Why does the NHS need updating?
The NHS is a national treasure. But despite the best efforts of staff, the NHS could deliver better care for patients. Right now around one in four cancer patients are only diagnosed when they turn up as emergencies. So although the NHS is good, it could be better still.
What is the purpose of the bill?
To update the NHS to give every patient the best possible health care by trusting family doctors, nurses, and other health experts to work with local people to decide, design and deliver the right health services to meet local need and deliver world class healthcare. The Health and Social Care Bill is designed to give every patient the best chance of surviving an illness like cancer, and the best quality of life if they have a long-term condition like diabetes.
It is basically about more control for patients, greater power for doctors and nurses and less central bureaucracy.
The Coalition’s plans to update the NHS will give patients the best-possible care, on the NHS.
Our plans to update the NHS in detail
- When a local hospital feels that they can provide diagnostic tests more conveniently to patients in the community, they will be free to do so.
- If local GPs see that there is a significant need for physiotherapy services in their local area, they will be able to organise local clinics for their patients – rather than giving them a default option of having to travel to a hospital miles away.
- When a GP feels that a patient with serious diabetes is in danger of not managing it effectively, they will be able to make sure the patient has the support to remain independent – preventing unnecessary emergency admissions to hospital.
- When frontline nurses feel that they can deliver better care to autistic children in partnership with a local charity, they will be free to make this happen.
- When a local community decides that they want a new health clinic or walk-in centre, their local council will be able to work with the local NHS to help achieve this.
The power and responsibility for decisions about NHS services will be transferred into the hands of doctors and nurses at the frontline, instead of remote organisations few people have heard of. This means that the NHS’s money will no longer be spent by ‘Primary Care Trusts’. Instead a wider range of experts (clinical commissioning groups) will be given the power and freedom to make decisions about health services for their local community by, for example, including nurses and specialists on the boards of clinical commissioning groups.
- To prevent political micromanagement, which has damaged patient care, responsibility for overseeing the NHS at the national level will be passed to an independent NHS body – the NHS Commissioning Board. This will stop politicians constantly interfering in the NHS. And we will do away with the top-down targets which do not improve care. We will instead focus on what matters to patients the results and quality of care. This means whether they survive cancer, whether they get seen when they need to be, and whether they are supported to remain in work.
- To give local communities more power, we will establish health and wellbeing boards in all local councils, with the responsibility of planning local services, jointly with the NHS and social services. These boards will publish a new ‘health and wellbeing strategy’, setting out the ways in which local NHS and social services will be improved in every local area.
- To give patients more power, we will allow them greater choice anywhere they want which meets NHS standards, so long as the treatment doesn’t cost more than it would do on the NHS. This means that charities and social enterprises will be able to provide services to NHS patients, free of charge, either together with the NHS or on their own. It also means that the private sector will be able to provide NHS services free-of-charge, and we will establish a strong economic regulator to make sure that no-one is behaving unfairly. Any decision about where to be treated will be for the patient himself or herself, in partnership with their doctor, and as now no-one will pay for their NHS care.
- To help patients and GPs decide where the best services are, we will give everyone more information about the quality of care each hospital and health service delivers. And we will establish a powerful new watchdog – HealthWatch – which will make sure that patients’ views about their local NHS and social services are listened to.
Changes to the Bill following the ‘pause’:
Among the key changes announced include:
- Wider involvement in clinical commissioning groups. A wider range of experts will be given the power and freedom to make decisions about health services for their local community by, for example, including nurses and specialists on the boards of clinical commissioning groups.
- Stronger safeguards against a market free-for-all. The health care regulator Monitor’s core duty will be to protect and promote patients’ interests, it won’t be required to promote competition as if it were an end in itself.
- Additional safeguards against privatisation. We will never privatise the NHS, and will create a genuine level playing field to stop private companies ‘cherry-picking’ profitable NHS business. We will ensure that competition is on quality and introduce additional safeguards against price competition.
- Evolution, not revolution. We will allow clinical commissioning groups to take charge of commissioning when they are ready and able, and a more phased approach to the introduction of Any Quality Provider.
- Greater information and choice for patients. The Government will make clear that the people who make decisions about local services have a duty to promote patient choice. And following current pilots, the Government will make it a priority to extend personal health budgets including across health and social care.
- Breaking down barriers within and beyond the NHS. A new duty for clinical commissioning groups to promote joined up services both within the NHS and between health, social care and other local services.
- Investing for the future of the NHS. We want all providers to make a fair contribution to the costs of education and training of NHS staff, but we will introduce changes carefully and take the time to develop the details right.
The Telegraph and questions as to what is evidence
The link is to a piece in the Sunday Telegraph which considers the analytical processes used in the Family Division.
Vicky Haigh's case, the Huffington Post and various campaigners
I have written an article about the problems with adversarial family justice on the Huffington Post
My own view is that the adversarial nature of family proceedings have made the whole process much harder to resolve and if any lesson is learnt from this that needs to be learnt.
I have also been criticised for the behaviour of Elizabeth Watson. There are a large number of people in England who are unhappy about the way the legal system operates. She is one of them.
I work with some of these people, but I do not work with others. Elizabeth Watson did contact my office. I advised her to obey the injunction and that her behaviour would be likely to result in her being jailed. I ended up having to ban her from being able to email me. I do not accept any responsibility for her behaviour. The court papers applying to imprison Elizabeth Watson were issued before I raised Vicky Haigh's case in the House of Commons.
I remain of the view that it was wrong for the authorities to attempt to remove Vicky Haigh's daughter at birth and that it was wrong for them to try to imprison her for speaking at the meeting in the House of Commons.
Vicky Haigh - yesterday's court hearing
Yesterday's court hearing brought into the public domain more about the case relating to Vicky Haigh.
It, however, has not brought into the public domain all of the issues relating to this case and the judiciary retain control of those aspects of the case.
I am not making any statement as to the details of the underlying care issue. The Judge who took the hearing yesterday was also the judge in P, C and S v The United Kingdom.
The link gives the case report from ECtHR on Bailii. In this case the decision was found to be in contravention of a fair trial on a procedural basis.
The same judge (Sir Nicholas Wall) was also a judge in the case which is now RP v The United Kingdom. I have considerable concerns about the way that particular case was handled by the judges concerned.
It remains that I am making no public comment about the underlying care case in respect of Ms Haigh. However,
1. Even if the court's decision is 100% accurate - does that warrant the removal at birth of Ms Haigh's baby. I don't think so.
2. Is it right to set out to imprison someone on the basis of what they have said to a Member of Parliament. I don't think so.
We now have someone imprisoned for 6 months for recording a court hearing and someone else imprisoned for 9 months for talking about court secrets. I think these sentences are excessive at least. In terms of the recording of a court hearings this always appears to be more about protecting the revenues of the transcription services than ensuring the fairness of trials. We do need to review the law from the perspective of allowing independent recording of the audio of court hearings.
Firing Bullets into the air
I always wondered about this issue. What goes up normally comes down (unless it reaches terminal velocity).
The link is to an interesting BBC story.
Who, What, Why: How dangerous is firing a gun into the air?
The rebel advance into Tripoli has been celebrated with gunfire
Libyan rebels have celebrated their advance into Tripoli by firing guns in the air. How hazardous is this?
It is, unarguably, an emphatic way to display one's jubilation.
Shooting an automatic weapon into the sky to signal an occasion one welcomes is a popular practice in much of the world, as the footage of Libyan anti-Gaddafi forces seizing the main square of the capital city has demonstrated.
Six months for recording a court hearing - Norman Scarth
The link is in Russian about the imprisonment of Norman Scarth who is actually 85. He has a complex history including a court hearing which found that he used a chainsaw to fight off bailiffs when he was 75. [a court judgment which is disputed see comments] However, that does not justify imprisoning him for 6 months for recording a court hearing (see the link and ask google to translate it if your Russian is not up to it).
It has got into the Argyll News
Because he has been held such that people cannot get to him to sign paperwork an application for a writ of Habeas Corpus was made today. This has been adjourned until next week.
The English judicial system is really not good at responding to major abuses of human rights by the judicial system.
Looting, the Riots, Families and the Role of the State
I described the events last week as a "game changer". I think they are as they highlight the substantial numbers of people who basically don't feel a personal commitment to following the rules of society and are willing to simply fight their own corner.
There seems to be a dispute between those who argue that it is a question of poverty and those who argue it is a question of discipline and law and order.
The problem is that actually it is both. Given a static situation in terms of discipline if there is greater poverty then there will be more people tempted to break the law. At the same time poverty in itself does not require that people don't follow the law.
Hence we need to look at both aspects and not pretend that either aspect doesn't matter.
The high levels of youth unemployment we see today are a problem. What the statistics have concealed, however, is that there have been growing numbers of people who are "economically inactive".
The jolt to the economy caused by the mistakes of the past which resulted in the credit crunch and recession has increased unemployment. What is behind this, however, is a more general increase in the numbers of economically inactive people.
Technology is the driver for much of this. Let us ignore for the moment the limits on availability of resources which will be constraining economic activity further in the future. There is actually a limit as to what each individual can consume and consuming more does not necessarily improve the quality of life. However, technological changes have made it possible to produce goods and to some extent services with far fewer people.
Even in supermarkets there is now a personal checkout system which weighs the goods that people buy so that there is no need for someone to operate a cash register.
My own view is that we need to look carefully about how to create more jobs. For example the quality of service on buses was historically better with a conductor. However, that increases the cost of the service. On the other hand having conductors who otherwise would be unemployed is a benefit for society. It makes an argument that it is worth the state agreeing to use some of the state's savings in terms of lower costs to provide a partial subsidy to the costs of providing conductors.
The wider question of quality of life for society as a whole has to be given a greater importance. We can have a society which has a small number of people working very hard and a large number of people on benefits. On the other hand we could try to share out the workload to have a better quality of life. I take the view that the latter is required. It would also be good to look at having a mechanism to ensure that organisations that provide services to the state also have some people in employment from the long term unemployed. Similarly this had wider benefits. Obviously we need to avoid doing anything that undermines international competitiveness. However, we need a greater focus on ensuring that people have opportunities to participate in society. This should apply to everyone not only those who have broken the law.
In a similar manner bringing back schemes like the Community Programme is something that does offer a mechanism of creating a more positive society rather than one of pure dependency. Our tax and benefits system should also encourage part time working. At the moment many part time workers are prevented from claiming in work benefits because they don't work enough (24 or 16) hours a week. It is far better for society where possible to have two people in work rather than one in work and one on benefits.
Doing all of the above, however, would not deal with the issue of the looting. That in part is because of the development of a subculture which has no commitment to the rule of law. This also goes hand-in-hand with a reduction in social capital.
A certain concentration on the existence of gangs and their role in the looting has occurred recently. What this ignores is that gangs are the inevitable consequence of the decay in the rule of law. There is always a balance between the rule of law and the rule of person. The gang acts as a group which has a tribal loyalty to the gang and it is controlled by the gang leader. This model is quite common. Some countries maintain this model as the underlying political structure (eg tribal areas). Other countries, however, have strengthened the rule of law and reduced the rule of person. This has moved away from a feudal structure towards what most people are used to in the UK.
Gangs develop where the rule of law has weakened. If a teenager feels under threat from other teenagers at school because of potential violence on the bus (which has no conductor) then that teenager can look for support from the gang. What the gang offers the teenager is the protection of a threat of retaliation from the gang against anyone who threatens the teenager. The weaker the discipline in a school and after school on the bus the stronger the development of a gang structure. Alternatively if the teachers provide the protection to the school children then there is less of a pressure on children to join gangs.
It gets worse when the gangs offer an alternative career path to low paid jobs or unemployment. We have seen in many cities how you then have disputes between gangs. The shootings which are normally called turf wars are more often retaliatory attacks, debt collection, rows or situations where someone has been shot in error as a bystander.
The question then is how to encourage people to develop a respect for the rule of law and be willing to hold back on their own wishes because of conflicts with others.
This is the area in which the intervention of the state has undermined families. Babies have no understanding of the rule of law. The first key development psychologically is that of attachment. At the moment the actions of the state create many children with attachment disorder, but the unaccountable nature of the child protection system conceals this.
As children grow older they need to learn to take into account the desires of others. That starts out with the rule of person in the home. Their parents are the authority figures who are "in charge" and they need to learn from their parents about how to behave. They also learn from being in school and at play.
There does need to be some constraint on the way parents and teachers deal with children. However, the greater the constraint then the more that parents and teachers are undermined as authority figures. At the same time this allows children to learn that they don't have to do what others say. This means that the habit of considering the response of others to their actions (and particularly the response of the rule of law) is weakened.
It is, therefore, important for society that the state intervention in families that undermines parents is kept to a minimum. The question is how to determine that minimum. It is easy to identify situations which intervention is appropriate. Peter Connolly's case (Baby P) is clearly one in which intervention was necessary.
It is important, however, to clarify the situation in respect of how parents are allowed to discipline their children. There are family workers who argue that parents should not shout at their children or say no. I think that these family workers should not do this.
Susan Pope's case
reported in the Daily Mail was a good example of a damaging intervention.
I have sadly seen lots of cases where the state has intervened in a family to undermine the parent (or parents) and done damage as a result.
If we consider the high proportion of children who were arrested during the looting who were in care we can see that state parenting is not of a high quality. Whereas I agree that if intervention is warranted it should be done at an early stage rather than a later one, firstly we need to ensure that intervention is not damaging.
Social Workers tend to be left to their own devices when dealing with families. This gives them too much power. There needs to be much clearer guidelines as to when intervention is appropriate and what intervention is appropriate.
Some children need a firmer approach to discipline than others. Applying, therefore, the same standards to everyone results in some children being less willing to adjust their behaviour than others. The approach needed has to be identified on an individual basis and is best done by the parent.
The Conservatives have picked upon the issue of marriage as being somewhere in this. This again is an over simplification. It is obviously better for children for their parents to both remain in their lives and ideally together. However, it is not the case necessarily that having more people being formally married will achieve this. There are situations in which a single parent creates a better environment for children than other situations where the parents are together. Furthermore a small financial benefit to marriage as opposed to couples living together will not have a massive impact on people's decisions.
There is a wider question as to whether it is right to have a system that financially encourages couples to separate. England is known as the divorce capital of the world because it often provides a large financial return to the applicant for divorce. A review of family law needs to look as to whether this is of a social benefit.
I did raise the issue of the undermining of parental authority with the Prime Minister last week. His response was positive. However, this is an area where the details are very important and I am unsure that people are managing to think outside the tramlines of conventional wisdom.
The looting, the police and politicians
I know there are people who are critical of the police. My own view is that I am supportive of the police action last week. It is always possible to dig little holes into someone's performance, but normally futile.
I think that Chief Constable Chris Simms of the West Midlands Police did a good job throughout the week and his management assisted in both bringing orders into the situation and also keeping things calm when they could have become much more difficult. I have personally thanked a number of the rank and file and our thanks as society should go out to them who have put themselves in harms way to deal with a difficult situation.
We must also thank Tariq Jahan for his efforts that assisted in dealing with a tragic and dreadful situation that could have been the flashpoint for further problems.
David Cameron and Ed Milliband are both doing speeches today. I think they need to get into the details of the issues. I would be interested in knowing how many of the children involved were wards of the state.
is worth reading although I do not agree with everything in it.
The State in the UK has been undermining parental discipline for quite some time. It should not be surprising, therefore, that situations like that which arose last week involve children as well as adults.
In privatising the use of force so that parents are prevented from keeping their children in off the streets a much more dangerous situation has been created for the children.
The argument that force or violence should not be used by parents to control children is flawed. It results in more extreme force or violence having to be used to control the situation when the same children encounter the police.
The best and the worst
The best people I met on my tour around the city centre were those who had come to help clear up. This is a photograph of the volunteer clean up crew.
Thanks to the efforts of the city council's staff who started work at 6am most of the mess had been cleared up by this point.
The aftermath of the worst is really looking at the attempts to steal a cashpoint machine.
All we had was an attempt to loot things. This does not warrant dressing up as anything more than this.
I am now updating my earlier post following meeting with The Chief Constable, other Police Officers and The Deputy Prime Minister.
The looting and vandalism (which is a concentration on looting and "free stuff") is done by ill disciplined youths who are out to get a small amount of money and get up to mischief. Nothing more should be read into it or the other events other than the event in Tottenham which was the catalyst. It is not as technically driven as people think although there is some organisation going on. It is not the serious gang members because the amounts of money involved are generally not worth the risk of being caught and punished.
I support the police strategy of maximising arrests and prosecutions.
Although we do need to find jobs for people generally (not only for young people) that is not related to these acts of theiving. The government needs to back parents and schools in creating a disciplined environment and ensure that the criminals involved are caught and punished.
Private Eye and GMC Cover Ups
The link is to another case where the GMC have been involved in covering up problems.
Where does it go from here
This is always the test of chart readers.
There is obviously an international element to the recent market movements. There is also recognition that even the US cannot simply fund demand on increasing debt.
I think there is also an August over-reaction as a result of many people being on holiday and people closing out positions. However, to hazard a guess I would not expect the market to go below the 2010 low.
I may, of course, be wrong. A goodly amount of weekend doomsaying could push the market lower. I think there is a 40% chance of bottoming out below the 2010 figure, but I am with a 60% chance of it bottoming out above that.
I think, however, that Labour's whinging about the government's policy of managing the deficit (too much too quickly) is now essentially proven to be wrong.