Just to balance things a bit. The Department of Health Co-operation [sic] and Competitions Panel have recently published a paper on AWP and they say that 60% of patients choose their local hospital which they spin as saying that 40% “choose to travel further to another provider”. Well from their own figures more than 3/4 of patients go to either the first or second nearest hospital.

However, C[sic]CP also say that around 40% of patients have access to at least three NHS Trusts within less than 20km. (Note that figure of 40% again?) Around 80% of patients have access to at least three NHS Trusts within 40km and that, on average, patients travel around 12km to their chosen provider.

While the C[sic]CP do not provide the raw data, it is very likely that those patients who choose not to go to their nearest hospital do so because the alternative is so near that they do not notice the difference in travelling. So they use some other criteria, like access, car parking, or length of waiting list. (Do not dismiss car parking, at my local hospital this is, overwhelmingly, the biggest area of complaints from patients.)

What this means is that patients choose their local hospital. It is important to note that for the *vast* majority of us our local hospital is an NHS hospital.

At the BMA SRM there were several interesting speeches. For example, one was from a doctor in the forensic service which has suffered from AWP under the last government. (Labourites take note: after we have sorted out Lansley, we have to get Ed Miliband to reverse the bad changes that the Blairites inflicted on the NHS.) Her point was very clear. these other providers were very *willing* but were neither ready nor capable, yet they still got the contracts. This is what we will find will happen to NHS care if Lansley gets his way.

@ 1 Richard Blogger

“While the C[sic]CP do not provide the raw data, it is very likely that those patients who choose not to go to their nearest hospital do so because the alternative is so near that they do not notice the difference in travelling. So they use some other criteria, like access, car parking, or length of waiting list. (Do not dismiss car parking, at my local hospital this is, overwhelmingly, the biggest area of complaints from patients.)”

On top of that, how are we defining “local”? I imagine it means “nearest your house”, but the most convenient hospital might be further from your home but nearer your workplace, your kids’ school etc.

For those that may not be aware there is currently two online petitions running that are also trying to protect/save The National Health Service. If you are interested take a look and most importantly Spread The Word Far and Wide.

http://www.38degrees.org.uk

http://saveournhs.org/

As a member, I am very pleased that the BMA is moving from a position of ‘critical engagement’ to out-right opposition. Similarly the vote of no-confidence in Lansley is very fitting.

However, I do not really believe the BMA can effectively stop the government plans. Only the LibDems or Cameron himself can stop this – hence my general sense of doom.

The only way for the BMA to really stop these reforms would be actual industrial action which is never going to happen.

@1 Richard,

I agree with your analysis of the damage done by new-labour’s use of AWP and I also agree with your point that the priority is stopping Lansley but that the Labour position needs work too.

AFZ

@2 ditto

My wife and I chose a maternity ward that wasn’t the closest technically to our home. The one we chose was a bit further away in mile terms, but was the one we thought had better transport routes to it and that those routes were less liable to block up during rush hour etc. We could also have chosen a hospital significantly further away, but much newer.

I suppose you could say I exercised a choice anyhow.

I did – but I clearly didn’t need privatisation around to offer me those three choices now did I?

A late rearguard action? – let’s hope so, but the road to privatisation has more or less been signed up to by all of the major parties (in one guise or another).

The gradual erosion of the founding principles of the NHS has obscured by a combination of semantics and the sort of language the public simply do not understand, or are not interested in at least until they are directly affected.

“Any willing provider”, or the even more ludicrous AWP is a prime example – why not just say private firms – I suppose there is an argument that one or two charities or co-operatives will see some of the action, but the overwhelming majority of health business will sooner or later come under the control of the big corporations.

Let’s face facts – all of the major parties are frightened by exponential health costs and can’t wait to pass the problem onto somebody else?

Labourites take note: after we have sorted out Lansley, we have to get Ed Miliband to reverse the bad changes that the Blairites inflicted on the NHS

+1.
Some within the rightmost reaches of New labour easily would have proposed much of what Lansley’s put out.

It shouldn’t matter even if the government tried to push it through as is. The Lib Dems party members voted overwhealmingly to make major changes to it, and so it should follow their MPs would not support it anyway, leaving the Tories short of votes to carry it through.

Clegg’s response at the weekend was to use a few weasel-words about taking the party’s concerns seriously, while effectively saying the bill even as it stands already meets what they are asking for. Downing Street’s response was to brush it aside with a simple ‘there will be no major changes’.

Now is really the test of how much the Lib Dem party faithful will accept from their parties leaders and ministers. The party is massively against the bill as it stands, and as time goes on it becomes clearer the medical professions hold at best very grave doubts, at worst down right hate it too. Many Lib Dems did vote with their concience on the Student Fees issue – I can only hope even more do on this issue, because without them it will be forced through regardless.

I seem to recall that the BMA also voted against the introduction of the NHS in 1948. Presumably, then, you think that the Attlee government should have listened to them and cancelled its plans?

9. XXX

As I’m sure you know, but probably don’t care anyway, that’s a bit of a myth.

“In view of the myths perpetuated over the years on the role of the BMA in the introduction of the National Health Service in the l940s, we would like to put on record the true history, supported by relevant documentation.

The initiative for a national health service came largely from the British Medical Association and the doctors. Long before governments and political parties produced plans for the nationalisation of medicine, the BMA produced its own proposals for a national medical service.

As early as 1918, the BMA in a pamphlet said ’The system of medical provision which the Minister of Health should seek to establish is one which would give to all who need it every kind of treatment necessary for the cure or alleviation of disease, and would utilise for this purpose every class of medical practitioner’.

During the l920s, the BMA studied in detail various aspects of ’The Health of the Nation’ and in l930 produced a report ’General Medical Services for the Nation’ (BMJ Supplement, 26 April 1930, pl66 – l82). In this document the BMA suggested that the medical benefits of the National Health Insurance scheme should be extended to include workers’ dependants and should provide everything considered necessary for the prevention and cure of disease, and for the promotion of mental and physical efficiency.”

http://www.bma.org.uk/healthcare_policy/nhs_system_reform/NHSBMAsupport.jsp

Readers may like to know of this link to the text of the editorial in the British Medical Journal on 21 January 2011:

NHS reform: too soon to let GP consortia out of the lab
http://www.hospitaldr.co.uk/features/nhs-reform-too-soon-to-let-it-out-of-the-lab

“What do you call a government that embarks on the biggest upheaval of the NHS in its 63 year history, at breakneck speed, while simultaneously trying to make unprecedented financial savings? The politically correct answer has got to be: mad. . . “

@ 10:

They may not have opposed the principle of free healthcare, but they still opposed the creation of the NHS. (Also, as a side note, you might find it easier to convince people that you’re right if you don’t insinuate that they are lying.)

[12] “They may not have opposed the principle of free healthcare, but they still opposed the creation of the NHS” – err, that was 60 years ago – what has it got to do with Lansley’s current hatchet job?.

Richard @1

The very last thing you’ve said here – “these other providers were very *willing* but were neither ready nor capable” – is this a comment upon the laissez-faire, hands off approach that you suspect commissioning services in the NHS will be forced to take up due to the new bill? Just out of interest, what makes you think that provision will get worse? I suspect I know roughly what your answer will be, but I was just wondering.

12 Totally agree, as always the devil is in the detail.

10
The doctors opposed the employment conditions of the NHS act ie becoming employees rather than self-employed. The government eventually brought them on board by allowing them to practice privately using NHS staff and facilities.
Several social studies have suggested that the ‘employing’ of doctors started a move towards the proletarianization of society in the post-war period.

[15] “Just out of interest, what makes you think that provision will get worse?” – the evidence.

The privates, largely thanks to NuLab have already got their fingers in the NHS pie (ISTCs, GP out of hours services, radiology, etc) – I’m afraid the portents are not good.

http://www.hospitaldr.co.uk/features/istc-programme-at-a-cross-roads-over-damning-evidence

http://www.keepournhspublic.com/pdf/Sercoleafletshort.pdf

Oops, should say [14] not [15]

@ 13:

“err, that was 60 years ago – what has it got to do with Lansley’s current hatchet job?.”

Well, either the BMA knows better than the government, in which case governments should listen to the BMA and not implement policies which the BMA opposes. This seems to be the underlying assumption behind this article; according to this logic, however, the BMA opposed the NHS back in the 1940s, therefore the Attlee administration was wrong to pass the National Health Service Act. If, on the other hand, the Attlee administration was right to pass the Act and establish the NHS, then that would suggest that the BMA isn’t always right, in which case BMA opposition doesn’t prove that a policy is wrong, in which case BMA opposition to Lansley’s current reforms doesn’t prove that government health policy is wrong.

[18] what bizarre logic – you seem to be saying that if a mistake was made after the war ago it still undermines any point of view arrived at 60 years later?

Do you apply it to all areas of policy or just health?

@ 19:

I’m merely pointing out that “the BMA opposes this” doesn’t automatically translate to “this is a bad idea”. The article as it stands is basically one long Appeal to Authority; “the BMA says…” is not a logically sound argument.

These “reforms” are not just fiercely opposed by the BMA (ie. the very GPs they are expecting to implement it), but by the RCN, the RCG and Unison, in fact all NHS workers who will be expected to work with it. Oh yes, and patients groups, and the general public. This is a back-door putsch, an abolition of the NHS not mentioned in any manifesto. It doesn’t have a scrap of democratic credibility. And if those Liberal Democrat MPs manage to develop a spine and follow their conference rather than their creepy, craven leader, then this bill cannot pass.

@21

So explain why it is OK for the GP to be a private contractor, why consultants can work privately, why the MRI scanner can be provided by a private company (as are most ‘things’ the NHS uses) but a hospital provided privately for the same cost and to the same standard will lead to the end of the world as we know it?

This explains why the streets of Paris are filled with the dead who couldn/t get treated, or why the Danish people are completely desperate for the NHS style operation as 75% of their ambulance service is privately run.

@ 22:

Precisely.

Also, you chaps might be interested in this link:

http://www.adamsmith.org/blog/health/the-state-of-the-union/

Last year I needed a hernia operation. My GP was initially unsure as to whether it was needed (he described it as ‘cosmetic’), but referred me to a consultant who only needed a very quick look to confirm that it needed surgery.

So I’m sceptical that giving GPs control of budgets (or rather, giving consortia control of budgets, who then pressure GPs to keep within them) would be that useful. People will be put off referrals by generalists, and so won’t get to see a specialist until it is potentially too late.

Oh, and I was given a choice of hospital, and chose the one that I could walk to (and get a quick lift back from). I’m not sure where the Tories get the idea that patients don’t have a choice, but it’s not from using the NHS.

Try this:

NHS reforms mean GPs could double their income to £300,000 a year

Andrew Lansley’s plans for the NHS cause increasing disquiet among doctors as BMA demands he rethink pro-market changes
http://www.guardian.co.uk/society/2011/mar/15/nhs-reforms-gps-double-income?intcmp=239

Tory MPs now in revolt on the issue too!

http://www.guardian.co.uk/society/2011/mar/16/conservatives-motion-critical-nhs-bill