Cry some moar.

[1] I’m afraid the only people crying will be debt ridden students or those patients with financially unattractive diseases (once the consortia have their feet under the table) – still, keep cheering for the exciting coalition policies.

2. Students won’t have debt in most cases (we’ve been over this), and the bill does not allow patients with “financially unattractive diseases” to be ignored.

It’s amazing how consistently wrong you can be in service to (anti)party rhetoric.

4 MPS just 4.Ifeel so betrayed I trusted you

Attacking democratic Lords reform as a pre-cursor to opposing the proposed changes to the NHS is a bizarre choice. It doesn’t fill me with confidence that you care about the NHS very much at all. This article is a damp squib.

[4] “Students won’t have debt” – a line that would not sound out of place in the mouth of ‘sqealer’ (Animal Farm).

I’m as wrong as the thousands of students who felt sufficiently concerned about the direction higher education was taking that they felt it necessary to organise mass demonstrations.

You assert that the bill “does not allow patients with “financially unattractive diseases” to be ignored” – but nobody is saying this.

Put a nurse in a clinic with a prescription pad and you have a service – even if the staff to patient ratio is diabolical and the waiting list is very long, and even when you are seen costs are astronomical (£5k for a simple chin laceration in New York to illustrate the pitfalls once big business, sorry consortia are in control).

A significant number of health bloggers have all expressed concern about the way services for less-profitable conditions (like MS or schizophrenia) will fare in the coalitions new health environment – as squealer might have said all animals are equal but some are more equal than others.

“Put a nurse in a clinic with a prescription pad and you have a service – even if the staff to patient ratio is diabolical and the waiting list is very long, and even when you are seen costs are astronomical (£5k for a simple chin laceration in New York to illustrate the pitfalls once big business, sorry consortia are in control).”

And how is this scenario any less likely under our current law pre-reform?

@Ciaran

Attacking democratic Lords reform as a pre-cursor to opposing the proposed changes to the NHS is a bizarre choice. It doesn’t fill me with confidence that you care about the NHS very much at all. This article is a damp squib.

Hmmm so you have not read my blog at False Economy where I have consistently shown that I do care about the NHS?

The Social Liberal Democrats have correctly identified a list of changes that should be made to the Bill. This list is similar to the changes that Labour have tried to make in the Bill Committee, however, Lib Dem MPs have blocked every Labour amendment because they are now joined at the hip to the Tory party. At no point did any Lib Dem MP on the Bill Committee ever present an amendment that was on the Social Lib Dem list, yet this was agreed by the Lib Dem Conference in Spring and forms Lib Dem policy. Yes, John Pugh voted against the bill at the third reading, but it was a bill that he supported throughout the Committee when he voted with the Tories. Burstow (a LibDem) is effectively a Tory because he is a minister and so has to do what Cameron tells him. The Lib Dems have no purpose.

So the Social Lib Dems say that the only place where meaningful amendments can be made is in the Lords. That effectively means that the Commons is pointless and MPs are subservient automatons. And what does Nick Clegg want to do? Turn the Lords into a Commons clone to get more automatons! If Clegg had his way this Bill would not be amended in the Lords.

If you had been bothered to read my linked article you would see that I was suggesting a democratic alternative to the Lords. However, my suggestion was to have experts in the Lords, not more politician clones. “Lords” would be elected by their membership organisations (professional associations, unions, churches, charities, groups like the National Trust, etc) the idea being to have a diverse group of experts who are there because they are elected by their peers. I want to keep the scientists, economists, artists, lawyers, doctors etc, people who are experts and are not there because they’ve climbed some political greasy pole.

The fact that you think that Clegg’s attempt to create a pointless Commons clone is more important than the amendments to the Health bill show how little you care for the NHS.

I share your concerns about Shirley Willams. I always remember the effect she and her chums Owen, Rogers and Jenkins had on splitting the opposition vote and letting Thatcher in when they formed their vanity project the SDP. That may be a source of bitterness towards her for me, but I also heard her interviewed a while ago about her thoughts at the time. She struck me as very dull and lacking depth, which surprised me because she had always had a good reputation.

Can Owen be relied upon? He certainly has the talent, and as a crossbencher he has no party loyalty. He can be rather unreliable, though, so leaving it to him to lead a fightback smacks of desperation.

I’ll be adopting a peer but the most likely source of effective influence in opposing this bill remains public awareness and an arising popular rejection. After all, 38 Degrees seem to have been more effective than any internal Westminster manouvres.

[7] “how is this scenario any less likely under our current law pre-reform?” – because decisions in the NHS are driven by clinical need rather than profit motive.

Companies like Helios (who are bidding to manage hospitals) provide a service, a service that must satisfy board members and shareholders (immediately diverting cash from patients into the company’s coffers) – such outfits are always going to be drawn to income generating health care, as well as those sectors of the population with the greatest ability to pay for whatever is on offer.

‘Spinwatch’ tell us that Lord Howe (standing in for Lansley) informed assembled private healthcare execs (at a £600 a head health conference) that “the NHS reforms will create ‘genuine opportunities’ for the private sector to take over large chunks of the NHS”.
The programme for the rest of the day is illuminating – the morning’s main session was called: ‘Income generation – new markets for the NHS and the private sector’, at which delegates learned that ‘many [hospital] Trusts are considering entering the private market’. Unlike Parliament, they were also given insight into the question: ‘Private Practice the new market for the NHS?’
Most revealing of all though is this afternoon’s session by the head of healthcare commissioning at private insurer, Bupa, called: ‘Medical insurers overview on the emerging NHS private sector’.

As head cheer leader for the coalitions health & education plans perhaps you trust shady characters like Geoffrey Howe, Andrew Lansley or old etonians like Dave Cameron – but if you are ever unfortunate enough to suffer from a chronic and unprofitable health condition you might be forced to reassess your glowing judgement once such change becomes part and parcel of health landscape?

“because decisions in the NHS are driven by clinical need rather than profit motive.”

Which shows you just how little you understand of the amended NHS reforms that were passed to the lords yesterday. There is no profit motive any more, only a motive to patient care quality improvement.

In fact the situation is potentially *better* in the new bill due to there being very specific checks and balances that ensure that if a consortia were to fail in the scenario you described, a clear step back in patient care, then the commissioning board, and potentially even the secretary of state if the board were not acting, could intervene and do something about it. (check section 14Z19 of the bill)

Someone can point me to evidence of where I’m wrong here, but currently there is no duty for the secretary of state to ensure that care provisions are improving in all areas, not even that he should have a view to ensuring! This compared to section 14Q of the current bill.

I’d say it’s actually less likely, in *legal terms* (i.e. accountable terms) that such a failing could happen in the future, not more likely.

[10] “There is no profit motive any more” – oh, I wish someone had told Sir Geoffrey and all of those delegates from BUPA and the like attending his £600 a head conference.

I will believe there is not a profit motive when AWP (any willing providers) do not stand to gain any financial benefit from providing clinical services.

BTW did you know Man City City have combined a stadium naming rights deal with a shirt sponsorship contract with Etihad Airways worth up to £400 million?
Now some would say that is just a dodgy deal to circumvent tedious fair play rules – I’m sure the health fat cats circling juicy NHS contracts would never stoop to such underhanded methods?

11. Businesses operate to get profit, no-one disputes that. But the people commissioning the services are bound by quality of care, not money… if business make money off of providing us improved patient care, that is not in itself a problem for anyone. Indeed it is win-win.

[12] “it is win-win” – very few in the know would share such an optimistic view, in fact hardly anybody outside the Dave’s immediate coterie, or those fat cats who stand to profit would frame covert privatisation of the NHS in quite the same way.

As a matter of interest who will the winners be – I mean what evidence do you have that the tries reform will benefit anybody apart from the rich, or the profiteers?

[13] I meant tories reform, of course.

@12 well you are of course assuming that private healthcare companies wouldn’t purposely undercut the NHS to steal its business, and then once it has been financially crippled, jack up the prices. It’s what I would do if I was one of those big American healthcare providers and was only concerned about profit.

Unfortunately the Health and Social Care bill doesn’t stop profit making, I would have no issue with it if the only providers that could bid were non-profits. Looks like in the end we will all be helping fund some American CEO’s 15th sports car. Happy times!

[15] Some of them are struggling on as little as $16.7 million p.a.
http://money.msn.com/top-stocks/post.aspx?post=c675224e-3ca5-4902-ae47-92f4bbba2331

How many cataract ops could be done for $16.7mil?

But I believe you are correct, as Dr Louise Irvine (Lewisham GP and member of Keep Our NHS Public) says big firms “will be allowed to undercut the NHS by offering cheap deals. The large multinationals poised to bid for these contracts – like United Health – will “loss lead” to capture the contracts. Local hospitals that lose contracts and become financially unviable will be closed or taken over by private companies (as has already happened to Huntington Hospital in Cambridgeshire). Public money will be siphoned off as profits for shareholders. Price competition will cause a “race to the bottom” where the cheapest bid wins and quality of care suffers”.

A definite ‘win-win’ situation, no?

“well you are of course assuming that private healthcare companies wouldn’t purposely undercut the NHS to steal its business”

And you’re forgetting, as I said, that the criteria for selecting providers is not based on cost, but on quality of care.

“As a matter of interest who will the winners be – I mean what evidence do you have that the tries reform will benefit anybody apart from the rich, or the profiteers?”

I’m not the one making the claims about some great catastrophe waiting to happen. What is YOUR evidence that a commission that is based upon improving patient care year on year, and commissioning services on the basis of care to the patient (not cost) will result in patients losing out while companies reap the rewards?

You have failed to address the main point I made in that last post, that lead to the “win-win” statement, that the legal framework is such that the principle is that the only way a company gets to make profit off of the NHS, is if they’re improving standards…do you have a problem with that situation?

[17] “And you’re forgetting, as I said, that the criteria for selecting providers is not based on cost, but on quality of care” – yes, the sort of quality associated with outsourced hospital food or cleaning.

Now surely those single pathology production lines (ISTCs) set up by non-NHS providers are providing better quality care than their NHS counterparts – apparently not!
Several reports have put joint failure rates (hip/knee, etc) at 6-15% rather than <2%, the standard for most NHS orthopaedic centres.

Bevan said, “A free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst" and “abuse occurs where an attempt is made to marry the incompatible principles of private acquisitiveness with a public service".

“Several reports have put joint failure rates (hip/knee, etc) at 6-15% rather than <2%, the standard for most NHS orthopaedic centres."

And now you're comparing an old system with a completely different system….

[18] well, put in the simplest terms I think you have almost no grasp of the vast difference between rhetoric and reality – once the changes have been forced through (despite the tsunami of objections) there will be no going back.

In order to appease a few dissenters the tories wasted more money on a phony listening exercise, but ask yourself this;
Why did the tories fail to mention (in their pre-election manifesto) that they were planning another expensive top down reform?
And who (with any credibility) sees the reform as a good thing (just one name mind).
And why are so many commentators framing the legislation in terms of an agenda for covert privatisation?

[18] well, put in the simplest terms I think you have almost no grasp of the vast difference between rhetoric and reality – once the changes have been forced through (despite the tsunami of objections) there will be no going back.

In order to appease a few dissenters the tories wasted more money on a phony listening exercise, but ask yourself this;
Why did the tories fail to mention (in their pre-election manifesto) that they were planning another expensive top down reform?
And who (with any credibility) sees the reform as a good thing (just one name mind).
And why are so many commentators framing the legislation in terms of an agenda for covert privatisation?

Of course, it’s possible that you are right and everybody else is wrong?

[20] you were talking about “quality of care” – I cited a comparitor, in other words the same procedure carried out by both state and non-state providers.

Not only did the NHS prove cheaper but also had fewer complications despite operating on a more complex cohort of patients (older, more co-morbidities, etc).

So I ask again – what is the basis for assuming that profit hungry consortia will out perform what we already have?

17@ sigh, you seem to misunderstand me I never said the quality would be any different.

I’m dealing from a hypothetical where the care quality could be the same, a big rich american business could run for several years at a loss until the NHS was out of business before jacking the prices up once its the only provider. In the end it becomes way more expensive, therefore we all loose out.

If you need anything further clarified or explained, please just ask rather than accuse me of forgetting something I had not.

we lose out.*

excuse me

@19 thanks a&e, thats some nice information to know. Ok if I borrow it next time this topic come up again in the real world?

Mason: Are you aware of the purpose of monitor?

@27 – The body which will be an economic, and only an economic regulator? Nope, no remedies there. It’ll response to individual complaints just like the OFT…

[27] “Are you aware of the purpose of monitor”, ahh, so you are asking people with complex health needs to put their faith in a new regulator?
I hope for their sake ‘monitor’ performs slightly more effectively than the bank regulators did.

Mind you the recent track record of NHS monitoring and inspection hardly engenders confidence.

First we had the rebranding of the Healthcare Commission as the Quality Care Commission in the wake of the Mid-Staffordshire scandal (changing names on the door tactic)

Then Baroness Young, the former head of the Care Quality Commission said the model of an independent regulator for care in the NHS could not be satisfactory.
She resigned (in 2009) from her role as head honcho for the Quality Care Commission, the organisation tasked with the role of regulating inspecting and reviewing all adult social care services in the public, private and voluntary sectors in England.

And now we have the new kids on the block, monitor ………… mmmm.

28. The body that exists primarily to stop the very hypothetical situation described above, yes.

“Healthcare Commission”

Brilliant, so there are already failings in the current system, let’s keep the current system!

“And now we have the new kids on the block, monitor ………… mmmm.”

They’re not new, they’ve been around since 2006, and in all fairness where they have regulated there have been improvements in service by comparison to non-regulated hospitals.

@27 Yes. The bill has been altered so they no-longer ‘promote competition’ but prevent ‘non-competitive’ behaviour. And yep you guessed it, it is competitive behaviour to lower prices. As long as there are enough private companies its not competitive to run another company out of business. Biofuel makers in the 80′s (might be off on that can’t remember which decade at this time of night) came across the same problem when competing against oil companies. Big oil companies had far too much economic power so they could run at a lost to push biofuel out of the market. Unfortunately thats fair competitive behaviour. Ironically big oil is now wanting to invest in it due to deep sea drilling becoming more expensive, so the companies that wanted it destroyed will now probably be at the forefront of developing it. anyway as I was saying…… if private companies can provide the same level of care but make it cheaper, it would be uncompetitive for monitor to step in a make it go to the NHS. If the NHS fails because it has no funds, it would be uncompetitive behaviour to save it. So in the end it would be monitors responsibility to prevent anyone saving the NHS, which sucks. Of course private companies could then raise their prices in a pack, much like we have with the gas companies.

.

4th line: should say ‘uncompetitive’ not ‘competitive’ derp!

@30 – Conflating their current responsibilities with the rules in the bill, which transforms their role utterly, is a bad mistake…

” it is competitive behaviour to lower prices”

Not in the way you described.

Also, I think it’s clear you haven’t read the new duties of Monitor, given you’re saying literally the opposite of the reality.

“Conflating their current responsibilities with the rules in the bill, which transforms their role utterly, is a bad mistake…”

Why?

33. Why?

@35 sigh, check the amendments that have been added to the bill in the recent listening exercise. I don’t blame you for thinking this hasnt happened you have to keep up to date with the most recent of changes.

Well I’m glad your here to tell every business on earth they can’t lower their prices to compete with their rivals, you must spread the word! Everyone has capitalism wrong!

@35

Full text is at this address.
http://www.publications.parliament.uk/pa/cm201011/cmpublic/health/memo28june/hsr16.htm

this is just a memorandum sent by the SHA, I didn’t have much time this morning, but it highlights the duties of monitor. You will have to read the sections below. As you can see those the original duty was to ‘promote competition’ and then the new amendments have changed it to ‘prevent anti-competitive behaviour’.

19. The Alliance was therefore concerned that Monitor’s original duty to ‘promote competition’ would have prevented the designation of providers of specialised services. As such, the Alliance welcomes the re-casting of Monitor’s main duty, in particular the requirement it places on Monitor to ensure quality in the provision of services (amendment 148).

20. However, questions remain, which mean that the Alliance is still concerned that in certain cases, Monitor could seek to prevent the designation of providers of specialised services. For example, how will Monitor balance the two parts of its main duty (promoting provision of health care services which is both ‘economic, efficient and effective’ and which ‘maintains or improves the quality of the services’)? In addition, how should ‘the interests of people’ who use services be defined in the new requirement on Monitor to prevent anti-competitive behaviour in the provision of services which is ‘against the interests of people who use such services’ (amendment 149)? Finally, what would happen in the case of a conflict between the requirements on Monitor to prevent anti-competitive behaviour and to enable health care services to be provided in an integrated way (amendment 149)?

check and mate sir.

[31] “They’re not new, they’ve been around since 2006″ – a tad pedenatic, Lee?

Anyway, if it’s not clear my points are that at best regulation in the NHS has a chequered past, and monitoring the activity of consortia will be a novel role.

We certainly have a history of failure when it comes to regulation of other industries (most notably the banks) and when it came to PFI the money men were easily able to run rings round government bureaucrats.

As a matter of interest who do you regard as the most erudite supporter of Lansley’s dogs dinner – yourself excluded of course?

@8 Richard Blogger

I haven’t read any of your other pieces, no – I don’t think that changes the fact that this post is actually about Lords reform and not really about the NHS at all.

That aside, I think calling reforms ‘democratic’ because people are elected by extremely restricted, and often arbitrary, groups of people is a little optimistic.

What makes doctors qualified to elect somebody to the House of Lords, but firemen not? What about representatives of people who actually make up most of the UK – like call centre workers, shop assistants, administrative officers, events planners? Are they not worthy of representation by experts? And if they are, what then? Should we have an expert for every profession?

The only way that reforms are democratic is if they are elected by the people. A strong power of recall would do much more to make sure parliamentarians didn’t vote against their constituents interests than cutting back the franchaise for millions.