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Not Having Your Cake and Not Eating It


Posted on 27 February 2012

cake.jpgMaxamillion Pemberton, the sugar in the petrol of the Torygraph’s accelerated pro-NHS reform package, has written an excellent summary of why the NHS is a jewel in today’s British crown. Predictably, the Rancid Right have started to pour the oil of scorn on Maxamillion’s article. One of the more able early commenters – many others are more lurid than lucid – takes phrases from the article, and puts the record admirably straight:

“‘It might be that none of this concerns you…’ It doesn't. ‘…or you may be horrified…’ I'm not. ‘Whatever your political leanings…’ Free market capitalism. ‘or health status…’ Perfectly healthy, thank you. ‘or experiences of the NHS,’ My experience(s) with the NHS (sadly) lead me to believe it was a diabolical 3rd rate service I wouldn't wish on a dog. ‘it is YOUR health service…’ No it's not…” To which Dr No can only riposte: well – that is all right then, isn’t it.

The Rancid ‘I’m all right Jack’ Right’s arguments against the NHS are all flawed. Neither the barbarians at the gate (immigrants and health tourists) nor the grey tsunami (hordes of bearded toothless Amises hoovering up a growing and ever more crippling share of GDP) arguments hold water, both being instead the products of hot and fevered imaginations. Of course the NHS isn’t perfect – no health service can ever be – but Tory allegations of disgracefully poor outcomes have been shown to owe more to hot and fevered Downing Street imaginations than any cool assessment of the facts. Even the accusations of gross waste and inefficiency turn out, when the proper comparisons are made, to be built on foundations of flammable straw. The facts are that, even with its faults, the NHS remains an outstanding achievement: an efficient, comprehensive and fair national health service that has both stood the test of time, and shown itself capable of growing with the times.

But just as you cant teach a mule calculus, so the Rancid Right will not hear a word in favour of the NHS. The NHS doesn’t concern them; it’s not their health service – they just don’t want anything to do with it. The divide is so severe that never the twain shall meet.

So Dr No has come to a simple solution. Those who know the NHS is crap, and can only get worse, can, at any age in their adult life, elect to opt out of the NHS. The opt out is absolute and irrevocable: there is no entitlement whatsoever to NHS services in any shape or form, and the opt out is permanent: it can not be reversed, whatever the future health, or ill-health, of those who elect to opt out. In return, the opter-out will be given Health Tax Credits, and can use those – if they so wish – to purchase private health insurance. At a stoke, they can be shot of the ghastly NHS, its miserable third rate service, and its diabolical outcomes.

Naturally, one hopes these NHS-free individuals will remain fit and well, and thrive and prosper into old age. One hopes they never flounder in the exclusions to their cover, nor need dialysis nor intensive care, nor – Heaven forbid – extended mental health care. One fervently hopes they never hear that dread phrase ‘pre-existing condition’. But if any such calamity befall them, crueller hearts may silently be tempted to whisper, in an distant echo of our Continental colleagues – whose health services the Rancid Right so often espouse – ‘let them eat cake’.

42 comments:

To be fair to the right wing commenters on the original piece, at least they are being honest. They are of the right, the Bevanite NHS is distributive and of the left. The right are allowed to despise it and their railing about inefficiency and so on are just manifestations of their cognitive dissonance. Facts about increased efficiency simply increase their dissonance and cause them to wail even more. Fair enough.

The people I really have problems with are those on the right, like Cameron, Lansley and Clegg, who claim to be completely in favour of a Bevanite NHS and against top down re-organisation but turn out to be lying through their teeth. Or possibly completely incompetent. Or both.

Seems to me that the bill is an attempt at a wedge strategy aimed at introducing co-charging and a massive transfer of public money to the private sector. Ken Clarke recently boasted that Cameron's Tories are far more radical that Margaret Thatcher's ever were. He was clearly had the dissolution of the NHS in the front of his mind when he said it.

A post I wrote last year, inspired by David Bell, president of the Institute of Psychoanalysis http://abetternhs.wordpress.com/2010/12/08/who-is-the-nhs-for-not-me/
The fear of vulneralibilty symbolises a deeper self-loathing

The last time the public was confronted with such a stark choice was in the days of video format; Betamax vs VHS.

Actually it's a very interesting proposition, and one that in theory could appease both camps?
In time selection would divide along class lines - private care for the rich, state care for the poor.

I wonder if your proposal is one of the reasons why some of the more lucid people who are contemplating what returns they will get from their private insurance are avidly supporting the health bill. The fact is, that those prepared to pay for private health care as it stands at the moment, cannot have the consultant of their choice. Many consultants do very little private practice or none at all. They either don't want to or are constrained by their NHS / university commitments. For this and other reasons, most doctors I know would choose NHS care for themselves and their families.

So, those who can afford private health care do not necessarily have the choice of the best medical and surgical care that is available across all specialties. In order to have such choice, the whole consultant establishment of the NHS would require to be at their disposal. Presumably this can only be achieved by abolishing the NHS completely as a certain think tank seems to be proposing. The alternative is, as the government is proposing, to integrate private practice more closely with NHS hospitals - by having 49% of hospital funding coming from private patients. Either way, all consultants will be forced to work in the private sector whether they like it or not.

I'm no expert in employment law, but it is likely that the new " irresistible" consultant contract cleverly foisted upon us by Alan Milburn a few years ago, carefully and intentionally paved the way for this enforcement.

How much? 86 UKP made up to UKP 100 per year? what about conditions currently excluded by insurers? What if they go bust? Govt. is quietly doing the PIPs. What if the insurer just change their name?

If Govt control insurers (they cover everything for ever) then, govt. can even buy insurance for their money draining patients.

A&E CN - "In time selection would divide along class lines - private care for the rich, state care for the poor" - Dr No briefly had in mind a rather more brutal Darwinian natural selection, as the Rancid Right pegged out for want of affordable/available healthcare - but then realised many will spawn before they peg.

More drones in the Lords today, and Nicki Poodle's 'didn't we do well!' letter. The way to set the NHS back to rights is in the hands of GPs. They got it right last time (1940s) and if they pulled their finger out of their pension a*seholes they might yet get it right this time. It will be a battle between the turgid union and the academic college. One hopes brighter brains will win.

You baffle me sometimes Dr No, at one time you said you had innovative ideas for your patients but could not deliver them because of those around you, yet you vehemently oppose competition, the very tool that aids innovation

You never strike me as someone who would be afraid - of anything, so long as it goes with what 'you' believe in!

Imagine a society where health is covered only by Health Insurers and there is legislation to sop them from discriminating, then you can see where competition will take us when patients can chose which insurer and insurer cannot turn away anyone.

Cartels will start to appear!

Things may be changing as the business approach to money infiltrates the medical mind, but the majority of doctors have never been ones to compete purely for financial gain.

Nevertheless, doctors are a very competitive bunch. Indeed it has always been necessary to guard against medical empire building and fair allocation of resources. Many doctors however just want their clinical service, their research, their teaching to be the very best. They want to be respected for their own personal clinical skills. This is often at odds with "business" style competition where value for money and profit are the bottom lines. Often spreadsheets in healthcare don't talk to or understand each another... Money is saved in one spreadsheet (perhaps by not allowing medical staff to innovate in some way) and praise is given to the "spreadsheet handler" but the knock on effect may be a massive overspend on another spreadsheet but the connection between the two is never made.

It takes a lot of vision to know what kind of innovation will be financially viable and what the knock on effects, good or bad, might be. Because of this lack of vision of those wedded to a single spreadsheet as well as the complexities of healthcare, where it is dificult to make a profit and still care about health, it seems to me that innovation and competition in this setting come from different stables.

"you vehemently oppose competition, the very tool that aids innovation" - do you mean financial competition, anonymous?
Surely it would be wrong to suggest there has been no innovation in the NHS during the last 60 years?
On the other hand if we accept there has been innovation then what has been driving it because it is certainly not the sort of competition envisaged by Dave and the health conglomerates circling ever closer to the £100 billion NHS budget.

Maybe you are referring to business competition, perhaps in the belief that by putting the needs of the shareholder at the centre of our health system it will lead to a new world of exciting and easily accessible health care?

While innovation remains an essential ingredient to good health care what is of far more importance is doing the things that we know make a difference to a consistent and high standard.
It is seldom lack of innovation that is a major factor when things have gone horribly wrong, but rather the fact bread and butter aspects of care have not been delivered, or have been delivered but in a slipshod or substandard fashion.

There are also some very interesting observations about the sort of culture that has emerged in the wake of technical innovation

If you find time to read the article you might then want to ask yourself, anonymous - do you really want to put our health care in the hands of rapacious businessmen?

Apologies, anonymous - the spam filter is activated when the web link is included.

Try googling, Beware the 'Janus face’ of modern medicine - (Daily Telegraph)

Anonymous "Imagine a society where health is covered only by Health Insurers"

We have insurers already, and those who prefer their services take a load off the NHS, nothing wrong with that. Then again, PM pledged ni American style NHS, that it will remain universal and free at the point of delivery. His deputy has now written to ensure the bill complies with that pledge to reassure everybody this will be the case 'for sure'.

WD [ those prepared to pay for private health care as it stands at the moment, cannot have the consultant of their choice.]

As far as I know, they mostly do WD, as for docs not currently involved in private medicine, foundation trusts will change that since doctors working in their hospitals will be involved in treating more private patients too. Again, why is this bad? ... more money for the hospital means more money to NHS patients plus better resources, experience, transparency, accountability plus opportunity to see your innovations become reality too ... and more financial gain for you too, why not?

A&E charge nurse "do you mean financial competition, anonymous?"

On of the amendments rules out competition on price, now to stop hospitals preferring private patients over NHS ones.

And I read your article in the link, it is this explosion in advances in medicine that is the reason why the government can no longer afford to provide for all

I am the practical type, the whole world is changing, economy trends and practice too. as George Osborne said yesterday, Britain needs lots more private money into the system, through more business creation, to support growth, otherwise, that will suffer and we'd head, head first, into another dip - Times are changing, and we too need to get real; the government has no money, they can no longer afford to respond to every whim or spoil all as before ... and the majority of business people are not as bad as you think, most will suffer themselves before putting a good employee in difficulty let alone have them sacked when times are hard.

Britain needs lots more private money into the system, through more business creation, to support growth, otherwise, that will suffer and we'd head, head first, into another dip'

Sam, sorry, but it is public money ie our taxes that is bailing out private debt right now. And the NHS reforms are not to enable private firms to put money into the NHS - it is to enable them to take money out of it, some £80 billion.

A&E CN (and anyone else affected) - apologies for the spam filter's erratic behaviour. From discussions with the service provider it seems to be as much to do with the originating (ie your ISPs) IP address as actual content in the comment which is even more perplexing not to mention irritating since Dr No knows you are all bona fide, not too mention much valued contributors. Dr No will continue to pursue it with the spam service...

Anonymouse - "You baffle me sometimes Dr No, at one time you said you had innovative ideas for your patients but could not deliver them because of those around you, yet you vehemently oppose competition, the very tool that aids innovation" - Dr No is not against all competition - indeed he can be very competitive when he needs or wants to be (even if, as he gets older, he finds he tends more to compete with himself rather than others!). And he accepts competition can be the engine of innovation: war is the ultimate competition, and we only have to look at how many innovations (including, somewhat ironically, in its own way, the NHS, as part of a land fit for returning heroes) came out of WWII to accept the positive influence competition can have on innovation.

But healthcare isn't war, and market competition in healthcare just has too many downsides: goal displacement ('competition on lobster thermidor...'), transaction costs, supplier induced demand, unnecessary duplication and surplus capacity etc etc - JT has a good post here on the ills of competition in healthcare - and, just as importantly, it gets in the way of collaborative innovation, for it is in collaboration, when the whole can be greater than the sum of the parts, that, at least in healthcare, we find the best innovation.

Julie - spot on!

Julie " it is public money ie our taxes that is bailing out private debt right now"

And that is not enough ... hence the need for private money

"the NHS reforms are not to enable private firms to put money into the NHS "

Yes they will, if putting this money in presents a good business opportunity, or yes, a chance to make 'profit'

"it is to enable them to take money out of it, some £80 billion"

But the pot was never that large for the private sector involvement and bill has been further amended to ensure that, even if it was, how much profit you think can be made out of that? A single figure, if lucky! ... now are not 'lucky' times

I opposed the original bill, but the amended one is now 'flexible' and provides real opportunity and better conditions for patients and lots more for staff. For starters, this foundation trusts idea is absolutely Brrriliant! Besides, if GPs learn the business from KPMG, who says they can't dump them later and take over themselves, with that newly acquired know how ... 'flexible' it is now, think about more, loaads!

And yes Dr No, business can sometimes be likened to war, hence the need for 'fighters' of high calibre ... and he who dares wins, always ;-)

I am yet to read the post in your link, but I will ... go make a cup of red tea and get some biscuits first ... then take it easy; it ain't that bad, cos as they say, opportunity is always a companion any' new endeavour, too true too!

Hi Sam,

hate disagreeing with you, but foundation trusts are not a great idea. It compels hospitals to be judged on financial criteria rather than healthcare ones and are classified as 'failing' if they are in debt. It encourages cherry picking, filleting of staff, dilution of grades and nurse bands. It discourages treatment of the elderly, complex and expensive operations ,training of new medics and anything which doesn't have a discernable financial profit. Ultimately it leads to the situation you had in Stafford, where they cut so many staff to meet foundation criteria that people were drinking water out of flower vases because they were not being attended to. And it's going to be used as an excuse to shut a whole lot of hospitals in London. Professor David Kerr is down giving Lansley advice - he tried to shut hospitals here and was chased out of Scotland. Now you've got to deal with him. You have been warned.

I respect your opinion Julie, but to me, foundation trusts is the modern way to run hospitals, based on a sound business model. So yes finance comes with the package, but that means better use of resources, forever endeavour to eliminate waste, get rid of inefficient individuals and the resulting payouts in compensation because of negligence, more emphasis on quality or trusts won't get the business; either NHS or private, better training for all staff, hence better treatment and morale, and less, much less stifling gang culture but proper cooperation instead, better pay or now 'quality' staff would move on, training in business management for key staff, hence better qualifications on your CV ... and young docs training on the values of innovation and enterprise from a young age thus avoiding stagnation and resistance to change on the way, it actually is a saviour for docs and nurses here ... making the whole thing a better experience for all.

Business is an educator in itself, it makes you forever on your toes looking out for opportunity and sifting the valid ones from piles and piles of ideas, hence innovation and with it research too become the culture of the whole establishment - and to aid this, good morale becomes a goal too, because once you become 'valued', you will not treated as a 'part' on an assembly line disposable and replaceable at any opportunity . Valued means you can expand and prosper, and move up too, or to greener pastures if you wish - even become a teacher on loan from your successful trust to help those others who need your excellence and expertise too! A happy environment where when you work hard, you feel an 'owner' with the responsibilities of that too, and with that comes a happy environment for all ... and a financially viable trust that won't be reformed only to be reformed again forever, but a stable and aiming forward business, thanks to you, and the rest of your 'team'.

Those you mention are the ones who can't adapt and will fail, maybe close too, and good riddens too!

Foundation trust will work on good business ethics or their reputation would be tarnished, meaning all patients including the elderly will have to get the best service there is. I think it also means that elderly people who are not in need of medical treatment will be accommodated elsewhere and not in an expensive 'hospital' bed, hence the need for the integration of health and social in the bill - if they do that right, then this solves this problem of healthy elderly blocking beds at great cost , and more dignity for them to live in a more sociable setting and not a hospital too.

Over all, I am optimistic about this FT idea :-)

Sam - good business ethics - there is no such thing - it is a contradiction in terms. You cannot serve two masters. Yes, there is a Venn diagram where they overlap - Raptor Portas being an example - but she serves the customer so that the business owner can profit.

The NHS is a service: it will never make a profit, and will always consume money. Given that, business/profit thinking has nothing to offer it. And given that we have had twenty or so years of Batman/Thatcher trials of 'business/market models', and the cost has gone up, and morale crashed, isn't it time to ditch the crazy market mentality?

BTB - saw LaLa on the News tonight, up against RoboNick. Robo had it in for La La - at last. LaLa looked increasingly unhinged and pop-eyed. This crazy bill may yet sink.

Sam,

The situation at Stafford with regard to the elderly drinking out of flower vases was a direct result of the foundation 'profit' model. And the business idea of waste and the health idea of waste are very different. This becomes very clear with regard to people who are chronically ill, disabled or old. They by definition are not going to get better, therefore it is a 'waste' of money to give them treatment that might amelliorate their condition. Believe me, I've seen it at first hand.

Was Strafford an FT then? As far as I remember, they were trying to reduce spending to achieve the status to start with, but the execs [plus a culture of fear to report] messed that process up hence the tragedy, which incidentally lead, not to severe punishment, but there was even some high rank promotions - in plain daylight too, the cheek! Had they been an FT already, could that irony have happened? I think not!

And Dr No, 'profit' is not a swear word, plus, FTs will use that to better their service and not to distribute on shareholders.

" good business ethics - there is no such thing - it is a contradiction in terms."

That's where we differ Dr No, on a fundamental point!

My interpretation is that Foundation Trusts will be allowed to generate income of up to 49% from patients who pay privately. Presumably that means their funding will come directly into the NHS from these patients' own pockets or from their private insurance. i.e the funding is truly private and it will not come from NHS money being diverted somehow into a private company working within the Trust. Take for example a convoluted merry-go-round arrangement where a private company pays rental to the NHS to cover space, facilities and staffing in return for money being payed back to them to treat NHS patients.

If the former is the case, my questions are :

Where will this large proportion of patients come from?

What conditions will they suffer from?

Who will treat them?

Stafford Hospital was the responsibility of the Mid Staffordshire Foundation Trust at the time of the problems relating to basic care of patients.

http://en.wikipedia.org/wiki/Stafford_Hospital_scandal

"Was Stafford a FT then?" - of the all bloggers who commented on the Mid-Staffs scandal few if any came close to the analysis provided by Witch Doctor - I bookmarked several of her observations.

Your education about Staffs (and the binds that can arise when financial considerations trumps clinical activity) starts here, anonymous.
http://witchdoctor.wordpress.com/2010/06/09/update-public-inquiry-into-s...

"Where will this large proportion of patients come from?"

:-)

That's where your entrepreneurial spirit comes in WD ... maybe we need to give those old GP contacts and those from abroad a polish, or maybe you have more ideas ....

And, while the abuse was going on at Midstaffs, it was in transition to FT status, but not a fully fledged one, hence it was the 'bureau' who messed up still

Sam,

My point is, that in attempting to meet the financial critera demanded by the FT model, the hospital became unmanageable as a hospital. In my own area, staff are being cut left, right and centre to pay off prohibitive PFI debt. It is not the way to run a health service. I'm not saying that money should not be a consideration; of course it is; but healthcare is by definition expensive and if you straitjacket the budget, and divide the larger universal risk pool into hundreds of smaller pots of money, a lot of healthcare is going to become impossible. ITU beds are not cheap. Major operations (such as those after a car accident) are not cheap. Most hospitals will square the circle by closing those facilities and do purely elective surgery on people under 65 without co-morbidities.

"in attempting to meet the financial critera demanded by the FT model, the hospital became unmanageable as a hospital."

I don't know Julie, are we saying here that management of this hospital was 'excellent' ptior to the FT idea?!

"if you straitjacket the budget, and divide the larger universal risk pool into hundreds of smaller pots of money, a lot of healthcare is going to become impossible."

Of course, you know what you are talking about re hospital management and I don't. However, in any management, the trick is summed up in one word; 'priorities', hence yes, some health care may become impossible ... unless of course you are then welling to take a partner in to help, and that's where private money can be of benefit, to avoid just that.

Let's put it this way, you can never approach a new endeavour without a high degree of optimism and that comes from high ambitions and hopes of success, but I know sometimes this sort of runs too high, you need 'caution' to put the brakes on a little ... and that's where you come in. So see, everybody has a place in that new endeavour, just let's give a chance first, then you can do all the tweeking, while the optimistic dreamers rush with their imagination to the sky, and beyond. But, honestly Julie, it 's going to be ok, I can already see it ... the recipe is finally about right now!

Let's wait and see :-)

"in attempting to meet the financial critera demanded by the FT model, the hospital became unmanageable as a hospital."

I don't know Julie, are we saying here that management of this hospital was 'excellent' ptior to the FT idea?!

"if you straitjacket the budget, and divide the larger universal risk pool into hundreds of smaller pots of money, a lot of healthcare is going to become impossible."

Of course, you know what you are talking about re hospital management and I don't. However, in any management, the trick is summed up in one word; 'priorities', hence yes, some health care may become impossible ... unless of course you are then welling to take a partner in to help, and that's where private money can be of benefit, to avoid just that.

Let's put it this way, you can never approach a new endeavour without a high degree of optimism and that comes from high ambitions and hopes of success, but I know sometimes this sort of runs too high, you need 'caution' to put the brakes on a little ... and that's where you come in. So see, everybody has a place in that new endeavour, just let's give a chance first, then you can do all the tweeking, while the optimistic dreamers rush with their imagination to the sky, and beyond. But, honestly Julie, it 's going to be ok, I can already see it ... the recipe is finally about right now!

Let's wait and see :-)

Oh dear, look what I've done! ... I was just dreaming, and then ...

Julie! R U there?? I need your HELP!

As a nurse, and having read the official report into the Mid Staff debacle, the salient points for me were that here was an organisation that put all its emphasis into meeting the financial criteria for Foundation trust status and didn't put similar emphasis on the mstandard of care they were offering. For example, in A&E receptionists triaged patients, Dr'S were taken away from seeing acutely unwell patients to see minor injuries who were going to breach the 4 hour wait target ( which attracted a financial penalty) and there was a lack of senior staff, including no one having had training in how to work the debrillator! Management paid themselves bonuses for meeting the financial targets and it took an outside organisation ( Dr Fosters) to point out the high HSMR. To my knowledge no one has been held to account for these failings and members of the management team were either paid off with handsome bonuses or re deployed ( wasn't Cynthia Bower implicated in some way)
Sam, I don't know if the management team changed to try and attract FT status. You talk about management priorities, in the acute hospital setting the priority is always towards the sickest patient,in Mid Staffs the acutely unwell were ignored and the finances took priority, with catastrophic results for the 400 to 800 patients that died as a result. I am glad I live and work in Scotland where, although the health care system isn't perfect, We are not going to be subjected to Lansley's ill advised legislation.

"here was an organisation that put all its emphasis into meeting the financial criteria for Foundation trust status and didn't put similar emphasis on the mstandard of care they were offering."

Management at fault, not idea of FTs, yes? Sound Management has a No 1 duty to properly prioritise tasks while always keeping their 'mission' clear in front of there eyes - in this case, they did not. Don't forget that deffeciency in management of the NHS was highlighted in 2008 when the Health Select Committee found that NHS managment were not up to the task of implementing the Darzi review - this doesn't mean all NHS managers are no good, although it indicates that 'some' are not, but mainly says that the whole the whole set up is too bureaucratic and that as a consequence, ability to change and move on with the time is hampered leading to loss of direction as in Stratford or when they are too slow to catch up with the self modernising management practices in the world outside the NHS, hence the need for reform.

I don't know much about healthcare in Scotland, but having a much smaller population than England, they may not have huge health demand and resulting costs pressures either

Excuse me, meant to say Stafford :-)

Anonymous, there is something almost Lansleyesque about your unwillingness to confront the evidence with regard to the mistreatment of patients at mid-staffs.

Once you put managers who have minimal direct contact with patients in charge of a hospital's overall culture, then task them to provide care in a cut throat financial environment then casualties are almost bound to be inevitable.

Knowledge about the poor standards at mid-staffs were known about for some time yet was deliberately suppressed (due to a climate of fear) - conditions there had bugger all to do with being 'too slow to catch up', or (absence) of 'modern' practices, this style of health care represents a vanguard in the kind of hospitals that will emerge once markets and money are afforded such great importance.

Why do you think so many people are saying that these wretched reforms will endanger patients, perhaps on a scale that will make mid-staffs seem like the good old days?

"Why do you think so many people are saying that these wretched reforms will endanger patients, perhaps on a scale that will make mid-staffs seem like the good old days?"

Breaking the system does not mean breaking the NHS as some think, hence the opposition. The bill as was was too ambitious, and I was the first one to notice it. The bill has now been amended and will result in a more flexible and open environment that is much healthier than the status quo, then there will be no more reform and the NHS can go about conducting it's business in a happier setting.

"there will be no more reform" - one thing NHS staff are aware of is the culture of near perpetual reform - the next stage will inevitably involve 'reform' of the way patients pay for services.

Incidentally the BMA have upped the ante in terms of criticising the bill - from todays gruniard

"That the BMA's general practitioners committee, which represents all GPs in the UK:

• Formally reaffirms its opposition to the NHS health and social care bill

• Believes that if passed the bill will be irreversibly damaging to the NHS as a public service, converting it into a competitive marketplace that will widen health inequalities and be detrimental to patient care

• Believes the bill will compromise the role of GPs, and could cause irreparable damage to the relationship between GPs and their patients.

• Believes the bill to be complex, incoherent and not fit for purpose, and almost impossible to implement successfully, given widespread opposition across the NHS workforce.

• Believes that passing the bill will be an irresponsible waste of taxpayers' money, which will be spent on unnecessary reorganisation rather than on patient care, as well as increasing the running costs of the NHS from the processes of competition, and transaction costs

• Believes that GPs' participation in CCGs does not equate to support for the bill, but that GPs are there to defend their patients' interests and mitigate the adverse impact of the bill

• Supports clinically led commissioning believing this will lead to improvements in patient care in the NHS, and believes this can be more effectively achieved within existing legislation

• Calls upon the coalition government to withdraw the bill and instead enter into productive dialogue with the BMA to agree a way forward for clinically-led commissioning.
http://www.guardian.co.uk/society/2012/mar/01/bma-letter-opposing-nhs-re...

http://www.healthinvestor.co.uk/(X(1)S(qwh4akz0lk3fdv55chb4zy55)A(1K3EGpIuzQEkAAAAYzg2NTkzZTYtZDM4Mi00MTk5LTg1NzItYjEzNmEwNjJkY2Jk-3e_AYyCPbUTikKxaZVmKv9oaqE1))/ShowArticle.aspx?ID=1488

I read this above and posted it on 'My scroll' back in January 2011! Why did it take well over a year for the BMA to realise what the content in the link above mean? This then makes me wonder if the letter in your link takes note of all the amendments since then - and BTW, involving firs like those does not have to be for life, indeed, there is a lot the GPs can learn from these people, then go it on their own, if the so wish later.

The bill is still in the hands of the experts at the Lords, and they know much more than us here so, let's hope for the best :-)

Oh Sam, Sam, Sam, hoping for the best is just not good enough!

“The bill is still in the hands of the experts at the Lords, and they know much more than us here so, let's hope for the best :-)”

Experts on what?

Is it not possible that doctor knows best here? Why the outcry from the Royal Colleges - GPs, hospital docs, nurses. Why the outcry from the BMA, The Institute of Healthcare Management, NHS Consultants’ Association, GMB, Unite and Unison unions, Faculty of Public Health, Patients Association, Institute of Healthcare Management, Medical, Management and Nursing Journals, Chartered Society of Physiotherapists, etc.

Are they not experts? Do they not have a better understanding of the NHS than those in The House of Lords?

Why the 166,220 signatures to the epetition? Why have 19,137 people donated £267,442 to the 38 Degrees NHS Billboard Ads campaign?

Why (at long last) have the media ceased to be silent?

And most importantly why do you refuse to see that the HSCB will murder the NHS?

Peace!

Anna :o]

Can I not differ?

I have been watching, and reading, a lot about this bill right from the start, and now I honestly believe what I said before @ 10.13pm

Again, since I am no expert, I will just hope that the Lords, who have all sorts of 'top' experts, including medics, lawyers, philosophers, society of all kinds, etc will arrive to the right decision.

Let's hope Anna :-)

That didn't go very well, did it?
http://www.youtube.com/watch?v=p0lPJFEjMKo&feature=related

Looked like the tight lipped Chief Exec (Mr Sloman) was more concerned about the Trust's bid for 'Foundation' status and the £40 million required in cutbacks, sorry, I meant efficiency savings, needed to achieve it?
http://www.times-series.co.uk/news/topstories/8956937.450_jobs_to_go_at_...

Looks like the time has come to ban politicians from formal NHS hospital visits and even recommend they wear wigs and dark glasses if, God forbid, they ever become patients with a condition that the private sector doesn't have the expertise to deal with.

Oh, I forgot for a minute, we're all professionals, so they'll be OK then.

Nice article. very interesting, thanks for sharing.

This is a very good tips especially to those new to blogosphere, brief and accurate information


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