Will Conservatives u-turn on NHS reforms too?


1:40 pm - December 5th 2010

by Ellie Mae    


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It was back to the drawing board for the Department of Health this week; as party policy extraordinaire Oliver Letwin was brought in to scrutinise Andrew Lansley’s NHS reforms.

Given that Letwin once declared he would ‘give his right arm‘ to send his children to private school, it seems unlikely he’ll take much issue with the looming prospect of privatisation: his concern is more to do with Lansley’s apparent inability to explain how his reforms will be implemented.

Specifically, Letwin is concerned with the intention to hand 80% of NHS funding to GP commissioning consortia, thus obligating GPs to commission care on behalf of their patients, and lifting the fine they currently face if they attempt to mix public and private treatment.

Though seemingly innocuous, this element of Lansley’s reforms is undoubtedly the most controversial – eliciting disconcertingly high levels of criticism since its announcement. The Royal College of Nursing, to name an example, found that 80% of its members opposed the move, not least because it was published without the NHS’s key players or the public being consulted.

The Royal College of General Practitioners expressed similar reservations, claiming to be sceptical that ‘the reforms outlined in [the white paper] will save money, in either the short or the long term.’

And last Wednesday, Dr Laurence Buckman, chair of the General Practitioners’ Committee said that the white paper’s lack of insight could result in unpopular GPs forming substandard practices; observing, curtly, ‘presumably we’ll have a crappy consortium somewhere on Lundy for people that no-one wants.’

Unsurprisingly, however, it was the eventual threat of the Department hemorrhaging money that lead to a review of the reforms. NHS Chief Executive Sir David Nicholson’s warning, last week, that ‘Stalinist’ measures would have to be put into place to control NHS finances was enough for the Tories to wake up and smell the anti-bacterial, and – deus ex machina – along comes Letwin.

It’s funny isn’t it? Just when you think the Tories are wreaking havoc upon our public services out of some kind of aristocratic contempt for the poor, they turn around and prove that it’s actually just good old-fashioned incompetence.

Not that they’d admit to it – in fact, this week the party was insistent that the Lansley’s not for turning, and that the delaying of the bill until January should not be read into whatsoever.

That’s not what insiders at Downing Street are saying though; one admitting: ‘[Lansley] has all the answers when he is asked the questions about how the implementation of all this will work. We are just not sure they are the right ones.’

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About the author
Ellie Mae is an occasional contributor. She is co-editor of New Left Project. She is on Twitter and blogs here.
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Story Filed Under: Blog ,Conservative Party ,Health ,Westminster

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Reader comments


“some kind of aristocratic contempt for the poor”

I love lines like this. Much like in schools, what the Tories are proposing is to extend to the poor the kind of freedom of choice that currently exists only for those who can afford it.

The rich go private, the well off can afford to move home to get closer to the good schools or the good hospitals and the poor are then stuck with what remains. You defend this system and yet you say it’s the Tories who have “contempt for the poor”. You couldn’t make this stuff up.

1.

Richard Littlejohn…?

“Just when you think the Tories are wreaking havoc upon our public services out of some kind of aristocratic contempt for the poor, they turn around and prove that it’s actually just good old-fashioned incompetence. ”

Well, if you will build these strange fantasies in the first place… Seriously, I don’t know why people do this. The more you paint someone as evil, the more powerful a figure you signify them to be (viz Thatcher).

The Thatcher – and New Labour – doctrine is that what matters is outcome performance, not who owns the productive fixed assets or how much taxpayers’ money is spent on subsidies, which is why we had the continuing privatisation programme of state owned industries and services – extending even to air traffic control, where pursuit of the profit motive was supposedly going to lead to civil airliners falling out of the skies.

Does anyone seriously think we should go back to those wonderful times when BT was a state-owned monopoly industry and anyone who wanted a new telephone line had to wait weeks for the privilege – in the “public interest” naturally?

C’mon. Other west European countries do well in terms of healthcare outcomes without having massive state-owned verging-on monopolies supplying medical services.

With 1.3 million employees, the NHS is the largest employer in western Europe: “The full-time occupations with the highest earnings in 2009 were ‘Health professionals’, (median pay of full-time employees of £1,031 a week), followed by ‘Corporate managers’ (£745) and ‘Science and technology professionals’ (£698). The lowest paid of all full-time employees were those in ‘Sales occupations’, at £278 a week.”
http://www.statistics.gov.uk/cci/nugget.asp?id=285

The manifest failings of the NHS have been widely documented of late. Until the New Labour government increased the output of medical school graduates, Britain had one of the lowest ratios of qualified physicians per head of population – France had almost twice as many. For many folks, this is the quality of NHS healthcare as reported:

“The Royal College of GPs (RCGP) is calling for appointments for standard patients to be increased from 10 to 15 minutes so doctors can spend more time with the growing number of people with long-term conditions such as diabetes, cancer and obesity.”
http://www.guardian.co.uk/society/2010/mar/23/gps-consultations-ill-patients

The predictable outcome of the 10 minute appointment regime is that GPs mostly just hand out pills.

“Britons are increasingly turning to prescription drugs to cure every ailment, a new study found. The average number of prescriptions dispensed per person rose from eight a year to more than 16 over the past two decades, according to the paper, titled A Pill for Every Ill.”
http://www.independent.co.uk/life-style/health-and-families/health-news/britain-turning-to-prescription-drugs-1930212.html

4

‘Does anyone seriously think that we should bo back to those wonderful times when BT was a state-owned monopoly industry and anyone who wanted a new telephone line had to wait for weeks for the privilege’
So new technology didn’t have anything to do with the reduction in waiting time for a telephone?

The fact is, Thatcher introduced more intervention into the economy such as the Monopolies Commission and the like. Privatization did not really create a free-market. Private healthcare companies in the UK are constrained and guided by a massive amount of government legislation, and I doubt if anyone would really want a real free-market in healtcare if they were really honest.

1 & 3

The phrase ‘aristocratic contempt for the poor’ was more a reference to the way the Tories are portrayed by their critics than my own opinion – bullingdon club, millionaires in cabinet, sharp elbowed middle classes.

The kindest thing I can say about you is that you are not troubled by the concept of duality of meaning.

(HT Stewart Lee)

@5 “I doubt if anyone would really want a real free-market in healtcare if they were really honest”

Why not? That’s a very sweeping statement. I do think one problem with people’s views on the free market is that they conflate the Thatcher privatisations with actual free-markets. As you rightly point out, with the monopolies commission and all other regulation, these markets are not free. I can see why privatised and regulated healthcare wouldn’t work (mostly because you have all the costs of government intervention but you charged directly for it), but actual free-market healthcare.. that’s a different beast altogether.

There are limits to free markets otherwise we should have let the banks fail? The same limitations apply to healthcare if they were allowed to become a free Market the focus would shift from providing healthcare to providing profits for shareholders? Postcode lottery comes to mind?

@8 “the focus would shift from providing healthcare to providing profits for shareholders”

A fair enough concern, but surely if a company tries to put profit before quality healthcare, people will just choose not to buy from that provider. The one that provides the service people want for a price they can afford will be the profit making one. Remember, we’re talking free market, it wouldn’t be equivalent to the regulated mess that is our electric market (in which the providers do abuse their position).

“Remember, we’re talking free market, it wouldn’t be equivalent to the regulated mess that is our electric market (in which the providers do abuse their position).”

No such thing as a free market. They all abuse their position

11. the a&e charge nurse

[9] “but surely if a company tries to put profit before quality healthcare, people will just choose not to buy from that provider” – yes, I tried a similar line with my bank manager – he told me to fuck off, saying, “there are millions like you”.

I didn’t have much joy with my utilities provider either – nor with the train service when I asked if it was really fair to charge MORE for a train ticket to Newcastle, than a flight from London to Spain?

Apparently it doesn’t take very long for the big boys to gobble up most of the competition until a virtual monopoly exists – as it does with the services previously mentioned.

12. Dark Heart of Toryland

‘Does anyone seriously think we should go back to those wonderful times when BT was a state-owned monopoly industry and anyone who wanted a new telephone line had to wait weeks for the privilege’

Bob B. Have you ever had to have a telephone connected by the wonderfully efficient private sector? I have – and it takes months. Last I moved, just over a year ago, it took two months for the land line to be connected by a certain well-known telephone company, with whom we were tied by a contract, even though there was already a landline in the house. The myth of private sector efficiency is exactly that – a myth. ‘Competition’ does nothing to increase effiency, because the ‘market’ is operated effectively as a cartel. We are certainly not any better off than in the days when BT was a state monopoly. And does anybody really believe that privatisation improved the efficiency of the railways?

Good luck with your so called free market when you get real sick and need a major operation that will require lots of drugs, and further operations down the line.

Your insurance premiums will go through the roof, and if you can’t pay them then you will die. That is what so called free market in health means.

@7: “I do think one problem with people’s views on the free market is that they conflate the Thatcher privatisations with actual free-markets.”

The Thatcher privatisations were almost invariably accompanied by parallel creations of regulatory institutions since the possibility of market abuse by private-sector owned utilities where competition was limited was well-recognised.

There are numerous examples of UK regulatory authorities so created: Ofcom, Ofgem, Ofwat etc and there was no naive assumption in government departments that privatisations equate with free-market capitalism.

After lively professional debates by economists on what forms regulation might take, price increases by privatised utilites in Britain were usually restricted by some such formula as “RPI minus X” – – in contrast to American regulation which was often in the form of restriction on permissible maximum rates of return on capital employed, a rule which can readily promote cost inefficiencies.

There is a huge professional literature on the theory of regulation – eg Baldwin + Caves: Understanding Regulation (OUP 1999)

@13: “Good luck with your so called free market when you get real sick and need a major operation that will require lots of drugs, and further operations down the line.”

Try: “The Netherlands was ranked first in a study comparing the health care systems of the US, Australia, Canada, Great Britain, Germany and New Zealand.”
http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Compare:

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication. The number of alerts relating to errors or ‘near-misses’ in the supply or prescription of medicines has more than doubled in two years, the National Patient Safety Agency said.

“More than 86,000 incidents regarding medication were reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005. The figures, for England and Wales, show that in 96 per cent of cases the incidents caused ‘no or low harm’, but at least 100 were known to have resulted in serious harm or death.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

@12: “Bob B. Have you ever had to have a telephone connected by the wonderfully efficient private sector? I have – and it takes months”

My mobile phone was stolen in a burglary a few months back. I walked into a Carphone Warehouse shop on a local high street and bought a replacement along with a new SIM card. It was effectively instantly connected as soon as I had paid in a top up charge.

Virtually every week, I’m getting leaflets or unsolicited phone calls offering deals on phone + broadband + TV services via cable or landline.

A few years back a phone bill dropped through my letterbox made out in my name at my address but not for my phone number. The phone company were very good when I telephoned them to tell them this was attempted fraud as I knew nothing about this phone number. OTOH the Police didn’t want to know – apparently because there was no fraud since I’d not paid the bill.

“Bob B. Have you ever had to have a telephone connected by the wonderfully efficient private sector?”

Can’t speak for Bob B but I certainly have. Twice. They were very efficient.

Hmmm, because the American “free market” healthcare system is such a big success. I see countries around the world just queueing up to copy that system.

Ellie Mae: “The Royal College of General Practitioners expressed similar reservations, claiming to be sceptical that ‘the reforms outlined in [the white paper] will save money, in either the short or the long term.’”

That’s a valid and important criticism of Lansley’s proposals IMO.

As events are developing in the London borough where I live, the commissioning functions of the current Primary Care Trust (PCT) will be split into two commissioning consortia each of which will serve one or the other of two neighborouring boroughs. It’s not self-eveident that such a split into two commissioning consortia, in place of one previously, will lead to greater cost efficiency.

But PCT had other functions besides treatment commissioning, such as patient liaison and patient complaints. Who or what will take on those functions?

As thing were, GPs could also act as patient advocates in the event of disputes over hospital treatments or permitted drug therapies. Who will take that function on if local GPs nominally control local commissioning consortia?

As things were, questions about particular PCTs could be – and were – put in Parliament. But that won’t be possible when treatments are commissioned by supposedly GP-managed commissioning consortia.

15
Reporting of incidents and near-misses within the NHS has been ‘tightened-up’ over the past few years, especially with regard to ‘near-misses’, therefore, comparing past and present figures does not really tell us very much.
According to the report ‘To Err is Human’, there is an average of 71,000 deaths every year in the US, caused by medical mistakes whilst in hospital, that’s 1 in 500, so using accidental medical deaths to compare the US with the NHS it’s clear that the NHS is better.
But attempting to compare other healthcare systems with the NHS is almost impossible because we are comparing different rather than similar, the best we can do is compare outcomes over time within the NHS, and that is far more complex than number-crunching.
16
It is the same with your example of the stolen phone, such technology did not exist in 1979, you cannot compare the GPO with current telephone companies.

@15 Bob – while I believe I agree with you, I’m sure you would find similar instances of bad practice in a free market healthcare system. Also you can find examples of good practice in the NHS so linking just to a few bas stories doesn’t clinch it for me, and I’m on your side.

On the main comments, there does seem to be more confusion going on about what a free market health system looks like. From what I’ve ever read (and feel free to correct me, I’m no expert) American healthcare is corporatist system, rather than free market. The high cost of regulation (often lobbied for by the big companies, and agreed to by government) keeps competition suppressed, leaving them with both the inefficiency of a near-monopoly system and the abuse of profit seeking.

There are no real examples of a truly free market healthcare system in the western world, and there is a good reason for this. It’s a risky policy. Most countries have got health systems that, although far from perfect (whatever that would look like), pretty much do the trick. Because the free market is unproven, no politician has got it in them to take the fight to the vested interests to overhaul a health system with one that you’re not sure exactly what would happen.

This isn’t an argument that’s going to go away though, and as healthcare costs continue to rise, someone, somewhere may well take the plunge and see if the free market can deliver what it promises.

“The kindest thing I can say about you is that you are not troubled by the concept of duality of meaning.”

That phrase is usually used to indicate a quite particular concept (ie, it does not just mean “a thing/word/concept with more than one meaning”), and it’s not immediately obvious how it applies to my comment.

@20: “It is the same with your example of the stolen phone, such technology did not exist in 1979, you cannot compare the GPO with current telephone companies.”

I can certainly compare the awful quality of service BT customers got when it was a state-owned monopoly through the 1970s.

Now, I choose to be a BT customer for telephone services – despite a higher cost – because I reckon it is a more reliable provider, especially if something goes wrong. That rarely happens but sometimes the telephone service does fail.

Competition is an effective means of promoting the interests of customers whereas monopolies, whether state-owned or in the private sector, protect the interests of the suppliers.

@21: “Also you can find examples of good practice in the NHS so linking just to a few bas stories doesn’t clinch it for me, and I’m on your side.”

The failings at the Mid Stafforshire NHS Hospital trust carried on for years – hundreds of patients there are estimated to have died prematurely as a result.

In a recent study of the care of the elderly in NHS hospitals, only just over third were judged to have had good treatment:
http://www.bbc.co.uk/news/health-11728163

These were not small scale glitches in an otherwise well-functioning national system of healthcare.

For decades – yes, decades – we have been fed the propaganda line that the American ways of healthcare are the only feasible alternative to the NHS. The successful healthcare systems of other west European countries demonstrate that is not so.

Instead of discussing these grand notions of socialised healthcare verus free market healthcare, IMO it would be a great deal more illuminating to focus on potential glitches in the treatment commissioning structures which are likely to supercede the Primary Care Trusts as the result of Lansley’s proposed reforms – which is what I attempted @19.

Btw if it’s suggested by NHS practitioners that I could be prescribed some new drug, one of the very first things I do is to check what the US Federal Drug Administration (FDA) has to say about it. Just this year, that led me to say: Absolutely not. The American healthcare system is not entirely “free market” although some libertarian zealots want to abolish the FDA.

Most healthcare systems in Western Europe have been consistantly better funded over decades. So comparing our system with theirs is rather like comparing apples with oranges.

It’s impossible to say how well the French system would perform if it had had UK levels of investment. Or how well the NHS would perform if it had French levels of investment.

By a lot of measures the NHS is one of the most cost efficient healthcare systems. If you look at this for instance. http://en.wikipedia.org/wiki/Health_care_compared#Cross-country_comparisons

The UK has one of the lowest levels of GDP spent on healthcare (about half what is spent in the US) yet has better outcomes than the US system, and not substantially worse than the French.

News update:

“The Coalition Governments NHS reforms to scrap ALL NHS Primary Care Trusts and replaced by competing GP Consortia’s to directly manage the £85 billion budget for patient treatment commissioning, looks set to be heading for a complete disaster on the scale of the last Labour governments GP Contracts disaster, as GP Consortia’s are being formed across the land on the basis of avoiding competition with one another. . . ”
http://www.marketoracle.co.uk/Article24781.html

“Most healthcare systems in Western Europe have been consistantly better funded over decades. So comparing our system with theirs is rather like comparing apples with oranges. . . ”

First, the facts from OECD as best as I can dig out from currently accessible sources:

Health expenditure as a share of GDP, OECD countries, 2008
http://www.oecd.org/dataoecd/45/55/38979836.pdf

Secondly, the trouble with the usual excuses about the under-funding of the NHS is the evidence of falling productivity in the NHS as its funding was increased as well as the evidence of shambolic administration, some public evidence, some personal:

“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.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

The chief executive of St Helier Hospital has called for a crackdown on nurses accessing Facebook at work after a complaint they have been ignoring patients because of it.

Sam Jones told the hospital’s IT team to stop staff logging on to the social networking site a fter an allegation nurses were checking their profiles rather than helping vulnerable patients at meal times.

The complaint was made to MP Tom Brake by one of his constituents.

A spokesman for Epsom and St Helier University Hospitals NHS Trust confirmed Facebook had been blocked from trust computers for at least two years, but conceded staff may have found ways to get round the ban.
http://www.yourlocalguardian.co.uk/news/local/suttonnews/8381082.Nurses_told_not_to_Facebook_at_work/

This can’t be explained away by under-funding of the NHS:

“Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.

“Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East. The Diabetes UK charity says the majority could be prevented.”
http://www.bbc.co.uk/news/health-11832233

“A report from the Organisation for Economic Co-operation and Development concluded that improving efficiency could do more to raise life expectancy than simply spending extra money.

“It found the NHS paid higher salaries but employed fewer doctors and that inefficiencies contributed to a lowering of life expectancy in the UK by two and a half years for women and three and a half years for men.

“Cutting waste is therefore more important for wealthy countries in the current economic climate than spending more, it said.”
http://www.telegraph.co.uk/health/healthnews/8169516/NHS-waste-taking-three-years-off-Britons-lives-research-suggests.html

The NHS was created when the notion of state-owned monopoly suppliers of services was highly fashionable in Britain but much less so in most of western Europe.

It really is time to move the debate on IMO and discuss the downsides of Lansley’s proposed abolition of the Primary Care Trusts instead of lamenting the passing of Britain’s Stalinist model for healthcare services.

@BobB

Multiple postings look like you’re raving. Get your thought in order and be brief, for all our sakes!

“Multiple postings look like you’re raving. Get your thought in order and be brief, for all our sakes!”

The separate postings are for different issues and because of the limit on links in each post.

The issues are complex and I have to deal with the problem of repeated denials of the documented evidence of NHS failings by NHS propagandists. There is no point in sinking more money into the NHS if it is to be absorbed in lower productivity, in even higher salaries and waste.

I’m waiting for a discussion here about the downsides of Lansley’s proposal to abolish the Primary Care Trusts – I attempted a start @19.

Ellie Mae

Oliver Letwin was right to say that he’d give his right arm to avoid sending his child to a Lambeth secondary school. His view is shared by many (perhaps most) parents of school age children in Lambeth.

The reason is that Lambeth schools are so crap that to send your children to one when you didn’t have to would be close to deliberate child abuse.

This is not because Lambeth pupils are poor learners. Indeed, Lambeth has four of the best primaries in the country (though these are good because they keep Lambeth Council at arms length by being faith or foundation schools.)

Equally, there are many people who would give their right arm to be able to send a loved one to a private/doctor or hospital rather than force them to suffer the miseries and indignities visited upon so many patients by the NHS.

Labour’s position is always to deny hope. Everyone must be forced to accept the third rate services that the state provides. Lots of people resent this mean-spiritedness. They want to be able to make sacrifices to help the ones they love. Perhaps by forgoing a foreign holiday they could send their child to a better school. Or maybe by spending what they currently spend on beer on private insurance they could escape the state straitjacket. Millions yearn for these opportunities. Labour will never be truly electable again for as long as it continues to rob ordinary people of any hope.

Sorry Bob B but quoting a stream of cherry picked anecdotes about how terrible the NHS is isn’t going to convince anybody. You could find examples of those things in any country’s healthcare system.

I could just as easily find a load of positive anecdotes to ‘prove’ that the NHS is great.

I don’t think you need any particular ideological preconceptions to have noticed that GPs are not trained to work as procurement managers.

So the consequence of Mr Lansley’s proposals will be either:

a. GPs’ consortia use part of their budget to hire professional procurement managers, so that the NHS has more managerial staff than ever; or

b. Poorer quality decisions will be made.

“I don’t think you need any particular ideological preconceptions to have noticed that GPs are not trained to work as procurement managers.”

Very good point. Who wants Harold Shipman running the NHS?

The point of all this is to move accountability from lazy, good for nothing ministers, and onto poor untrained doctors. If it all goes tits up the medical people will be blamed.

35. Flowerpower

GPs are not trained to work as procurement managers.

The whole problem with the left’s bureaucratic approach is encapsulated here.

Medical care is not the kind of service that can or should be purchased by procurement managers.

The decision about which specialist a GP should send a patient to, or which hospital would be best for that patient’s particular mix of symptoms is not something to be delegated to a bean counter.

“Medical care is not the kind of service that can or should be purchased by procurement managers.”

Funny, usually it’s the Left that’s accused of idealistic naïveté …

Unless the Government decides to hand out blank cheques, the consortia will be subject to the same financial constraints as anyone else. Which means the people who run them need to know about budgeting and returns on investment and financial risk. They’ll need to be able to negotiate with people like AstraZeneca and Pfizer, who you can be sure have some heavy-duty beancounters of their own.

Do you think GPs receive training in any of this at medical school? And do you think there may be a reason why a CIMA or an ACA require several years of postgraduate study?

37. Flowerpower

@ 36 Ricardus

For most of one of my forebears time as a GP, he was free to send his patients to any specialist he chose. One of the criteria he would sometimes use was that he had been at medical school with specialist concerned. Today that would be denounced as cronyism and doctors would be told that bureaucrats had already “commissioned services” along the “rational” and “objective” lines you describe.

The funny thing is that the old, informal and friendship based lines of referral actually worked rather well. GPs would know the specialist personally – either as a colleague or a golf partner – and patients would be greatly reassured that the person looking after them was an old mate of their family doctor.

The new systems have proved in many cases more expensive and clinically less effective than the traditional system.

Actually, a blank chequebook, together with indicative tarrifs, could well be the answer.

The thing is, it’s not that I’m positively in favour of rational and objective bureaucratic financial management, it’s more that I see that approach as an inevitable consequence of having a fixed budget to work with.

And I’m all in favour of giving GPs more influence over the way funds are spent – it’s just that making them responsible for 80% of the NHS’s budget, when they haven’t received training in any kind of financial management, seems irresponsible.

@38: “And I’m all in favour of giving GPs more influence over the way funds are spent – it’s just that making them responsible for 80% of the NHS’s budget, when they haven’t received training in any kind of financial management, seems irresponsible.”

What is happening in my Primary Care Trust area is that we are heading towards one GP managed commissioning consortium for the practices in the borough where I live and another, separate GP managed consortium for the neighbouring borough which used to be served by the same PCT. Two commissioning organisations will take the place of one.

One obvious question is whether this split in commissioning will enhance or reduce cost efficiency for the same function? Another is whether public accountability will be diminished since questions about particular PCT could be – and were sometimes – raised in Parliament? I seriously doubt whether it will be possible to table PQs about a GP managed commissioning consortium.

The PCT had other functions besides commissioning work, including oversight of their patches, patient liaison and dealing with patient complaints. What will happen with those functions when the new commissioning bodies are GP managed.

The PCTs for the South West collated the data showing “the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East. The Diabetes UK charity says the majority could be prevented.”
http://www.bbc.co.uk/news/health-11832233

Will that still be possible with commissioning decisions made by GP managed consortia? Will the new consortia undertake the monitoring of treatments and treatment outcomes in the way that the PCTs did? And who will pay for the monitoring costs?

What will happen if a GP managed commissioning consortium runs up a deficit?

IMO we need answers to these crucial questions before we can confidently endorse Lansley’s proposed abolition of the PCTs.

bob b do you know angela evans? because you sound like her..the free market delivers better than socialistic stalinist state controlled monopolies….utter bollocks ..
i tell you what the free market delivers..more and more of the same with no regard to where it is or what an area really needs….i saw this happen in microcosm where i used to live..an area about 2 mile square…the high suddenly had a fast food outlet, mostly to cater for pub refugees on their way home, within weeks another one opened up presumably to get on the bandwagon…having seen two fast food oultlets created the perception that this was popular so another opened up..so now 3, but wait another followed by another and so on till we had 12 of them all in a very small area..the problem was that the area had very elderly population who didnt eat that junk food..and rather wanted things like coats and gloves for the winter months but no no no that wasnt popular it had to be fast food or nothing..now these elderly people not being car owners had to rely on ‘public’ transport in reality a newly privatised bus system who made money by reducing cost by cutting maintenance work on the buses and increased driver hours. Before long one after another we were seeing buses careering and skidding off the road crashing into shops, houses,trees endangering those elderly passengers lives..the free market is a myth it does not provide choice .just more or the same with little regard to anyone except itself…health care should not be a product in a market, because it isn’t..its a service, and should remain so. if i’m involved in a road accident i dont go shopping around for my ambulance ‘products’..when did the adam smith school of life decide to pop onto here?

correction helen evans…

@40

– I’ve not the foggiest who Helen Evans is.

– “..the free market delivers better than socialistic stalinist state controlled monopolies”: I’ve persistently argued for years that (a) we don’t have “free markets” – except, perhaps, in the middle of jungles or deserts where there is no rule of laws and regulations, (b) so-called free markets are NOT inherently desirable because of the many (widely recognised) reasons for market failure.

OTOH few evidently believe that the peformance outcomes of Stalinist state-owned monopolies are to be preferred over the outcomes from competing suppliers where consumers have the opportunity of choice.

The better outcomes from healthcare systems in other west European countries is evidence that there are feasible alternatives to the American healthcare system.

The extensive documented evidence of systemic failings in Britain’s NHS is hardly a persuasive advertisement for the superior benefits of a state-owned and controlled monopoly for providing healthcare services.

IMO the whole discussion about state-monopoly v free market supply of healthcare is just ignorant and silly.

Far more timely and relevant here are the foreseeable issues arising from the proposed abolition of the Primary Care Trusts – which I attempted @39.

@bob b so whats the answer then? let healthcare be no more than a product like a tin of beans..and treat it as such..? during the us healthcare reforms the tea party were kicking up a fuss..i was online to some of them..all i kept hearing was two thing..(1) us govt shouldnt poke its nose into how consumers make choices
(2) why should someone have to pay for anothers healthcare

the right seem to consider healthcare is a product using a one way piggy bank finance system where they pay money to health insurance company
who in return promise to give nothing back..(they dont promise they just lie.and deny you your own money to pay for thousands medical conditions they judge unworthy..) its robbery really..

so how does a healthcare system run on behalf on the public and how you fund it? avoiding those (medical equipment, drug companies) who use it to make money from (including property developers)

btw helen evans is a doctor and head of nurses for reform…an adam smithite pro market think tank…

@43: “@bob b so whats the answer then? let healthcare be no more than a product like a tin of beans..and treat it as such..?”

What a silly question! Healthcare services are extensively regulated in virtually all countries with developed economies. The pervasive and persisting presence of asymmetric knowledge as between customer (patient) and healthcare provider is widely recognised.

The credit for first implementing a national insurance scheme for healthcare costs goes not to Britain for creating the NHS in 1948 but to Count Otto von Bismarck, first Chancellor of the German Empire.

“The Health Insurance bill . . was passed in 1883. The program was considered the least important from Bismarck’s point of view, and the least politically troublesome. The program was established to provide health care for the largest segment of the German workers. The health service was established on a local basis, with the cost divided between employers and the employed. The employers contributed 1/3rd, while the workers contributed 2/3rds . The minimum payments for medical treatment and Sick Pay for up to 13 weeks were legally fixed.”
http://en.wikipedia.org/wiki/Otto_von_Bismarck

Whatever else, Count Bismarck had no socialist inclinations whatever. Quite the opposite, in fact.

The Civitas website has a collection of briefs on a selection of current national healthcare systems in other countries, including France, the Netherlands and the US:
http://www.civitas.org.uk/nhs/health_systems.php

@Bob B

The extensive documented evidence of systemic failings in Britain’s NHS is hardly a persuasive advertisement for the superior benefits of a state-owned and controlled monopoly for providing healthcare services.

Really!! An independent survey conducted in 2004 found that users of the NHS generally expressed very high levels satisfaction about their personal experience of the medical services they received: 92% of hospital in-patients, 87% of GP users, 87% of hospital outpatients, and 70% of Accident and Emergency department users.

http://www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/Classesofinformation/Communicationsresearch/DH_4129933?IdcService=GET_FILE&dID=16549&Rendition=Web

Admittedly this was six years ago. But I doubt too much has changed.

46. alienfromzog

Bob B

You’ve very boring.

On a similar thread it was explained to you why simplistic analysis of falling productivity in the NHS is completely flawed and yet you go on and on and on and on about it. And once again you use sensationalised anecdotal stories in the place of evidence.

I repeat as I said before, it is not that you’re so-called NHS-apologist are blind to its failings. I can list them. Its that people like you are completely blind to its successes and have this totally ridiculous notion that simply abolishing it would solve all the problems.

AFZ

@bob b civitas i remember them, another adam smithite think tank who came up with some very doubtful numbers concluding ‘ most people think the NHS is appalling and should be scrapped’ they make this shit up you know….

Of course I’m boring – personal abuse is the preferred tactic of those who have no coherent responses to the documented systemic failings of the NHS – in the treatment of the elderly, for example, or how the horrific abuses at the Mid Staffordshire Hospital Trust could continue for years. I was also called boring and senile c. 10 years back when I kept posting then in web forums that Britain should keep well away from joining the Euro.

I’m totally unsurprised that a 6 year-old survey conducted by the Department of Health could come up with that amazing finding that the NHS is wonderful. Nine years ago my local hospital trust was officially named by the government’s health improvement commission as the worst hospital in the country – press reports about that are still on the web.

While I was on private convalescence recently recovering from NHS surgery, I guy complete with zimmer frame came to sit at the same dining table. He had had surgery in a single operation for double hip replacements – not something I’d like to endure. Another interesting difference is that his surgery had been done at a private hospital but paid for by the NHS although he didn’t know why. Gradually extending that model is feasible. Private sector hospitals are asking for more NHS work.

49. the a&e charge nurse

[48] “Another interesting difference is that his surgery had been done at a private hospital but paid for by the NHS” – I hope he does better than some of these patients?

“People having hip replacements at private treatment centres brought in to cut waiting times are up to 20 times more likely to need painful and expensive repair work. Many operations are having to be redone in NHS hospitals, at great cost and with serious staffing implications for the health service.
A study by orthopaedic surgeons in Cardiff found that of 113 hip operations on patients sent from their NHS trust to Weston-super-Mare NHS Treatment Centre between 2004 and 2006, two thirds showed clear evidence of poor surgical technique, such as poor cementing of the hip.
In the three years since the operation, 18 per cent had undergone revision or were awaiting an operation — 20 times the 0.9 per cent NHS-wide revision rate at three years. A study on knee operations at the unit, conducted earlier this year, recorded a tenfold increase in revision rates”.
http://www.timesonline.co.uk/tol/life_and_style/health/article6843637.ece

Still at least they can be comforted by the fact they were not failed by the world’s 3rd largest employer?

After 7 days in an NHS hospital I arrived at a private convalescence home with bed sores – but to all appearances so far the surgery was fine. The convalescence home took immediate remedial measures for the bed sores – air mattress and ointment, which together brought quick relief.

While in the NHS hospital ward awaiting discharge a patient came into the post-recovery ward where I was who had had his third (three) hip replacement operation in the course of just 6 months – the story he was told was that there was a manufacturing fault in his previous artificial hip and metal surfaces were fragmenting.

Curiously, my very supportive and encouraging personal friends who had experience of hip replacement surgery – or a knee replacement, in one case – had private healthcare insurance and they all elected to have their operations done privately resulting in complete success – which is why they were so encouraging. Btw several seem to have had the widely respected senior surgeon who also does NHS surgery in this region.

I don’t have private healthcare insurance but I now understand why my friends do.

The survey wasn’t conducted by the Ministry of Health, it was conducted by the independent polling organisation MORI on behalf of the Ministry of Health.

@bob b thanks for that, for providing us with another example of double standards, on one hand rubbishing public services, whilst on the other more than happy to profit by it, take for example all the companies lining up at tory fund raising bashes. oiling palms in order to get high paying govt contracts . after all it serves two purposes (1) tory mps bored out of their wits having to deal with messy public services which they hate anyway, (2) gives them less to do freeing them up to run businesses or on board of directorships of companies, after all being an mp is just one step up to the business world. and thers all that nice lobbying money to play with.
then theres the mickey mouse companies, the companies that you have to invent just to get those contracts.then having got those contracts screw up as they havent got a clue as they are useless…as the words public service is an alien concept to them…nope free market economy=chaos and instability which goes against what people really need .

@52:

That amounts to an incoherent rant – try taking medication.

All this grand fantasy stuff about socialist v free market healthcare is childish and irrelevant.

Other west European countries have fully functioning national healthcare systems without state owned and controlled near-monopoly providers of healthcare services.

By several independent assessments, some of these systems were judged to produce better outcomes for patients than the NHS – try: “The Netherlands was ranked first in a study comparing the health care systems of the US, Australia, Canada, Great Britain, Germany and New Zealand.”
http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

In the real world context, what will matter are the downstream consequences of current proposals to abolish the Primary Care Trusts.

@ bob b incoherent rant? as much as a rant when maggie thatcher tried to flog off the NHS like some 2nd car salesman, only to be stopped bu edwina curries words of advice that she would be lynched…maggie was egged on to do it by neil hamilton and his no turning back group..in a tv interview he envisaged ‘profit centres’ at every hospital…sound advice from a corrupt politician who got found out getting bungs re cash for questions expose..
point is flogging off NHS and without public debate or indeed with consent strikes me as being anti democratic..old fashioned as that may sound to you..

55. the a&e charge nurse

[50] a friend’s daughter has just been diagnosed with type I diabetes – the child was called to the hospital the same day abnormal lab results were reported, seen by a paediatric consultant, endocrinologist, psychologist and she will not be able to return to school until teaching staff have been briefed by a nurse specialist.
Her mother cannot praise the NHS highly enough.

Where does anecdote tennis get us?

56. alienfromzog

Oh Bob, that was so far from a personal attack.

You’re boring not because there is no response to your posts. As I said, you blithely ignored the facts as to why your simplistic statements about productivity are misleading. That’s why you’re boring – you continually state your views but never engage with the criticisms. As many have noted anecdotal incidents are not especially helpful to the debate and yet whenever challenge you revert back to anecdote. That’s why you’re boring.

Yesterday, a patient of mine who was going home following complex thoracic surgery, spent time thanking every member of staff for the excellent care he’s received. He’s the second patient I’ve seen this week who wanted to shake everybody’s hand and say thank you.

How does that help the debate at all?

(http://liberalconspiracy.org/2010/11/29/does-the-british-media-hate-the-nhs/#comment-204554 – link to Richard Blogger’s detailed explanation of measurement of NHS productivity)

AFZ

For late readers here, try this interview of Lansley in Wednesday’s FT:

Lansley to press on with NHS reform
http://www.ft.com/cms/s/0/4b315f6c-0233-11e0-aa40-00144feabdc0.html#axzz17X3wWaH1

A clutch of official papers about forming GP-managed treatment commissioning consortia and the abolition of Primary Care Trusts by 2013 are to appear shortly.

“You’re boring not because there is no response to your posts. As I said, you blithely ignored the facts as to why your simplistic statements about productivity are misleading.”

The quoted statements about falling NHS productivity came from the Office of National Statistics.

@bob b its all about the money and production with you …anyone would think the NHS is a factory producing commercial products…no one can guarantee long life and no pain..public or private..what pisses me off is that private sector claims it can ……………for a price..but only gives you more misery by ripping you off and handing you no hope….

@bob b ” For late readers here, try this interview of Lansley in Wednesday’s FT:

Lansley to press on with NHS reform
http://www.ft.com/cms/s/0/4b315f6c-0233-11e0-aa40-00144feabdc0.html#axzz17X3wWaH1

That link you posted took me to FT.com ( financial times ) of which wanted me to register at some cost..so NO THANKS for that!!!!!!!!!!!! also why am i meant to read some crap on a site that only dribbles on about the profits of companies and telling what shares to buy..why does FT think it has an opinion on a major public service in this country…

think it tells us a bit more about you……

bob b…sorry but you suffer (like most tories) from head/arse syndrome..

why arent you on the adam smith institute arse licking site saying ‘hear hear’…
its about time the air got privatised..all that resource going to waste think of ht money that can be made from that….


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