/ Health

Is the NHS in intensive care?

Intensive care monitor

The government is taking a break from the Health and Social Care Bill in order to hear any ‘legitimate concerns’. So what does the Bill propose, why the ‘listening exercise’ – and what’s your prescription for the NHS?

When I wrote a Conversation back in January about the Health and Social Care Bill, it was clear that its contents would be hugely important to the future of the NHS.

What I didn’t expect was quite how many acres of newsprint would be dedicated to it – or that more than two months later the Health Secretary Andrew Lansley would be announcing a ‘natural break’ in its progress through Parliament.

The patient’s history

Last July, the White Paper Equity and Excellence set out Andrew Lansley’s vision for the NHS of the future, a ‘patient-centred’ service where no decision would be made ‘about me, without me,’ measured against better health outcomes rather than targets.

One of the biggest changes proposed was the way that services are planned and managed. Local Primary Care Trusts are currently responsible for making sure there are enough of the right kinds of health services in local areas.

In the future, groups of GPs (‘consortia’) would be responsible for much of this job – but opinion was mixed about whether they actually wanted to do it. Some people also feared that the NHS could effectively be ‘privatised’.

We patients were promised more choice about our treatment, and a new body called HealthWatch to look after our interests. But back then I wondered whether too much choice could mean no choice at all – and others had much stronger reservations…

The Bill has provoked enormous and heated debate across the political spectrum. The Leader of the Opposition has called it ‘a bad Bill, based on bad assumptions and dangerous ideology’, and the chairman of the British Medical Association has suggested that the ‘ideal scenario would be to withdraw it altogether.’

A break between treatments

In his statement to the Commons yesterday, Andrew Lansley recognised that ‘substantive concerns’ had been raised about the Bill, and the speed of the changes it proposes. He announced that the Government would ‘pause, listen and engage’, before making amendments to improve the plans further.

But as the Bill has already started on its journey through Parliament, could the Government really make major changes to it, even if they wanted to? The wheels already seem to be in motion, with 220 ‘pathfinder consortia’ in place, representing 87% of the country.

You’ve seen some of what the professionals had to say about the Bill, but what do you think? Would you make changes to it, and if so what? As a patient, what do you want from the NHS?


My prescription for the NHS – is simple

Get rid of this appalling “Government”!!!

Snowdin says:
5 April 2011

As a patient I appreciate that wants, expectations and increasing longevity will always outstrip funding, so I want a rationing system that is explicitly stated and fair for all. I want my GP to be my advocate, the role for which he or she was trained and which concurs with the values that encouraged my GP to join that profession. I do not want my GP to be my rationing agent, who may be rewarded for reducing or denying my referral or treatment, or who might gain financially by referring me to a private provider with whom he or she may have a financial or business relationship.
There is virtually no evidence that Fundholding produced any significant benefit, not just because New Labour eventually stopped it, and Fundholders were generally highly motivated and entrepreneurial types, so why should GP Commissioning, the next step, work when it includes far more of those who are kicking and screaming?
Finally I heard today that there are now fewer NHS managers and an extra 2000 doctors. How many of these 2000 were full timers? Could you count them on the fingers of 2 hands? I want the DH to treat me as an adult and tell me the truth.

Sybilmari says:
6 April 2011

I don’t use the NHS as I have found over the years that NHS dentists have ruined my teeth and I have had to pay privately to have them sorted out. I don’t have a GP because I found they made me worse, not better. I use alternative treatments which work well for me – even with serious problems. Financially I just have to juggle to manage it but it is better than losing one’s health completely and it leaves me in control of my own health care. I suspect that very few people genuinely benefit from modern medicine as it is practised in England. I don’t believe that chopping and changing works – that is like refurbishing a very dilapidated house full of dry rot and woodworm. There comes a time when it is better and cheaper to pull the house down and build new.
It would be more cost effective to start the NHS again and make it local. Cottage Hospitals always worked. Choice would be good. The French system works very effectively. Other European health care systems are also much better examples. Why don’t governments see what works elsewhere and what the outcomes of their systems are? Then get advice from those countries?

I have just tried to ring my GP’s surgery to be told I must now dial 0844 to get them – this means according to talk talk it will now cost me (instead of a free phone call to a local/national number) 9.9p just to dial the number and thereafter 1p to 5p (depending on what my surgery is demanding from them for payback on this line). I immediately rang my PCT to ask them what was going on and told that as long as it was a low call the Surgery could do this and they were not responsible if my provider happened to charge more(!!!) I pointed out that, apart from BT, Talk Talk is probably the second largest provider in the country. I am now serving a freedom of notice information on my surgery in order to find out exactly what monies they are getting and will then take it up with my MP. Anybody out there who is in the same boat suggest you do the same!! My calls to the surgery are always on hold and never less than 4/5 minutes in length these days. Dot

I have complained to mine and asked for the land line number – free to most people.
They refused.
Costing £1-50 a week in calls

I should have pointed out that that is 1p to 5p for every minute I then hold/speak to the surgery.

Andy says:
8 April 2011

Having been unfortunate enough to require the services if the NHS over the last 14 mnth and recently in Hospital the last week I can safely say that the service provided is a joke.
There was a time when this country could be proud of the service,, but no longer, although the myth and brainwashing prevails.
I have never seen such inefficiency and incompetence. couldn’t even deliver the correct meals that were ordered.
Went in on Thursday supposed to have scan on Friday never happened, kept in all weekend at god knows what cost , told that they don’t do scans at the weekend, finally got scanned on Monday at 14:30 no one able to give results till Tuesday at 13:00 hrs had to wait 7 hours for a discharge letter.
Overheard Doctor say that I was on antibiotics when I wasn’t challenged this and it was then prescribed.
Never saw the same doctor twice and had to repeat my symptoms and medical history to each one,very frustrating and annoying.
One doctor listened to my right lung saying he could not hear the crackle that had been previously reported, told him I wasn’t surprised as the blood clot was on my left lung.
In listening other patients and family’s this is not an isolated situation but the norm.
Many other examples happened to me during the past 14 mnth.
Hope and pray you never need the services of our wonderful NHS ,its a myth.
I did consider making a formal complaint but life’s too short

I’d much rather have my GP available to treat or refer me than spend half his time worrying about the paperwork involved in running a consortium. Let someone else with some medical knowledge but who hasn’t spent ten years in training do the administration. There were plenty of them around in PCTs. I assume they are being made redundant with big payouts and many will be recruited by GP consortia when they find they can be doctors and administrators. Were the PCTs really that bad that it is worth this cost and disruption to get rid of them?

There used to be the idea that the money followed the patient. I wonder how GP practices within a consortium will argue forr how much money their consortium will get and how they should split it between the GPs. What criteria will used to determine local need and allocate the money?

I’m deeply concerned that the government will be giving a significant tranche of our national funds to be allocated by an uncontrolled (other than by the BMA) unelected group of individuals. This wouldn’t be too bad if there were the possibility of moving to another practice if you didn’t like your local one, but in reality this isn’t an option for most people. For a market to work, you need choice. In the proposed system choice is limited, and the alternative – publicly elected representation – is completely absent unless at minimum local councils get a say.

You mean including the appalling rates of pay that led to the enormous importing of foreign nurses and doctors that their own countries needed.

Under Tories NHS pay and conditions fell – The Labour Government improved pay and conditions to ensure NHS staff had a worthwhile career structure.in this country.

OOps the above reply to Peter Fisk should be a reply to Martin Jones two below – I do wish this forum had an edit facility.

Denis Mooney says:
8 April 2011

Some if not all of these proposed changes are totally ill considered.
GPs are not there to run bureaucracies – they are there to deal with medical need and that is what they should be left to do.
I do not want to be talking to a doctor who is even remotely concerned about resources. I want him or her to be solely concerned about my health.
If PCTs are abolished they will simply end up being replaced by something akin to a PCT but with a different acronym.
If the government is listening why haven’t they listened to the BMA who have already made their position clear on this stupidity.

The answer is simple. Roll back all the changes effected by meddling politicians and unions over the last 20 years.

1. Restore the Hippocratic oath as the principle motivation for nursing.
2. Restore management to those medically trained – nurses. Get rid of jobs for the boys.
3. Restore nurse training to nursing management.
4. Ban unions and restore the professional nursing body – the RCN.

Unions want the best hourly pay and lest work they can get for members. Professional bodies want professional standards

Can you hear the uproar from unions, management and nurses? Now you know you are not going to achieve it. To restore nursing standards you will also need to reverse the deterioration of educational standards of the UK, both in schools and universities, and the Universities claim that every job has to have a degree. Bring back learning on the job.

Politicians, especially socialists, are not going to achieve change. They want medics vote. Socialists want unions subsidies.

Its also the wrong time to seek change. Change is easier to achieve in an expanding economy. People are resistant when their pay and work conditions. The reality for all on the NHS, in the UK and the west is their relative income is set to decrease. State employees will demand the state bails them out, never mind the cost, never mind if they are achieving excellence or not.

What happens in the private sector in times like this? Companies lay people off, improve their standards or go bust. That does not happen in the state sector.

The NHS is not run for the consumer, the patient, it is run for the staff.

The only way to improve standards is give power back to the consumer, in this case the patient. The Coalition Government are trying to restore patient power by giving power to the patient Representatives – GPs. It wont work.

The only way is to give patients the right to choose.

Otherwise put your hands in your head and cry.


PS. I’m not a member of the RCN or any political party. I am a patient

Yet again the current Government are demonstrating that they have no understanding of the needs of the public they are supposed to serve. Perhaps if they spent some time living a normal person’s life they would understand why their ideas are so ridiculous.

Brian Ormondroyd says:
8 April 2011

The attack on the NHS is ideologically based. Putting, through private companies[ many to be possibly US owned] profits before patients interests. The Condems are merely following the New Labour line.
The sacrifices of the many ordinary folk who fought for our NHS must not sacrificed to the market.
My GP said, ‘we must make these changes work’

What nonsense. An ignorance of the reality. Yet he is not alone. How many people have fallen for the Condem line? Cuts, yes, on bankers, millitary spending and more, Taxes on the rich and the tax exiles. ‘until the pips squeak’.
That would be a start – not only to save our NHS but to start getting Britain back to work.

Sue . says:
8 April 2011

The NHS does need fixing as it is still top heavy with managers, bureaucrats and ‘Men and Ladies in suits’ It is not run for the patient but for the staff and their customers are often seen as a necessary evil and the NHS would run much better without them. G.P.s should be concentrating on delivering the best quality primary care and not worrying about budgets and paperwork. I have seen many G.P.s who are only interested in getting a larger slice of the budget for themselves and not putting it into patient care ( that’s not to say all of them, and they shouldn’t all be tared with the same brush).
The customer of the NHS should be more involved in saying what services should be provided in the local areas and monitoring that these services are value for money.Remember that the NHS services are not all about Doctors and Nurses but many other healthcare professional too (like physiotherapists, pharmacists and X-Ray technicians ) shouldn’t they get the right to have their say on what services are provided. Also ask the patients they are after all the ones who pay through their taxes

MB says:
9 April 2011

1. How can GPs possibly commission the 54 medical specialities? The knowledge and dedication of the speciality consultants (and patients and local authority inmterests) must be harnessed in strategic planning. That is obvious unless one is blinkered by a market philosophy that demands buyers and sellers.
2. Commissioning i.e. buying services costs £14 billion and is unnecessary. It should be replaced by collaborative planning as in 1. above
3. The bill will fragment and privatise the NHS. It is a monster that must be slain.

Margaret Pratt says:
10 April 2011

At least this Government are prepared to listen to people’s concerns – hence their
statement to “pause, listen and engage”!

Sorry – The only reason they are “listening” is because they do not have a mandate to change the NHS – They are a minority “government” It was not well thought out – nor explained – It will be a disaster if it happens – privatising the NHS is not the way to go.

If they were a majority government – they would not consider any changes – Just like the previous Tory Government – That sold off the manufacturing Industry – Sold off Council Housing – deregulated rents and Banks Supported the Finance Industry leading to the Credit Crunch and the financial disaster.that we are suffering from and paying for.

Some great comments so far…

What does everyone think of today’s news that 40,000 NHS job could be axed, half of them frontline staff such as doctors and nurses?

Is this a good way of cutting back on funds or a short-sighted budgeting exercise that will leave many patients worse-off? To me, these are the roles that are already stretched beyond capacity – I can’t understand how on earth our health service will cope with tens of thousands fewer key staff.

Our Health Service won’t cope with staff cuts – we’ll go back to the bad old days of long waiting lists and dying before treatment – but The Condems will blame it all on the “inefficiencies” of the NHS not the cuts. It is an idealogical ploy in the worst traditions of the Tories. They did the same with state education.

I have already been made redundant as NHS Buckinghamshire sucked the rear of the local Conservative safe seat and decided to disband the NHS Bucks PCT early.

Stephen Hale says:
14 April 2011

It’s really interesting to read all the comments here. The NHS Future Forum is now providing multiple routes for comments like this to feed straight into the process during the listening exercise (see: http://healthandcare.dh.gov.uk). I’ll make sure DH links to this page from the content about the listening exercise. Stephen Hale (Department of Health)

Dr Philip Symmons says:
14 April 2011

My first complaint is being unable without trawling through the actual bill- I might die first – to know how specifically the bill will work. Lansley apologises for not explaining enough; he hasn’t explained at all. For example on what criteria decided by whom is the amount a consortium gets determined? What happens if a consortium overspends? How is collusion between consortium and hospital prevented? The hospitals will be like rail companies bidding for a franchise with a new round every few years.How can a hospital operate like that? How are contracts to be phrased? Many treatments are not standard and even standard can have expensive complications. How will consortia be administered? Will all doctors in a consortium be on the board? What meanwhile will happen to the patients? Are the minutes to be made public? How will the plan reduce the “post code lottery”? I could go on and on.I can’t envisage simple answers to these questions. I can’t find any answers at all. But I worry most about the doctor/patient relationship. Now the doctor can do his best to get a Trust to pay for an expensive treatment. In future he will have to say “The consortium of which I am a member can’t afford it.” To which the patient might say,” You might be able to if you cut x, y and z. For a start you might take a cut in salary. You earn 4 times what I do.”
PS Not a medical doctor M Sc Ph D *** Inst Stat

J Sims says:
20 April 2011

I am amazed that Andrew Lansley was suprised that his ideas have met with so much resistance.The Health Service is one of the most important services provided by the State.
Any changes are bound to be scrutinised by a worried public who fear that the service could be privatised, or at least cherry picked by the Private sector for the most lucrative work. The idea that this idea will save money is wrong, every GP group will have to employ extra managers to deal with the individual patients needs and look after the budget. The whole idea needs to be much more transparent, it would be nice to see the man on the street represented on the controlling committees rather than local councillors.

Malcolm Webb says:
20 April 2011

Let the NHS be run by the people who know, i.e the doctors and nurses, go back to Matrons. Ok you have to have money people, but not in the numbers we have.
Where is the money coming from, for a start, the so called managers obscene salaries, levy more from the bankers who the tax payer bailed out.
Let us not forget the vast amount of the machines etc donated by grateful people, which , if this stupid tory plan went through, would be used by private firms to swell their coffers.