A quick scan of the best of the commentariat:
• The BBC’s Robert Peston asks “what is the optimum share of NHS provision that the private sector should provide to deliver this benign outcome (right now, the private and voluntary sectors provide about 5% of NHS healthcare)”?
• Daniel Finkelstein in the Times (paywall) tries to pinpoint Andrew Lansley’s fundamental weakness as health secretary
Andrew has always been a different sort of political operator. And a formidable one in his own way. Early in their political career, both David Cameron and George Osborne worked for Andrew Lansley when he was director of the Conservative Research Department and they both say that their old boss, whom they like and respect, taught them a good deal. But he’s never been much of a one for balancing factions and appeasing opponents… The problem is that if Andrew isn’t political in the conventional sense, the NHS is. Deeply so.
• Nick de Bois, the north London MP, guest edits healthpolicyinsight.com and outlines his Tory “red lines” for any deal with the Lib Dems.
Of all of my red lines, I do believe that competition on quality is the most important’
Hardly anyone will argue with that.
This blog likes to keep track of the sparky, innovative, eye-ball-grabbing political tricks that fill the web. So we’d like to congratulate False Economy on this take on this embeddable subversion of Tory election hoardings.
The moving trail highlights cuts, I mean efficiency savings, in the NHS. The latest one is that “more than 700 hospital beds are set to be slashed across Birmingham and Solihull in new cost-cutting plans to save millions by health bosses”.
Paul Corrigan (right) is one of the best political thinkers in health. In his blogpost today he offers the government an insight into how to do politics in the NHS. As he authored the Blairite reforms between 2001 and 2007 and then devised a way to sell them to the general public over the heads of the medical profession, who opposed each change, he is a voice well worth listening to.
His basic message is that you need to outline a problem and then a solution to solve it. Basically the PM has to start telling the public that there are some difficult decisions to make on NHS expenditure. He even offers the PM a draft speech:
“At the last election we pledged that we would increase NHS expenditure every year of this Parliament and despite the very difficult decisions this has meant for the police, schools local government and the armed forces with, we have kept to that pledge. The NHS will get more money year on year throughout this Parliament.
But over this period and into the future, there will be an increase in the demand for health care that is mainly caused by the very good news that people are living longer. More people who live to be over 85 years old have a long term condition and this means that there will be many more of those new older people with one or more long term conditions. Therefore as we have more older people we will have greater demand for health care.
If we spend resources on this new demand for NHS health care in the same way that we spend our existing resources, the NHS will need to increase its income faster than the nation can afford. We therefore have two choices
If we fail to reform the NHS and in the face of this extra demand, fail to obtain much greater value for money from it then parts of the NHS will fall apart. Patients will not be able to get the services they have a right to expect and they will have to wait longer for care than they should.
Or we institute our reforms and develop an NHS that can provide much better value for money”
But Corrigan notes that “the Prime Minister’s problem is that he cannot stop the story here. He needs to go on and detail how each reform will improve value for money for the NHS. And, as we shall see, each relationship between reform and better value outcomes provides him with a political problem”
“Let me now detail how our reforms will create much better value for money in the NHS.
First GP Commissioning Consortia. GPs spend most of the money for the NHS because they are the people who refer patients. Putting GPs in charge of commissioning ensures that the financial decisions that make or break the NHS are made by the people who make many of the medical decisions. GPs will make much better medical and business decisions about the distribution of health care. In particular they will ensure that the numbers of people who go into hospital, and do not need to, are kept out of hospital. This will reduce the expense of emergency admissions, outpatient and inpatient care. Putting GPs in charge of this will create much better value for money.
Second creating more competition. We are sure that working with the third and private sectors we can develop much better value for money in the organisation of integrated care. This will reduce the cost and hospital usage of nearly every person with long term condition.
Third if every NHS acute and mental health trust has to become a Foundation trust it is clear that a number of trusts are not clinically or financially viable to become FTs. They will have to be taken over by financially viable FTs and some of the more inefficient and unsafe services will stop.
In this way our reforms have the nerve to address the value for money issues that must be tackled if we are to maintain the NHS for the extra demand for health care that comes from an ageing population”
Corrigan sums up the dilemma:
He and his current Secretary of State want to conserve every hospital and all major services in every hospital. This is why they are conservatives. Their reform policy will lead to radical changes in some services that are provided by hospitals. So they can’t create a narrative that explains what the outcome of the reforms will be because they are frightened of what it would have to say. So they have to have a story which says we have to improve value for money, but the reforms we are bringing in won’t really do much about that. They have a choice to identify the honest problem they have and then to clearly identify how their reforms deal with it. This leads to a row about how their reforms improve value for money. OR to introduce a set of reforms without telling us what they are for. They will then have a row about why on earth they are introducing these reforms if there isn’t any point to them. We will know which they choose within the month. Given their courageous track record to date – what do you think they will do?
We’ve just spoken to the head honcho of child health in England, professor Terence Stephenson, who is the president of the RCPCH.In the interview below he raises a number of concerns about the health bill, saying:
– Market principles would not serve children well, largely because young people are more likely to be admitted for emergency treatment or complex conditions. Stephenson says that children “don’t need competition or cherry picking”
– Stephenson says there is a “degree of planning paralysis” as child health services wait to see what happens in the pause
– He says when he met the prime minister, David Cameron “connected with and recognised” his concerns
After the interview Professor Stephenson added a few more thoughts:
There are likely to be big challenges for children who suffer from conditions like diabetes (if the health reforms go through) which are common for children’s hospitals but very rare for GP consortia
Children who need multidisciplinary treatments may also suffer:
The private sector might be able to deliver hernia factories – providing simple treatments very efficiently – but they are unlikely to be able to deal with high emergency and multi disciplinary cases
Here is a round up of today’s latest health reform news in print and online:
• The NHS reforms are unlikely to take place before February, reports the FT (behind a paywall).
According to the newspaper:
The NHS Future Forum – the group of 40 experts recruited to help the government “reflect on and improve” its NHS plan – originally due to report at the end of May is not now expected to hand in its report until Monday week at the earliest, according to insiders. It is possible that its report will be presented to Cabinet on June 14.
The government will then have to decide what to do, and formally respond, before the bill – assuming it still goes ahead – is redrafted. There is then the likelihood that all or some of it will have to go back to its Commons committee stage. That would rule out the legislation going to the House of Lords before the autumn. It would probably be February next year at the very earliest before it became law.
That would be a set back.
• Here at the Guardian, our colleague Sarah Boseley writes up the King’s Fund warning that
GP consortiums and hospitals may not be fully accountable for the large sums of NHS money they spend and the care they deliver because of weaknesses in the coalition’s reforms
• A letter in the Guardian also sees charities and medical experts “warn that the government’s changes to the welfare system are having a devastating impact on hundreds of thousands of people with mental health problems and have driven some of the most vulnerable to try to take their own lives”.
• The BBC’s Panorama programme captured scenes of appalling patient abuse in a residential hospital – and went out last night. The hospital’s owners, Castlebeck, have apologised unreservedly and suspended 13 employees today.
The BBC reports:
Police in Bristol have arrested four people after secret filming by BBC Panorama found a pattern of serious abuse at a residential hospital. Winterbourne View treats people with learning disabilities and autism. Andrew McDonnell, a leading expert in working with adults with mental disabilities, labelled some of the examples captured on film “torture”.
• The Telegraph splashes with a front page story
Terminally ill patients are to be asked by their doctors to write down how they want to die, under new guidelines to be unveiled today.
• Over at the Sheffield Telegraph there are reports of management slipping in redundancy notices to NHS staff ahead of a government deadline.
MORE than 200 hospital staff aged over 65 in Sheffield have been told they must step down this autumn – receiving their letters just a week before the national default retirement age was scrapped.
Few people have asked how the health reforms might affect children and young people, so today we’re devoting the live blog to answering just that. Here’s the line up:
9:30am: President of the Royal College of Paediatrics and Child Health Professor Terence Stephenson will be giving an exclusive interview to the blog laying out his thoughts on the health reforms.
1pm – 2pm: Chief executive of the National Children’s Bureau Sir Paul Ennals and director of the Council for Disabled Children Christine Lenehan will join president of the Royal College of Paediatrics and Child Health Professor Terence Stephenson in a live Q&A online.
4pm – 5pm: We’ll be hosting another live webchat with young people and those that work with them directly on the front line in the healths service. We’re still confirming names, so if you want to be on the panel, get in touch!
As ever, if you have any comments or questions for our panellists, please comment below the line now or email rowenna.davis@guardian.co.uk or randeep.ramesh@guardian.co.uk.
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