We can show those French a thing or two

We got off the ferry at Dover with a crowd of Belgians, French and Germans. The lorries were from further East, Poland, Czech republic or Latvia, but the cars and motorcycles were mostly from Western Europe. We had driven two thousand miles in France and had occasionally suffered from congestion; in total we had been delayed by perhaps twenty minutes. We set off on what should have been a four hour drive. By the time we had been driving for an hour, the predicted journey time had increased to five and a half hours.

We decided to stop at one of the UK’s motorway service areas. French travellers should note that service areas are not as frequent in the UK as they are in France, and in order to ensure that drivers get back into their cars and join the traffic jam on the motorway as quickly as possible you will be fined £60 if you stay for more than two hours. It is perhaps better not to order a three course meal and then hope to enjoy a leisurely cup of coffee afterwards.

Motorway Services

Quality dining at a British Motorway Services

This particular service area consisted of a tin warehouse with no less than five fast food outlets. There was no-one serving what one could describe as a meal. You could have sandwiches, burgers or bits of chicken in batter. There were no fresh salads or Boeuf Bourguignon and no drinking-water fountains. I opted for a jacket potato as the healthiest option I could find and had it served in a cardboard tray. I didn’t have to eat it with my fingers, I was supplied with a plastic knife and fork which broke.

Before long I was back on the crowded motorway. By now it was apparent that the M6 was closed and there were traffic jams on the M1, M25 and M40. Our journey took six and a half hours. Still, that was better than a previous visit when there were four motorways closed and the journey took seven hours.

We Brits certainly know how to live. No wonder these all these foreigners are trying to get into the UK.

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Lib Dems to be offered radical new Health Policy

I shall go to Glasgow this weekend with a group of others to promote our new policy on the NHS.

After a year of deliberations, a policy working group set up by Liberal Democrats failed to reach agreement. Two policy documents were produced. One favours the status quo, continuing to outsource public services and subject the NHS to all the rigours of market competition with the complexity and costs that that entails. This is the policy that fragments healthcare and offers parts of the service to private providers in what amounts to a one-way route to privatisation. The other promotes a view of a public service NHS: a service for all regardless of where they live or what their medical need.Hosp_corridor

One document will be promoted with the full vigour of the central party machine, the other will be promoted by a group of individual party members and experts.

We have seen the Conservatives protesting their love of the NHS, while starving it of cash and at the same time breaking it up and offering it up for sale. We have seen Labour protesting at Lansley’s disastrous Health and Social Care Act (HASCA), but leaving open the door to privatisation by continuing the cumbersome, dangerous and damaging market in healthcare. Andy Burnham says that he will repeal the HASCA but he is not committed to removing the market. Labour under Blair and Brown did more privatising of the NHS than did Margaret Thatcher. Simply repealing the HASCA leaves more questions unanswered than answered. What happens to all the Clinical commissioning Groups or to NHS England, which Labour themselves have described as the biggest quango in the land.

Our proposed policy draws on the evidence of experts and the experience of international healthcare systems. We have consulted with doctors from all fields, and our view is that the NHS does not need a market: not the internal market, not the external market. The NHS does not need to sell itself. We believe that a directly provided, publicly funded NHS is the best way to deliver a joined-up service that is efficient, effective and equitable.

We look forward to welcoming Professor Allyson Pollock, a renowned expert in public health research and policy to our meeting in Glasgow. Allyson spoke out for years against the iniquitous and wasteful Private Finance Initiative and the damage that it was doing to the NHS. For years the establishment tried to ‘rubbish’ her. Now politicians of all parties accept that she was right. We look forward to hearing what she has to say.

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Will Lib Dems take the high road or the low road to Scotland?

Liberal Democrats meet this weekend at Glasgow for the Autumn Conference. It is only a few days since the eyes of the world were looking to Scotland with one big question in their minds. Anyone who cares about politics will now look at the Liberal Democrats with another question in mind.

Has the Liberal Democrat Party disappeared? The Liberal Democrats were known as a radical campaigning party, a party of its grass roots, a liberal party, a democratic party. Has it become another version of New Labour: another unnecessary and unwanted pale imitation of the Tories? Or will the radical thinking re-emerge. Will Liberal Democrats once again show themselves to be a party that listens, a party that thinks and a party that campaigns for what is right?

Members attending the Lib Dem conference at Glasgow this week will be offered two views on Public Services: the liberal one, and the neo-liberal one.

Some of us have spent much of the last year going to weekly meetings of a working group developing Party policy on Public Services.

Unfortunately both the process and the outcome were very frustrating to me and several other members of the working group.

The resulting policy document is pretty lack-lustre and seems to accept as party policy the Tory agenda on the marketisation of public services. This has never been Lib Dem policy in the past, and in our view what is needed now is a more radical Liberal Democrat Party, not an anodyne ‘don’t lets rock the boat’ party

Seven members of the working group have produced an alternative report which we believe contains some exciting policies. We submitted it to the Federal Policy Committee who have attempted to suppress it. We shall therefore be promoting it at a fringe meeting at Glasgow on Saturday.

“Serving the Public: an alternative report on Public Services” is available to download.

Our Fringe meeting:

“Is there an alternative to the market in delivering excellent public services?”

is 12.00 – 13.00 on Saturday 4 October
and takes place in,
Crowne Plaza, Congress Road,
Glasgow G3 8QT

Charles West

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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