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?

Finally, on this:

1. The only game in town for the NHS - and health services around the world - is improving primary and community care, especially for patients with long-term conditions, to cut the use of expensive acute care. In the NHS, this is called QIPP. There are some early signs it's working - referrals are starting to fall as GPs are focusing more intently on keeping patients well and out of hospital. This means some hospitals are starting to suffer financially, but the job of the NHS oughtn't to be keeping hospitals going at all costs, it's to keep patients well. It's a good thing that patients aren't needing to be in hospital as much as they did a couple of years ago. We want more of this.
2. I just don't understand why it should be a problem for doctors to think about population health as well as the health of the individual patients they see. That has been the whole purpose of public health for many years, and no-one has previously said that public health is an inherently unethical field - quite the opposite. With a limited pot of money, the money will simply run out if we try to treat everyone aggressively for everything. I'd rather have doctors making these decisions than managers.

slhilly,
'I don't know why you would say something for which you have no evidence whatsoever': doctoring Hibbert/Hodes report to serious case review (baby P) into St Anne's, Haringey 'for legal reasons' www.bbc.co.uk/news/uk-england-london-13715065; letter of no confidence from 40+ consultants convened by BMA 'growing concerns over patient care' www.telegraph.co.uk/health/healthnews/7805990/Great-Ormond-Street-crisis-as-hospital-consultants-reject-management.html; 3y suspension for whistleblower Dr Holt, apology 3y too late www.telegraph.co.uk/news/uknews/baby-p/7280085/Baby-P-whistleblower-being-hounded-out-of-Great-Ormond-Street-Hospital.html.

nooka,
'... 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.' Exactly.

We all appreciate it's not easy running a health service and nobody's perfect but it would be nice to listen to staff with suggestions and concerns rather than sacking them.

Here is today's patient experience of GP commissioning. GP practice takes on entire university, goes into overload, doesn't employ enough GP cover or admin. I request urgent tertiary hosp referral for child with chronic eye inflammation flareup. 2wk later GP still hasn't dictated letter 'v v sorry, we are too busy'. Child goes blind. Actually, no, not this time. I take her to well-known eye hosp A&E purely to get sorted (£40 train fare). If you're not rich/online/well/untrusting/available 24/7 to travel to random 'centres of excellence' or 'community providers in other towns', I would be watching the NHS reforms closely. As far as I know, there is no NHS provision for travel unless you're on benefits.

Eicos, I'm not sure what you think in the links you posted demonstrates that you know that Jane Collins would be happy to maximise income and sod patient care.

Some consultants don't like her or have confidence in her; others do. Medical politics is a pretty vicious place, and the death of a child is guaranteed to make it even more toxic.

Your awful experience is not one of GP commissioning, btw. It's of GP provision.

I am wondering whether GPs are ready to commission.

slhilly,
'I'd rather have doctors making these decisions than managers.' Totally, totally agree. So pleased to hear my friend's sons had a management component to their medical degree. It has to be compulsory, surely.

Doctors are not yet ready to commission. They need training and they need managerial support. But if they are just trained by the current management of the NHS, they'll learn all the old bad habits and it won't actually be any better than what we had before. So they need outside help. But that means spending money, and taking time out from treating patients, and neither of those is easy.

JC is a paed neuro, btw. Don't get me wrong, I love the place. Health service management is indeed scary.

Over 400 public health doctors and specialists from all over the UK have called on members of the House of Lords to reject the government?s Health and Social Care Bill [2nd reading 11 Oct]. An open letter to House of Lords members says: ?The Health and Social Care Bill will erode the NHS?s ethical and cooperative foundations? and ?will not deliver efficiency, quality, fairness or choice.? They suggest the Bill will undermine the country?s overall public health capabilities. Signatories of the letter, which is published in the Daily Telegraph, include over 40 directors of public health and over 100 leading public health academics. www.hospitaldr.co.uk/blogs/our-news/public-health-doctors-speak-out-against-health-and-social-care-bill

The current bill is an absolute dog's dinner. At least the original white paper was coherent, even if the ideology was hard for many to stomach. But now we have something that will lead to local councillors being able to grandstand with local services, while a centralised quango spends £40bn!

There has been only one good thing in the whole reform: having doctors take on both clinical and financial accountability, rather than having these split.

BMA briefing 6 Oct on Health & Social Care bill, second reading in House of Lords www.bma.org.uk/lobbying_campaigning/bmapositionhealthandsocialcarebill.jsp

New questions for your doctor:
How much of your clinical decision is based on incentive?
Is the provider you're referring me to in distress or failing?
Can I have a copy of my notes?

Good Qs. I'd add: does the consultant see enough cases of this type to be safe? Do I really need this intervention, or are there other better options ( including doing nothing)?

Yep, it's a worry when budget is the motivation. We have this in NHS orthodontics, always wondering why how essential the work is, what protocol we're working to, who's regulating it.

Another Q. Do you have a financial interest in the provider you're referring me to?

Fuck.

I want to cry hearing this. If our healthcare goes like NHS dental care has then we are all in trouble, unless you can pay for private.

It's not all bad. We should get much better out-of-hours services evening and weekend, and smart new local clinics, seen and treated quickly, for specific services we would otherwise be on regional hosp waiting lists for. Round by us that already includes eg MRI scans and surgery.

Maybe increased private sector services will subsidise NHS services and free up waiting lists.

In my dreams, the specialist teaching hosps would be operating 7 days a week, theatres humming, and more flexible and interesting jobs would be available for our sainted medics. Less income will be available if they don't take advantage of these opportunities.

I would guess that definitely the intention is that hospitals/services should be allowed to fail so we need to look out for that if we are referred to a massively stressed department. Transparency and support on this would be nice, or people and docs will definitely suffer, don't you think?

The loopholes need plugging in the Lords fast to make sure the intention to treat everyone from the public purse is not eroded.

awaywego1, UK Uncut, and everyone who was at the demonstration on Westminster Bridge yesterday - we love you www.guardian.co.uk/politics/2011/oct/09/labour-tories-nhs-bill
And also, the House of Lords tomorrow: 'Lord Hennessy and the former leader of the social democrats Lord Owen are to propose that parts of the bill are referred to a special select committee for scrutiny.'

It was a good day with a good mix of passionate people there..whether it'll make any difference i don't know, but it felt important to me to demonstrate against the proposed changes ahead of the house of lords debate tommorow. I feel really frightened about what this will mean if it goes through. Not for myself necessarily..i could (just about) afford health insurance but for the less fortunate and more vulnerable members of society. How many people now dont go to the dentist because they can't afford it? if you generalise that out to all other aspects of healthcare the consequences are dire.

It's being treated on the so called NHS for dental treatment which has scared me the most.

I visited my dentist when the new rules came in and he just said he was sorry he couldn't treat me and my DD anymore as the NHS wouldn't pay them enough money. I was a patient with the practise for over 20 years. DD and I couldn't find another dentist who would take NHS patients for 2 years when they brought in a new practise that took NHS patients. They struck my DD off their list for being 10 mins late for one appointment and missing one (my fault). She hasn't had a dentist for 2 years now and she isn't 18 yet. I was 10 mins late and they have me on the danger list for being struck off.

They don't do any treatment, I haven't had a filling for 4 years. They refuse to replace 2 front crowns that need sorting out, unless I go private and they have a big adverts behind reception advertising their real business which is botox and fillers. Be warned.

They abolish the NHS. Remove the statutory duty on the Secretary of State to provide a health service - after lots of objections, the bill was taken away and rewritten but the replacement text isn't much better. Just says the SoS has to use 'the powers under this Act' to promote health services - quite vague but crucially, there are no powers contained in the Act anyway!

Rest of it is just as bad. Makes competition the most important duty - the most powerful health service regulator, Monitor, is charged with preventing anti-competitive behaviour. Not ensuring patients are safe, or providing decent quality health services or anything like that - just ensuring there's a market and lots of opportunities for the private sector to make money.

There will be no accountability for services provided to NHS patients, or for the money spent on them - it will be left up to local groups allegedly of GPs, but actually the work will be contracted out to KPMG or other consultances, as is already the case in London.

Thing is, they aren't waiting for the law to be passed, they are doing it already - see KPMG getting the contract to run GP commissioning in London. Astonishing arrogance to start dismantling the NHS even BEFORE they get the Bill through.

How will Strandednomore know whether her caesarean is clinically advised or just expedient?

Ruddy phone/broadband nightmares, I think my most recent post was answering a question that was acutally way, way down the thread! Oops.

Btw, someone further down objected to my criticism of Jane Collins of GOSH. She's the chief exec who refused to staff the clinic that saw Baby P (Peter Connolly) properly, despite warnings from the consultant in charge that children would be harmed as a result. And the chief exec who misled the inquiry into his death by submitting a heavily edited report, one that took out many of the most serious criticisms of GOSH. She didn't bother to tell the inquiry the report had been tampered with. The woman may well have lots of friends and an impressive career but her conduct over Peter Connolly is shameful.

I want the monitoring authority to be similar to OFSTED for schools - spot checks, ensuring standards, special measures, take-over in crisis, examination of near-misses, and in that case, misses.

www.bbc.co.uk/iplayer/tv/bbc_parliament/watchlive House of Lords debate live until about 11.30pm
Lord Rea thanked the Westminster Bridge protesters 'I will not let you down'
Lady Thornton ...the NHS represents a guarantee of decency in this country - Andrew Rawnsley has ignored this

Lansley

I'm still worried this is a gigantic Trojan horse excuse for not treating some groups of people from the public purse.

Raised in the Lords yesterday, the vulnerable groups selected for non-treatment/lack of coordinated care/written off appear to be random: children, adults with mental illness/impairment, elderly incapable, rural dwellers, chronic illness, rare diseases, too poor/sick to travel. None of which, attractive to the independent provider.

OK, I'm going mumsnet now: if you're an obese, smoking, diabetic who wants some skin tags removed you'll be fine.

How much is all this bureaucracy going to cost?