NHS reforms

[MrMetro]

What are people's thoughts on the controversial NHS reforms? I'm expecting this thread to go on for a long time!

[Mark]

I think that Cameron got elected based on his promises not to touch the NHS. And as soon as he gets in he does exactly that.

[Rollo]

As I understand it, GPs will have to form themselves into consortia to buy and sell health services between levels.
I suppose that this would then make GPs into private practices, as is the case in Australia, with hospitals and other units like pathology, x-ray, etc all separate entities.
GPs are happy because it gives them more immediate control over their own private practices.

In theory it could work, but then there's implications about corporatising and privatising the system later, which is precisely what the Tories want to do.

I don't think that Cameron's reforms are about making anything better, but rather improving the lot of the friends who fund the Conservative Party through some sort of as yet unseen nepotism and graft.

[Malbec]

As I understand it, GPs will have to form themselves into consortia to buy and sell health services between levels.
I suppose that this would then make GPs into private practices, as is the case in Australia, with hospitals and other units like pathology, x-ray, etc all separate entities.
GPs are happy because it gives them more immediate control over their own private practices.

In theory it could work, but then there's implications about corporatising and privatising the system later, which is precisely what the Tories want to do.

GP practices have always been privately owned entities which are funded by the NHS. They are owned by some or all of the GPs who work in them (partners) or more recently by private companies that have started to buy entire practices up.

Previously under the Labour government GPs were given a list of hospitals they could refer to for each service they required by their local PCT. The PCT negotiated directly with the hospitals what they would be paid for what service and also assessed which services and hospitals offered the best value for money (amongst other things). Under the new Tory reforms the PCTs will be abolished and the GPs will negotiate directly with hospitals and basically do what the PCTs used to do.

Previously funding would reach the PCTs then flow to the hospitals. Because the GPs had some choice in which hospitals they referred to they would have a virtual budget to play with but no money would actually go through their hands. Now funding will go to GPs which will then flow to the hospitals.

The advantages of the system are that by abolishing PCTs a whole layer of management will be wiped out on paper, however it does not take a genius to realise that since the GPs are already working flat out they will not be taking over the management work the new system requires but will be hiring managers from the PCTs to do the job for them, ie we're talking about moving around the management structure not reducing it.

Some GPs I know (the business minded ones especially) are looking forward to the reforms. Others don't really see why they should be getting involved in the management aspect especially since its something they've never trained for.

While people are concentrating on the privatisation aspect the fact of the matter is that the better run NHS hospitals and those with a bigger brand (ie big city hospitals) will be able to compete with local DGHs for services and win, starving some of the less well run hospitals of business and therefore funding. Its the intra-NHS competition that will cause problems in the long run not NHS/private competition because the inevitable result is that poorly run NHS hospitals will eventually go bankrupt and that is not something either the electorate or politicians are willing to accept.

Its the scale of the reforms that is most worrying however. What I've written above is a simplified version that only touches on subjects you raised. The reforms affect just about every aspect of the NHS and will be implemented quickly, the speed and scale will likely have serious implications that the government and NHS will not be aware of until after the event. That is at a time when NHS funding has been frozen and demand is skyrocketing. Most organisations are looking at making 5-10% savings per year for at least a half decade merely to break even.


I don't think that Cameron's reforms are about making anything better, but rather improving the lot of the friends who fund the Conservative Party through some sort of as yet unseen nepotism and graft.

Which would make them no different to Labour's reforms whereby the inquiry into whether and how private healthcare companies could 'assist' the NHS was lead by people from the private healthcare industry. Many of the first contracts given out to private healthcare providers under the Blair government were generous beyond belief including guaranteed payment regardless of the quantity or quality of service actually delivered. In many cases NHS organisations were simply banned from bidding for contracts including services they already delivered. The Tory reforms set out how private healthcare can compete for NHS services but unlike previous Labour reforms will not subsidise them nor shift the goalposts to help them.

In terms of 'privatising' the NHS this set of reforms doesn't go anywhere near as far as Tony Blair's did. The only recent PM to not be interested in increasing the amount of work given to private companies was Gordon Brown, though he was one of the main architects while he was chancellor.

[Dave B]

Want to know what one of Cameron's own advisors thinks of the changes?


According to a glossy brochure summarising the conference held last October, Britnell told his audience: "GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer." He added: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."


http://www.guardian.co.uk/politics/2011/may/14/david-cameron-adviser-health-reform?mobile-redirect=false

[Malbec]

Want to know what one of Cameron's own advisors thinks of the changes?


According to a glossy brochure summarising the conference held last October, Britnell told his audience: "GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer." He added: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."


http://www.guardian.co.uk/politics/2011/may/14/david-cameron-adviser-health-reform?mobile-redirect=false

While I like the Guardian a lot when it comes to the NHS they are guilty of the utmost hypocrisy. When Blair opened up the NHS to private contractors and gave them subsidies, favourable contracts and conditions etc they were silent. Now the Tories want to change the system without the same favourable conditions for the private sector they cry foul. Seems privatisation is fine for the Labour party but unacceptable for the Tories.

As for the sage words of advice from this junior advisor, I would not want to be a private healthcare provider entering the British market over the next few years. The days of easy profits and subsidies to cover startup costs are long gone. Britain is a mature market now. The GPs will not be wanting to refer much business to anyone other than themselves, they are already learning to provide more healthcare services themselves so they can avoid money leaving their consortia. The NHS hospitals are pretty lean after years of budgetary restraint and have a wealth of expertise that the private sector cannot easily poach, and there are many well-entrenched private healthcare companies already in the UK that have spent their golden years under the Blair government investing heavily in services and recouping their startup costs. All of them will be seriously tough competition for a new entrant that has to pass on startup costs and with no proven track record in the UK market.

Not only that but quality control has been tightened and the standards raised both by the last years of the Labour government and further by the Tories. Private sector companies can't do the old shortcuts they were allowed to under Blair where they were exempt from the same quality control as the NHS, the same standards apply to everyone.

Its going to be tough out there but at least its going to be fair.

[driveace]

I totally agree with your post Dylan.
Lets have some fairness,and maybe prices for ops will be reduced.A fiend of mine needed a hip replacement,they made a mess of it first time,and he was never free of pain.So went to see his Doctor who told him he could not have another one so early after the first one.So he decided to go private,went for exrays,where they told him that the surgeon who had done his first hip replacement had cut the bone nearly 1 inch short,and that was why he was walking with a slant.The price due to this damage was going to be £14000.He then went on the net and found a hospital in Boulougne.After all the checks the price was £6500,so they picked him and his wife up in Yorkshire by Minibus,took them both out there,carried out the hip replacement,she had a room next to his,and they brought them both back here.He said the hospital was spotless ,food was good and he is now sorted.

[BDunnell]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

[Sonic]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

I'm all choiced out after deciding on Jam or Marmite on my toast. ;)

[Mark]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

Many of those choices are an illusion. As for electricity and gas, of course you don't have a choice where you get them from, the only choice you have is who handles the billing process.

Someone in the government suggested that in the future the NHS wouldn't exist, except as a state health insurance scheme, a prospect which fills me with dread!

[Malbec]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

The quality of gas and electricity you receive in your home is the same regardless of who you pay for it.

The same is not true of medical care, whether it be the logistics of going to a clinic close to home or a specialist centre far away or the levels of expertise and equipment available at comparable hospitals.

That said none of the reforms have really been about patient choice, in fact there was far more choice under the old system that ended at the first round of New Labour reforms whereby you could opt to be treated anywhere for anything. New Labour managed to perform the quite awesome feat of taking away patient choice altogether then reintroducing it bit by bit and taking credit for it.

Patient choice is only important in that it is a tool to 'reward' better performing hospitals and organisations with more custom and therefore funding just as in a free market. However because patient decisions are often made on factors other than how well that hospital works and how cheap its service is many other factors are taken into consideration.

As Mark said, patient choice in the modern NHS is an illusion. Its like a computer game where you think you can walk anywhere you want till you come up against an invisible wall and you have no choice but to turn back.

[ArrowsFA1]

Its going to be tough out there but at least its going to be fair.
Is it really going to be fair, and if so fair for who and in what way?

My experience of the NHS has never included the thought that it was "unfair" and my first thoughts about features of the Tory reforms certainly do not include "fairness".

Fortunately we have had a "pause" in the implementation of a fundamental (in practical and philosophical terms) NHS restructure, which was being railroaded through. "Quick, get this done and no-one will notice until they can do nothing about it" seemed to be the plan. It worked when the likes of gas, eletricity & communications were privatised all those years ago.

Who benefitted from that?

[Malbec]

Is it really going to be fair, and if so fair for who and in what way?

Its going to be fair in the sense that both NHS and private companies will be able to bid for the same contracts on a level playing field. That didn't happen before.

Let me give you an example. To cut down NHS waiting lists for hips Blair introduced an idea called independent sector treatment centres (ISTCs). These would be built in each region entirely through private funding with operations performed by NHS doctors from throughout the region. The private company running the ISTCs were allowed to pick and choose which hip replacements they did and chose (obviously) the simple easy ones. The NHS hospitals were left to work on the complicated and potentially expensive ones.

The problem was that the amount the ISTCs wanted to charge per hip was in excess of what it cost those NHS hospitals to do the op themselves. Some hospitals (I know of one on the south coast where this definitely happened) refused to send patients to these centres as it cost them more money but were overruled directly from Whitehall as the ISTCs had been guaranteed custom.

In other cases involving radiology or GP contracts, existing NHS providers were simply banned from bidding as it was classified that their local specialist knowledge would confer an unfair advantage over private bidders with no experience in the sectors they were bidding for. I can tell you of another case on the south coast where the in-house NHS radiology department was not allowed to bid for a contract to increase capacity to cut waiting lists at its own hospital. Several years later an audit of the private contractors work there showed a horrendous number of errors so the hospital had to pay its own radiology department millions of pounds to re-report the scans that had been contracted out to the private supplier.

In others private bidders were allowed to import non-British registered doctors and other staff to cut costs, something an NHS organisation would never be allowed to do.

Under the new reforms both NHS and private providers will be able to bid and will be treated equally and have to meet the same quality standards. The NHS providers will not be shackled like they were before.

As I said before, the winners will mainly be NHS organisations that are well run and have a 'brand' to sell. Would you prefer to have your cancer treated at St Elsewhere's or at the Royal Marsden? If your child is unwell would you prefer Great Ormond Street or Noname DGH? Well run private organisations too will win, but many of them have the obstacle of having to invest heavily to expand before bidding and their startup costs will inevitably be passed onto the consumer (ie the NHS) so their bids will be less competitive.

Other NHS organisations that become more efficient and adapt to changing circumstances will also do well, those that don't won't. As I said, some hospitals will inevitably close as there is overcapacity in many parts of the UK, will politicians and the public have the guts to face up to that?

Needless to say, poorly run private companies won't do well either.


My experience of the NHS has never included the thought that it was "unfair" and my first thoughts about features of the Tory reforms certainly do not include "fairness".

Fortunately we have had a "pause" in the implementation of a fundamental (in practical and philosophical terms) NHS restructure, which was being railroaded through. "Quick, get this done and no-one will notice until they can do nothing about it" seemed to be the plan. It worked when the likes of gas, eletricity & communications were privatised all those years ago.

Who benefitted from that?

I don't see any difference in the way the NHS has been treated by Labour and the Conservatives. Had you not been aware who had been in power over the past two decades, you would have assumed that the reforms in the early 2000s were put in place by an extreme right wing party with a pathological dislike of state-owned and run organisations. The current Tory plans represent a refinement or development of Labour reforms, again had you been unaware of who was in power you wouldn't be able to tell on philosophical grounds who was behind them. If anything the current NHS reforms are carefully thought through as if someone has spent years studying the NHS and thought carefully about how to reform it. I still have major reservations however as I don't believe such major reforms can take place without major negative impacts, and I certainly don't think it will save money.

The difference as far as I can see is that the media wasn't interested in NHS privatisation before, it is now. Excuse me if I'm cynical about cries and protests about Tory privatisation plans...

[ArrowsFA1]

The difference as far as I can see is that the media wasn't interested in NHS privatisation before, it is now. Excuse me if I'm cynical about cries and protests about Tory privatisation plans...
Fair enough, and thanks for your clear reply :up:

It may not be explicit but IMHO the ultimate aim is to relieve the government/state/us of what some see as the "burden" of a National Health Service. The process of privatisation may have begun in some way with a Labour government but regardless it is a process which I fundamentally disagree with.

The National Health Service (the use of "NHS" does help distance us from what it actually is) was created as, for lack of a better term, a safety net. Are we now saying we can't afford that safety net, and if so doesn't that make us a poorer society?

[Malbec]

The National Health Service (the use of "NHS" does help distance us from what it actually is) was created as, for lack of a better term, a safety net. Are we now saying we can't afford that safety net, and if so doesn't that make us a poorer society?

The blunt answer is that we will reach a point in the future where we won't be able to afford that safety net.

Healthcare costs are rising way above inflation as is demand. Thats not just the case for the UK, that applies to pretty much the entire world. I remember an American study that claimed that if US healthcare costs and demand kept rising at its current rate then healthcare spending would reach over 100% of projected GDP by 2050 or so.

Like final salary pensions the NHS in its original state is a system that worked well when people were expected to die at the age of 60-65. Now people live 20 years beyond that and the system has to adapt to meet the rise in demand. We also live in a reality where the electorate firmly believe more can be delivered for less tax burden and any political party that tells them otherwise pays the price. Politicians are also too frightened to confront the public with the truth, if they want affordable healthcare then in future there needs to be a public debate about what we can expect the NHS to cover and what it shouldn't. Meanwhile making the system more effective and efficient by introducing and refining a competitive system involving private healthcare will keep things going for a few more years.

I too am strongly attached to the concept of a healthcare system free at the point of use and where treatment choices are not decided by affordability but by clinical need regardless of wealth. I just wish there was a real debate about healthcare and not just the usual lowest common denominator mudslinging as usually happens.

[BDunnell]

Politicians are also too frightened to confront the public with the truth, if they want affordable healthcare then in future there needs to be a public debate about what we can expect the NHS to cover and what it shouldn't.

The phrase 'public debate' is often thrown around, not least by politicians, when such contentious issues arise, yet I am yet to understand how said debate would take place, how it would reach a conclusion, and so on.

[Malbec]

The phrase 'public debate' is often thrown around, not least by politicians, when such contentious issues arise, yet I am yet to understand how said debate would take place, how it would reach a conclusion, and so on.

Raising the level of debate beyond "MRSA" and "do you trust the Tories with the NHS?" would certainly help.

Sadly as the AV debate showed there isn't much drive from either politicians and the press to look at complex issues and how to solve them anymore.

[BDunnell]

Raising the level of debate beyond "MRSA" and "do you trust the Tories with the NHS?" would certainly help.

I agree, but still the question remains: what form does said debate take? People chatting in the street? Comments on internet message board and news 'Have Your Say' sites? Public meetings? A referendum?



Sadly as the AV debate showed there isn't much drive from either politicians and the press to look at complex issues and how to solve them anymore.

Because they are all too fond of simple sloganising, for one main reason — let's face it, large sections of the population show few signs of being able to cope with anything much more.

[Malbec]

I agree, but still the question remains: what form does said debate take? People chatting in the street? Comments on internet message board and news 'Have Your Say' sites? Public meetings? A referendum?

All or any of the above.

The level of debate for example in threads on this forum concerning the US healthcare system demonstrates that even posters that are barely able to string a sentence together on other topics can articulate principles and arguments that are way above what I've come to expect from similar debates on the NHS here and elsewhere. Since the US electorate on both sides of the political spectrum are more knowledgeable their media and politicians can't get away with spewing the simplistic and often plain untruthful platitudes they get away with here.


Because they are all too fond of simple sloganising, for one main reason — let's face it, large sections of the population show few signs of being able to cope with anything much more.

Also because the complexity of the issues involved are often too difficult even for those drawing up the plans to comprehend, let alone those who merely read a few paragraphs from a newspaper on the subject.

[BDunnell]

All or any of the above.

Fine, but to what end? I'm afraid I am always suspicious of the notion of having a 'public debate', because it strikes me as a very nebulous concept.

[Malbec]

Fine, but to what end?

To what end?

So the government can be questioned over the need to waste £20 billion on the Connecting for Health IT project before it got commissioned let alone cancelled. Bank bailouts were questioned, why shouldn't burning £20 billion on a project the government were told by contractors was impossible?

How about questioning the government over privatisation of parts of the NHS when it happened 8 years ago instead of now when its far too late?

Lack of interest from the public in any area means the government will try and get away with murder if it thinks it can get away with it.

[BDunnell]

To what end?

So the government can be questioned over the need to waste £20 billion on the Connecting for Health IT project before it got commissioned let alone cancelled. Bank bailouts were questioned, why shouldn't burning £20 billion on a project the government were told by contractors was impossible?

How about questioning the government over privatisation of parts of the NHS when it happened 8 years ago instead of now when its far too late?

Lack of interest from the public in any area means the government will try and get away with murder if it thinks it can get away with it.

I think you misunderstand slightly, if I may say so. How is any much-vaunted 'national debate' on a subject such as the NHS supposed to come to a conclusion? Even were a conclusion to be reached, it would still upset many. People debate subjects of concern to them all the time. Agreement is never reached. Without staging a referendum, there is no way of putting any such debate to rest; of rendering the concept anything other than meaningless.

[ArrowsFA1]

It could be argued that we have had a referendum. The election determined which policies would be implemented in this Parliament; included among those policies was reform of the National Health Service.

Two problems with that. 1) We all voted, then a deal was done between two parties who then formed the government. The coalition agreement shaped policy, but we didn't have a say in that agreement. 2) I'm not at all persuaded that the NHS policy now under discussion was laid out before the electorate during the election. In fact David Cameron said there would be no top-down reorganisation and that his aim was to cut the deficit not the NHS.

So, there may be an argument to have a referendum for us to decide the future of the NHS, but on the evidence of the AV "debate" what's the point?

We have this government for the next four years. What they say goes and there is little or nothing the electorate or the opposition can do about it if they wanted to.

Democracy is a wonderful thing :p :

[Rollo]

I'm not at all persuaded that the NHS policy now under discussion was laid out before the electorate during the election. In fact David Cameron said there would be no top-down reorganisation and that his aim was to cut the deficit not the NHS.

There is a distinct difference between what a politician says and what they do.

http://www.mirror.co.uk/news/top-stories/2009/12/28/kick-in-the-privates-115875-21926813/
David Cameron's vow to back the NHS was exposed as a sham yesterday after a secret meeting with a group bent on privatising the health service.
The Tory leader invited Nurses For Reform to his Commons office for an hour's talk even though they have branded the NHS a "Soviet-style calamity" and want to see it sold off.

Among issues discussed were ending nurses' national pay rates and letting hospitals close if they run out of cash. Mr Cameron - drenched during a charity run yesterday - did not publicise the meeting, prompting claims he would "abandon" the NHS at the first opportunity.
Health Secretary Andy Burnham said: "No matter what cast-iron guarantees David Cameron gives in public, it is now clear, in private, he is discussing abandoning the NHS as we know it."

This was back in December of 2009, well before the General Election. The truth is that meetings were held, talks have been in place and the intent is still there.
Privitising the NHS sits squarely within Tory ideology because it goes against the ide of free-market economics and more importantly redistributes services to poorer people.

Cameron is a genuinely nice person, [i]alledgedly[/Ian Hislop tone]

[BDunnell]

It could be argued that we have had a referendum.

In that case, how on earth could it be worded?

[Malbec]

Privitising the NHS sits squarely within Tory ideology because it goes against the ide of free-market economics and more importantly redistributes services to poorer people.

You really need to put to bed this bizarre idea that the Tory party is the NHS privatisation party.

As I described earlier the Labour party under Tony Blair initiated privatisation of NHS services using fair means or foul, including having senior representatives from companies like Capio and Alliance medical on teams drawing up reports as to whether the private healthcare sector could 'assist' the NHS. This is akin to consulting arms makers as to whether attacking Iraq was a good idea.

No mainstream party has proposed repealing Labour reforms to the NHS and turning the clock back to 2000. Hence every mainstream party stands for privatisation of NHS services.

There is hardly any difference between Labour and Tory NHS policy except that the latter are especially vulnerable to accusations of privatisation because of their history during the 80's. What is amazing is that so many people persist in believing stereotypes.

[BDunnell]

You really need to put to bed this bizarre idea that the Tory party is the NHS privatisation party.

As I described earlier the Labour party under Tony Blair initiated privatisation of NHS services using fair means or foul, including having senior representatives from companies like Capio and Alliance medical on teams drawing up reports as to whether the private healthcare sector could 'assist' the NHS. This is akin to consulting arms makers as to whether attacking Iraq was a good idea.

No mainstream party has proposed repealing Labour reforms to the NHS and turning the clock back to 2000. Hence every mainstream party stands for privatisation of NHS services.

There is hardly any difference between Labour and Tory NHS policy except that the latter are especially vulnerable to accusations of privatisation because of their history during the 80's. What is amazing is that so many people persist in believing stereotypes.

I agree.

Do you believe we have a better or worse NHS now as a result of the reforms of the past decade? I struggle to think of any public service that has, overall, been improved as a result of the influence of the private sector.

[Malbec]

I suggest you have a look at these two book reviews which summarise recent changes to the NHS and the role of both the Labour and Tory parties in increasing private sector involvement. Blaming one party and not the other for privatisation really does not provide an accurate reflection of real events.

http://www.nhscampaign.org/uploads/documents/Confuse%20%26%20conceal%20review.pdf
http://www.islingtontribune.com/reviews/books/2011/may/books-review-plot-against-nhs-colin-leys-and-stewart-player

[Malbec]

Do you believe we have a better or worse NHS now as a result of the reforms of the past decade? I struggle to think of any public service that has, overall, been improved as a result of the influence of the private sector.

I could write a whole book about the NHS reforms over the past decade. There are many positive and many negative results.

On the positive front, real spending has increased massively and this will not be undone by current spending freezes. Targets such as the four hour rule in A/E have improved access to healthcare although initially at the expense of quality. The introduction of quality control means by both the Labour and Tory party has and will continue to improve quality although the Tory party have thankfully relaxed time targets to allow the NHS to focus specifically on quality. There are more frontline staff who in turn are better supported by improved diagnostic and logistic chains. Having worked through the reform process I would not want to see a return to the old system. The Labour party need to be congratulated on this although I believe the Tories would have continued this process had they come to power in an economic boom rather than the current recession.

On the negative front huge amounts of money has been wasted on projects such as connecting for health and the degree of propaganda surrounding Labour reforms to the NHS was incredible although this applies across the board to many fields of Labour activity. Training quality has been massively reduced both at medical and nursing school level and through clinical training. Services have been privatised at great expense to frontline NHS services that have had to pay over market rates for services that they could have handled themselves but were forced to outsource from Whitehall. Poorly run NHS organisations have been hit hard financially (which arguably they should be) which has put them in a vicious cycle whereby they lose income and therefore find it difficult to invest in and improve services. The Labour party also mismanaged contract negotiations with both GPs and consultants mainly by underestimating how much work both groups performed, then blamed GPs and consultants when payments under those contracts were higher than they had estimated. The Labour party had no problem whatsoever using its quite impressive media spin machine against both nurses and doctors when it felt the need to divert blame away from its reforms.

For patients I think the NHS has improved under Labour but the improvement hasn't been proportional to the amount of money invested for reasons I've already described. Also staff morale has dropped under the Labour party to the extent whereby at the worst times admitting you supported Labour was a bit like admitting you're a paedophile.

[ArrowsFA1]

Blaming one party and not the other for privatisation really does not provide an accurate reflection of real events.
Nor does it help in any way when looking at the NHS as it is now.

All public services suffer from see-saw politics. Each successive government has their own ideas on how things should be run but it is the services themselves which bear the brunt of constant and repetitive change. Is it any wonder that there are problems to be solved?!

As someone who works in education I'm well aware of policy changes in emphasis, funding being switched from one area to another or removed altogether, the promotion of particular training/courses over others, all of which helps no-one and improves little, and the frustration of those left to implement those changes and the learners trying to get a decent education.

In those circumstances it's very easy for politicians to come along with some "new" policy that proports to have all the answers and promises to solve all the problems. We get to see those kind of claims every few years.

[Dave B]

My two big problems with the proposed reforms: firstly that there's no mandate for them. Cameron specifically promised "no top-down reforms of the NHS" in his election campaigning, and yet here they are with one of the biggest shake-ups in its history relying on semantics (apparently it's a bottom-up reform). Nobody voted for this, and I suspect the election result would have been different had the public known the Conservatives' true intentions.

Secondly I have a real problem with GP commissioning. There are only two ways this could go: either GPs handle their own commissioning (and therefore have less time to spend with patients); or they contract it out, effectively buying in from a for-profit company a service they currently receive from the PCT.

The government say this will increase choice, but in reality we'll still be directed to whichever service our GP prefers. Even if there was an appetite for increased choice, and there's precious little evidence, this wouldn't be a way of providing it. We'll either end up with a situation where there's a true postcode lottery, with patients of one surgery denied treatment they could get from another GP; or we'll end up with bloated corporations like Serco or Capita raking in profit for providing a service previously managed by the existing PCTs.

It's ironic that as the USA slowly creaks towards copying the better parts of the British system, our government seems determined to go in the exact opposite direction.

And don't be under any illusion that this "listening exercise" will yield any major changes. The policy is already being enacted despite never having been voted on. PCTs and hospitals are culling staff, others are leaving before they're forced out, waiting times are increasing, non-urgent procedures are being cancelled, and for-profit comanies are licking their lips. The reforms may be watered down, Lansley may be forced to fall on his sword, the Lib Dems may threated to derail the process, but mark my words the government will force the substantive parts of this bill through no matter what the opposition.

[Mark]

And we'll end up with a situation similar to the railways, where private companies rake in massive profits and the result is the taxpayer having to pay more while getting less.

[Dave B]

And with Andrew Lansley on the board of one or more private healthcare providers once he has left his cabinet post.

[Dave B]

Incidentally, we were debating how much patients really want "choice" earlier. They already have choice in some areas, and yet...


Patients made little use of available information on the performance of hospitals; just 4 percent consulted the NHS Choices website and 6 percent looked at leaflets, both of which provide comparative information on hospital performance"

http://www.kingsfund.org.uk/document.rm?id=8687 (PDF)

I'd rather be guided by a doctor with years of training and experience than look on a website and trust my gut feeling, thanks.

[Mark]

I don't want to choose. I just want whatever problems I have sorted.

[GridGirl]

I had a bit of an accident while mountain biking on Saturday morning. Although I'm not in as much pain as I was I have an ankle the size of an elephants due to the swelling. I've just had a trip to the local minor injuries unit which also happens to be on the estate I live on. I was seen is around 2 minutes and had an X-ray in around 10 minutes. Luckily for me I havent broken anything but bloody hell was it a good service. Sure as hell beats waiting around in A&E when I know my injury is rather painful but not exactly an emergency. To be fair I've never had many complaints of the NHS previously but I am well impressed with the service I got tonight. :) The NHS gets a big :up: from me today.

[Dave B]

No doubt this will be dismissed as my quote comes from the bed-wetting pinko commie rag The Guardian, but anyway:


The number of patients waiting more than the recommended maximum of 18 weeks to be treated by the NHS has soared by almost half since last year, official data shows.

A total of 28,635 patients in England who were treated in an NHS hospital during August had been waiting more than 18 weeks, compared with 19,355 in the same month in 2010 – a rise of 48%.

The figures, released by the Department of Health, confirm that despite repeated ministerial pledges that the NHS would stick to waiting time targets despite growing financial pressure, the number of people having to wait beyond the department's own recommended maximum time is rising.

The 28,635 is the largest number since the coalition came to power last year, when the health secretary, Andrew Lansley, reviewed or eased several NHS waiting time targets.

Source: Sharp rise in NHS patients waiting more than 18 weeks for care | Society | guardian.co.uk (http://www.guardian.co.uk/society/2011/oct/13/nhs-waiting-times-rise-cuts)


NHS reforms going well, Mr Lansley? :s

[Bolton Midnight]

Seems privatisation is fine for the Labour party but unacceptable for the Tories.



Well at least we agree on one thing, Guardian = hypocrites


He said the hospital was spotless ,food was good and he is now sorted.

The UK's quality of life index slipped under Labour esp re healthcare, other countries spend less and have less staff yet get better results.


Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

As you've already shown you prefer to be told what to do by Nanny State.

More choice will mean better standards.


It worked when the likes of gas, eletricity & communications were privatised all those years ago.

Who benefitted from that?

Well I did, re shares plus far better service these days than back in the dark days (often literally) of nationalisation.

[Bolton Midnight]

The blunt answer is that we will reach a point in the future where we won't be able to afford that safety net.

Healthcare costs are rising way above inflation as is demand. Thats not just the case for the UK, that applies to pretty much the entire world. I remember an American study that claimed that if US healthcare costs and demand kept rising at its current rate then healthcare spending would reach over 100% of projected GDP by 2050 or so.

Like final salary pensions the NHS in its original state is a system that worked well when people were expected to die at the age of 60-65. Now people live 20 years beyond that and the system has to adapt to meet the rise in demand. We also live in a reality where the electorate firmly believe more can be delivered for less tax burden and any political party that tells them otherwise pays the price. Politicians are also too frightened to confront the public with the truth, if they want affordable healthcare then in future there needs to be a public debate about what we can expect the NHS to cover and what it shouldn't. Meanwhile making the system more effective and efficient by introducing and refining a competitive system involving private healthcare will keep things going for a few more years.

I too am strongly attached to the concept of a healthcare system free at the point of use and where treatment choices are not decided by affordability but by clinical need regardless of wealth. I just wish there was a real debate about healthcare and not just the usual lowest common denominator mudslinging as usually happens.


Public sector pensions need a complete overhaul bringing them in line with private ones, they need to pay in a lot more, work longer and not get as much out - welcome to the real world.

[Bolton Midnight]

And we'll end up with a situation similar to the railways, where private companies rake in massive profits and the result is the taxpayer having to pay more while getting less.

Been happening since 97, costs increase services become worse.

[Bolton Midnight]

I don't want to choose. I just want whatever problems I have sorted.

Who do you want to choose how your ailments are sorted a bureaucrat or a medical bod?

[Dave B]

Who do you want to choose how your ailments are sorted a bureaucrat or a medical bod?

My wife works for the PCT (for now, it's being abolished) so I can give you some insight here. When they decide whether to fund non-NICE treatments or exceptional cases not normally covered by the NHS, the panel consists of local GPs, clinicians, and where appropriate outside specialists. Now, my other half is what you could describe as a "bureaucrat" as she organises and minutes the panels. You could theoretically do away with her role, which you would no doubt describe as a "non-job". So now either these meetings don't take place, or the doctors and surgeons give up time they could be using for actual medical work to book meeting rooms, arrange transport and parking, coordinate diaries, take the minutes, etc etc etc.

Sorry if this goes against your entrenched opinion, but any large organisation needs its share of bureaucrats. I have absolutely no doubt that there's waste and inefficiencies in the system, but the system proposed by the coalition makes no sense whatsoever. Instead of the PCT providing this service, individual GPs will have to do it themselves. This means either (A) they take even more time away from patient care to do admin work, or (B) they buy the service in from a profit-making private provider. Instead of a network of local commissioning bodies we'll have hundreds, all with their own varying views on what should and shouldn't be funded, all requiring admin staff and facilities, and introducing a true postcode lottery. It's madness.

[Bolton Midnight]

Odd that isn't it, folk in the real world manage to hold meetings all the time without somebody there to whet nurse them, and how many meetings does she have about the meetings?

[Malbec]

My wife works for the PCT (for now, it's being abolished) so I can give you some insight here. When they decide whether to fund non-NICE treatments or exceptional cases not normally covered by the NHS, the panel consists of local GPs, clinicians, and where appropriate outside specialists. Now, my other half is what you could describe as a "bureaucrat" as she organises and minutes the panels. You could theoretically do away with her role, which you would no doubt describe as a "non-job". So now either these meetings don't take place, or the doctors and surgeons give up time they could be using for actual medical work to book meeting rooms, arrange transport and parking, coordinate diaries, take the minutes, etc etc etc.

Sorry if this goes against your entrenched opinion, but any large organisation needs its share of bureaucrats. I have absolutely no doubt that there's waste and inefficiencies in the system, but the system proposed by the coalition makes no sense whatsoever. Instead of the PCT providing this service, individual GPs will have to do it themselves. This means either (A) they take even more time away from patient care to do admin work, or (B) they buy the service in from a profit-making private provider. Instead of a network of local commissioning bodies we'll have hundreds, all with their own varying views on what should and shouldn't be funded, all requiring admin staff and facilities, and introducing a true postcode lottery. It's madness.

The work that people like your other half do still has to be done. What is likely to happen is that they'll be employed by gp commissioning groups instead. Its just going to end up in management being taken out of one place and put into another.

[Bolton Midnight]

And maybe for a more realistic salary. The NHS salaries for pen pushers are far higher than equivalent jobs in private sector. So even if numbers were only slightly less the overall wage bill should be a lot less hurrah.

The folk protesting make me sick, if they were on more realistic wages then there wouldn't need to be as many job losses.

[Bolton Midnight]

Nursing chief: £5bn savings possible of 'scandalous' NHS waste - Telegraph (http://www.telegraph.co.uk/health/healthnews/8303433/Nursing-chief-5bn-savings-possible-of-scandalous-NHS-waste.html)

CentreRight: We must not ring fence the waste in the NHS (http://conservativehome.blogs.com/centreright/2010/02/reform-of-the-nhs-is-a-difficult-nettle-to-grasp-as-a-general-election-approaches-the-public-may-easily-but-inaccurately-ass.html)

Burning our money: Waste In The NHS (http://burningourmoney.blogspot.com/2006/01/waste-in-nhs.html)

[Bolton Midnight]

Major analysis of NHS reveals nearly 12,000 unnecessary deaths a year | Home | The TaxPayers' Alliance (http://www.taxpayersalliance.com/home/2011/10/major-analysis-nhs-reveals-12000-unnecessary-deaths-year.html?utm_source=MailingList&utm_medium=email&utm_campaign=TPA+Bulletin+111014)

[Dave B]

Major analysis of NHS reveals nearly 12,000 unnecessary deaths a year | Home | The TaxPayers' Alliance (http://www.taxpayersalliance.com/home/2011/10/major-analysis-nhs-reveals-12000-unnecessary-deaths-year.html?utm_source=MailingList&utm_medium=email&utm_campaign=TPA+Bulletin+111014)

I see your link, and raise you:

TPA publish another flawed attempt at rubbishing the NHS | Liberal Conspiracy (http://liberalconspiracy.org/2011/10/13/tpa-publish-another-flawed-attempt-at-rubbishing-the-nhs/)



It is classic of TPA output in selectively presenting information to suit its conclusion.

The report title are those hypothecated as being “amenable to healthcare”, assuming that the “amenable mortality rate” for the UK can be measured against that for “selected European countries”.

The difference is then multiplied out to give a suitably large number, just over 11,500 for 2008.

This figure is then put forward, together with increased spending on the NHS between 2001 and 2011, and is held to prove that the NHS is not such A Good Thing and should therefore be reformed, although what a reformed system would look like is not told, possibly because the models followed in those “selected European countries” (the Netherlands, France and Spain) are all different.

There are a number of problems with this approach.

Firstly, as the TPA at least concedes, is the lifestyle factor, which is known to influence significantly life expectancy levels across the UK.

Second, the TPA seems unable to limit its comparison to the Netherlands, France and Spain, bringing in comparisons with Australia, Sweden, Norway, Canada and even Cuba.

And thirdly and potentially most important, the only country that has its healthcare spending examined in depth, together with productivity, pay and increases in frontline staff versus managers, is the UK.

The nearest the TPA gets to making a cost comparison is when they describe the system in Switzerland (yes, yet another comparator thrown in to the mix) as “expensive”.

So the NHS is getting rubbished by comparing it to systems across Europe and elsewhere, but there is no comparison of costs, just the inference that the NHS model is wrong and everyone else’s is better.

So what the TPA have presented is a partially researched hatchet job on the NHS, with sufficient information provided to fit the headline already written – rather like the Daily Mail, the kind of paper that eagerly churns over their press releases.

The sad reality is that informed debate on the NHS cannot be other than A Good Thing, but this is not it. It’s a waste of time.

[Dave B]

Nursing chief: £5bn savings possible of 'scandalous' NHS waste - Telegraph (http://www.telegraph.co.uk/health/healthnews/8303433/Nursing-chief-5bn-savings-possible-of-scandalous-NHS-waste.html)

CentreRight: We must not ring fence the waste in the NHS (http://conservativehome.blogs.com/centreright/2010/02/reform-of-the-nhs-is-a-difficult-nettle-to-grasp-as-a-general-election-approaches-the-public-may-easily-but-inaccurately-ass.html)

Burning our money: Waste In The NHS (http://burningourmoney.blogspot.com/2006/01/waste-in-nhs.html)
As for these links, big wow. Nobody is denying - at least in this thread - that there's not waste and inefficiency in the NHS. It needs addressing, you'll get no argument from me. But the kind of reforms being enacted by the coalition (despite Cameron looking straight into a camera lens during the televised pre-election debates and promising no such thing) are not the answer. They'll create more admin and bureaucracy, not less.

[Bolton Midnight]

They'll create more admin and bureaucracy, not less.

Yet to be seen whether it does but even if it did create more jobs but with more realistic salaries for these peoples ability then that is a good thing no?

Over paid, useless folk have no place within the NHS - sack em.

[Dave B]

Yet to be seen whether it does but even if it did create more jobs but with more realistic salaries for these peoples ability then that is a good thing no?

Over paid, useless folk have no place within the NHS - sack em.
So you're in favour of getting rid of "non-jobs", your phrase de jour, but quite happy to create jobs which dupicate existing roles? For goodness sake man, make your mind up. What little credibility you may have once had is long gone.

[Bolton Midnight]

But they won't duplicate will they if the first lot are sacked, doh!

Talk of credibility yet can't even follow plain English.

It really is not that hard to follow, too many people are doing jobs that just aren't needed, and they are useless at their jobs too yet are paid handsomely for doing sweet FA, meetings about meetings doing nowt, yet feeling v important about themselves.

They are parasites and need treating as such. They are worse than dole scroungers as they cost so much more.

[Dave B]

But they won't duplicate will they if the first lot are sacked, doh!

Talk of credibility yet can't even follow plain English.

I do apologise if I've confused you, I shall try ever so hard to explain myself clearly. The duplication arises not from replacing sacked public sector staff with a similar headcount in the private sector, that much is so obvious that I didn't feel it needed spelling out. Rather, the problem is that instead of having a small number of commissioning bodies, the coalition's plans involve each GP cluster potentially becoming a commissioning body in its own right. Each of which will need to either find their own staff (and this is where the potential for an increase in headcount arises), or to buy in services from private providers (who will need to produce a profit).

Profit in itself is not "a bad thing", far from it; but these plans lay the way for the private sector to profit from something which is currently provided by NHS staff.

[Dave B]

Any thoughts yet about the Taxpayers Alliance report being debunked as worthless, by the way? (Little hint for you before you try to dismiss my source as biased: switch on your irony detector and ask yourself whether there could possibly be any bias in your own source ;) )

[Bolton Midnight]

Yet more guesswork........

It would be nigh on impossible to make it less efficient than it is now.

And the private sector would pay more realistic wages than the public sector so if there is an increase in numbers it'll still be cheaper, so not sure what your beef is.

Unless of course you have a vested interest in useless unemployable people being paid well for doing non essential work, well do you?

[Bolton Midnight]

Liberal Conspiracy - what a flaming joke, you'd have to be stark raving mad to believe anything that site said.

[Dave B]

Any thoughts yet about the Taxpayers Alliance report being debunked as worthless, by the way? (Little hint for you before you try to dismiss my source as biased: switch on your irony detector and ask yourself whether there could possibly be any bias in your own source ;) )


Liberal Conspiracy - what a flaming joke, you'd have to be stark raving mad to believe anything that site said.

Facepalm, as I believe the youth of today are fond of saying.

[Bolton Midnight]

So it is fact when a site you find says one thing but utter rubbish when one I find says something different

facepalm indeed

[Malbec]

And the private sector would pay more realistic wages than the public sector so if there is an increase in numbers it'll still be cheaper, so not sure what your beef is.

I love the private sector too, they pay me about 7-8 times what I get paid by the NHS for the same work. Can't beat it!

[Bolton Midnight]

What the Taxpayers Alliance?

No as what they say makes sense unlike some unheard of loony fringe website, Liberal conspiracy indeed, epic fail quoting that website, well done.

[Bolton Midnight]

I love the private sector too, they pay me about 7-8 times what I get paid by the NHS for the same work. Can't beat it!

Beauty of the private sector is you are paid what you are worth unlike the public sector who expect annual pay rises regardless.

[MrMetro]

Who do you want to choose how your ailments are sorted a bureaucrat or a medical bod?

I would personally want YOU, Bolton Midnight to choose how my ailments are sorted.

[BDunnell]

I would personally want YOU, Bolton Midnight to choose how my ailments are sorted.

Absolutely. No doubt we would be right as rain in no time thanks to his input.

[Bolton Midnight]

I would personally want YOU, Bolton Midnight to choose how my ailments are sorted.

Trust me you don't I'd send most to the vet as they are better than doctors as their patients can't tell them owt yet some get cured, some get shot granted but it is still pretty impressive.

My rule of thumb with my kids is unless the bone is poking out through their skin I'm not interested.

[Bolton Midnight]

What do you know, hospitals going bust because they have been mismanaged by the public sector so badly.

BBC News - NHS hospital in Cambridge to be run by private firm (http://www.bbc.co.uk/news/health-15679742)

and there are many more

BBC News - Why is Heatherwood and Wexham Park Hospitals Trust in debt? (http://www.bbc.co.uk/news/uk-england-berkshire-15125192)

and the oh so wonderful NHS doesn't seem to get such a glowing report from the Patients Association

Patients Association launches damning report into poor care in England (http://patients-association.com/Default.aspx?tabid=80&Id=23)

yep so as I said all along, things are certainly not tickety boo with the NHS

[Bolton Midnight]

Oh missed this one off

BBC News - Trafford General Hospital 'could be privatised' (http://www.bbc.co.uk/news/uk-england-13114964)

[ArrowsFA1]

Beauty of the private sector is you are paid what you are worth...

...in 1978, the head of British Aerospace was paid £29,000. By 2010, the head of its successor company, BAe Systems, collected a package worth nearly £2.4m, a rise of 8,000%...
Executive pay consultants behind escalating boardroom salaries | Business | The Guardian (http://www.guardian.co.uk/business/2011/nov/18/bonuses-executive-pay-increases)

[Bolton Midnight]

And your point is what exactly?

I'm sure the CEO of Vodaphone gets a fair whack but he earns it and if the service was crap I could switch to Orange couldn't I? Public sector doesn't work like that, we can't shop around so as they have a monopoly the pay at the top should reflect that by being a lot less.

[ArrowsFA1]

And your point is what exactly?
The value, or lack of, placed on different jobs and the increasing salary gap as illustrated here:

The haves and the have-nots: City workers pay soars 12% to £83,000 a year... but manual workers get just 2.4% rise | Mail Online (http://www.dailymail.co.uk/news/article-2064198/The-haves-nots-City-workers-pay-soars-12-83-000-year--manual-workers-just-2-4-rise.html)

[Bolton Midnight]

Army Pay Scales - Armed Forces - British Army Officers Pay Rates - Other Ranks Pay Rates (http://www.armedforces.co.uk/armypayscales.htm)

so a captain or major gets the same as tube driver and less than a diversity or 5 a day manager :confused:

[ArrowsFA1]

So, despite profits falling (http://www.telegraph.co.uk/finance/newsbysector/epic/badot/7262229/BAE-Systems-profits-tumble-after-near-1bn-write-down.html) 88% the head of BAe Systems earned 41 times as much as a major in 2010 :crazy:

It seems that a certain sector rewards inefficiency far more than another ever has.

[Bolton Midnight]

So do you think it is right to pay a 5 a day co-ordinator over 30k?

A simple yes/no will suffice.

[ArrowsFA1]

So do you think it is right to pay a 5 a day co-ordinator over 30k?

A simple yes/no will suffice.
Yes/No

[Rollo]

I'm sure the CEO of Vodaphone gets a fair whack but he earns it

No he doesn't.

The firm earnt the money. People who produced the goods and services for sale earnt the money. Management of itself produces no discernible salable product.

Market forces determine how much he is paid.

[Bolton Midnight]

Yes/No

I'll take that as a don't know.

So which part of the public sector do you 'work' for then?

[ArrowsFA1]

I'll take that as a don't know.
That would be a fair assumption given that none of us have seen any details of this co-ordinator job you've talked about.

We know far more about Vittorio Colao (http://www.vodafone.com/content/index/about/about_us/board/vittorio_colao.html) so do you think it is right to pay a CEO €932,000 salary plus bonuses making a total of €2,264,000 in 2009?

[Bolton Midnight]

That would be a fair assumption given that none of us have seen any details of this co-ordinator job you've talked about.

We know far more about Vittorio Colao (http://www.vodafone.com/content/index/about/about_us/board/vittorio_colao.html) so do you think it is right to pay a CEO €932,000 salary plus bonuses making a total of €2,264,000 in 2009?

What do you think they don't exist then? Or climate change coordinator or real nappy coordinator etc etc. What is it like putting your head in sand, taste okay?

Doesn't bother me as I'm not paying it, so they are free to pay him a trillion euros and hour as far as I'm concerned. Let those who use Vodafone worry about it.

Grasped it yet?

[ArrowsFA1]

What do you think they don't exist then?
It would simply be very useful if you could provide the details of such a job seeing as you asked the question (http://www.motorsportforums.com/chitchat/142184-nhs-reforms-2.html#post986594), or is there a problem finding one?


Doesn't bother me as I'm not paying it...
Grasped it.

[Bolton Midnight]

cba, only a complete idiot would require a link to prove they do exist.

You've got it then have you, well done, shame it took you so long. Presume that'll be the end to your pointless and incorrect replies then?

[Dave B]

So do you think it is right to pay a 5 a day co-ordinator over 30k?

A simple yes/no will suffice.

It's absolutely impossible to tell from a job title alone. It sounds a lot for very little, but what's the overall benefit to the taxpayer down the line if these kids' health is improved as a result of this job? They might need less frontline treatment, they might take less time off work as adults in the future, they might raise their own kids better. Might.

Simply put, if paying somebody £30K generates savings of £30,000.01 or more then the answer to your question is "yes".

[Bolton Midnight]

There's a lot more than 1 of these non jobs, so it would have to save millions (what it will end up costing the taxpayer).

It is not up to the council to try and educate re food they should concentrate on parks, libraries, bin collections and the like.

Labour Manchester - wasting money and cutting the front line | Local Government (http://conservativehome.blogs.com/localgovernment/2011/01/labour-manchester-wasting-money-and-cutting-the-front-line.html)

Spending cuts have to be made. The public sector grew by over 0.9 million between 1997 and 2010, a staggering 17 per cent, so it would be irresponsible to suggest that there will not be job losses, there has to be. Paying staff is the main cost for many public sector organisations and this has increased to an untenable amount.

[Bolton Midnight]

BBC News - Royal Lancaster Infirmary faces A&E closure threat (http://www.bbc.co.uk/news/uk-england-lancashire-16869192)

marvellous

[ArrowsFA1]

UK's largest medical college says the health and social care bill will 'damage patient care and jeopardise the NHS'
Royal College of GPs calls for David Cameron to scrap health bill | Society | The Guardian (http://www.guardian.co.uk/society/2012/feb/03/royal-college-gps-health-bill)


The NHS is not in peril if these reforms don’t go ahead. On the contrary, it is the Bill which threatens to derail and fragment the NHS into a collection of competing private providers. The Bill will result in hundreds of different organisations pulling against each other, leading to fragmentation, chaos and damage to the quality and availability of patient care.
http://www.telegraph.co.uk/comment/letters/9052445/The-health-reform-Bill-will-derail-the-NHS.html

[Bolton Midnight]

They need to cut costs, and best way to achieve that is to sack thousands of managers/admin types.

People are living longer, medicines and treatments are getting more expensive so something needs doing. Sitting around thinking it is all fine and dandy is not the answer as it clearly is not.

[ArrowsFA1]

People are living longer, medicines and treatments are getting more expensive so something needs doing.
Agreed, however the key point is that the "something" this government is implementing has been seen as "damaging, unnecessary and expensive", will "cause irreparable damage to patient care", and will lead to "a fragmented, expensive and bureaucratic health service" leading ultimately to a system where care will be "defined by a patient's ability to pay".

[Bolton Midnight]

Some parts of it maybe, but that does not mean it is all bad, do you see that?

Or have you a vested interest in things remaining as they are now?

Slash and burn - only way out of this mess. A true bloodbath budget not the watered down versions we've been getting so far.

[Bolton Midnight]

Oh and by the way Labour privatised more of the health service than the Tories ever have done or would do in the future.

[ArrowsFA1]

Or have you a vested interest in things remaining as they are now?
My interest is in what those being expected to implement the changes have to say. Those who are treating patients. Those who the government said they would listen to.

[Bolton Midnight]

I'm more interested in the patients and those who are paying for it all.

People pay for a National Health Service that works yet aren't getting that.

[ArrowsFA1]

I'm more interested in the patients and those who are paying for it all.
Fair enough, and have the government listened to their views? After all Cameron promised "no top down reorganisation of the NHS" during the election.

It seems not only does the government not listen but they don't keep their promises either.

[Bolton Midnight]

Fair enough, and have the government listened to their views? After all Cameron promised "no top down reorganisation of the NHS" during the election.

It seems not only does the government not listen but they don't keep their promises either.

We haven't got a Tory or a Liberal government so their manifestos are irrelevant. But yes they have to some extent, as if the patients were saying all was well they'd leave it well alone.

Name me one that ever has?

See the taxpayer is going to have to bail out these failed PFIs set up by Labour, bloody marvellous! My god they were useless, they should be barred from ever being elected again the mess they have made of things.

Leave the NHS for now, get these boundary changes sorted first, banish Labour for ever is far more important for the future of the nation.

[Dave B]

Knowing how much our departed friend distrusts The Guardian but loves The Telegraph I wonder what he'd make of these articles from today:


The extraordinary volte face which the party performed as soon as it arrived in power – when an absolute promise that there would be no "top-down" reorganisation of the NHS suddenly turned into the most fundamental restructuring of the NHS in its history – could scarcely have been more shocking. And heading up what must have seemed like a breathtaking betrayal of an unambiguous promise was a man who is – how can I put this? – not known for his political tact and adroitness.

Suggested solution: sack Lansley and appoint Stephen Dorrell in his place. Then try to salvage the valuable bits out of this dog's dinner of a healthcare Bill.

Will Lansley go (at last)? (http://blogs.telegraph.co.uk/news/janetdaley/100135501/will-lansley-go-at-last/)

Or this:


Government officials are reportedly exasperated with the Health Secretary’s failure to win more support from critics. The Times quoted one “Downing Street source” as saying: “Andrew Lansley should be taken out and shot. He’s messed up both the communication and the substance of the policy.”

An “insider” told the paper that Mr Lansley has proved to be “a disaster” and was “a law unto himself”.
Downing Street 'does not want Andrew Lansley 'taken out and shot' - Telegraph (http://www.telegraph.co.uk/health/healthnews/9066483/Downing-Street-does-not-want-Andrew-Lansley-taken-out-and-shot.html)

[Dave B]

Fair enough, and have the government listened to their views? After all Cameron promised "no top down reorganisation of the NHS" during the election.

It seems not only does the government not listen but they don't keep their promises either.

I remember seeing Cameron's shiny head on 40ft billboards claiming "I'll cut the deficit not the NHS" before the election. Thus far he appears to have these pledges the wrong way round :s

[ArrowsFA1]

The NHS bill, like the Poll Tax before it, seems to be becoming the defining moment for this Conservative government.