UK: NHS Reforms

Paul G · **#1181** by **Paul G** » Mar 09, 2012 5:06 pm

Ok so we have a new health bill, I know everyone seems to hate it but we've drawn up a list of risks.

Can we see it please?

No. You should support the bill though!

http://www.guardian.co.uk/society/2012/ ... k-register

Mojzu · **#1182** by **Mojzu** » Mar 09, 2012 5:30 pm

I think it's pretty clear what the risk register will say, if things were hunky-dory with the bill then there'd be no reason to hide it.

Strontium Dog · **#1183** by **Strontium Dog** » Mar 09, 2012 5:34 pm

Paul G wrote:*Replies with obfuscation, ad hominens, dismissal, misconstrual, ignores all previous postings and explanations*

Complete and utter shit.

You say there's nothing of value in the Bill. I highlight three things plucked at random that are clearly of value. You put your fingers in your ears and accuse ME of being dismissive, obstructionist etc etc.

It would be funny if it wasn't so tragically sad.

Strontium Dog · **#1184** by **Strontium Dog** » Mar 09, 2012 5:38 pm

Mojzu wrote:I think it's pretty clear what the risk register will say, if things were hunky-dory with the bill then there'd be no reason to hide it.

"Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers."

Paul G · **#1185** by **Paul G** » Mar 09, 2012 5:42 pm

Strontium Dog wrote:
Paul G wrote:*Replies with obfuscation, ad hominens, dismissal, misconstrual, ignores all previous postings and explanations*

Complete and utter shit.

You say there's nothing of value in the Bill. I highlight three things plucked at random that are clearly of value. You put your fingers in your ears and accuse ME of being dismissive, obstructionist etc etc.

It would be funny if it wasn't so tragically sad.

smudge · **#1186** by **smudge** » Mar 09, 2012 6:20 pm

Paul G wrote:Ok so we have a new health bill, I know everyone seems to hate it but we've drawn up a list of risks.

Can we see it please?

No. You should support the bill though!

http://www.guardian.co.uk/society/2012/ ... k-register

If nothing else perhaps this will motivate some LibDems to speak out against the Bill at conference.
I can't comprehend why they've let it get this far but perhaps the freedom of information thing will motivate them to action over the NHS.

Hell. I dunno. Getting a bit late to stop this.....

:nono:

Strontium Dog · **#1187** by **Strontium Dog** » Mar 09, 2012 6:34 pm

Every time I have doubts about whether the NHS Bill is a good thing or not, I just look at the relentless bile that has been aimed in my party's direction from the left for the past two years. It's impossible that such unreasonable people are on the right side of the argument, literally impossible.

DaveD · **#1188** by **DaveD** » Mar 09, 2012 6:47 pm

So you support the bill out of spite? Because people you don't like oppose it?
Is that what you call grown-up politics?

Scot Dutchy · **#1189** by **Scot Dutchy** » Mar 09, 2012 6:51 pm

Strontium Dog wrote:
Paul G wrote:*Replies with obfuscation, ad hominens, dismissal, misconstrual, ignores all previous postings and explanations*

Complete and utter shit.

You say there's nothing of value in the Bill. I highlight three things plucked at random that are clearly of value. You put your fingers in your ears and accuse ME of being dismissive, obstructionist etc etc.

It would be funny if it wasn't so tragically sad.

And I put up three which just show how a terrible it is and you have not replied to those.

Your three are of little worth to people who will be unable to get free care at point of delivery.
What do think is going to happen hospital waiting lists if you are a public health patient? Answer that one.

Mojzu · **#1190** by **Mojzu** » Mar 09, 2012 7:57 pm

Strontium Dog wrote:"Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers."

Because being more informed about the way in which we are governed and how MPs make decisions is really dis-empowering the electorate?

Strontium Dog · **#1191** by **Strontium Dog** » Mar 09, 2012 8:03 pm

Mojzu wrote:
Strontium Dog wrote:"Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers."

Because being more informed about the way in which we are governed and how MPs make decisions is really dis-empowering the electorate?

I don't actually agree with the words I put in that post which is why it's in quotation marks. I took it from Andy Burnham, who wrote it in 2007 while serving as Labour's junior health minister.

Mojzu · **#1192** by **Mojzu** » Mar 09, 2012 8:08 pm

Strontium Dog wrote:I don't actually agree with the words I put in that post which is why it's in quotation marks. I took it from Andy Burnham, who wrote it in 2007 while serving as Labour's junior health minister.

I think New-Labour is equally guilty of such abuses, but that in no way should relieve the current government of its responsibility to inform the populace about policies which could greatly affect their lives.

Would you support the release of the risk register?

Strontium Dog · **#1193** by **Strontium Dog** » Mar 09, 2012 8:14 pm

"Publish and be damned" is my approach to most things, and I haven't seen any compelling reason to make an exception here.

chairman bill · **#1194** by **chairman bill** » Mar 09, 2012 8:37 pm

I wonder what the response from the Parliamentary LibDems will be if their conference votes against supporting the bill? If the party-at-large votes to bin it, what will Clegg et al do?

smudge · **#1195** by **smudge** » Mar 09, 2012 8:41 pm

chairman bill wrote:I wonder what the response from the Parliamentary LibDems will be if their conference votes against supporting the bill? If the party-at-large votes to bin it, what will Clegg et al do?

Clegg will resign with a bit of luck.

More likely, those already up to their necks in Tory sh*t will attempt to ignore their party.

Clive Durdle · **#1196** by **Clive Durdle** » Mar 09, 2012 8:57 pm

http://www.allysonpollock.co.uk/adminis ... reBill.pdf

Health and Social Care Bill 2011: a legal basis for
charging and providing fewer health services to people
in England
Despite recent amendments to English health bill in response to opposition, Allyson Pollock, David Price, and Peter Roderick argue that it will enable charging for health services that are currently free
Allyson M Pollock professor 1, David Price senior research fellow 1, Peter Roderick public interest lawyer 2
1Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 4NS, UK; 2London, NW1 0XG, UK

Entitlement to free health services in England will be curtailed by the Health and Social Care Bill currently before parliament.1 The bill sets out a new statutory framework that would abolish the duty of primary care trusts (PCTs) to secure health services for everyone living in a defined geographical area. New clinical commissioning groups (CCGs) will arrange provision of fewer government funded health services and determine the scope of these services independently of the secretary of state for health. They may delegate this decision to commercial companies. The bill also provides for health services to be arranged by local authorities, with provision for new charging powers for services currently provided free through the NHS (clauses 1, 12, 13, 17, and 49), and it will give the secretary of state an extraordinary power to exclude people from the health service. Taken together the measures would facilitate the transition from tax financed healthcare to the mixed financing model of the United States.

Please tweet this.

Rick · **#1197** by **Rick** » Mar 10, 2012 2:36 am

With Dutch healthcare similarly subject to reform, including the introduction of greater competition, not ignoring its compulsory public insurance, I’m surprised at your strong objection to the proposed UK changes, Scot.

By Ab Klink
Minister of Health, Welfare and Sport

The Netherlands is undergoing a reform in health care, concerning both the insurance market and the care purchase market. We are using competition and a certain amount of regulation to pursue what many in the US-especially interesting in this year of Presidential elections-hunger to achieve: health insurance for everyone, coupled with incentives and controls to prevent a cost explosion.

All the western countries face comparable challenges: population aging, an increase of chronic patients, increasing costs, the advantages of new medical technologies. A health system must cope with the ambitious goals of a healthy society on the one hand and on the other hand the pressure of rising demand and costs on the system. Curing the health care system is also required from the perspective of a competitive economy.

To become 21st century proof, the Dutch health care system in recent years has undergone enormous changes, adopting a-still quite regulated-private health insurance model. The main objective behind the introduction of our new Health Insurance Act in 2006 was to strengthen solidarity and to simultaneously create a more efficient and cost-effective system. I want to emphasize that the Netherlands never had a state-run system. We didn't, and still don't, deliver "socialized medicine". Unlike many other European nations, the Netherlands has a private health care system with primary care physicians and practices, hospitals, nursing homes, mental health providers, and other health care organizations negotiating contracts and budgets with various health insurers.

To conclude, the Netherlands is moving towards a more competition-based system which aims at safeguarding a solid and cost effective system. So far the first results are promising, and the Dutch population seems highly satisfied, according to international research.

http://www.aarpinternational.org/resour ... _id=705282

Rick · **#1198** by **Rick** » Mar 10, 2012 2:41 am

I think we all agree on the importance of keeping an open mind:

March 9, 2012

Both economic theory and evidence from the UK shows that state-funded healthcare which incorporates market-type incentives will save more lives and reduce more suffering

Commentary by Allyson Pollock et al misrepresents the findings of economic analyses of quasi-markets says Julian Le Grand. Looking at the evidence (and recognizing the defects of state agencies’ administration of healthcare) shows that quasi-markets with fixed prices perform better. Competitive mechanisms in the NHS were also supported by previous Labour reforms.

The theoretical and empirical literature on market failure in health care is indeed large. However, most of it relates to what we might think of as ‘full’ markets with private finance and private provision. There is much less on ‘quasi’-markets: these are competitive markets, but where the state in some form provides the finance and there is competition between a diversity of providers, private, public, non-profit, etc. Such quasi-markets are common in health care, including many social insurance schemes in continental Europe, Medicare in the United States – and, since 1991, the English NHS.

Now there are theoretical problems with quasi-markets – mostly involving patient information. But there are theoretical problems with state systems as well –mostly involving the absence of market incentives. The question then becomes an empirical one: which performs best – or least worst – in practice. And here, contrary to Pollock et al’s assertions, most of the evidence tends to support the quasi-market, especially when prices are fixed. Simon Burgess and Carol Propper from the University of Bristol’s Centre for Markets and Public Organisation surveyed the evidence for the United States and other countries on hospital competition, finding that competition with fixed prices both reduced costs and increased quality. There were other, more specific, findings, including one that the effect of competition was to give more appropriate treatments, with sick patients in less competitive markets receiving less intensive treatment and having worse health outcomes than those in more competitive ones.

Closer to home, these results tie in, not only with the results of Cooper and colleagues, but with those from the comprehensive set of evaluations of the Blair Government’s market-oriented health reforms reported in the Kings Fund publication Understanding New Labour’s Reforms to the English NHS. They concluded (on p. 131) that ‘the market-related changes introduced by New Labour tended to have the effects predicted by proponents and that most of the feared undesirable impacts had not materialised to any extent’.

http://blogs.lse.ac.uk/politicsandpolic ... -le-grand/

Kingsley · **#1199** by **Kingsley** » Mar 10, 2012 2:55 am

I'm very late to the wicket on this issue, largely due to our inadequate media only properly reporting on this late in the day I have had a fairly neutral stance up till now-ish. As I state below I don't have an ideological dog in this fight but after reading the BMJ article (which I would have linked to if Clive Durdle hadn't already done so), I can no longer remain neutral.

I received a circular email from Lib-Dem president, Tim Farron earlier today, regarding how Income-Tax changes will make most people £60/month better off. I replied thus:

Kingsley wrote:Dear Mr Farron,

I would probably just stare at it on my bank statement wondering how I was going to pay for the Health Insurance that will be necessary to cover the treatment I am currently receiving on the NHS. Or more importantly any future treatment family, friends and myself may need.

I hope you have read the BMJ's recent article on the bill: http://www.allysonpollock.co.uk/adminis ... reBill.pdf

For me, this is a Rubicon moment and I know there are many others who feel the same. I may not currently be a member but I have been a candidate for local elections twice (both times coming desperately close to unseating a Tory incumbent) and have continued to work as an activist for the party, even after letting my membership lapse. If you doubt the truth of this you can forward this to the Executive Officers of the Stourbridge and Halesowen Lib Dems, who will be able to confirm. I hereby waive and Data Protection rights and give the aforementioned Executive Officers of the local party in question full authority to give you any information they have on work I have done for the Lib Dems.

If the Conference this weekend does not vote to kill this bill you will have lost a former and potential future candidate, an activist and above all a voter. If this bill is passed with Lib Dem support, it will be a long, long time before I am able to vote for the party that I though stood for "a fair, free and open society" (to quote the party constitution).

I am not opposed to reform of the NHS. I am not opposed to private sector involvement in the NHS. I am opposed to reforms that mean the richest 20% get treated better than the poorest 20%. I am opposed to USA style competition that means doctors and other clinicians are hamstrung whilst insurance companies and pharmaceutical companies will be able to enjoy even larger profit margins. If major reform of the NHS is necessary (and it probably is) why can't we follow the Dutch model that opens up service provision to private providers whilst keeping costs to individuals at about the same level as the TV License and according to the OECD has the best heath outcomes of any Nation?
Is it simply to make Andrew Lansley's wife richer? It certainly appears to be!

No compelling case has yet been presented to the public for these reforms, and I doubt on ever will be. It is only now, at Two Minutes to Midnight, that We, The People, are starting to wake up and be afraid. The lack of public opposition largely comes from the ingrained belief the not matter what happens, the NHS will be there for us, From Cradle to Grave, Free at the Point of Use. Whilst this Bill might not end that intermediately, it certainly provides any future Secretary of State for Heath with the ability to end it on a whim.

Please use your position to help kill this Bill. Please use it to to distinguish the Lib Dems from the Tories. Please do not not allow people to become scared to go to the doctor for financial reasons as well as health ones.

I hope to be able to continue voting for and working for the Lib Dems into the future. However, despite the reforms for the House of Lords I will in good conscience be unable to do so if all 62 Lib Dem MPs are not whipped to kill it when it returns to the Commons.

Thank you for your time reading this.

Kind Regards,

<Redacted>

I'll be sending a slightly re-edited version of this email to my MP tomorrow. However given she is Deputy Chairman of the Conservative Party, I doubt she will give a damn.
Which is a shame. She has done far more for our Constituency in the last 2 years than here predecessor did in 5. And she is one of the Tories prime advocates of gay marriage. I want to like her. But somehow I can't.

ETA: Damn! I can't believe how many typos I didn't spot before send that message to Farron! At least most will be cleaned up before I send the message that James will file in her virtual wate paper bin!

Rick · **#1200** by **Rick** » Mar 10, 2012 4:12 am

Although a tad wordy and rhetorical perhaps, a well written letter, Kingsley, although, I’d probably eliminate the lines: “Is it simply to make Andrew Lansley's wife richer? It certainly appears to be!”

And suggesting you decided against the proposals, with it now a ‘Rubicon moment’ for you, largely or solely because you happened to read Allyson Pollock’s criticisms (simultaneously asserting that “No compelling case has yet been presented to the public for these reforms . . .”?), doesn’t altogether seem a winning argument.

Why not simply: ‘having exhaustively examined the proposed changes’, or similar?

You’re aware that the Dutch system is based on compulsory insurance for all, whereas also being currently opened up to greater competition?

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