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Could the NHS become the Conservative Achilles heel?


9:05 am - December 21st 2010

by Sunny Hundal    


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Most of the media will concentrate on Vince Cable’s usage of the phrase “nuclear option” in the Telegraph sting, and speculate whether he is now endangered. But I think this is the important bit:

There is a kind of Maoist revolution happening in a lot of areas like the Health Service, local government, reform, all this kind of stuff, which is in danger of getting out of… We are trying to do too many things, actually. Some of them are Lib Dem inspired, but a lot of it is Tory inspired. Actually, the problem is not that they are Tory-inspired, but that they haven’t thought them through. We should be putting a brake on it.

Tory led plans on the NHS that haven’t been thought through? Why yes, we’ve been saying that for months. Glad Mr Cable agrees.

Coincidentally, the Telegraph also publishes this provocatively titled article by Mary Riddell today: The NHS warning signs that should horrify David Cameron:

Short of reintroducing smallpox into the UK, Mr Lansley could not have formulated a less popular scheme. The British Medical Association and the Royal College of GPs are among those who have registered their alarm. Even those who support the structural changes warn that setting up GP “consortiums” will be an expensive and highly risky distraction from finding huge and necessary savings.

Mr Lansley’s claim that his programme is a modest evolution has been demolished by the NHS chief executive, Sir David Nicholson, who declares the change programme “so large that you can see it from outer space”. Any Martian with a long-range political telescope might also detect a looming crisis for David Cameron.

Forget about the Libdems, the key challenge for Labour and the Left will be to find ways to track what is going on within the NHS, how that is affecting services and explain why the Conservatives are to blame.

That would hurt Conservative support much harder than Libdem support.

But this is easier said than done. Will there be any big signatures issues put to the vote? Is it possible to mobilise hundreds of thousands of people on to the streets, if they’re not sure how their services have been affected? What key flashpoints would there be that can be used to generate energy? Is any direct action possible?

Is it even possible to have a nationwide campaign on the NHS? Would it be better to focus on local campaigning here? And more importantly, how do we better speak to middle class voters who would be key to this issue (i.e. the users, not just the workers)?

I’m just throwing questions and thoughts out there. I’m not sure Labour has been able to significantly break through in the national debate on the NHS.

Tuition fees has so far been the only major issue to get the whole nation talking. How can we make the NHS the next big topic?

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About the author
Sunny Hundal is editor of LC. Also: on Twitter, at Pickled Politics and Guardian CIF.
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Reader comments


Quality of service will be the blue touchpaper. Already the waiting times are detiorarting and the winter pressures are exacerbating the problems. The preparations for this winter have been woeful and the non-fillling of vacancies have put the screeching brakes on nearly ten years of steady improvements.

Abolition of SHAs and PCTs will centralise resource allocations to Whitehall especially as GPs have neither the will nor the ability to deal with the high-cost packages of treatment. And the drug companies are poised to squeeze these budgets with smart marketing.

Labour should focus on monitoring the quality using the voices of patients, staff and local health support groups- as NHS is being prepared for the slaughter by a Tory-led government.

It’s true that waiting times are increasing. It seems to have happened after Lansley indicated that he would not be paying any attention to the 18 week target for some ooperations.

see here http://braveheart-braveheartsblog.blogspot.com/2010/12/hospital-waiting-lists-soar.html

Well it’s about bloody time.

Could the NHS become the Conservative Achilles heel? erm hasn’t it always been? Though I admit that being glib, as I was, isn’t going to get the people on the streets.

People are starting to talk about the NHS, and not just because of Dr Cable. Waiting times have increased, fairly or unfairly Lansley is getting stick on swine flu (showing that though the r-wing tabs profess to hate the nanny state they get in just as much of a tizz over perceived inaction.) and it’s becoming clear that Cameron’s guarantees are meaningless due to other policies impacts on the NHS.

There would always be a time-lag on the NHS becoming an issue as it’s all very well numerous people warning that patient care will suffer and that funding is actually being cut but those who don’t have a political view give the benefit of the doubt to the govt. until they have a bad direct experience. (or an example of one is all over the papers.) If Lansley’s reforms are one tenth as chaotic as everyone seems to think, what with health cost inflation, demographic pressures and cuts to huge services that decrease the burden on the NHS, then patient care will decline. Then Cameron’s NHS pledges may well come back to haunt him like Nick Clegg’s on tuiton fees.

The problem is that it’s difficult for Labour to get a campaign angle on it.

The Tories have chosen a reform which is good for presention but daft for implementation. How do you explain to people that their GP shouldn’t be the person in charge and that a faceless beaurocracy called the PCT should be in charge. Not an easy sell.

The key to the NHS is that it can sap support for the government, not that it can trigger revolution.

The best way to use the NHS against the Tories and Lib Dems is to be investigative and keep the press well informed of the problems being inflicted.

People have got used to a background of gradual improvement in the NHS. Significant specific problems made the papers over the last ten years, but the sense of decline and decay was reversed as more people were treated quickly and successfully.

The changes being proposed are likely to reverse that again. And it will be a quick reversal.

So making sure the human interest stories get out there, and the sense of government failure and uncaring is established – is the main priority. GPs and nurses will no doubt have plenty to say, but the real power lays with patients and with making sure the public know how they suffer.

It very much depends on whether Labour, and those outside the party who oppose the Coalition, can present a viable alternative. It should be a no-brainer that the Tories will be on the back foot when it comes to the NHS, but I agree with some of the posts above…. the devil will be in the detail, in ensuring that people know how the NHS will be affected by these plans.

It is already evident that many within the LD’s are unhappy about the half-baked approach taken by the Coalition on a range of policy issues; the question is, can that be translated into measures to combat the proposed changes?

9. the a&e charge nurse

[1] “Quality of service will be the blue touchpaper” – NuLabour’s infatuation with the market contributed in no small measure to the scandal that hit North Staffordfordshire.

The official report makes for grim reading – “In the trust’s drive to become a foundation trust, it appears to have lost sight of its real priorities. The trust was galvanised into radical action by the imperative to save money and did not properly consider the effect of reductions in staff on the quality of care. It took a decision to significantly reduce staff without adequately assessing the consequences. Its strategic focus was on financial and business matters at a time when the quality of care of its patients admitted as emergencies was well below acceptable standards [p11].
http://www.cqc.org.uk/_db/_documents/Investigation_into_Mid_Staffordshire_NHS_Foundation_Trust.pdf

So we had, a sexy new Foundation Trust, the epitome of the NuLab mind set, with a “strategic focus was on financial and business matter” – surely, if the marketeers were to be believed this could only be a win-win situation?

Sadly not – hundreds may have died unnecessarily and many more certainly received appalling care – not least because of the NHS’s ferocious reputation for abusing whistle blowers.
http://www.socialservicehell.org/index.php/news/159-tenfold-rise-in-whistleblower-cases-taken-to-tribunal

Still the coalition are hell bent on plowing on with same madness – a situation that persists primarily because recent generations of health reformers have won the propaganda war on language and semantics.
The project of COVERT PRIVATISATION can be called anything but that, and the poor old patient (and in fact half the NHS workforce) won’t realise what is happening until the day comes when a GP or hospital consultant says that will be £50, £500 or £5,000 please …….. next.

The students (and others) were finally galvanised by charges (£9,000 tuition fees) a development that woke everybody up the insidious nature of burdening young people with more and more debt (another Tony Blair brainchild) – health awaits a similar epiphany on it’s painful road to Damascus?

Recent news clips reflecting the realities of ministerial competence:

“Across swathes of the country, patients waiting for the most common types of surgery, including hip and knee replacements, and cataract operations, will now be forced to wait months longer for treatment.

“Patients’ groups described the decisions as ‘desperate’, warning that thousands of people, especially the elderly, will be left to suffer in pain this winter as their conditions deteriorate.”
http://www.telegraph.co.uk/health/healthnews/8181390/Patients-denied-hip-surgery-and-fertility-treatment-amid-NHS-cash-crisis.html

Hundreds of thousands of NHS patients are being denied routine procedures as dozens of trusts cut back on surgery, scans and other treatments in order to save money, a Daily Telegraph investigation has found.
http://www.telegraph.co.uk/health/healthnews/8208958/Patients-denied-treatment-as-NHS-makes-cutbacks-Telegraph-can-disclose.html

MPs issue warning over NHS spending plans

A group of MPs has warned that government spending plans in England will test the NHS and social services to the limit. The cross-party health select committee says the plans assume efficiency savings never seen before in the NHS or in any health service anywhere in the world.
http://www.bbc.co.uk/news/uk-11988856

No country in the world has achieved the levels of efficiency savings now being demanded of the National Health Service, a cross-party committee of MPs warned on Monday.
http://www.ft.com/cms/s/0/9594ac58-06de-11e0-8c29-00144feabdc0.html#axzz184Vkh1pE

The biggest problem faced by opponents to cuts is picking their battles, and getting their message across. The coalition is winning the PR war hands down, because it’s far easier, and a far clearer message, to pretend the argument is a black and whit one of cuts vs no cuts, when almost all sides agree there needs to be cuts at some level, and just disagree on where and how much.

However, there is now a real opportunity to show that the coalition are driven, at least in part, by ideology rather than neccessity, by tackling the issue of NHS pay. Cameron has suggested that NHS workers must take a second real terms pay cut, by agreeing to waive their yearly incremental increases for two years, a measure which will supposedly save £1.9bn pounds a year. Yet they are, at the same time, continuing the path to implementing a massive reorganisation of the way NHS services are commissioned, which you could say at best is completely untried and untested, and at worst you could say has already been tried and failed spectacualrly when it was a similar scheme in the guise of GP fundholding. Yet this scheme will likely cost more than £3bn. How can this government possibly claim that these cuts are due to the deficit in these circumstances?

@9
the a&e charge nurse

The other massive issue with the white paper is highlighted by your example there. Currently there is a major amount of scrutiny required to become a Foundation trust, and as we can see from your example, it failed miserably in the case of North Staffs. However, the new white paper is going to remove massive swathes of the scrutiny that already exists, while at the same time requiring that ALL hospitals either become Foundations trusts, either individually or by merging with other hospitals. Given how badly run some trusts are with the more prescriptive standard NHS regime, giving them the extra freedoms provided by Foundation trust status is a recipe for disaster.

13. the a&e charge nurse

[11] oh, it goes beyond a pay freeze?
http://www.nursingtimes.net/story.aspx?storycode=5023035&PageNo=2&SortOrder=dateadded&PageSize=20

Staff are now being asked to work for free to clear up the mess left by the managers – of course nurses have always worked for free to the tune of around 7 hours per week.
http://news.bbc.co.uk/1/hi/health/2395659.stm

@11: “The coalition is winning the PR war hands down”

ROFL!

News about the NHS in the Telegraph, the FT and on the BBC website? C’mon.

Hannan sticks his oar in
http://blogs.telegraph.co.uk/news/danielhannan/100069192/are-voters-ready-for-radical-reform-of-the-nhs/

But we already know what he thinks of the NHS.

16. the a&e charge nurse

[15] Hannan says “if we absolutely must have a state monopoly in healthcare, it at least makes sense to devolve decision-making from central bureaucracies to local clinicians” – ahhh, doesn’t that bit of Danny-speak sound lovely – so why do many of our GPs fear the ‘consortia’ model?

Well 70% of GPs felt the DoH was simply trying to ‘pass the buck’ by handing them a commissioning role.
http://www.gponline.com/News/article/1017168/GP-anger-forced-consortia/

And if GPs are busy ruminating over £80billion health pounds – how many of them will be left to look after the poor old patient, eh?
Of course none of the GPs will be conflicted once they are responsible for both commissioning and provision of health care?

Hannan is an ideologue who never troubles himself too much with the evidence.

@6. dan mccurry

The problem is that it’s difficult for Labour to get a campaign angle on it.

The Tories have chosen a reform which is good for presention but daft for implementation. How do you explain to people that their GP shouldn’t be the person in charge and that a faceless beaurocracy called the PCT should be in charge. Not an easy sell.

Yup. I have given several public speeches over the last couple of months about the Tory NHS plans and the first thing I have to do is explain what commissioning is. That hardly makes for a tub thumping speech!

Actually, there is another campaign angle which I have been banging on about for a year and that is: hospitals.

Lansley has kept quite quiet about them, and the Press has said little because the Department of Health spin doctors have deliberately steered the agenda towards GP commissioning (as you say, who can argue against your GP determining what is best healthcare for you?)

Lansley’s plan is to take all hospitals out of public ownership. Few people want this. Most of the public want our NHS hospitals to be owned by the NHS, but Lansley wants to wipe his hands off the responsibility for providing hospitals and to pocket the cash when they are sold off (as so-called “social enterprises”).

The response to the White Paper consultation has rowed back a little from the white paper (which said that hospitals should be “employee-led social enterprises”) to suggest instead that “services in a hospital should be provided by social enterprises”. In other words, individual wards and departments sold off rather than the entire hospital.

In my opinion, this is the place to start. This is the campaign point: keep our NHS hospitals public!

The California Nurses Association/National Nurses Organizing Committee was very good at getting US issues raised, do UK nursing staff need a more radical/lobbying org than exists now, in terms of media message no politician wants to be seen attacking nurses. So nurses attacking them, is full of win. Public would back them to the hilt too.

@12. Mark

However, the new white paper is going to remove massive swathes of the scrutiny that already exists, while at the same time requiring that ALL hospitals either become Foundations trusts, either individually or by merging with other hospitals. Given how badly run some trusts are with the more prescriptive standard NHS regime, giving them the extra freedoms provided by Foundation trust status is a recipe for disaster.

Yup. A month ago I was at a public meeting with the Finance Director of our local FT, he was explaining the effects of the white paper on the trust. He pointed out that although half of trusts are now FTs, the “low hanging fruit” have gone. (Take a look at the graph of the “progress” of FT conversion, on this page.). The other half are going to be very difficult. The director pointed out that some of the remaining trusts (in his words “many of them in London”) are large, and have large debts that are hidden through loans by PCTs and other trusts. Idiot Lansley is forcing a timetable that cannot be achieved.

20. the a&e charge nurse

[18] “do UK nursing staff need a more radical/lobbying org than exists now” – a very interesting point – UK nurses have no meaningful tradition of opposing political moves that damage either the profession or patients.

We seem to have adopted a siege mentality – and as research shows sometimes it is hard to see self evident truths once you are in an abusive relationship for long enough.

I think nurses are frightened because the NHS almost always focusses on punishing whistle blowers rather than addressing clinical concerns that are raised by them – a situation that applies equally to doctors.
The suits are well aware that if something does go horribly wrong (see Stafford) then it is easier to hold an enquiry so that lessons can be learnt, etc, rather than do something about it at the time?

Re: 20. the a&e charge nurse

That’s kinda what I thought, long standing bodies become tame and are about managing dissent not supporting it, (eg students vs initial NUS timidity). And a more strident nurse org could then with others support much better whistleblower legislation which we all need.

This is the campaign point: keep our NHS hospitals public!

This is a good point Richard. Has anyone done any campaigning on this? Can you email me about it a bit more? Might be worth discussing more at the Netroots event.

“the key challenge for Labour and the Left will be to find ways to track what is going on within the NHS, how that is affecting services and explain why the Conservatives are to blame.”

Presumably if the NHS improves on whatever indices you choose to measure success by then you will be equally praising the Conservatives, no?

Perhaps in the interest of fairness you might spell out now exactly how you will be measuring the quality of patient care, that way you can’t be accused of cherry picking data in a few years when the effects, good or bad, of these reforms will be truly felt.

It’s also nice to see care for the patients coming first. Instead of saying “well I disagree with the changes, but I hope they work” you’re actually hoping that patient care will degrade, just so that you can be right. It’s pretty repulsive actually.

I really hope this is the next big topic, not for the sake of my particular party, but for the sake of the NHS. It’s clear that all those who work in the NHS loathe these reforms, yet they’re being pushed through regardless. Someone really needs to stand up to Lansley and make him rethink. Please Ed, we need strong leadership on this more than anything else.


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