The hush hush health policy

So what are these proposals that no-one dare let Liberal Democrats see at Conference?

There is an increasing body of reputable opinion and evidence that market competition is an expensive irrelevance in healthcare. It is interesting to note that every government since Margaret Thatcher has pursued the same policy: that of exposing the NHS to more and more market competition. The assumption has been that the only way to raise standards and reduce prices in the NHS is the market. Recently a string of professors have spoken out. Calum Paton and Alan Maynard on the costs of running a market, Clare Bambra on widening inequalities and Chris Ham on the way competition is a barrier to the provision of integrated care. Judith Jolly, until recently the co-chair of the Liberal Democrat Parliamentary Health Committee said that the action taken by the Competition Commission over the proposed merger of Bournemouth and Poole Hospital Trusts was scandalous “We need to sort out the competition thing.” Chris Ham says that we need legislation to unscramble at least some of the Lansley Bill. David Nicholson, chief executive of the NHS, has said that competition is a barrier to delivering quality.

Several witnesses to the Public Services Policy Working Group have pointed out the advantages of funding healthcare by means of a capitation budget, but acknowledged that this was very difficult when operating in a market of many providers.

My proposals are simple but radical. The full document with supporting evidence is available.

  • Set up Local Health Boards covering populations of around 1 million.
  • Abolish the market (internal and external) in healthcare.
  • Give Local Health Boards a budget based on capitation and direct management of hospitals, community services and GP contracts in their area.
  • Pool nationally the PFI debts of hospitals, to facilitate the re-negotiation of those debts.
  • Give patients the choice, through their GP to be referred to any NHS hospital in the country.

These proposals would render redundant a large number of national quangos and return at least some measure of local democratic control over the delivery of health services. The costs of running a market are already large and are set to rise very greatly. These proposals would therefore save large sums of money, and a very considerable amount of clinician and management time. There are more details in the full document and there is more work to be done.  We need to bring together the fragmented Public Health roles and work on integrating health and social care but these proposals would, I believe, go a long way to alleviating many of the cost pressures on the NHS and removing the key barriers to integration and improving quality.

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How democratic are the Liberal Democrats?

Sometimes I despair. Sometimes I have hope. The UK may not be as corrupt as the Ukraine, but the influence of big business, consultancies and think-tanks on political policy development is scary.
Russell Brand says that we should not vote. I have often argued the opposite point of view, but if the three main parties are all proposing the same policies I do wonder why we bother. Just how democratic we are in the UK.

On the face of it Liberal Democrats are extremely democratic. Party Policy is determined by votes of national conferences on policy papers drawn up after studies by working groups and consultation sessions with the members. Sounds good, doesn’t it?
What follows is my own experience of policy development. It is possible that my experience is unique, but if replicated through other policy areas, and in other political parties then it is no wonder we finish up with policies that are unhelpful, inappropriate or plain stupid.
I have long been frustrated by the fact that Liberal Democrats lack a coherent overall policy for health and the NHS. I now know at least some of the reasons for that failure. It was certainly not party policy to break up the NHS and replace it with a National Health Insurance Scheme. (See footnote)

The first hurdle is to get Federal Policy Committee (FPC) to decide that we need a policy working group.
As an area that accounts for 18% of public expenditure and regularly comes among the top areas of public concern you might think that health is quite important. But no, alas, FPC decided to have a Public Services Working Group that would look at health, education, transport and other locally delivered services.
As someone with a lifetime’s experience of the NHS both locally and nationally in General Practice, Management and Health Informatics, I have something to offer on the subject. As a councillor, parliamentary candidate and Local Party Chair I could also consider the political context. But my name was not on the preferred list produced by the Party leadership. I was even told that when my name was suggested an objection was raised that that would mean too many male members on the group. Clearly such an objection would apply equally to several other names under consideration.

Gender notwithstanding, I was appointed to the working group. The problems of our wide brief were compounded by a very tight time-scale: we had in effect five months to produce a consultation document. Had we been set up to fail?
There are twenty-one members of the working group. Until this week I am the only member to have attended every meeting, apart from the chair. Typically we have between six and twelve members attending. We are sometimes outnumbered by Special Advisers and policy analysts seconded from Price Waterhouse Coopers.
The chair of our group decides on the agenda and the evidence givers. During the meeting he is quicker to give his own opinion than to listen to those of others. He writes and approves the notes of meetings, which are erroneously referred to as minutes. And he has written the consultation paper. He has flagged up issues as important and persisted with them despite disagreement from members of the group and contrary evidence from witnesses.
The remit of our working group included a requirement to “review the current legislation governing the provision of these services, including recent reforms to the NHS, and consider what changes to recommend.”

To focus our discussions I wrote a draft paper which I circulated in early October. Four meetings came and went while our chair prevaricated. Interestingly, other papers from members have been discussed within 24 hours of circulation. Finally, several members of the group supported me in my insistence that it should be discussed. At the last minute our chair arranged that Health Minister Norman Lamb should come to the same meeting and present a different paper. When the notes of that meeting were circulated they contained no reference to my paper or any of its recommendations.

And so it is that at the Spring Conference Liberal Democrats will be offered a consultation document that totally fails to address the most important issues facing the NHS and that neither reviews the Health and Social Care Act of 2012 nor recommends any changes.
Why is that? Some people do not want to rock the boat. They do not want to change anything. There are even some who think that it would be embarrassing if Liberal Democrats adopt policies that are out of line with legislation passed by the Lib/Con coalition. To promote such a view would be to deny the voters choice, and raise serious questions about the relevance of our parliamentary democracy.

Footnote: These were policies advocated by Nick Clegg and David Laws in 2005 and 2004 respectively.

Posted in Democracy, Health, Lib Dem Conference, Nick Clegg, Norman Lamb | Tagged , , , | 2 Comments

Special Train Administrators

I would like to repeat a story that I heard recently as I believe it bears telling more widely. It is a story of trains and supermarkets.
There is a supermarket in South London called Food Four All. It was doing well and wanted to expand. The local council would only allow them to expand if they rented the land from a consortium of local builders and financiers who put the rent up year on year until Food Four All was in such dire financial straits that they called in the administrators.
The administrator told the other big supermarkets in the same part of London that they would have to refer a quarter of their customers to Food Four All. They were also to change their web sites so that a quarter of all customers that tried to log on to one of their web sites was automatically routed to the web site of Food Four All.
“You can’t do that” said the big supermarkets.
“I can, and I shall” said the administrator.
“You can’t do that,” said the judge, “it’s illegal.”
“Then I shall change the law” said the Secretary of State. And he did.
I was so disgusted when I heard this story that I left the meeting and decided to head for home.
When I got to Euston I was not in a good mood. I faced a three and a half hour journey to get home, but at least I would be back in my own bed tonight.
Imagine my fury when I was told that my train was cancelled and I would need to take a different route involving four changes and taking five hours.
I tackled the inspector.
“Why was the train cancelled? No driver? Broken down train? Accident?”
“No,” said the inspector, “the Special Train Administrator has ordered main line train companies to cancel a quarter of their services in order to force more people to use other train companies who are in financial difficulties.

Is this the craziest reason for cancelling trains? But that, dear reader, is what is happening in the NHS.

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Your hospital could be closed or taken over without any consultation.

In the law of the jungle we see nature red in tooth and claw, dog eats dog, might is right, competition is king and the playground bully rules the roost.

In a civilised society, however we have different values. We believe that everyone should have food in their belly, a roof over their heads, education and healthcare. In a civilised society we recognise that it is in all our interests to identify and treat the patient with TB. It is neither in the interests of the individual nor of society that patients wander round coughing tubercle bacillus all over the other passengers in the bus.

A civilised society provides healthcare for individuals and for communities.

For fifty years the British NHS provided one the most effective, efficient and comprehensive healthcare systems in the world.

The discipline of Public Health is concerned with the health of whole populations and communities. It is responsible for controlling outbreaks of disease, preventing or managing epidemics and the planning for the healthcare delivery to whole communities.

Public Health is not the same as the provision of healthcare for individuals, but both work better when they are integrated. Because Health Authorities and more recently Primary Care Trusts had the responsibility for providing care for all those who lived in a particular locality they could benefit from working with experts in epidemiology and community medicine. And because many public health objectives can only be delivered by treating individuals, Public Health could benefit from working with the bodies that delivered healthcare.

The delivery of Public Health, like many other things, has been dealt a severe blow by Andrew Lansley’s Health and Social Care Act 2012. It is now about to be attacked again.

In the post-Lansley NHS the Secretary of State no longer has the duty to provide a comprehensive health service. Nor do the Clinical Commissioning Groups (CCGs) have a responsibility for everyone in the neighbourhood, but they do at least have the responsibility for commissioning the care needed by their own registered patients. The CCGs are about to be undermined.

When Jeremy Hunt, the current Secretary of State for Health called in a special administrator he hoped that he would be able to put off the financial collapse of the South London Healthcare Trust at least until he was no longer the Secretary of State. The plan the administrator came up with was to close services at neighbouring Lewisham Hospital and transfer them and the money that went with them to shore up the shaky finances at South London. Not surprisingly patients and doctors at Lewisham objected. The CCG in Lewisham believed that it was in their patients’ interests to continue the services at Lewisham Hospital. The courts supported them.

Jeremy Hunt’s response has been to attempt to change the law. He has added a clause to a Care Bill already before Parliament. If this clause is passed, then Trust Special Administrators will have the power to reconfigure healthcare services not only at the NHS Hospital Trust that they have been called in to sort out, but at any other healthcare facilities in the neighbourhood, and to do so without public consultation. If the clause is passed Trust Special Administrators will be able to take services away from hospitals that are currently running perfectly well, that are serving their neighbourhoods and are in a strong financial position. As almost half the hospital trusts in the country are facing financial difficulties, we must assume that every hospital in the country could find itself under the scrutiny of a Trust Special Administrator. If services are moved around to suit the financial convenience of these Administrators it will become quite impossible for CCGs to decide what services they wish to commission and from where these services should be delivered.

The CCGs will be impotent. They will not be able to serve their patients needs.

We shall see whether Jeremy Hunt gets his way. If clause 118 of the Care Bill is allowed to pass we shall see the short term financial needs of bankrupt hospitals destroy any attempt by CCGs to plan a coherent set of services for their patients.

Clinicians who wish to register their objection to clause 118 please sign this open letter drafted by Dr David Wrigley.

Other possible campaigning actions include writing to your MP and your local newspaper.

petition organised by Louise Irvine on the 38 Degrees website already has a quarter of a million signatures and is still open to sign.

Anyone can also submit evidence directly to the committee examining the bill – see details here and keep an eye on the Keep Our NHS Public website for more advice on that shortly.

Posted in Health, NHS, Uncategorized | Tagged , , , , , | 1 Comment

Where next for the NHS?

As we read of another scandal of neglect and cruelty in a privately run nursing home, as we hear that competition law is blocking the co-operation between NHS providers in Torbay and in Bournemouth and Poole, as we hear of millions of pounds spent in putting contracts out to private tender it would be tempting to say that it is all over for the NHS. It feels like standing in a greenhouse being bombarded with hailstones the size of golf balls with shattering shards of glass falling all around and nowhere to hide.
BrokenGlass

Rather than despair, those of us who know and love the NHS are asking “Where next for the NHS?”

I am currently going to London every week as part of a policy working group for the Liberal Democrats. We are looking at the delivery of public services.

This is a crunch time for Liberal Democrats as well as a crunch time for the NHS. Nick Clegg made it quite clear at the autumn conference that the Liberal Democrats are a separate party and will go forward to the next election with Liberal Democrat policies. We shall not be campaigning on coalition policies, but presenting the electorate with our vision for the country.

So what will come out of our policy working group? We could lamely endorse the Lansley reforms of the NHS and think of a few tweaks here and there that will make it look as if we are doing something. Or, alternatively, we can come up with a genuine vision for an NHS that is effective, efficient and equitable: and NHS of which the country and Liberal Democrats can be proud.

Which will it be? Do the Liberal Democrats still have passion? Is there still some of the vision of Beveridge? We shall see.
To help the working group in their deliberations I have produced a discussion paper, which they have all seen but the chairman has yet to find the time to discuss it. If you would like to see it for yourself you can download it by going here and then click on the book like the one below.
book_health_policy

Posted in Health, Lib Dem Conference, NHS, Nick Clegg | Tagged , , , | 1 Comment

Happy Birthday NHS – or is it?

When I was a medical student we regarded patients over 65 as being elderly. They would be admitted to the geriatric ward instead of the medical ward. There was almost a feeling that the elderly were not worth saving. Things have changed, I am glad to say. Sixty five does not really count as old now, and patients are not written off even if they are a lot older than that.
In 1948 politicians had the courage and vision to introduce the world’s first universal free health service. The NHS provided free healthcare to everyone in the UK: men, women and children, old and young, rich and poor, those in work, unemployed or retired. With its efficient simple structure, direct provision and universal nature it became the envy of the world. Data as recently as 2007 ranked the British NHS as first in the world both for effectiveness and for efficiency. Commonwealth Fund report 2010.
By their 2011 report the British NHS was not so clearly in first place, though it remained number one in some respects. It is noticeable that the USA ranks bottom in both reports. Many of the features being introduced in the UK are modelled on the US system, and are being driven by US companies.

So, on July 5 the National Health Service marks its sixty-fifth birthday. Is it so old that we should write it off, or do we think it is worth saving?

To mark this important birthday I was asked to join a group of experts from around the country to write a book. It is called “NHS SOS How the NHS Was Betrayed – and How We Can Save It

NHSSOS Book Launch event at Church Stretton

NHSSOS Book Launch event at Church Stretton

Will it survive?
The NHS has survived for sixty-five years. How much longer will it survive? If we leave it to our current politicians and the vested interests of private companies and management consultancies, it will not last long.
Our book tells the story of political attacks on the fundamental principles of the NHS going back three decades and involving politicians of all three main parties. But the blame goes wider than just the politicians. Business interests, lobbyists, media and senior doctors all come in for criticism.
Reading this book will make you angry. But most importantly it will also tell you what we can all do if we value the NHS and wish to stop the destruction.

There will be a number of book launch events around the country. We held one of our own in Shropshire.

At
Burway Books
Church Stretton.

“When you turn round and notice that the NHS as you have known it no longer exists – its principles rewritten, its ownership and services alienated – you might wonder exactly who did exactly what to this much-admired institution. NHS SOS presents the lethargy, dishonesty and corruption without which this executive coup would not have come about. It is a cogent, sobering and necessary read.”
Julian Barnes

“Across society, there is a realisation that the National Health Service is one of our greatest social achievements and that to keep it is an enormous political challenge. This book is a weapon in that struggle.”
Ken Loach

“Davis and her co-authors do not pull any punches. In chapter after chapter we see the way in which determined neo-liberals have hacked away at a cherished British institution.”
Bernadette Hyland

In this book “one finds the soul of a healthcare system that the public is not prepared to see destroyed. This book is written mostly by professionals who work in the NHS, many of whom I know well and support. It does not make comfortable reading. What Winston Churchill, Anthony Eden, Harold Macmillan, Alec Douglas-Home and John Major did not want to do, and Margaret Thatcher’s government deemed too “politically toxic” to proceed with, David Cameron and Nick Clegg, with no democratic mandate whatsoever, have blithely forced through. Charles West’s chapter will make heart- rending reading for Liberal Democrats….
“The battle to save the soul of the NHS is not over and it will be led by patients and professionals.”
David Owen

“Have you read NHS SOS – explains all.”
Clare Gerada on Twitter in reply to Dawn Connor’s tweet
“Doctor has already raised cost implications of various options. 1st time in life I have heard this. Not v. comfortable.”

“’NHS SOS’ is a masterful, cleverly executed book. Its length is perfect, in being sufficiently adequate to address the complexities of the various strands of the enactment of the latest legislation for the NHS. The book does not read like a bitter complaint letter, nor like a political statement of any variety. It is a polite, soberly written narrative from various perspectives, which attempts to rationalise how the NHS came to be a full market, as easy as possible for private providers to enter.”
Shibley

First print run is sold out. Only five left at this Shropshire Independent bookshop

First print run is sold out. Only five left at this Shropshire Independent bookshop

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Are the Tories losing their grip?

It may not have escaped your notice that I am not the greatest fan of the Conservative Party.
For those of us who believe that the Conservative Party promotes a divided society which puts opportunities for the strong above caring for the needy, that puts profits before people, market competition before fairness and privatisation ahead of public service; for those of us who see the dismantling of the NHS as typical of Tory values, we have been going through a dark period over the last few years. And nowhere more so than Shropshire.
We have had a clutch of Conservative MPs. The Conservative domination of Shropshire’s Unitary council has enabled them to take control of every committee, even the Scrutiny Committee whose very function is meant to be to call to account the administration of the Council itself. We even had a Town Council in Shrewsbury that was dominated by Conservatives.
This Tory domination of politics has made it particularly hard for those of us who believe in a fairer Britain, a greener Britain and a Britain where caring for the most vulnerable is more important than the blind pursuit of ideological dogma. We have even seen economic growth sacrificed on the altar of austerity. To add insult to injury, the Liberal Democrats in government have to a greater or lesser degree had to go along with these policies.
Well, the tide may have turned.
Liberal Democrats entered into coalition with the Conservatives at Westminster because that is what the country voted for. We have had achievements, notably the pupil premium the triple lock that guarantees a real annual rise in the old age pension and the reductions in income tax for lower earners. We have raised the starting point for income tax to £10,000 and as a result 13,000 people in Shropshire no longer need to pay any income tax. Vince Cable has tightened bank regulation and made a good start on rebalancing our economy with more apprentices and research investment in engineering industries. We have also managed to prevent, or reduce some of the things that might have been introduced had we had a single party government. We have raised the minimum wage when the Tories wanted to reduce it and we have insisted on better regulation of the press. But it has been hard. It is not easy to work with a party with such different basic values.
Well, the tide may have turned.
The local elections this month have reduced the Tory majority on the Unitary Council and pushed the Conservatives into a minority on Shrewsbury Town Council. We must welcome this as an opportunity for more open local democracy, and perhaps a sign that the voters are beginning to reject the simplistic solutions promised by the Conservatives.

Posted in Economy, NHS, Shrewsbury, Shropshire Council | Leave a comment