Five things you need to know about the NHS bill


8:45 am - February 20th 2012

by Clifford Singer    


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1 The bill will cost at least £2 billion
Estimates of the cost of implementing the Health and Social Care Bill range from the government’s £1.3 billion to Labour’s £3.5 billion, but most independent analysts estimate at least £2 billion.

The government claims the bill will save money in the long run but even the Conservative-led parliamentary health committee says this is unlikely unless standards of care are cut. £1 billion is being spent on redundancy for managers, only for many to be rehired as consultants.

2 The bill will create more bureaucracy
The NHS bill replaces three levels of management (Department of Health, Strategic Health Authorities, Primary Care Trusts) with seven (Department of Health, NHS Commissioning Board, Strategic Health Authority clusters, Commissioning Support Organisations, Clinical Commissioning Groups, Clinical Senates, HealthWatch), and creates two unaccountable super-quangos (Monitor and the NHS Board).

3 Waiting times will grow – unless you go private
The bill allows hospitals to fill up to half of their beds with private patients, and waters down guarantees on NHS waiting times. NHS patients will increasingly find themselves at the back of the queue, even for their own local hospital.

4 Care will depend on a postcode lottery
The bill will break up the NHS and create a postcode lottery on a scale not seen before. With no national standards, there will be widespread variation in the treatments available on the NHS. In some areas, people may have to go private to get services available for free elsewhere. Scotland and Wales, which are not covered by the bill, will continue to provide services denied to patients in England.

5 Private companies, not GPs, will be in control
The bill says GPs will plan and commission healthcare. But this complex role cannot be done on the side while providing the same level of care to patients. We expect pilots to have excellent flying skills – not to design and purchase their own planes.

In fact leaked papers show the government expects private companies called Commissioning Support Organisations to take over this role. CSOs will decide how care is delivered but there will be no democratic control over them.


This is one of two simple fact-sheets published by False Economy. One on the NHS and one on the deficit. Share them with other people!

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About the author
This is a guest contribution. Clifford Singer runs The Other Taxpayer's Alliance website. You can join the Facebook group here.
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Reader comments


1. the a&e charge nurse

The HSCB epitomises all that is rotten about our system – politicians pandering to corporate lobbyists, the wishes of the public being flagrantly disregarded, policies being driven by blind ideology rather than evidence, etc.

In such a climate, facts, no matter how powerful, become virtually redundant.

Oh, and the pilot analogy is a nice one – GPs, will not, I repeat will not have the time, energy or more importantly the skills to be both expert commissioners AND clinicians – perhaps that’s why, as a body, GPs have overwhelming rejected Lansley’s wretched turd burger

“The bill will break up the NHS and create a postcode lottery on a scale not seen before. With no national standards, there will be widespread variation in the treatments available on the NHS.”

Err, yes, that’s the point. That’s the point of having a market rather than a monolithic system. So that different places can try different things and by observing what happens we can find out which of these different new things are better than the old ways.

This is what market based systems do: through the experimentation and the incentives for such experimentation they, over time, increase total factor productivity (ie, we get more or the same resources, or get the same for fewer resources) better than planned and or centralised systems.

We’ve very good evidence that this is so. It’s called the 20th century. The roughly market based economies vastly outperformed the non-market economies in this very field. Paul Krugman has reported that the Soviet Union managed not to increase tfp at all in its entire existence: all growth came from the use of more resources. At the same time the market based economies had 80% of their growth coming from tfp improvements and only 20% from increasing resource use.

Which brings us to the point of having markets in education or health care. The true argument is not that they are more efficient than planned systems. It is that they are a better mechanism for improving efficiency over time. And I think that we would like to bequeath to our children and grand children the best health care or education system that we can?

Which is why we bring markets into education and health care. For the children.

I agree with this article completely and it has completely convinced me that the reforms won’t work.

In fact it has convinced me that no reforms can ever work in the NHS because the size of the task is too great and the vested interests resisting improvement have become too strong.

So let’s just obliterate the whole thing and move on.

4. the a&e charge nurse

[2] if you think for one nano-second that this bill is for the benefit of our ‘children’ rather than the giant health conglomerates jostling for position in the £100 billion health market then you are seriously deluding yourself.

Most people know how markets work, and their purported benefits – maybe some people might be better off when Bupa and their ilk claim a bigger share of the pie (a population that will mostly consist of those with sufficient buying power) – the question is will the trade off be worth it, because there is no doubt that the cost of these changes will, in time, be the end of a universal and comprehensive service that is free at the point of delivery.

@ Tim W

“Err, yes, that’s the point”

Err, yes, that that’s the point is the point. I’m sure the OP is very well aware that this is an intended and not an unintended consequence of the changes.

6. Limiting Factor

@2 – “….different places can try different things and by observing what happens we can find out which of these different new things are better than the old ways….This is what market based systems do.”

Complete and utter tripe. Markets do not exist to allow different communities to try different things, nor do they help us find out which methods are better than others. Markets are merely systems organised to allow the exchange of goods and services, and it operates by very basic laws, ie maximise profit, minimise loss. Markets do not respond to the need or the pain or the desperation of the sick and the weak, or the elderly or the newly-born – they respond to buying power.

Oh, that whole trying different things and figuring out the best solution – er, thats what’s known as the scientific method, the very embodiment of critical rationality, a quality singularly lacking in the actions of bankers, stockbrokers, and speculators of every kind.

7. the a&e charge nurse

Ha, ha, ha, honestly you couldn’t make it up – the tories continue to push through legislation to initiate privatision of the NHS, despite there being no public mandate, and outright rejection from the overwhelming majority of health professionals.

In order to win the propaganda war Dave claims GPs will be at the heart of the new system only to find there is no support from the RCGP to his dreadful turd burger.

So what does Dave do? – he arranges a special summit but does not invite the very group who are meant to be the bedrock of the ‘new’ NHS system.
http://www.guardian.co.uk/politics/2012/feb/20/pressure-mounts-cameron-nhs-summit

To my mind this exposes what we knew all along – Dave was NEVER really listening to the grassroots, and GP commissioning was no more than a fig leaf for the tories true intentions (which was to enrich the fatcats – and force through competition at the expense of co-operation).

Dear, oh dear, oh dear ……….

6
Totally agree.

Tim, nobody took-up the challenge of providing education for the general population other than churches and a few charitable industrialists. It was the state who had to step in and provide for a real need; education for a newly industrialized society.
It was the same for health-care and I doubt if any of the private/privatized sector have/will offered to pay for the training of medical/nursing staff. Latest figures I’ve seen indicates that it costs the N.H.S. around £50k to train a doctor.
This, of course, is not just the case for medical staff, higher education for other professions has cost the taxpayer dearly in the past, now it’s up to individuals to pay the full amount for the privilege of working for private employers as well as the public sector. Should it not be a cost that should, at least, be shared?
Another point, comparison with the USSR isn’t useful, most western countries had industrialized by 1850, Russia was basically a feudal system in 1917, and it’s demographic and geographic was both massive and diverse, its’ technology almost non-existent and it was socially and economically in chaos.
I know most liberals and neo-liberals like to point to Russia and China as indicators that planning doesn’t work, but all we can say is that, given the circumstances and the then environment, planning was not as successfull as it could be. Maybe planning, with our existing society, technology and political stability, not to mention a more homogenous culture, would have a different outcomes.

I know most liberals and neo-liberals like to point to Russia and China as indicators that planning doesn’t work, but all we can say is that, given the circumstances and the then environment, planning was not as successfull as it could be. Maybe planning, with our existing society, technology and political stability, not to mention a more homogenous culture, would have a different outcomes.

So you are suggesting we stake our future on your “maybe” and hope that Stalin and Mao just had a bit of bad luck?

Seems a bit high risk to me………..

10. the a&e charge nurse

[8] “Latest figures I’ve seen indicates that it costs the N.H.S. around £50k to train a doctor”

Maybe the private providers can do it for £50k – the training cost for med students in the NHS is closer to quarter of a mil – actually given the date of the parliamentary source the figure may well be considerably higher – back then you could train a nurse for <£50k though.
http://www.parliament.the-stationery-office.co.uk/pa/cm199900/cmhansrd/vo001117/text/01117w09.htm

11. the a&e charge nurse

[9] “Seems a bit high risk to me……….. ” – well we have already had one experiment in turning health care over to the market, and as sure as eggs are eggs the profiteers lost little time in demonstrating their true colours – not much in the way of sexy innovation that Tim W pines for either.
http://www.dailymail.co.uk/news/article-1393294/Southern-Cross-Healthcare-destroyed-Stephen-Schwarzmans-private-equity-firm-Blackstone.html

10
Thanks A & E, the figure is far higher than I expected, maybe it was the figure for nurse training I saw.
9
Actually, modern health care and services are already planned, firstly, training and education takes anywhere between 2 years for a post-graduate nurse training to about 9 years for a clinical psychologist. Also, the drugs and equipment used in healthcare are not subject to competative forces, the research and development is protected by copyright and licensing. Research and development of pharmaceuticals can take anything up to ten years and $500 million, this needs massive planning.
The NHS is currently the country’s largest purchaser of healthcare equipment and pharmaceuticals (in the UK) It’s really difficult to see the difference between this and full on planning. If anything, private healthcare givers are advantaged by the NHS, firstly they do not pay anything towards training and education and secondly, the NHS bulk buy, so the initial costs of development are paid for, thus, bringing price down relatively quickly.
As far as the wider debate about planning goes, there are few new products that aren’t subject to protection via copyright and a long period of research and development. There is also now sophisticated research tools and technology to predict markets, compare that to China and Russia and we are looking at different universes.
Planning in markets is designed to take the risk out of producing new products, why can’t this be done by a government agency?

@ 2 Tim

“This is what market based systems do: through the experimentation and the incentives for such experimentation they, over time, increase total factor productivity (ie, we get more or the same resources, or get the same for fewer resources) better than planned and or centralised systems.”

Could you explain to me how the markets have innovated and improved in the energy and rail industries for example? The energy companies are profiteering and the rail network is dependent on government funding to run an increasingly poor service.

14. the a&e charge nurse

[13] perhaps Tim was thinking of FINANCIAL innovation – an array of private equity firms buying and selling services based on remuneration rather than clinical need?

Wasn’t it an ex goldman sachs bod who took over Hinchinbrookes in cambridge – how is he doing, does anybody know?
http://www.guardian.co.uk/politics/2011/nov/12/care-private-company-nhs-hospital

Could you explain to me how the markets have innovated and improved in the energy

Hmm, toughie that one. The energy companies fired thousands, tens of thousands, after privatisation.

That is, they provided the energy desired with fewer inputs. This is rising productivty, and increase in tfp, this is freeing up productive assets to be used in other activities.

So, umm, Jeez, I dunno.

The railways are carrying more passengers than ever before. You know, this more output shit?

I just don’t know where anyone could possibly have got the idea that efficiency increases in private for profit organisations happen. Just cannot get it for we’ve only these two examples that you offer.

16. the a&e charge nurse

Perhaps that should be SIX things you need to know about the bill?

[6] even Dave’s supporters think the HSCB is crap.

From the gruniard – “If David Cameron was hoping for an easy ride on his controversial NHS shakeup by excluding its fiercest critics from the Downing Street gathering of carefully selected health leaders, he will have been disappointed. While the atmosphere was polite and constructive, those invited used the opportunity to detail their concerns about how the health and social care bill could damage the NHS. They raised directly with the prime minister the same fears and uncertainties that the leaders of Britain’s nurses, doctors and other professions who want the bill scrapped would have mentioned – if they had been present”.
http://www.guardian.co.uk/politics/2012/feb/20/david-cameron-nhs-reforms-summit

Official reports confirm the public are right to be concerned about Dave’s mission to enrich the fatcats.
http://www.guardian.co.uk/politics/2012/feb/14/nhs-health-social-care-bill

Is he listening to voters or health professionals? – or is he listening to the corporate lobbyists? ……… mmmmmmh

17. the a&e charge nurse

Things you need to know about the bill No7 – ‘Care UK’ was Lansley’s biggest donor prior to the last general election.
http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lansley-bankrolled-by-private-healthcare-provider.html

18. the a&e charge nurse

Things you need to know about the bill, No:8 – it is apparently “inappropriate for individuals to raise personal concerns about the proposed Government reforms” – those that do are threatened with disciplinary action.
http://www.channel4.com/news/nhs-reforms-critic-speaks-out


Reactions: Twitter, blogs
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