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Stop the Killing of Our Free Public Health Service

The Government's Health and Social Care Bill 2010-11 will destroy the NHS as we know it - for ever. Consider these facts:1. The Government will no longer be responsible for delivering a comprehensive health service - only paying for some of it.2. The Government will no longer be directly accountable for providing a comprehensive health service.3. The Bill opens the way for no health services to be free to patients.4. GP consortia will be able to employ private companies to commission and provide health services. There will be no duty on these consortia to provide comprehensive healthcare for all residents.5. Satisfaction levels within the NHS have never been higher - so implementing the Bill must be a cost cutting exercise.If you are unhappy with these proposed changes you can write to your MP and join 254,506 others who have signed a petition at www.38degrees.org.ukIf you are happy with these proposed changes please enlighten us all on this forum with your reasons.

Eric Alan Leach ● 5503d90 Comments

"Some types of hernia surgery are currently being restricted by the NHS in some areas of the UK and waiting lists are becoming significantly longer. Inguinal (groin to you and me) hernia operations for adults for example are sometimes being restricted to those with more serious symptoms. For these reasons many people opt for private hernia treatment" This is from the website of the Spire Hospital Bristol (a private service so it must be right). On the 4th Jan 2010 Cameron (a public servant so he must be wrong) said "I'll cut the deficit not the NHS".Looks to me like cuts to the NHS in this example in the Bristol area. I was directed to this by a surgeon who noted from his colleagues in Bristol that NHS patients with hernias were being turned away and being directed to the private sector. His professional opinion? This is a dangerous option that hasn't been tried for many years because a proportion of these hernias can become emergencies and life threatening. Truss oops trust Cameron eh Phil?.

Arthur Breens ● 5305d

And now Channel 4 News is reporting that 300 paediatricians and child care workers have called on the Government to rethink its plans to change the way NHS services are funded in England. They fear that the reforms will make it harder, not easier, to fund care and find care for children with comoplex needs.La La Lansley, the Government's Health Secretary, was at his patronising best when he responded by saying that the the 300 professionals hadn't uderstood how the reform would work.

Eric Alan Leach ● 5305d

A GP peer who led the Liberal Democrat revolt against the NHS reforms in the second chamber has conceded defeat over the health bill, which she claims is a 'nasty trick' against the public.This week the Health and Social Care Bill returns to a committee of the whole House of Lords after the second reading was passed by peers who rejected another former GP peer Lord Rea's  amendment that would have effectively killed the bill.Former Lib Dem health front bench spokeswoman Baroness Jenny Tonge, who voted with the Labour side,  told Pulse that she was ‘very depressed' because the vote had ended any ‘realistic hope of saving the NHS from this act of privatisation.'Baroness Tonge said the bill was ‘unconstitutional' and a ‘very nasty trick against the British electorate' because it was not in either Conservative or Lib Dem manifestos or in the coalition agreement.‘This was not something they voted for and never dreamt would happen and now it is here,' she told Pulse.‘My party should be ashamed of itself. I am very ashamed that they have allowed themselves to be drawn into this. Nick Clegg and the other leaders have sold their souls and betrayed the NHS.'

Allison Franklin ● 5305d

Allison,I would be keener to listen to opponents of NHS reform if they used logic a bit more and scaremongering a bit less.  The Coalition has essentially fixed NHS budgets in real terms which is by far the most generous settlement that any part of government has had.  Your line "a £20bn  reduction in NHS funding" is nonsense.  The £20 billion Nicholson challenge predates the coalition and is about getting NHS productivity back on track after Labour's disastrous management of the NHS where they kept shovelling more money in and getting less for it.  Without it the NHS will be unable to deal with increasing demand.  Do you demand that NHS budgets increase in real terms?  See here, check the date:http://www.telegraph.co.uk/health/healthnews/5524693/NHS-chief-tells-trusts-to-make-20bn-savings.html

Phil Taylor ● 5305d

Councillor Taylor,I've had a quick look at the backgound of your Baroness Murphy and she's not as independent as one might have liked. She is a Director of the NHS Regulator Monitor which will play a massive, complicated role should the NHS reforms actually become law.

Eric Alan Leach ● 5306d

...and on this particular reform, Mr Taylor, every single Royal College has objected to very large parts of it and even when they haven't objected outright to certain clauses, they have voiced their concerns.  The truth is that this egregious Act is unnecessary and unwanted by the vast majority of organisations representing medics.  Even the RCGP - the very organisation representing the group of clinicians likely to be in charge of the bulk of the commissioning budget - do not like what they see.  The Government has continued to lie about the effect of this Bill.  One only has to examine the bureaucracy that the H&SC Bill will spawn to see that it is absolute nonsense to present it to people as making the NHS leaner and meaner (well, it certainly is getting meaner) and more responsive and better value for money and all the rest of the drivel Lansley and his supporters have been banging on about. My five gets your ten that before very long we will have an organisation that looks remarkably like an SHA in place but it will be called something else. Someone has to do the work they do. Deaneries are being restructured and hacked to pieces.  The work they do has to be done somewhere and decentralising when you want to save money is not the way to go.  This is a dog's breakfast of a Bill and coupled with a £20bn  reduction in NHS funding, I feel as though I am watching an imminent train wreck which I am powerless to stop. I too want to see evolution and good developments in the NHS; change is not something that makes me uneasy.  This isn't change that I welcome, though, particularly as it is nothing more than an ideological attack on the NHS. 

Allison Franklin ● 5306d

Arthur,Both manifestos made it clear that there would be some very big changes in the NHS but Baroness Murphy confirms they are evolutionary in nature.  The Tories said in their manifesto:Give patients more choiceWe understand the pressures the NHS faces, so we will increase health spending in real terms every year. But on its own this will not be enough to deliver the rising standards of care that people expect. We need to allow patients to choose the best care available, giving healthcare providers the incentives they need to drive up quality.So we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers. We will make patients’ choices meaningful by:putting patients in charge of making decisions about their care, including control of their health records;spreading the use of the NHS tariff, so funding follows patients’ choices; and,making sure good performance is rewarded by implementing a payment by results system, improving quality.We will strengthen the power of GPs as patients’ expert guides through the health system by: giving them the power to hold patients’ budgets and commission care on their behalf;linking their pay to the quality of their results; and,putting them in charge of commissioning local health services.So choice, any willing provider and GP commissioning are all there in black and white.  The LibDems approach was slightly different but implied equally radical change and the idea of any willing provider which was also in Labour’s own plans.  Empowering local communities to improve health services through elected Local Health Boards, which will take over the role of Primary Care Trust boards in commissioning care for local people, working in co-operation with local councils. Over time, Local Health Boards should be able to take on greater responsibility for revenue and resources to allow local people to fund local services which need extra money.Giving Local Health Boards the freedom to commission services for local people from a range of different types of provider, including for example staff co-operatives, on the basis of a level playing field in any competitive tendering – ending any current bias in favour of private providers.This government's days are indeed numbered.  It will end in May 2015.

Phil Taylor ● 5306d

Wow - just how desperate can you get in a discussion when you bring up the behaviour of an organisation over 50 years ago? Life in 1948 could have been significantly different from life in 2011. I was four years old at the time and I suspect your existence hadn't even been imagined at that time.Baroness Murphy is of course entitled to her opinion. But so are the almost 500,000 people/patients who have petitioned to stop this NHS revolution.I'm not playing politics and I do want the NHS to evolve but not to be subjected to the radical, revolutionary changes that are being proposed.

Eric Alan Leach ● 5306d

This Bill started as a lie. "No top down reorganisation". That is what Cameron told us before the election. Sorry Baroness Murphy. Sorry Phil. A lie. And why do people lie? You tell me Phil. Not in the manifesto! The people don't want it. A trick. Now tell me how competetive the power generation industry is and how the big six have produced such "low and competitive" prices for the consumer. It is twaddle Phil. We are overjoyed to think we will be looking forward to an increasingly poor service "free at the point of use" provided by this government. As the anticipation of the Bill's successful passage bites we'll see more rationing and the evolution of the healthcare lottery. Simple rule, if you want decent health care don't be poor. This is a government that is becoming more and more detached from the values of the people it purports to serve. On that basis I am certain this government's days are numbered.

Arthur Breens ● 5306d

Eric,The doctors and the BMA do not have a good record on reforming the health service.  The BMA has opposed every NHS reform.  Indeed, in a vote held in February 1948, months before the NHS was due to come into effect, 40,000 members of the BMA voted against the NHS, with fewer than 5,000 expressing support.http://www.oup.com/oxforddnb/info/freeodnb/magazine/health/I was struck by Elaine Murphy's (Baroness Muphy, a crossbench peer) speech in the recent Lords debate.  Murphy is one of those rare creatures an experienced doctor and administrator. Maybe we should listen to her and not the wreckers who are playing politics and do not have a viable alternative. She said:"Seldom have so many health policy folk fought so many pre-Bill skirmishes over what in the end has proved to be rather modest changes intended to preserve and improve the NHS based on the principles of the NHS constitution, and rarely have I received so much misinformed lobbying about a Bill. I hear that the Bill heralds the end of the NHS as we know it; I read that armies of evil capitalists from the United States and the Middle East are geared up to zoom into the UK like the hordes of Genghis Khan to hoover up our favourite hospitals and services. It is twaddle. In fact, this Bill contains no privatisation at all, it does not transfer any assets to the independent sector and, if we build on the contribution of the independent sector of 1 to 2 per cent per annum, we shall be doing quite well. We have been building on the expansion of existing policies that have been in place and developing slowly over the past 20 years and introducing a new level playing field for providers from all sectors. As another noble Lord said, this is a vast improvement on favouring the independent sector treatment centres. I quite understand why that had to be done in the early days, but this puts everybody on a favourable, equal footing. It will sharpen NHS commissioners to get the quality of care improved and, crucially, will improve productivity, which has fallen quite catastrophically as investment has risen in the past decade. This Bill improves the contribution of clinicians to the planning and management of services and shifts a hospital system chained to central diktat towards a regulated emancipation to manage their own affairs. In my view, the most important aspect of this Bill is the introduction of the independent regulatory framework for providers, with the tools to promote a sharpening of competition and co-operation that will promote the kind of integrated care across primary community and specialist services that we all want. Those of us who were at the meeting last night heard Sir David Nicholson repeat what the NHS Confederation has constantly stressed: that any delay will be profoundly depressing to the service, which now wants a clear steer and direction of travel. We have had two years of delay already. Almost all the features of this Bill are familiar to us: clinical commissioning; foundation trusts; a regulatory system; competition and collaboration between qualified providers; and patient choice. They have all gone before, so the new Bill builds on what has been learnt, especially by ensuring that competition is based on quality not price. There seems to be a widespread misunderstanding that we are basing these new proposals around price. That is absolutely not the case, and I would not support this Bill if it did. Some people talk nostalgically about the demise of PCTs and SHAs, but the demise is in an orderly fashion, and as a former chair of a strategic health authority, I can only say “Hurrah”. In fact, clinical commissioning groups are what primary care trusts were supposed to be in the first place. For those who can recall primary care groups, those were also what clinical commissioning groups were meant to be. The difference is that we have a national framework to support and empower them that will not be diverted into the provider system."

Phil Taylor ● 5306d

On 24 October 2011 the British Medical Association published the results of its most significant survey of English GPs in recent years. 18,757 GPs participated in the survey.Key findings include:- 75% of GPs do not agree with the proposals in the Health and Social Care Bill to link practice income to the performance of their Commissioning Group- 68% of GPs are concerned about conflicts of interest in the reforms- 85% of GPs do not believe that practice boundaries should be abolished.I've also learnt this week that the new would-be boss of the new NHS, Malcolm Grant, is a lawyer who will be running the NHS Commissioning Board part time as his full time job is running UCL.There's still time to kill off this Bill and you still have time to lobby Members of the House of Lords and your MP.

Eric Alan Leach ● 5306d

And one of the points about hospital PFIs is that the PFI company owns the hospital. The PFI company might decide to sell the PFI contract (ie ownership) to another company which could, of course, be a foreign company. There's no public consultation, patient consultation or staff consultation - the hospital just changes (private) hands.

Eric Alan Leach ● 5354d

When you see the links between Blair and US healthcare, Libyan secret service and BP, then Murdoch and the dodgy dossier we see that Britain has had a lucky escape. The big problem at the moment for the NHS is the millstone of PFI and that ties in with the deficit crisis. When you read about proposals to convert St Marys Paddington in to flats this shows the extent of the crisis. We are in a mess because of private money ripping off joe public. invented by 2 brain willets and used to an extreme by labour we will have plenty of shiny hospitals that will become bankrupt.

Peter Chadburn ● 5355d

I watched much of the NHS debate in Parliament on TV today.Labour Frank Dobson MP delivered a brlliant speech tearing the bill apart.The Tories made the point that Blair opened up the NHS for private company involvement but put a cap of 5% of total turnover on it. In the last year of Labour rule the private sector involvement was just 2.2%. Under the proposed new legislation the sky is the limit on private company involvement.The Health Minister was asked whether it was possible for foreign companies to run NHS hospitals in the future. The Minister refused to answer the question.....Try and watch more of the debate on the Parliamentary channel tommorrow.

Eric Alan Leach ● 5355d

Why this flawed bill threatens the very future of the NHSThe new health bill displays an unhealthy fascination with the discredited US system  reddit thisComments (81) Shirley WilliamsThe Observer, Sunday 4 September 2011Article historyAs the passage of the Health and Social Care Bill has ground on, the doubts and questions that accompany it have become ever more difficult to address. This is a bill that has been subjected to a listening exercise, extensive consultation and a report by Steve Field, chairman of the Future Forum, redrafting by Parliament, more than 100 hours of debate, and dedicated efforts by the deputy prime minister, Nick Clegg, and the Liberal Democrat minister of state for social care, Paul Burstow, to amend it to meet the worries Lib Dems expressed at their conference last spring.Now that 38 Degrees, a group of concerned citizens, has sought the advice of leading lawyers, the confusion thickens further. The central issue is whether, if the bill is passed without further amendment, there will be any legal duty on the secretary of state for health, Andrew Lansley, to provide and secure a comprehensive health service for the people of England, free at the point of need – the heart of what the NHS is all about.At present, the duty to provide and secure such a service has been delegated to the primary-care trusts and strategic health authorities. These commission the services that have to be provided, some of them listed in section three of the 2006 National Health Service Act. That section requires him or her to provide hospital and other accommodation, nursing and ambulance services and services for vulnerable groups such as children and pregnant women. But in the new bill, section three is repealed.Those responsibilities are no longer delegated; the secretary of state can set objectives and even intervene in the case of a significant failure by a commissioning body, but he is no longer legally and constitutionally responsible. That view, however, is not shared by the Department of Health's legal team. "The removal of the duty to provide," the department declared, "does not in any way undermine the secretary of state's accountability or responsibility for the health service which remains unchanged since the founding of the NHS."The opinion of the lawyer in the 38 Degrees case was equally unambiguous: "It is clear that the drafters of the Health and Social Care Bill intend that the functions of the secretary of state in relation to the NHS in England are to be greatly curtailed. The most striking example of this is the loss of the duty to provide services pursuant to section three of the NHS Act 2006." (The services I mentioned.) "Effectively," he continues, "the duty to provide a national health service would be lost if the bill becomes law." By passing these duties down to an unknown number of commissioning consortiums, the government, he says, will be "effectively fragmenting a service that currently has the advantage of national oversight and control, and which is politically accountable via the ballot box to the electorate".The Department of Health is inclined to dismiss such comments. The position of MPs who are not lawyers is made extremely difficult by disputes of this kind, which may reflect the politicisation of a civil service which is meant to give impartial and objective advice.Let's move on to the constitutional issue. More than £80bn pounds of taxpayers' money is poured into the NHS every year. Taxpayers have been willing to pay for a service most of them deeply care about and find satisfactory. But they expect the government, the minister and, ultimately, Parliament itself to be held accountable for the delivery and quality of the services for which they pay. Mr Lansley is right to want greater freedom for doctors to work with their patients and to restrain political interference in the NHS. But to throw out accountability in order to tackle petty interference is to undermine democracy itself.The conflicting interpretations of the secretary of state's responsibilities are made worse by an amendment to the bill, added after the recommissioning exercise, "the hands-off clause", which requires him to respect the autonomy of the National Commissioning Board and the commissioning bodies. The minister would have to show that any intervention by him was essential, a tough test to meet. He could be subject to legal challenge if he failed to meet that test, making "hands-off" a prudent path to follow. This is a provision that must be dropped, just as the reinstatement of the secretary's duty to secure provision of a comprehensive health service should be reinstated.There have been changes for the better. Nick Clegg's intervention ensured that the commissioning bodies will have lay people on them, will be much more transparent in how they act, and will consult HealthWatch and other local bodies. He managed to get the coalition to drop competition on price altogether and to make co-operation and integration objectives for Monitor, the independent regulator of NHS foundation trusts, alongside its duty to oppose anti-competitive practices.One thing that remains, however, is the decision to lift the cap on private beds in foundation hospitals. Not only could that mean that many of our finest hospitals would gradually become private, it also means that inevitably foundation hospitals would be subject to European and British competition law. It would be much better to amend the law so that no foundation hospital anywhere could have a majority of private and commercial patients, while leaving the exact figure to be determined by each within that ceiling.There is an even bigger question to which I have no answer. Why have so many of our politicians, Labour and Conservative, sought to introduce a market into health? I am not against a private element in the NHS, which may bring innovation and good practice, provided it is within the framework of a public service – complementary but not wrecking. But why have they been bewitched by a flawed US system? I worked in the US for a decade between the 1980s and 1990s and saw the misery of people who could not afford even to insure themselves against the catastrophe of serious ill health.The NHS is recognised by the OECD, the US Commonwealth Fund, most of our own medical organisations and many of those who use it as one of the most efficient, least costly and most effective in the world. It could become more productive and more innovative, especially through greater integration of services and sensitive reconfiguration, ensuring that treatment is undertaken locally or at home rather than in hospitals. But reform need not mean upheaval and disintegration. The remarkable vision of the 1945 Attlee government – of a public service free at the point of need for all the people of England – should not be allowed to die.

Allison Franklin ● 5358d

This coming Tuesday will be the high water mark in the passage of this disastrous Health and Social Care Bill.  Our only hope is that the Lib Dems stop negotiating and being understanding and accommodating and vote no.  No equivocation, no humming and hawing, just a straight out No.  The NHS does not need more quangos, more privitisation and fewer managers.  There will be the equivalent of 20 seconds debating time per clause because there are now over 1000 changes to the original bill.  The debate and discussion should take up thefirst week of Parliamentary time but it won't.If you have not already emailed your MP, then please do so NOW.  If you cannot think of what to say, go to the 38Degrees website and email them from there.  Don't rely on snail mail; your letter will not arrive in time.  The link (which you will need to copy into your web browser) http://38degrees.org.uk/campaigns.Below is the article from today's Observer.------------------------------------------------------The future of the government's health reforms has been plunged into fresh doubt as the Liberal Democrat peer Shirley Williams raises new concerns, and secret emails reveal plans to hand over the running of up to 20 hospitals to overseas companies. The revelations come as MPs prepare to return to Westminster on Tuesday for what promises to be a crucial stage of the flagship health and social care bill.Baroness Williams, one of the original leaders of a Lib Dem rebellion against health secretary Andrew Lansley's plans – who appeared to have been pacified after changes were made over the summer – said she had new doubts, having re-examined the proposals. "Despite the great efforts made by Nick Clegg and Paul Burstow [the Lib Dem health minister], I still have huge concerns about the bill. The battle is far from over," she said.Writing in Sunday's Observer, Williams raises a series of issues that she says must be addressed. Chief among them is a legal doubt as to whether the secretary of state will any longer be bound to deliver "a comprehensive health service for the people of England, free at the point of need".Some critics of Lansley believe the Tories are bent on a mission to privatise the NHS, gradually handing it to the private sector. They fear that moves to end the legal obligation on the secretary of state to deliver comprehensive services may be a deliberate part of the process.Concerns that ministers want more private involvement will be strengthened by details of email exchanges involving senior health officials about handing the management of 10 to 20 NHS hospitals to international private companies. The emails, which were made public following a freedom of information request and were obtained by non-profit-making investigations company Spinwatch, show that officials have been planning since late last year to bring in international companies. This is despite repeated insistences by both David Cameron and Nick Clegg that there will be no privatisation of the NHS. On 16 May, Cameron said: "Let me make clear: there will be no privatisation." Clegg said: "Yes to reform of the NHS, but no to the privatisation of the NHS."One of the emails released by the department shows that officials at the private sector firm McKinsey, which advises ministers, were in active discussion about bringing in overseas firms to take over up to 20 hospitals in return for contracts running into hundreds of millions of pounds. An email to Ian Dalton, head of provider development at the Department of Health, who is heavily involved in the reform programme, in November last year talks about "interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints".The emails show that McKinsey is acting as a broker between the department and "international players" that are bidding to run the NHS. The documents even lay out some of the conditions required by "international hospital provider groups" for running NHS hospitals. "International players can do an initiative if 500 million revenue [is] on the table." They also need to have "a free hand on staff management". The NHS would be allowed to "keep real estate and pensions".The Department of Health attempted to play down the significance of the emails, saying they were referring to what might be done if any one hospital trust asked for the private sector to become involved in running a failing hospital. A spokesman said: "It is not unusual for the Department of Health to hold meetings with external organisations. Any decisions to involve organisations, such as the independent sector or foundation trusts, in running the management of NHS hospitals would be led by the NHS locally and in all cases NHS staff and assets would remain wholly owned by the NHS."But a spokesman for the public service union Unison said: "Regardless of what Cameron and Clegg say in public, it is clear that behind the scenes the government is planning to privatise the NHS. Private companies will only run hospitals if they see a profit in it. This, together with lifting the cap off the number of private patients NHS hospitals can treat, will completely change the culture of the NHS. It will be profits before patients."We demand that the government come clean on their plans. If this is true, patient choice is a complete sham. The move to any qualified provider is clearly about creating a market for private companies. Any MP who votes for the health and social care bill is voting for the end of the NHS."Williams also raises worries about the extent to which the role of the private sector is being expanded. "I am not against a private element in the NHS, which may bring innovatory ideas and good practice, provided it is within the framework of a public service …" she writes. "But why have they tried to get away from the NHS as a public service, among the most efficient, least expensive and fairest anywhere in the world? Why have they been bewitched by a flawed US system that is unable to provide a universal service and is very expensive indeed?"She adds: "The remarkable vision of the 1945 Attlee government, of a public service free at the point of need for all the people of England, should not be allowed to die."John Healey, Labour's shadow health secretary, said: "As David Cameron's government railroads the health bill through parliament, MPs are being denied their constitutional role to properly scrutinise his plans for the NHS. The prime minister has already done a political fix with Nick Clegg on the health bill, and now he's trying to force it through with a procedural fix."

Allison Franklin ● 5358d

"And what's exactly wrong with social democracy?"Them's swearwords in certain areas of "society".I can hear it now...."H**ler had the blighters rounded up and shot you know." "Did he er... you don't think we could,erm... I mean, erm no we couldn't could we?" " No Boris, not yet anyway." "Ok Dave".

Tony Wood ● 5358d

Thank you for that Peter. Yes I can see that these internal market structures and certainly PFIs do much to hobble a clever scheme. If I may I have to come back to Phil Taylor who in his post above 2 Sept asked Eric Leach "Have you wondered why the NHS is so inefficient?" Unemployment in the US stands at around 9%. That's bad but as many US citizens get healthcare through employer provision this 9% will have healthcare limited by their own savings, if any. At a recent GP Consortium meeting I met an US researcher who told me 30% of its citizens were without healthcare provision. A study by Professor Prichard found that "The NHS is one of the most cost-effective health systems in the developed world." and "(of) the 17 countries considered  the US healthcare system was among the least efficient and effective." Lansley in his wisdom has all these private companies lined up to rip our system apart and guess where most of them come from...hey yes the US.I know you've been away Phil and we missed you but unless you use words in the same way as most of us do much of what you say is incoherent and seldom backed up by facts.One of your Conservative Party colleagues thought that this forum was a waste of time which could be better spent posting leaflets. Forget posting leaflets you keep posting here Phil. I have unblocked drains so for me it is an immense privilege and pleasure to see you digging deeper and deeper and taking your party, Angie Bray and Lansley's rubbish bill with you.

Arthur Breens ● 5358d

The problem with the health service is PFI and also the legions of overpaid management consultants who have plagued it with internal markets and other inneficiencies. A good friend of mine who is a life long conservative and also part of the anti-maastrict campaign made a good point in that a hospital serves a set population with a set number of beds, sheets, nurses, doctors, etc and it should not be rocket science to manage that. The so called experts do not like that and have a vested interest in making money out of making things more complicated. whether the geordie tories under blair or other experts there is a political orthodoxy at the moment that says there is something wrong with the health service and then proceed to recomend more of the same. let us get back to the way hospitals were run 40 years ago and we may get a clue about how to take things forward.

Peter Chadburn ● 5359d

In two short days next week the government will railroad through the Commons the longest NHS bill in history, with 1,000 new amendments. (That includes debating the abortion clause, wasting precious time to insult grown women with compulsory counselling from faith groups.)The government may hope attention has wandered over the summer. No doubt the bill will pass in the Commons – but some Lib Dems will lay strong amendments, their conference will see heated debate and the fight in the Lords will be championed by Shirley Williams. The Lords may regard the shocking lack of time for Commons scrutiny for a bill not in either party's manifesto as exactly the kind of constitutional occasion when they should step in. Whatever the government claims, privatisation is still there in its new clauses. The chaotic progress of this attempt to dismantle the NHS will be a casebook study in how not to govern: the NHS may yet lose them the next election.David Cameron inherited an unenviable legacy: the world crisis left him deep debts, inevitable cuts and rising youth unemployment that made inner cities combustible. But whatever else he called "broken", one service that flourished was the NHS. Confronted with such serious problems, why take the grave political risk of wrecking what was working so well?The Commonwealth Fund, comparing similar countries, puts the UK top for effectiveness, care and efficiency and for patient confidence, equity and safety; the UK is significantly less expensive than France, Germany and the US. Britain is the only country where those on below-average incomes are no more likely than the better-off to report trouble in paying medical bills or accessing health due to cost. Mortality from cancer and heart disease was falling faster than anywhere, while waiting lists were all but abolished. Labour's spending yielded good results, despite bad deals on doctors' pay and PFIs. When David Cameron told the Today programme in January that the NHS was "second rate", he had to apologise sharpish.Yet he embarks on this great disruption, costing £2bn, just when the NHS faces its harshest financial squeeze. Funds are not ring-fenced as promised, hit by extra VAT, national insurance and inflation, plus £500m sliced off for social care. Ageing and new technology – new cancer drugs, mechanical hearts – add extra just to stand still. Waiting times are up, hospitals are declaring deficits and by next year, cash shortages will be critical. So why break it all up now?The only explanation is blind ideology, still there in the revised bill, revealed by the legal opinion commissioned by the activist group 38 Degrees, expounded by Dr Evan Harris, rousing the Lib Dems. Spelt out, here are the key clauses that would change the NHS irrecoverably:• The secretary of state will no longer have a duty to provide a health service to all: that's devolved to an unaccountable National Commissioning Board. Nor will he have power to instruct the NCB, only a duty to respect its autonomy: no one can appeal to him against bad decisions.• Local GP commissioners, renamed Clinical Care Groups (CCGs), must put a duty to ensure choice (competition) well above "having regard to" equality. They can be challenged by private companies that want to tender, opening the whole system up to EU competition law, so all the NHS is up for privatisation.• The bill allows wholesale outsourcing of commissioning to the likes of KPMG or United Healthcare if CCGs prefer not to do it: will these prefer the private sector?• The National Commissioning Board has no obligation to distribute funds fairly according to an agreed formula. With no democratic input, it can distribute funds as it likes. Already money is gradually being shifted from north to south: the postcode lottery will grow.• Hospitals have no cap on private beds. When financially squeezed, priority can go to paying off debts with foreign patients. This too opens the NHS to EU competition law.• Monitor, the regulator, has barely altered since the row: it now has a duty to prevent anti-competitive behaviour – which is another, possibly stronger, way of saying promote competition.Extraordinarily, this gigantic re-disorganisation is already happening, with the husks of PCTs already handing over without waiting for the act. So badly construed is this law that some of it will surely never happen. Politically hospitals will not be allowed to go bankrupt, as this envisages. (Research to be published shortly shows that hospital mergers neither save money nor improve quality.) Whatever the bill claims, of course, the health secretary, Andrew Lansley, will still have bedpans tipped over him in the Commons when the NHS erupts. People already protest against any hospital closure: imagine their wrath at finding local beds blocked with private patients to cover costs, or hospitals closed by liquidators. With every NHS organisation vehemently opposed, where's the political profit? The only explanation is that the very existence of an exceptionally successful nationalised health service is such an affront to everything Conservatives believe in that it's worth the political risk of demolishing it once and for all.Let's get one thing straight. The NHS does need constant reform – always has and always will. Megalomaniac politicians of all parties love mighty structural upheaval, but what works is detailed, expert and quite dull. Health economist Prof Alan Maynard, observer of many pointless upheavals, has made the case for evidence-driven medicine for decades. Money is saved and health improved by obliging all to follow best treatment guidelines. The Isle of White saved A&E admissions by sending nurses to teach asthmatics to use their inhalers correctly, so why not everywhere? Nurses can do 70% of what GPs can do, cheaper and, he says, often better because they do follow guidelines. And why have GPs just escaped scrutiny of their performance, by refusing to hand over their data? Prof Ara Darzi's research shows re-admissions after bowel cancer operations vary wildly: heart treatment was improved by eliminating the worst practice outliers. Nursing patients kindly sends approval rates soaring.Forcing all the NHS to follow Nice guidelines doesn't need markets or politically inspired reorganisations. Money coupled with tough targets worked well for Labour, though it too squandered much on vainglorious "new" systems. Let's hope the Lords arrest the damage done by this one.

Allison Franklin ● 5359d

And what's exactly wrong with social democracy?

Eric Alan Leach ● 5359d

Phil  There you go again with the "Rude" card,quite fond of that aren't you? I try to balance my rudeness to the occasion,lies from someone who should know better being at the top of my list.  Truth hurts,and is apparently quite alien to you.   It seems that you feel it's OK to use lies to back up your tenuous (in extremis) suppositions,please show us any proven evidence that you have to back up your claims re 38 Degrees.  Trying to keep a check on the current Government doesn't count,that doesn't make them communists,we don't know how they will behave with any future Labour government and that can only be supposition.    Give us the facts to back your claims please.

Tony Wood ● 5359d

Tony,Don't be rude.  38degrees ASSERTS that it is not political but it certainly has a centre-left, I would suggest Social Democratic, point of view.  It merely omits to align itself with a particular party.  I repeat 38degrees is intensely political.

Phil Taylor ● 5359d

Grrr! I'm really,really angry with you Phil,that was a complete lie you wrote about 38 Degrees being politically aligned,it slipped past me and I'm "F squared off" with you.http://en.wikipedia.org/wiki/38_DegreesLiar!

Tony Wood ● 5359d

I'm well aware who they are Phil,I have been a member for some time,at the moment it's still legal to do so.  Mind you,as their popularity among the politically  disaffected rises,I'm sure the Government will find a way to "control" them.

Tony Wood ● 5359d

Tony,38degrees is a Social Democratic campaigning organisation.  It is totally unaccountable refusing to divulge its structure, funding or decision making process.  If a public body, charity, limited company or political party acted like this it would be breaking the law.  38degrees is intensely political and their NHS campaign is intensely political.  I suggest you write and ask them for details of their funding, etc.  Don't expect any answers.

Phil Taylor ● 5359d

"It seems that neither 38 Degrees, their Toytown barristers or you have a commercial bone in your collective bodies."Phil...  It seems to this casual observer that by using the same criteria as yourself, I could conclude that your party may only have commercial bones in their bodies.   I'm not at all convinced that's a good thing either.Others...I have to say that I'm getting more and more impressed with 38 Degrees, I'm just hoping that they don't get all political and turn into mushroom farmers as have all other political parties.

Tony Wood ● 5359d

It's odd that if I am such a commercial dunce that I managed to run my own business profitably for 12 years. And do you think that the 480,000+ who have signed a petition against these NHS changes are all commercial dullards as well?'Toytown barrister' eh. You dodn't have much respect for other people's skills do you Phil?

Eric Alan Leach ● 5360d

The reason the NHS is so inefficient is that all the changes brought in to increase competition etc... have had the opposite effect. i.e. to manage outsourcing contracts you have to recruit expensive managers and staff that cost more than the staff that got outsourced. this is what happens when some private companies do it. the nhs management costs have outstripped in percentage terms that cost of other staffing in the nhs. so more reform in the same vein of what blair and predecessors have done will deliver more inneficiency and higher costs.

Peter Chadburn ● 5360d

Eric,On procurement the advice seems to be that NHS bodies will have to follow the same rules that other public bodies do.  Wow, big deal!  Have you ever wondered why the NHS is so inefficient?  There is a risk that NHS bodies will incur legal costs but this is slight - very few suppliers want to get a reputation for being litigious with repeat customers - doh!  The legal advice ignores the more likely outcome that if the NHS uses fair (if a little clunky) procurement rules it will save rather more money than it risks in legal disputes.  It seems that neither 38 Degrees, their Toytown barristers or you have a commercial bone in your collective bodies. 

Phil Taylor ● 5360d

New, independent, expert legal advice on the proposed changes to the NHS confirm that the Government's plans pave the way for a shift to a US-style healthcare system, where private companies profit at the expense of patient care. Postcode lotteries for treatment will increase and UK and EU law will allow private companies to take NHS commissioning groups to court if they don't win contracts.You can view the full legal report at https://secure.38degrees.org.uk/nhs-legal-adviceIf you suspect that your MP will vote for these crippling NHS reforms you can email her this damning legal evidence at:https://secure.38degrees.org.uk/email-the-evidence

Eric Alan Leach ● 5360d

So sorry to update you in this way. The Health and Social Care Bill gets its 3rd reading in the Commons on the 6th and 7th of Sept with the vote to pass or not to pass it to the Lords on the 7th. I still can't believe how such a "hopeless monster" could get so far.

Arthur Breens ● 5366d

As ever "spot on" Eric. Two stories. My friend's toddler had started walking with a limp. Visit GP. Second question," Have you got health insurance?" Next story posted by the Gazette about the Urgent Care Centre run by Care UK that triages and treats A & E cases at Ealing Hospital. Remember it was Care UK who picked up the £53,000,000 contract shortly after the election to provide medical services to prisoners. Oops forgot they gave the Tory party and Andrew Landsley lots of money before the election.Anyone with any more information good or bad about this private  initiative in Ealing Hospital?

Arthur Breens ● 5388d

Don't think that because the NHS Revolution Bill has not yet passed through Parliamant that NHS privatisation changes are not happening anyway. Large well funded private healthcare companies including Care UK, Circle, General Healthcare Group, BUPA and United Health started lobbying hard in October 2010 to be paid by the NHS to provide services.CCP, the NHS regulator, is apparently siding with the private helathcare companies (and enjoying their 'hospitality') and last week accused PCTs of letting patients 'die' whilst waiting for operations in NHS hospitals. There's nothing like a level playing field - and this clearly is not one.

Eric Alan Leach ● 5391d

Eric you asked that if people were happy with these changes then they might enlighten us here on this blog. They haven't really rushed in and other supporters of the Bill are now demoted from writing on this forum to leaflet delivery. We were hoping to hold a public meeting. In order to do this we were looking for a well informed Bill supporter. We seem to have failed to locate one locally.

Arthur Breens ● 5402d

Whilst the press, TV and many of us, are somewhat pre-occupied with the rapid meltdown of the management of the Met Police, the destruction of the NHS continues in the background.The Committee stage in the House of Commons has now been completed. The Bill will return to the House in September and during that month or in October the Bill will be reviewed in The House of Lords.Expert opinion tells us that changes to the Bill have been made but that overall the toxicity of its intentions and outcomes is just as severe as it ever was.Consider these points, the Bill will:1. Enable private equity companies to buy NHS facilities and asset strip them with direct parellels to the demise of Southern Cross.2. Satisfy the Government's wish to have the maximum number of both purchasers and providers, in order to create a citizen-consumer competitive market to drive forward the forces of  'creative destruction' on the NHS.3. Drive Foundation Trusts into further debt, forcing closures, mergers and private management takeovers.4. Inevitably cost us all more money to receive less care and a precious, principled and cost effective national, universal health service lost for ever.

Eric Alan Leach ● 5405d

The small print in this Bill has huge implications.How about this one:'....THE  CREATION  OF  SURPLUSES  FROM  THE  PATIENT  CARE  BUDGET  CAN  BE  DISTRIBUTED  TO  STAFF  AND  SHAREHOLDERS  AS  PART  OF  FINANCIAL  INCENTIVE  OR  BONUS  SCHEMES  (Section 23),  AND  THESE  SURPLUSES  CAN  BE  GENERATED  BY  SELECTING  PATIENTS  OR  SERVICES,  DENIAL  OF  CARE  OR  REDUCTIONS  IN  STAFF  TERMS  AND  CONDITIONS.'This clearly is a charter for GPs to print their own money.

Eric Alan Leach ● 5414d

Eric we are no further forward we are indeed a long way further back. The whole issue smacks of poor government, poor leadership and dogma. Clegg and Cameron signed off this monster bill without reading it or if they did read it they never really understood its implications. Thousands of voters have tried to understand it. At least I had the help of medical students from UCL. That was back in February. In June it is now exposed for what it really is, an attempt to cast off the NHS from political responsibility like some energy utility and blow it apart by opening it up to private companies. Like a dead whale Lansley's bill lies beached and rotting. You can smell the stench for miles. And for all the PR and spin the stench still hangs in the breeze.

Arthur Breens ● 5435d

Recent expert opinion on the government's latest intentions with regards the NHS is that the amended bill will continue to state that the Secretary of State's duty will be to (only) promote a universal healthcare service not. So with the absence of a duty to provide a universal healthcare service  we are no further forward.

Eric Alan Leach ● 5435d

I think we should all be cautious about the latest set of changes announced by Cameron, Clegg and Lansley at Guy's Hospital yesterday.We need to see specifically how the Bill is reworded. The idea that they would restore the Duty of the Secretary of State to provide a universal healthcare service throughout England seems fanciful - as this is the basic Lansley tenet of creating a 'Notional' Health Service.For intelligent comment on this on-going debate I recommend the BBC's NHS Blog.

Eric Alan Leach ● 5439d

Two multi-millionaires who asset stripped Southern Cross are JP McManus and John Magnier. And equally shocking is the revelation that the owners of the company which runs Winterbourne View 'hospital' (who Panorama exposed for systematic patient abuse) are McManus and Magnier again.I'll bet McManus and Magnier can't wait to get their hands on bits of the NHS and 'sweat' the assets which we have all paid for in taxes over many years.

Eric Alan Leach ● 5440d

Whilst the NHS may not have been privatised many of the driving forces behind such a move are well placed within the NHS. Southern Cross rents the homes from companies who then are mortgaged to the hilt. so the empire is based on fresh air and profits for all concerned. I am sure a mix of mutual organisations would do a far better job. if the companies went bust the new owners would be us via the RBS so any rescue should mean just taking public ownership and then putting them into a mutual structure.

Peter Chadburn ● 5442d

Interesting to note and you may draw your own inferences and conclusions (my apologies ifthis is mentioned elsewhere) that Patricia Williamson, Group HR Director of Southern Cross Healthcare Group PLC, is also a non-exec at Ealing Hospital NHS Trust. Source: http://www.ealinghospital.nhs.uk/about-us/board-members/non-executive-directors/I would have thought that dealing with 3000 job losses and multiple home closures was enough work at the moment.

Nigel Brooks ● 5443d

The key is that various people have their fingers in the pie based on large loans from RBS.lots of profit for a few people.

Peter Chadburn ● 5443d

So what’s now likely to happen is that capacity in the sector will continue to be reduced forcing local authorities to provide the service themselves (at a substantially higher cost because they are less efficient), or elderly / vulnerable people will simply have nowhere to go. -----------------------------------------What evidence do you have that local authority care homes are less efficient than privately owned ones? I would have thought that Southern Cross's Director of Finance, CEO and Board are about as inefficient as it is humanly possible to be.  They paid £1bn for the group, did not restructure the way in which the group was run before now and seemed to find it unimaginable that local authorities would find themselves having to make cutbacks.

Allison Franklin ● 5443d

Oh Ed thanks for putting us all right about Southern Cross. It was (according to you) the local authorities 'what done it'.Was it really?What about the multi-millionaires who asset stripped the company by selling off all the freeholds on the care home properties?Southern Cross is going bust under private control not under public control. No doubt the 'below cost fees' could have been predicted when the finacial geniuses took over the Southern Cross care homes from the public sector.It's one thing for millionaires to asset strip Leyland/Rover car company but for millionaires to carry out a similar swindle putting 30,000 elderly, vulnerable people at risk is a different scale of obscenity.

Eric Alan Leach ● 5443d

"This week Southern Cross is at risk of going under. They have taken over a state activity. So what happens to the residents to whom some statutory duties of care are owed?Next we have the private owners of London's Fire Brigade vehicles at risk of going bust. Pudding Lane here we come again.So if the different types of scanners in Ealing hospital become privately owned and the company goes bust then do we just take herbal remedies?"This misses one rather obvious point - a significant contributor to the position Southern Cross finds itself in is the below cost fees paid by local authorities.As anyone who has a relative in care will know, private residents effectively subsidise the local authority residents despite receiving the same service - the delta between the fees for the same service can be as much as £200 a week but in the best cases is still north of £100 a week.To compound this, minimum standards have been raised (which is a good thing) but the result of the additional investment required is that care home operators have found that the working capital requirements are such that it’s not possible to continue in business – many have gone bust over the last 5 years.So what’s now likely to happen is that capacity in the sector will continue to be reduced forcing local authorities to provide the service themselves (at a substantially higher cost because they are less efficient), or elderly / vulnerable people will simply have nowhere to go. What’s required is for local authorities to make a fair contribution to the costs that their residents incur, instead of expecting private residents to subsidise it or the hard working people who work in care homes to always have to work for the minimum wage.

Ed Yelland ● 5443d

I've missed Lansley's "listening exercise" sorry I wasn't invited. Twernt for the public!!! What have they got to do with it?  But tonight I enjoyed excellent speeches by Katy Clark MP, Dr John Lister and Andrew Fisher at an open public meeting in the Town Hall. Along with about a hundred others we were reassured we are a rich country and our borrowing as a proportion of GDP is lower now than it was under the Thatcher or Major administrations. George Osborne wants us to cut not to cure the debt but to reduce the size of the state. He, if he really believes we are in a terrible mess, has lost his sense of proportion, a worrying trait for a chancellor. But we will be in a terrible mess if we  are forced to follow his dogma. A library or a hospital unit once closed may never be reopened

Arthur Breens ● 5444d

This is a big issue with privatisation and the problem is that the fire brigade contract was signed in 2001 under labour. so who is there politically against all these stupid contracts.

Peter Chadburn ● 5449d

This week Southern Cross is at risk of going under. They have taken over a state activity.So what happens to the residents to whom some statutory duties of care are owed?Next we have the private owners of London's Fire Brigade vehicles at risk of going bust.Pudding Lane here we come again.So if the different types of scanners in Ealing hospital become privately owned and the company goes bust then do we just take herbal remedies?

George Knox ● 5450d

With NHS outsourcing and an eye to profiteering at the expense of people's ill health how much worse will life be? The really sad thing is if some one had found a pet which had been hacked to death by a vandal or if we were debating hunting with hounds, or religion, or the AV issue, or immigration or libraries and car parks then there could be up to 200 postings.But talking about the NHS seems to be a turnoff.Have you been to or in a hospital recently? Have you been snapped at by bad tempered staff? Is it true that staff will not care for you if the function is not in their job description? Has any body seen a job description? Do any of the staff read your file at the end of your bed? Have you had to wait for ages to be assisted to the WC? How many beds get soiled? Who turns you and how often? Have you eaten their overcooked tepid food? Have you heard the groans of patients at night in a general ward when only a couple of staff are on duty? Have you been a victim of not been given drinking water which we read about? Why does your half filled glass of water get taken away and then a new jug of water appears so much later? Have you waited ages for a hospital appointment only to have it deferred yet again? The list is endless.Apart from again enjoying the satire of Beyond the Fringe etc,the most interesting comment for me on a programme about Amnesty last night was that our culture has changed so much. Young people are worried to bits about how they can afford to make ends meet. People are so consumed by their careers that they have neither the will nor the energy to pursue the big issues of the day. The will to fight for causes has diminished so greatly that the actions we saw in the 1960’s and 1970’s seem like a black and white film about the eccentricities of a former and forgotten age.Did we really have so much more time on our hands 50 years ago that we could campaign and get change implemented? Is today’s “progress” implemented by young senior managers actually a retreat from decent moral standards?

George Knox ● 5452d

And there is still time for you to join the 422,748 people who have signed the 'Save Our NHS' petition.www.38degrees.org.uk

Eric Alan Leach ● 5452d

Stop Press Brilliant News.The  government seems to have stepped down on its plans to privatise the Blood Tranfusion Service. This is the envy of the world. In the UK high quality blood is obtained for free. It is a magic formula as all of us who have received or given blood will testify.In other countries blood has to be bought and frequently from the poorest and thus unsafest sectors of the population.Had this privatisation gone ahead our service would have drifted downhill to match the rest of the world.

Arthur Breens ● 5455d

The purported need for Lansley's Health and Social Care Bill is to cope financially with us oldies getting more numerous and more expensive and dammit getting to live longer. How inconsiderate is that? That and the ever increasing drugs bill we are told means our old tried and tested NHS formula is obsolete.However in all this discussion it is difficult to detect a logical connection between the changes proposed and how they will generate more money to fund us oldies in our demise or the burgeoning drugs bill. Like "Animal Farm" the bill perhaps is trying to tell us that "some animals are more equal than others" and that this is the way using an ever increasing private sector that some may get better care than others. Is it that some may pay and therefore get priority in a two tier system and this is how care can be afforded. This bill is starting to introduce a system like they have in the States where 30% are just not covered and just make-do and die. Let's not pussy-foot around lets "Kill the Bill" before we become its casualties.

Arthur Breens ● 5465d

Yes the people in Monitor are worrying especially the former Blair aide. a bit too business friendly. Found it funny that our Council leader was protesting against a closure of ealing hospital that has not been announced when he was silent on the closure of albert dane and other facilities for the disabled.

Peter Chadburn ● 5466d

Cameron and Clegg are both saying that they don't want to 'harm' or privatise the NHS.But there is just no sign that they are going to back changing Lansley's proposals in order to retain the duty on the NHS to provide a comprehensive healthcare service or to retain the Secretary of State's powers to block charges to patients.There's also no detail coming out of Cameron's or Clegg's mouth to suggest that general practice and commissioning functions will NOT be operated and managed by for-profit companies.Cameron visited Ealing Hospital yesterday and spoke to staff there. But no-one told the 300,000 residents in Ealing about this. We were not given the chance to see and hear Cameron listening to us about the proposed NHS changes.Well over 380,000 in the UK have now listened and signed the 38 Degrees petition objecting to the NHS changes. If you haven't joined them yet please do so.

Eric Alan Leach ● 5467d

My MP has confirmed the fact that patients are not at the heart of the Lansley's NHS reforms because she tells me in today's newsletter that the "LISTENING EXERCISE" is confined to health experts and medical staff. Just who are to be the beneficiaries of the NHS reforms? Can't be the patients otherwise you'd be keen to listen to them.

Arthur Breens ● 5472d

In the days when I was a kid you watched cowboy films at the local cinema. Often a sad seated native American spoke the immortal words,"White man speak with forked tongue". The only London government panel "LISTENING EXERCISE" which is a key feature of the progress of this miserable Health and Social Care Bill is I understand in Islington between 2:00 and 4:00pm this Friday. While the public and patients are a key element of the NHS they are of couse EXCLUDED.

Arthur Breens ● 5473d

The Royal College of General Practitioners is the first organisation to submit evidence on the NHS reform Bill. The college is sharply critical of the bill and says that the healthcare reform plans could destroy the NHS unless they are substantially overhauled. These doctors' leaders warned that the bill would allow GPs and hospitals to charge for certain services, weaken the NHS by allowing 'any willing partner' to treat patients and allow parts of the health service to be taken over by venture capitalists and foreign healthcare companies.Doctors' leaders also fear that it will be impossible to deliver integrated services in practice, especially where integration relies on close collaboration between different providers and commissioners, and could be seen as anti-competitive.Further they fear that the scrapping of the Health Secretary's duty to ensure a comprehensive national healthcare service means that the NHS founding commitment to universsal, free healthcare is under threat.

Eric Alan Leach ● 5475d

So....either Monitor did not work out the 'efficiency savings' aka cuts figure correctly in the first instance OR they put out a 'challenging' figure, Trust CEOs took the bait and agreed to go ahead without compromising front-line services (they must be having a giraffe) and now they find they are being asked over a 5-year period to cut 37% without compromising frontline services, patient care and safety.------------------------------------------------Hospital efficiency target rocketsBy Sally Gainsbury and Nicholas TimminsPublished: April 28 2011 22:27 | Last updated: April 28 2011 22:27NHS hospitals which took the government’s pledge to “protect frontline services” with “real terms” increases at face value, were hit by harsh reality on Thursday when their regulator said they would need to find efficiency savings equivalent to £2.9bn this year alone.The 6.5 per cent savings target of the regulator Monitor for 2011-12 is 2.5 percentage points, or £1.1bn, higher than that set by the Department of Health in December.Compounded over the five years for which Monitor has published projections, the efficiency target for hospitals is 37 per cent.Chief economist at the King’s Fund think-tank, John Appleby, said the savings needed were a “substantial hike” over earlier forecasts.“I can see a hospital doing this for one or two years but not five years,” Professor Appleby said. “It’s like the unit cost of a hip operation [around £6,000] has got to decrease by 37 per cent. How?”The numbers are more than just a description of the financial pressures faced by the NHS, however. They are also the figures the regulator will use from May 1 to assess the robustness of applications from NHS hospitals to become independent foundation trusts and for any takeovers planned.By, in effect, raising the bar for those assessments, Monitor may have made it more likely that struggling NHS organisations will be offered to private companies rather than merged with existing foundation trusts.There are about 85 NHS hospitals and mental health trusts that have yet to become foundation trusts, with the government aiming to have all of them reach that status by April 2014. In the last financial year, when Monitor’s efficiency target was much lower at just 4.5 per cent, only seven organisations met its standards for approval.The Department of Health is growing increasingly concerned about those hospitals within the 85 that have expensive private finance initiative deals which make foundation trust status unachievable. It has invited consultants to review 22 particularly severe cases and propose options.The bulk of the gap between the health department’s 4 per cent efficiency target and Monitor’s 6.5 per cent is accounted for by changes in the inflation forecast and Monitor’s more pessimistic assessment of hospitals’ ability to cope with the new financial penalties that the department has introduced.The consequences include not paying hospitals, in some cases, for patients who are readmitted. The health department assumes that hospitals will be able to reduce readmissions by 60 per cent over the next five years. However, Monitor assumes that readmissions will continue to grow at 4 per cent a year.Monitor said: “It is a more challenging environment than in previous years. If Monitor had not made these adjustments, we would effectively have been lowering the bar and increasing the risk of failure among newly authorised foundation trusts.”Nigel Edwards, acting chief executive of the NHS Confederation, said Monitor’s numbers “fit with the anecdotal evidence that we are hearing”.He added: “Very few hospitals are having to make only 4 per cent efficiency savings. Many are facing six, seven or eight per cent and one or two over 10 per cent. And not necessarily for one year, but year on year for two or three years.“Whether that is achievable without fundamental changes in the way services are delivered must be in doubt. “The history of this is not that encouraging and there must be questions about whether it is possible to deliver this.”

Allison Franklin ● 5483d

For those who haven't signed the Save The NHS petition, go to www.38degrees.org.uk and join the 264,582 people who have signed the petition.In the case of the planned destruction of the NHS as we know it, silence is not golden.

Eric Alan Leach ● 5483d

We have come some distance here but Peter and Eric seem to have left you behind Ed. In one entry you are supporting Lansley's Bill by advocating GP Commissioning Consortia as a good thing. In another entry the very next day you go into a tirade about GPs,their self interest and salary hikes. Lansley's Bill puts both money(80%?) and power into the hands of GPs. Many don't want that. They fear clinical judgement might be compromised because they are also being asked to hold the purse-strings. My worry is Ed that neither you nor my illustrious MP have made any sensible or coherent case for the Bill. From you I get "all nurses are against it" and I never wrote that and from our MP my wife receives some Tory crib sheet widely circulated in many constituencies with tone, inaccuracy and slant that does much to dispel her suggestion that "the natural break"...."is a genuine listening exercise".

Arthur Breens ● 5489d

Well said!!! privatisation is what labour/tories want

Peter Chadburn ● 5489d

Well... in answer to my questions about which organisations have welcomed Lansley's healthcare changes and whose interests they represent....Virgin, Care UK, Chilvers McCrae, UnitedHealth UK and Circle are all commercial medical organisations who welcome these changes and they all represent the interests of their shareholders. I'm sure all of them are 'driven by considerations of their personal remuneration'.To re-iterate, the Bill as drafted amounts to the abolition of the English NHS as a universal, comprehensive, publically accountable, tax funded service, free at the point of delivery.

Eric Alan Leach ● 5489d

I'm not sure that the support of the Trade Unions or the Royal Colleges really counts for anything. There's no better evidence of the quality of their judgements than the fact many medics fought tooth and nail against the establishment of the NHS in the first place, claiming that it would damage patient care.By way of a historical example, GPs initially advocated a greater provision of services under their direction as an alternative to the NHS, but 50 years later claimed that this exact model would be dangerous when the proposals for Polyclinics were made.What you see when you look at the behaviour of the professions over any length of time is that they typically work solely for their members' interests and are far too driven by considerations of their personal remuneration as is the case now.GPs were supposed to have improved primary care in return for a 40 pay rise and dropping night time responsibilities. 6 years on, and with average GP pay now touching £115K / £130K for dispensing GPs, the quality of care hasn't risen, GPs are working less hours than before and to cap it all, they've offered to take back responsibility for night services in return for additional pay. Nowhere in this have the interests of patients (or tax payers) received proper consideration.

Ed Yelland ● 5490d

I think you'll find that Trades Unions attempt to protect their members' interests.Out of interest which medical associations or medical organisations have come out in favour of the Landsley changes? It would be interesting to see who these groups are and whose interests they are attempting to protect.

Eric Alan Leach ● 5490d

We end up with union bashing arguments. however it is the question of the future of the nhs. are we to end up with a us style health service or carry on with a free nhs. key question for labour. as they appear ambivalent over the future of the nhs.

Peter Chadburn ● 5490d

Arthur, 499 trade union members voting in the same room together does not mean that "all nurses are against it". It just means 499 trade union members wanted to make some political capital.Likewise - many thousands of GPs are actively involved in the new commissioning consortia - you'll hear lots of doctors working in secondary care warning of the "destruction of the NHS" but in practice what's happening is a long overdue shift in care settings from hospitals to the community.

Ed Yelland ● 5490d

The RCN and BMA are Trade Unions - they both have a pretty good track record of resisting any reforms that impact on their members and typically use the guise of "protecting patients' interests" to divert people's questioning.

Ed Yelland ● 5490d

Angie Bray MP wrote a letter saying that doctors and nurses are not against our (Lib-Dem) plans for the NHS. My wife received this letter on the very day the Royal College of Nursing Conference overwhelmingly (99%) backed a motion of no confidence in Andrew Landsley's handling of the NHS reforms.My fishing mate in Chertsey received a very similar reply from his constituency MP. We read the letters to each other an alternate line at a time (no scanner). Now how sad was that? Well it was a hoot actually. There were some minute deviations which we stopped and pondered over but the similarity of the pedigree could be easily detected.Reckon we've found you a job Ed.

Arthur Breens ● 5491d

There's no reason why I should have known about Monitor's existence - I'm only a humble patient after all.Why do you think the RCN, BMA and many other NHS professionals are so bitterly opposed to the Lansley proposals?

Eric Alan Leach ● 5493d

Eric,The NHS Constitution will still protect the rights of patients and ensure a comprehensive service - the current legislation is duplicative and as the Secretary of State has made clear, the NHS should have more freedom to operate without political interference.Monitor is not "about to be created". It's been going for at least 4 years and for the sake of labouring a point, does not have a remit to create a "market" in the way the way that most people would understand i.e. a commercial construct. The Monitor definition of a market is more focussed on ensuring that there is sufficient capacity in the system - particularly for specialist treatments e.g. rare blood cancers, that affect small numbers of patients whose needs would otherwise be overlooked. In this regard, Monitor works with other bodies e.g. the DH, to set the price that can be charged to ensure that it's possible for Providers to maintain a viable service even if patient volumes are low. It also works in a similar regard to help set the price / tariff for more common treatments and uses this as a way of driving efficiency / productivity - the CQC remains focussed on quality and safety by way of balance.

Ed Yelland ● 5493d

The specific wording of the Act states that the Secretary of State has a duty to promote a comprehensive service. The duty to provide one is abolished. My reference to 'chargeable local authority' is taken from 'House of Commons. Health and social care bill 2010-11. Explanatory notes. Staionery Office, 2011'.Monitor is being created to regulate a health care market. I don't want a market in health care. Monitor, apparently, will decide whether the Secretary of State is promoting a comprehensive healthcare system instead of Parliament deciding.I'm not saying that anything you say is nonsense. I'm trying to interpret the proposals as I and expert sources perceive them.

Eric Alan Leach ● 5493d

"In the current set up there is a duty to provide a comprehensive health service throughout England. So if certain healthcare units are under performing the national government has a duty to attempt to improve the under performing unit. Under the Lansley approach this duty is abolished, and the State will have no duty to improve that healthcare unit. If that healthcare unit 'fails' under Lansley patients in that locale will have to turn to the chargeable local authority sector.(Local authorities under Lansley become healthcare providers of last resort)."Eric, sorry but that's almost complete nonsense and is also a distortion of the facts.All providers are required to comply with the regulations set out in the Health & Social Care act. This takes the form of demonstrating compliance with the Essential Standards of Quality and Safety for all services they provide. In addition to that, Providers who will over time mostly become Foundation Trusts, are also regulated by Monitor.So in the current system, two (in fact there are well over 60 in total) regulators have primary accountability for making sure that care meets minimum standards and that provider organisations are well run. Your claim that "So if certain healthcare units are under performing the national government has a duty to attempt to improve the under performing unit" is therefore not true - it's regulators who directly manage providers and not the national government (or even the SoS for that matter).Your second claim that "If that healthcare unit 'fails' under Lansley patients in that locale will have to turn to the chargeable local authority sector.(Local authorities under Lansley become healthcare providers of last resort)" doesn't even make sense. There's no such thing as the "chargeable local authority sector" for healthcare - LE's only provide social and domicillary care. In practice what will happen in the event that Providers are found by regulators to be delivering sub standard care is the following:1. They will be required by the regulators to demonstrate improvement in the relevant areas2. If that doesn't happen, senior managers and clinicians will be replaced3. If that doesn't result in a change, a takeover by a high performing provider would be encouraged4. If that doesn't happen, patients would be referred to other providers (private or public - as is the case currently) who can provide the same services.

Ed Yelland ● 5493d

Eric,methinks that whilst the alnsley approach may on the outside appear an improvement, the devil is in the detail and you with your engineering hat on find it an easy one to knock down.

Peter Chadburn ● 5494d

Even if we privatise vast portions on the NHS we won't get away from the fact that some organisations and individuals will always perform better than others.In the current set up there is a duty to provide a comprehensive health service throughout England. So if certain healthcare units are under performing the national government has a duty to attempt to improve the under performing unit. Under the Lansley approach this duty is abolished, and the State will have no duty to improve that healthcare unit. If that healthcare unit 'fails' under Lansley patients in that locale will have to turn to the chargeable local authority sector.(Local authorities under Lansley become healthcare providers of last resort).

Eric Alan Leach ● 5494d

The revoulution i would want is to wind the clock back 20 years and look at what was good/bad then. then look at what has happened in the last 20 years and learn from good/bad and then work out how to fix things. all we see from hewit/milburn/burnham/lansley is the same old rhetoric about how private industry can make things more efficient. i would say that when you look at monopolies both private and public they only have to be efficient as they need to be. we have seen fat bloated profitable private companies plunged into crisis as soon as competition comes along. competition in the health service is different. it is wanted by the consultancy/private brigade and creates extra levels of beuracracy. we need to simplify things. "i am ill if go to the docs, he/she sends me to an appropriate local hospital and i get fixed" ensure that this simple relationship is maintained andd that the healthcare professionals do not have to go throuigh hoops to do it.

Peter Chadburn ● 5494d

"Funny how the NHS has worked pretty well for over 50 years.It might well need reform and better regulation but why should it need a revolution?"It depends what your measure of "pretty well" is.If you measure by the things that really matter:- survival rates for cancer- clinical outcomes at 1 and 5 years for procedures- number of errors that result in serious harm or death being caused to a patients- number of patients on an unsafe mix of medicines- number of patients with a long term condition admitted as an emergency- number of patients who have surgery and need to return for a repeat procedure within 30 days of discharge- number of patients who have surgery and are admitted as an emergency case within 30 days of discharge- number of doctors and nurses who are employed without references being checked... you'll find that some NHS Trusts really are excellent in every regard, but the typical picture in most Trusts is highly variable despite receiving a similar level of funding. If some Trusts can be "excellent" and other Trusts are poor and funding remains equal, and no major improvements have been delivered with Trusts left to their own devices, it's fair to assume that a more directive approach is required in order to protect the safety of patients.

Ed Yelland ● 5494d

The advisors aren't / weren't from US Healthcare organisations - that's just media spin and nonsense thrown about by Trade Unions.The only person who was actively involved at the time and who now works for a US Healthcare provider is Simon Stevens - and even he works for their Ovations business which provides services to elderly patients in the US so has nothing at all to do with healthcare in England.

Ed Yelland ● 5494d

It's good to get responses.Funny how the NHS has worked pretty well for over 50 years.It might well need reform and better regulation but why should it need a revolution?You didn't deal with the fact that patient satisfaction levels are at an all time high. Yes it's true that waiting times are extending. This is hardly surprising given that PCTs are leaking staff and staff are uncertain about the future and many are demoralised.It's clearly a 'religious' issue to me that the State runs a national health service. It's clear to me that this is not a religious issue for you. You clearly want efficiency (not a bad thing in itself) but you don't seem to care about accountability, equity of access, commitment to free of charge services, and the mandating of a national, comprehensive healthcare service.

Eric Alan Leach ● 5494d

Ed,you make some good points on that but what we see is politicians with a vested interest (Milburn,Hewitt,etc) moving to privatise the NHS. The advisors are from US Healthcare organisations. The result could be chaos

Peter Chadburn ● 5494d

But you can't blame the private providers for being paid for operations they didn't do when it was the vested interests of NHS Commissioners and Clinicians that effectively stopped patients being referred to them.... In many cases, GPs still don't tell patients they have a choice of where to be treated, and even in the event that they do tell the patient, they simply tell them where to go on the basis "that's the best place" which has more to do with knowing people / having friends who work there than any consideration of the clinical outcome that the patient might experience.Given that the private contractors were required to make up-front long term capital investments, it's reasonable for the DH to commit to a minimum referral volume. Given that the Providers have no direct relationship with patients and are restricted from promoting their services, there's not much they could have done to get more patients through their doors. The questions that really need to be asked are:1. Why did commissioners and clinicians deliberately work against the policy mandated by the DH?2. Why were clinicians and commissioners not punished for withholding information on choice that could have enabled patients to be seen more quickly and get better treatment?3. Why do clinicians think it’s ok to effectively prevent patients from using services that would alleviate pain and suffering more quickly?Another way of looking at this would be to use the example of an Events company, contracted to put on an event on behalf of the client. If they deliver on their contract by booking a venue, the band, food etc, but the client's guests fail to turn up, should they be expected to not charge the client and pay for everything?

Ed Yelland ● 5494d

general public’s obsession with buildings and an unwillingness to focus on the servicesThe press and politicians are the people obsessed with our so called obsession. service is what we actually want. my girlfriend kathy who died in 2009 was treated at the brompton for many years which is an old building but the service was high class. would a resulting pfi improve the service. no it would not as money goes away from patients to bankers. the private examples i talk about are the various heavily subsidised private ventures under labour which got waiting lists down but often got paid for operations they did not do. i agree that something needs doing. however the solutions are in a sense more of the same. they nhs we knew and loved as such has not existed for 20 years or more. commercialisation of hospitals has been going years with a resulting increase in clipboard johnies. in a sense we need to strip back everything and see what a hospital actually needs in order to run efficiently and provide a service to patienst (not customers as labour/tory consulancy types want to call us) the current wisdom is to replace public with private. but inneficiency just becoms better rewarded. people from private industry do not bring their skills into the NHS. If they were any good they would be making money. a real revolution is what is needed in the service.

Peter Chadburn ● 5494d

the "marketplace" has given us:1. PFI Contracts that screw the taxpayer. I agree. There's no disputing this - Labour wasted c£60Bn on building white elephants - new hospitals that were too big for the needs of the local area, cost too much to run and in many cases are already no longer needed due to the ongoing move to provision of more services in community settings. Having said that, this largely reflect the general public’s obsession with buildings and an unwillingness to focus on the services. We’d rather have nice shiny hospitals that we don’t actually need rather than closing down hospitals we don’t need and investing the savings into better community services  - and we won’t listen to politicians, clinicians or evidence that tells us this is daft.2. But ...the marketplace has given us the proof that it's possible to complete more procedures at lower cost without compromising outcomes. Until this happened the professions were adamant this was not possible and as such, have had to find ways of improving their productivity. Since the use of private sector provision, waiting times have come down largely because surgeons have to spend more time in surgery rather than "training" (although many still spend 1/4 of their time undertaking "training").2. The private companies haven't "cherry picked" - they have been asked to bid for limited contracts and have largely delivered similar (or in many cases improved) clinical outcomes for the same cost but without access to “free” working capital and  a 40 year of investment in real estate. Importantly, they also pay all their own staff costs, unlike the NHS which doesn't currently pay the c40% effective "employers contribution" to staff pensions - this is paid for centrally and thus serves to make the NHS much more expensive (at least 25%) than the private sector when these costs are taken into account.3. "Manager being paid what they would recieve in commercial work but still counting paperclips" is a nice story that you'd expect to read in the Daily Mail but doesn't reflect the reality, which is that only 4% of NHS Staff are managers (compared to 10+ in most organisations). Of these, 50% are actually senior clinicians working in managerial roles - clinicians are paid substantially more than managers (£110k for GPs, £150-£270K for Consultants, £115K ish for a chief nurse) and thus drive up the "average" management cost.4. “- amongst that there have been the usual advances but these would have happened anyway.” The fact the activity rates hadn’t improved for the best part of 20 years until private sector provision was used is ample evidence that the “usual advances” don’t happen in the NHS due to the overwhelming inertia and vested interests of the professions / trade unions.“the only way to reform the health service is to totally remove all of that marketplace crap and get back to making people well again. doctors and nurses, physios, etc.. the only glimmer in the current health reforms is the role mof doctors. however the commissioning is much as labour would have done in carving up amongst us healthcare companies. so labour or tory no real substantial differenc”Again, this is a nice Daily Mail story but a quick look at the facts doesn’t support it. The “marketplace” has given us reduced waiting times and improved outcomes at reduced cost. The US healthcare companies are certainly not “carving up” anything – perfectly illustrated by the fact that one of the biggest; Humana, is shutting down its UK operations because they can’t actually build a going concern against a backdrop of NHS Trusts who take years to take simple decisions and  Commissioning Managers who are proven to restrict patients legally protected choice of provided in order to protect the vested interests of other NHS colleagues.

Ed Yelland ● 5494d

There is a Labour/tory wisdom that say that improvements are made through the marketplace. But what has the marketplace given the health service over the last 15 years?- PFI Contracts that screw the taxpayer- private companies cherry picking easy contracts to take money await from hospitals suffering under pfi contracts.- manager being paid what they would recieve in commercial work but still counting paperclips.- amongst that there have been the usual advances but these would have happened anyway.the only way to reform the health service is to totally remove all of that marketplace crap and get back to making people well again. doctors and nurses, physios, etc.. the only glimmer in the current health reforms is the role mof doctors. however the commissioning is much as labour would have done in carving up amongst us healthcare companies. so labour or tory no real substantial difference.

Peter Chadburn ● 5494d

Eric, perhaps no-one is engaging because of your inflammatory choice of wording? In the normal world, a health service that receives inflationary increases in budget at a time when all other services are being cut can hardly be considered to be being "butchered". If you take the time and trouble to look at the facts, you'll see that the NHS has been tasked with making productivity gains (against a backdrop of 10 years of productivity falls) so that the savings can be returned to fund new cancer medicines and improved community services (funding for new cancer medicines has already started).This is against a backdrop of Alistair Darling admitting that Labour would have made cuts to the NHS Budget had Labour remained in power.Not that it will change your point of view, but this evidence based paper sets out the rationale for the productivity target and shows just the NHS could easily save £20B every year by focussing on waste, inefficiency and turning round or closing under-performing services.http://www.guardian.co.uk/society/interactive/2010/jun/02/mckinsey-report-future-nhs

Ed Yelland ● 5494d

It's been over week now and no-one has posted to this thread that they are in favour of the Tory health care reforms.Maybe the new top Tory in Ealing - Councillor Millican - might join this thread and explain to us why he is in favour of the proposed 'butchering' of our State health care system.

Eric Alan Leach ● 5495d

The reason there is no stampede Eric is that few Coalition supporters or indeed Coalition MPs understand the Bill,the medical professions or the public mood. The "natural break" in the legislative process (a very unusual step) is an attempt to lower the lid to prevent this very long and complex bill sliding down the pan of obscurity.

Arthur Breens ● 5498d

The reason there is no stampede Eric is that few Coalition supporters or indeed Coalition MPs understand the Bill,the medical professions or the public mood. The "natural break" in the legislative process (a very unusual step) is an attempt to lower the lid to prevent this very long and complex bill sliding down the pan of obscurity.

Arthur Breens ● 5498d

Well Eric a real stampede of happy Bill supporters enlightening us here!

Arthur Breens ● 5502d