Who's saving the NHS from who?

'After all you're not asked for your credit card before going to hospital in France or Holland.'

I don't know about France, but in the Netherlands everyone must have compulsory health insurance (which it's very hard to visit a doctors without), which like all insurances have an excess. So you do actually have to get the credit card out when getting to the hospital.

"the debate has been about how much choice, diversity and competition it is possible and desirable to have within the NHS."

The debate has also been about ho to fund it. I am told by a medical statistician friend in Germany that the German "Krankenkassen", which operate the compulsory insurance scheme, are inefficient and very bureaucratic, pushing up costs and diverting resources from medical care.

So it's like taxation, but less equitable and more expensive.

"......the debate has been about how much choice, diversity and competition it is possible and desirable to have within the NHS."

If only that were true Nick. There has been no proper debate about what the NHS should do and how much we are prepared to pay for it because if it were ever suggested the Labour Party would scream that it is an attempt at privatisation whilst the Tories keep quiet as they are terrified of being accused of breaking the NHS up. Hence the ridiculous ring-fencing of the budget which Cameron often throws at Miilband at PMQs as though it is a badge of honour.

Like all of the big issues none of the political parties is honest enough to engage in debate but prefer the politics of vacuous soundbite.

In the light of what we learn from this article

https://www.spectator.co.uk/coffeehouse/6845488/nick-clegg-was-claiming-that-the-nhs-reforms-were-the-lib-dems-idea-just-three-months-ago.thtml

it is hard to see how Nick Clegg can escape a charge of hypocrisy over his attitude to the NHS.

Lets not beat about the bush - Clegg would not be out of place as a spokesman for the Adam Smith Institute.
"The NHS is a system that fails to allow for the disciplines of choice, diversity and competition which can help to ratchet up standards"

What standards were ratcheted up by the privatisation of the energy and railway industries or even BT. ISTC's were hardly a success and of course the near disaster of the private sector lead Connecting for Health IT programme. Shall I go on?

The key thing about the NHS is that it's a huge public sector organisation. That pretty much automatically means overmanning because of the line of least resistance which the public sector tends to take in hiring and firing. The question is not whether but where the overmanning occurs.

Reports also say that there are areas of the NHS that are undermanned - at least partly because of poor management due to the lack of Darwinian selection of public sector managers.

All of that suggests reform - with which all political parties seem to agree.

The problem is the turkeys with their traditional approach to Christmas.

There should be NO choice in the NHS.

Any person anywhere in the country should be able to go his/her GP and receive the same quality of care. It should not rely upon the GP being able to 'work the system' or to know which strings to pull, and it should certainly not depend upon an individual's postcode.

There are few elements of Government expenditure for which I would welcome a tax increase, but preserving the integrity of the NHS is one.

If forced to a choice, I would rather have an inefficient NHS which provided proper care for all according to need, than an 'efficient' NHS which exacerbated the problems of waiting lists, unavailability of suitably-specialised clinicians local to patients, etc., etc.

'Lest anyone read this blog as me suggesting...

The very idea.

Well, it's all about savings, where best to make them, who most qualified, and who has 'the power' to decide, and bestow, one supposes.

And as this 'Beware of the Leopard' blog often closes rather uniquely fast on occasion, and before more than a few score licence fee payers get to share their thoughts, perhaps the author or other BBC notables might also wish to comment on the reaction so far to this:

https://www.telegraph.co.uk/news/politics/8501690/Nick-Robinson-How-I-gave-power-to-the-people.html

Instead of just complaining all the time why don't we put our efforts into improving each other's lives? The conservatives are still on a quest for a superior moral justification for selfishness. FACT

What is really necessary is some honesty between politicians and the public. The NHS never has, and never will be able to fund all treatments on an instantaneous basis. That dreadful word rationing has to be openly discussed. The public dont want to hear it. Politicians dont want to discuss it, and clinicians make use of it for intermittent episodes of shroud waving. However it is a fact and in the end it will have to be dealt with rather than covered up with meaningless and ineffectual layers of beaurocracy in the form of expensive reorganisations.

The only thing Clegg is trying to save is his party and career. If it were otherwise the Lib-Dems would have killed bad Tory ideas like these health reforms and Michael Gove's Free schools fiasco. The fact is that Conservatives who worship at the altar of Margaret Thatcher and laissez faire economics simply do not want the NHS. It is the crowning achievement of a Labour govt from over 60 years ago and is still an example of socialism existing in a capitalist economy. Continually Tories try to apply market principles but cannot because they do not fit. In any scenario a patient (client/customer) will not enjoy the luxury of "perfect knowledge" so the principles of the free market fall down. Not that this will stop our neo-Thatcherite friends from trying to dismantle the NHS. Still we always got Nick Clegg to protect us so that's ok then. Remind again what Bill Cash said about the Lib-Dems on Friday?

True - and not 'healthy' - that the NHS is regarded by many as an inherently wholesome entity, to criticise which is tantamount to announcing that one still likes Gary Glitter. All it is is our current model for delivering free-at-point-of-delivery health care to the populace; it's not rubbish (silly to say so), it has improved a lot in the last decade or so (silly to say it hasn't), but neither is it the bees knees and neither does it represent superb value for money. It should certainly be 'in play' as regards reform. And should 'choice, diversity and competition' lie at the very heart of any such reforms from whatever political party? Absolutely not. When I get sick (as one day I will) I want good and suitable treatment quickly meted out in a place close to where I live. I do not want a choice of where to go, I do not want to be humming and drumming over a diverse range of possible medicines, and I don't want different providers fighting amongst themselves for the dubious pleasure of sorting me out.

Whilst I am a great supporter of the NHS, I am not opposed to reforming it. It is unwieldy, expensive and bureaucratic - the additional funding seems to have been creamed off by an overpaid elite instead of being used predominantly for the improved care of patients.

The proposed reforms do not address the basic problems - it is hard to see how replicating commissioning at a more local level will do anything other than increase bureaucracy.

Many of us already have health insurance but the private sector is not interested in the infirm or those with chronic conditions and it is important that the core services provide a safety net for those with no alternative.

The proposed reforms like so many other coalition policies seem ill thought out and the product of the musings of a group of über intelligent people without an ounce of common sense between them.

It is poor policy and even poorer politics.

Nick dear chap, i know you went to Oxford so this sloppy grammar will not do - I am sure you meant 'from WHOM' but you make a very valid point and one that John Healey has already briefed on - this bill has had two readings in the commons and was passed with Lib Dem support with a substantial majority at its 2nd reading so who is kidding whom here ? It seems not a little duplicitous from a man who promised a new politics of transaprency ? He's just the same as the others and that is why his party were kicked good and hard in the rump last week.

Dear Nick Robinson, it would be more efficient, if health tourism, free on the NHS was tackled?

Airports all across the UK receive people from many countries that are ill - and are seeking free NHS treatment. Paramedics, doctors and nurses know this to be the case, but do not complain.

How can health tourism on the NHS be tackled?

I was a senior manager for a plc and recently worked in the NHS - it is desperate for modernisation. There are far too many senior managers on high salaries going round in political circles. The reality is that people should be paying for part or some of their treatment and especially for food! Politicians are using it for a political punch ball. There is no such thing as a free lunch and this applies to the NHS. We should have a referendum on this and not daft issues such as AV when you vote for a horse and get a camel.

@Nick Robinson
Please ask someone in government why they want changes that are so clearly not wanted at all that even a Tory source is happy to raise the idea of scrapping the NHS bill.

''After staging 100 meetings in which 10,000 NHS staff have been engaged I am told by a Tory source that it is a statement of the obvious that "no bill is better than a bad bill" but that "everyone expects to improve and not dump" the NHS plan.''

Perhaps if the government listen to the staff then it can make the savings without a NHS bill as it has clearly not been doing that and has wasted a year when it could have made savings with the staff and health trusts.
Voters value the NHS and clearly when they read doctors saying the changes for permanently damage the NHS both parties will know that voters will not ever forget any bad changes to the NHS by the government.

Perhaps his comment has more to do with the fact that Nick Clegg is an atheist. I can't imagine him criticising the NHS as an institution. Not even Thatcher did that.

I support the NHS. Labour tripled spending on it during their 13 years in power.

As a country, we are broke: so spending more is just not an option.

So how do we encourage better performance? And also for the NHS to be more patient focussed, rather than process and bureaucracy focussed?

Change will always antagonise those with special interests which they would like to protect, and who scream loudly therefore at any hint of change: but that doesn't mean change isn't right, or necessary.

Personally, as long as its free or paid for through my taxes, I don't care whether I am treated privately or publicly: I just want that treatment to be quick and good. Currently, the NHS is too often neither.

I think both David Cameron and Nick Clegg fully understood the implications of the NHS reforms. If you introduce competition and free market forces into the NHS the result will always be lower patient consideration and higher profit consideration.
The trouble is that Nick Clegg needs to save face after his humiliating defeat in the polls - his main concern isn't how to save the NHS but how to save the Lib-Dems!!

It comes down to simple cost/benefit analysis. The NHS is good in some areas, failing in others.

It is about time that taxpayers knew the cost per person in terms of the tax they have to pay. Add to that the costed increase in care needed for an ageing population and simply say that there will be no cuts but to pay for it tax has to rise for everyone by cutting the personal allowance, and those who don't pay tax will have to accept a reduction in benefits.

The revolt would be a wake up call for the NHS. It's not a religeon, it's a service.

Lot's of comments being moderated here! I'm afraid the CON part of the CONDEMS has truly found its Lee harvey Oswald, just what part of history repeats itself, did the DEMS not understand! Was the lure of ministerial office that seen them being hook, line & sinker, the latter being the operative word as the DEMS will sink to the bottom mostly akin to the depths of TITANIC..............

Dear Nick, have you ever considered standing for the Tories?

"From a European perspective the NHS doesn't look that special. After all you're not asked for your credit card before going to hospital in France or Holland."
I don't know about Holland, but in France one is obliged to pay 21 Euros when one visits the GP (60% is later refunded, but you have to have it to start with). When one is admitted to hospital or attends an outpatient clinic, one is obliged to pay a non-refundable 17 Euro administration charge. After treatment one receives a bill for 40% of the cost of treatment (unless one has supplementary health insurance). The patient is obliged to pay 40% of the cost of blood, urine etc. analysis (unless there is supplementary health insurance.

(A good post Mr Robinson, thanks.)

The NHS debate does seem to be typical of all current politics - point scoring rather than improvement. If choive, diversity and competition are introduced, and importantly the competition acts at the level of service provision then this is (/will eventually be) a good thing.

"hospital consultants and nurses who fear that GPs will not fund them as generously as politicians" - indeed with nearly 5% of the UK working population employed by the NHS, and the health sector having one of, if not the, highest median pay - it is not surprising that concerns bubble up.

Overall, around 8.4 per cent of the UK's gross domestic product is spent on healthcare, which is 0.5% below the Organisation for Economic Co-operation and Development average and about one percent below the average of the European Union.

https://en.wikipedia.org/wiki/Healthcare_in_the_United_Kingdom

Germany spends 10.8%. I don't know how much of any of these figures is the cost of administration. The UK costs certainly include PFI deals.

If anyone is to take credit for the changes to this bill it should be the public . The health service is a large part of our cost which no party has managed well . It dose need to be brought in to line and there should be reforms but it should be done at a pace that allows things to be trailed and then reviewed. Its not about just private against public the way the Labour party are trying to show it. They threw lots of money at it but did not always get value .

"From a European perspective the NHS doesn't look that special. "

This might be true in the case of France and Holland. But is certainly not the case as far as Germany is concerned, where the involvement of private insurers makes their system much more expensive and less comprehensive than the NHS, and the use of private providers means that the quality is often dubious.

"The NHS is a system that fails to allow for the disciplines of choice, diversity and competition which can help to ratchet up standards"

This misses the point does it not? I'm sure there are standards that could be racheted up and the NHS can become a more efficient service, but this apparent reverence of *choice* is quite bizarre. When you are ill you do not want a choice in your treatment, you simply want the best treatment you can get (something that should be left to medical staff, who are obviously going to know). The current lack of choice I would argue is PART of a good service: it removes the worry that would come with having a choice to make in something you know little about. We don't want to be left in a situation where you have to shop around on ebay for the best deal on a hip replacement... Although, potential new markets for gocompare?

I am in pain right now. I also need to use the toilet for a wee every 30 minutes. I do NOT want choice, I want to have someone make me better. Thats all.

The Lib/Dems signed up to the NHS reforms, just the same as the Conservatives did. The Lib/Dem manifesto apparently talks of reforms to the NHS. This is pure opportunism by them and is not unexpected considering the Election defeat that they have just had.

It would be actually much better if the Lib/Dems stopped moaning in this Coalition and supported their partners, the Conservatives, to achieve the policies which are needed to see Britain back on its feet again. I am not sure the poor showing in the Election is being interpreted correctly by the Lib/Dems. I think the public in England do see the need for cuts and reform to services, and feel it is the Lib/Dems in this Coalition which are holding these policies back. Thus the public did not vote for them. Otherwise, the Conservatives would have been punished as well and Labour would have done much better.

The public now see the Lib/Dems for what they are, being in Government has exposed their weaknesses. They are political opportunists, who have been able to hide their poor policies, because it would be unlikely they would ever see the light of day, as they would never form a Government. This meant from opposition they could be all things to all people, now however, because they cannot deal with the harsh realities of actually being in Government, they continually whinge.

The NHS has to be reformed or it will decline, as in its present form it is unaffordable. These policies by Lansley merely continue what Blair started. It is obvious therefore, that the Lib/Dems put the need for power for their party above enacting the policies to help Britains recovery which they signed up into in the first place.

A friend has recently had a brain tumour removed in a German hospital after having been shamefully treated by the NHS - even sending her home after having shaved her scalp ready for the operation to be called off at the last minute. Yes they had to pay in Germany but the surgery and hospital were superb - frankly better than anything I've ever seen in the UK. And you sign a contract that binds the surgeon, aneathatist and nurse in charge of the theatre to perform the operation on a specific date. So our debate on the NHS would be far better informed by true comparisions with the model in other countries instead of this unhealthy belief that it is only the NHS way that works. If we were starting a universal healthcare system from scratch now - we would not come close to creating the NHS.

The NHS badly needs substantial reform, in my opinion.

I think it will never improve as long as people hold onto their misplaced beliefs that the NHS is the best in the World. It is patently not. Recently the NHS was found to be 14th out of 21 in Europe; hardly a ringing endorsement. The largely privatised Dutch system was placed 1st.

By far and away the best thing is to have doctors, consultants and nurses in charge of the NHS - they know the needs better than anyone else and exactly where stupid bureaucracy can be done away with. It would also behove the NHS to try to distance itself as far from politics and politicians as possible - get Government out of the NHS. HMG should be setting minimum standards and maximum budgets and that is all.

Who's saving the NHS from who? Perhaps that's the wrong question. We should instead ask *Who on earth is going to save taxpayers from the NHS?* The NHS has become a monster, and the vast salaries and pensions enjoyed by GPs, consultants and managers ensure that our NHS is staggeringly expensive and stubbornly unproductive. Small wonder they resist any reform which threatens to allow competition from organisations who can provide a better service for less money.

More vomit-inducing dishonesty from Clegg.

In Jan. he argued in favour of the bill stating that all the main points were in the Lib Dem manifesto. He signed the NHS White Paper. He and all the Lib Dems voted for the first reading of the bill apart from one absention and the Lib Dems helped to vote down all the Labour amendments in committee stage. Yesterday, he makes a "pledge", sure to get all student voters back on side (lol), to block the bill knowing that the changes he mentions have all been discussed.

Has this man got no sense of shame whatsoever? Does he think all voters are half-wits?

@Southern 123:

"Hence the ridiculous ring-fencing of the budget which Cameron often throws at Miilband at PMQs as though it is a badge of honour."

Yes but it was (or should have been) obvious to everyone that this is a political device. To ringfence a budget (for a limited period) does not prevent one from laying the foundations of privatisation by restructuring. You didnt really think the Tories would just leave the NHS alone did you?
IMHO the NHS is too expensive. But that is because it is bloated and tries to do too much. If anything it would be better to not ring fence the budget but keep the overall philosophy and organisational structure. The LAST thing we need is a move toward privatisation in part or in full. I say this for two reasons:

1) In the US where I have lived and used hospitals (including for a serious incident), the care is not better. Worse, there is a conflict of interest because the hospital can bill for treatments, so they do things like 'take a rainbow' which means to take loads of blood and do lots of tests for which they can individually charge. Many of them are not needed and they do it partly to head of the danger of later litigation. Many people in the US despise the cartel of insurance companies because they squeeze employers and consumers alike. As a previous post said, health insurance is like a regressive tax in which you get no say. It is also a tax on employees if (as in the states) it is incumbent on the employer to provide it. Also if you have budget insurance, you get poor care.

2) We have spent the last 20 years trying to get rid of the postcode lottery element of healthcare. Then when we finally achieve it, we start contemplating dismantling it. Its all very well to say that you can 'shop around' for you health care, but that is irrelevant if your leg is hanging off.

I'm all for fiscal restraint and am not automatically anti tory, but this is madness.

Why get Clegg involved at all? No one blieves a single word that comes out of his mouth, and he's still using that annoying 'I'm different, I'm sincere' voice he had a year ago.

The Tories have proved on Friday that they can do whatever they like and get away with it. I think the Lib Dems will be shouting at the sidelines whilst the Tories get on with tearing the NHS apart.

"Both Cameron and Clegg realised too late the political danger of the reforms they'd agreed to."
Poor dears, I'm more afraid of the physical danger I'm in, recently unemployed and with type 1 diabetes.
"assuage the anger of hospital consultants and nurses who fear that GPs will not fund them as generously"
OR, maybe, they know how the changes will affect the people they help.

Maybe its about time you got a job with the Daily Mail

By the way, it should be "from whom" and not "from who". English is still a partly inflected language, and in this case the dative form is the only correct one.

I do expect BBC journalists to make an attempt to use correct English.

Thanks for explaining the origins of this beast, there were suggestions that Lansley was beavering away on his own in some right wing think tank basement. So they were all in that basement occasionaly emerging to harass real NHS people into rubber stamping their plans. Shades of the doomed to fail NHS IT project, where private 'providers' rip off the system and provide next to nothing of value. Whatever happens now is bound to be a 'miserable little compromise'.

David Laws back in the news later iin the week Nick.? Looking forward to David Laws being unveiled as the new Health Minister. More Lib/Dems in the Cabinet and the coalition could yet see out it's full term.

Nick "No wonder then that Clegg signed up to the Orange Book - published in September 2004 - which proposed that the UK should adopt a Euro style health insurance model".
---------------------------------------------------------------------------------
But does that mean that I’ll be getting a refund on my NI contributions to pay for this & will I have to pay extra for my non earning Wife & Children?

Hang on; Bertie wants to combine the NI with Income Tax doesn’t he?
Mmm, I think I see where this one is going & it isn’t going to be cheap.
Trouble is, I’ve got no money to pay for it & - if we carry on the way we are – neither will anybody else.

Perhaps the Gov' should give employers a refund of NI contributions as well; people often forget the amount they pay in as employers contributions.

Dear Nick,
Having heard your contribution to the Today programme this morning and now read your blog, I am sorry to say that I think that you are yet again trying to protect the tories. During last year's election, I was dismayed at your pro-tory analysis, albeit very cleverly disguised as impartial political analysis. I strongly object to a BBC political commentator behaving in this way and I do not think it is appropriate from someone who is clearly a Tory supporter being given the power that you have to influence the electorate.

The issue of what to do with the NHS is a fine example of the innate conservatism of left-wing voters. On more and more fundamental policies, it is Labour supporters and Neo-Labour Lib Dems who crave for things to remain as they are - even as the world changes around them. Am I alone in thinking that these sentimentalists and fearmongerers who would like to see our institutions set in aspic should be re-branded Conservatives? That would free Cameron to relaunch the centre-right as The National Party - which might just capture the mood of the times?

No one has highlighted how the GPs will cope with the extra level of responsibility put upon them with this new system.

Or what qualifications they must acquire to manage budgets and deal with commercial activity, or will these qualifications not be required due to the fast nature of this change, making them an exempt underqualified financial and commercial unit?

12. At 12:39pm 9th May 2011, sagamix wrote:

"When I get sick... I want good and suitable treatment quickly meted out in a place close to where I live. I do not want a choice of where to go, I do not want to be humming and drumming over a diverse range of possible medicines, and I don't want different providers fighting amongst themselves for the dubious pleasure of sorting me out."

----------

^ Spot on.

I'd like to see evidence of where (or even whether) this supposed "desire for choice" exists among the public. I'd wager that when polled, literally nobody would even mention the word "choice" when asked what they require from the NHS.

At best, it stems from leading questions in public polling ("Do you believe that greater choice would be a good thing, if it led to better quality of services?"). At worst it's downright political fabrication with the aim of setting the scene for private sector "choice providers".

Smarten up the NHS, sure. Trim some of the fat. Give it a good scrubbing down. But don't open the door to privatisation: the BMA doesn't want this; NHS staff don't want this; and I don't believe that patients do either.

As with the deficit... taking issue with the method of addressing the problem is not the same as denying that the problem exists. But of course, Cameron and co. like to paint a much simpler, black and white picture, as they do with all other areas of policy. In Dave's world, people are either with them or against them. And if they mess this up, they'll soon find that most people are against them.

Well, the LibDems have left it too late, haven't they? I mean, assuming they're more interested in their saving their seats than in saving the NHS. I told them quite clearly, on these very blogs, that their only way out was to make a stand on the NHS and even bail out of the coalition if necessary. But that would only have worked BEFORE an election. Duh!
Does anybody listen? No!
Would the world be a much better place if they did? I think it would!

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

Or, have I got it all wrong, and they are actually more interested in saving the NHS than in saving themselves?

If so, then way to go, Lib Dems! I'd have voted for you!

The big things are won't want a US style system that only helps the middle class and wealthy. We don't want a regional postcode lottery.

We also don't want to maintain the Labour approach where you simply spend, spend, spend on PFI and don't try to get value and efficiency - knowing the a.n.other party that does try to get improvements will be cursed and suspected of dire intent.

As a Lib Dem voter I do want to see the NHS reformed and facing up to the future that is going to be very, very challenging.

My biggest concern, and I suspect that it is largely Tories being too gung ho and senior Lib Dems too 'helpful', is that they have been trying to go far too fast.

As they say Cumbria is not London. It is also true that our NHS is not the best health service in Europe and further that like trains the objective is to get a good service without losing too much money in the process.

I don't want choice. I want provision.

It's of course popular to beat Nick Clegg right now, and many believe he's simply changing his mind out of some kind of malice.

Rationally though, it seems more likely he's changing his mind because in this two party coalition he's leading the half of the coalition that's been honourable in towing the party line, whilst the Torys in contrast have dodged responsibility where it suits them, and taken credit where it's beneficial, with the net result being that the Lib Dems have been blamed for what are almost entirely Tory decisions, which with the Tories being the leading party in government is fair enough.

Realistically it seems the Lib Dems are now simply fed up of towing the coalition line when the Tories haven't been doing the same, and when the Lib Dems have suffered for it as a result.

Of course it all wouldn't be so bad if it weren't for the fact that half the people slagging the Lib Dems off over the likes of tuition fees didn't actually vote Lib Dem in the first place- perhaps if those people wanted no tuition fees so badly they should've voted Lib Dem so they'd have had a majority.

But it's all academic anyway, the swing from Yes to No over the AV campaign with a bit of Tory propaganda and money pumped in shows how fickle and ignorant the UK electorate is anyway, they don't vote based on rationality and what's best for them (Really, people think it's bad to have an MP that at least somewhat represents half their constituency rather than an MP that only represents sometimes as little as 20% of their constituency and rarely ever more than half??). Our country is screwed politically regardless due to our populations severe political ignorance and complete inability to think logically and rationally on such issues.

Isn't it about time the media put the comments of these bodies into perspective. The BMA, The nurses associations, the GP bodies.. they are all Unions, and have and will oppose every change ever made to the NHS. Let's have some perspective, the BMA even opposed the foundation of the NHS!

This is all daft. These reforms are a good idea. Where else do you give people money and then they make the choice over who, when, and where you will spend it without your consent, approval or even involvement?

Why, because this is the NHS, should it be any different?

Yes, Doctors are afraid. This places work on them to know their customers better. It makes nurses accountable because if they're rubbish then custom - and their money - goes elsewhere. At no point is this talk of privatising the NHS. It simply allows the customer - the mug paying for it - to choose where to be treated and who by. If that means a private hospital, so be it. If that means an NHS hospital has no custom and the private one does, then let the private hospital take over the NHS one. The money comes from the same place, you're not paying for it any differently, it's just the choice is now yours, instead of theirs - which it should always have been.

If Labour were not using this as a political weapon to protect their own interests and were acting for the tax payer instead of out of political greed they would support this. The NHS is an easy stick to hit the electorate with over complex legislation. It is utterly, morally wrong that they use the NHS to punish tax payers like this.

It would appear that we as a nation are unable to have a serious conversation about health provision and it is clearly political suicide for politicians to suggest there might be alternatives to the glorious NHS.

Politicians of all persuasions use the NHS as a political football to score points against their opponents. We are living through one such episode following the recent elections. I believe this interplay has worked to a large degree in for example the obvious public distrust of the Tory party in this matter. My personal view here is that all politicians would wish to see a good and fair health service regardless of their political leanings.

The NHS can deliver excellent care and treatment; it can also deliver very poor care at times. It is infantile to suggest that it cannot be improved and that alternative methods of delivery are impossible to find and cannot even be discussed.

What matters is that we get a good, cost effective service that provide top quality treatment and care whilst maintaining patients dignity. We should have some choice in this and yes, some competition. This should as far as possible be free at the point of need and with a consistent quality across the country. Whilst the NHS is in political hands, we will probably never get this! We need to get a solution that is apolitical, that can be designed and monitored professionally and independently, and perhaps, without the politico’s being involved, we may get something truly world beating.

Thanks to continued, unchecked and unaccountable spending by the last UK government, the NHS has become a behemoth. A slow moving juggernaut that guzzles tax and spits out not much in return - apart from the superflous noise which accompanies such an institution. The much beloved institution has become bloated and inefficient and is in serious need of a strict fitness regime. Just like they encourage people to exercise and keep fit to keep healthy, so must the same apply to the NHS.

By ringfencing spending on the NHS Mr Cameron has placed a millstone around the neck of this coalition which is going to choke the life out of it. Far from increasing spending on the NHS, the government should cut spending by 3% each year and expect the standard of service to increase each year of the cuts, or face deeper cuts the following year.

The notion that an bloated institution must not face reality and radical reshaping and change is a complete misnoma which is going to cost us all dearly.

13. At 12:41pm 9th May 2011, meninwhitecoats wrote:


"Many of us already have health insurance but the private sector is not interested in the infirm or those with chronic conditions and it is important that the core services provide a safety net for those with no alternative."

Coats. you mean that the Insurance Companies take bucket loads of premiums for providing very limited cover and then expect the NHS to pick up the tab for anything non profitable? This being the case perhpas we should tackle this issue first before looking at the NHS reforms. Could save the NHS loads of cash if we get the Insurance Companies to actually pay out on the premiums they receive?

6#

Well said.

7#

Well, you've got your wish already then, havent you? Lets just hope that if you do depend on it for your life or that of your loved ones that the inefficiencies that you're quite happy to pay a tax rise for, dont cost you or them the ultimate price.

37#

Flowery rhetoric.

nick clegg should take a leaf out of his own book, and practise what he teaches when he says " no bill is better than a bad bill " i,e a no vote on av and a no vote on
health service deforms! which they no mandate!

19 Bluntjeremy

Good post.
*************************************************************
As a country we have revered the NHS and held it up as an example but if you study other health models abroad it can fall short. I do not know if competition would increase standards of care but it seems to me it is sketchy across the country with some hospitals wonderful and others downright dangerous. Something does need to change and it is too beaurocratic. One junior doctor friend of mine has said in the hospital she works at there are beaurocrats with clipboards making sure patients are not waiting more than the 4 hour target time even if it means shelving a patient who is more critically ill but has been there a shorter time. This cannot be right. The lib dems know that but think it will improve their political standing if they are to be seen in step with the public worrying over this matter. To be honest, as a british taxpayer who is not working in the NHS I am quite relaxed about change so long as it improves health provision. Much of the posturing comes from vested interests and political opportunists.

Susan 31

Sounds like sour grapes, Susan.

No time for sour grapes. 75% of the Coalition policies are Lib/Dems policies and these have to be pushed through by 2015 if the Tories have any chance of being re-elected.

A member of the coalition I have consistently underestimated is Mr.Osborne.He is not only dexterous in argument but has a consistency and backbone missing in his colleagues.I sense he is the real power behind the throne,not the deputy Prime Minister who hasn`t got a real job and is just window dressing to maintain the government in power.

Mr.Osborne`s attitude to the health reforms will be interesting.If he supports Mr.Lansley,the changes to the NHS will largely survive,if not the Health Secretary will be sacrificed for the greater good.

He is also a successor to Mr.Cameron if he makes many more mistakes.The PM leads his party because he is an effective political performer with few firm opinions of his own.Mr.Osborne has the ideological ballast he lacks, and which commends him to a wide section of the party who dislike waverers, which the PM increasingly resembles.

"Who's saving the NHS from who?"

Who's forgotten their basic grammar? :)

Most would agree that the NHS needs to shed some weight and become more efficient, less bureaucratic and achieve a more consistent level of care across the country. Not sure why this can't be achieved under the present basic set-up. Why can some hospitals/trusts get it right and others not?


#30. Thanks for sharing.

I rather liked the way that (Dr.) Liam Fox (Secretary of State for Sinking Things) appeared to suggest on Friday that this health service 'reform' was a step towards mixed ... wards? ... no, a mixed public and privatised NHS.

Also, can someone explain why someone with a degree in politics from Exeter, who has done nothing in his whole life but politics (and the PR related end of it at that, https://en.wikipedia.org/wiki/Andrew_Lansley%29 gets to spearhead the reform of the NHS?

How utterly tedious for all concerned.

How long do we have to wait before the Royal College of Nurses give an overwhelming vote of 'no-confidence' in Nick Clegg's reforms?

Separately, how many hospital passes is Nick Clegg determined to take? (no pun intended). He's already messed up tuition fees and now he wants to repeat the experience with the NHS.

All it really could end up achieving is the total oblivion of the libdems at the next election.

Now that the dust has settled in the calamity that was the first test of public opinion since the general election we can arm ourselves afresh with a few facts...

There is no 'progressive consensus' in this country despite the protestations of sagamix. The 'progressive consensus' were defeated by 70% of those who voted on AV. Further, the labour party has failed to capitalise on their allegations about unpopular cuts. They lost Scotland, failed to gain Wales and didn't even trouble the scorer against the tories in England. So the son of a Belgian Marxist does not appear to be getting his message across; after his appearances at PMQs is anyone really surprised? The Miliband team pushed their opposition out of the way but now they have the prize they do not appear to know what to say. The parallels with the Brown era are striking.

And now we have a coalition government with one half bleeding, treading on one banana skin after another (David Laws, Chris Huhne, Vince Cable, to name but three) and effectively no credible opposition. How many commentators on these posts were trumpeting that there would be a wipe out of the coalition in the local elections? How many times did we hear Miliband himself say they would get over a thousand gains? And it all came to nothing; the only real winners in the local elections and the AV vote were the tories and the SNP.

But herein lies the rub, at precisely the time the liberal intelligentsia is shivering with excitement about a possible snap election called by the tories the prime minister is handing the biggest political hot potato on the planet to the most rejected party at the elections. And won't they hate him for it? I really do wish him (Clegg) well - the NHS is in desperate need of productivity improvements, new thinking and fresh direction. But nonetheless this is a hospital pass from the tories and I take my hat off to them for having the political nous to do it.

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

It is difficult to take anything seriously that any politicos say about the NHS.

Both Cameron and Clegg are changing their tunes on this, even though the Bill has created and debated in the last few months. How could they have changed their minds so quickly? Do they expect us to accept that there has been some sort of Damascene conversion or that lurking within the wording of the Bill there was an unseen disaster waiting to happen that has been stymied at the last minute?

Few of them, including Labour, have a clue on what to do over the future of the NHS. Those that do are shouted down by the naysayers on all sides. And the rest of us, the poor bl**dy infantry, are left in the middle trying to secure a decent and dignified health system whilst those who have private insurance can afford not to care if they so wish.

Despair indeed.

#44 Jeremy Lee

There has always been an innate conservatism within the Labour movement (the split over the AV vote is evidence of this) and this has had a significant impact on its attitudes to meeting the challenges of modernisation. This may be a reason why Blair was treated with scepticism by his rank and file.

Let's take a step back here. One of the most important points forgotten in the constant bicker of what we can or can't afford in the NHS, is that everybody who works pays National Insurance contributions, which we are told fund's the NHS. This should mean that the NHS is largely funded through a NI based contribution system. As everyone knows when they look at their payslip NI contributions continue to rise, so funding should not be as much of a problem as the Govt. would have us believe. However, if the NHS funds are not ring fenced (which is likely, and the Govt. should come clean if so) then our hard earned taxes are being used for something else. So questions must be asked of our govt. who are always keen to ask for more tax and at the same time tell us to expect less. Another important point about the financing of the NHS is that it was not designed to provide non urgent care, and as time as gone on, more and more non urgent procedures are having a draining effect on the NHS revenues, and a mature discussion needs to take place on what should be afforded and what should be paid for privately. There has always been a case for Private Medical Insurance to cover the treatments not provided for under the NHS. Perhaps the Govt should ask Private Insurers to quote for this scenario which would likely be at minimal cost, whilst at the same time, this Govt could cease to idealogically tinker with the NHS. By all means bring down the admin costs of the NHS, but recognise that we pay quite highly already for the NHS through our National Insurance contributions.

These NHS revisions have been revised & revised until they are practically unrecognizable. What's so drastically wrong with NHS that it requires such a radical overhaul? The BMA were so concerned about the reforms they held their first meeting in 20 years; then, the BMA passed motion (after motion) fighting against almost every aspect of the Health and Social Care Bill including: "We deplore the Government's use of misleading and inaccurate information to denigrate the NHS and to justify the Health and Social Care Bill reforms." Wow! I wonder what, if any evidence, the BMA included with this statement.
The Health Bill creates a division between GPs and the rest of the medical profession by giving most of the NHS budget to GPs and calling one "purchasers" or "commissioners" and others "providers" and "liberating" them to compete in a competitive health-care market with private companies.
Can NHS do this? Are they competent to do this?
Private providers include major national corporations with years of experience of negotiating the marketplace. A. Fawcett, CEO of the LRGEST PRIVATE HOSPITAL GROUP (General Health-care Group - GHG) said that "we" are entering a new, exciting era, driven by the forthcoming health-care reform that will ultimately change, TO OUR BENEIFT, the landscape in which we operate." Is this what we want? The Government countered by hiring consultants McKinsey to find out how much money the NHS could save. This deeply flawed (I think) assessment came up with a figure of £20bn, so now the Government is making the deepest and most sustained cuts to NHS.
NHS hospitals are unprepared; GPs have had no training for this, and the management that we depend on has disappeared almost overnight with the abolition of Primary Care Trusts. (Did this latter have Parliamentary approval?)
Some GPs, feeling their own incompetency, are already paying private health insurance companies like United Health to do their commissioning work. Commissioning organizations save money by rationing services and blocking GP referrals.
The Health Bill needs a rework to prevent a disintegrated, competing health care markets. In fact, scrap it! In a few years' time, assuming the Bill is passed, because of the cuts, several unprofitable departments, will have closed. Services may or may not be somewhere, but the "sick" patient will be forced to travel to inconvenient locations. They can always pay extra to jump queues for treatment, have side-rooms in hospital and/or additional care.
The NHS does need reform. It desperately needs to improve co-ordination of services and c

One of the arguments put forward by those who promote GP commissioning is that it places the patient at the centre. None of the doctors in the GP practice where I am a patient will reply to my request for information about how they see their new power and status conferring benefits on their patients.

No41 Mr N,,
It is reported that David Laws obtained £40,000 of taxpayers money during the expenses dabacle for what was regarded as 'dubious purposes'. Has he paid the money back? and could you remind me of the circumstances leading to his resignation from the cabinet?

12 Saga
46 Skol303

Absolutely spot on.

I don't want a bloke in a Jag deciding what medication i or my family receive, but that's the way we're heading.

I've witnessed the birth of my three children in NHS hospitals and last year had to spend several weeks in A&E - my limited first-hand experiences of the hospitals arm of the NHS is that although it's not perfect it works, why the sudden need to revolutionise it all?

As a retired GP,I am heartened that this issue is finally being aired with the general public.To get the most out of the latest "listening exercise",the politicians must be quizzed as to how,in great detail,their proposals will work to improve the NHS,how the various components will gel together ,how the GPs will have the time and skills to manage their proposals,considering the enormous pressures on them already,and the low morale in the workforce as committments rise and pay stagnates.
The politicians need to be made to explain what had gone wrong with previous arrangements,and why they cannot be fixed without major upheaval.From speaking to colleagues ,still working,I understand PCTs are in a state of flux as staff fear for their jobs.Again,politicians should be made to account for the distress they have caused so far,with little gain,to justify their dramatic proposals.
I agree that GPs should be involved with developing services in their locality,but in conjunction with hospital consultants and public health bodies where the medicine needs cooperation.
I implore all journalists,including yourself Mr Robinson,to critically interview the politicians in the coming weeks,and not let yourself be sidelined with soundbites .Make them account for the real meaning of every word they utter,to see if their idea still holds muster at the end of the day

Jeremy@44

The purpose of any reform is that it should be more efficient, cost less and hopefully improve services. If the proposed reforms are likely to achieve none of the above it is time to look at Plan B.

If you read through the posts many on either side of the divide acknowledge the NHS is not exempt from reform, they are just not convinced of the merits of these reforms.

As for the National Party - that is a sure fire way to lose the next election sounds far too exclusive in all senses of the word.

I just hope the ruling party do not pander to the upset poor little liberals and let them waste more of our scarce money than they already are. I still don't understand how Huhne and Cable are still involved in cabinet - I wouldn't let them loose with scissors let alone a government department.

Time for an election and we could get a single-minded government to clear up Labours mess properly without distractions (which after all, is what the Liberal party is, and now a more irrelevant one than ever).

39. At 13:44pm 9th May 2011, Sasha Clarkson wrote:

I do expect BBC journalists to make an attempt to use correct English.

I don't. I remember the Today presenters laughing about people who want apostrophes to appear in the right place. And people who prefer 'stadia' to 'stadiums' and 'referenda' to 'referendums' were considered to be even funnier although, admittedly, that's Latin.

Andrew lansley must be wondering what he has been doing for the past 7 years, first as shadow health secretary and now as Health Secretary, what a monumental waste of time! https://bit.ly/kcP1o6

I'm not all that surprised to hear that - once again - Clegg is being utterly dishonest.

Does this guy EVER tell the truth?

Never mind though, at least he now feels a need to lie, whereas previously he was smug enough to do a TINA. The tories still need the liberals and the fear of disapearing as a parliamentary party at the next general election is bringing the liberals to heel.

The strategy of targetting the liberals to trip up the tories is working well.

Not just two faced but multi faceted reflecting whatever political audience he is addressing at the time.Nick Clegg?,actually David Cameron.Mr.Clegg has always been consistent in his inconsistency because the broad Lib-Dem constituency has no settled opinion on anything.

It is hilarious watching the Li/Dem leadership appearing to be aggrieved after being stabbed in the back by the Bullingdon Kids. Perhaps they are beginning to understand how their members and voters feel following the betrayal.
'Red Vince' has reminded everyone that the Tories are 'ruthless and calculating' and yet they remain in the government,they must be enjoying their ministerial cars and salaries, how spineless.
The Tories chopped their legs off in regard to the little matter of constitutional reform, they will chop their heads off at the next election if there is a chance of winning an extra seat in The House of Commons.

Susan-Croft @ #31 - that is an entertaining interpretation of the local elections. The people want the cuts but the lib dems are holding the Tories back so won't vote for them.

"The current NHS proposals were drawn up not just by the Tory Andrew Lansley but by his Lib Dem Deputy Paul Burstow. They were reviewed and approved not just by the Conservative Oliver Letwin but by Clegg's soulmate Danny Alexander. The foreword to them was signed not just by David Cameron but by Nick Clegg too".
Yes - of course that's how government works and it was possible because the coalition agreement was too hasty and lacked detail on this.The difference for Nick Clegg is that since then his party has had a conference at which members voted on the NHS proposals and demanded changes. That democratic process is unique amongst the main parties. Both Nick Clegg and Paul Burstow have been given a mandate by members, including many very well-informed experts on the NHS, to go back and make changes to the legislation. Nick Clegg is doing what his party has asked of him.

Not just two faced but multifaceted for whetever political audience he is addressing at the time.

Nick Clegg?,David Cameron actually.Mr.Clegg has always been consistent in his inconsistency because his broad Lib_Dem constituency has no settled opinion on anything.

From a tory PM something firmer is expected,but he was even quicker than his hapless deputy in imposing a pause when he saw the way the wind was blowing despite signing up like Nick to the changes lock stock and barrel.What has blown Nick off course are the election results, producing a sudden need for political redemption.

It may be they will try to get away with cosmetic changes,but they know in their hearts it`s the structure that`s at fault in its covert and dishonest attempt to expose both GP commissioning and hospitals to the private sector.

The lesson to be drawn is they deserve each other,they think the world begins and ends with political expediency.The policy was sprung on them by Mr.Lansley,putative sacrificial lamb,and they liked the sound of the language,patient choice,diversity,competition.Adam Smith buzz words.There`s also Libya,the forests,each with a ministerial victim earmarked for the next reshuffle.

"54. At 14:19pm 9th May 2011, bubbles151 wrote:
This is all daft. These reforms are a good idea...........It simply allows the customer - the mug paying for it - to choose where to be treated and who by"

Yes of course. And if I have the misfortune to become seriously ill, shopping around with my GP will be at the forefront of my mind.

Royston P at #55 echoes my earlier point. None of the political parties dare have a sensible apolitical conversation about what we need as a country and what we are prepared to pay for it. But that is also true of all the big issues we face.

Well Nick Clegg has given another pledge! We all know what that means - reneging at the first sign of a threat to keeping him and his discredited party in power. The NHS is not safe in the Tories hands and certainly Nick Clegg will do nothing to save it. When will he reailse that he displays all the old politics of sacrificing principle to gain power and not one iota of the new politics he is so fond of talking about. He cannot be trusted and is rapidly becoming an irrelevance.

I just wish someone would get on with it - the problem is the typical tragedy of the commons. We all know it needs to be reformed and could work much better but while it's being reformed we personally might be worse off so let's leave it as it is.
I think it was a great idea but ran away with it's own bureaucracy, about time it was cut down to size so that it's paid for by government but run by both NHS and private practitioners.

53. At 14:18pm 9th May 2011, AndyTheScientist wrote:

"Isn't it about time the media put the comments of these bodies into perspective. The BMA, The nurses associations, the GP bodies.. they are all Unions, and have and will oppose every change ever made to the NHS."

^ Fair point. But then a 98% vote of no confidence from the Royal College of Nursing should surely carry some weight in this debate. Depends on where you place your trust, I guess.

54. At 14:19pm 9th May 2011, bubbles151 wrote:

"It simply allows the customer - the mug paying for it - to choose where to be treated and who by."

^ Assuming the "mug" in question has the money and mobility to enjoy this choice. Otherwise, they're left with second best in a two-tier system.

Those who want choice in their health care can already find it via BUPA and the likes. But people don't sign-up to BUPA because of choice; they do so because they believe the quality of service is better.

Honestly, the only reason why the notion of "choice" is being banded around is because that's what private sector involvement would bring to the NHS. Where we read "choice" we should be reading "competition", that's the truth of the matter.

So, who's for more competition in the NHS? (doesn't quite have the same ring to it, does it??).

Nick Robinson is spot on. Underlying any view of policy, especially in health, there are a hatfull of narratives about value, and in the UK these go back to people like Tawney and Temple. These writers, along with David Jenkins, are at ease with talking about the NHS, for instance, as a 'sacrament of care' for the nation. When I mentioned this to Andrew Lansley his response was, 'we would not use such language'. My challenge to him and Clegg alike is then what language would you use to explain your underlying philosophy of care, and have you listened to the different narratives of care that inform any health service.

Rockrobin - I've said to you before that your views would hold more sway without the inane crowing at the end of every post. Who takes anybody with a catchphrase seriously?

I wonder, now that Cameron has the political initiative, whether he will introduce some Tory policies that he ditched "for the good of the coalition"?

Or will he, as we know he will, continue to be soft on crime, soft on immigration, pro Europe, hopelessly misguided on education etcetc. Blue labour in other words.

It's not great to be a Tory Robin. We are completely, utterly disenfranchised. If you cared about what is happening to the country rather than chanting like a football supporter that your team is in power you would instead be holding your head in despair.

I think that someone needs to sit down with Nick Clegg and show him a picture of a horse and a picture of stable door, holding his hand until he gets the two in a common sense order.

Oh- as for who and whom, didn't you know that official BBC policy is to be more colloquial- the plural of roof is very much rooves (embarassing) if you are a BBC employee, and this morning, in the interview with the head of the RC of GPs, irreparable was pronounced irr-ee-pair-able by the BBC employee. As we pay for this institution (and the pensions of those who retire from it), I would rather that correct grammar and OED pronunciations were retained. Innit.

75. At 15:09pm 9th May 2011, FrankVine wrote:

I don't want a bloke in a Jag deciding what medication i or my family receive, but that's the way we're heading.

-------------------

In what way is that different from now? Your GP is invariable working for a private health practice, they probably drive Jags as some of the highest paid workers in the NHS.

If you end up in hospital, the consultant almost certainly drives a jag, as does the commissioning manager of the trust.

Even those NICE chaps, who ultimately decide what we can and can't be prescribed all are very highly paid.

"Who is saving the NHS from who?"

Well, from bitter personal experience, the NHS has not saved a close relative who had been suffering recently from mental health issues following business difficulties and is now dead.

We cannot prejudge an inquest, but almost certainly in this case, the NHS will be paying out compensation for gross maladministration to a family that has now lost its bread-winner.

The politicians have created this unwieldy monster called the NHS and I cannot help reflect that a more efficient model would almost certainly have saved my relative.

Tell everyone what needs to be done and let them fight it out what can be done. That's what Andrew Lansley has done after years of research into the problems of the NHS.

One government after another has realised that the NHS is out of control and unaffordable in its present form and has to be restructured.

For years apart from a bit of tinkering here and there the problems have been pushed into the long grass for the next government to sort out. This time the money has run out so it needs to be sorted if we are to retain a health service still fit for purpose for all of us.

None of us can understand the arguments against reform for they are all political whereas all the people want is a reliable and caring health service to look after them when they are at their most vulnerable.

You do have to pay to see a doctor in France. If you're working, you almost certainly have top-up insurance through your employer (one of the numerous deductions on your payslip). But in many cases you still have to write a cheque and then claim it back, thus making a compulsory interest-free loan to the system, and specialists in particular are expensive. My son was recently sent to see a cardiologist. We didn't have to wait particularly long for the appointment (about 6 weeks from memory) but we did have to pay over 100 Euros up front. Which not everyone has just lying about for surprise medical expenses.

For hospital, you fill in a bunch of forms (or the person who is with you does it if you are bleeding all over the floor as in my last visit to casualty) and the bill is sent direct to your insurance company but there is still a bill, and depending on who you see, you may get hit for an excess without warning. The system is expensive and beaurocratic and increasingly unpopular.

The biggest con in all of this is we're always constantly tricked into believing any change in the NHS is a revolution. The same people currently working for PCTs will be the exact same people managing the GP commission budgets. It's all a game, at the publics expense.

There seems to be an inherent inertia to the NHS, simple tasks get complicated.

GP practices are organised in a manner that means something that could be dealt with in one visit ends up with multiple visits, one to see the GP, then another to see the Nurse to do the tasks the GP is now too grand to do, then off to the phlebotomist, then anything remotely difficult is referred to another specialist (assuming your blood test results have not gone astray) and hey presto six months down the line (if you are lucky) and you are no further forward on a matter a competent GP should have dealt with in a single visit.

It's a self perpetuating process - add GP commissioning into the mix and goodness knows where it will all end up.