Save the NHS!
- Thread starter scorza
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I have, and it's clear that most of those protesting haven't, as what they are protesting about (such as privatising the NHS or making it a system when payment is necessary) appear nowhere in the bill.
Full text of the current bill (as sent to the HoL) is here
http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0092/lbill_2010-20120092_en_1.htm
Accompanying notes are here.
http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0092/en/12092en.htm
It is a rather large bill, so it takes some time to read through.
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It would be nice to think that someone has
For what it is worth, the bill currently runs to over 400 pages, written in the usual opaque legislative jargon and I very much doubt that anyone other than a lawyer or other specialist can get to grips with what exactly it means - or allows.
The Department of Health describes its main objectives as:
- strengthening commissioning of NHS services
- increasing democratic accountability and public voice
- liberating provision of NHS services
- strengthening public health services
- reforming health and care arm’s-length bodies
The second (which I simply don't believe) and most particularly the third objectives (which suggests privatisation) are what concern me most.
As to 'strengthening commissioning of NHS services' that means handing the budgets over to GPs who haven't actually got much on their plate at the moment and needless to say, are to the last man and women trained and highly skilled businessmen and women
The bill itself describes its purpose as:
I would still suggest that if you want to see what the Tories plan for the future of the NHS, you need look no further than the state of dental provision in this country
I have maybe you could address the points (Castiel asked for) I made in the other thread:
and
Firstly - Why not GPs rather than others? It all depends on the implementation above all else. If done correctly GPs will be more concerned with ensuring a correct referral than making money.
I agree, parliament should be responsible and held to account.
Don't see what the point is? What staff expertise do CSH have that Assura don't, given they are taking over Surrey Community Health staff as part of the contract (who are clinicians).
I think attacking 'highly paid consultants' doesn't add anything to the argument either way, they'll be used in whatever model is proposed.
They can do unannounced visits, but yes, the underfunding of CQC is abhorrent and represents one of the biggest risks in the current economic situation and NHS reforms.
It's not true private care. It's still a public health service but provided by private companies (or mutuals).
You can have patient choice to a degree - do you want/not want to be treated, do you want to die at home, etc. I appreciate NICE cannot allow treatments to be prescribed that are extortionately expensive, the money can be better spent on other care, so there will be a lack of choice in some respects if the treatment isnt available.
But you do not see a direct conflict of interest where a GP can directly refer to a service that they themselves make a profit from over a service where they do not. Most GPs would refer appropriately I am sure but surely this is just not right?!? Referral should be based upon best evidence not feathering your own nest.
Well for a start they were a clinician group that did so well David Cameron hailed them as a shining example of his Big Society scheme so much so that they were award winners but when they failed to match the bond amount provided by the Assura then well they kind of got forgotten quickly even though they had the clinical expertise as they were an initiative set up by medical practitioners using the very model that Dolph says he wants to see set up to aid the NHS!
Yes, and isn't that half the problem and a cause of great wastage to then implement change for changes sake rather than towards a concrete goal and by doing so turning money away from direction patient care is surely a bad thing. As I said in the other thread paying people astronomical sums to to try and directly assimilate the NHS into a model that was forged on a car assembly plant is kind of crazy. Yes some of those ideas are good and applicable but it does not need to be followed wholescale because all the managers covered it doing their MBAs and other management theory.
Agreed with the every increasing numbers of qualified providers that will follow this instigation along with the decreasing number of inspectors provided by this administration then one wonders how any real external quality assessment will take place. Not that is matters as no one is going to take accountability for a damn thing. And yes they can do unannounced visits but how often does that occur you always know you are going to get a visit as the cleaners are actually cleaning and all the managers go around making sure everything is correct which is a mockery as it completely misrepresents the actual state of affairs.
Mutuals formed along the lines of CHH which were ignored in place of bigger business. Private companies have very little expertise across the board in this country. To then think when they are more competitive that they will directly assimilate any existing quality whilst running a tighter financial ship is rather naive and contrary to what experience tells us. Along with the fact like I say they have no consequence for their errors
Well that is hardly a choice is it and you don't have the choice to die at all the legislation in this country gives a pet dog more right to die than its owner. And despite NICE guidelines those treatments are given in some postcodes, people who are not entitled to treatments still clog up London's hospital, etc and in the meantime people who have paid into the system are sometimes getting a very raw deal.
On this specific point alone, you'll find that in whatever model or whoever is in control will inevitably be seen to have a conflict of interest. Be it the private company who refers to their own service, or to an "allied" company. If anything, doctors may be more likely to have a conscience and do the "right thing".
Far more likely for a private company or individuals to be unscrupulous and "feather" their stockholders nests.
These NHS reforms open the way to abolishing quangos like the CQC altogether. After all, why do you need pesky regulators getting in the way of genuine wealth creation? Let the market decide who provides what standard of healthcare. Anything goes wrong and it's not the Secretary of State's problem that's for sure.
You have read all 400 or so pages?
Totally agree if it changes to what is proposed but where is the conflict of interest when a GP refers using the current system. That's correct it is not there - yes there are ways to "game" things but nothing like what will be possible with the proposed changes. The point is the changes are not wanted, not needed (which is different to no change needed which I don't think anyone would argue is the case) and open to abuse by the people who will be the first point of contact and therefore most likely to refer.
I have it was enthralling ...
It's a fair point, have not read enough on the referrals process in this new fangled way of working to see if/if not there'd be a high risk of it happening. But we already have commissioning structures in place for community health services and referral payments, but it doesnt appear to have affected patient care from the quality outcomes I have seen.
The rumours about the bond amount are just that - rumours. Put up by the press a day after the award notice when all parties are tied into confidentiality and are not allowed to state why one bid failed over another. There has been nothing since to say it was around financial assurance.
There are good consultants who earn their crust and there are bad consultants. I know of both within the NHS. I wouldnt tar all with the same brush. Whether you see it as 'change for changes sake' is a different matter.
To be honest I think, if it was properly resourced, the way CQC works is quite positive and a good way of doing things.
There is a consequence - they could lose their CQC licence (and subsequently their contract). Or face other contractual penalties.
I am not a fan of Assura but I think we should keep an open mind as to how they will perform. If it was a financial bonds issue then the government of course need to look at that and ensure there is proper financial support for mutuals to compete. But, you cant criticise the decision until we know for certain why they won over CSH. Do you know the reasons why they won? No, you don't, unless you are in the inner circle of NHS Surrey, CSH or the procurement hub who ran the tendering process.
People have a right to not be treated and die, as long as they have the mental capacity to make such a choice. If you know of instances where this hasn't occurred then you should raise it with the CQC to look into
People have a right to not be treated and die, as long as they have the mental capacity to make such a choice. If you know of instances where this hasn't occurred then you should raise it with the CQC to look into
My point was more that people do not have the right to be treated to die.
fair enough, I agree with you on that particular point.
Will do, having a somewhat busy weekend
Yes, I never debate subjects I haven't done at least some research on.
Will do, having a somewhat busy weekend
You should know better than to set me off on one ...
I suspect we're on the same side on this.
With the proposed system, there will be potential for abuse both for referring and for NOT referring too (ie Bonus if you keep referral rates down, or keep referral rates down "or else")
Interesting when we actually got down to the key issues it all went a bit quiet for the pro-crowd.
Ok, time for a reply. Been a bit busy over the weekend as I became a Dad (and much praise for Derriford Hospital for being Brilliant this weekend, although it doesn't change the issue that I think there is much scope for further improvement in the day to day stuff in the NHS)
Couple of things before I start. I'm going to try to avoid mirroring the emotive language where possible. I'm also not going to treat 'profit' as a dirty word or having negative connnations.
This happens already, with the way GPs practices and their relationship with the NHS is structured. However, I would add that I'm not adverse to this, if it is part of the trade off needed to build a more patient focused service. For example, catchment areas make little sense if the operation is being run a genuinely commercial basis, nor do poor service or rude staff. Currently, all these things occur within the NHS, and they shouldn't. If it requires a financial motive to help GPs push back against this, that's fine.
This isn't what the bill says at all. It does not remove all accountability for the NHS from the Secretary of state for health. What it does remove is the ability of the secretary of state to perpetuate one of the biggest problems with the NHS, that of politics and political expediency instead of what is the right thing to do for patients. It strictly defines the limits of both what the secretary of state is responsible for, and also what they cannot interfere in. (Part 1, sections 1-5 of the bill)
From what I can see, the biggest problem was that CSH couldn't raise the required surety amount to fulfil the expected terms of the contract. Or to put it another way, they were in a much worse position to be sure they could provide healthcare throughout the duration of the contract compared to other bidders.
Staff expertise is important, but so is clear evidence that the company employing the staff can guarantee to be there throughout. It's also worth noting that the staff from the existing provision will be passed over to the new company, so there should not be a lack of skills there.
As you have noted, I support the ideas behind groups like CSH, and I think that there is more the Government can do to help support this form of enterprise (for example, by giving them access to credit easing funds). That doesn't mean they should get exclusive or preferential treatment.
There's an awful lot of emotion, supposition and well poisoning in this paragraph, and not a lot to work with.
Essentially, I think you're asking whether or not I support the use of consultants that will be needed to manage the change in the short term, even though their use in the past have not really added value. My answer would be that generally the NHS needs to get better at using consultants. It isn't a dirty thing to use external expertise when you don't have what is needed in house, which may be the case in some areas where they are not used to genuinely patient focused and driven care (note that this is not the same as 'caring for the patient), or around the various business changes needed to support the new operating model. However, it is also possible to waste a lot of money on consultants with very little to show for it, if either the contract is badly written or either the management or workforce intransigent.
There is a hope that, by pushing the responsibility further towards the patient (although these reforms don't go far enough IMO down that route), and allowing providers to fail/be changed if needed, that standards will rise. Of course, additional inspection is necessary, and it certainly should be unannounced (as it is in pretty much every private sector industry), but currently the inspection system doesn't seem to work anyway.
Both Private and NHS care is often very deficient, it can also often be excellent. This is the problem, but the difference is, under the new system, it will be easier for the deficient provider to be removed whereas currently it doesn't happen.
This is where we start to really diverge. I don't buy the idea that the medical profession must be treated as some kind of godlike entity which we mere mortals couldn't possibly understand, which seems to be what you want to imply.
This is largely irrelevant, nothing whatsoever about the bill remotely threatens the free at point of use nature of the NHS.
In many cases, no they aren't, which is why contracts need to be better written. It's also, however, why surety is common and important in the contracts.
Couple of things before I start. I'm going to try to avoid mirroring the emotive language where possible. I'm also not going to treat 'profit' as a dirty word or having negative connnations.
This happens already, with the way GPs practices and their relationship with the NHS is structured. However, I would add that I'm not adverse to this, if it is part of the trade off needed to build a more patient focused service. For example, catchment areas make little sense if the operation is being run a genuinely commercial basis, nor do poor service or rude staff. Currently, all these things occur within the NHS, and they shouldn't. If it requires a financial motive to help GPs push back against this, that's fine.
This isn't what the bill says at all. It does not remove all accountability for the NHS from the Secretary of state for health. What it does remove is the ability of the secretary of state to perpetuate one of the biggest problems with the NHS, that of politics and political expediency instead of what is the right thing to do for patients. It strictly defines the limits of both what the secretary of state is responsible for, and also what they cannot interfere in. (Part 1, sections 1-5 of the bill)
From what I can see, the biggest problem was that CSH couldn't raise the required surety amount to fulfil the expected terms of the contract. Or to put it another way, they were in a much worse position to be sure they could provide healthcare throughout the duration of the contract compared to other bidders.
Staff expertise is important, but so is clear evidence that the company employing the staff can guarantee to be there throughout. It's also worth noting that the staff from the existing provision will be passed over to the new company, so there should not be a lack of skills there.
As you have noted, I support the ideas behind groups like CSH, and I think that there is more the Government can do to help support this form of enterprise (for example, by giving them access to credit easing funds). That doesn't mean they should get exclusive or preferential treatment.
There's an awful lot of emotion, supposition and well poisoning in this paragraph, and not a lot to work with.
Essentially, I think you're asking whether or not I support the use of consultants that will be needed to manage the change in the short term, even though their use in the past have not really added value. My answer would be that generally the NHS needs to get better at using consultants. It isn't a dirty thing to use external expertise when you don't have what is needed in house, which may be the case in some areas where they are not used to genuinely patient focused and driven care (note that this is not the same as 'caring for the patient), or around the various business changes needed to support the new operating model. However, it is also possible to waste a lot of money on consultants with very little to show for it, if either the contract is badly written or either the management or workforce intransigent.
There is a hope that, by pushing the responsibility further towards the patient (although these reforms don't go far enough IMO down that route), and allowing providers to fail/be changed if needed, that standards will rise. Of course, additional inspection is necessary, and it certainly should be unannounced (as it is in pretty much every private sector industry), but currently the inspection system doesn't seem to work anyway.
Both Private and NHS care is often very deficient, it can also often be excellent. This is the problem, but the difference is, under the new system, it will be easier for the deficient provider to be removed whereas currently it doesn't happen.
This is where we start to really diverge. I don't buy the idea that the medical profession must be treated as some kind of godlike entity which we mere mortals couldn't possibly understand, which seems to be what you want to imply.
This is largely irrelevant, nothing whatsoever about the bill remotely threatens the free at point of use nature of the NHS.
In many cases, no they aren't, which is why contracts need to be better written. It's also, however, why surety is common and important in the contracts.
While I have no axe to grind with regard the NHS nor have any complaints about failing service, it wouldn't bother me in the least whether I was treated by private providers or the NHS if medical needs arose that I needed treatment and that treatment was the best available or at least comparable to that provided by the NHS!
Annual costs are currently just under £2000 for every man, woman and child in the UK to fund the NHS from our taxes - as long as I get equivalent medical care/service to meet my needs and it doesn't cost me any more, then I don't see a problem!
For too long, left wing politicians and unions have used the NHS as a political tool to frighten voters into voting for them - the fact is that in it's present form it's too expensive and needs reforms to make it more efficient!
Annual costs are currently just under £2000 for every man, woman and child in the UK to fund the NHS from our taxes - as long as I get equivalent medical care/service to meet my needs and it doesn't cost me any more, then I don't see a problem!
For too long, left wing politicians and unions have used the NHS as a political tool to frighten voters into voting for them - the fact is that in it's present form it's too expensive and needs reforms to make it more efficient!