First, and perhaps most importantly we need a moratorium on change – many NHS staff are simply exhausted trying to keep with the plethora of diktats and policies belched out on an almost daily basis by the DoH.

Yet despite this mountain of paperwork patients still die in the middle of London teaching hospital due to a lack of basic care;
http://www.telegraph.co.uk/health/healthnews/7383752/Police-probe-death-of-hospital-patient-who-begged-for-water.html

Perhaps the other issue to address is the fragmentation of services which many have argued are simply a precursor to outright privatisation – how much do the public know about PFIs, ISTCs or changes to out of hours care?
They certainly know about the dire conditions at Stafford – said to be driven by an obsession with ‘Foundation’ status, and tight financial controls?
http://www.guardian.co.uk/society/2010/feb/24/brown-wants-hospital-managers-answers

Well, residents around the Whittington are finally beginning to see the endpoint of NuLab’s infatuation with untested market solutions;
http://liberalconspiracy.org/2010/03/02/protesters-take-to-the-street-to-save-whittington/

I hope Milliband listens to your ideas, Paul, although I suspect he will pay far more attention to the thoughts of Richard Branson, and other major players seeking to establish a foothold in the lucrative UK health market?
http://www.pulsetoday.co.uk/story.asp?sectioncode=35&storycode=4125253&c=2

Oh, and as an afterthought – the NHS’s treatment of whistle blowers is shameful.

Far easier to shoot the messenger of course – this is what seems to have happened at Staffs amongst other places;
http://news.sky.com/skynews/Home/UK-News/Whistleblower-Nurses-Are-Being-Ignored-By-NHS-Managers-Says-The-Royal-College-Of-Nurses/Article/200905215279092

@1: “First, and perhaps most importantly we need a moratorium on change – many NHS staff are simply exhausted trying to keep with the plethora of diktats and policies belched out on an almost daily basis by the DoH.”

Sadly, this is familiar territory.

As the late Harold Wilson used to say when he was Party leader and PM:

“The Labour Party is like a stage-coach. If you rattle along at great speed everybody inside is too exhilarated or too seasick to cause any trouble. But if you stop everybody gets out and argues about where to go next.”
http://creativequotations.com/one/480.htm

When Blunkett was education minister 1997-2001, he was issuing more than one new policy, regulation, ministerial letter etc etc every day – the LibDems kept track and published figures showing that schools were buried under a mountain of paperwork. By 2000, the New Labour government had sent out 315 consultation papers, 387 sets of regulations and 437 sets of guidance to LEAs since May 1997.
http://www.independent.co.uk/news/education/education-news/teachers-warn-of-action-over-flood-of-paperwork-698137.html

#health @EdMilibandMP Reinforce valuable role of walk-in centres by secondment of A&E staff and provision of further emergency capacity.

Valuable role ? A coupe of nurses in a building the other side of town necessitating a drive through several dodgy estates at 3 am in the middle of winter with a sick toddler ? A dangerous waste of time and money

Scrap them and use the money to provide a genuine out of hours service staffed by doctors (who were all apparently “busy with terminally ill patients”, otherwise I was offered the choice of phoning an ambulance). Walk in centres are all part of the drive to restrict acess to doctors. I’ve said it before and I’ll say it again, the NHS worked better under Thatcher.

“I’ve said it before and I’ll say it again, the NHS worked better under Thatcher.”

And how many NHS patients were on long waiting lists for diagnosis or treatment?

[4] “I’ve said it before and I’ll say it again, the NHS worked better under Thatcher”.

What evidence do you have to substantiate this claim, personal anecdotes aside?

We do know Thatch was responsible for the ‘internal market’ – a device that caused admin costs to double (from 6% – 12% of the NHS budget)
http://www.guardian.co.uk/commentisfree/2009/sep/03/nhs-business-markets

A scandalous waste of money in my opinion – but the ‘internal market’ was the only way to appease the Iron Lady, if she’d had her way it would have been full blown privatisation;
http://www.hsj.co.uk/internal-market-was-only-way-to-stop-thatcher-privatising-nhs/26572.article

NuLab have perpetuated Thatch’s flawed vision of the market, perhaps fearing the responsibility of managing the NHS budget, which now runs to some £100 billion, annually.

Have a look at this before tweeting Milliband – absolutely essential viewing if you want to understand the full extent of NuLab’s destruction of the NHS
http://video.google.co.uk/videoplay?docid=2948518517097034197#

A&ECN @1,3,6,7: I agree with a lot of the point you make about the need for a fundamental rethink within Labour about the NHS’s ‘marketisation’, as well as the need for a settling down period given the constant changes (though I think you’d accept a manifesto based on not doing very much at all is hardly going to appeal to Miliband-land!).

Specifically on Stafford, there’s a follow up to this post on here about that, though with a focus on medical wards rather than the A&E issues there, related to my last ‘twitter point’ on staffing levels. It’ll only be an edited version of what’s already at http://thoughcowardsflinch.com/2010/03/03/labours-manifesto-the-need-to-commit-to-nursing/ if you want a quick preview.

Matt Munro @4: I have to agree with A&ECN’s point that one experience does not provide evidence that the NHS under Thatcher was better. For the reasons set out by A&ECN and by B from B and many many more that is palbably untrue.

The point about Walk-in Centres is that they were established in poorer areas initially (your ‘dodgy estates’) specficially because of relatively limited decent access to primary services in these areas. However, they have become seen as quasi-A&E’s by local populations and start to be remodelled as such to meet these legitimates expectations. With respect, your view that i’d paraphrase as ‘only a doctor will do’ is part of an enduring (and perhaps enduringly gender-based) misconception about the skill levels of nurses in such places of work, although I do accept that in your case a GP out-of-hours service would have been more appropriate.

Clearly I’m not sure why that wasn’t properly in place the night you needed it, but I do know the establishment of GP co-ops for out of hours service delivery has, in many place in England, been a relative success story in the NHS in recent years allowing decent access to GPs at all hours while moving away from the old-fashioned but ridiculous norms of GP hours (and single practice GPs), although certainly i am critical of the way other aspects of GP contracts and Practice-based Commissioning have worked out in practice.

@7: “Have a look at this before tweeting Milliband – absolutely essential viewing if you want to understand the full extent of NuLab’s destruction of the NHS”

I listened carefully to John Lister’s lecture of nearly 2 years ago but didn’t hear any explanation for this:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK. A leading economist said the figures were a consequence of having extra doctors and nurses in the system.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

If we check carefully, I think that we’ll find some EU countries with better healthcare outcomes than Britain but where healthcare spending is a lower percentage of national GDP.

Finland, Luxembourg, Ireland and Spain in western Europe do well in terms of healthcare outcomes – according to an independent Swedish think-tank on healthcare – while spending a smaller proportion of their national GDP on healthcare.

The distinctive feature of the NHS is that it combines a social insurance scheme, to cover (approved) personal healthcare costs, with what comes close to a state monopoly on the provision of healthcare services – hence the relatively small percentage of Britain’s GDP spent on private healthcare.

Other west European healthcare systems have not followed Nye Bevan’s NHS model of a state managed, verging on monopoly supply of healthcare services and instead focus on social insurance schemes of various kinds. It would have been helpful if Lister had illuminated the fundamental differences between national healthcare systems.

For an alternative assessment of the NHS internal market, try these Civitas papers:
http://www.civitas.org.uk/nhs/pubs_articles.php

Civitas briefs on other national healthcare systems are accessible via this link:
http://www.civitas.org.uk/nhs/health_systems.php

I would like to have heard John Lister speak about this too:

“Almost 4,000 NHS patients in England died last year following ‘safety incidents’, in which some aspect of their care went wrong.

“A further 7,500 patients suffered severe harm as a result of accidents or botched medical treatment.

“Figures for the final six months of 2008-9, published yesterday by the National Patient Safety Agency, show that over the year 11,504 patients died or suffered severe harm as a result of medical errors, a rate of almost 1,000 a month.”
http://www.independent.co.uk/life-style/health-and-families/health-news/why-hospital-is-a-dangerous-place-to-be-1799083.html

[9 & 10] a number of questions, most of which have complex answers once we really start to dig.

Lister reminds us that the UK’s health infrastructure (post-war) was ramshackle at best. Hospitals were often dilapidated, a far cry, if you like, from the hi-tech environment depicted in many recent hospital dramas.
Additionally for the best part of 40 years little more than 6% of GDP was spent on the NHS – a rather meagre amount given its relatively good performance.

Perhaps we are ALL finally beginning to realise that high standards of health care are never cheap – even so France, Germany and Switzerland still cost more than the NHS and always have done (a point strongly emphasised by Lister).

You are quite right to point out that the NHS has belatedly received a modest cash injection (long overdue in my opinion) – I agree that this cash has not been invested well.

A lot of talk has focussed on the NHS supa-computer (which cost at least £12 billion – and probably far more) – but I can tell you now the driver for this technology is not so much the efficient handling of health data but rather a concerted attempt to itemise each fragment of care so that BILLING becomes a more scientific process – in other words the IT system is a further precursor to the privatisation agenda, rather than a device to boost clinical standards.

Without ducking the question of European comparisons I think we have to frame each question in terms of the many variables that affect outcome – a simple starting point is that the health of a nation is NEVER dependent on the health system alone.
Additionally we cannot cherry pick the best each European country has to offer then complain the NHS does not measure up – for example, the NHS may be worse for cancer care (when compared to country A) but sightly better for HIV, or treatment of heart attacks say?

My point is not even that the NHS is the be all and end all – there may well be another model that produces more favourable clinical standards (and not just greater customer satisfaction, which is a slightly different measure) but shouldn’t we at least have an open, and meaningful debate before introducing such a major change in heath policy?

The main problem, in my opinion, is that privatisation has been being ushered in, and far more extensively than people realise, without so much as a murmer.
Ironically, it is NuLab who are responsible for the insidious nature of these changes (favouring market solutions) – I have no doubt Aneurin Bevan must be turning in his grave?

“Lister reminds us that the UK’s health infrastructure (post-war) was ramshackle at best. Hospitals were often dilapidated, a far cry, if you like, from the hi-tech environment depicted in many recent hospital dramas.”

That is daft to start with because in 1948 much the same could be said of most war damaged western Europe countries – let alone eastern Europe.

The challenging crucial issue is why didn’t all the other west European countries adopt Bevan’s NHS model and instead opt to create or recreate social insurance models?

The Bismarckian social insurance model for personal health care costs goes back to the 1880s, after all. Lister conveniently ignors what happens in other west European countries except to stress that in France a larger percentage of national GDP is spent on healthcare.

He doesn’t mention that there is NO verging-on state monopoly there of healthcare services and that there is continuing competition between healthcare providers, a structure he regards as abhorrent. He also forgets that in 1997, France had about twice as many physicians per head of population as we had – which is another reason why healthcare is better there, as evidenced by slightly longer life expectancy, lower infant mortality rates and better survival rates with cancer care etc.

IMO Lister is just a propagandist and not a serious analyst.

[12] “Lister is just a propagandist and not a serious analyst” – that’s a bit unfair?

If the main objective is propaganda it begs the question on who’s behalf – there’s certainly no support for any particular party in his observations?

I accept that Lister is a proponent of the NHS’s founding principles, i.e.
That it meet the needs of everyone
That it be free at the point of delivery
That it be based on clinical need, not ability to pay
But he’s certainly not alone in this respect.

Lister touches on Europe but does so mainly to highlight the marked differences in historical funding, especially when comparing health costs in France to that of England.
It is clear that the health expenditure by the NHS was far lower for DECADES when compared France (see p108)
http://content.healthaffairs.org/cgi/reprint/6/3/105.pdf

The main analysis, and in fact the main thrust of Lister’s presentation is to draw attention to profound changes in the way health is being delivered in England.

You have always disapproved of Bevan’s model, fair enough everyone is entitled to their opinion – I cannot say why other European countries did not follow suit, although the NHS was one of the first, if not THE first system, to offer comprehensive health care to all citizens, free at the point of delivery.

Lister in a separate lecture asks;
Where is the evidence to demonstrate that market solutions provide better outcomes?
Where is the evidence that the public want covert privatisation to continue apace?
Surely these are more important questions than why this or that system of health provision came into being 60 years ago?

[13] Where is the evidence to demonstrate that market solutions provide better outcomes?
Where is the evidence that the public want covert privatisation to continue apace?

To be clear, these rhetorical questions are aimed at recent changes in the NHS rather than the wider issue of private vs public in other health systems

In the mid 1990s before TB became PM, I came across official NHS leaflets virtually boasting that the NHS employed 1.2 million people, making it the largest single employer in western Europe.

The obvious first questions are: How come and why have our peer group countries in Europe opted for such radically different approaches in their national healthcare systems?

The NHS is based on a Stalinist model of a state-owned national monopoly. It was created a time when the notion of state-owned monopolies was highly fashionable – hence the nationalised coal, gas, electricity and steel industries, all established within the space of a few years.

For decades, the British electorate swallowed the guff put out by the high priests of the NHS at the LSE – like Richard Titmuss – that the NHS was wonderful because the American system of healthcare was so awful. The American system is demonstrably awful – which is why Obama is trying to reform it – but it doesn’t logically follow that the American market system is the only alternative.

It is literally only within recent years that analysts in Britain have seriously compared the structures of national healthcare systems in west European countries and have incidentally concluded that by comparison the NHS is very mediocre in terms of patient outcomes. And in west European national healthcare systems competition between providers by and large prevails. There aren’t state monopolies and there are no providers employing anything like 1.2 million – it’s more now.

A natural (and intelligent) response to such basic facts is to wonder whether – on the evidence – the whole notion of the NHS is fundamentally flawed.

For comparisons between west European national healthcare systems in terms of patient choices and outcomes, try the links here to an independent Swedish think-tank on healthcare:
http://www.healthpowerhouse.com/index.php?option=com_content&view=category&layout=blog&id=36&Itemid=55

We need to privatise the NHS. Most other western, developed nations have privatised health care resources, and the differences in the quality of care is startling. Namely, their’s is great and our’s is crap.

Instead of the government running the health care service with a top-down approach, people should be able to deposit money into health care savings accounts, and use these accounts to pay for medical costs. For catostrophic health care needs, people should be given a top-up to purchase high-deductible health insurance.

This way people are empowered to “shop around” for the best deals on health insurance and health care, whilst the poor have access to health services. A similar system has been tried with great success in Singapore: with a little tweaking, it would work great in the UK too. We let the free market govern 70% of the economy, why not the remaining 30%?

[17] I think Unity has already dealt with the myth that Singapore represents some sort of health care holy grail;
http://liberalconspiracy.org/2009/08/14/i-bet-the-trains-run-on-time-as-well/

By the way when you say ‘their’ health system is great, what, or who do you mean exactly?

To the best of my knowledge no developed country in the world trusts the market (alone) to meet it’s citizens health needs – now why is that, I wonder?

“To the best of my knowledge no developed country in the world trusts the market (alone) to meet it’s citizens health needs.”

That’s true – and credit must go to Bismarck, first Chancellor of the German empire, for pioneering a social insurance scheme to cover personal healthcare costs in the 1880s.

But from the fact that developed country electorates have universally rejected exclusive reliance on market systems for healthcare, it doesn’t logically follow that the NHS is therefore wonderful and better than the national healthcare systems in other west European countries.

On the evidence, it isn’t. And other countries haven’t opted to create anything like a state-owned, verging-on monopoly supplier of healthcare services employing 1.3 million people, the largest single employer in all western Europe.

“I think Unity has already dealt with the myth that Singapore represents some sort of health care holy grail;
http://liberalconspiracy.org/2009/08/14/i-bet-the-trains-run-on-time-as-well/”

No, Unity has just pointed out that Singapore is not a very nice place to live (no disagreements here). However, that doesn’t change the fact that its health care system is something to replicate for cost control and quality.

“By the way when you say ‘their’ health system is great, what, or who do you mean exactly?”

Most Western European countries, with their evil, privatised health care systems (Switzerland, Germay, Netherlands).

“To the best of my knowledge no developed country in the world trusts the market (alone) to meet it’s citizens health needs – now why is that, I wonder?”

Because all governments get off on punitive regulations and controls, maybe?

[20] “Because all governments get off on punitive regulations and controls, maybe”.

I think you’ll find most of the punitive regulations and controls exist within health systems were there is a direct relationship between provision of care, or treatment, and how much the shareholders stand to earn.

I’ve heard for example, that the USA spend something like $400 billion annually (almost half the entire NHS budget) purely on bureaucracy?
http://www.lightparty.com/Health/HealingRegeneration/html/HealthCareWastes.html
While doctors are employed to deny people access to care if they suffer with certain conditions?

According to this item;
http://www.balancedpolitics.org/universal_health_care.htm
“One of the biggest weaknesses of our current health care systems (USA) is that patients with a past or current medical condition such as cancer or asthma often cannot obtain affordable health coverage. Some insurance companies won’t even give a policy to such individuals, or if they do, they will cover everything BUT their past diagnosed conditions. Anyone with an expensive illness or disease must then often face one of two choices: use up all their own money, or leave the condition untreated. In a universal system, no one with a pre-existing condition would be denied coverage. People could change jobs without fearing the loss of health insurance”.