The future of the NHS (if any)

[Alan H]

I'm not sure we've had a proper discussion about Lansley's plans to privatise reform the NHS, but this is a good place to start.

A picture that puts things into perspective is always good: Who supports these NHS reforms?

[Nick]

Sorry, Alan, I think that graphic is pathetic. If you compared the BHA to the Catholic Church, you'd get the same results. Should we just be crowd followers? If you want to argue one way or the other, let's see the reasons.

And it's obviously politically biased. On one side we have individual "healthcare professionals", listed individually. On the other, all lumped together, we have "43 GP's". How do we know who's been asked? How do we know who has understood it? It says nothing about it's merits. If we had believed the opinion polls of professionals in the 1940's we'd never have had the NHS. And given that, if it is passed, it'd mean at least a couple of hundred extra on the "reform" side, that would render the graphic spectacularly inaccurate.

And frankly, if I see "38 degrees" on one side, it's a pretty fair bet that we should be on the other.

[Alan H]

Sorry, Alan, I think that graphic is pathetic. If you compared the BHA to the Catholic Church, you'd get the same results. Should we just be crowd followers? If you want to argue one way or the other, let's see the reasons.

I am not responsible for any of that graphic; nor do I necessarily think that every single part of it is absolutely correct in every detail; nor have I checked all the details. However, this is not a comparison of unthinking 'believers': it's a comparison of those with knowledge of the NHS (and, yes, those who will be affected by the proposed changes), those with grave concerns and a mark of their stance in the situation. What is clear is that there is huge opposition to what appears to be a top-down reorganisation of the NHS and one which might change it for the worse.

As the introductory post in a thread, I presented it as a way of stimulating a debate so that we might all learn and I hope it could have been seen as that.

[Dave B]

This government's attitude towards the NHS seems to get worse by the day. Yet another scheme, it seems, to disrupt the cohesion of the organisation so the Tories can say, "Look, its a failure, our mates in the medical industries can do better."

Then the response that the nurses do not like the new disruptions because they do not like the pay deals being offered - sounds like sour grapes on the side of the minister to me. Just about every medical sector if against these new changes, even if a degree of that is the protection of a status quo that is to their liking how can any sane non-medical manager believe they know better how to run such a service? I think this is not just a case of finding the correct financial model, it has to be the right medical model first surely.

[Alan H]

Things are likely to come to a head later this week:

Health reform in new crisis as MPs savage Andrew Lansley's plans

Health reform in new crisis as MPs savage Andrew Lansley's plans
Conservative-led committee attacks health secretary as royal colleges call urgent summit

Toby Helm and Denis Campbell
guardian.co.uk, Saturday 21 January 2012 21.00 GMT

Andrew Lansley's health reforms face a fresh crisis as a powerful committee of MPs says the changes are obstructing efforts to make the NHS more efficient and that they fail to address the most urgent health challenge of modern times – how to care better for an expanding elderly population.

A highly critical report by the cross-party select committee on health, due to be published on Tuesday or Wednesday, comes as the medical establishment prepares to stage its own summit on Thursday to discuss concerns over the health and social care bill. The report, a late draft of which has been seen by the Observer, will cause alarm in Downing Street as it is the work of a committee with a Tory and Liberal Democrat majority and is chaired by Stephen Dorrell, a former Conservative health secretary.

One of its key messages is that Lansley's far-reaching attempts to restructure the NHS in England and devolve more power to GPs are making it more difficult to deliver on a separate target of £20bn of efficiency savings by 2014-15. The report echoes the widespread view in the medical profession that it is deeply unwise to be inflicting far reaching structural reform on the NHS at the same time as asking it to make huge savings.

The MPs say that instead of finding savings by innovation and greater efficiency, many hospitals and trusts are simply cutting services, despite Lansley's assurances that this would not happen. It says: "The reorganisation process continues to complicate the push for efficiency gains. Although it may have facilitated savings in some cases we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings."

The report voices frustration that Lansley's plans fail to grasp the real challenge facing a cash-strapped NHS – that of moving more care into the community in order to provide better, more affordable and more integrated social and health services for the elderly. Members of the committee, including Dorrell, are known to be concerned at the rising cost to the NHS of caring for elderly patients, many of whom could be kept out of hospital if they were offered help to live at home or in the community.

Calling for a change of direction, the MPs say they found "precious little evidence of the urgency which it believes this issue demands – on both quality and efficiency grounds".

Last week the pressure on Lansley increased when official health department data revealed that the number of patients not being treated within the 18-week time limit has soared by 43% since the coalition took office. Thursday's meeting of all 20 members of the Academy of Medical Royal Colleges has been called by the British Medical Association, which, along with the nurses' and midwives' unions, wants the bill scrapped. The meeting comes as one of Downing Street's advisers on the NHS, Professor Chris Ham, King's Fund health thinktank chief executive, warns that growing disquiet across the medical establishment "could become an NHS version of the Arab spring".

The bill returns to the House of Lords next month.

Shadow health secretary Andy Burnham said: "The committee have delivered a damning verdict on Lansley's mishandling of the NHS. It is time for David Cameron to listen to what doctors, nurses and now his own senior MPs are saying and call a halt to this reckless reorganisation."

Ham said the MPs were right to warn that Lansley's reorganisation was stopping the NHS making necessary changes.

Health minister Simon Burns said: "We all know the NHS is facing pressures from an ageing population and the increasing costs of medicines. That's why we are spending an extra £12.5 billion on the NHS. If we are to put the NHS on a sustainable footing for the future reform is essential. Our modernisation plan will put doctors in charge, slash bureaucracy and give much more power to patients."

How to win friends and influence people:
Royal College of Nursing nothing more than trade union: Andrew Lansley

[Dave B]

And politicians wonder why people have no respect for or trust in them.

[Alan H]

Patient choice and competition? Forget it: advice on haggling with your doctor in America

[Alan H]

NHS privatisation: Compilation of financial and vested interests.

This list represents the dire state of our democracy. The financial and vested interests of our MPs and Lords in private healthcare. Why are these people allowed to be in charge of our NHS, to vote on a bill that they clearly have something to gain from. Who cares that they have put it in the register of interests. This doesn’t excuse their interests, it merely highlights clearly why they should have no part in the privatisation of the NHS. It is privatisation, despite the media’s continued use of the word ‘reforms’. The question must be asked. Are they public servants or corporate servants?

The list is long, and could surely be longer, I make no apology for that, tragically that is the reality of our politics today; and although the majority of vested interest lies with the Conservatives, as you might expect, it is a cross party issue. It is compiled from accessible and trusted sources throughout the Internet. If one of these listed is your MP or Lord, then contact them and let them know you will not be voting for them again if this bill goes through.

[Dave B]

I feel sick.

[Alan H]

I'm not sure we fully know who is attending Cameron's summit on the health privatisation tomorrow, but Ben Goldacre has but together this:

Who is, and is not, invited to Cameron's emergency NHSbill summit? A data visualisation.

[Dave B]

Ah, meeting only open to yesmen then? Standard political ploy #1!

[Alan H]

Ah, meeting only open to yesmen then? Standard political ploy #1!

Yeah. It makes sure they get the right answer.

[Alan H]

From today's Guardian. Looks like Cameron might not even be that good at organising a piss up in a brewery.

David Cameron's NHS summit guests refuse to follow reforms script

Prime minister's plan to discuss implementation of health bill backfires as 'supporters' take opportunity to outline concerns

Denis Campbell and Nicholas Watt
guardian.co.uk, Monday 20 February 2012 21.30 GMT

David Cameron speaks at Downing Street during the summit on the proposed NHS reforms. Photograph: Stefan Wermuth/PA
If David Cameron was hoping for an easy ride on his controversial NHS shakeup by excluding its fiercest critics from the Downing Street gathering of carefully selected health leaders, he will have been disappointed.

While the atmosphere was polite and constructive, those invited used the opportunity to detail their concerns about how the health and social care bill could damage the NHS. They raised directly with the prime minister the same fears and uncertainties that the leaders of Britain's nurses, doctors and other professions who want the bill scrapped would have mentioned – if they had been present.

Much of the hour-long meeting around the long table in the cabinet room heard concerns raised about the danger of extending competition in the NHS; the government's refusal to publish the Department of Health's official assessment of the risks inherent in the radical restructuring; the potential for NHS hospitals to be allowed to raised up to 49% of their income from private patients; and much else besides – all the major issues that prompted the demonstration outside Downing Street's black gates which ensnared the health secretary, Andrew Lansley, as he tried to get through.

"The idea that those around the table were gung-ho supporters of the government's NHS reforms didn't ring true if you were sitting there listening to the issues everyone raised when they had their turn. Pretty much everyone expressed concerns," said one attendee.

The purpose of the meeting, as designated by No 10, was to discuss "implementation" of the planned reforms, not their pros and cons. Unfortunately for Cameron, his guests did not follow that script. "In his introduction he made it clear that he wanted us to talk about the long-term implementation challenges, rather than the bill itself. The bill itself was a bit like the elephant in the room for a short while," said one person who attended the summit.

But then Jeremy Taylor, chief executive of National Voices, an umbrella group representing dozens of charities, raised anxieties about the present – the bill and its potential impact – rather than the post-bill future that Cameron wanted to concentrate on.

Taylor said: "I told the prime minister directly that a lot of my members were very concerned about the disruption and uncertainty being caused by the bill, and about how we reconcile the need to integrate services with competition and devolution, and that there's a lot of unease about … how the government, for whatever reason, has failed to command the support of a large proportion of the health professional community."

Lansley sat beside Cameron as others followed Taylor's lead to voiceand itemised their concerns.

Sir Richard Thompson, president of the Royal College of Physicians, was one of the few leaders of the medical royal colleges present. Those representing nurses, doctors, GPs, physiotherapists, radiologists and others, all of whom want the bill abandoned, were not invited.

Thompson said: "I raised with the prime minister our concerns that competition could damage – and is already damaging – integrated care pathways and that the government should commit to a high-quality threshold for any qualified provider for clinical services.

"In addition I raised our view that the raising of the private income cap must not displace NHS provision. For example, NHS beds must not be closed to open private beds, and so any private provision in NHS hospitals must be additive."

Professor Terence Stephenson, president of the Royal College of Paediatrics and Child Health (RCPCH), was also invited; he, like Thompson, has been painted as supportive of the bill. He said after the meetinglater: "The RCPCH has never supported the bill, but we have embarked on a strategy of critically engaging with government."

But he added: "It has become clear over the last few weeks and months that, despite several concessions, there is growing concern amongst our membership … That's why we have decided to survey members on whether to continue our current approach of meeting with government to influence the bill or whether to call for its withdrawal."

He said he had used the meeting to voice "our grave reservations that the bill carries risks for England's 11 million children and young people". Greater competition between hospitals could make it harder to provide packages of care for children with complex medical conditions, who currently may receive care in several different NHS settings, he said.

Mike Farrar, chief executive of the NHS Confederation, made what some of those present interpreted as a coded criticism of the exclusion of many of the medical bodies by stressing that implementation of the plans depended on doctors and other clinical staff being brought onside.

"Whatever parliament now decides, getting the whole NHS and clinical community behind any changes will be vital to their success," said Farrar, who represents hospital bosses. "Clearly, there are rifts that will need to be healed if this is to happen. People outside the meeting at No 10, as well as those inside the room, need to be engaged," said Farrar, who represents hospital bossessaid Farrar, who represents hospital bosses.

Dr Hamish Meldrum, head of the British Medical Association – one of the many anti-bill groups not invited – was blunter. "It is extremely disappointing that the government seems increasingly to be indulging in selective listening," he said.

Visiting a hospital in east London, the Labour leader, Ed Miliband, again called on the government to drop the bill.

"The prime minister is holding a Downing Street summit which excludes those from the medical profession who disagree with his bill," he said. "I have to say I think this bunker mentality is the wrong way to run the NHS."

The exhortation by ex-Labour health minister Lord Darzi – another attendee – to get the bill through parliament as soon as possible to ease health professionals' fears, and the benefits for patients of GP-led commissioning extolled by several family doctors proved more positive for Cameron.

After this particular listening exercise, the prime minister summed up by promising to think about four things he had heard: ministers' lack of a convincing narrative for the reforms; greater integration of health and social care services; how to allay NHS staff's fears and uncertainties about the bill; and the need to show that good practice in some parts of the NHS can be copied elsewhere.

"But I'm still baffled as to why I was there and doubt any of it will change the government's approach," said one attendee.

Health groups: for or against?

Against the bill

(None of these organisations were invited to the Downing Street summit)

British Medical Association

Cautiously welcomed the July 2010 white paper which set out the coalition's NHS plans. As concern grew, it adopted a policy of "critical engagement": lobbying ministers to amend or drop proposals it deemed too risky, damaging or ill thought-through. But rising anger among grassroots doctors, and deep frustration that Lansley did not really heed their concerns, prompted BMA last November to adopt policy of all-out opposition.

Royal College of Midwives, Royal College of Nursing and Royal College of GPs

Recently made the same switch as BMA, and, after initially seeking major amendments to it, now want the bill scrapped, which is also Labour's position.

Chartered Society of Physiotherapy

Concerned that letting non-NHS providers start treating NHS patients, paid for out of NHS funds, will see patients denied physiotherapy sessions they need through the opening up of more NHS services to outside bodies through the "any qualified provider" policy.

Royal College of Pathologists

Concerned aboutcurrent and future impact of the combination of the changes this bill brings, the current "manner and pace of reconfiguration of services, including managerial, and the arbitrary removal of 20% from NHS spending on pathology services".

Royal College of Radiologists

Has "grave concerns" about "many serious and as yet unresolved issues", including the risk that the shake-up will widen health inequalities between richer and poorer patients. It is also "alarmed that the dangers of unfettered competition as outlined in the bill will adversely affect integrated care in both clinical oncology and clinical radiology".

Royal College of Psychiatrists

"Believes the bill is fundamentally flawed and "will not improve the health and care of people with mental illness", said Professor Sue Bailey, its president.

Unite and Unison

Fear the extension of competition in the NHS, and anticipated greater use of private healthcare firms to provide NHS services, will lead to the break-up and privatisation of the NHS.

Undecided

(All were invited to the summit)

Royal College of Paediatrics and Child Health

Obtained some concessions but still has "grave reservations that the bill carries risks for England's 11 million children and young people". "Opposition to the bill among some paediatricians is increasingly hardening", according to president Professor Terence Stephenson. The results of a survey of its members are due later this week.

Royal College of Physicians

Its emergency general meeting next Monday could see it switch from being critical of the bill on some issues – such as competition and raising the amount hospitals can earn from private patients – to a more hardline stance.

Royal College of Surgeons

The one medical royal college to refuse to sign a strongly-worded joint statement, organised by the Academy of Medical Royal Colleges last month, saying the bill was unfit for purpose in its current form. It denies it actively supports the bill.

Royal College of Obstetricians and Gynaecologists

Agreed to support last month's joint statement but later withdrew its support, after being lobbied by Lansley. "We have never said we fully support the bill. Instead we have always stated that we have concerns with elements of the bill which we have tried to address through the NHS listening exercise and meetings with the Department of Health and politicians," said president Dr Tony Falconer.

For the bill

(All were invited to the summit.)

National Association of Primary Care

Group of entrepreneurial GPs that has supported Lansley's plan from the start. It welcomes family doctors gaining control of £60bn worth of contracts to GP-led clinical commissioning groups (CCGs) to spend as they see fit on treatment.

NHS Alliance

Has embraced the NHS shake-up, though recently voiced fears that CCGs' independence could be threatened by the new NHS national commissioning board.

Association of Chief Executives of Voluntary Organisations

Chief executive Stephen Bubb is a keen advocate of extending competition in the NHS in order to drive up standards and reduce costs.

[Alan H]

What is the problem the NHS bill is meant to solve?

[phalarope]

One thing about the NHS that occurs to me is that if the organisation did not exist then politicians would urgently need to invent it. It seems to me that there is this vast apparatus that is on the surface a health body designed to make people better or to help us live with our ailments. Below surface however the NHS could be conceived as an apparatus that is ideological, with all that implies in terms of bolstering the state and its legitimacy. The ownership question you quite rightly bring to view Alan H is quintessentially ideological in that, IMO, capitalism garners the functions of the state to serve its market purpose(s) in many ways. Profit comes in various disguises, especially for big corporations who already dominate some aspects of the NHS, such as Big Pharma and medicines in the supply chain. " Privatising" the NHS for me is merely about tinkering at the edges and fussing about waiting times. The real 'ownership' of the service was cut and dried in 1948, when Bevan simply functioned as the ideological handyman for a type of state welfare set up that would lull the populace into thinking that the NHS was a 'people's NHS'. What a mistaka to maka.

Why would corporate capitalism want to 'privatise' the NHS. It is already and has been since the beginning a prop for a steady source of capital accumulation, somewhat like a client colonial state useful as a source of raw materials, or more closely, like a permanent war economy that is manna for the arms manufactures. Lansley et al are merely performing the usual Tory cabaret concerning their take on the welfare state. Like I say, politicians need a motif, Blair's Education. Education. Education. to trumpet . The louder you blow the privatisation horn the more the mist rolls in.

[Alan H]

Is there anyone left (who doesn't have a vested commercial interest in the NHS) who still supports the Government's 'reforms'?

Max Pemberton in the Daily Telegraph:

Read this – and prepare to fight for your NHS
I support the NHS is because countless pieces of international research have shown it to be the fairest and cheapest way of providing health care.

[Nick]

I don't have a vested interest in the NHS, except as a patient.

My overall comment about the reforms are that just about everyone who makes comments doesn't have all the information at their disposal, but spouts platitudes and dog-whistles. Ed Milliband is a prime example of this.

I can't tell you whether the reforms will work or not. I simply don't know (though I hope so). But I am sure the government is doing it in order to get more efficiency from the system, not for commercial or ideological reasons. To accuse them of "privatisation" is just mendacious.

WHat bugs me, is that critics seem more concerned that everything is done on socialist lines. That the politics is more important then the health-care. That no-one has the space to advance their particular sphere, because that will create "a 2-tier system". Grrr!! In some ways, I want a multi-tier system! Not because I want some people to have a sub-standard system of coursse, but if an improvement can be found, it must not be snuffed out, just because it cannot be immediately replicated across the country.

I really don't care if someone makes a profit, if the resulting service is improved. It is a fallacy to claim that profits are necessarily a drain on the budget. They could be, of course, not not axiomatically. After all, why doesn't the government nationalise all the drug companies and medical suppliers?

The NHS, so we are told, employs more people than any organisation apart from the Chinese army. To change anything is bound to ruffle a few feathers. And in health-care, it will ruffle even more.

All too often, decisions about hospitals are influenced by (well meaning) people who want to preserve an old hospital because it took such great care of their mother, or some such reason. I can see their point, of course, but that is no way to run a health service.

[phalarope]

Private, public, new, old, the central point about the NHS is that it is a vast apparatus, and vast apparatuses have to be managed. Managerialism is the issue, not better health or improved ways of directing cost-cutting or spending on hospitals and drugs, PFI, Big Pharma. The reality if instrumental. The NHS, like the Chinese Army is an organisation Kept In Being, and that is its primary rationale. The parallel with the London Underground system in one way links to the necessary and sufficient being of the system for the Metropolis, its politicians, the economy of London as a small state within a larger state (will passengers get a referendum on how to run and pay for the Underground akin to Scottish independence?) The NHS from its inception was a management device linked to the state capitalism of 1947 and today. Privatisation, doctors' increased involvement, patients' rights, Lansley's sleepless nights...all grist to the mill of managerialism.

Within that context humanistic nursing and a decrease in the emotional exploitation of workers in the NHS is the best we can hope for.

[Nick]

Of course, all GP's are still self-employed; a hang-over from their original objections to the NHS. Why is it that the doctors aren't clamouring to be employees of the NHS....? It might be understandable, but ISTM that a large proportion of the resistance is fear of change, not the proposals themselves.

[Alan H]

On a similar subject (warning: Daily Mail, but well worth reading):

Suicide training in Job Centres? Cancer patients scrubbing floors? Welcome to Cameron’s Brave New World