Big changes to the NHS on the way?

notsoblue

From Dr Ben Goldacre's blog (http://bengoldacre.posterous.com/what-w ... in-5-tweet)

In case u don't understand NHS bill: GPs know they're being set up to fail by being given commissioning powers. Those are specialist skills.
After GPs fail, private commissioning expertise will be needed: large private corps, which will come to operate like health insurers.
These large bodies, like public/private insurance co's, will be able to pick & choose patients. Note no geographical responsibility in bill
Small differences will emerge in what services they offer. Top up plans will become available. And that, kids, will be that.
It is so very obvious that GPs are being set up to fail at the specialist task of health service planning that it's clearly not an accident

Some more here:
http://www.guardian.co.uk/society/2012/ ... is-heading

One element missing from current discussions of the health and social care bill (Report, 19 January) is a straightforward account of what will happen if it becomes law. From a detailed study of the bill and academic and policy literature about it, plus many discussions with experts, I've distilled this simple scenario of England a few years after the bill's enactment.

The NHS will no longer be a provider of services, as GPs, hospitals and community health services will all be outside the public sector. The NHS will be a publicly funded budget and a brand name for a subcontracting operation for competing private organisations, subject to European competition laws which will allow private companies to predominate over other (eg third-sector) providers.

Since competition and collaboration are incompatible – and co-operation between providers will be punishable by law as anti-competitive – co-ordinated services for people with chronic or complex conditions will break down and disappear except within the restricted framework of tied providers under the so-called "integrated care" model developed by the US health insurance industry.

Because the post-credit-crash NHS has a more or less fixed budget, services judged to be "of lower clinical priority" will no longer be provided free. Increasingly common NHS charges will create a demand (ie a market) for health insurance, which will mainly be affordable by the most affluent and which will also drive up costs because of administration fees and private profits.

The trigger for the roll-out of top-up insurance will be the impending introduction of personal health budgets, which represent a first step towards user charges. Clinical commissioning groups will operate on an individual basis so as to be compatible with the insurance companies, unlike the traditional GP service, which is population-based and pools risk across the whole country. Illness will begin to cause bankruptcy as is common in the US. Inequalities will increase enormously. Large amounts of public funds raised through taxation will be redirected as profits for the private companies which will provide NHS services and NHS commissioning support, and direct NHS charges (or health insurance payments to cover these) will become a normal item of household expenditure.
Dr Alex Scott-Samuel
Liverpool

• Those expressing concern about forthcoming NHS changes need look no further than my area, West Sussex, for an indication of where we are heading. Across the county GP practices are seeking to levy rental charges on other NHS services that provide treatment within surgeries. This is leading to the ridiculous situation where the local talking therapies services will have to pay hundreds of thousands of pounds of public money to rent space in surgeries in order to provide help to people referred by the GPs from those same surgeries. The rationale given for this is that each surgery has to "maximise its income". This is an example of how the marketisation of the NHS is leading to a waste of public money.
Name and address supplied

• The proposal that credit rating agencies should decide the fate of hospital services (Report, 19 January) is final evidence of the intent behind the health bill to commercialise the NHS. Now that the BMA, RCN and Royal College of Midwives have all expressed outright opposition to the bill and Andy Burnham has pledged to repeal the legislation if elected, the health unions and others should work together to persuade the government to drop the bill. Lib Dem activists can play a crucial role in pressing their leadership to change course. Already 98 crossbench peers and 11 bishops have voted with the opposition in at least one Lords division on the bill. At report stage, they should at the very least amend this legislation to ensure the continuing responsibility of the secretary of state for a free and comprehensive service, the maintenance of the public sector as the dominant provider of services and the retention of the commissioning function and funding in public hands.
Dr Anthony Isaacs
London

Sorry for all the copy/pasta, but my BS interpretation of what those more knowledgeable have said on the matter would have been pointless. Anyway, I'm pretty worried by all of the above! Its privatisation by the back door, and if the population understood what was going on they wouldn't be able to get away with it. *This* is why I don't like the conservatives... People like the alliterative one going all gaga over Mensch while their children are being robbed of the NHS they enjoyed.

bails87

The changes are very, very worrying. I know of several senior people who are leaving (taking early retirement), simply because they don't want to be any part of it.

Virtually no one in the NHS wants the changes, and that refers to clinicians as well as PCT/SHA staff.

Lansley is incredibly arrogant, responds to criticism with "I just don't accept that", puts opposition to the bill down to bitterness about pension reform or wage cuts.

The government were ordered by the Information Commissioner to reveal the Risk Register for the bill (sums up the harm it's likely to cause to patients) but the government has refused to reveal it. Which would suggest that it's pretty damning.

It's pretty worrying all round tbh.

bails87

An insider's view:
(LaLa = Lansley, btw)

There's a guy on the sofa reading the paper. His wife is in the kitchen buttering a triple-decker. The Ten-O'Clock News is on the telly. An item catches his attention. "Hey Marge!" he says, "Come and look at this......."

There is no doubt; the RCN, pulling support for the Bill, was unwelcome news for LaLa. When I knew it was on the way I wondered how he'd react. I never thought he would try and obfuscate it with a transparently, obnoxious attempt to pretend it was all about wages and pensions. But, it was as clever as hell. As crafty as the devil. Absolutely the right thing to do. We know it's not true but it doesn't matter.

"Hey Marge, come and look at this; the NHS thing the nurses don't wanna do; it's about pay cuts and hanging onto their fat pensions.............."

It's what press and PR people call the 'Hey Marge!' moment. Something that strikes a chord, something that people can identify with. Something that chimes with people's lives and understanding. They know about wages, cuts and pensions. They do not know (or care) about CCGs being big enough to carry risk.

LaLa is not a fool. He knows the unpopularity of his cause and the damage he is causing within the NHS - he just needs to get it off the government's books. The simple truth is he doesn't care what you think. He will dismiss your objections as special pleading. What he must care about is the electorate and the focus groups. He cares about Marge.

I can tell you from immediate personal experience the NHS is working as well as it ever has. The public have no idea what awaits them. Waiting times are holding up. Outcomes improving. There are the usual concerns about long-term care but they are the 'usual concerns'. The public, or perhaps more importantly, the media are annealed to them. They have no idea what to do. No one wants to pay. Marge parks the issue and crosses her fingers she can park her mother-in-law, free.

All of these 'user interfaces', (in plain English, where the public come into contact with the NHS), are good, and the ones that aren't demonstrate LaLa's need for reform. It is not until Marge cottons-on to what is happening that anything will change.

The fact that no one in the NHS really wants to do 'Liberation' does not impact on Marge. Until the consequences of the Bill are spelled out for Marge, LaLa will sail on.

I think Marge needs to be told 8 things:

She might see her MP to complain about her NHS, treatment or waiting times. The MP will say; 'I can no more help you with a matter concerning the NHS than I can a cockroach in a supermarket. Go and see Monitor, the CQC or the local HealthWatchers'. LaLa is not responsible anymore.

Marge might not know, when her GP says; 'I'm not going to recommend an operation right now. I think it is premature and we can cause you less disruption and help you with physiotherapy and some pain killers', he might mean; I have overspent my budget; or, I am trying to save the budget to bump up the quality premium and spend my share on a new car.

A GP might tell Marge that she can't have her usual pill, as somebody in 'commissioning support services' says she can't.

Marge might be delighted with a private provider but not, if, in the middle of her treatment, they go broke and there's no one to pick up the pieces.

Marge might never know that the nice GP has referred her to a clinic where he owns the shares and is getting paid twice for looking after her.

Marge could be faced with a service available to Brenda, Marge's sister down south, but not where Marge lives.

Marge's husband might hear on the news; NHS Trusts spent £80m suing each other and taking Monitor to the High Court.

Marge might not be able to see her usual doctor; 'sorry, he is away at another CCG meeting'.

You can complain all you like. LaLa won't care until Marge cares.

It's all about Marge.

SXI82

I work for the local PCT and can see it all going wrong, already waiting list times are increasing, skilled staff are upping and leaving, GP's don't have the capacity to manage contracts which local PCT's currently manage.

We are in a voluntary redundancy stage at present and probably looking at compulsory redundancy within the next 12 months.

As said above this is a way of privatising the NHS as GP's are not employed by the NHS yet they are being giving the NHS budgets to control.

nation

Worth pointing out that a lot of the NHS institutions that are to be abolished were brought in specifically to remove the unfairness and inefficiency of GP fundholding arrangements. Also that a lot of people seem to miss that GPs are not part of the NHS, they are independent private sector contractors.

So, the Tories are basically returning the NHS to the state it was in in 1996, but with even less oversight and less obligation on the part of providers to ensure fair and free access to the system. Anyone remember "the postcode lottery"?

Going to be moving at some point in the next couple of years depending on the wife's job, if the possibility's there then it's looking like time to move back home (Scotland).

thegibdog

Ah, but you are forgetting that the NHS needs to change and therefore it's all justified.

bails87

There are other risks issues. I'm told the Risk Register, when it is finally published, will (in terms) say; "The chief warning is that the reforms will spark a huge surge in health costs and the NHS will become unaffordable as the private companies siphon off profits". It will also include a darker warning; "GPs have no skills or experience to manage costs effectively".

Apparently...

And thegibdog, yep, we're constantly told how bad the NHS is, but rarely hear how well it does with the vast majority of patients, and how our health outcomes are so much better than they were 10, 20, 30 years ago, or compared to our neighbours. Some things need to change, to pretend any organisation like the NHS could be considered perfect would be foolish, but it doesn't mean the current changes are right. (I'm pretty sure you were being sarcastic though )

veronese68

I've had more than my share of the NHS's time. I am extremely pleased with the way I was dealt with, I'm still here and I'm healthy.
Whenever something has had to be dealt with as a matter of urgency it has been. For the more routine stuff you may have to wait, but that's understandable.

leodis75

The sacking of 3500 nurses already is a sure sign the NHS will return to the skeleton it was in 1997. No one remember the 2 year waiting lists for basic surgery?

It’s always the same, privatisation ends up taking jobs, costing the taxpayer more in taxes and they receive a worse service. There isn’t one thing the Tories or Labour for that matter have privatised that has given a better service.

My wife is a sister on a Oncology day unit, their work load is constantly increasing due to cancer wards closing. The amount of pressure these critical wards are under are scandalous, the private sector will end up doing the basic high profit work and the NHS will end up with the dregs of health care of which the private sector see no profit in leading to a two tier health system costing the taxpayer more money.

I wonder who will be doing the price comparison for the GP's? They will need a lot of free time to research costs of each referral or will they be paid/back hander’s by the private sector and who will be regulating this?

We all agree the NHS needs to be reformed but is privatisation via the back door the answer?

rjsterry

Someone needs to dig up some dirt on Lansley, á la Liam Fox. He seems to view the fact that virtually every interested body disagrees with him as just further proof that he is on the right track.

DonDaddyD

The NHS was working and was making year on year 3% savings during the twighlight years of Labour's reign. At worst it now needs to make 4-5% savings these were and are mostly made up on services changes, amalgamations, efficiency changes that I'd arguye needed to happen.

Most of those had to or have happened and now many NHS bodies need to look at the workforce. A well respected HR director I know always said Labour's policy of over inflating the workforce was unsustainable and reducing the workforce was bound to happen naturally. Here we are.

I still think the NHS needs to change, it needs to change the way it delivers healthcare and peoples attitude and practices involving the NHS need to change as well. Society is ever evolving so it's no bad thing if a service adapts, grows and changes to meet the needs of an ever changing populous that use it.

A large proportion of the proposed changes, however, I don't think are the right ones.

I can't see them going through. It was bad enough the nurses issued a vote of no confidence, this resulted in concessions and changes to the GP consortia composition to include other clinical staff. However, this composition looks incredibly similar to the original composition to the outgoing PCTs.

That the GPs are now issuing concerns - and these were the people that were to benefit the most from the Health and Social Care Bill - I really cannot see the proposed changes going forward.

If the changes don't go through that's Lansley's job and maybe even challenges to the validity of the Coalition continuing (they dicked with pension and froze pay rises so they've lost those votes anyway).

Also there is the expense of these changes thus far, I've been told that in redundancies/service changes and establishing the GP consortia the Governemtn will spend close to as much (£20 billion) changing the NHS as they expect it to save.

Cameron may have overreached with this one.

notsoblue

DonDaddyD wrote:

NHS needs t change, the way it delivers healthcare and peoples attitude and practices involving the NHS need to change as well.

A large proportion of these changes, however, I don't think are the right ones.

I can't see them going through.

You work in that sector don't you? Why do you think these changes aren't the right ones?

DonDaddyD

notsoblue wrote:

DonDaddyD wrote:

NHS needs t change, the way it delivers healthcare and peoples attitude and practices involving the NHS need to change as well.

A large proportion of these changes, however, I don't think are the right ones.

I can't see them going through.

You work in that sector don't you? Why do you think these changes aren't the right ones?

I've changed my post.

I'm a little close.

http://healthandcare.dh.gov.uk/factsheets/

There is a case and proven evidence - to the tune of £150million increase in turnover from new business plus a surplus being made at the end of the year - that injecting competition within the public sector can lead to service improvements. The surplus must be reinvested into services and not used to increase salaries, pay bonuses.

The key word is surplus. Some public bodies get to make a surplus and are measured on their surplus. It gives the corporate arm of the organisation real motivation to steer and push for service improvements (better services, better reputation and more business contracts won - hence the £150 million increase I'm citing). Obviously this appeals to the achivement and less profit driven amongst us.

A surplus implies that the service is still about the patient and not about the pockets of those at the top. By opening up NHS services to the private sector surplus becomes profit and services become less about the patient (in their own way) and more about the money that could be made/saved.

Allowing the NHS to compete within the open market and bid for private services is brilliant. Allowing private companies to run NHS services, I'm not so keen on. But there needs to be parity. I acknowledge this.

There is other stuff in the bill. Probably too much to comment on.

notsoblue

Bit of a tangent, but this is an appraisal of a privatised public service we'd probably all agree on.

UK railways 'last in Europe league'
http://www.guardian.co.uk/uk/feedarticle/10079228

My fear is that a similar thing will end up happening to the NHS in this country. i.e. More expensive, less accessible and awful performance.

DonDaddyD

I'm more annoyed at Labour than anything else.


While they focus on bankers bonuses they're seemingly ignoring the uproar surrounded changes to the NHS. And they have been written to, i've seen the letters.

rick_chasey

notsoblue wrote:

Bit of a tangent, but this is an appraisal of a privatised public service we'd probably all agree on.

UK railways 'last in Europe league'
http://www.guardian.co.uk/uk/feedarticle/10079228

My fear is that a similar thing will end up happening to the NHS in this country. i.e. More expensive, less accessible and awful performance.

Chronic long term under investment = sh!tshow.

rick_chasey

DonDaddyD wrote:

I'm more annoyed at Labour than anything else.


While they focus on bankers bonuses they're seemingly ignoring the uproar surrounded changes to the NHS. And they have been written to, i've seen the letters.

I think the problem with the NHS issue is that a lot of the specific issues are reasonably complex, so a broad, convincing, alternative (which right now sounds like "as you were", which doesn't go down well with voters) is difficult.

The line between being credible, convincing, and appealing to voters, yet not losing them in the complexity of the issue is pretty fine on this one.

I think for most people, myself included, it goes like this "nurses & doctors are saying it's bad so it must be!" and that's about it.

bails87

Yep Rick it's the "Marge" issue highlighted above. The reasons for it being bad are very complicated, most 'punters' probably aren't even that aware of PCTs or CCGs, nor do they know what they do. Which is why LaLa's "oh, they're just moaning because of their pensions" excuse has worked. That and a mostly compliant press.

DonDaddyD

Rick Chasey wrote:

DonDaddyD wrote:

I'm more annoyed at Labour than anything else.


While they focus on bankers bonuses they're seemingly ignoring the uproar surrounded changes to the NHS. And they have been written to, i've seen the letters.

I think the problem with the NHS issue is that a lot of the specific issues are reasonably complex, so a broad, convincing, alternative (which right now sounds like "as you were", which doesn't go down well with voters) is difficult.

The line between being credible, convincing, and appealing to voters, yet not losing them in the complexity of the issue is pretty fine on this one.

I think for most people, myself included, it goes like this "nurses & doctors are saying it's bad so it must be!" and that's about it.

Try this.

"The Government is trying to privatise the NHS by allowing private companies to bid for funding and run NHS services."

The rest falls into place.

notsoblue

DonDaddyD wrote:

Try this.

"The Government is trying to privatise the NHS by allowing private companies to bid for funding and run NHS services."

The rest falls into place.

I'm not sure thats enough actually. I mean, I personally think that privatisation of a public service like this is a bad idea but I don't think its self-evident to "Marge". Can you think of a simple one line explanation of why privatisation in this case will be a bad thing?

bails87

notsoblue wrote:

DonDaddyD wrote:

Try this.

"The Government is trying to privatise the NHS by allowing private companies to bid for funding and run NHS services."

The rest falls into place.

I'm not sure thats enough actually. I mean, I personally think that privatisation of a public service like this is a bad idea but I don't think its self-evident to "Marge". Can you think of a simple one line explanation of why privatisation in this case will be a bad thing?

I agree.

The public instantly think "privatisation....ooo, BUPA hospitals are quite nice, I'd like it if A&E was like that". Or just "private=more efficient".

I think it's the picking and choosing, taking the profitable work and leaving the diffcult scraps for the NHS to do that will cause problems. Think about the fun of trying to get an NHS dentist....imagine if getting any health care was that difficult.

Not that the tories care, or it seems the Lib Dems, getting rid of the NHS as a proper public health system seems to be an ideological goal.

notsoblue

Yeah, actually is that a fair comparison? Will dealing with your GP become like dealing with your dentist?

Also agree about the ideological goal. The main purpose of these changes seems to be to open up a market for the private sector to exploit.

rick_chasey

notsoblue wrote:

Yeah, actually is that a fair comparison? Will dealing with your GP become like dealing with your dentist?

Also agree about the ideological goal. The main purpose of these changes seems to be to open up a market for the private sector to exploit.

It is crazy that the gov't are using the '08 crash and subsequent depression to justify MORE free-market private sector influence.

bails87

notsoblue wrote:

Yeah, actually is that a fair comparison? Will dealing with your GP become like dealing with your dentist?

Also agree about the ideological goal. The main purpose of these changes seems to be to open up a market for the private sector to exploit.

Who knows.

We will have situations where GPs can pay themselves to refer their own patients to a private clinic that they own, which then gets paid by the NHS for treating the patient. A treatment that was deemed necessary by the person who benefits finacially from the treatment being provided. Or where (as happened somewhere in Yorkshire, I think, a few months ago) a group of GPs decide to stop offering certain treatments on the NHS, but are happy to provide the treatment privately for an inflated cost. You either don't have the treatment or you pay your GP.

Free markets are all well and good, but the average man on the street is so in the dark about health matters that he can't know if the GP is sending him for unnecessary treatments simply because the GP makes a nice profit on them.

notsoblue

Rick Chasey wrote:

notsoblue wrote:

Yeah, actually is that a fair comparison? Will dealing with your GP become like dealing with your dentist?

Also agree about the ideological goal. The main purpose of these changes seems to be to open up a market for the private sector to exploit.

It is crazy that the gov't are using the '08 crash and subsequent depression to justify MORE free-market private sector influence.

The way they're selling it is even more crazy. By all measures I've seen the NHS is actually pretty good value for money and there doesn't actually seem to be any evidence that more private sector influence will make things better. In fact the most obvious comparison, the US healthcare system, seems to indicate completely the opposite.

notsoblue

bails87 wrote:

notsoblue wrote:

Yeah, actually is that a fair comparison? Will dealing with your GP become like dealing with your dentist?

Also agree about the ideological goal. The main purpose of these changes seems to be to open up a market for the private sector to exploit.

Who knows.

We will have situations where GPs can pay themselves to refer their own patients to a private clinic that they own, which then gets paid by the NHS for treating the patient. A treatment that was deemed necessary by the person who benefits finacially from the treatment being provided. Or where (as happened somewhere in Yorkshire, I think, a few months ago) a group of GPs decide to stop offering certain treatments on the NHS, but are happy to provide the treatment privately for an inflated cost. You either don't have the treatment or you pay your GP.

Free markets are all well and good, but the average man on the street is so in the dark about health matters that he can't know if the GP is sending him for unnecessary treatments simply because the GP makes a nice profit on them.

Its just another way of funneling tax payer's money to the private sector.

notsoblue

I'd love to hear the opinion of someone who is pro these changes. W1?

bails87

notsoblue wrote:

I'd love to hear the opinion of someone who is pro these changes. W1?

Apparently 50 GPs co-signed a letter supporting them.



Out of about 15,000 working GPs in England.

W1

notsoblue wrote:

I'd love to hear the opinion of someone who is pro these changes. W1?

Is that another of your ill-considered presumptions?

walkingbootweather

Don't know about ill-considered presumptions, but I hope we can all still obtain a prescription when considered ill.

notsoblue

W1 wrote:

notsoblue wrote:

I'd love to hear the opinion of someone who is pro these changes. W1?

Is that another of your ill-considered presumptions?

Surely the question mark indicated that it was a presumption... So I'm wrong? Whats your opinion on it?