John Hemming's Web Log John's Reference Website
Monday, January 31, 2011
  Labour's myths about NHS proposals
Labour myths answered

Myth: There is next to nothing of Lib Dem policy in this huge top-down reorganisation:

Absolutely not true.
The Liberal Democrat manifesto promised that new social enterprises would be created to deliver NHS services, that all types of providers – NHS, voluntary, or independent sector – would be free to deliver, the scrapping central, top-down targets, and cutting back on unnecessary administrative costs . Abolishing SHAs, increased competition, stronger local democratic input in the NHS and greater integration between health and social care are also all Liberal Democrat policies explicitly set out in our manifesto.

1. GP commissioning

“[We will ensure] that local GPs are directly involved in providing out-of-hours care.” (page 43, Liberal Democrat manifesto)

2. Provider-side reform

“[We will put] front-lime staff in charge of their ward or unit budgets, and [allow] staff to establish employee trusts giving them real involvement and a say over how their service is run.” (page 42, Liberal Democrat manifesto)

3. Any Willing Provider

“[We will reduce] centralised targets and bureaucracy, replacing them with entitlements guaranteeing that patients get diagnosis and treatment on time. If not, the NHS will pay for the treatment to be provided privately.” (page 42, Liberal Democrat manifesto)

“[We will give] Local Health Boards the freedom to commission services for local people from a range of different types of provider, including for example staff co-operatives, on the basis of a level playing field – ending any current bias in favour of private providers.” (page 42, Liberal Democrat manifesto)

4. Choice

“[We will give] every patient the right to choose to register with the GP they want, without being restricted by where they live, and the right to access their GP by email.” (page 43, Liberal Democrat manifesto)

5. Reorganisation

“We will cut the size of the Department of Health by half, abolish unnecessary quangos such as Connecting for Health, and cut the budgets of the rest, scrap Strategic Health Authorities and seek to limit the pay and bonuses of top NHS managers so that none are paid more than the Prime Minister.” (pages 40-41, Liberal Democrat manifesto).

6. Targets / bureaucracy

“[We will reduce] centralised targets and bureaucracy.” (page 42, Liberal Democrat manifesto)

“We will cut the size of the Department of Health by half, abolish unnecessary quangos such as Connecting for Health, and cut the budgets of the rest, scrap Strategic Health Authorities and seek to limit the pay and bonuses of top NHS managers so that none are paid more than the Prime Minister.” (pages 40-41, Liberal Democrat manifesto).

7. Social enterprises

“[We will allow] staff to establish employee trusts giving them real involvement and a say over how their service is run.” (page 42, Liberal Democrat manifesto)


Myth: The reforms open up all parts of the NHS to private health companies:

Unlike the last Labour Government, we aren’t setting an arbitrary percentage of services that must be run by the private sector, with guaranteed volume levels and higher prices. Instead, any willing provider means that patients will be able to choose on the basis of quality, but without guarantees for providers. Private providers will not be able to “cherry pick” services. The less complex the procedure, the less someone-including in the private sector-will be paid. Unlike Labour, we won’t rig the market in favour of the private sector. That’s why Monitor has been given the powers of an economic regulator to prevent anti-competitive behaviour.


Myth: The legislation seriously restricts openness, scrutiny and accountability both the public and to Parliament.

This couldn’t be further from the truth. Under Labour the right of local authorities to scrutinise local health services was restricted to public healthcare providers. Where as before there were limitations on where the scrutiny could go under our changes scrutiny will now, for the first time, be able to follow the NHS pound by allowing local authorities to scrutinise private providers.

Local govt will no longer just be an observer when it comes to health commissioning. Instead they will be responsible for shaping local health services through Health and Wellbeing Boards, which will inject real democratic legitimacy into the NHS for the first time in almost 40 years.

GP consortia will be public bodies with a range of legal duties including adhering to the ‘Nolan principles’ of good governance and ensuring public and patient engagement.

The Secretary of State and the Department of Health will continue to retain overall accountability for the NHS. The Secretary of State will set a ‘mandate’ for the NHS Commissioning Board which sets out key priorities and outcomes for the NHS, this will be produced annually and will be subject to consultation and reporting to Parliament; our aim is to make political accountability more transparent ensuring that Ministers will no longer be able to micromanage the system in the way the last Government did.


Myth: Conservative ideology of full market competition is at the heart of this NHS reorganisation:

Not true.
Our manifesto included a commitment to commission services “on the basis of a level playing field” (p. 43). That is exactly what the ‘Any Willing Provider’ model allows for. We want patients to be able to choose to be treated wherever they want to be – whether it’s an NHS hospital, or one in the voluntary or private sectors. This is because more choice will lead to better care for patients. But we don’t want to set a target for the amount of private sector involvement in the NHS – unlike Labour – and unlike Labour we won’t pay the private sector any more than we would pay the NHS.


Myth: The BMA describe the changes as ‘extremely risky and potentially disastrous.

This is effectively the same position the BMA has held on NHS reform for years. It should not be forgotten that the BMA opposed the original creation of the NHS in 1948. It is a sad truth that the Labour Party, which once had interesting ideas on the NHS, now aligns itself with the opponents of modernisation. However, the Labour Party does seem confused about whether it is the principles or the implementation it objects to:
John Healey's speech to The King’s Fund: 19/01/11
“The general aims of reform are sound – greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes – and are common ground between patients, health professions and political parties.
 
Comments:
Mr Hemmings I trust that you are aware that the Coalition proposals will take money out of the NHS in the form of profits and will cherry pick the services which it will offer. The market only provides efficiencies at the margin so long term care for the elderly will result in increased cost.
 
That is a clear misunderstanding. Unlike Labour's policy there is no drive to increase the amount of services provided outside the NHS.

Furthermore the market can provide efficiencies in core services. It is not just a marginal issue.
 
Opening up the commissioning process this way WILL drive services outside the NHS, as the private hospitals will be able to cherry pick the operations that they wish to offer, leaving NHS providers with the expensive trauma care and the difficult work, unable to offset the costs with lower cost work.

Most GPs don't think it will reduce bureaucracy or improve outcomes - and how you can claim that increasing the number of commissioners will result in less bureaucracy or greater efficiency is beyond me.

The unions - including those hotbeds of radicalism, the Royal Colleges - are deeply concerned.

There is no evidence that this will improve outcomes - indeed quite the reverse is true. In the short term, the 'reforms' will cost billions that could have been better used in patient care.

If you want to act as one of the pallbearers to the NHS, then that's your choice, but you are betraying the people of Yardley.
 
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