NHS changes: A bitter pill to swallow?

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In the world of politics it is not difficult to find someone who will support almost anything.....personal advantage in the future is a prime motivator for those who play these games....so and so supports it...therefore it must be correct...what nonsense.
But, we must pay those big bonuses to keep those valuable bank staff on board...they are more critical than healthcare providers...you need to see the big picture to understand....or like me you may never understand.

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As David Davis (Con MP) said on Andrew Neil's Daily Politics show at lunch time, Landsley has been Shadow Health Sec since Cameron became Tory leader plus almost 1 year in the post and has been working on the planned changes in all time. Why was Cameron "surprised" at the reaction to the changes? Had he not read the draft documentation? There is a stink here and it is following Cameron. He cannot abrogate all responsibility forever.

Communication of policies since last May by the coalition has been by and large appallingly bad. That they have not recognised this nor remedied the problem speaks loudly of poor leadership: the finger is pointing at Cameron. It took a pertinent question by John Redwood to salvage Landsley's poor performance in the HoC to help explain why the NHS reforms were necessary. At least Redwood knows how to communicate, but he is too right wing for Cameron's taste so Cameron's preferred choice is to settle for mediocrity.

It pains me to say it but Cameron reminds me more and more of the previous PM. Both are far too fond of throwing away tax payers cash on the EU and International Aid.

David Davis also claimed that the Armed Forces are nearing a state of exhaustion in particular the RAF crews flying in Libya. He also said that 5 out of 8 missiles/bombs missed their targets on recent missions. If true this is a very serious state of affairs and with the military cutbacks something has to give.

The Liberal Democrats and the Tories have more in common than everyone thought - they have both openly broken the central plinths of their campaigns within the first year of office!

Tuition fees and breaking up the NHS are pretty emotive topics to dump your political capital into.

Is this brave or just evidence of really, really bad policy management?

(From my experience in working with the government in a professional capacity, I would conclude the latter - departments are running ahead with campaign messages as policy. They are not even attempting to look at practical solutions to the issues the country faces.)

And what are the staff going to do?

They have no alternative but to work for the NHS, do they? Claarly the most steadfast oponents of change will be those who wouldn't dream of abanding the feathered nests of their guaranteed final salary pensions. Guaranteed by the rest of us as their contributions don't match their withdrawals.

One million people working for an organisation that has become the closest thing we have to a national religion. It's the dependency and entitlement culture writ large.

Free at the point of delivery? What a joke, it costs over a hundred billion pounds a year to keep it open; ther is nothing free about the NHS.

He's not shutting it down, he's merely carrying out the reforms his labour predecessors were too spineless to attempt. It's a tragedy that the BBC has descended into knee-jerk hysteria mode about this issue as if they had the faintest hint of journalistic objectivity they could actually lead the debate rather than swallow the self appointed liberal elite's version of the debate.

Name me a country that has followed the NHS as an example of how to run a country wide health service. None exists and for a very good reason; it has become self protecting, self serving and dysfunctional. No healthcare professional can claim to offer a dispassionate view of this anymore and more's the pity.

Clearing up labour's mess...

It's a great time to be a tory...

The vested interests will always oppose change but I think there was a fairly widespread uneasiness that the reforms had not been properly thought through. I give Cameron credit for meeting the problem head on - but this is not the first time they have rushed into policy announcements without proper consideration and it may start to smack of incompetence.

Whilst it is entirely sensible that those GPs with vision and managerial acumen are involved with the organisation of the NHS , if practising GPs are seen to have any benefit from the treatments they prescribe this will inevitably create a schism in the doctor patient relationship.

There were some interesting comments on yesterday’s blog comparing our system to that on the continent – are we in danger of trying to re-invent the wheel instead of trying to adapt the best of practices elsewhere?

"If you were health secretary for the day and had a magic wand and could change one thing what would it be?"

The politicians would not like my answer: to take meddling politicians out of the picture!

Let's look at it in military terms. Like most veterans, I believe in the civilian control of the military (no juntas here!) but in time of war, I expect only the broadest strategic direction: the civilian is just about qualified to say, "Capture that castle" but not to specify the tactics to be used.

Two of the jewels in the UK's crown, health care and education, have been wrecked by incessant micromanagement by mediocre unqualified meddling politicians. Step back and let the professions do their job - you might even find some time (if not the capability) to do yours!

Told you the politicians wouldn't like to hear my opinion :) But they are accustomed to ignoring their employers....

The best summary I've seen was an article on the BMJ web-site about the "reforms". Check it out, it's scary stuff. I don't think most people have much idea about how far reaching and how profoundly pro-market these reforms actually are, nor the impact they will have on patient care (I certainly didn't).

A re-launch before the launch is what this is about. Questions about Cameron interest in the reforms abound because Mr Lansley has been at it on health since 2003. What has he been doing and what has he been saying to Cameron since then - big question!

4#

Sadly true, ECB, I agree with practically every word. He's turning into the worst possible combination of Blair and Edward Heath. Sooner we're shot of him the better, I'm afraid.

Just worries me that in such an event, the other lot of recently deposed liars and incompetents will be voted straight back in. The nation will end up being no better off and certainly no better led.

Time to stock up on baked beans and bullets methinks.

It is the duplicity that angers me.I am not against changes, not even radical ones.I am against the duplicity of going into an election, keeping quiet about these major changes and then revealing them as soon as you are elected. Cameron must think we are idiots: do we really believe the proposed changes have been dreamed up by Lansley alone in a few months since the election?Of course not. Cameron et al lied by default about their plans for the NHS. What else have they lied about?

How can there be reform, when those charged with carrying out the reforms are those already in charge of the incompetence and a major part of the problem . The upper echelons of administration will make changes and implement cuts , but these will be to services and patient care and not to the root cause of the problem . Unless the administration, like every other public service is reined in and drastically curtailed, there will be no change. Like local government, where chief excecutives and assistants and their assisstants drain resources we run out of bin men and see roadworks and basis services curtailed.

This is a truly "Difficult Area" for any Government of any political colour. Yes, it is good for the present Government to have to "Present and Sell" their proposals to us the public/electorate in some detail.

No, it is wrong for the "vested interests" working within the NHS (their jobs), to hang on the political levers of "The NHS is Safe in Our Hands" just to block any changes. This is what happened to Tony Blair too...

It must be obvious to anyone with a brain that the current "formula" or whatever you want to call it, is clearly not going to work into the future. Either the public "expectation" changes of what the NHS should deliver or, "Free at the Point of Need" will.

I am not saying that these proposals are either right or wrong but, I suspect that the NHS needs to be seen as the "Sacred Cow" it has become before we can get sensible reform of this essential service.

The NHS like Education has for far too long been seen as 'election material' by both the Tories and Labour. WE THE ELECTORATE, need to tell them that BOTH issues should be debated and agreed on a bi-partisan platform (or multi...). Both issues need to be divested of any "political emotion or, perceived political advantage'' by all. These are National Issues and as such and regardless or whoever is in power, should be treated as such.

As long as there are political divisions on these matters, self seeking, self interested 'special pleading' to exploit these divisions will take place inside the NHS, Education Universities and any other "Public" organisation that sees its wholly unearned privileges, paid for by us through taxation, as under threat.

Shouldn't the publication of the white paper (Equity and Excellence: Liberating the NHS) have been the time to listen? This bill seems to have begun by being rushed through, but now the brakes have suddenly been applied.

Anyway, it seem as though the public already seem to be behind the changes: https://www.nuffieldtrust.org.uk/uploadedFiles/Ipsos-MORI-Media-Briefing-100311.pdf

has dave and nick tried to win over norman tebit. that is the true test, not the nhs staff where he might find a meingle or speirs.
to stop this fiasco once and for all contact your mp and complain that the public gave them no mandate for this. there lost in the woods again. give them a way out
or a vote of no confidence, this is not a partisan issue.

@#12

Pretty much everything, I think!

Here's that research I mentioned yesterday about high levels of satisfaction amongst the general public for the NHS: https://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_125483.pdf

It also shows that the vast nmajority think that the NHS will run into financial trouble in the future and that it is currently too bureacratic.

We're watching a great hope fading - the coalition came in with a roar and will be reduced to a whimper in tiny increments. It started with not selling forests and carries on with not reforming the NHS. I wish they'd just get on with the job of sorting it out now rather than struggling on and allowing hysteria and fear to rule politics.

This is a make or break 6 months for the coalition, and David Cameron and Nick Clegg are scrambling around to save the NHS proposals which are a cornerstone of their program. Andrew Lansley is lucky to still be in a job, but will this exercise be anything more than a filibuster to change the language, and spin the idea differently to the public? https://bit.ly/hUQnTo

He's not changing his mind because of the public - the tories have made it very clear that they have no intention of taking any notice of the public as they push through their programme to transfer wealth to their rich backers.

This is because the liberals are starting to waver, coming up to the local elections.

Cameron can not afford to lose Clegg and the support of his liberal toadies.

Cameron - a Prime Minister in name only .

6. At 16:12pm on 6th Apr 2011, rockRobin7 wrote:
Name me a country that has followed the NHS as an example of how to run a country wide health service.
================================

Name me a country where health care is run in the way proposed by your public schoolboy chums.

Yet another fiasco.


It's a great time to laugh at the tories.

The NHS has always been where the rights and duties of citizenship elide.We pay our taxes,we are cared for when we are ill.

Nor is their a general objection to more competition or private provision if it improves services to patients.

The objection is to wholesale privatisation without adequate provision that quantity and quality of treatment would be safeguarded.

There will be a huge transfer of funding to private practice who will commission medical services.GP`s run taxation funded businesses,they will now allocate resources as well between different treatments and therapies.The commissioning bureaucracy which replaces PCTs will "include" private companies who will determine which hospitals receive the GP`s patients.Anyone can apply to negotiate on behalf of GP consortia,in practice it will go to private professionals.

To me this looks like privatisation.How can the PM and Mr.Lansley claim otherwise? But then Mr.Cameron was always more interested in becoming prime minister than in policy.He has only just woken up to an impending shipwreck.

12. fromtheedgeofthefen

What else have they lied about?
--------------------------------------

1. No frontline cuts

2. Protecting the NHS budget

3. 3,000 more police officers

4. Keeping VAT at 17.5%

5. Keeping the Future Jobs Fund

6. Keeping Education Maintenance Allowances

7. Preserving tax credits for middle earners

8. Removing the “couple penalty”


9. Scrapping tuition fees

10. No bonuses for bank directors

11. 3,000 more midwives

12. Three more army battalions

13. Pupil Premium additional to the schools budget

14. Keeping Child Benefit universal

15. Stopping A&E and maternity closures

16. A Post Office Bank

17. No new nuclear power stations

18. Removing high marginal tax rates

19. No cuts to the Royal Navy

20. Automatic prison sentence for carrying a knife

21. Cutting rail fares each year

22. Keeping the Child Trust Fund for the poorest families

23. No more top down NHS reorganisations

24. No cuts to public spending this year

also dont forget, that this CONDEM lie list is fluid, ie, very likely to get longer and longer in the months ahead!

Good question at the press conference this morning Nick -I think it put the PM on the spot a bit.

I was encouraged by the event this morning. There were a few changes in direction (not U turns) but nevertheless welcome. The statment by the SoS that 'any willing provider' should be 'any competant provider', the idea that it will not be a fee market but a controlled one in that the private sector will not be allowed to cherry pick the profitable areas. Hopefully the reference to the tendering being subject to EU competition rules will hit the bin as well.

The DPM also hinted that commissioning consortia will have a wide representation and that there will be more scrutiny of private health providers to make them accountable to the tax payer.

The lack of all of these were, I felt, the main problems with the white paper and the reason why the health professionals are not supportive.

Politically its a disaster area though -rushed legislation, not throught through then having to be consulted on. It does show the PM not to be on top of the detail in another area. This is starting to be a repeat pattern and sounds like Brown -a relaunch followed by a relaunch of key policies. The Government meeds to get a grip on what they are doing. All of this could have been avoided if the White paper had been a Green paper and the proposals developed from there.

The Health Secretary has really messed this up -I know he used to be the PMs boss but I think he needs some time on the backbenches to reflect on how he should have implemented these changes including why he supressed the highest staisfaction ratings ever for the NHS in a survey last November. He has made the NHS a major issue after all of Osbourne's work to make it a non issue at the last election. I would have thought that Cabinet support is very shakey for the Health Sec at the minute.

As a business man and no lover of the nanny state, I have to say that I have never seen such a mess made by the government in terms of getting it's point accross to us all, and showing how the proposed changes are going to put our money to more effective use. The premise of scrapping PCT's to save money is fine - but what is it being replaced with? I have heard of the creation of more tiers of beauracracy in the form of Doctor, Patient, Local Councilor, Local Business People forming boards at regional levels who answer to National Boards. So where is the money being saved ? How much is it costing to sack PCT skills only to re-hire some of them to do the same job as before. How much is it costing to hire Business professionals to run logistal support for the new 'GP Area Boards'. How much profit margin will the Private Medical Sector take in every health pound provided by the taxpayer ? Should a hospital trust fail financially, who pays the redundancy money ? If Messrs Cameron, Lansley and Clegg want to Know why so many of the Professionals and the Public are set against this change, it is because they have not provided us with the figures in their business plan to prove it works financially. Whilst these figures are not forthcoming, the government will play into the hands of Labour and the Unions who smell a 'Privatisation By The Back Door' ideology, which is very much in the minds of us all. Prove it is not beyond all reasonable doubt with the disclosure of hard figures, and try not to treat the public like mushrooms, because very often, we are ahead of the politicians, and we do know how to read financial data. Finally, it is better to change course now than have a financial calamity that will make the collapse of the Royal Bank of Scotland look like monkey nuts!

I am like Fubar at 3, I wish Cameron would grow whatever is necessary to get a bit of backbone. He undermines his Health Secretary, whose plans he must have know about from the beginning, by going into what he calls listening mode. If I were Lansley I would resign, Cameron is making him look inept when he is not. Of course, the people in the NHS will oppose any reforms, what is new about that. The Government should have just got on and made the reforms, rather than give time for the usual suspects to scare the public. The Lib/Dems are behind a lot of this dithering, what a mistake Cameron made going into Coalition with them.

What a mess this is all starting to look. The NHS has had its budget ring fenced when it should not have been. Cuts have been made to defence which is proving to be a mistake. No real cuts have been made to Government spending, just less of an increase. The Coalition agrees to spend more as soon as anyone in the public or public sector kicks up. Libya looks more like a mistske everyday. Cameron talks of cuts in Britian, then gives money away to other Countries who can well afford to take care of their own people. The foreign aid budget has increased as has our payments to the EU. Money has been thrown away in giving tax reductions in the personal allowance, which is unaffordable. Osbornes, if it was his, tax on the oil companies, to cut 1p of tax is proving disastrous to future investment. The UK will be giving bail out money to Countries in the EU. This is no way to run a Country in financial difficulty.

Is Cameron trying to give Labour the next election?

The problems for Britains economy are mounting, and strong Government is needed. This does not seem to be what we have. U turns, particularly when dealing with the public sector, are a very bad idea, it shows weakness. Those who work for the public sector, will think that they only have to push Government and it will cave in to their demands.

The problems for the Coalition are only just beginning, the Scottish Elections could see the Lib/Dems hit very badly. Cameron must assert his authority at this time, and not give in to the weakened Lib/Dems, who will want to see change on Government policy. On Camerons performance so far, I don't think he will hold his nerve.

This really isn't being handled well at all by the government. Whilst I can see the need for change, the way this has gone so far doesn't fill me with confidence that there's going to be any major improvements. The concern for me is that they'll dismantle one management system and replace it with another one in a different from doing the same job.

In my area there's a recently upgraded "super hospital" and a few local ones were closed or run downas part of this process in recent years. The problem is that now the PFI costs mean that the PCT (or whatever) are really struggling to make these payments and to provide the services for which the super hospital was intended. Increasing the car parking fees can only cover so much of the shortfall. This is definitely a Labour Made Mess, and Gordy's magic money tree is no longer available to hose it down with cash.

[For the benefit of those who like TLAs in their CTPs (Continuous Troll Postings) - NHS control will be given to GPs instead of PCT CEOs, but this is complicated by MRSA and PFI. The problem is due to LBW (Labour Being Wasteful), and to blame the Tories for this is simply not cricket.]

"DC, I'm sick to the back teeth of imploring you to grow a pair. You obviously arent going to, so maybe its about time you stepped aside for someone who will." - FS @ 3

Worry not, Fubar, the time may not be nigh but it’s getting nigher. He’s coming, your Saviour. He’s here now amongst us but he’s not quite ready. He’s young – too young – but that’s changing each and every day. And as he grows, so does his anger; it hardens and so does pretty much everything else about him. He’s becoming very very hard. Hard-headed, hard-hearted ... hard of hearing ... the lot. And as his hardness gets more and more extreme, so too his politics, his hatred for all things namby pamby. His will to whip the country into line – the country which bore him but now bores (and disgusts) him – his iron will brooks no opposition and will one day smash all before it as, clad in tight leather shorts and yodelling like a crazy man, he leads his reactionary troops on Downing Street. He’s coming, Fubar, he’s coming.

In my view the following are major concerns in the proposed measures
1.the introduction of the profit motif
2. the conflict of interest between the choice of treatment and the place of treatment
3. I may be totally wrong but i haven't seen anything so far banning the GP consortia (and/or the managers of the consortia if it is contracted out by the GPs) from having a financial interest in the providers of treatment
4. the destination of unspent balances in the consortia accounts
(as self employed contractors the GPs will have every incentive to underspend their funds)

The whole idea of having 'free markets' in the supply of services is so that the government can say that it isn't their fault when things go wrong. They will cherry pick the bits that they know they can make work and blame it on others when things go wrong.

My local council is a highly regarded Tory council. However they decided to cut the funding to a large number of charity run day centres for old people in order to balance the books. The blame goes to the Council not the government who have cut the overall grant. I'm not saying whether it was the right decision, but wondering who takes the flack.

Free markets only work when you can affect the income as well as the expenditure, otherwise it ideological rubbish.

You naughty boy, Fubar! What did you do to incur the wrath of the Mods?

Onto more pertinent matters. Whilst wishing to stay out of the party politicking there is a legitimate question to be asked as to what on earth is going on in government at the moment? I didn't see David Davis earlier but ECB (#4) paints a depressing picture. The current run of ineptitude is Brownesque and would be funny if it were not so worrying.

Points to consider:-

1) Just what is the strategic aim in Libya? Mission creep is imminent, I fear, and Cameron/Hague seem clueless as to whom they should be talking (a shame about Hague - a contact in the FO told me a while back that he was a breath of fresh air after the Labour paralysis).

2) These NHS reforms appear to be an attempt to nail jelly to a wall. Cameron gives a decent impression of not knowing what Lansley is up to, and the whiff of panic is in the air.

3) I have no problem with the strategy of giving aid to Pakistan to assist in reducing the influence of the madrassars, but does Cameron not understand domestic politics? It is impossible to justify £650 million of aid to the majority of the British public that is scared as all hell as to what the next few years hold for them economically and is being told that services have to reduce expenditure.

I suspect that Cameron is missing Coulson and his political antennae. Hilton and the rest of the Notting Hill set lack empathy with Worcester Man or whatever he is called these days, and has Craig Oliver started work yet? I hope not for Cameron's sake as if this is what he brings to the job then it might be 'taxi for Mr Oliver' sooner rather than later.

The NHS reforms furore is syptomatic of a general malaise that has set in extremely quickly. If next month goes badly for the LD's at the polls (and if AV is rejected) then it could be all bets off in a matter of months.

Another example of it being much easier to oppose than govern, I suppose, but the lack of nous shown at the top is woeful.

And another thing...

Forgot to mention that I have rarely read such a pointless post as the one Mr Robinson has produced here. It contains nothing new and, if I were a cynic, I would propose that it has been posted for nothing else than to give us all another forum to spout off again.

Come on Nick, give us something to get our teeth into!

Lansley is came in so keen on bringing private business such as National health and KPMG in to take over the roll of the PCT that he forgot to work out how the finances would even add up. The whole plan is a dogmatic mess covered up by buzzwords such as "improving outcomes" and "giving people choice". I had a triple heart bypass 20 months ago the handover from GP to NHS hospital and back to GP worked perfectly whilst my treatment was not emergency it happened well within the 18 weeks laid down by the last government, thank god for targets and not the "rubbish" rhetoric of Lansley and Cameron.

As one whose previous NHS experience was directing large London acute hospitals, I have been encouraged by my findings during the last four months working with a number of GP practices wishing to establish a GPCC. Although there are areas for improvement in the proposals, we are all agreed that the White Paper places healthcare planning and commissioning with those best placed to decide....the GP. And, if the team of GPs with whom I am working are typical of those setting up other GPCCs, I would suggest that the NHS is "safe in their hands".

#30

Saga,

If Ed Miliband is the answer then I want a different question, please.

"it costs over a hundred billion pounds a year to keep it open;" - RR7 @ 6

Oh come on, Robin, that's not even as much as the deficit. Any case, all very well throwing these 'big' numbers about - maybe gives you a buzz? - but one of the very few things (on topic) we established with any certainty on yesterday's thread was that we don't in this country spend much on health care - either per capita or as % of GDP - compared to our peers.

"If you were health secretary for the day and had a magic wand and could change one thing what would it be?

Request a brain transplant, perhaps

Oh I wish he had asked the right questions of the staff - especially the nurses.

I have had a lot of Nursing friends over the years, most within the NHS and they universally have a really low opinion of GPs.

So, you can imagine the thrill they feel at the idea of GPs becoming their bosses.

A woman from Liverpool was just interviewed on the 6 o'clock news about the NHS reforms. Her comment: "I like the way there's grass root input into GPs and that broadens their spectrum". Thanks, BBC. What exactly was she trying to say? Was that the best vox pop you could find to support the reforms?

"In my area there's a recently upgraded "super hospital"" - SP @ 29

Hey that sounds like good news, Mr P. Especially if (as the 'super' tag implies) it's a full service jobbie, not just the glamorous stuff. Has a psychiatric wing, for example.

Been away in darkest Norfolk for a few days. No TV, no internet. Nice.

6. At 16:12pm on 6th Apr 2011, rockRobin7 wrote:
...It's a tragedy that the BBC has descended into knee-jerk hysteria mode about this issue as if they had the faintest hint of journalistic objectivity they could actually lead the debate rather than swallow the self appointed liberal elite's version of the debate.

As one who occasionally challenges some of your radical ideas, it's only fair to say when I agree with you, and I do when you suggest that the BBC should perhaps raise the profile of this hugely important debate even further. Lead it? maybe even that.

But, you can't have a self-appointed elite, Robin. It simply doesn't work. I offer the present Government front bench as an example of what I mean.

30. At 17:48pm on 6th Apr 2011, sagamix wrote:
"...his iron will brooks no opposition and will one day smash all before it as, clad in tight leather shorts and yodelling like a crazy man..."


Geez S, been at the Fisherman's Friend drops again?

"If Ed Miliband is the answer then I want a different question, please." - bass god @ 37

:-)

Suppose the 'tight leather shorts' was what got you thinking along those lines. Or maybe the yodelling.

Either way, perhaps a need to ponder on what might be going on there.

Yes, Blame (44). Yes I have. New flavour too - takes a while to get accustomed.

Believe me, Saga, Ed Miliband in lederhosen is not an image that I choose to dwell on.

Forgive me if I got the wrong end of the stick but I am a mere mortal and do not always understand the prophecies of a cyber deity such as your good self.

Enlighten me, oh wise one!

Lansly and Cameron have been dreaming of this reform for six years,so why the pause. Please let us know before May elections then, we will know how we can vote.I think the libdems should rebrand themselves LIBERAL CONSERVERTIVES and change the logo to a yellow bird nesting in a green tree

I hesitate to intrude on private grief (see @croft,pickled,fubar above) but would now be the time to say 'We told you so!' Having been disappointed by New Labour we were ideally placed to to sniff out this catastrophe well before it happened. We told you they were a continuation not a new start but would you listen....? We may be implacably opposed policy-wise but we both seem to be capable of recognising incompetence when it is writ large. It just takes some of us a bit longer to set up camp in the correct place.

'Cyber Diety' (47), is very acceptable; certainly been called many millions of worse things than that. But anyway - from one God to another as it were - no I think we'd best leave this one right there. Wrote it for Saunders really (he'll get it and probably wish he hadn't) but it looks like he's skidaddled. People get their priorities all wrong sometimes, don't they? Nick gives us a nice blank canvas to work with (since I agree with your 34) and yet so few can be bothered to daub. Ah well, SYLA.

There is a pettern building up around this government. It is constantly announcing policies and then finding it has to consult on them afterwards - the national forest, tuition fees, school sport, EMAs etc. This is a strange way to govern. Governments normally consult first and announce afterwards. The NHS reform programme is a shocking example. You simply cannot develop policy like this, whether or not the policy is desirable. The biggest reform of the welfare state for fifty years and it does not have an electoral mandate and has not been researched fully, I ask you.....

In all honesty I believe David Cameron may be the only member of his party or the house of commons who actually really values the NHS. Watching the care of a beloved family member as they leave this life, when the NHS does this well, must surely give rise to a whole lifetime of concern and care for the NHS.

But the Tory Party, the Labour Party and even the Liberals are so full of privileged users of private healthcare I do really fear that even though David Cameron is nominally in charge that he will fail to impress his colleagues of the virtue of the national treasure that is the NHS.

The NHS should do things more efficiently and make better use of technology. There are still so many senior staff that are essentially computer illiterate. We need electronic personal records, but not some mega expensive and undeliverable all knowing database. Why can't we keep our own records on our mobile phone or a memory chip. Cheap cheerful and available with us all the time. The whole philosophy behind the computerisation of the NHS was misbegotten right from the time that Tony Blair ignorantly insisted that it must be done in two years. Like the computers on the Nimrod - decades out of date before they get into service.

Make the patient the centre of patient care. Let the patient book appointments and decide on which GP or hospital consultant they want to see. Let the patient keep their own (open) medical records. Let the patient pay for the care received and be 100% reimbursed by the state. If a 'patient service facility' (Hospital!) has some free time let them offer discounted routing operations and give the patient the financial benefit. If patients miss appointments without notification change them a (non-reimbursable) fee. (Perhaps these ideas are too much like a half warmed fish, but you see where I am going!) The whole basis of facility provisioning is built about patient care. Facility management that provides good service get more customers(patients) etc. Patients would know how much their care costs and if the bill from the GP or hospital had, say three month payment terms, and the direct reimbursement by the NHS was fast enough things could work quite well. The side effect of course would be to be able to provide non-UK (i.e. non NHS insured) patient care who would have to pay for it themselves. Anyway this set of ideas is a worthy of consideration as the idea of letting GPs run the budgets. About all any change has to be piloted and tested FIRST.

The problems for Britains economy are mounting, and strong Government is needed. "This does not seem to be what we have. U turns, particularly when dealing with the public sector, are a very bad idea, it shows weakness. Those who work for the public sector, will think that they only have to push Government and it will cave in to their demands. "

Your faith was misplaced, but then it usually is.Mervyn King said it all when he reviewed Cameron and Osborne on Wilileaks: "They are more interested in politics than policy."

The government is less than a year old,so far everything they do is coming apart.it took Labour ten years to reach this stage,should give you pause for reflection.

Using the public sector as scapegoat for the government`s failings is wearing thin.You can do it once,even twice,after that you have to take responsibility.I take it you are calling for Mr.Lansley`s resignation? Don`t stop there,other heads will soon roll.

Just been listening to Lansley being questioned on just one of my big concerns - corruption.

Interviewer: couldn't a GP set up a business and then send NHS patients, NHS money, to themself?

Lansley: (Laughs) yes of course they could. Happens now.

Yes, indeed it does.

But at the moment GPs don't have ~£200 million (per consortium) of the tax payers money to launder through their own businesses or those of relatives and friends.

I think the interviewer was surprised at a government minister laughing at taxpayers money being funnelled into peoples own pockets, but of course that is one of the main objectives of this scheme - transferring public money to private pockets whilst fragmenting the NHS to ensure there is no accountability at government level.

IDB 49

No private grief on my part, I call it like it is, which is more than can be said of many. Having emotion with regard to politics would be a very grave mistake indeed. What Strictly, Fubar and I show are independent brains at work rather than a mindless declaration of loyality, displayed by the likes of Sagamix and associates.

Nothing could match the incompetence of the last Labour Government who caused the financial problems for Britain in the first place, therefore it would be impossible for you to set camp up in the right place. So I agree, some of you will take longer to understand the real problems.

Saga@30

Wow scary - I wondered what Balls was doing.

By the way 25 mins in before the Laffer curve - suckered again!

43 IDBI

The hospital I mentioned went an extensive rebuild at a cost of £256 million. This contract has now resulted in PFI payments of £44 million for the next 31 years. This is just another example of New Labour "investment", and one can only speculate as to how many more there may be like this, and I doubt we've had all the bills yet for New Labour's "spend now, borrow to pay later" approach. The PCT (or whatever) are now struggling to make these payments. At least Cameron is attempting to sort it out starting with a review, but you have to question the people responsible for creating this situation in the first place.

See the link below :

https://www.portsmouth.co.uk/news/local/east-hampshire/pm_gives_the_green_light_for_qa_deal_review_1_2464562

In fact, many PCTs seem to be resorting to asset stripping to make ends meet :

https://www.portsmouth.co.uk/news/regional/pfi_hospitals_asset_stripping_1_2563486

I'm sure that the George Osborne Andrew Lansbry (GOAL) dream-team have it all under control ....

35. At 18:01pm on 6th Apr 2011, notfooledsteve wrote:
I had a triple heart bypass 20 months ago the handover from GP to NHS hospital and back to GP worked perfectly whilst my treatment was not emergency it happened well within the 18 weeks laid down by the last government, thank god for targets
===============================

Exactly.

I listened to a lecture from one of top doctors in the last government a short while ago. He is a cardiac surgeon.

His pride in how they had slashed the waiting lists for potentially life saving operations was very clear.

He told the story of how (under the last tory government) he would explain to a man that his heart was dying and he needed a bypass. He would watch the guy go quiet. The wife would ask 'how long, doctor?' He spoke of how ashamed he was to tell them eighteen MONTHS - not weeks - and the look on their faces as they realised the guy would be disabled until then and might well die before he got that operation. (Unless they could afford to go private, of course)

Here we are again.

The tories are back less than a year and already we are back to operations being cancelled and patients being told to wait (unless they can afford to go private, of course)

42 sagamix

"Hey that sounds like good news, Mr P. Especially if (as the 'super' tag implies) it's a full service jobbie, not just the glamorous stuff. Has a psychiatric wing, for example."
=====================================

I don't about a psychiatric wing - but defintely be meninwhitecoats though.

There was more nonsense on the radio this evening about the Tories "not doing a good job of communicating their policies".

Far from it. The uproar is because the policies have been communicated only too well.

"Although there are areas for improvement in the proposals, we are all agreed that the White Paper places healthcare planning and commissioning with those best placed to decide....the GP. And, if the team of GPs with whom I am working are typical of those setting up other GPCCs, I would suggest that the NHS is "safe in their hands"."

Congratulations on your recent posting.I would like to know however why you think the average GP whose professional career is structured around the client-doctor relationship would have an insight into the structure and strategic direction of the NHS in their area?

The degree of criticism by professionals on the scope of the changes reinforces the impression that GP fundholding,Consortia, and privatised bureaucracies to commission treatment from hospitals, brings the market into the NHS in an inappropriate way for a public service.For example,GPs can have a commercial interest in commissioners who may encourage hospital consultants to select patients on the basis of cost.

These institutions from GPs to commissioning boards to hospitals are taxpayer funded. We don`t want the NHS governed by profit,the privatised utilities are an example of the exploitation of the public when control passes to private corporations.

Keep off,it`s ours not yours.

sagamix 47 50

Hubris, of the most boring type.

55. At 20:01pm on 6th Apr 2011, Susan-Croft wrote:
Nothing could match the incompetence of the last Labour Government who caused the financial problems for Britain in the first place
===============================

The financial problems were caused by bankers who collapsed the economy.

This happened in countries accross the world, including the USA, which had a republican government at the time. They did not have gordon brown, but they did have bankers, and their economy collapsed just the same.

The tories have now chosen to take on this mess - and made it worse. Meanwhile those bankers - who fund the tory party - are back to their old tricks while the rest of us pay the price for their greed.

You're right that nothing could 'match' the incompetence of the last government - this lot are surpassing it.

Susan_Croft @55
Possibly a little ungracious but I take it that overall we are (as has happened a few times before) in agreement. The issue was never about Labour or Conservative but rather whether this Coalition experiment could work in practice. FWIW I think it could have given the correct leadership. No that's a bit harsh. They are newbies after all and in three years time things may be different. The signs, as you say, are however not hopeful.
Strangely there may have been some justice in Gordon having to sort it all out (Labour 18 years then Conservatives for 18 years perhaps?). Could have made sense in a strange sort of way as he may have been much better placed to be firm with the unions and strict with the public sector. He may have been a right so and so, according to some, but perhaps that's what's needed (and lacking so to speak).

There are two sides to this issue. Should this change occur? And, is there any political mileage in implementing it? Yes & No respectively, I would say.

Expert (stake holders) resisting change is nothing new, it happens in the private sector all the time. Fear of change / removal from comfort zone is natural. It does not however (on its own), invalidate the logic of the proposal. As such, individual actors / ‘collectives’ in the NHS opposing change is both unsurprising and largely meaningless.

However, this is one area that the Tories should have left alone (given the overall unpleasant agenda). And, when Cameron said the NHS would be 'ring fenced', he should have meant it (unambiguously) or not said it at all. Any proposals of change to the NHS, were always going to provoke hysteria, and the 'left' were always going to misrepresent the changes and exploit to the maximum. In my opinion, Cameron should have put a Liberal in here, and given him a brief to do basically nothing.

What is most surprising however, is that he now appears to be 'no mans land'. He must of known that Lansley’s (rationalising) ideas were going to create outcry...so why let him embark on it in the first place...if he wasn't prepared to see it through?

47 Bass_God

"Believe me, Saga, ....

Forgive me if I got the wrong end of the stick but I am a mere mortal and do not always understand the prophecies of a cyber deity such as your good self.

Enlighten me, oh wise one!"
============================

A good post Bass_God if I may say - you have chosen your enlightener well. He certainly has a growing band of followers on here these days.

I like your username as well. Is it fair to assume that you play the Bass guitar ? Do you have one of those amplifiers where the volume dial goes up to 11 ?

Strictly @temporaryconcordat
PFI - don't start me! Hated it when Major's lot touted it. Couldn't believeit when New Labour adopted it. Always thought it might end in tears (You really can't trust some parts of the private sector either!) Many new labourites told me I was old fashioned. 'Just like taking out a mortgage or leasing instead of buying -Everyone's doing it.,' they cajoled. Me? I was already concerned enough about the fact that every bank and building society I had ever been in contact with was offering me more and more credit which apparently I would be a fool not to take advantage of. Buy a bigger house, a more luxurious car, swanky furniture, round the world cruises. It could all be mine. Seems I was one of the exceptions - turned them down (bit of a pessimist by nature). You can't predict Black Swans or spend/waste your life anticipating them either. The Black Swan is by nature unseen but anyway nearly everyone simply didn't want to see it. Why would they?
Anyhoo. They have made a terrible mess of the NHS thing. It's a strategy thing I think. Wrong time, rushed, poor leadership/presentation, a fight they didn't need to pick yet.

susan @ 62

"Hubris, of the most boring type."

Let's not get into Greek Gods as well!

Bulls-eye! (evening John), no, I mean it. Bang on the money. As I said somewhere above it's a strategic mistake to do it now whether you agree with part/all of it or not. Perhaps a little early as yet but anyone for a stalking horse?

John Bull @ 65

They should give you a job, John. Absolutely this is bad politics (a bad 'reform' too, in my view, but let's park that); many of their more astute supporters - yes it is just about possible to be a tory and not a complete nincompoop - are surprised they're messing around like this.

"What Strictly, Fubar and I show are independent brains at work rather than a mindless declaration of loyality, displayed by the likes of Sagamix and associates." - SC @ 55

?

This comment was removed because the moderators found it broke the house rules. Explain.

Victor@69

I am with you on PFI - if you really need something just pay for it - if you don't, leave it - and never under any circumstances have marble floored bistros where health care is rationed!

This comment was removed because the moderators found it broke the house rules. Explain.

jon @ 54

I'm so glad I'm not the only one fretting about that aspect. Put tens of billions of pounds per annum of public money in the hands of self employed doctors? Bizarre idea. And not even proper doctors - GPs. Before you can say 'Michael Jackson', they'll be getting all 'entrepreneurial' and we know what this means, don't we?

Oh well. No point posting anything now in reply to anyone, because if it doesnt fit in with the views of the censorial Nazi who is on moderating duty tonight you'll get deleted.

You can only say what he/she thinks you should say. So much for licence payers having free speech. Even the Guardian doesnt go that far.

Might as well bog off to bed. Night all.

And whoever you are, Modzilla, I hope you're pleased with yourself.

Great start to this Blog, Mr Robinson; it's not often that you make me guffaw!

I get the impression that what David Cameron and Andrew Lansley (and I assume the Chancellor and LibDems) would really like to do is make a lot of civil servants at the Department of Health redundant in order to cut (what I guess is) a substantial NHS overhead. I could be wrong, of course.

Could it be that a direct approach would create such an almighty head-on battle with NHS and Civil Service unions (with the TUC, N.Labour and everyone else who wants to give the Coalition and the Conservatives a 'kicking' wading in from every angle) that by doing it as a much needed reform - possibly with Joe Public fully or largely on-side - the opposition may be deterred or diffused or dismantled from the outset?

The oddest thing about these NHS 'reforms' is that neither the Tories or Lib-Dems mentioned it in their General Elections manifestos.

Since the Wheeler case on the promised EU referendum, when a judge ruled that manifesto 'promises' were mere aspirations, and therefore, in his view, not to be taken particularly seriously; only political wonks would thereafter read manifestos anyway and I understand that there was nothing in them about these NHS reforms.

Given that these NHS reforms seem to have come out of nowhere, apart from brewing in Andrew Lansley's mind for the past seven years, then it does seem that the Coalition have simply put themselves onto a hiding for nothing.

Except for Camerons foolish pre-election promise to match Labour spending on the NHS (including inflation), which we cannot really afford now ... so that is probably the somewhat hidden driver for this.

It does seem like pretty dumb politics to me, I mean, it is not as the Coalition are'nt going to be totally hated in a few months time anyway as the cuts really start to bite.

Or is it to be the Millwall syndrome ... nobody likes us but we don't care.

re #61 on this Blog: am just popping up, Bryhers, to compliment you on your #60 on the previous NR Blog. Unfortunately, the Mods had closed that Blog to entries by the time I could get to read it and others.

Laughter is good medicine and I'm getting some (meant in the best way) from posts here tonight. #29's last para is great although should not the final sentence also conclude with BTT and SNC?

Perhaps some 200 GPs and I have been working on a different agenda from that understood by politicians, the media and others but I have yet to hear any of the GPs with whom I am working talk about the reforms offering them the opportunity to place juicy contracts with the private sector. Quite the opposite. We are keen to work with, and ensure the long-term viability and success, of our local DGH and other local service providers. As one example, GPs are now leading a series of cross functional teams of primary and secondary care professionals established to develop new and improved Care Pathways. We are also examining ways in which services can be provided in new settings (acute in primary and primary in acute). Believe me, this central engagement by GPs in healthcare planning would have been resisted by many in secondary care if GPs were to remain with no or little financial clout. By giving GPs, not managers or secondary care consultants, the responsibility to decide where, when, how and by whom the care is provided will, I am sure, bring about real and beneficial changes to healthcare. So let's move on from the rather emotive argument that the NHS budget will line the pockets of the private sector. Some maybe, but t'was ever so and would remain so irrespective of whether the commissioning of services were in the hands of PCTs, Secondary Care or GPCCs. After all, there really are some good care/service providers in the private sector. But a wholesale shift of purchasing into private hands? That is pure scare-mongering and does little to provide the public with a balanced insight into the pros and cons of GPCCs.

I'm sure he's just trying to do his job as best he can, Fubar. Now, to try and rephrase my 72.
I was wondering why George Osborne appears so low profile on this issue and others that have caused problems. I'm sure he supports the NHS policy but..... Wondering whether he needs some 'distance' should the party as a whole decide they need someone more decisive and forthright at the helm.

As a mental health worker for many years I have never seen a time when it is more difficult to provide care under the weight of a hugely bureaucratic and stifling system. This reform does nothing to address this and is highly misguided in regard to the provision of mental health care. Many clients have very little contact with their GP and GP’s have little or no input into the day to day care of client’s mental health. In my experience, GP’s (with some exceptions) have only a superficial knowledge of mental health which is 'medicentric'. Already they have insufficient face to face surgery time to listen to these issues, now they will have less.

JC@78

I am a great advocate of the NHS but would not rule out a coherent reform of it - I am not convinced the coalition have nailed it in that respect but that does not mean the status quo is unassailable.

Just saw Cameron whittering on about this on the telly. He sounds and looks more and more like a PR man every day, mixed with a little bit of posh Swiss Tony on a 2nd hand car forecourt.

Maybe another trip to the Pole (North or South, who cares) might help. Failing that he could hug a hoodie. Alternatively he could cycle into work with a 7.0 litre engine Lexus, oops I mean Jag, oops I mean whatever British cars are left, bringing his change of clothes and briefcase behind him.

If it all gets too much for him he can simply wait until after Easter and get all red-faced, angry and abusive at PMQs again.

Unmanifestoed, unTVdebated, unwanted, unthoughtthrough NHS changes. Truly rubbish politics from a truly rubbish PM.

IDBI@82

I fancy Davis has his eye on that role - strange man never bought his libertarian stance, must be rubbing his hands with glee over the current debacle.

coats @ 56

"Wow scary - I wondered what Balls was doing."

Wasn't at all thinking of him but yes I like it! - a vision to keep 'Middle England' awake all night. Every night.

'IDB' @ 82

Mmm, Osborne. Keep an eye on that man. Eyes on the prize.

Menin @86
Mr Davis? Yes can follow the thinking but I doubt he would get a second chance. Could make a suitable stalking horse should it come to it. There is undoubtedly a lot of angst on the right re 'wrong image' and LibDem contamination on issues such as the NHS 'pause for thought'. Surely it all turns in the end on seeing economic recovery so why take extra risks such as large scale alteration to the NHS? Having guaranteed an increasing budget and ring fenced it, it doesn't seem sensible or necessary to rush into this.

It is becoming blatantly clear that his smoke screen by Cameron and Clegg is all about 'lots of persuading' ... 'and nothing about listening'! ... 'pausing to listen' ... what a joke ... 'getting someone else to try to sell it' ... more like it!

MPs are themselves heaping yet more pressure on the government now by suggesting GPs should not be allowed to take control of the budget all by themselves - take a look at https://www.telegraph.co.uk/health/healthnews/8427672/NHS-reforms-Health-Bill-in-peril-as-MPs-tell-ministers-to-make-big-changes.html for instance.

The House of Commons' health committee said they should be joined by a range of staff including nurses and hospital doctors to decide how funds are spent.

The move would improve accountability and decision-making, with the MPs stating that the sole focus on family doctors involved in GP consortia was wrong.

Instead, they said the GP consortia should be re-named NHS commissioning authorities and be overseen by a board with representatives from other specialities.

"The expertise of other professionals was essential to ensure the best decisions were taken and to avoid conflicts of interest"

The MP's in the Health Committee are pointing out the obvious ... the need "to avoid conflicts of interest" ... Public health vs GP profits (from rationing healthcare).

People need to remember "ignorance blinds, but apathy kills", and to stop them destroying the nation's healthcare the coalition need to be 'massacred' in the local elections (as IMHO that's the only way they will really listen ... PS I do not work in the NHS and I am not a fan of labour ... I'm just interested in people's health and well-being)!

NB their suggestion will not solve this problem entirely ... as a GP's decision to refer a person for treatment is taken in their head ... so most of the time people won't know whether their GP has rationed their care or not! Hence GP's should not be allowed to profit from decisions they make in any other way! NB if you think all GP's are honorable and trustworthy, just remember how they took the taxpayer to the cleaners the last time they re-negotiated their contracts (whilst dumping out of hours cover) ... which was unfortunately down to the incompetence of the Government at the time too!

Another triumph for democratic coalitition government, with the Tories able to deliver a policy they never told anyone about helped by Lib Dems who never even knew of the secret policy until after they had signed the coalition agreement.

THe Lin Dems have been very naive as they will discover when the local election results come in. The Tories should learn to trust the electorate enough to allow us to vote for the policy.

As our Nick pointed out on the goggle-box this evening, if Cameron, Clegg and Lansley can't sell it to healthcare professionals, then Joe Public (in the English NHS) isn't going to buy it either.

Despite what these politicians say, this must really be about money.

In that, if these 'reforms', whatever the final form, turn out to be 'more efficient' then when the squeeze is applied to the NHS, as it will be at some point, then money will be saved and a reduced budget applied.

Honest politicians would be able to say this upfront but honesty and the political trade seem to be uneasy bed-blocked fellows.

The Coalition ring fenced the NHS - 'apart from apparently inflation costs '- so the inflation costs are equivalent to 20 billion pound cuts between here and 2015 which equals 80,000 NHS job cuts,
? so many bed cuts and service losses!
The new social and heath care bill on average will cost billions too
The BMA are against it, so are many GP's and Health Care Professional's and experts.
The coalition were planning for this bill " white paper' to go through nationally - England, Ireland, Scotland and Wales,at the same time
where is the strategic planning ,
1) talking to experts ?
2) there is nowhere in this new bill ( thank you David) as to what happens if it fails ???
3) why have they not had a trial in one local area to see what the failings are ?
4) at the moment there is a public forum - a community in said locailty can have an open forum about what is the need in a local NHS service - there is a democracy - nowhere in the current bill is there a public forum for discussions and input to decisions made locally

appendix 55 - Susan- Croft - I think you are misinformed
In the post war years -Britain was financially in debt far more than we are now - the way that debt was dealt with was timely and well thought through and it may have been a slower process but it saved the working lives and economy of Britain over a 30 year period
Labour aren't responsible for the debt we are in now , the bankers are.
What the coalition are creating are a huge divide - where bankers aren't taking any responsibility for the decisions they make, where tax evasion is encouraged and yes
lets make the general public - pay for those failures
my advice to you would be - wake up

93#

Everything is so simple on your planet isnt it? Where is it, third stop north on the Piccadilly line after Kings Cross?

Or most of the way to Scotland on the A1?

Susan may be misinformed, but being misinformed is better than brainwashed.

harveygal 93

There was quite a lot wrong in that post about the NHS reforms, so I did not expect when reading it, a balanced approach, from the outset.

Even if you are making the assumption that the banks are to blame for the financial problems that the UK finds itself in, which they are not, Brown and thus Labour would still be to blame. Regulation on the banks was so poor it left the financial sector virtually unregulated. Even the FSA, which Brown set up himself as regulator, and was not effective in regulating the banks, gave 29 warnings on the state of the banks due to low levels of capital. Private debt was rising, anyone with an ounce of knowledge, on economic matters, would have called an end to easy credit, but Brown did not. So either way, whether you blame the banks for the the recession or the running defcitis in Government spending, Brown would still be to blame.

Britain would still have gone into to recession, with or without the banking crisis. The tax from the financial sector, was in fact, one of the only growing sectors, which kept Britain afloat for 13 years of Labour. Growth during the boom years was for the most part merely an illusion of easy money. Brown made Britain totally reliant on this one sector, the financial sector, to power Britains economy, instead of spreading growth throughout Britain. Therefore, should this one productive sector fail, the whole economy would come tumbling down. Added to this Brown had used the taxation during these boom years to increase spending rather than growth. The Government spending was used to increase the most unproductive parts of the economy, the public sector. Because the money was used for expanding the public sector to unsustainable levels and short term consumption, deficits began to form year on year. There was no money used to stimulate the economy, just easy credit to fuel spending.

There is a difference between debt and deficit. Britain has a structural deficit which means that even at full pelt the economy could not produce enough money in taxation or other, to pay for Britains Government spending. Therefore the deficit has to be cut. However Britain has no growth to speak of either, so it leaves Government a tough balancing act. If taxation, as it is at the moment, continues to rise to help cure the deficit, these measures will impede growth. The best way forward therefore, is to make deep cuts to Government spending and lower tax, particularly for high earners to encourage growth and investment. The Coalition at the moment is merely raising tax to cure the deficit and that is a recipe for disaster for the UK economy.

Britains debt is if you like is an accumulation of all the deficits over the years.

The bank bail outs should not have been made in the way they were anyway. There was a much cheaper option for the taxpayer, which Brown did not take because all that toxic debt would have been exposed. This will happen anyway when interest rates have to go up to cure inflation.

So take your choice banking or the economy, either way Brown and Labour would still be to blame for the position Britian finds itself in.

As to the financial crisis itself the war is a red herring, however, the closest to this crisis is probably in the 1970s, which saw some similar problems. Britains debt was much lower, but the UK still needed a bail out from the IMF. On the good side, there was in the 1970s a potential for the economy to grow, that is not true of now because Britain has very little to offer the World. Furthermore, there is a much more competitive Global Market to take into account.

I get it now. Doctors who are trained in medicine and whose main interest is (I hope) medicine become business managers. Politicians who have never done anything other than climb the greasy pole in their own party are qualified to run the country. British amateurism at its best.

You can see how well it works. A Health Secretary, who has been working on this idea for many years, leaves many 'details' unresolved. But Hey-ho we'll sort it out eventually. Sorry if we caused grief. If it was such a good idea why didn't they enter serious discussion with interested parties before the election?

The problem I cannot get away from is that in most parts of the country all the practices will belong to the same consortium. It will be only in large population centres will there be a realistic choice. So what patients will get is a privatised PCT. I thought it was about patient choice - not doctors' choice. This change does not improve patient choice. in 10 years time consortia will have merged to produce organisations larger than many PCTs (more buying power) and at that point they will be as remote as PCTs are accused of being. There will be armies of bureaucrats to ensure that there is good use of the money after the inevitable scandal in just one rogue cosortium and we will be back to where we were.

Perhaps if there was a long term discussion with the proffessionals they would come up with something better. But No! ameteurs know best. Lay people are essential, but they should be allowed to run the show regardless.

30 "He’s coming, Fubar, he’s coming."

I don't know what curtains you're peering through Saga, but it's got to stop.

The Shared agenda 81

I`m sure this is not a conspiracy to line the pockets of GPs,nor do I doubt the integrity of the majority.

The concern is the structure of the service and accountability.To transfer commissioning powers to GPs and their intermediaries, who will negotiate with hospitals, represents a huge transfer of economic power and strategic direction to people for whom the client-doctor relationship has been the central concern.

This inevitably means delegation to commissioning bureucracies,many for profit,who will provide the culture and direction of which individuals GP`s, occupied in their surgeries, have neither the training,time or inclination.

It`s not the goodwill of the carers that`s questionable,it`s structure,accountability,control.At present it`s unclear where power will actually lie.This makes people uncomfortable,especially the professionals who are likely to be just as much victims of the changes as the public.

Yes, I was watching University challenge too and noted the Laffer Curve question. The bonus question was "Some fiscal idiots advocate a 65% top rate of income tax, name a developed country with a 65% top rate of income tax"

Of course, it was a trick question as there aren't any.

Only two things to say to you, Andy (99). Imagination. Innovation. They put the 'Great' in Great Britain and there's no reason - no reason whatsoever - why they shouldn't start to feature in our tax regime. Let's get ahead of the pack on this one.