“He promised “no more pointless and disruptive reorganisations””

I do find this whole thing bizarre. I’m not truly exercised by any of the actual proposals, but the fact that it’s being done at all right now doesn’t make any sense. Cameron *is* less of a meddler than many in his party. And an end to top-down meddling with the NHS was in the Lib Dem manifesto too. You’d think the government would be grateful to leave at least one thing ticking over. Is it a sop to the right wing, and if so how? Or no more than a vanity project of Lansley’s? If it’s to disguise net cuts from bureaucracy that aren’t going to be ploughed back into the frontline, why have the Tories changed their minds on ring-fencing? Originally it was the Lib Dems who argued against that.

@Alix read my blog from January. These plans were well known by anyone who could be bothered to read their health policy documents. Unfortunately Labour could not be bothered and consequently did not bother to campaign on the NHS at the election. In 2009 they published their NHS Autonomy and Accountability draft bill. I blog about it here. In 2007 they produced a detailed policy document about NHS re-organisation. There have also been policy documents freely available on their web site about targets and their plan to privatise public health. There is nothing hidden about this. The problem is that no one in the mainstream press could be bothered to report this, and the Labour party could not be bothered to campaign against it.

@sunny

take to the streets to protect the NHS from cuts. Let’s do it

Will do. You organise it and I’ll be there.

By the way, did you join the march to protect public services in April. I was there. Unfortunately, not many others were. Pathetic.

Richard, that is part of the fightback, which I outlined earlier today. I think it’s a bit early yet, but we need specific instances we can use to highlight what’s going on and campaign on.

[2] I think your analysis is spot on.

What I find so infuriating is that much of the groundwork was coneniently laid by NuLab (PFI’s, ISTC’s, a national billing network, outsourcing of ancillary services, etc, etc) – I’ll bet the Tories, sorry, coalition could hardly believe their luck?

My guess is the public will not fully realise what is going on in the NHS until they are asked to pay at the point of delivery – and given the recent developments in GP-land I suspect they might be one of the first groups to start charging?

“My guess is the public will not fully realise what is going on in the NHS . . . ”

You could have stopped there. IMO the public haven’t understood what has been going on in the NHS by way of management for decades.

What the public do know about is waiting lists, how they are treated and about how much choice they have to select a GP or a hospital. They have read press reports about the better cancer survival rates in many other west European countries and can look up the differences in the numbers of physicians per head of population, average life expectancy and infant mortality rates.

[6] “They have read press reports about the better cancer survival rates in many other west European countries and can look up the differences in the numbers of physicians per head of population, average life expectancy and infant mortality rates”.

Differences that are negligible in the main (and may be attributed to factors other than standards of health care, such as quality/accuracy of data collection, etc).

It is also a nonsense to compare the NHS to an entire continent.

Name the condition you are MOST concerned about, and which country you are comparing the NHS to, then maybe some of your wooly generalisations can be unpacked further?

@ 6 “What the public do know about is waiting lists, how they are treated and about how much choice they have to select a GP or a hospital.”

I agree with the first two, but what is this obsession with “choice”?? I want good healthcare that I can access easily, so a doctor near my work/home and if I need to be in hospital one that isn’t hundreds of miles away, so that I can get there and that people can visit me relatively easily.

I recently had to vist a clinic at the local eye hospital, along with my appointment letter I received a form and a load of guff about “choose and book” (which I now understand is some massively expensive, underused and largely unwanted IT system) . Did I want to choose where to go ? No I didn’t. Even if I did, on what basis would I make that choice ? My GP had booked me into the local clinic, am I supposed to know better than her ? Added to which the nearest alternative eye hospital is, I think, over 100 miles away. Even ignoring the practicalities and the expense, do I know better than my own doctor and what does it say about my local hospital if I chose not to go there ? As it happens the appointment was excellent, the nurse were excellent and the consultant was excellent, the optician that picked up the problem was excellent. The dead hand of the government wasn’t

The proposals in the white paper have a number of flaws. Firstly, 90% of those GPs surveyed do not wish to undertake the commissioning role. To date some commissioning using this model has been done with mixed results.

I question the contention that this will decrease bureaucracy. It will certainly decrease centralisation as PCTs and SHAs are abolished and replaced with more numerous commissioning bodies some 500, in fact. The cost of abolition of PCTs and SHAs in redundancies will be £1.7 Bn in redundancies. I doubt it will save that amount. Mainly because a lot of these administrators move from PCT/SHA payroll on to the payroll of these commissioning bodies.

The problem is that this would lead to a real postcode lottery as 500 devolved bodies (largely unaccountable) make spending decisions without the ability to look at the entirety of the system and gain a strategic overview. What happens when the money runs out? Will clinical decisions be made or will decisions largely be made on the grounds of cost? I fear the latter even more so under this system.

The only people who will eventually gain out of this system are pharmaceutical companies (no doubt scheduling the meetings with the doctors in these new bodies to sell their goods) and eventually private healthcare providers such as tribal and BUPA.

The eventual outcome will be Lansley or his replacement stating, we have broken the NHS and can no longer afford it. Private insurance all round. And retirement to a directorship or two at tribal or BUPA for the architects of all this.

[8] I’m glad you had reasonable care – this is the experience of most, but obviously not all NHS patients.

But this debate is not about standards of treatment per se but rather the LACK OF TRANSPARENCY i.e. the neo-cons privatisation by stealth agenda.

If team Cameron wanted to privatise the NHS he should at least have had the decency to include it in the Tories pre-election manifesto so that the public could weigh up their preferences before voting for them.

Lansley does not have the balls to call a spade a spade nor why he believes markets and privatisaion will produce better clinical outcomes, perhaps because there is no evidence (so far) that it does when compared to comparable state provided services.

Matt Munro

So it is your wife or family member who goes to the doctor with a life threatening illness under the new system. The doctor says “Sorry I cannot afford to treat your wife, I have spent all the money.” As a consequence, your wife/family member cannot be referred for the treatment or have the drugs required. The commissioning consortium next door, that you have no access to, can afford it but you fall outwith their catchment.

Wheres the money gone? Spent on drugs from the Rep he saw the last week who will take him to the Open next year. Wheres the accountability? Wheres the improvement?

@7: “It is also a nonsense to compare the NHS to an entire continent.”

But I didn’t. I’m comparing the NHS with national healthcare systems in other west European countries because we are all part of the same peer group in terms of affluence. Healthcare think-tanks in Britain have made similar comparisons – Civitas briefs on other national healthcare systems, mainly in western Europe, can be accessed via this link:
http://www.civitas.org.uk/nhs/health_systems.php

One benefit from international comparisons is that we can hopefully learn from the experience of different systems and structures in other countries.

“Name the condition you are MOST concerned about, and which country you are comparing the NHS to, then maybe some of your wooly generalisations can be unpacked further?”

I read reports of independent assessments of the NHS and what happens in other west European countries and these are seldom favourable to the NHS – cancer survival rates being one example.

I mentioned physicians per capita, average life expectancy and infant mortality rates because those are widely used as indicators to make international comarisons – and the NHS does not emerge well even if the differences in output measures are usually small. I was greatly surprised to discover that towards the end of the 20th century, France had getting on for twice as many physicians per capita compared with Britain.

[12] ‘cancer’ is a group of over 200 different diseases – which one are you talking about, and how do you quantify the difference?

More to the point, how will Lansley’s crappy plan actually improve survival rates for any of them?

@8: “what is this obsession with ‘choice’?? ”

In London and other large conurbations, there are often several GP practices within easy commuting distance. GP practices are not perfect substitutes for one another but, until just, it was made exceptionally difficult to change practices.

And again, several hospitals are often accessible. It happens that until recent changes, I couldn’t have gone to the nearest hospital to me for treatment even if I had wanted to because I was not in its catchment area. Besides that, hospitals have different success rates for treatments and have sometimes had widely different hospital infection rates.

I’ve had my own bizarre experiences with choose and book.

@13: “More to the point, how will Lansley’s crappy plan actually improve survival rates for any of them?”

I’ve posted quotes on that before:

“Chris Ham, chief executive of the Kings Fund health think-tank, said: ‘There is a real risk that people will be distracted and preoccupied with this huge organisational change, just at the point where they need to be increasingly focused on productivity and efficiency.’”
http://www.ft.com/cms/s/0/dc1eee7c-7a25-11df-aa69-00144feabdc0.html

“Moves to transfer commissioning responsibility to GPs could cost the NHS its £20 billion efficiency savings target, and worse.

“The coalition government’s White Paper on the NHS is due to be published next week. It is widely expected to outline plans to hand control of as much as £80 billion of resources in the NHS from Primary Care Trusts (PCTs) to consortia of GPs.

“Analysis by the independent think tank Civitas suggests such moves are likely to:

- Lead to at least a one year dip in performance in the NHS in absolute terms.
- Set the NHS back at least three years relative to what could be achieved without any structural change.”
http://www.civitas.org.uk/press/prcs_GPcommissioning.php

Here’s what the BMA said:

Health commissioning best handled by staff in doctors’ jobs, says BMA – 13 Jul 2010

He made the comments following the publication of the coalition government’s new health white paper, which laid out plans to give staff in doctors’ jobs the freedom and responsibility to commission care for their patients.

So, you could have run with a rather different headline – ‘BMA endorses Lansley’s reorganization’.

“Health commissioning best handled by staff in doctors’ jobs, says BMA”

As Mandy Rice Davies memorably said, “They would, wouldn’t they?”

The question is whether the average GP is well enough informed about the symptoms and treatments of unusual ailments, not the regular, routine stuff, and where the best specialists are posted.

The minister is already talking about local GPs getting together in “consortia” to do the commissioning work, presumably on the principle of more heads being better than one, which, in the context, is sensible.

“More than 5,700 patients in England died or suffered serious harm due to errors latest figures for a six-month period show. The National Patient Safety Agency said there were 459,500 safety incidents from October 2008 to March 2009 – the highest rate since records began. Patient accidents were the most common problem, followed by mistakes made during treatment and with medication.”
http://news.bbc.co.uk/1/hi/8295417.stm

“More than 3,000 hospital patients have died because of errors by NHS staff in England over the past year, figures show.”
http://news.bbc.co.uk/1/hi/health/7813634.stm

“More than 17,000 people receiving treatment in the UK have died unnecessarily because of the inadequacies of the NHS, it is claimed today. The figure, in a paper published by the Taxpayers’ Alliance, is calculated using data given to the World Health Organisation. It compares the number of people who died prematurely, even though their illness was treatable, in five European countries.”
http://www.guardian.co.uk/society/2008/jan/18/health

“The UK now has one of the highest rates of maternal mortality in Europe, with 13 deaths per 100,000. Britain ranks below countries including Poland and Hungary, and is above Bulgaria, Bosnia, Belarus, Romania, Armenia and Albania.”
http://news.independent.co.uk/uk/health_medical/article2326232.ece

A post made here has just disappeared. Why is that?

“A post made here has just disappeared. Why is that?”

I suspect it happens a lot – either that, or people on here are uncommonly bad at citing the right number for the comment they’re replying to.

And I do wonder what it’s about, especially as other comments are explicitally moderated out.

“Health commissioning best handled by staff in doctors’ jobs, says BMA”

As Mandy Rice Davies memorably said, “They would, wouldn’t they?”

How come this then?

“Reform of the NHS planned under the government’s white paper will cost around £3bn without saving money or improving patient care, a leading academic has warned in the British Medical Journal.”
http://www.telegraph.co.uk/health/healthnews/7894203/NHS-reforms-will-cost-3bn-and-will-not-work-academic.html

And patient care is what we should be worrying about with reports in the news such as this:

“More than 5,700 patients in England died or suffered serious harm due to errors latest figures for a six-month period show. The National Patient Safety Agency said there were 459,500 safety incidents from October 2008 to March 2009 – the highest rate since records began. Patient accidents were the most common problem, followed by mistakes made during treatment and with medication.”
http://news.bbc.co.uk/1/hi/8295417.stm

The worrying insight is that there are many similar reports in the media.

Try this balanced assessment in Saturday’s The Economist of Lansley’s proposals for reforming the NHS

Once more into the ring:
http://www.economist.com/node/16592445?story_id=16592445

What’s so worrying for those of us dependent on NHS healthcare is the number of informed independent commenators who are posting warnings.

Btw for any readers still unfamiliar with the context of my reference above to Mandy-Rice Davies, try this:
http://en.wikipedia.org/wiki/Mandy_Rice-Davies