NHS: What did Cameron and Clegg’s speeches today mean?

Looking forward to comments on this…

‘ANY WILLING PROVIDER’ must go!!  absolutley…it should NOT be in this bill at all….

question: lanslely was at meetings at 2020 private health lobbying company..also UK health refurbished his offices….adam smith think tanks were on the case too..everywhere you looked yoy could see private companies…will the private company contracts get scrapped? will they  be compensated?  if so why?  Lansley owes us some explanations as to what he has been up to ..what were the changes he drafted up 5 years a go…why did he think of introduce them even though it was not in the Tory manifesto

any attempt by Tory right wing backbenchers must be resisted already we’ve seen certain members with their own vested interests try to scupper the amendments

Hmm I’m definitely not confident yet – seems like more delaying tactics to find new ways of bypassing the public. I hope people aren’t prepared to rest their heads at news of “safeguards and rules” that at this time could mean anything…

What does this mean in reality?  Our local hopsital is run with a GOP comission set up – we are supposedly to be one of Lansley’s success stories.  Some of the hopitsl land is to be sold off and the money used to build a new cancer unit for local cancer servcies to be provided.  we have lost our maternity services and A&E and will lose other stuff here too.  But, aging population and all that, dictates the need.  However, the cancer unit will be run by a private company, picking and choosing from staff at the hospital who will work for the new unit.  They will cost it all up, put int he equipment and set up a PFI type contract.  This means that every little change will be billed and the cost of the private provider will be met over and above other more flexible NHS costs.  No matter what costs need to be met, the private provider’s contract will need to be paid so all future svaings needed will be from the NHS budget while the private provided bills more and more each year as new/adjusted services are needed. The private provider will be able to use the facilities for their own private patients.  Where the patient priorities lie I don’t know, but if there is an NHS wait, there is most likely to be an option to pay and jump the NHS queue.  Changes to this bill aren’t going to stop this from happening.  Why does a private provider need to provide this service?

This is all flannel. They have made absolutely no substantive changes to the bill.

David Cameron says we will not be moving towards an American style system. This is not true. We are going to have a massive public-private partnership with funding from the state and provision by the private sector (notice he is still continuing with Foundation Trusts, which will effectively become private businesses, sinking or swimming according to the market). This is exactly like the Medicare/medicaid system in the US.

He says he wants competition “to benefit patients”. He has not explained why this will work in the UK, when it fails spectacularly in the US. The US has the most competition, but some of the worst health outcomes in the developed world. What does he know that the Americans don’t?

He has provided no details as to how he will prevent “cherry picking” and “ensure a level playing field”.

Monitor’s duty to promote “patient choice” still means promoting competition. How can there be choice without several competing providers?He said he will not cut spending, and yet he is still proceeding with the £20bn of ‘efficiency savings’ (which are basically enforced cuts).He says he will not endanger universal coverage, yet GP consortia will only be responsible for registered patients. So if you’re not registered, you’re not covered. There is no mention of continuing to provide comprehensive care, so the NHS will be free to stop covering treatments as its budget is cut, and people will need health insurance to cover the gaps.As for his pledge on integrated care, this doesn’t mean integration between your GP and local hospital, it means integrated within a private provider as in the US – see http://en.wikipedia.org/wiki/Kaiser_PermanenteAlso GP consortia will still exist, and will eventually morph into the US-style HMO. Private companies are already getting contracts to provide commissioning support, and will almost certainly take over this function completely – ergo – privatised NHS.

Hi David,

Although the “duty to PROMOTE a comprehensive health service” (Section 1(1)) is indeed being addressed, there is a much more important “duty to PROVIDE” specific listed services like hospitals and ambulances (Section 3(1)) which really defines the NHS and which is still being abolished, despite today’s announcements.

Basically there has never been a “duty to PROVIDE a comprehensive service” as you describe in the table above. The duty with real strength is the “duty to provide specific services” later in the Act and it is still due to be abolished. It is introduced in Section 1(2) and set out in Section 3(1).

I’m not a lawyer, but we’ve been publishing the legal views of public interest lawyer Peter Roderick at http://www.dutytoprovide.net. Perhaps we can put heads together and come up with a simple specific demand around this that can’t be wriggled out of? The Bill will be redrafted pretty quickly I gather, so there’s not a huge amount of time.

There is a Clegg like smirk on Andrew Lansley’s face that I don’t like. It suggests that he knows that you can fool most of the people most of the time. Unfortunately, the only analytical scrutiny being voiced is from groups such as 38 Degrees which should be loudly applauded, but what of the official parliamentary opposition - not a lot to be heard really!
While I have no confidence in either Mr Clegg, and in Lansley definitely none, I’m worried about the eloquence of the opposition leader. It needs someone who can strike straight through all this deliberately created smokescreen and gather public opinion properly – now…but who? David Milliband…David Davis…Lord Tebbitt…surely someone will emerge!!

It needs to be someone independent, because unfortunately all three political parties see competition and at least some private provision to be the solution.

@Russell  Tebbit? Davis?  aarrgh…both Tory privateers….naaah!!

Ok joke gone sour, but still we could do with a strong voice!

the queen?  imagine HM after a spot of hunting coming to the aid of her loyal subjects

Do not overlook the impact of removing waiting time limits.

With those out of the way a malicious government could starve the NHS of funds and detract from the obligation for treatment,
An example would be: If you have a dodgy hip, OK the free point of use would be  your Doctor will diagnose and recommend a replacement.
So what happens now – without the discipline of a time limit for that replacement, and without a fat wallet and without expensive Health insurance you will have to await a NHS dysfunctional because of lack of funds and you end up in a wheelchair, or dead.
It is as simple as that. The `competition’ clause is a virus to allow mission creep and we end up with a privatised Health Service dependant what or what you cannot afford.
So forget the crocodile tears of Cameron and Co. they have won by the back door – they have got their privatised Health service and you will pay, pay, pay, pay.
 

pace of change – PCTs will be wound up as planned by the end of March 2013 (or sooner if consortia and senates are ready), if consortia are not ready then the National Commissioning Board will hold this for them….can’t imagine what that means and NCB’s accountability needs a long hard look.
Still far too little about patient and public engagement/involvement in OUR NHS, whatever Rethink says. Delighted to help with the line by line read through.   

David

This is the most useful short piece I’ve seen yet on the reality behind the rhetoric, and you are absolutely right to suggest that the devil is in the detail when it comes to Monitor’s role and the drive towards competition. I am not surprised that govt. is focusing on its changes to the commissioning arrangement, which are themselves largely cosmetic if the key commissioning power remains with existing consortia players, since it hides from view the more important issue about what is there to be commissioned.

YES BUT: original problems of the NHS remain, from democratic deficit / corruption of motivations.

We remain highly vulnerable, as patients, as citizens: care dependent on secret battle outcomes.

Priority for integration may curb worst; will not preclude failures, function and finance, public and private.

Despite all vocations, services will reflect societies: we need universal freedom of conscience.

High-level judgement scewed: on tax and spend, public and private, sensible and hot-money attraction.

By the prevailing logic, to attract the highest foreign investment, we shoud vote for slavery…!

As an ordinary citizen, I would prefer ‘the democrastic gamble’, making our own luck…!

BUT we need to know what kind of ‘democracy’ is sustainable, not to find ourselves in mob-rule chaos.

Look at the fate of democracy, ‘the vote and frail parties’, in countries unable to stave-off desperation.

To be permanently free, for all to exercise freedom of conscience, we need to allow ourselves security.

There is no real freedom if some are ruled by greed, some by fear and greed, and some by just fear.

THINK how different would be an equal income-share, compared to a greasy-pole average income…

We can hope for the best from Cameron’s claim of reversal: ‘doctors to be supported by bureaucrats’.

To avoid disappointment, not just over local healthcare but over global survival, time to choose equality.

No moral basis for the radiation of fear in some families, the risk of corruption in others.

EVERY reason to set example here, to contribute to Global Spring: share, improve, save our one world!

To gain sustainable democracy, to choose secure equality, we have first to understand our choice.

38-degrees might make the difference…

Secure democracy, to secure all else?

Dictatorship, like nuclear disaster, like climate catastrophe, might be low-risk… but given time…

I commend democracy, the preclusion of dictatorship, the visibility of any corruption, the rule of love?

thanks – help scrutinising the detail definitely welcome!

Joe – thankyou, and yes, would be good to put heads together. We had an email about this from Peter Roderick late on yesterday.

but whats going to happen to all those Tory donators hoping to a get a big slice of the NHS budget? will they  be compensated out of joe publics fund? and those lucrative contracts….then the companies that build hospitals  and rent going to them from health budget too..they say they want to make cuts but still keep paying off the privateers….cant lansley please tell us wha hes been up  to in past years or so .why all those meetings with  2020 health?

There’s an interesting article in The Indpendent:
http://www.independent.co.uk/life-style/health-and-families/health-news/the-national-wealth-service-2297546.html

I also think that the changes to the Bill are just cosmetic and increased competition will go ahead as planned.

The increased competition is absolutely going to go ahead. They haven’t scrapped the ‘any willing provider’ part, and the only change with regard to competition is altering Monitor’s duty to promote competition, to a duty to promote patient choice. How will they get patient choice? By having competing providers of course.

The 3 main ways of saving money for the NHS are 1. Reduce number of non medical staff by 75%.
2. Serve home cooked meals and get rid of the contracted catering staff & massive wastage of inedible food that is purchased and thrown away.  3.  Stop the companies that supply expensive equipment from having service contracts that cost the NHS thousands and let the hospitals’ own medical physics service these machines.  The 3 important ‘don’ts’ for the government are 1.  Don’t let GPs take charge.  2.  Don’t pay for advice from non-medical management who have no understanding of the needs of the NHS.  3. Don’t make any firm decisions on changes until trials have been carried out to prove that they are the right move.

This is immoral….I am so frustrated that we are seemingly unable to stop this for profit set up

Totally agree…can we send a petition to Ed M to encourage him do something positive to stop this in it’s tracks?

Please lets find an independent person AND Ed M who might have an interest. What about Sir Christopher Meyer ex US Ambasador?

Me too..very happy to help. I wwas a radiographer for 40 years and have some idea how the NHS should be working and how it used to work.

Terrific piece. All in a nutshell.

YES BUT:

Original problems of NHS remain, from democratic deficit / corruption of motivations.

We remain vulnerable, as patients, as citizens: care dependent on secret-battle outcomes.

‘Priority for integration’ may curb worst not preclude failures: function/finance, public/private.

Services will reflect societies, vocations helped or hindered.

We need universal freedom of conscience.

There is a skewed judgement, dominant, on tax and spend, public and private, sensible and hot-money attraction: a race to the bottom.

By the prevailing logic, to attract the highest foreign investment, we should vote for slavery!

The graduate with £30K debt is grateful for work.  With a family. he or she is a virtual slave.

Against plutocracy / slavery, I would prefer ‘the democratic gamble’, making our own luck!

WHAT kind of ‘democracy’ is sustainable, proof against descent into mob-rule chaos?

Look at the fate of ‘democracy’ in countries unable to stave-off fear and desperation.

No security in ‘the vote and little-relevant parties’.

To be free, free beyond the instant, the gesture, we need to allow ourselves security.

No real freedom if some ruled by greed, some by fear and greed, and some by just fear.

We need universal freedom of conscience,

THINK how different would be an equal income-share, compared to a greasy-pole average income…

‘Doctors supported by bureaucrats’: some hope but not enough from Cameron’s claimed turn.

To avoid disappointment, not just over local healthcare but over global survival, time to choose equality.

No moral basis for the radiation of fear in some families, the risk of corruption in others.

EVERY reason to set example here, to contribute to Global Spring: share, improve, save our one world!

To gain sustainable democracy, to choose secure equality, we have first to understand our choice.

38-degrees might make the difference…

Secure democracy, to secure all else?

Like nuclear disaster, like climate catastrophe, lack of democracy might seem low-risk from day to day… but given time… our children might live to curse our folly.

I commend democracy, the preclusion of dictatorship, the visibility of any corruption, the rule of care such as upheld by the NHS.

1.  Worth watching Lansley’s interview with Jon Snow on Ch 4 news
last night:
http://www.channel4.com/news/catch-up/display/playlistref/140611/clipid/140611_LANSLEY_14
It
is clear from this interview a) that the NHS Future Forum was stitched up.  Note
how he says that they’ve listened to the committee after its listening exercise
and that the notion of more involvement blah blah ‘… are supported’ and then
goes on to say ‘They support x, y and z…’ meaning the committee.  So they’ve
not listened to the opposing voices at all;

b) that the bill really based
on ideology rather than need.  Near the end Lansley says that the most important
thing is to be true to the vision and principles that the tories set out in the
bill, even though they will make amendments.  So, after all this, it is not to
do with cuts, not to do with improving services, not to do with ‘too many old
people’ (to which I object strongly) or expensive drugs’:  it is quite cimply a
matter of principle to decimate an institution which affects
everyone.

Just hope the BMA and the RCGP etc see through all this
guff.

2.  Is there any way anyone could organise a mass lobby of
parliament?  38 degrees, UK Uncut, Keep our NHS Public, public service unions
(Serwotka)….  if we all joined forces we could show real strength.

Having seen the NHS kill my mother in a cruel and vindictive manner over a seven week period, I have no faith whatsoever in the NHS.  I can only hope that not every hospital is as dreadful as that.  The main problem with these hospitals, is that nurses are too important to nurse.  They don’t like moving away from the nurses stations, and certainly don’t want to touch the patients.  In all the seven weeks of abuse that my mother was subjected to, she was only washed once and they removed her teeth and threw them away for all I know.  They certainly wouldn’t discuss anything with me.  Mum died of dehydration, and the doctor lied on the death certificate.
I know this is not the forum for this, but I really can’t approach this matter in a subjective way.

So the review, undertaken by a GP who supported the original bill, comes up with a few, mainly cosmetic, changes and the top-down re-organisation left largely intact. The questions remain, What is the purpose of the bill? and Is it likely that it will achieve that purpose? The aim of reducing cost is unlikely given demographic change, technological development, particularly if NICE is emasculated as the drug industry and Lansley want, and the inevitable standstill that ensues from top-down re-organisations. If the coalition government is serious about improving health (and reducing cost) then they need to look at broader issues than simply tinkering with structures in a health service that has seen enormous improvements in quality and effectiveness over the last decade or so. (Yes, things still go wrong, but often because of the enormous pressure placed on services to save money rather than ensure that the patient is always the absolute priority.) 

Some services do need to be re-modelled so that more patients can be treated at or near home rather than in large hospitals, but this transition needs investment which is unlikely to happen during a period when there is such severe downward pressure on costs. Other lasting improvements will come with greater investment in public health, including addressing the increasing inequality in our society, not the defunding of public health initiatives or transferring them to organisations with a contrary interest, which seems to be Lansley’s instinct. At the same time individuals need to be educated and helped to take responsibility for their own health, as has happened with smoking but needs to happen with at least the same vigour for diet, alcohol and exercise. 

The problem now is that the Health Bill will divert attention from these real issues and delay the progress on them that really needs to be happening now.

Do you really know what non-medical staff do in our hospitals? Like many professional services our hospitals would come to a fairly quick halt without the right support staff in place. The best solutions to the three issues you cite above can probably already be found in many of our hospitals. The problem is getting best practice rolled out across all hospitals & this is more likely to happen through collaboration than through commercial competition.

I sympathise with you but why were you not on her case with regards to her care. You should have gone and kicked up hell of a fuss and refused to leave her side even if you had to go to the top.

My husband had a major accident and died but the doctors got him back, he then endured months of ops, the doctors and nurses saved his leg which had been chewed up by a caterpiller tractor in a dirty
farmyard which meant infection was paramount. I visited him everyday for more than six months and made sure everything was going ok and when tests etc were done I wanted to know exactly what they
were testing for and what antibiotic they were going to treat him with. I was lucky because I worked for a
pharmaceutical company for ten years and I had friends who were microbiologists so I contacted them
for information.

https://www.facebook.com/l.php?u=http%3A%2F%2Fwww.guardian.co.uk%2Fsociety%2F2011%2Fjun%2F18%2Fnhs-reforms-hide-new-threats&h=9d186
Check out this link.re NHS and competition by another route.its makes very interesting reading and a good case as to why we should keep the pressure up about these evolving health reforms