49% of Hospital Work Can Now Be Private

[Highlander]

Previously, it was 1%.

This can happen right now, one of many meaures allowing a 2 tier healthcare system, Bill or. No Bill.

John, have you actually read the dog's breakfast that is the health bill? The NHS is being opened up to EU competition law, so services will have to be put out to tender - and they are already being contracted out to companies like Serco (community healthcare) or McKinsey's (GP commissioning). Thanks to Lansley and the Lib Dems rushing ahead and implementing the bill without bothering to wait for Parliament to actually approve it.

Tell me, did you notice the bill left out the bit about the Secretary of State actually having a duty to prove a comprehensive national health service? And that even when people noticed this rather glaring abolition of the NHS, the government pretended it was an 'oversight' and said they'd put it back in, only kept failing to do it?

Did you notice that clinical commissioning groups will be able to decide what the NHS actually is in their local areas? So if McKinsey's decide diabetic footcare isn't a 'priority' in Plymouth, diabetics in Plymouth won't get footcare. And will end up having their feet amputated.

Good luck explaining that postcode lottery to your constituents. And good luck dealing with constituents who expect you do to something about it, when you can't - the power is in the hands of huge bureaucrctic unaccountable bodies such as Monitor or the NHS Commissioning Board. Neither of which give a flying fart about your constituents - look at the people in charge and their track records. Especially the role of Monitor in helping to kill those 400+ patients who died of neglect in Mid-Staffordshire - a place where hospital patients were so desperate they resorted to drinking the water out of vases of flowers, but hey, it deserved foundation trust status.

Did you notice, btw, that clinical commissioning groups are not going to be covered by the CQC? So there's no monitoring of the people who make the decisions about what services to 'buy' from Serco and Crapita and Group 4 and McKinsey's. Sod patient care, what's important to your government is fat profits for companies like them.

The health bill is the Lib Dem's fault. You went for it because you wanted your local authority power base to get their mitts on the NHS. Only your party's done rather badly in local elections, so you've screwed that up. Shame the rest of us have lost the most precious thing this country has ever achieved - the greatest act of collective goodwill, as Bevan put it.

so services will have to be put out to tender - and they are already being
contracted out to companies like Serco
Where is that in the bill? The contracting out currently is from previous health legislation.

An awful lot of people here are assuming that there is an untapped market of private patients who are going to suffocate NHS resources.

Those who want private healthcare are already very well provided for on the edges of the NHS. Why does anyone think this part of the health care sector is going to suddenly grow?

I think it's expected that the private sector will grow becaue the health bill gives the secretary of state the power to exclude people from the health service. This means that in order to get some treatments some people will be forced to go private.

Read this article published in the BMJ to see how the NHS Bill provides a legal basis for charging and providing fewer health services to people.

Which people are we talking about?

Would be good if the private sector injects a bit of 20th century technology into the NHS, let alone 21st. If a private clinic can take xrays and email to the GP, why does an NHS clinic put them in an envelope for me to collect and phycically transport to the GP, with tehpotential for them to be lost or damaged - simply because any time wasted delays tehm needing ti tkae further action- speed and efficiency seems not to register on anyon's radar. The private sector will not let themsevels be duped into mega it projects that are bound to fail and that no-one is accountable for as happens now in NHS procurement, but will have mini-projects to improve efficiency and delver faster and better. Bring it on!

It depends on the commisioning group (CCG) for your local areas as to who is excluded and what services are kept or removed because they aren't profitable.

"The bill also transfers from the secretary of state to CCGs the
power to determine what is ?appropriate as part of the health
service? for certain individuals. The services concerned are care
of pregnant and breastfeeding women, care of young children,
prevention of illness, care of people with illnesses, and aftercare
of people who have been ill."

It will mean the return of the postcode lottery for health where the care you receive depends on wher you live.

CCGs also no longer have to provide care for the following services for the people in the geographical area and the local health authority does not have to provide them either (with the exception of sexual health services):

? Services provided at walk-in centres
? Facilities and services for testing for, and preventing the spread of, genitourinary infections and diseases and for treating and caring for persons with such infections or diseases
? Medical inspection and treatment of pupils
? Services relating to contraception
? Health promotion services
? Services in connection with drug and alcohol misuse
? Any other services that the secretary of state may direct.

Wonder if John will come back and comment on your excellent posts, gamer?

Unless he's not been paying attention, he must know full well that the DH has been pressing ahead with the privatization 'reforms' before the legislation was in place. Acting as if PCTs had already been abolished, despite them still existing as legal structures that have legal duties. I didn't see McKinsey's being appointed to run the NHS in London under the previous government actually.

But obviously John thinks he knows better than the RCGP, the BMA, the RCN, and all the other medical and healthcare organisations that were opposed to the bill.

Being in Portcullis House while the division bills were ringing the other night was horrible. It's no exaggeration to say they were sounding the death knell for the NHS.

That's a list of services though. I am more interested in which people are excluded.

We have an inherent "postcode lottery" for health because as a minimum the services in Scotland, England and Wales are governed differently.

In my view it is a good idea to allow local variations so that the service can be tailored to local needs.

The reforms that DH was dealing with are based upon the 2006 act. (which was reiterated in Labour's 2010 Manifesto).

Public Health issues are generally moved to local authorities.

Section 12
Duties as to improvement of public healthAfter section 2A of the National Health Service Act 2006 insert?
?2BFunctions of local authorities and Secretary of State as to improvement
of public health
(1)15Each local authority must take such steps as it considers appropriate for
improving the health of the people in its area.
(2)The Secretary of State may take such steps as the Secretary of State
considers appropriate for improving the health of the people of
England.
(3)20The steps that may be taken under subsection (1) or (2) include?
(a)providing information and advice;
(b)providing services or facilities designed to promote healthy
living (whether by helping individuals to address behaviour
that is detrimental to health or in any other way);
(c)25providing services or facilities for the prevention, diagnosis or
treatment of illness;
(d)providing financial incentives to encourage individuals to
adopt healthier lifestyles;
(e)providing assistance (including financial assistance) to help
30individuals to minimise any risks to health arising from their
accommodation or environment;
(f)providing or participating in the provision of training for
persons working or seeking to work in the field of health
improvement;
(g)35making available the services of any person or any facilities.

Well yes, there has always been a postcode lottery.

This brouhaha is a case of 'moving the deckchairs on the Titanic'. It is nothing new - swings and roundabouts, blah blah blah.

One thing that is true about healthcare is that you can't stand still and try to live in the past. Health, longevity and attitudes are very different nowadays, and it takes a different approach to deal with modern issues on a similar % of GDP.

The electorate didn't vote for this. It was not in any manifesto, nor in the coalition agreement. In fact the Tory manifesto specifically pledged that there would be NO top-down reorganisation - much as the Lib Dems pledged to vote against increasing tuition fees.

It is dramatically new in size, scope and intention. Hence the united opposition from all the Royal Colleges (bar one IIRC). Trying to downplay it is either a case of not understanding it or deliberately misleading people.

It is hard to understand because the bill is a complete dog's breakfast - it was shockingly badly written in the first place and is even more of a mess now. (Claims about 'oh we just forgot to put the bit in the beginning that says there is a duty to provide an NHS' should be taken with a bucketful of salt.)

There have been previous dalliances with some involvement from the private sector but these have been limited (and hideously expensive and wasteful - ISTCs spring to mind) but they are nothing like this. Which is ultimately wholesale privatisation.

No previous government has dared to say 'fuck off, little people, your local unaccountable and unelected bureaucrats are entitled to say what the NHS is and does and you have no say in the matter at all'.

Much of what is being criticised was not only in the Lib Dem manifesto, but also the Labour manifesto.

No previous government has dared to say 'fuck off, little people, your local
unaccountable and unelected bureaucrats are entitled to say what the NHS is
and does and you have no say in the matter at all'.
However, the bill moves away from unaccountable and unelected bureaucrats towards accountable systems including the local health and wellbeing board.

Which is ultimately wholesale privatisation.
er ... no.

johnhemming just because I despise the coalition, don't imagine I support 'slow cuts' Labour.
edam and gamer you're right, keep up the fight!
Bevan said that the NHS will only survive as long as people fight for it.

edam and gamer you're right, keep up the fight!
What exactly are they right about?

It helps to know.

We are right that you, John, have betrayed the electorate. We are right that the health bill sounds the death-knell of the NHS. We've actually read it, sounds like you haven't. I've worked with some of the people who were lulled into working with it in the early days, when they believed it might be about getting doctors, nurses and other healthcare professionals more involved in decision-making. All of them despairing now.

And you can stop peddling lies about cutting bureaucracy. This bill introduces a whole new wodge of bureaucracy. How else would you describe the NHS Commissioning Board, pray tell? As far as I'm aware, McKinsey's won't actually be performing any actual surgery for NHS London - their role is bureaucracy and won't they be paid handsomely for it.

The previous government had indeed muddied the waters with stupid ideas about involving the private sector. All that money wasted on ISTCs and don't even mention the electronic patient record. Those were bad ideas - but they never went anywhere near privatising the whole damn thing. Doing something 1,000 times worse than the last government isn't anything to be proud of.

The bill really does not conflict with the manifesto. The commissioning board is because GPs should not commission themselves.

Where exactly does it say that NHS trusts are being sold off? ("privatising the whole damn thing").

Under the new proposals private providers won't be paid more than the NHS providers unlike under Labour's system.

I don't understand this bill at all - why are GPs being dragged off from doctoring to sit on bureaucratic boards?

Our county is replacing its previous arrangement with something that looks much the same except has a load of GPs on - reducing the available GP resource for patients.

As I said, I don't understand the bill, but I don't get why this is good.

There speaks a Lib Dem who voted through a three-fold increase in tuition fees despite a very clear manifesto pledge to vote against any increase in tuition fees... Lib Dems could teach Alice in Wonderland a thing or too about believing six impossible things before breakfast.

AE, there are two ways to think about whether doctors should be involved in strategy and admin.

Some people think they should be doctoring for 100% of the time and leave the admin to management consultants. Others believe that GPs should have a say in how they work and how their work is prioritised (funded).

It tends to swing back and forth.

I dare say that some might end up being not terribly good doctors, but are much better at serving the health care sector in more admin and strategy roles.

I think the balanced view is that it is good to have some medical expertise at decision making level, but we need to make sure that we are putting years of medical training to optimal use.

johnhemming 'doesn't confllict with the manifesto'? 'There will be no top down reorganisation of the NHS' oh, wait - that wasn't in the manifesto, it was just a random lie

MrsMeaner - thanks. Do you mean professional managers? (Mgt consultants being "project" types rather than "running day-to-day", in my brain).

I Re medical involvement: yes, to informed involvement at some level but surely this should be planned for not suddenly started, so that the reduction in GP resources can be planned for - or even funded properly to avoid.

This has been a hot potato for years and years - as long as I can remember, AE.

Auntie, you are right - we are now paying huge amounts of money for locums to cover the work of experienced GPs who are off dealing with the massive changes being imposed on the NHS.

Clinical involvement in commissioning is undoubtedly a good thing but a. not if it involves pulling hundreds of GPs away from their primary tasks, that they have trained for over many years and at great expense and b. we didn't need these hugely expensive and disruptive reforms to do it. We could have looked at the old Primary Care Groups, the forerunners of PCTs, which had clinical leadership.

McKinsey's wrote a report for the previous Labour government that went too far even for Blair 'I love the private sector me' and Brown. It demonstrated a. that they don't understand healthcare or the NHS and b. that they wanted to grab power and money by recommending the NHS be broken up into units that they did understand.

And that's exactly what has happened now - hence McKinsey's winning the contract to run NHS London. And what is NHS London doing? Shutting down the good maternity department at a good hospital and forcing women to go to a shit maternity department that has managed to kill five women over the past couple of years. Tells you everything you need to know about the character of the cheerleaders of these reforms, and what is likely to happen everywhere else.

The pledge on student finance was to get a fairer system. The subsidy has been transferred from a general subsidy to one which is concentrated on the less well of graduates. That to me is a fairer system and in accordance with the pledge. (not that this is relevant to this thread)

The "no top down reorganisations" was in the conservative manifesto. I am not a Conservative MP and am defending the proposals from the perspective of the Lib Dem manifesto.

I cannot comment on the details in London. I concentrate on the situation in Birmingham.