Todays reporting from the guardian –

Powered by article titled “NHS reforms live blog – they’re listening, what do you want to say?” was written by Randeep Ramesh and Rowenna Davis, for on Tuesday 31st May 2011 09.03 Europe/London

5.46pm: Thanks to everyone who has contributed to the live blog today. We have been gathering your thoughts on the NHS reforms on the final day of the government’s listening exercise. Check out our comments below the line here, our Flickr gallery here and some of the comments we’ve brought above the line here. We’ll be compiling a document of all your comments and passing them straight to the department of health, who have promised to look at them.

Don’t forget to tune in tomorrow where we’ll be having a focus day on how the health reforms will affect children and young people. We have a star cast lined up including the new President of the Royal College of Paediatrics and Child Health Professor Terence Stephenson, chief executive of the National Children’s Bureau Sir Paul Ennals and director of the Council for Disabled Children Christine Lenehan all online to answer your questions from 1pm – 2pm. Don’t miss it!

5.02pm: Interesting tweets on cuts from @BBCLookEast

#NHS hospitals in eastern England face budget cuts of half a billion pounds and the loss of 2,500 jobs. Details @BBCLookEast at 1830.

4.49pm: A deadline approaches and there’s a flurry of news:

• Secretary of State for Health Andrew Lansley and Professor Derek Bell be online tomorrow at the department of health website. If you want to catch the highlights follow @clahrc_nwl on twitter.

• Tired of trying to get through to NHS Direct? Download you NHS Direct app for an iPhone here.

• The Association of Directors of Adult Social Services have put out their response to the pause. It’s a thumbs up for localism (no surprise for local authorities’ directors to back) and a welcome for transfer of public health responsibilities to councils (ditto) but

ADASS notes with concern the reports of the Ombudsman, and the work of CQC on the standard of hospital care for older people. These are signs of a system that is in urgent need of reform to cope with the new demands of an older population, living with long term conditions and a higher incidence of disability, we welcome a new integrated system with reformed care at the centre of a social model that allows everyone to enjoy the success of modern healthcare in longer life, with the joy of quality of life.

4.30pm: There is just half an hour before the government’s “listening exercise” on the NHS in England ends. The department of health says they have received around 15,000 website responses and 720 letters.

The Guardian’s NHS liveblog will be presenting comments posted, flickr’ed and emailed by readers in the past six weeks to the Future Forum panel of health workers and patient groups overseeing the exercise. The forum, chaired by Prof Steve Field, will then present its report by mid June.

We’ll continue liveblogging on the pause before the report.

3.57pm: Dying people need integrated services, not open competition says Help the Hospices, the national charity for hospice care. Strange that the government wants to create the biggest social enterprise market in the world – drenched in competition – while charities yearn for a planned, collaborative world of integrated healthcare.

The press release reads: Jonathan Ellis, Help the Hospices director of policy,

We are not opposed to a mixed economy within the health sector. Local hospices are themselves outside of the NHS, but work in collaboration with other providers like the NHS and local authorities to make sure people receive the highest quality health and social care at the end of life. But we fear the proposed reforms are too focused on competition instead of collaboration and we are worried the model of competition proposed in the bill could threaten future collaboration, which is so essential to the development of complex services like hospice and palliative care.

Read more here.

3.21pm: On the final day of the listening exercise, we’d like to unveil our Flickr account where readers have been using images to communicate their thoughts on the NHS reforms. If you’d like to add your own image, visit this site.

2.29pm: We’ve just come across this fantastic timeline of the health reforms over at Timetoast. We tried embedding it, but sadly our systems refused to let us*.

*Update: We’ve made it happen:

But ultimately, who needs a fancy graphic when you can have a link to this interesting article on whether ordinary people can take part in GP consortia?

*Update a reader rightly notes that health analyst Roy Lilley posted these on his email newsletter, that is vital reading over at

2.16pm: Here’s a quick afternoon news round up:

•The Cockroach Catcher says that NHS reformers always highlight US company Kaiser Permanente as an example to emulate. Why? It’s just “like the old days of Regional Health Authorities!!!”

•And on Liberal Conspiracy Sunny Hundal has another pop at the shadow health minister John Healey for not doing more on the NHS, joining Michael Meacher’s criticisms referenced earlier.

And a few other bits of news outside of the blogosphere:

• While in England the coalition will drop the 18 weeks target, in Scotland they are sticking with it reports STV.

• And on the final day of health minister Andrew Lansley’s NHS “listening exercise” a delegation from the pressure group 38 Degrees delivered a 400,000 strong “Save The NHS” petition to the department of health.

According to a statement from 38 Degrees, the delegation included NHS staff, and the boxes containing the petition were delivered on a stretcher, to illustrate their belief that the Health and Social Care Bill is sending the NHS into critical condition.

1.55pm: An interesting privacy story is doing the rounds:

The Manchester Evening News reports that dozens of patients have been warned that their details might have been passed to personal injury solicitors as part of an alleged security breach at Bury.

According to the newspaper:

Hundreds of cases were reviewed as part of an investigation by the Information Commissioner and health bosses in Bury suspect up to 189 patients may have fallen victim to the alleged breach.

The BBC also takes up the story, saying that the source of the leaks is said to be Dawn Makin, 33, who was found unconscious beside the body of her daughter, Chloe, four.

The BBC adds that the Information Commissioners’ Office is now taking legal action against the alleged recipient, but no action is being taken against Ms Makin – who remains in hospital three months on from the killing – because it was not considered to be in the public interest.

1.31pm: We’ve had a barrage of interesting submissions via email. Here are a couple of thoughts from health professionals, carers and patients with their comments in full below the line:

This came from a carer whose husband has MS:

Keeping my (40 y.o.) husband mobile and independent doesn’t translate on to balance sheets. A consortium wishing to increase their profits would make a quick gain by cutting his medication, not caring that he could start to go downhill quickly. We can’t afford to pay for the drugs ourselves.

Below the line Solonge writes:

The NHS is essential to maintain, but needs major rehaul…not tinkering. As is proven by NICE, many useful drugs cannot be passed for patient use due to the expense. We need to means test the NHS and some people will need to pay to ensure that all, including the poorest receive a service.

Andrew from East London told us his father’s story in an email:

In January 2005 my father, who had chronic Parkinson’s Disease was referred to a new long stay head injuries specialist unit in Hertfordshire-the Jacob Centre in Sawbridgeworth. It is a private facility from which PCTs can purchase care making it also a very instructive example of how Lansley’s new system is designed to operate.

In the six months my father stayed at the Jacob Centre it changed owners THREE TIMES due to the system of competitive tendering. The standard of care at the facility deteriorated each time it changed owners despite two audits. My sister and I eventually had to move my father to a private care home and use our own savings to pay for his care because we were so unhappy at the shocking levels of neglect he was enduring in a so called specialist private facility.

And this email from a reader who says she is a nurse on an acute hospital ward in London:

With two wards in the hospital having closed in the last two years my own ward is always full with outlying patients filling our empty beds (patients who should be cared for in other departments). The hospital is more often than not on black alert – meaning we are at full capacity. As the wards from which the patients are transferred to us are short staffed they often transfer to us the patients with the greatest care needs in order to reduce the pressure on their workload.

Greater ‘efficiency’ as a staff nurse is not possible – an incontinent and immobile patient can only be assisted to wash and change at a certain speed; a deteriorating patient cannot be closely monitored if you are simultaneously caring for a patient in severe pain, a patient recovering from surgery, a patient who is incontinent, etc. Patient care suffers and the public estimation of the NHS will suffer too.

11.54am: The blogosphere buzzes with NHS news…

Michael Meacher MP over at the self declared socialist blog Left Futures says:

The voice missing from (the NHS debate) is Labour’s. Our position is that we want a wholly public service, not a privatised service where the NHS survives only as a kitemark. We want a health service that is not crippled by £20b cuts over a 4-year period which no other health service in the West has had imposed on it in such a timetable. We want a health service that takes only 8% of GDP, absorbing almost the lowest share of national income of any comparable health system in the Western world, to be protected from closures, service cutbacks, job losses and deteriorating patient care. Cameron promised no real terms cuts, and has reneged on it. Labour would deliver it because we are not trying to shrink the state, we are not seeking to pare back all public services, and we would not pursue a massive cuts strategy as the means to reduce the deficit.

To make sure that we all get the message (Meacher takes pop at Labour leadership over NHS) the former Labour minister ends his piece with this thought:

Ed Miliband calls for a ‘national mission’: this would be a perfect place to start

With friends like these….

Paul Corrigan, the architect of Blair’s health reforms, picks up on the PM’s assertion that the coalition’s “NHS will be much like what we have today.”

He says the key to understanding the tension within modern Conservatism is that the party will have to decide whether “it is for radically changing the NHS or conserving it”.

He points to the fight over the soul of the ideas animating Conservatives:

Corner shops, bank branches, high street stores and then post offices and job centres all closed because they weren’t economic any more. In a market they were not sustainable. Many market towns and villages represented by these same Conservatives had their hearts ripped out by the market forces that the Conservatives had unleashed. But these same Conservatives, as the name suggests, really want to conserve sets of social relationships and institutions. They love the continuity that exists in many parts of the country. This is a genuine powerful part of what makes modern Conservatism work. They love the continuity of institutions over time.

So they do believe passionately in the radical transformative outcomes of markets and believe that much more of our society will be a better place if the writ of markets ran much faster through much more of society. And they do passionately believe in the importance of “Conserving” social relationships and institutions which form the bedrock of how one generation passes on history and continuity to the next.

• Isabel Hunter at the MHP blog says the message from surveying international trends in healthcare is that generally “you get what you pay for”.

The UK has average outcomes and broadly average expenditure: the UK is ranked 16th out of 34 OECD countries in terms of total health expenditure per capita, and sits at 17th when it comes to total health expenditure as a proportion of GDP.

However she admits:

there (is no) a clear link between activity and expenditure. For example, when you look at levels of drug usage, there is no clear correlation. Spain is a relatively high user of drugs but has comparatively low levels of expenditure per capita whereas Norway spends high levels per capita but is a relatively low user of drugs

11.26am: A great piece from Pulse shows patients appear to be becoming disillusioned with their local family doctor. An analysis of around 18,000 comments on the Department of Health-run website shows patients have become increasingly critical since the site was launched in October 2009. The story continues:

Just 45% of patients said they would recommend their GP practice, with 32% saying they would not and 23% expressing no view – a significant decline since an early analysis of the first 1,000 comments, which found 60% recommended their practice and only 17% did not. The analysis, entitled ‘What Patients Think’, found a ‘preoccupation with appointments and the customer service aspects of GP practice care’ in the comments left by patients, with 51% mentioning appointments, 37% reception staff and 27% telephone access.

Famnily doctors are much worse at responding to patients’ comments than hospitals – responding to only one in eight comments, compared to hospitals’ one in every three.

The report said the lower number of replies and the ‘defensive tone’ of many showed GPs were still coming to terms with the value of online feedback in helping to improve services.
The analysis names the Cowplain Family Practice in Cowplain, Hampshire, as England’s most recommended practice, while six of the bottom ten practices are in London, including two in Tower Hamlets and two in Haringey.

11.15am: It may be the last day of the government’s listening exercise but there’s still reams of news out there

• Cancer UK has an interesting point to make on the bill, saying that research is being left of the agenda when it comes to the bill in a letter to the Times (paywall)

It is vital that the NHS Commissioning Board and every consortium has a clear duty to promote clinical research and that the Government ensures this is a priority as it will ultimately improve survival for cancer patients.

• Jonathon Tomlinson, a London GP who blogs at a better NHS, posted about a terse response from Tory MP Sir Peter Bottomley to a “detailed and serious letter from a constituent raising concerns about the government’s proposed NHS reforms”. Sir Peter’s wife Virginia was health secretary under John Major – and he was PPS to Norman Fowler when he was health and social security minister in the 1980s. Given his expertise the reponse from Sir Peter was surprising:

Thank you.
Are GPs private contractors?
Should they be nationalised and made salaried state employees?
Sir Peter Bottomley MP

The blog says the the first question is a bit simplistic.

In answer to Sir Peter Bottomley MP’s second question, I would say, ‘possibly’. The advantages of a cottage industry of independent GPs is most eloquently argued in this essay by an American GP (Family Practitioner) David Loxterkamp, The Dream of Home Ownership. He contrasts the traditional model with the corporate model where GP surgeries are owned by large corporations or hospital networks. This is what we should be comparing, because whether I believe that nationalised, salaried general practice is preferable to the traditional model or not, it is not the choice we have, or are likely to have in the near future.

• The Evening Standard reports that “NHS bosses at a London trust are being investigated over claims of bullying, harassment and fraud. The allegations have been made against managers at Camden Primary Care Trust. A whistleblower has claimed that seven staff felt forced to quit their jobs.”

• The NHS could save more than £40m a year by making simple changes to the way patients are prepared for surgery and helped to recover, according to the Department of Health. The Health Service Journal says that changes piloted at the Royal Surrey County Hospital in Guildford led to the average number of bed days for patients being cut from 10 to four for certain types of surgery. This could free up 171,500 bed days. The report (paywall) is here.

10.38am: Paul Waugh, editor of Politics Home, put out this rather interesting tweet this morning:

Unfortunate headline segue for Coalition. Today is final day of NHS listening exercise + also anniversary of launch of Titanic

10.00am: Here’s a round up of health reform news over the bank holiday weekend:

• Hospital beds are being targeted in the NHS efficiency drive according to the Telegraph, which reports that some trusts are losing over 100 beds.

Medical correspondent Stephen Adams reports that trusts hope to make “efficiency savings” of 4.7 to 7.8 per cent to balance their budgets.

His article quotes an interesting internal memo from Imperial College Trust – responsible for five London hospitals – which expects to cut up to 160 beds, which reads:

In order to reduce costs, we will be reducing our bed numbers while doing our best to maintain the patient experience

• At the other end of the hierarchy, “NHS fatcats” are receiving seven figure “gold plated pension plans” according to the Daily Mail.

The newspaper quotes Conservative MP Daniel Poulter – who spoke to the blog on Friday – who said:

It is completely unacceptable that under Labour, senior NHS managers, some of whom were already paid salaries ten times more than hard-working nurses, received annual pay increases of around 7 per cent when front-line NHS staff received only 1.8 per cent

• Meanwhile the FT website leads with a fascinating investigation into UK care homes. Behind a paywall Sarah O’Connor and Cynthia O’Murchu write:

Britain’s care homes face a deepening crisis as some private-sector companies that piled into the sector struggle with their financial miscalculations amid fresh evidence that they provide worse quality care than their non-profit rivals.

They go on:

The quality of care in one in seven privately run homes in England was rated “poor” or “adequate” by the government regulator. The low ratings indicate potentially serious problems such as a failure adequately to feed or clean residents.

By contrast, the low ratings applied to one in 11 homes run by non-profit organisations or local authorities, based on April 2010 ratings from the regulator, the Care Quality Commission, which were scrapped in June 2010.

• On Saturday the Guardian led reports on protests led by anti-austerity group UKuncut who succeeded in occupying a number of banks in the biggest direct action against proposed changes to the NHS to date.

Ben Quinn writes that the action was aimed at drawing attention to the bank’s role in creating the deficit:

After assembling shortly before midday in London, close to 100 protesters staged actions outside three banks in Camden and held a mock trial of the health secretary, Andrew Lansley. Other groups were able to enter a Natwest bank in Brixton and a branch of RBS in Islington and stage protests inside.

• But over at the Telegraph Brendan O’Neill says the most striking feature of the protests is how small they are. He says it’s not hard to see why:

The NHS might be of profound symbolic importance to left-wing activists, but to the general public, to the masses who make up its clientele, it is a patronising, snooping and increasingly politically motivated institution. Save it? Why, exactly?

• Over the weekend the FT echoed its calls to have the bill scrapped, with Philip Stephens writing that the unpopularity of the bill threatens to undermine the whole case for public sector reform:

Mr Cameron likes to think of himself as a decisive leader. Well, it is time to be decisive. And, you never know, by throwing overboard one ill-judged plan, the prime minister might recover some of the political credit he needs to modernise the rest of Britain’s welfare state.

• Speculation about whether the health secretary Andrew Lansley can hold on to his post given the controversy surrounding his bill continued at the Independent.

• And Jackie Ashley pointed out on Comment is Free that the “NHS fiasco” represents a massive opportunity for Labour.

9.03am: As the government’s listening exercise draws to a close, we’re encouraging readers to submit us their thoughts on the health reforms. We’ll compile all your contributions and submit them direct to the department of health. Please start posting your thoughts below the line here now or email or

9.03am: As the government’s listening exercise draws to a close, we’re encouraging readers to submit us their thoughts on the health reforms. We’ll compile all your contributions and submit them direct to the department of health. Please start posting your thoughts below the line here now or email or © Guardian News & Media Limited 2010

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