I agree with the thrust of this article. The nice old ladies in Tory constituencies should really be paying for their own health care.

I’m not quite sure what counts as special NHS provision for the deprived.

How about those polyclinics – or local care centres – so the poor and needy can be cared for and treated mostly in their own homes without taking up hospital beds? Does that count?

My concern about the NHS pushing the polyclinic or local care centre route is the much greater likelihood of patients being seen by someone they have never seen before and probably will never see again.

It’s the ultimate rationale for spending that £12+ billion on developing a national database of personal medical records so that any healthcare professional, anywhere in the NHS orbit, can access a patient’s medical record and make treatment decisions. Never mind all that hysterical stuff about protecting patient confidentiality.

@1: “The nice old ladies in Tory constituencies should really be paying for their own health care.”

The end of any intention to provide universal healthcare so the affluent will have every justification for opting out? How about tax breaks for the premiums on personal healthcare insurance policies as well?

Would this be the same little old ladies who, after the tory’s 1991 Community Care Act, were charged for nursing care if they happened to require residential care? It wasn’t until 2001 that this changed, but for over 10 years, thousands of elderly people paid, often at private rates, for care from a registered nurse, which was supposed to be free at the point of delivery.
No doubt elderly people from tory constiuencies paid, but so did people, on moderate incomes from poor areas, because they were made to sell their homes. This fate was probably avoided by the more wealthy who could afford legal advice on how to avoid forced sales.

Look it’s not that complicated, but both parties seem to want to game things to their own advantage. Universal provision,no special preference to rural ‘rich’ areas or to socio-economically deprived ones (though every PCT area is a mix of rich and poor pockets), the sole weighting done according to clinical need: to each according to their need…pitch it that way and the ‘poorer’ areas in terms of health outcomes get most. By the way I think the author is mixing up public health expenditure (the area in which the Tories will allegedly target the ‘poor’ areas,presumably for DH hectoring, but as I say, there’s no clear demarcation for those) and ‘regular’ health spending.

#2

Bob, polyclinics are basically just for London. There are walk-in centres elsewhere which are open 12 hours a day, 7 days a week. But it’s not either/or – you can go to a walk-in centre AND have a registered GP. But you might want to see a doctor out of hours (perhaps your kid has a problem and you want to deal with it quickly, or you work long hours and don’t want to or can’t take a day off work). It’s predominantly poorer & working class people who are likely to find themselves in this situation, so I’m all in favour of it, as long as it remains the case that you can attend and have a registered GP.

One example of extra provision for deprived areas is that the recent cash for extra NHS dentristry facilities has gone mainly to deprived areas.

@ tim f. I’m afraid you’re off beam with polyclinics. Every PCT area has been under tremendous pressure to come up with a darzzi clinic, regrdless of the suitability of the model for the area or of the level of need. speak to more enlightened commissioners and they’ll tell of waste aplenty as a polyclinic is imposed on their area, when a better solution would have been to renew and refurbish the existing primary care provision. The polyclinic idea might work in London, with far bigger commuter/transient population, but was being imposed everywhere, very,very rigidly, until the credit crunch put a freeze on. Hopefully this will allow for a less dogmatic phase and a rethink. By the way, the evidence re walk-in centres utterly contradicts your asssertion that they are mainly used by the poor and working class:indeed the RCGP and the King’s Fund separately found that walk-in centres have increased access primarily for affluent people, thus increasing health inequalities.Many are provided by for-profit companies, with bare-bones medical staffing (odds of seeing a nurse consultant or a doctor aren’t great) so you can’t and aren’t meant (see the guidelines) to go with anything vaguely serious or ominous. Mucho expenditure for little actual service (being told to go away and see you GP isn’t a service) and the main beneficiaries are middle-class commuters (walk-ins often being by train stations) with no severe and enduring or acute problems.Is that really a success, given the money lavished on walk-ins?
Let me be understood-neither polyclinics nor walk-in centres are of themselves necessarily bad things,but the top-down, headline-grabbing, imposition of them has been wasteful,had unintended poor consequences, and demoralising for NHS staff as they see more white elephants, or sub-standard care provided by privateer contractors.

Darzi, not darzi. The guy was still a supercilious arse, used by New Labour to put a veneer of clinician’s approval (though clinicians didn’t like or back him, and both doctots and nurses I know who worked with him dislike him rather intensely) on their back-door privatisation (before the credit crunch all of the PCTs were besieged with polyclinic plans form the likes of united healthcare and Virgin health, and commissioners were encouraged to outsource). Again the basic idea might have been okay, in the right metropolitan setting, but the implementation by New labour was appalling: get the cherry-picking privateers in, insist on polyclinics where they’re not needed and wasteful, oh, and of course use f*cking PFI to pay for them.

@4 “By the way I think the author is mixing up public health expenditure (the area in which the Tories will allegedly target the ‘poor’ areas,presumably for DH hectoring, but as I say, there’s no clear demarcation for those) and ‘regular’ health spending.”

A bit, perhaps. But as you also hint at, the Tories started it.

They say they want to ring-fence public health spending, but they’re incredibly vague on what that involves. Do they mean innoculations? Subsidised gym memberships? Flouride in the water? Patronizing adverts telling us to drink less? Last time I looked into this – admittedly, this was a few months ago now – they couldn’t tell me.

So while I did elide “public health spending” and “NHS spending” slightly, until they can actually demarcate the two themselves I think that’s fair comment.

To be honest, all these ideas – “we’ll ringfence public health”, “health premiums for poor areas”, “reversing Labour’s political manipulation” – feel more like talking points and soundbites than fully-fleshed out strategies. They’re politics rather than policy.

Which is a worry, as they’re going to win, and I’d rather they didn’t wreck the NHS.

John,

I think you are missing the big picture (they are sneaky, those Tories, hiding things from you).

First, there is a difference between funding for acute care and public health. Basically, for most people, most healthcare is consumed in the last five years of life regardless of what age you die at (of course, life expectancy is important and poverty is a factor). So if you want to target the people who most need acute care, it will be the little old ladies that you mention. Affluent areas often have higher numbers of the elderly, since, well, affluent people live longer. I am ignoring a lot of issues here but basically that is the case.

In terms of public health (obesity, smoking, etc), the poor tend to have worse health than the affluent, hence they need more public health funds. The ‘health premium’ that the Tories mention are for the public health funds, so yes Cameron is being nicer to poor people. But there is an agenda, so bear with me…

In terms of acute funding (hospitals) there is a formula that gives PCTs for deprived areas more money. It is a secret formula, but it is well known that PCTs of poorer areas get more money than needed for the population. That’s what your Simmonds chap was talking about. The problem with this secret formula is that hospitals are paid differently, the change is only recent. It is called payments by results, but should be called payment per procedure because there is a payment for every treatment performed. (Unfortunately the Tories also use the term payment by results, but it is a new system they will introduce which will reduce funding to hospitals.) The problem is that the money comes from the PCT, so if the hospitals in a PCT area do lots of procedures, they will be paid a lot by PbR, and the PCT may run out of money. This is the case for hospitals in affluent areas, since those PCTs do not have the extra funding that deprived area PCTs have. From my reading of the Tory so-called draft manifesto, there is no mention of reforming the funding to PCTs. The reform is for funding for public health.

The Tories have a separate document for their plans for public health. Here’s a quote:

“To encourage a new market … we will require local public health directors to ensure that an increasing proportion of contracts are awarded to providers from the private and voluntary sectors”

To coin a phrase “are you thinking what I am thinking?” This is a blatant announcement that public health provision (£3 billion) will be privatised. No if’s no but’s but an increasing proportion. This is the very same public health budget that Dave will be boosting with the “Health Premium”.

Basically the extra money won’t go to the poor, because it is needed to go to his buddies in the private healthcare corporations.

This is the first of my blogs on the Tories plan for public health.

This is the conclusion of my series of blogs on the Tories draft manifesto for health.

@richardblogger
torylies.blogspot.com

@8 John.

I do believe that Cameron is serious about the ring fence, but again, that is because he has an agenda. First, it is worth pointing out that the Department of Health Operating Framework for the NHS in England 2010/11 says

“2010/11 is a pivotal year. The NHS still has a year of significant growth. The Chancellor’s Pre-Budget Report announced that between 2011/12 and 2012/13, NHS frontline spending will rise in line with inflation.”

So there is a ring fence from labour too. The difference is that Labour plans are for this money to go into the NHS.

The Tory “draft manifesto” is littered with phrases like “new providers”, the fact that they keep saying that makes you wonder where all of these new providers are coming from. Another thing that is clear from the “draft manifesto” is that other than saying that all NHS hospitals will be encouraged to be Foundation Trusts (which is Labour government policy anyway) there are no commitments in the document to existing NHS providers. The reason is clear: the Tories commitment is to the “new providers”.

The Tories want to create the super-quango, the NHS Board, and the policy document you mentioned above says that the NHS Board will determine commissioning policy. As I have mentioned in my last comment (#9) commissioning will be based on a principle of “an increasing proportion of contracts awarded to providers from the private and voluntary sectors”. So the NHS Board will mandate that local commissioners have to commission a proportion of healthcare from private suppliers.

In my concluding blog of the series of blogs I wrote on the Tories “draft manifesto” on health, I liken this to the 1990 Broadcasting Act. That act mandated that the BBC had to commission 25% of the programmes it broadcast from independent production companies. The first health bill from a Cameron government will do the same in healthcare provision, and what’s more it won’t be a fixed proportion, it will be an increasing proportion. I should need to say that this is privatisation, pure and simple. This is why Dave needs his ring fence, he has to be able to guarantee an income to those new providers that he hopes will start up.

This next election will be about the NHS – whether the providers are NHS owned, or whether they will be privately owned.

@richardblogger
torylies.blogspot.com

[10] “This next election will be about the NHS – whether the providers are NHS owned, or whether they will be privately owned”.

Indeed, it even looks like the head of the BMA has jumped ship in favour of the gimmicky, and financially lucrative Polyclinics (or ‘Holly-clinics’ as they were dubbed, after Richard Branson’s medically trained daughter, Holly, was linked to them).
http://www.telegraph.co.uk/health/healthnews/4164848/Head-of-BMA-to-run-polyclinic-after-opposing-them-vehemently.html

http://women.timesonline.co.uk/tol/life_and_style/women/body_and_soul/article5205203.ece

[6] hard to disagree with any of that – the drive toward an increasingly consumer driven health service will not be without consequences, even if it is only the kind of volte face exhibited by Hamish (I’m not doing it for the money) Meldrum.

@9 Richard Blogger:

“To encourage a new market … we will require local public health directors to ensure that an increasing proportion of contracts are awarded to providers from the private and voluntary sectors”

I doubt anyone within a mile of the leadership of the Labour Party these days would have the slightest problem with that as a policy. They’d probably see it as both laudable and inevitable. Modernisation, reform etc etc