.

    I have read about the concerns of private suppliers being used but that is happening now. At the moment the private suppliers can "cherry pick" and just do the lucrative procedures leaving the complicated expensive health care to the nhs. As I understand it, under the new bill that will not happen. More transparency and the decisions being made by clinicians, with support, who could argue with this?

    I do think that the coalition have not managed to make the argument because most of the british public, unless they are heavily involved, tend to get hooked up on media sound bites and those who are unhappy with the current government presumably because they are labour supporters are quite happy to support the labour party's political posturing. I listened to the questions and discussions in the house of commons and they were laughable.

  • Comment number 88.

    bass god @ 55

    "Robin, please stop using Private Eye's 'It's Grim Up North London'"

    Oh please no, don't tell him that - big risk we'll end up getting the quite stupendously annoying 'it's a great time to be a tory' instead.

    Interesting that you're of the opinion a privatised health service (e.g. with true competition) could work. Maybe it could - since the litmus is good universal health care free at point of delivery (i.e. decoupled from personal means), not so much whether it's public or private sector - but how, in a 'for-profit' set-up, would one ensure that we get this? Wouldn't we almost inevitably end up with something of a 'money talks' situation? You know, Lucinda gets seen to - and more thoroughly - way before Lorraine, type thing.

  • Comment number 89.

    "79. At 18:23pm on 4th Apr 2011, Susan-Croft wrote:
    jon 53

    The reforms will save a small amount of money. Yes there will be problems if not enough thought out planning is put into the introduction of this policy.

    I have already said the taxpayer will still have to fund vast amounts of money to the NHS at 42, and explained why. I have also said that England must move away from the taxpayer based NHS to an insurance based model, because in the future this is unaffordable, so these reforms for me, will not achieve this aim.

    What I do like about the new policy is that it introduces competition and this inevitably pushes up standards.

    BTW you must stop listening to propaganda jon, that is the department of sagamix.
    "


    Propaganda? Literally everything you say is pure conjecture and has nothing to do with facts. Just your gut feel. Please follow your own advice and present facts.

    - Insurance based healthcare costs more per capita. Fact.
    - The US health care system costs nearly double per capita than the UK. Fact.
    - 15% are not covered by the US health system. Fact.

    https://en.wikipedia.org/wiki/Health_care_in_the_United_States

    - Average life expectancy is higher here than in the US. Fact.

    https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

    These are verifiable facts.

    Now tell me why privatisation is a good idea using facts because you seem to be presenting blind belief as a reason to change things and your arguments are bereft of verifiable facts. Conjecture (mine).

  • Comment number 90.

    #87 - pure conjecture. No substance whatsoever. Its nothing about presenting the argument, its everything about the idea being a pointless sham.

    https://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/

  • Comment number 91.

    Below, direct quotes from the so called "Coalition Agreement".

    "We will stop the top-down reorganisations of the NHS that have got in the way of patient care."

    "We will ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust (PCT). "

    The second clearly implies a strehgening of the role of the PCT.

    Then just a couple of months later we have a Top down reorganisation with PCTs being scrapped.

    It must take years to build up the levels of arrogance needed to feel you can lie with this sort of impunity.

    It will lead to a massively chaotic and very costly reorganistion, where staff involved in commissioning for PCTs will be employed by the consortia, often after a massive payout from the PCT. What a farce at exactly when the country wants it least!!!!!!!

    Same Old Tories (Thanks Clegg, you put them there..role on the local elections)



  • Comment number 92.

    Saga,

    I suspect that Robin might not think it is such a great time to be a Tory after next month's elections.

    Anyway, back to the matter at hand. I have to believe in the private sector as I teach in a private school despite (or possibly even because of) being brought up in a working class home. I just don't think that the state has all the answers for a situation like the one the NHS finds itself in. I agree that PFI has been a disaster - the pupils I teach (all Lucindas, by the way) Politics to are shocked that the private sector was allowed to get its mitts on such public largesse - but that doesn't mean that the baby should be thrown out with the bathwater. Surely those of us who can afford to should pay and state funding can concentrate on those who are too vulnerable to be left to their own devices. I accept that there may well be an element of two-tierism and although this saddens my egalitarian soul I do not see any way around it without bankrupting the nation.

    It is time for a more ingenious way of doing things, I suspect, as the ideological battlegrounds of the 20th century give way to the problems of the 21st that have little or no relevance to the arguments of Marx, Burke et al.

  • Comment number 93.

    They are only doing this because of the local elections in May!! It will be back to normal soon after.

  • Comment number 94.

    26 Mark from Manc

    "Why is everyone so hung up about privatising the NHS?

    Private companies sell us the water we drink,"

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

    Thats true Mark, they do via a Prixatised Monopoly position, gifted them by tthe Thatch in the 80's.

    Ever tried buying the water from your tap from another "Private" company?

  • Comment number 95.

    79. At 18:23pm on 4th Apr 2011, Susan-Croft wrote:
    jon 53

    ...
    What I do like about the new policy is that it introduces competition and this inevitably pushes up standards.
    ==================================

    Competition inevitably pushes standards down.

    Competition on price means the bidder who pushes the cost down lowest wins - the issue is what they have cut out to achieve that low bid. Subsequent to that, the issue is what they are doing in order to bid so low and still extract a nice juicy profit.

    NHS cleaning is a good example.

    When the NHS employed it's own cleaners under supervision from people like the ward sister you could have eat your dinner off the floor. Once private contractors took over you needed to wipe your feet on the way OUT of the hospital. Remember the MRSA?

    Little story.

    NHS hospital contracts out cleaning. Contract says to clean clinical rooms daily. Lists everything to be done. List does not include moving the clinical waste (soiled old dressings, bandages with blood on etc) bin to one side and mopping underneath. Ward sister up in arms that she has told contract cleaners this needs to be done, but it is not in the contract so they won't. Eventually ward sister takes to going into the clinical rooms each day and moving the bins two or three feet to the side herself, then back again the next day. Contract cleaner still just mops around bins but effectively is now mopping underneath.

    Hospital later finds out nearly one third of the contract cleaners are asylum seekers who are not entitled to work in UK and have not been CRB checked. Few could speak English.

    Now that's how you out bid the in-house bid and still make a nice juicy profit.

    As andyc555 says, the role of the private sector is to rip you off if you are willing to let them. I say - very true, but not in the NHS please.


  • Comment number 96.

    bass god @ 92

    Well there you're getting into the topic of switching away from universal benefits/services towards the means-tested approach. I have time for this argument; indeed I'd also consider things like the state pension (why pay to somebody who isn't on their uppers?) - since we do need to keep tabs on the public purse as we make inroads into this 21st Century - but the 'MT' approach has downsides. Still, what doesn't? Everything bar blueberry muffins has a downside. Protecting my own egalitarian soul (which I suspect is more precious and easily bruised than yours) but also wanting - if at all possible - to avoid bankrupting the country, I reckon I might go for ending universal benefits (e.g. this one, free at point of delivery health care), support us moving to a 'you pay if you can, otherwise it's free' system ... so long as the 'free' service is just as good as the 'pay' service. But if it isn't, I'll be vetoing.

  • Comment number 97.

    Our local GP surgery can't even organise their appointments without an army of people to do it for them, yet Lansley proposes to let them and their ilk lose with £60 bn of taxpayers money and imagines that this will not create yet more pen pushers come off it. Also due to the over generosity of the last goverment with the new GP contracts most of them only work part time for an awful lot of money and they will see this as a way to make yet more money.

  • Comment number 98.

    It's all very simple really - the Government are actually after 'savings' at source - by bribing GP's to ration NHS care (by not referring patients, or pointing them to 'cheap' treatments) and they're prepared to offer GP's hefty brides to do this (management fees, bonuses, shares in GP commissioning consortia, referring work to themselves).

    e.g. take a look at the following article by Kieran Walshe (professor of health policy and management at Manchester Business School for instance https://www.guardian.co.uk/society/2011/mar/15/nhs-reforms-earner-private-sector

  • Comment number 99.

    Changes which are unwanted, unneeded, untested and driven entirely by the Tories pathological desire to privatise absolutely everything.

    Improvement of the NHS is always possible, naturally but the obsession with privatising the NHS is based on a faith (that the private market always makes things cheaper) which is flat wrong. There is no logical reason that a private company needing to make a profit can provide a service cheaper than a public one which doesn't have to make a profit (all other things being equal, see above point about improvement always being possible). The "magic of the free market" doesn't work for sectors with a captive market i.e. where you cannot leave the market without risking your health/life. Every time privatisation has been tried with these sectors, prices explode and standards are taken out back and shot. The NHS costs us comparatively little (about half what the US version costs), provides for all regardless of income (unlike the US where if you're poor and get sick, you die; I can hear the Mail readers cheering) and, while some reform is needed, is in no need of this kind of wholesale root-and-branch destruction. This isn't governance, it's vandalism from the most radical right government we have ever had and what lies at the end of this road is the US example, triage by wallet.

  • Comment number 100.

    53 again.

    Competition improves standards!

    Not as far as the Railways or privatization of energy/utility companies. THis has cost Tax payer a fortune & BT British Gas are 2 of the most complained about companies in the UK last I heard.

    By the way can anyone tell my why these private health firms don't provide A & E services?
    Rhetorical question honest!!

 

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