NHS Reform vote passed - what will it mean?

[CeliaFate]

Everyone I follow on Twitter (journos and media types) are lamenting what they see as the demise of the NHS. What are the planned reforms?

Princess last week was 'NHS week of action', lots of demo's nationwide. Dp & I did the local hospital with local anti-cuts group. Join yours soon! Try www.anticutsprotests.co.uk

www.38degrees.org.uk/page/s/Protect_our_NHS_Petition
Petition to sign from unaffiliated campaigning group 38 Degrees who hired independent lawyers to comb through the Bill for us, brought about amendments, almost 450k signatures so far.

Alice, thanks for protesting. I am panicking too.

No, no, don't thank me!
Get on those barricades! This can be stopped if we all keep the pressure on. Don't get mad, get organised!

Anyone else joined a Trust as a member of the public?

eico, sadly the whole GP commissioning thing has already persuaded many doctors that they have to make the care of the population their first concern - i.e. NOT the patient in front of them. It's fine to ration care, apparently, because delaying Mrs Brown's cataract surgery means you are 'freeing up resources' for something else. I've heard lots of doctors talking in those terms. They appear to have forgotten they have a legal duty to treat the individual patient in front of them in the consulting room to the best of their ability. Maybe they need a sharp reminder. But everyone seems to take the 'responsibility for the whole population' thing as a fait accompli.

Of course it makes sense to get doctors and other health professionals more involved in shaping local healthcare services, but NOT if it means denying someone the care they need and especially not if the doctor is tempted by 'savings' going into their back pockets - the idea is part of GP pay will depend on the 'performance' of their commissioning group i.e. how much money they save.

Thanks, Edam. Already suffering this with monitoring paediatric eye inflammation, a non-budget area. All eye clinics make out they're doing us a favour by even having a look since it's chronic unfixable. If DD was an adult with quick-fix cataracts or a glaucoma target group, she'd be a desirable budget item. I'm starting to feel like a charity case. I really wonder whether there will be rebellion from ethical docs, treating people outside the remit.

Wayhay, the private sector is commissioning as well. [At the Lang and Buisson Independent Healthcare Forum, 7 Sep] Lord Howe said that he saw those opportunities for the private sector extending from the provider side to the commissioning side in providing support for GPs working in clinical commissioning groups. www.pulsetoday.co.uk/newsarticle-content/-/article_display_list/12663018/big-opportunities-for-private-sector-in-health-bill-says-minister

We are all going to hell in a handbasket if they get away with this... and don't let the Lib Dems blame it on the Tories, they started all this because they wanted to give control to local councils (which is where their power base is - although what the fuck councils know about, for e.g. cancer care, I don't know, and given turnouts for local elections are very low, I wouldn't claim they are beacons of democracy either).

Sorry to hear about the way dd is being treated. I wonder whether the Patients' Association may be able to offer you some support/talk you through how to make the doctors realise they can't just ignore your dd because her eye condition isn't fixable? Lots of things aren't curable - MS, diabetes, arthritis - doesn't mean doctors can just write you off and refuse to monitor!

Edam, thanks for kind thoughts about DD, I have balls of steel now having learned the hard way, docs scurry into their rooms when they see me, made a surgeon's hands shake the other day and those guys are well hard. I merely present the paediatric ophthalmology service as an example of a criminally neglected and underfunded specialism which AQPs are not going to cover.

No, not unless they think there's oodles of cash to be made - and if it's chronically underfunded now that's doubtful.

(love the idea of the quaking surgeon - that DOES mean you are well 'ard. )

Anything that does away with the rafts of people in non jobs is a great idea.
Bring it on.
NHS needs a massive boot up the arse.

yeah, I just bet private sector commissioners and providers will get rid of people on fat salaries who don't actually do any bottom-wiping or heart surgery... It's all just a game where the executives made redundant from PCTs or SHAs are being re-hired at extortionate rates as 'consultants'. When no doubt they will recommend that lots of money can be saved by sacking the people who actually do wipe bottoms.

Mark Britnell, for instance, who developed this policy when he was director of commissioning at the Dept of Health, is now earning loadsamoney advising private sector companies who stand to make money out of his policies. And has told the fat cats the NHS is there to be carved up and 'wont' know what's hit it'. This isn't about better patient care, it's about making money at the taxpayers' and patients' expense. No doubt it'll be the usual government privatisation story where the fat cats get the profitable assets and activity, the taxpayer gets the liabilities (especially pensions), people who really do the job get squeezed and the poor old patient/service user gets far worse care.

The House of Commons has already passed the Bill, though it still needs the agreement of the Lords. Among many other bad things, the Bill allows GPs to collect personal bonuses from any savings they make by cutting spending on treatments.

Moondog - this Bill replaces 160 bureaucratic layers with over 500!

What you have to remember about the tories is that the welfare state is possibly one of the things that has disadvantaged those they represent more than anything else over the past 60 years; it's caused a huge swelling of middle class people (like most MNers, I think it's fair to say) and threatened the assumed superiority of the born-to-rule lot in a massive way.

To put it bluntly, they wish we'd never been born and the sooner they can 'inadvertantly' cull our class back to a more manageable size, along with our upperty ideas about equality and living wages and the like, the better. That idea is the one unifying principle behind pretty much every act that's been passed since the 'coalition' came to power. Why we're not angry about our own imminent demise is probably down to scary marxist ideas about false consciousness and other outdated rubbish...

As a Choose & Book customer of the new NHS I will be enjoying exercising my shopping skills, and so will the GPs I've been talking to, so the AQPs better shape up I am loving the out of hours providers though.

OK, here we go -

GP practice advertising private services to their NHS lists. Have you received an approach like this? BBC want info, hopefully to make a programme www.bbc.co.uk/news/health-15182186

NHS Choose & Book - gone round by us. The 'Clinical Review Team' will be triaging into 'intermediate services in a community setting'. Let us hope intermediate services are qualified to assess, treat, refer on as needed without delay. Yes, it's better than being triaged by the receptionist or office staff, but what happened to patient choice??

Some brill posts on here - Moondog I don't think it's the NHS that needs a kick up the arse............could be that someone else does though! Maybe you will have to find out for yourself over time that the health service here will eventually (as others have pointed out) will be like the US system. If you have health insurance the care is first class, if not (and in broken Britain) I don't think there are many normal people who are going to be able to afford the bus fare to the surgery let alone bloody private health insurance.

Actually the care is not always first class even if you do have health insurance in the States. You'll get lots of tests though, as they make plenty of money and reduce the risk of the doctor being sued. And then you'll probably find that your insurer won't cover it for one of a myriad of small print reasons (they are insurers after all). Patient safety is just as big an issue in the States too.

I am an ex-NHS manager (now living in Canada) and I find this all incredibly sad. Of course the NHS had it's flaws (I managed complaints and investigations into clinical incidents so I know that things sometimes go wrong, communication fails etc) but the changes are utterly counterproductive and will lead to much higher costs for almost certainly reduced levels of care. The private sector will take the high profit/low risk work, do a variable job (as they do now) and leave the NHS remnants with the tricky expensive stuff. I think it will be like the railways, a complete shambles.

I'll be interested to see if the government really lets hospitals go bust - one of the reasons why the health service has been getting increasingly expensive is that there are simply too many hospitals but it's always been considered political suicide to support a planned closure. You just have to look at what happened with Barts, where there was an excellent case to say that the area was already over-served and the building hopeless for modern care, but the campaign was such that it ended up being turned into a cardiac and cancer centre at huge cost, and with the Brompton and the Marsden nearby totally unnecessary. Likewise in my patch (South East London) it was never possible to rationalise the seven hospitals even thought four of them were running with a significant deficit. Instead they got expensive PFI rebuilds that they couldn't afford (the private sector contractors did very well of course) and clinical standards slipped as they tried to balance the books.

This is a truly frightening development. Its hard for us to understand what life is like without healthcare. Yes, there are huge problems with the NHS, its far from perfect but it really is better than the alternative. Starting to privatise the NHS is a step in a terrible direction, which will see the most vulnerable in society suffer the most. The health inequalities between rich and poor will become even wider.
If you care about the NHS sign the petition or attend the demo on sunday.

www.38degrees.org.uk/page/s/Protect_our_NHS_Petition
www.ukuncut.org.uk/blog/block-the-bridge-block-the-bill

letter in the Guardian today

I think this brings an interesting dimension to the debate on the NHS

Edam

1. This "it's already happening anyway, extremely fat multi-million pound contracts to run little things like the whole NHS in London have been awarded to the private sector" is complete hogswash. The extremely fat contract you're referring to was a ~£500k (not "multimillion pound") contract to design a massive training programme for GPs so that GPs could commission some services for the NHS in London. The vision you have of NHS London being run by Capita or whatever has just not happened. NHS London and the PCTs are run by civil servants and doctors.

2. What you said here re GOSH: "I've no doubt their chief exec will be only too happy to 'maximise income' and sod patient care for ordinary people who can't afford to go private" is sailing pretty close to libel.

I don't know why you would say something for which you have no evidence whatsoever (you can't possibly know what makes her happy or sad) but which serves to attack a woman who has dedicated her life to the treatment of sick children. Jane Collins is, by the way, a distinguished paediatrician, as well as being the CEO.

I don't like many aspects of the reforms myself, but there's absolutely no value in having a discussion based on misreading of the facts. And it's important to remember that very large chunks of care are currently provided by the private and voluntary sectors:

• GPs run their own small businesses, they're not salaried employees of the state (by and large)
• Mental health services are often provided by organisations like Turning Point (a charity)

etc