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Lansley and me…

February 10, 2012 3:00 pm

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Mark Ferguson

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There’s been quite a lot of Andrew Lansley in the press lately – mostly because he’s been making a terrible mess of NHS “reform”. It seems that no-one else can think of anything good to say about his reforms, especially the Prime Minister whose best riposte so far has been something along the lines of “Errrm, there’s a doctor in Doncaster who likes them…so there.” Enlightening, I’m sure. Now he’s been given the magical vote of confidence from Cameron – like a football manager being “bolstered” by support from the Chairman. Alas the manager that Lansley most closely resembles is Fabio Capello – everyone wonders why he hasn’t gone already, no-one seems to rate him, he’s lived on his past reputation for years and no-one will be bothered when he goes.

But what all of this Lansley coverage has managed to do is dredge up a memory that I had obviously been suppressing in the very darkest recesses of my mind. The memory of my own history with Andrew Lansley MP…

Back in 2006, I was the President of my Student’s Union. As part of a campaign to lobby MPs on issues concerning students, I’d invited all of the local MPs to meet up and talk things through. Lansley, as MP for South Cambridgeshire, was just about on my patch. He agreed to meet. So far so good. Now this meeting took place 6 years ago and I may be looking at it through the opposite of rose-tinted spectacles – as such this is my own highly subjective/biased version of events. But it was only me and Lansley there, and I doubt this was an especially memorable meeting for him either, so it’s likely the only version of events that remains…

One morning he turned up bright and early, turned down my offer of shoddy coffee, squeezed himself into a chair in my office, and asked what students cared about. I took him on a brief tour of student issues – from major issues like fees, to the cost of housing in Cambridge, and even relatively mundane issues like the lack of street lighting in the town.

Immediately his eyes glazed over. I knew he was a long shot, but I expected a better effort than this. I’d heard about politicians. They were supposed to be slick, reassuring, comforting – they’d make you think they agreed with you when they didn’t. I didn’t get that from Lansley. He was bored, and he’d decided I was wrong. On fees, he waved away my concerns. Not interested. However, he had once been a student officer himself.

He then proceeded to tell me exactly what I should be interested in, based on his somewhat outdated experience of student life. Realising this was a waste of my time (nevermind his) I desperately tried to wind up the meeting. But it was too late. So it continued. For over an hour.

You may well wonder what this somewhat obscure anecdote has to do about anything. Well if there’s a point at all, it’s this. I very quickly realised that Andrew Lansley wasn’t a good listener. He patently didn’t give a toss what I thought. He was arrogant, high handed, snooty and not at all reassuring. The way he dealt with me six years ago was a microcosm of the way he has handled health professionals today. I can imagine now the way his eyes glazed over when they told him about their problems with the health service. I can hear the tone of voice he’ll have taken when he explained that he knew best. I can feel the pain of the NHS staff we realised he had never been listening in the first place.

So I apologise to NHS workers, doctors, nurses and most importantly patients. I should have said something. I always knew Lansley would make a mess of a big job – especially one with a prominent “listening exercise” attached. I should have shouted it from the rooftops all those years ago about the worst listener I’ve ever met…

Anonymous
Now that 3 cabinet ministers have apparently t0ld Conservstivehome that the health reform bill should be scrapped (The World At One Radio 4 today 10/2/12), hopefully Lansley’s days as a minister, or at least an “important” minister are numbered. Ministry of Sport for him in March.
Also, of course, he has always been a massive cheerleader for the private health industry, so no wonder he doesn’t listen

Anonymous
I was under the impression as well that Lansley had consultancies and perhaps other interests in the health sector.
This is his entry in the Register of Member’s Interests.
LANSLEY, Andrew (South Cambridgeshire) Nil.
Anyone else smell a rat?

Anonymous
No doubt he will say it is either:
1) An oversight
2) A misunderstanding
or
3) Simply not true
They seem to be the stock answers to political liars

Anonymous
How many more MPs and Minister should go when you have debts like this hanging over your NHS hospitals.
Currently the combined debt for some 800 PFI projects, including 103
PFI hospitals in England, stands at about £300 billion, according to
makers of the programme.
When a BBC Panorama programme contacted 85 hospital trusts with PFI
deals, it found 80 of them said they were having to make increased
payments due to inflation.
When most of the deals were set up, inflation was low and the outlook was for that to continue well into the future.
Most trusts decided not to protect their debts from rising inflation, against the advice of the Treasury.
By contrast, the companies building the hospitals insured themselves against losses due to inflation.
The PFI deals, under which companies build hospitals to be leased back by the NHS, typically run for 30 years.
Margaret Hodge, the Labour MP who now chairs the Public Accounts
Committee, admitted to the programme: “We should have been much more
transparent about the costs. I think we got the balance wrong.”

http://www.facebook.com/profile.php?id=697126564 Paul Halsall
PFI was a disaster from the get go. You have to read Private Eye with a great deal of care to sort out when it’s being incisive from when it’s just being old fogeyish. Still, PE has been knocking on about PFI for almost a decade, and most of its predictions have come true.
This is something that Ed Miliband could apologise for (on behalf of Gordon Brown).

Anonymous
Somebody had better come up with idea of how to solve the debts.

Chris Cook
@treborc:disqus
Yup.
Got that sorted.

Anonymous
you never met tim yeo then he was a master a/ h……
charles.ward
“Immediately his eyes glazed over. I knew he was a long shot, but I expected a better effort than this.”
“Realising this was a waste of my time (nevermind his) I desperately tried to wind up the meeting.”
Pot, meet kettle.
Anonymous
Hi Mark, I think your observations back then are highly pertinent now.
What it sounds like is lack of adequate skills and the right attitude for the task;
and certainly listening, a genuine interest, and importantly- respect
for the actual people involved is paramount to gain trust in, and respect for himself.
I think some politicians show excellent skills, or at least are willing to learn
from others; but something I personally can’t relate to or tolerate is any form of arrogance.
I also don’t think any one minister or even government should have the right or power
to subvert or dismantle the whole fabric and ethos of something so valuable
as frontline public services, and especially the NHS.
I don’t doubt he believes what he is doing is the right way forward.
But why didn’t he share this along the way- consult and collaborate
with the myriad of staff, professionals and patient groups in depth?
Instead, it looks like it’s been highly selective and behind closed doors;
some aspects almost veiled in secrecy.
Why does this appear such a detailed technocratic exercise
which seems to miss the point?
Does it obscure the real implications, and prevent people
from engaging in process?
This is wholly unacceptable; no wonder the medical, nursing,
and allied professions have come to a unanomous decision,
after long hard thought and consideration?
This is unprecedented- nursing professional bodies for example
have been very accepting of upheavals and changes over the years.
But this goes too far- and has not brought people on board.
Let alone the public view.
It matters little about individual ministers’s career prospects
compared to the fate of the NHS- which affects us all-
and the future health and well being of the nation.
What’s needed now is honesty, humility and courage-
and letting real experts lead the way, not technocrats
or civil servants.
Reform and innovation is always possible- but NOT like this;
it’s pure shambles.
I don’t care what happens politically- but I care passionately
about the health service I’ve worked in for nearly 3 decades,
and how it can change people’s lives for the better.
I do NOT want it to become a marketized fragmented impersonal
system run along any lines for profit, or by vested interests/cabals.
It is not a supermarket, and patients are not commodities.
We do not want every valuable public service in this country to be
stripped back to a mere skeleton, staff demoralized, and patients
receiving an inferior quality of care.
It requires skill, dedication, support and resources.
That also involves training staff to high professional standards-
and retaining them.
It is they who should be leading the way- not just a handful of
pilot projected GP’s and management consultants/private sector.
There are many skills and allied professions and workers in
the health and social care fields; this should be an integrated
and collaborative venture, and care delivered providing a
comprehensive package- not merely a patchwork of
companies competing with each other for profit motives.
Finally- it’s possible this is all part of the ideological drive
to roll back the welfare state” as we saw back in the 80′s onwards?
It’s surely not just about cost savings; if it was- these reforms
would not be so far reaching.
Dr C.Gerada said recently on R4 that 18 months ago the NHS was
functioning well- certainly in primary care.
Now it’s potentially being threatened with chaos
and massive disruption.
None of that is justified; let alone the huge costs.
Someone has to get a grip of this- and fast!
Thanks for sharing too Mark- explains quite a lot.
PS I don’t hold anything personally against AL- but he’s not the right person
in this role, and DC is not showing leadership by not listening to NHS staff.
Jo

Anonymous
Just a few points I couldn’t let pass:
‘I also don’t think any one minister or even government should have the right or power
to subvert or dismantle the whole fabric and ethos of something so valuable
as frontline public services, and especially the NHS.’
So if the elected government doesn’t have the power to change public services – who does?
‘Instead, it looks like it’s been highly selective and behind closed doors;
some aspects almost veiled in secrecy.’
But the Bill is on it’s way through Parliament and has been (including the ‘pause’) for quite a few months now. Don’t see how this is behind closed doors.
Ideology cuts both ways – the Tory party ideologically believe in reducing the state and providing services via private provision as much as possible, Labour believe (I think) that all public services should be provided by public employees (Well it used to be, not so sure now)

Anonymous
”
“So if the elected government doesn’t have the power to change public services – who does?”
Two points:
1) Before the 2010 election Cameron promised not to privatise the NHS and that is what he is doing
and
2) It could be argued that the Conservatives were not ”elected” – they did not have a working majority, and being propped up by the Lib-Dems, they can hardly claim to have a mandate – especially for something as major as this.

jaime taurosangastre candelas
1. The NHS is not being privatised under the current proposals. To claim that it is is simply wrong. I’ve got a list of 17 major and 63 minor concerns about the proposals as they affect acute and emergency care, but not one of those concerns is about privatisation. They centre on timeliness (7+22), communication (4+12), management (3+8), policy and autonomy (3+5), with a further 16 minor concerns around admin.
2. That’s Parliamentary democracy. By your logic, the 2005 General Election also produced a Government with no legitimacy. (35.2% Labour in 2005 vs 2010 36.1% tories in 2010). If you add together the percentages of tories and Lib Dems in 2011 (59.1%), no single party or coalition has ever had such a proportion of the popular vote since universal suffrage.
I think Jo’s thoughts on who has the power to change public services were unfortunately expressed. It is entirely correct that a democratically elected government can change public services, which are paid for from public money. To think that somehow some organ of the state is immune to democracy is laughable, and not what Jo meant. If the public wanted to get rid of the NHS entirely, it would be democratic for their political representatives to do so. I wouldn’t advocate that, but democracy is sovereign.
People say that no one knew what the tories were going to propose, but looking at their manifesto and reading Lansley’s speeches from pre-election, it is entirely clear that he was heading in this direction. Whether it is right or wrong, or more probably somewhere in between, all of the signposts were there pre-election.

Anonymous
Jamie
Let me respond to you by first saying that I am from the right of Labour. I am not attacking the Bill from an ideological point of view. I know, on a very personal level, that the NHS desperately needs reform.
The NHS literally saved my life in 2010. I have experience of the NHS in both its beauty and awfulness.
My greatest objection to the Bill is the clause that allows NHS hospitals to increase the revenue they earn from private treatments from 2% to 49%.
How can that possibly lead to a positive outcome for those who depend on and are waiting for state-funded procedures?
I am genuinely interested in your thoughts on this.
Thanks
jaime taurosangastre candelas
Hospitals won’t see much change from the perspective of the patient, whose planned and unplanned attendances will continue as before. The surgery will be conducted by the same people, to the same standards as before. There will not be a bill presented to the patient. Changes in hospitals are to do with technical authorisations, workload balancing, regional specialisations between Levels 1-3 hospitals, some centralisation. The effect is that some patients on long-term review will be asked (in my local case) to stop attending Hinchingbrooke or Royston and instead attend Addenbrooke’s, and clearly that is an issue for some patients. Time, travel plans, distance, etc. But they will find increased facilities and staff numbers at Adeenbrooke’s, as well as centralised experience and facilities in a bigger medical team.
The big changes are happening in commissioning, which is GP territory, and in the interaction between practices and secondary care. If you have a referable case, you may find that in the future you are offered an appointment (via your GP) to either the old hospital you would expect to be referred to in 6 weeks, or to a different hospital in 4 weeks. Sometimes that hospital will be further away, but you then have a choice. 6 weeks for reasonably local, or 4 weeks for a 1 hour journey? Depending on your case, you and your GP will need to decide what is best for you.
I’m completely prepared to concede that among his proposals there is quite a lot of technical detail that is not quite right (and my own professional College of Emergency Medicine goes long on pointing that out), but it is also not wrong either. The current setup is far too focussed on geography, not outcomes or speciality. Most of the opposition I see is from vested interests in maintaining local geographic full coverage, but that is not economically sustainable.
Frankly, the whole exercise is load-balancing and efficiency. The current setup is not very efficient. What Lansley is trying to achieve is best understood in engineering terms. He’s a pretty poor engineer, and his communication of new policies is bad, but his pretty poor engineering skills are in fact better than leaving the status quo in place for both patient outcomes and financial aspects.
derek
Hardly surprising? as your constituency always returns a tory MP. The 23% liberal vote opposed tuition fees a VAT increase and opposed any re-organisation of the NHS as did the leader of the Tories.
Could you define “sovereignty?” as far as I’m aware parliament is sovereign to the crown not the people?
Anonymous
David Cameron will today unveil an audacious attempt to reinvent the Conservatives as the party of the NHS.
Pledging to make health his priority in the way Tony Blair once
declared his as “education, education, education”, Mr Cameron will close
his first autumn party conference as leader promising there will be no
real term cuts in NHS funding under a Tory government.
Capitalising on ward closures and financial deficits rocking NHS
trusts across the country, he will also commit the party to ending
“pointless and disruptive reorganisations”.
In his second keynote speech of the week, Mr Cameron will use his
family’s own reliance on the NHS – his eldest son Ivan suffers from
severe epilepsy and cerebral palsy – as evidence the service would be
safe in his hands.
“I believe that the creation of the NHS is one of the greatest achievements of the 20th century. I always believed this.
pointless and disruptive reorganisations”.
Of course you know as well as I know one should never trust an MP or leader when they say something is safe in my hands.
many ways of taking the NHS down a private route you can as Blair tried sell it off in bits, or you can bring in private forms.
But what Lansley is now doing is wrong totally wrong, but of course after new labour and Brown the fact is do people believe Miliband, if they take the NHS down this route and we will get in we will change it.
NHS own review:
When Labour came to power in 1997 Frank Dobson
(and his minister Alan Milburn) found to their dismay that in
opposition the party had developed no health service policy ready for
implementation. They were starting from scratch. In December Labour
issued the The New NHS – Modern, Dependable ,
their initial vision for change to NHS structure, conceding that some
of the features of the Conservatives’ internal market were worth
keeping. They built on Conservative initiatives while denouncing them.
The Government wanted to get things done fast and without necessarily
relying on local management bodies. Watch-dogs, systems of audit,
targets, and quantified, external and retrospective methods of control
proliferated, as did “zones”, initiatives and ‘czars’ with a
responsibility for improving specific service.
http://twitter.com/gonzozzz dave stone
“no one knew what the tories were going to propose”
On the contrary. The Tories had stated their intentions on a number of occasions. The purpose was to assure voters that the Tories could be trusted with the NHS.
But once in power they did an about turn and reneged on their assurances.
You say the “signposts were there pre-election”.
I suppose, unlike everyone else, you didn’t notice these signposts:
Cameron’s words from a speech at the Royal College of Pathologists (2 November 2009):
“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”
And a very similar pronouncement had been made by Andrew Lansley in a Conservative Party press release (11 July 2007).
Even in the Coalition’s programme for government (20 May 2010, p. 24) we can find the following: “”We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”
What we now have is much much more of the tiresome, meddlesome, top-down re-structuring that is going to get in the way of patient care.
The choice for Cameron is simple: ditch the bill or be remembered for destroying the NHS and lose the next election regardless of how well the Labour Party perform.
jaime taurosangastre candelas
It’s bottom up, not top down. It is devolution of commissioning power to GP surgeries. I’m not going to try to defend or support big changes, but if you look at where the changes are happening, it is to the bottom, not the top. It changes the NHS, for sure, and time will tell whether the changes are wise or not.
You should read the Tory manifesto, and also Lansley’s speeches pre-2010. There is very little being proposed now that was not in the public domain before the election. If politicians or voters had “not realised” what was on the cards, they have only themselves to blame.
I’m agnostic about the whole set of proposals. Good in many parts, ill-thought out in others. What is certain is that maintaining the status quo was rapidly becoming unaffordable. For every person who holds to the view that the NHS is the world’s best health system, there is a logical argument that it is (was) unaffordable, unless you want to start taxing people and business a lot more.
The reality is that for patients, not much will change apart from being offered some new choices that they will want to work through with their GP.
For the GP, yes, lots changes.
Daniel Speight
It’s bottom up, not top down.
Jaime, did you say that with a smile on your face? It’s such politician newspeak it could almost have come out of the mouth of Tony Blair himself.
Daniel Speight
Oh and in case I have to explain the comment above Jaime, the reorganization is being carried out from the top by government. It wasn’t carried out because of a groundswell of opinion from the bottom by those in the front line NHS jobs like your good self or by the general public.
Dishonesty is dishonesty, whether it’s the Liberals making pledges on student fees or the Tories promising not to have another massive reorganization of the NHS.
jaime taurosangastre candelas
Daniel,
I’m not going to try to defend the tories spin, but from my perspective, it is an “ordered from the top reorganisation from the bottom upwards”. That sounds – and is – a stupid narrow description, but it is also accurate.
There are many things I have concerns about with the proposals, but they are essentially technical, not of principle.
The fundamental principle of the NHS – free at the point of care – remains unchanged. What these proposals are about is organisation, funding, efficiency, value for money, timeliness.
I am not an engineer, but I could have taken that career choice and enjoyed it. I like thinking in terms of systemic efficiency and design. I’ve got a mind that likes numbers and organisational construct. I see the NHS as an organisation that produces fantastic results but at the cost of enormous inefficiency. What we would all want is an organisation that produces fantastic results but is also efficient.
What we currently have in the NHS are two (main, there are others for specialist services) strata. Primary care needs to be geographically based because it is ridiculous to ask people to access primary services that are not local to them. Secondary / tertiary care (i.e. hospitals, specialist clinics, research, trials, teaching) is the other strata. It does need to be so rigidly tied to geography, but instead has the opportunity to achieve better effects through concentration of expertise. Instead, in many cases it is also geographically based, meaning overlap and inefficiency. A new way of thinking is needed.
Many opponents of the proposals oppose them from either a misunderstanding, or a locally-based is best perspective. The misunderstanding is that somehow the core principle of the NHS of being free at the point of care is being thrown away. Locally-based is not the best answer to many issues, but it is an ingrained way of thinking.
Please don’t think I am a fan of the proposals, the tories or Lansley. I am agnostic about the proposals as being poorly engineered, but do know that the status quo is unsupportable.
Daniel Speight
I’m not going to try to defend the tories spin, but from my perspective,
it is an “ordered from the top reorganisation from the bottom upwards”.
That sounds – and is – a stupid narrow description, but it is also
accurate.
Starts to get a bit silly doesn’t it Jaime. We must try and keep some logic to our thinking. If it’s ordered from the top, it’s top down reorganization. that’s it, it doesn’t matter whether it’s needed or not, it’s still top down. Bottom up would mean something totally different. It would mean that employees or even patients of the NHS were changing the organization from within.
To repeat this bottom up mantra is just joining in the political ‘newspeak’ and spreading what is an untruth. And I sure all parties are capable of doing this, but those outside their Westminster bubble mustn’t join in and encourage them. To use yet another literary allusion it’s Alice in Wonderland stuff.
http://pulse.yahoo.com/_ZPXYLRVP4XOIGGDJWAL6HUO7U4 David
Daniel, if that definition was what was implied then Cameron might have just as simply said “no change to the NHS”, since any change, by your interpretation, is top down: that he didn’t implies that his definition of that phrase must surely have been closer to Jaime’s than yours, would you not agree?
Daniel Speight
Answering David below as these threads are getting too slim.
You are getting into the position of words meaning what you want them to mean, not what they say. The only reason the ‘bottom-up’ phrase was introduced was because they were caught out breaking a promise. It’s meaningless in the reality to what they are doing.
http://pulse.yahoo.com/_ZPXYLRVP4XOIGGDJWAL6HUO7U4 David
Continuing the thread…
I make no effort to interpret Cameron’s mind, merely to point out that your interpretation has him saying something and immediately doing something else, while the suggestion Jaime makes at least shows an element of consistency.
Daniel Speight
Likewise continuing the thread below.
So let’s play the ‘what ifs’.
What if Cameron said ‘no top-down reorganization’ even though he knew Lansley was planning a major reorganization of the NHS. So let’s guess that one of the spin doctors, Hilton or Coulson said to him we can reassure the public we are not going to screw with the NHS by using the word top-down to qualify the ‘no reorganization’ promise.
So all we get back to is the dishonesty of the phrase. Of course the honest statement would have been that he was going to disband the PCTs and replace them with GP groups. It was nothing to do with bottom up, just a spin doctor being clever.
Of course that’s probably not the truth as the ‘bottom up’ phrase seems to have been invented after the Tories were picked up on the promise of no top-down reorganizations. It was a pretty poor answer for having been caught breaking the promise.
I’m sure we can all remember Blair and Campbell doing similar, but for those outside of the political class it would be good to pick them up when they stretch our credibility too far.
Anonymous
Jaime: Whatever Lansley’s writings and witterings said, Cameron himself gave an assurance about the NHS (using his own personal circumstances) which he has now given up on – and yes – I know politicians do that all the time.
However you try to excuse it, it is privatisation in that private companies will be allowed to pick and choose what work they deign to do. If it is anything like our local BUPA hospital, it will be a glorified beauty salon. I’d love to see them having to offer 24 hour A & E.

Anonymous
The wife of the former Labour prime minister is one of the founders of a
business planning to open private clinics in supermarkets.
Her choice of venture is likely to prove controversial among Labour
supporters, who will today set out their opposition to greater private
involvement in the health system.
Party members jeered at a mention of Tony Blair’s name earlier this week
during Ed Miliband’s conference speech.
The company is thought to represent Mrs Blair’s first foray into commerce. It
is approaching City financiers just as her husband’s business interests have
come under renewed scrutiny. Mr Blair said that while business chiefs often expressed envy of the
ethos of service and duty in the public services, in turn those services
could learn lessons from the private sector. Private companies
were in many cases more responsive to the needs of consumers. They
appreciated that poor service, lack of courtesy and massive delays could
destroy their success. “It would be surprising if the public sector could not learn something from that responsiveness to consumers,” said Mr Blair. Ms HewittOur reforms include the involvement of the independent sector – an
involvement that is not unprecedented. Nye Bevan recognised that there
would always be some independent sector involvement in the national
health service. GPs were – and most still are – independent contractors
wholly dedicated to caring for NHS patients. High street pharmacists,
opticians and most NHS dentists are self-employed professionals or small
businesses. The private sector builds our hospitals and provides our
equipment. More than 20% of the NHS budget goes on medicines supplied by
pharmaceutical companies. And individual NHS organisations have always
purchased small numbers of treatments from the private sector to keep
waiting lists down. None of this was privatisation, none of it
compromised the basic principles of the NHS.Today, there are
three reasons why we are using the independent sector to provide some
treatments for NHS patients: to increase capacity, support patient
choice and help improve value for money by raising productivity and
innovation.The problem is how long before Blair and new Labour would have gone down the same route and you have to spend an hour type in Blair NHS privatisation into Hansards and you have 100′s of choice New Labour privatisation.We all rember the news problem about the lines of people trying to get an NHS dentist even today the waiting list to get a dentist is five years, five years not having your teeth seen unless you pay.So you know the Toriues are not going much more or less then labour did or tried to do.Out sourcing was the name of labour game.
Anonymous
This will have to be brief for now geedee; my main complaint in this regard is it’s been said in the planning by AL for possibly 7 yrs or so; and yet the electorate were clearly led to believe: “no top down reorganization; cutting the deficit, not the NHS” etc.
I think most are pragmatic and realise these need for savings- but NOT
wholescale dismantling and huge disruption to the very fabric of the organization, with little consultation with the main body of staff and patient groups.
Yes, of course ideology and politics applies on all sides- but not when it comes to intefering with the whole function of what has proven a highly effective service for over 60 years and is rightly valued and cherished by the public.
Of course it has its faults and anomalies-but not surprising considering huge demands and in many areas, limited resources.Considering all of this it’s been hugely cost effective compared to how it would be in a privatized system.
It’s also the road set we will be travelling down that matters.
Finally- I strongly believe from years working in primary care- GP’s will struggle terribly with the scale of responsibility and competing demands of clinical and business practice.We do not want a load of private companies lining up either to offer management advice. J.

Anonymous
Hmm
I recognise your complaint etc. I still say that:
- the elected government has the right to change public services on behalf of the taxpayer, and no one else does without their approval
- the parliamentary process has exposed the Bill to scrutiny and it cannot be said to being ‘behind closed doors’
- I’d add that your penultimate paragraph is telling – what you seem to be saying is that ideology is OK so long as you agree?

Anonymous
Geedee, on your particular points:
I believe currently there is an onslaught on public services,
which may be part of the “rolling back the state” agenda, as they see it.It’s not just about cuts- but ideology,
as I remember full well in the 80′s, when economically,
times were better.I see it as about choices and priorities,
but also process of management of any changes that are agreed necessary.By collaborative consensus- not
imposed to down, and behind closed doors.
If this bill was 7 yrs in the planning- there was plenty of opportunity to air in the public domain, and with actual workers who deliver care; patient groups etc.
But quite the opposite was said at the election- and
that narrative has been quoted many times.
I don’t see potential dismantling of frontline services
as something any one person or party has the right to do,
especially without a mandate or due process.
My comment about being behind closed doors refers to the lack of transparency, especially at last election;
also many years in the planning, as said.
Also- very limited consultation with a range of professions and pilot projects.
The public also do not know or understand what possible conflicts of interests, eg opening up services to private companies? By abolishing the function of PCT’s as middle managers and commissioners- it allows potentially the precedent for other providers to step in, eg as management consultants or accountants to assist GP’s?
It’s been said- 5 new tiers of management have already been created since this hailed abolition of “quangos.”
It’s become more complicated and burdensome
than ever before- a contradiction to aims of bill.
Not only that- already GP’s have to comply with some of the changes, and yet we are told, this proves they are in favour- and it’s all running smoothly.
I do not call that being honest and straightforward;
it’s selective information- and we’re only being told by
politicians and media.
D.Owen, a liberal peer, suggested some interesting comments about lack of due process last week; sorry I don’t have article to hand. But it seemed to me, pretty damning.
In fact- a huge amount of concern and criticism across parties, professions, and the public.
Re “ideology.”
No, I’m more interested in pragmatism and function
of organization, but clearly the ethos and culture is important; for example, principles of co operation,
collaboration, integration, as opposed to a purely
market driven competitive system, where potentially
services can succeed or fail like nine pins,
and clinicians may be forced to compromise
on their practice, and pressurized to the point
where it becomes undermined.
Morale of staff is also paramount.
Most of my ex colleagues I remember were not in any way overtly political; but many do care passionately
about the NHS and want the very best for their patients.
I believe the staff are the best advocates, and it is they who should be being consulted and leading the way for any future plans; not a minority of doctors and possibly private interests who may stand to gain the most from opening up to competition.
The public value and cherish the NHS for good reason.
It’s possible for changes to evolve over time- but
this is entirely the wrong way to go about it IMO.
J

Anonymous
”
I don’t doubt he believes what he is doing is the right way forward.”
Hello Jo. I am afraid, due to his outside interests in the private health sector I (which apparently he no longer has?) I think his motives are, (to put in very mildly) questionable. When his second rate career hits the buffers, no doubt those connections and loyalties will result in a well paid job in the sector
It reminds me of when John Major privatised British Rail, despite advice from industry experts who advised him against it. He forced it on his own party. The result of that has not been good with multiple fares to the same destinations and enormous subsidies, but a similar disaster with the NHS would be a massive disaster.
Also, it has to be remembered that Blair was quite arrogant forcing through what he wanted in the face of his own party’s opposition. So many politicians from all the parties suffer from arrogance

Anonymous
Hi Alan- sorry, didn’t see earlier- but thankyou for insights.
My main PC is having problems using the disqus system-
so time is a bit limited on here at present- bear with me!
Hope you have a good weekend.
I had a lovely morning in the company of some artists,
discussing the in’s and out’s of contemporary fine art;
viewing some incredible work, hearing heartfelt stories-
which made a lovely change from listening to politicians
spinning their yarns.
Besides- they have far too much power over issues
which are fundamental to our lives.
I wouldn’t resent it so much if they had had years of experience
working in the field, or had bothered to genuinely consult
with a wide range of people who know what they are talking about!
I’ll stick with art over politics every time; although- even there-
it exists, when it comes to issues like funding and control over agendas.
Must sign out now- hope good debate.
Cheers, Jo.

derek
Hi Jo, I don’t think Lansley isn’t creating any masterpiece with his rash brush strokes. The NHS is a provider, if you mess about with the eternal structure and evoke privatised management, then the end result will be just like what happened to our dentistry departments, fragmented breakdown of a once national provider, where the cost element overrides the services.
I guess unless we can bloke these changes, we will witness many government artist! all drawing the Dole?

derek
Sorry should have read block? that bloke Lansley.
Anonymous
I got your reply Derek via disqus- thankyou.
Sorry has to be limited posting for a while,
as problems with my main PC getting through.
Please keep up the input- we need Labour voices.
Jo

Anonymous
I was just settling down to a nice relaxing mug of tea listening to Classic FM,
when suddenly Mr S.Burns, health minister, seemed to appear out of nowhere
to announce something along these lines:
We are going ahead, nothing is going to change, no one is leaving their job.
(Not exact words- but meaning clear.)
Followed by- “the NHS is far too important to be treated like a political football!”
(Last bit almost word for word- 7pm news.)
Maybe how this “spin” thing works is adopt the phrases
and position of opposing arguments- but subvert to suit one’s own?
In this case- assuming role of being impartial and responsible?!
Just stop playing games, stop telling us- and actually listen to the experts-
of which there are many.
The only thing that interests us is the future survival of the NHS,
quality care for patients, and being left to our jobs as we’ve been trained.
We are the real advocates on behalf of the public- and recipients
of care.
We’ve also moved on several decades ago from the “medical model” IMO,
and don’t need to be lectured to or spoken down to by “kindly” politicians
or a handful of doctors; after all- who stands to gain- and who is managing?
If these reforms were non political- then how come it was DC’s flagship message
at the election, when he promised no top down reorganization and no interference?
18 months on- that’s exactly what we’ve got; and that’s before leglislation
has even been passed.
How can the public trust anything that is said now,
and what attitude does it reveal- that they will just press on regardless
of consequences? Is there a mandate also?
I think they are out of their depth, and it’s probably time for a cross party
rescue package, but more importantly- let all the professionals and patient
organizations lead the way in the future.
NOT vested interests, or those that would gain from turning
our public services into market based competition and a postcode lottery.
Govt also has its responsibility to meet the public health needs of the population
and maintain quality frontline services/skilled training; adequate staffing.
Savings can also be made without this horrendous disruption
and uncertainty; as can any sensible reform from within-
but led from the frontline/ground upwards.
As for “political,” well- I’d say- more ideological;
as in wider ambition to “roll back the state”
as they define it; not as it exists in reality.
Maybe this is partially about cutting costs, devolving
responsibility, and fragmentation of structure;
ultimately relying on the vagaries of the market
to offer “services,” regardless of true complexity
of needs of care?
It’s what’s being set in motion and its implications a few years hence
that is of grave importance; once damage is done- may be impossible
to reverse?
These are my impressions- but I don’t think a million miles
from what is being written about and heard across a wide spectrum
of professional and public views.
Thanks, J.

Anonymous
Simon Burns. He was on The World At One today saying the same things. Apparently he was a junior health minister in the Major government.

Anonymous
All I can say is “big deal” Alan….
He looks a bit shifty to me when I’ve watched some of the debates!

Anonymous
I agree with you on all your post about the NHS, but you know as well as I do the NHS is changing and it will change if by nothing else then cuts to money.
Not to long ago I saw my hospital cleaning crew which was on duty in three shifts twenty four hours a day, go to a private firm, and one twelve hour shift, in which a team of three people had to spend a day in each ward, so when my ward was cleaned it was another three days before they returned, oh yes they had a young lady of eighteen who’s job it was to empty bins. But the actual cleaning of the beds the frames the walls the mirrors was once every three days.
I had my spinal operation was brought back and had to lay on my stomach for seven days while the clips and the dressing was changed each day. Then one day I told the nurse I was feeling sick, my temp was taken and a doctor was called I had swabs taken and I was told I was being taken to ICU, for three weeks I was close to death and that is no exaggeration, it was only when I was allowed back to the ward I was told how close it was and I my infection was in fact MRSI. In my eighteen months in hospital I caught it twice more and had to battle back, before the hospital put in place an idea that cleaners were just as important as nurses.
In my hospital they are paid £1.50 above the min wage and they are trained with a Three month course they also do courses and have to attend lectures on cleaning and hygiene, in the past three years we have not had a single MRSI.
That was also New labour and the out sourcing of work.
SO ok Miliband is new, but as yet he has not told us his idea of what the NHS will be, what it will do. And how he intends to pay for the service

Anonymous
Hi Robert- so sorry having to sign out just now, but will try to return in the next day or two to respond.
Thankyou for sharing experiences, and sorry you have had such a very tough time; hope things are slightly improved these days?
I’m sure too there are many testimonials out there;
perhaps there should be some kind of collation of this,
so people can participate in wider debate?
I do have thoughts about points you make- but will have
to get back later when I can do justice Robert.
Many thanks again.
Jo

Anonymous
There is now such widespread opposition to the Bill (including Tory supporting media) that Labour should consider plotting a “national march to save the NHS”.
If we could get a million people on the streets, I’m sure it would – finally – topple the Bill.
I hope Ed will keep his focus on killing the Bill, rather than allowing it to pass and making political capital from the devastating consequences of its passing.

Anonymous
Labour does not get people to march Unions or the public them selves do it.
But I think over the years of using the NHS as a political football, the public are a little bit tired of it. It would take as we saw with the pension strike and march in my area the vast majority of teachers who took the day off ended up in Tesco shopping.
The picket line had so few we decided to go to the town hall where only a hand full of people bothered, no Police or photographers needed.
I think labour has played the education education and NHS to death.
http://www.figurewizard.com Joe Jonkler
Will this march you propose include those carrying banners protesting about £68 billion of PFI obligations incurred under the last government that are currently ruining the finances of many hospital trusts across the country?

Daniel Speight
We should always remember that the Tories have previous form regarding the NHS. Wasn’t it the first department that Maggie let loose the hounds of Hayek and Nash with their targets and privatization? That 13 years of Labour didn’t clean up the mess that made is to Labour’s shame.
We should also remember that doctors have a lot of previous too and are not those we should trust with running the NHS. If they want local control then have elected health boards. Wasn’t that what the Liberals had in their manifesto?
Dave Postles
In my book, bottom-up reorganization is when you devolve the responsibility for reorganization to those at the cutting edge to devise their own solutions to providing a more effective service at their points of contact within the overall strategy. Lansley is mandating what should happen at those points of contact: dissolving the PCTs (even before the legislation receives assent) and prescribing GP commissioning en bloc and singularly. It’s top down reorganization.
Dave Postles
As is reported in a detailed conversation with Stuart Hall today, the simple question is the morality of private profit from people’s healthcare. There’s nothing to prevent people who want that option from taking it for themselves. To impose that morality into the ethos of the NHS is aberrant. Personally, I do not want my health and healthcare to contribute to private profit. My taxes, as far as they contribute to the NHS, should be for a common good which is public, not for private extraction of profit. New Labour was wrong, but at least the damage (apart from PFI) was limited. My health is not a commodity to be traded in the market place, thank you.

Anonymous
Well said Dave.
My other concern is- GP’s may not be able to cope with demands,
are not well placed to take on the scale of these changes;
not to mention many other staff and practioners,
and in specialities.
I do not believe this debate is being properly aired by those who will be directly affected
and expected to carry out these ideologically driven changes- which are immense
and very costly.
Politicians should not be leading this debate- only on the periphery.
Jo

Dave Postles
PFI NHS debt
Instead of buying gilts from the banks, how about buying up some of the PFI debt with QE?

Anonymous
As they are not buying gilts from the banks…..from the BofE website.
‘This policy of asset purchases is often known as ‘Quantitative Easing’.
It does not involve printing more banknotes. Furthermore, the asset
purchase programme is not about giving money to banks. Rather, the
policy is designed to circumvent the banking system. The Bank of England
electronically creates new money and uses it to purchase gilts from
private investors such as pension funds and insurance companies. These
investors typically do not want to hold on to this money, because it
yields a low return. So they tend to use it to purchase other assets,
such as corporate bonds and shares. That lowers longer-term borrowing
costs and encourages the issuance of new equities and bonds.’

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