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Similar to NHS: Not for Sale. 20th October
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NHS: Not for Sale. 20th October
- 1. NHS: Not For Sale Wendy Savage Clive Peedell John Spencer Pete Campbell (Chair)
- 2. Saving our NHS 20 th October 2011 Professor John Spencer GP & Sub-Dean for Primary and Community Care
- 3. Disclaimer
- 6. Fifteen major reorganisations of health and social care in last 30 years " We trained very hard, but it seemed that every time we were beginning to form up into teams we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing--it can be a wonderful method of creating the illusion of progress while creating confusion, inefficiency and demoralisation ." Attributed to Gaius Petronius Arbiter (c AD 60)
- 8. +
- 10. British Medical Association, most Royal Colleges, health unions, academics, policy analysts etc etc The public e.g. 38 Degrees’ petition to House of Lords ½ million signatures
- 11. Radical ‘surgery’ at a time of serious financial squeeze
- 14. Barbara Starfield (1932 – 2011) Johns Hopkins University Health systems with strong primary care have better health outcomes. e.g. Cuba versus United States
- 19. The Health and Social Care Bill: The end of democracy and the NHS? Wendy Savage MBBCh(Cantab) FRCOG MSc (Public Health) Hon DSc Co-chair KONP NrthEast KONP 20.10.11
- 35. As Aneurin Bevan said of the NHS: "It will survive as long as there are folk left with the faith to fight for it".
- 39. The Politics of NHS marketisation and privatisation Dr Clive Peedell Consultant Clinical Oncologist James Cook University Hospital, Middlesbrough DOI: Co-Chair NHS Consultants’ Association Member BMA Council and Political Board
- 49. Theory of market failure in healthcare
- 61. “ Only a dunce could believe that market based reform will improve efficiency or effectiveness” Woolhandler/Himmelstein BMJ 2007 So why have so many countries, including England, gone down this route? It’s the economy, stupid!.......and Politics and Philosophy
- 65. The power of the bond markets
- 78. Health Investor
- 90. NHS: Not For Sale Pete Campbell
Editor's Notes
- The NHS Consultants association is a group of about 750 doctors who believe in the NHS and on the whole do not do private practice. NHS Support Federation was started in 1992 after Working for Patients’- Kenneth Clark’s introduction of the purchaser provider split and the internal market by Professor Harry Keen.. Health Emergency was started 25 years ago by John Lister as London Health Emergency . He did his PhD on global health reform and published a book based on this. He has been a tireless campaigner for improved health services Visit our website. which has a round-up of news stories, policy documents and names of those who have signed the launch statement up joining form . John has just put a video of a lecture on there and there is also a clip from Spin Watch about the lobbying activiites of the health care industry. We started the organisation because we were so worried about the covert privatisation that was going on within the NHS. In 2003 the Commercial Directorate was set up in the Department of Health (DH) heade d by Ken Anderson who had worked in Texas and then for Amey a Biriish company specialising in services for the public sector He left to work for a Swiss bank specialising in Health investments in ?date. He was replaced by Channinng Wheeler from United health in the US who left in 2008. Questions were raised about f stock dealings whilst he was at UH when he was appointed and it was thought he had left to spend more time with his lawyers. According to the D this was to spend more time with his family…… The Commerciai Directorate closed in 2010
- We are not aligned to any political party and with our small budget have been quite successful n getting the message across to the media and to parts of the public. We have active groups in many parts of the country. We believe that it is important that NHS services are provided by NHS staff and that the NHS does not just become a logo.
- Nobody could disagree with Lansley’s aims but it does not need this massive re-organisation-not in the party’s manifestos or the coalition agreement - sweeping away the entire adminiistrative infrastructure. Proms or patient reported outcome measures are still in their infancy and whiclt research goes on it is hard to see how these can be used to make contracts
- SHAs are responsible for planning services for a region and monitoring Primary Care Trusts (PCTs. According to a letter I have just had from Tim Farron ‘This is not particularly controversial given that they waste money doing work which the central Department of Health should be doing. PCTs commission (ie purchase) services and oversee GPs and have 140 statutory functions. The new National Commissioning Board (NCB) appears to be a super quango, members appointed by the Secretary of State not by advertisement and open competition and the six non-executive members then appoint the executive members. No mention of job descriptions or competencies for this powerful body .They will hold consortia to account, commission specialised services and nonmedical services like dentistry and pay for general practitioners (GPs) and be responsible for practice standards. They are supposed to do all this centrally. The Chief Executive has already been appointed before the Bill has been debated in the House of Commons-is this democratic? GPs forced into consortia which can be as small as two practices and the only requirement is that they write a constitution and have an accountable officer. They do not have to meet in public or publish minutes or involve the public or public health or hospital or mental health professionals. They will be rewarded for ‘doing well’ according to the NCB. They are given government (ie tax payers) money to purchase services for patients from hospitals (trusts) and other care organisations Conflicts of interest may arise as 25% of GP practices are engaged in some provision of services Encourage ‘any willing provider’ At Health Select Committee on 22.3.11 Andrew lansley revised the amount of money to be paid to GP consortia from £80 to 60 bn-do they have any idea what they are doing?
- Force all hospitals to become Foundation Trust .c (FTs) and encourage them to become employee led social enterprises. Increase the powers of Monitor (who oversees FTs) who ‘will become an economic regulator, to promote effective and efficient providers of health and care, to promote competition, regulate prices and safeguard the continuity of services’. Any willing provider was the policy of all three parties although latterly the labour party said the NHS should be the preferred provider. The risk of fragmentation of services, destabilisation of hospitals is huge if this is pursue. The risk of legal action and EU competition law raises the spectre of private companies wasting NHS resources in lawsuits Sir David Nicholson the head of the NHS is the CEO of the NCB already appointed worked for McKinsey in early part of career. David Bennett appointed head of Monitor has also worked for McKinsey an American management consultancy firm. They are probaby responsiblefor the £20bn savings figure demanded by Sir David Nicholson in 2010. Reduce NHS management costs by 45% over the next 4 years. Nowhere is the cost of the market mentioned which may well explain the growth in managers over the last decade. The huge redundancy costs as staff are encouraged to leave PCTs and SHAs –oackage offered if they decided to do so before the end of November 2010 when consultation about the white paper had only just finished and Bill had not been published is another example of undemocratic behaviour
- At a time of austerity it seems the height of folly to embark on such a radical restructuring. Coupled with the insistence that the NHS needs to save £20 bn over the next three years a task that has never been done anywhere in the world the risks of complete chaos are very high. Drspite the rhetoric it seems unlikely that paitns will be at the cntre of things and the governance arrangements are opaque if mentioned at all. Although Lansley is handing over power to the NCB he still holds the reins and similarly they can control the consortia tightly-at least economically. All the evidence is that health care is not a suitable area for a market-as I was taught by Julian le grand when doing my MSc in Public health in 1998!
- We were gong to have the new politics but this Bill has been spun very effectively. Clinicians in charge, GPs know what patients want and are trusted but they are likely to be decommissioning services if this Bill goes through. Choice is a useful smokescreen but what people want is a good local hospital not 5 choices of where to go Protect NHS budget and ‘front-line services’ is a good slogan but we can all see how frontline services are being slashed even before the Bill has passed as the ‘efficiency savings’ demanded by Nicholson start to bite. If you listen to the Public Bill Vommittee on 8.3.11 with Sir david Nicholson ofr the NHS, David bennet for Monitor snd Sue Sliman for the Foundation Trust network you will see that they are talking confidently and enthusiasictly about a market. www.parliament.live.tv/Main/Player
- Before the 1984 r-organisation which brought in managers not aministraotrs administrative costs were 5% of a much smaller budget. By 1997 when the internal market had arrive they were estimated to be 12% and in 2003 a comparative study with other countries put them at 14%. Since then we hav sen the growth in managers that the Coalition say justifies their 45% management costs cut but the department is very reluctant to reveal the cost of the market. We believe that it is at least £10 bn a year ie 10% of the bigger budget and may be as high as £18% of the NHS budget. We do need managers to administer the system and calling them faceless bureacratsis unfair to many hardworking people