Tag Archives: Health and Social Care

Low Down behind the Health and Social Care Bill

Comment from the invaluable

LONDON, ENGLAND - MARCH 07: Protesters campai...

campaign against the government's Health and Social Care Bill (Getty Images via @daylife)

NHS Managers.net

Whoever said politicians never listen to you once you have cast your vote was 100% right.

After all the eminent medical associations and just about any patient who understood what was going on, had condemned the Health and Social Care Bill – Parliament gives it a rubber stamp.

So what does this mean for you?

Well, if you are the sort of patient the NHS loves: never protests, keeps your mouth shut ‘in case they victimise me’, and goes by the mantra NEVER criticise the NHS, it won’t make much of a difference. You’ll just have to keep your mouth shut a bit longer. But if you are already worried at the changes you see happening whenever you need the NHS, raise a cup o’ builders and eat a Hob-Nob in praise of Roy Lilley, who has tirelessly read through the whole 473 pages on our behalf.

Roy’s analysis (in his words – my comments in red)

“Well, I’ve done it. I got the wet towel, the bucket of builder’s and did it. I have read every one of the 473 pages of the Health and Social Care Act. I am a fully qualified anorak.

Here’s the story; each year the Secretary of State must provide the new NHS Commissioning Board with a ‘Mandate’ of the objectives that they considers the Board ‘should seek to achieve’. Note ‘should‘ not ‘must or I’ll kick yer backside all the way to Leeds and back’.

By the way, he is not permitted to tell them how. Instead, there is a labyrinthine procedural palaver about publishing business plans, writing annual reports, letters of assessment and documents laid before Parliament. Effectively, we now have two Departments of Health. One DH with a Board of executives and non-executives would have done nicely, wouldn’t it? It’s barmy but it was in the Bill.

The Commissioning Board is really a carbuncle on the backside of the DH . Annualised plans like the Mandate are too short a time scale, don’t align with three year funding cycles and anyway; it takes a year to find out that something’s gone wrong, a year to fix it and another year to be sure it’s working. The Carbuncle adds nothing to modern, streamline, single layer, nimble, responsive management. It’s barmy but it was in the Bill.

What about your local GP?

Clinical commissioning groups can be comprised of two or more providers of a PMS contract: in effect GP practices.

We all know two coming together would be too small to be authorised, too small to carry risk, too small to manage themselves and too small to support a governing body, provide a needs assessment, liaise with their local authority health-watchers, have an audit committee, a remuneration committee, declare a register of interests, promote the NHS constitution, improve the quality of services and do the day job. So why not define a population this is big enough to enable CCGs to do all that by themselves? I know, it’s barmy but it was in the Bill.

To be a CCG (Clinical Commissioning Group) you have to be authorised. To be authorised you have to have a constitution. A constitution is a complex legal document that can bind practices to a form of behaviour and dismiss them if they err. Effectively put them out of business. The Carbuncle authorises CCGs, provided they have a constitution. So, to save messing about with 250 different constitutions they have produced a template. Just fill in the blanks for your CCG. This document describes what you would recognise as a PCT. It’s barmy, but it was in the Bill.

Incidentally have just spoken to my local GP’s Practice Manager, who phoned to apologise on behalf of my so-called GP to say she is so busy with new Health Bill’s Commissioning that she hasn’t been able to deal with my medical problems. Reassured Manager that I had ‘sacked’ this doctor over three months ago, when I found after six months she hadn’t sent off an important referral letter. And was now dealing with another doctor – but no-one has recorded this – hence the apologetic phone call.

Didn’t someone say “No decision about me without me?”

Sadly for LaLa Lansley his statement was well-documented; he has been trying to forget this ever since.

What about choice, no decision about blah, blah? The Carbuncle must make arrangements ‘to secure that individuals to whom the services are being or may be provided are involved whether by being consulted or provided with information or in other ways’. That’ll be a leaflet then?

Even if I am consulted I may not get what I want as; ‘Each clinical commissioning group may arrange for the provision of such services or facilities as it considers appropriate’. Please note; ‘It considers’, not what I chose. It’s barmy, yes, but it was in the Bill. And as patients are already finding out, if a service is cheaper – not better, but cheaper – the patient for whom the GP commissed the service has to go there and use that service. Forget that Sally has looked after you for several years, very competently. She is now going to be replaced by a less-qualified ‘operative’ because that person is a lower grade, with less training so unable to spot changes (why you are having the annual check-ups), but cheaper.

What is Monitor?

This is one of the numerous bodies that are replacing some of the layers of NHS Admin with even more layers/bodies, etc.

Main duties; protect and promote the interests of people who use health care services which are economic, efficient, effective, maintain or improve quality, prevent anti-competitive behaviour, enable integration, provide fair access, reduce inequalities, ensure the best use of resources, promote cooperation, research, achieve high standards in the education and training of health care. Plus, publish guidance under the Competition Act 1998, consult on the national tariff and write an annual report.

Oh, and ‘where Monitor considers that any of its general duties conflict with each other, it must secure (it) is resolved in the manner it (Monitor) considers best’.

Monitor considers best……… ‘Avin’ a larf? No it was in the Bill.

It was all in the Bill and now it’s in the Act. I do not know how sensible, educated people with an ounce of common-sense could have voted for it. There is so much more but I only have room for 700 words and frankly, I’m lost for words”.

So what now?

For years consultants have been saying that the patient that makes a fuss gets better quicker.

Stand back – there is a lot to be fussed about.

And thank Roy Lilley for condensing 400-odd (very odd) pages down into a few paras. As for the rest, is anyone prepared to bet how long it will be before the next Secretary of State for Health is producing a ‘new’ plan for the NHS?

For more of Roy’s invaluable background to the NHS: www.nhsManagers.net

What future is there for NHS?

Leave a reply

Food for thought

~ for the Future

The current malaise in the NHS is dragging patients down.

They say they are fed up with nurses and doctors looking grey, over-worked and dispirited.

And even more fed up with longer waiting times,
being told the post-code lottery means they don’t get a drug,
or shuffled laboriously through the system to get what should be simple tests.

It is OUR NHS – isn’t it about time we said “enough is enough”?

Brave Soul

Dr Kailash Chand, a GP in the north of England, has started a government email petition. If he gets 100,000 signatures, this automatically forces a debate in Parliament on the Health and Social Care Bill.

No doubt his bosses won’t be pleased with him (the Dept. of Health doesn’t like those who speak up), but if you want to support him click through to

https://submissions.epetitions.direct.gov.uk/petitions/22670

What else?

It is time to challenge the myth/mantra repeated time and again by NHS staff – French care may be better but it is more expensive.

When you compare like for like (i.e. if you take out of the equation all the private rooms, home care, massages etc. the French receive ) and work out who pays what – the French and ourselves are paying pretty much the same.

Perhaps we could go back to a report, written in 2008, for the think tank Reform. What Prof.Nick Bosanquet, Andrew Haldenby, Laura Hurley, Flavia Jolly, Helen Rainbow and Prof. Karol Sikora wrote is worth re-reading, as a basis for patients to challenge just what is the NHS and La La doing with OUR money?

The typical UK patient pays around £2,250 per individual per year, so that everyone is covered by the National Health Service.

So the thoughtful report should be required reading for Cameron and Lansley; instead of repeating “European healthcare is better”, and leave it at that – perhaps instead of devising all his time and money wasting plans, Lansley would take on board what the Reform Report says – and ACT on it.

So why change?
Over many years, Reform says academic studies have pointed to a gap in performance between the UK and other countries.

Health outcomes are difficult to measure, but the UK delivers a poor level of social equity despite having universal provision. Other countries have systems that rely on part tax funding – part personal insurance funding for health care.

International options point to two key conclusions:

1. Drawbacks of voluntary coverage concern both effectiveness – due to the problems of adverse selection – and equity. The only major developed country which operates voluntary health insurance is the USA, and that country is itself divided as to the wisdom of the policy. The NHS does provide cover to every UK citizen (although not for every condition), and that is a valuable strength.
2. In recent years new insurance-based systems, in particular the Netherlands, have been created. Systems with strong insurance characteristics, such as France, Germany and Switzerland, are reforming in order to manage demand and continue to deliver a better standard of healthcare than the UK. The UK looks out of line with global developments.
The Prime Minister claimed that the NHS was “the best insurance system in the world” because, in systems with greater insurance elements, the costs of healthcare could bankrupt families on normal incomes.

Reform says people living in countries such as France, Germany, Switzerland or the Netherlands have the same kind of protection as the Prime Minister described, including cover against the very high costs of catastrophic illness. The task for the NHS is to combine its universal base with the focus on the patient evident in other countries.

Insurance incentives have the following advantages:

> they provide reasons for individuals and authorities to value the long term;
> they achieve greater value;
> they incentivise individuals to participate in their own healthcare;
> they remove unequal access to treatment; and
> they de-politicise healthcare.
Insurance-based systems are closely focused on individual patient outcomes as healthy patients cost less. This means a focus both on general well-being and on ensuring customers that do become ill recover in the shortest period of time.
In other words, an insurance-based health system encourages preventative medicine – something sadly lacking in the NHS.

Ending the postcode lottery
In insurance based systems patient entitlement is defined, and patients are aware of what drugs and treatments they have access to. This empowers patients and makes the system inherently patient centred, and would overcome the current difficulties in the NHS where some patients in one area have access to treatment while other do not.
The key elements of insurance success
We have seen the advantages of insurance incentives. However, there are a number of crucial elements that are required to make an insurance system work.

Firstly, it is important that a sufficient range of providers are able to operate in the market. Secondly, the core system of compulsory insurance needs to cover the vast majority of health problems to ensure that it is for only a minority of conditions that people are buying healthcare for through self-payment or supplementary insurance. Thirdly, people have to be incentivised to prevent abuse of the system. Finally, information and capability to use that information must be present.

Incentives to stop abuse of the system
People may have an incentive to abuse an over-generous system of provision.

In 2004 the average French GP prescribed drugs worth €260,000 a year and the French used three times as many antibiotics as the Germans. The French have tried to tackle this problem of overtreatment by requiring co-payments for many drugs and GP visits.

One academic has estimated that between 20 and 30 per cent of healthcare funds in America go toward unnecessary treatments which can in fact have a detrimental effect on public health.

UK families already spend £1,600 per year on healthcare
Reform research shows that the average household invests significant amounts privately on their own health. At a conservative estimate the average household is spending £1,200 a year privately on core areas of healthcare, including private hospital treatment, dentistry, optometry and over the counter medicines.

Alongside this spending individuals are also spending a considerable amount a year on improving their own lifestyles through diet and exercise.The average family spends around £400 annually on areas such as gym and sports club membership as well as complementary therapies.

The basic healthcare package in France, which includes the cost of social security contributions and the cost of a basic supplementary insurance, is £2,021.46.

This is a comprehensive package which covers the cost of consultations, pharmacy, dental costs, surgical costs, hospital stay and ambulatory transport amongst others. Furthermore, the French state currently guarantees patients access to all cancer treatments, including experimental ones.

The option to top up for luxury services or rare drugs
Supplementary insurance would cover a wider range of health treatment and pharmaceuticals that are not available in the core package. Supplementary insurance could be purchased for an additional charge from the Health Protection Providers.

Based on supplementary insurance in other countries, examples of cover might include:
> Additional surgery e.g. additional eye surgery during a cataract operation to alleviate the need to wear glasses.
> Drugs not available in the core package.
> A higher standard of hospital accommodation, such as a private room.

Competition
An essential element of a system that acts as an insurer is competition. Competition drives efficiency and quality of services for patients. However, competition has to be on a level playing field, and signs are that current plans for commissioning services won’t take into account all the factors.

Role of government
Now, this is where it gets interesting. I can never understand how a politician, with no training whatsoever, can suddenly find themselves managing a health budget of billions. No company would run this way. Yet the NHS expects a rookie Minister to know how to commission health services.

Reform suggests the role of the Government would be considerably reduced.

It would have a regulatory function to ensure that all Health Protection Providers and service providers were of sufficient quality. Further tasks would include allocating contracts for emergency services and deciding the budget of the service on a five year cycle. The reduction of this role would eliminate the need for regional agencies i.e. Strategic Health Authorities.

This would depoliticise the running of the health service, and remove it from the political cycle.

The authors
Nick Bosanquet is Professor of Health Policy at Imperial College London and Consultant Director of Reform.
Andrew Haldenby is Reform’s Director.
Laura Hurley was an intern at Reform during the summer of 2008.
Flavia Jolly was an intern at Reform during the summer of 2008.
Helen Rainbow is Reform’s Senior Researcher specialising in health.
Professor Karol Sikora is Medical Director of CancerPartnersUK and a consultant in cancer medicine.

Report costs: £20.00
Reform, 45 Great Peter Street, London, SW1P 3LT
T 020 7799 6699
info@reform.co.uk
www.reform.co.uk
ISBN number: 978-1-905730-12-4

Last ditch attempt to stop Health and Social Care Bill

Leave a reply

You CAN make a difference

NHS future being debated here Wikipedia

Please sign the petition

https://submissions.epetitions.direct.gov.uk/petitions/22670

Dr Kailash Chand, a GP in the north of England has started a government email petition.

If it gets 100,000 it forces a debate in Parliament, but just as importantly it will get big publicity for the cause.

If you have time

Lobby the Lords. Its still worth writing to the Lords who are still scrutinising and trying to amend the bill. They are doing this without access to the governments risk register and some are not at all happy about that.

David Owen said recently that Lords are so unused to getting letters that even a dozen or so on a topic makes a big impression.

There are 153 cross bench Lords. So its worth writing to them as well as the bishops.

For most impact:
post the letter, don’t email it. The address is House of Lords SW1A OPW.

Keep it short and to the point - make it personal – relate it to your work or your area in some way. Key issues could be: risk; cost; conflicts of interest; constitutional issues (see Allyson Pollock’s website for her parliamentary briefings on this issue)

Legislation can be defeated or fundamentally amended in the Lords – its happened before and could happen again. Or it could fail because it runs out of time.
BMA Members

All of you who are BMA members consider emailing Hamish Meldrum welcoming the decision to oppose the bill and have a public campaign and urging him to start the campaign now, as time is running out. His email address is hmeldrum@bma.org.uk

10 days ago BMA Council passed a motion to change its position to one of opposition to the Health and Social care Bill and to rapidly organize a public campaign against the bill.
The above is an extract from an article by Dr Louise Irvine.

Macmillan conference agrees – NHS MUST put patients at centre of care

Leave a reply

But Macmillan’s conference preaches

~ to converted

Two hundred Patients, Supporters, Carers and Staff gathered at this year’s Cancer Voices Conference, held at Gatwick. It’s Macmillan’s 100th anniversary, so expectations were high.

But many delegates had attended before, had found their feet, and were wanting to get out there and get active to improve services, particularly for patient services.

The blurb on the Macmillan website said delegates could

contribute to discussions, debates and give your input on how we can improve cancer services
meet other people who have had similar experiences
hear about the future direction of Macmillan
find information and resources.

But instead, we felt that sessions were mostly about fundraising; many of us have been doing this since we were in our teens – but now need more ‘meat’ to get our teeth in to, to be able to campaign on ‘how we can improve cancer services’.

One friend emailed to say, “where were the Forums?” Instead, there were many sessions designed to give volunteers support in fundraising, etc. But some of us wanted to use the time and hotel services that Macmillan were paying for, to discuss actively carrying campaigns forward, what type of help Macmillan could best provide (bearing in mind cancer care is going to change radically with cut-backs), etc. What action plans we could get our teeth into once we had left the conference?

Highlights for me were Mitzi Blennerhassett promoting a survey on what we think of medic’s communication skills (not a lot), and the chance to catch up with old friends.

Stands

There were some new stands, including one that highlighted the role of Hospital Chaplains, and how they aren’t just there for prayer, but are a very effective voice to help patients bridge the gap between medical treatment and finding information.

I remember the Chaplain at the Royal Marsden was more help to me, than many professionals, as he had been on the Ethical Committee that approved Tamoxifen. Whenever I got another side effect, he was able to look these up, and confirm I wasn’t going mad – what was happening had been noted during the clinical trials – and then ‘forgotten’.

Standing by the NCAT stand was Mitzi Blennerhassett, carrying out a short survey. This was on patients’ and carers’ views about the need for health professionals, involved in cancer, to have communication skills training. We only had three places on the form where we could write in comments – there should have been pages!

The stand also promoted a book which features on the Connected website: ‘Nothing Personal, disturbing undercurrents in cancer care’, written by Mitzi, and published by Radcliffe Publishing. This patient narrative shows the consequences of poor communication in healthcare and raises many issues.£14.99.

Discussion sections throughout the book look at what needs to change, backed by research references for better/evidence-based practice. The author was dismayed to find that a copy of Nothing Personal, lying among promotional material, disappeared on Saturday morning. Many of the stands offered free pens, writing pads and other materials, and the book may have been taken by someone who thought it was a ‘freebie’. If you have any relevant information, please get in touch with Mitzi on b_mitzi@yahoo.co.uk or telephone: 01653 628369.

Overall impression

So much of the conference was just going over what has been discussed in previous years, and it seemed that those present fell into two group

Carers and patients – they were enjoying meeting others and talking about their problems. It was wonderful for them because it gave them a break
‘Experienced’ patients, who know the system, and wanted to get on with campaigning for better cancer care.

It would have been helpful if sessions focussed more on what would be reasonable for patients to ask, what services should be provided, and how Macmillan could help obtain these. Many said they would have liked more serious discussions to talk about campaigns for different issues and to have had sessions with Macmillan’s senior people to actively get on with campaigns. If we had had some actions to take forward, we would have felt time was well spent.

e.g. patients who have Osteoporosis as a result of being on cancer drugs, are trying to get hospitals to set up similar exercise classes to those that patients in Europe receive, to help reverse the condition. These exercise programmes use equipment such as wobble boards, bouncers, treadmill etc. Simple stuff in every hospital gym – but hospitals turn a blind eye to the need. But backing from Macmillan would soon get them using physios and equipment towards greater benefits for us. For many with osteoporosis, there e a bleak future with almost inevitable fractures; my local hospital assures me “WHEN (not if!) you get a fracture, we can deal with this” – costing £12,000 upwards?

So I went to the ‘Benefits of Exercise’ workshop to learn about the latest reseach on exercise for cancer patients (and there has been a lot recently, both in UK and USA). Instead of being able to ask how our local campaign for osteoporosis exercise classes could get help, we were given exercises to do – which were good for our health, but didn’t provide any plan of action to get this – or any other type of rehabilitation – excercise available to us.

In many of the workshops we had to fill out A1 sheets of paper with our thoughts – but we did this last year, and the year before, and STILL we aren’t getting ‘world class’ care. One fellow delegate said we could have filled in a computer-readable sheet with things that were important to us before we arrived; then during the conference we could have been told what majority wanted, and how we can campaign for this.

Perhaps next year there could be a session where we talk to the Policy team, and actually come away with a plan of action? There are signs already in many areas that the Health and Social Care Bill is extending waiting times, patients are being denied care, drugs are again in short supply, etc. Worst of all, after Macmillan campaigned strongly for Co-payments, all has been forgotten. Why no session to repeat what Macmillan campaigned for with these co-payments, and give out a laminated sheet we could thrust under the noses of commissioners for hospitals and doctors; we already need this in my area (London). When I wanted to pay extra to be given an infusion specifically designed for cancer patients, Chelsea and Westminster Hospital

refused to discuss co-payments, saying they didn’t agree with them
when I said that Alan Johnson had promised Macmillan we could have these – ignored his decree
then said if I continued to ask for this drug I would be struck off and would have to pay to go privately.

Considering how much time and money Macmillan spent on this campaign, it would have been helpful to discuss what is happening now. Perhaps we could submit ideas for what concerns us, and Macmillan could pick a ‘top ten’ for workshops next year? With the proviso that if we raise the subject, we are expected to go ahead – with Macmillan’s help.

Arriving for the last session, I could hear drums beating out. Whilst this might have been fun in other situations, having spent two days cooped up in the hotel, this was last thing my head wanted! A friend emailed, “Why end the Conference with a ‘sing-along’ ‘dance-along’ when a great number of attendees were physically disabled ie unable to dance or following throat cancers etc ie unable to sing. I noted that the hall was only half filled for the final bit which made me think that others worked out what we were in for and left early”.

So next year – let’s harness the energy that was in the conference, and get out to campaign effectively. We need to follow the type of lobbying that is seen in the USA, because under the Health Bill we are going to need this.

Two days later the Breakthrough Breast Cancer conference showed how it should be done; 60 MPs were lobbied by constituents, and 40 peers turned up during the event. And the conference team made sure we all had plans of action to continue lobbying – so we felt we were really contributing to improving cancer care.

Could The Apprentice do a better job running NHS?

1 Reply

NHS needs Sugar's straight talking Flickr

Latest on Un-Healthy Bill

Go on the web, turn the sound down and re-watch The Apprentice.

Management speak is rife, and substitute an NHS manager for an Apprentice and you begin to see where they are coming from. Scary!’

More layers – not less

Administration levels are beloved of Health Ministers since the 1960. Doctors started to go on management courses, and came away with lots of buzz words. They were quick to see the courses could help them build empires, and rule over plebs who didn’t go on courses, but just got on with their work, looking after patients.

Today’s Health Bill is compounding the awful layers, and the latest blog from Abetternhs says it brilliantly: www.abetternhs.wordpress.com :

The government’s intention to privatis,the NHS continues unabated after a so called ‘pause-and-listening’ exercise in which the rarely spotted ‘future forum’ gathered opinions from carefully selected stakeholders and reported back to No.10. (There was ONE patient included in the 46 great and good).

Of greatest significance is that the duty of the secretary of state for health, enshrined in the NHS act since 1948, ‘to provide and secure the effective provision of services’ has been delegated to an unaccountable quango called the NHS Commissioning Board. Withdrawing the duty leads to the abolition of structures and functions that follow from that duty, meaning that eligibility and entitlement to a comprehensive range of NHS services will no longer be assured.

The other significant non-change after the pause is the role of competition, which was widely reported to have been watered down, but emerges intact and probably more central than before the pause, with the Competition and Cooperation Panel (CCP) taking on the role of preventing anti-competitive behaviour. They have made it clear that they regard existing NHS hospitals as ‘vested interests’ and that competition is an unmitigated good.

Hostility to the bill is widespread in the medical and nursing professions, with the British Medical Association voting for the bill to be withdrawn at their ARM this month, and protests taking place outside hospitals throughout the country.

The question that remains more than a year after the publication of the health bill is what problems the bill is supposed to resolve. It has never been the opinion of significant numbers of either patients or professionals that the NHS was in need of more choice or competition.

From my perspective as a GP the main problems that need reform are listed below. It is important to note that the health bill fails to address any of them, and in almost every case will make the problems worse.

Collaboration. Both hospital specialists and GPs are aware of huge variations in clinical practice, but without good communication and collaboration, little or nothing is done. Evidence from the US Mayo clinic and others shows that when clinicians collaborate rather than compete, costs and clinical errors are reduced and quality increases. In the last few years we have set up historically unprecedented close working relationships between GPs and our local hospital. We have improved the quality of GP management, reduced unnecessary referrals and made sure patients are seen by the appropriate specialist without the need for repeating investigations. By introducing a range of providers to compete with NHS hospitals with the Cooperation and Competition Panel enforcing competition, the health bill will allow private providers to challenge us for colluding unfairly with each other and will fragment and disintegrate patient care. GPs should be federated so that they have to take responsibility for their peers to ensure uniform quality of care in a geographical area. The health bill encourages GPs to collaborate by setting up commissioning consortia but allows them to exclude underperforming practices and challenging patient populations allowing the creation of ‘sink consortia’ and very small consortia with an unsafe risk pool.

Management. There is a long history of animosity between clinicians and managers and between NHS managers and the public. This pariah status of managers is unwelcome and unjustified. The promise to increase clinician involvement in the planning of services in the health bill was initially welcome, but any good has been blown apart by the unjustified demonization of NHS bureaucrats, the arbitrary 45% cuts to management, the destruction of existing NHS structures at huge cost, and the replacement of 163 statutory bodies with 521 new ones.

The purchaser-provider split. The purchaser-provider split rewards hospitals for doing more and GPs for referring less. Consequently it damages relationships between GPs and specialists and hinders rather than facilitates joint responsibility for patient care because GPs suspect hospitals of over investigating and over treating patients for profit, whilst hospitals suspect GPs of holding onto patients who need specialist attention to save money. The purchaser-provider split needs to be abolished, but it is central to the market-driven health bill.
Guidelines. The National Institute for Clinical Evidence assesses the cost-effectiveness of treatments. The potential benefits are enormous. Clinical guidelines are all too often not followed because of lack of familiarity rather than clinical reasoning and there are unwarranted variations in the quality of care. IT needs to be improved to aid clinical decision making. Guidelines need to be available instantly so as not to interrupt workflow or consultation time. The health bill has lurched back and forth over its position on NICE.[3] Social policies such as a minimum price on alcohol and banning smoking have much bigger health impacts than medical interventions, but worryingly what remains cut is NICE funding for a number of important public health projects including studies into reducing harm from alcohol. Instead the government have entered into public health partnerships with the food and drink industries which have clear conflicts of interest.

Inflation. Health care costs are rising because of a number of factors including the costs of new treatments and widening diagnostic and treatment thresholds. Ageing, surprisingly makes little difference, no more than 1% per year. The health bill has no analysis of why costs are rising or what to do about it. By introducing competition and converting health care to a commodity the evidence is that costs will increase much faster than before.

Data. The outcome of health care is health gain. It is very difficult to measure health gain because of the huge numbers of variables, the social determinants of health, the subjective nature of health, the variable time-lags between interventions and outcomes and more. If we are to become more efficient, then we need also to agree on how to measure efficiency. For all the emphasis on outcomes and efficiency in the health bill there is nothing in it about how to improve the measurement of outcomes or efficiency.

Inequalities. Having worked in deprived and affluent areas I know that general practice in deprived areas is far more clinically challenging and less financially rewarding. There are serious inequalities in the resources available, the quality of care and the incentives for GPs. There is nothing in the health bill to reduce inequalities, indeed the evidence is that competition in healthcare creates, ‘islands of excellence in a sea of misery’

Accountability. There is and always has been a democratic deficit in the NHS. From the secretary of state to the GP commissioner, at every level there will be less accountability as a result of the health bill.

The specious separation between health and social care. For general practitioners and patients it is obvious that there is a continuum. When the social care of a vulnerable patient fails too often they end up in hospital where they remain at great cost until appropriate care in the community is found. There are enormous cuts to social care and the NHS will remain the refuge of those with nowhere else to go.

The opportunity to address the problems the NHS faces has been wasted by this coalition government on a neoliberal project to hand a cherished public service over to commercial interests. If the government were seriously interested in preserving a comprehensive NHS, making it more fair and ensuring it is affordable and sustainable for future generations they would be listening to people who spend every day working in it and being treated by it instead of those who see it as a business opportunity.

Could anyone persuade Lord Sugar to shoot the next Apprentice series in a hospital, and set the contestants the enormous task of cracking down on money-wasting that is rife in the NHS – from 1,000 different types of rubber glove to Gluten-free loaves costing 1000% more than in supermarkets.

Tell your MP what you think of Health Bill

3 Replies

The Houses of Parliament, also known as the Pa...

Image via Wikipedia

And keep up momentum for change

Thanks to the huge outcry against their original NHS plans, the government has been forced to make some changes to the Health Bill – but not enough.

A committee of MPs have already started discussing the government’s latest NHS plans. These 25 MPs have a choice to make.

Will they wave through the government’s latest NHS proposals?

Or will they ask tough questions and expose the dangerous problems with the government’s plans?

If MPs think their voting public doesn’t want the ‘new’ clauses in the Bill, or questions what is already in place – they will ask more questions. And the more they ask, the more the Government will realise they HAVE to respect what the public wants.

So make sure your MP knows what questions you want them to ask committee members.

How?

Email your MP now and tell them you’re still concerned about the government’s plans:

https://secure.38degrees.org.uk/were-still-watching

You can ‘personalise’ this letter – in fact it’s a good idea to add your comments so MPs know the letters come from genuine constituents.

However, if you have already written on this subject – leave the poor MP alone!

Last election one charity tried to get on the bandwagon and get us all bombarding our MP asking questions about cancer, after Breakthrough Breast Cancer had already done a superb job. It doesn’t work. To keep your MP on your side let them know what you think, and what you would like them to do – then leave them to get on with it.

However, there is nothing to stop you emailing this article to friends – and getting THEM to write! And because of the clever way those IT boffins have worked it out, anyone, wherever they are in Britain, who clicks on

secure.38degrees.org.uk/were-still-watching

can write same petition – but get it sent their MP.

Why do this?

Hidden in the Bill’s small print are some causes for concern:

It looks like they are still trying to water down or abolish the health minister’s ultimate responsibility to provide NHS services (at the moment the buck stops with the health minister – they’re trying to change that).
Experts warn that private companies may end up in charge of determining what services you can get on the NHS and who provides them (in other words, doing the work of new “NHS commissioning bodies”). This is fine if your local NHS hospital teams up with a private hospital that runs efficiently – but no good if we end up with more PFI disasters.
There’s too much emphasis on competition – rather than encouraging different bits of the NHS to work better together.

Soon, your MP will vote on the government’s plans. But right now, your MP can help make sure these issues are tackled, by putting pressure on MPs who are on the health committee to do a proper job.

Over the past few weeks, thousands of the public have been deciding the future of our NHS campaign. The results were overwhelming. In a 38 Degrees poll, 97% of us voted that there is still more to do to protect our NHS for future generations, so we should keep the campaign going as one of our top priorities.

By working together now, we can make sure that everywhere MPs on the health committee go, they’re facing tough questions about protecting our NHS.

Please take 2 minutes to send your MP a quick message and tell them if you’re still worried about the government’s NHS plans.

How to get NHS to pay for treatment in Europe

Leave a reply

Image via Wikipedia

Implications of the recent EU Directive on cross-border healthcare

EU law clarifying the right of patients to receive healthcare in EUmember states adopted

Directive will extend patient choice for medical treatment beyond national borders….

but will take some time to take effect, particularly as in UK the outcome will certainly be a significant amount of patients wanting to be treated abroad – whereas other EU countries know that they could gain income from NHS patients.

What it’s all about

For some time UK patients, with enough time and patience, were occasionally able to get their local PCT to fund treatment abroad. The EU got involved, and now there has come a Directive which means that it should be easier for those patients who can persuade their GPs that they would receive better, more up-to-date treatment in certain European countries, to receive NHS funding, now they have won the right to ask for treatment to be funded by NHS.

Hoever, be aware you will still have to find travelling expenses, and possibly accommodation (except in certain circumstances).

This Directive has come about because, as the EU says ……. the landmark “Watts” case which concerned the NHS directly. In 2003 Mrs Watts, a UK patient who had gone to France to seek treatment to avoid a long waiting time in the NHS, and had then sought reimbursement of the cost of her treatment from her local primary care trust, had her case referred to the European Court of Justice. In 2006 this Court ruled that she was entitled to the treatment and that the NHS should pay.

Now, UK cancer patients in particular can ask for better treatment in Europe to be funded by the NHS. BUT – first you will have to negotiate the mine-field of NHS commissioning, and commissioners are not going to open the purse-strings very readily.

Key points

The right of patients to receive healthcare in another EU member state, and to be reimbursed by their country’s healthcare
System has been established by several decisions of the European Court of Justice.The recently adopted EU Directive will clarify how this right is implemented in practice.
Many questions arise on how the rules will be implemented on the ground. The NHS will be helped by organisations to understand them and to ensure that their views are heard throughout the implementation process.

Key provisions in the EU Directive

The rationale underpinning the Directive is that it should be as easy as possible for patients who want to access healthcare abroad to do so, subject to the same conditions which apply when accessing treatment at home. (In practice this means your GP must help you to go abroad for treatment, if there is a valid reason).

Therefore, as well as restating the existing rights established by the European Court of Justice, the Directive builds on them to provide clarity on the rules and processes applicable for patients who want to seek healthcare abroad.

Alongside this, the Directive encourages cooperation between member states in a number of areas related to cross-border healthcare, such as:
• the recognition of medical prescriptions filled out in other member states (in practice I have found this generally works well already)
• cooperation between providers, especially in the area of rare diseases
• the use of e-health for the transfer of patients’ records between countries (bit difficult for us – I wouldn’t trust this to NHS at the moment!)
• the assessment of health technologies.

The provisions in the Directive of key importance from an NHS are:

Determining what treatment a patient can receive
The Directive clarifies the rights that patients have to access healthcare in another European country and to receive reimbursement towards the costs
quality and safety standards will apply, and what to do if anything goes wrong.
It will also end the uncertainty that commissioners currently face over decisions about what care patients can receive abroad, while allowing the NHS to maintain control over patients’ entitlements.

On the provider side, the rules will offer opportunities to increase income by providing services to EU patients when capacity allows.

It is worthwhile noting that,alongside this new Directive, a separate EU mechanism for patients to obtain planned
treatment in another European country at the expense of their home healthcare system already exists under longstanding EU regulations on the coordination of social security schemes (the ‘S2 referral’ – formerly known as
E112). The difference betweenthe two routes to cross-border healthcare is not always clear cut.

In principle, the Regulation on the coordination of social security schemes governs the following situations:

health cover of UK nationals who are resident abroad;
commissioners’ decisions to refer patients to another EU country,
for example, if certain treatment cannot be provided in the UK or in case of ‘undue delay’; as well aspatients needing emergency care during a stay abroad.

The new Directive, reflecting freedom of movement principles under the EU Treaty, goes further.
It provides a legal framework to apply to situations where a patient takes a personal decision to travel abroad to receive healthcare.
Taken together, these court cases have established that patients have certain rights in relation to cross-border healthcare.
However, there were a number of uncertainties around the case law which made it confusing for patients and difficult for health systems to implement in practice. For example, it was not clear when or if health systems could apply
a system of prior authorisation or what levels of reimbursement should apply. The proposed Directive sought to clarify the situation, for the benefit of both patients and those managing health services.

After a lengthy EU decision making process, the Directive was formally adopted at EU level in March 2011. The NHS European Office engaged significantly with the proposals throughout the process, briefing EU decision makers on NHS views and ensuring that the rules will not impact negatively on the NHS.
The NHS European Office says, “thanks to our extensive lobbyingwe are pleased with the agreed text. The Directive will help patients to make informed decisions about cross-border healthcare by providing clarity on matters such as:

what reimbursements they will be eligible for
what costs they will have to meet themselves

Patient choice beyond borders cannot be made conditional on the use of this system and patients will still be entitled to seek reimbursements for treatment that they have already received.

Determining costs and the level of reimbursement

Under the Directive, patients can seek any healthcare (including private care) in another European country that is th same as, or equivalent to, a service that would have been provided to the patient under the NHS.

The Directive allows for two possible systems of payment of crossborder healthcare costs:

either patients pay up-front and are then reimbursed by their local commissioners;
or commissioners pay the provider abroad directly.

In any event, commissioners will not be required to pay more than the cost of that treatment if provided by the NHS.

However, it is more than likely that the cost may well be LESS – hospitals and health services in Europe may not be as s greedy as the NHS. e.g. I needed a DXA Scan – in Italy this could have cost me £40 in a modern unit; in London my insurers would pay the NHS £120 for a scan in a scruffy basement room.

NOTES

there is no requirement for commissioners to pay travel, accommodation or other expenses that would not be covered if treatment were provided in the home country. This means that the patient would normally need to cover these costs, as well as any difference in the cost of their treatment, themselves.
Warning! You may not be allowed to travel by air, and if you do, you will be sensible to pay for Business Class travel NOT go by budget airline.
Nevertheless, commissioners may decide to pay additional related costs, such as accommodation and travel costs, for individual patients’healthcare. Prior authorisation is only possible for healthcare which is subject to planning requirements and which involves at least one night in hospital, or requires the use of highly specialised and cost-intensive medical equipment.
Authorisation can only be refused in limited circumstances listed in the Directive and decisions have to be taken in an objective and non-discriminatory manner. For example, authorisation could be refused when the patient would be exposed to a very high safety risk that cannot be regarded as acceptable.
It is important to emphasise that authorisation cannot be refused where a patient is experiencing ‘undue delay’ in receiving treatment under the NHS. While there is no formal definition of ‘undue delay’, the European Court has stressed that judgments must be based on a clinical assessment of what is a medically acceptable period for the individual clinical circumstances of the patient, and that this assessment needs to be kept under review while the patient is waiting for treatment.
Significantly, the European Court has said that offering treatment within a national waiting time target does not necessarily avoid ‘undue delay’.
For other types of healthcare, a voluntary system of prior notification can be introduced to encourage patients to inform their commissioners of their intention to receive healthcare abroad and to discuss what reimbursements they will be entitled to. It should be noted, however, that reimbursement of treatment that the patient would have been entitled to at home. It confirms that it is always the home health system that decides what healthcare is available to its citizens, regardless of whether they are treated at home or abroad.
It also recognises that patients wishing to receive cross-border healthcare can be subject to the same ‘formalities’ as patients seeking healthcare in the NHS. This would include, for example, requiring that a patient seeks GP referral to access specialist care. This provision is particularly important for the NHS which, as opposed to social insurance systems, does not have a basket of healthcare to which all patients are entitled, but rather makes decisions on eligibility locally, taking into account the circumstances of individual patients.
N.B. Talking to officials this could well be the stumbling block for UK patients seeking care abroad. Commissioners have told me that if a patient seeks treatment abroad (perhaps for a new procedure that NHS hospitals don’t offer) persmission could be refused as procedure is not available in Britain. This seems to negate the object of going abroad, to receive better treatment than one can receive in UK.
Authorising patients to receive treatment abroad, The Directive allows member states the option of introducing
a system of prior authorisation for patients seeking cross-border ‘Commissioners will not be required to pay more than the cost of that treatment if provided by the NHS.
Authorisation cannot be refused where a patient is experiencing ‘undue delay’ in receiving treatment under the NHS.

Significantly, the European Court has said that offering treatment within a national waiting time target does not necessarily avoid ‘undue delay’’

Key points for commissioners
• NHS patients have the right to seek in another European country any healthcare that they would have received under the NHS and to be reimbursed by their commissioner up to the amount that their treatment would have cost the NHS to provide.
• The patient pays the difference if care abroad is more expensive. The patient would also normally have to cover travel and other costs, unless their commissioner decides to cover these additional costs on an individual basis.
• The Directive does not give NHS patients rights to reimbursement towards the cost of treatment that they would not have received under the NHS.
• Patients seeking treatment abroad can be made subject to the same conditions that apply when accessing treatment under the NHS. For example, a patient who wanted to see a specialist abroad would still need GP referral.
• Prior authorisation systems (where a patient makes a request to be treated abroad before they obtain treatment) may only be introduced for healthcare which is subject to planning requirements and which involves at least one night in hospital, or requires the use of highly specialised and cost-intensive medical equipment.
• Prior authorisation cannot be refused if a patient is experiencing (based on their individual circumstances) ‘undue delay’ in receiving NHS care.
• Commissioners have a duty to ensure that patients who receive crossborder healthcare can have access to follow-up healthcare if and as required when they travel back to the UK.
• Commissioners may decide to pay directly for healthcare in another European country, if this would benefit the patient. This would not apply to treatment provided in other European countries, even where this treatment was provided to NHS patients. Instead, it would be the provider country’s equivalent system for ensuring quality and
safety that would apply. Similarly, NHS hospitals treating patients from other EU countries would do so to NHS standards.

Quality and safety standards
The Directive confirms that the legislation and requirements that apply on matters such as quality, safety and liability are those of the country where the healthcare is being provided. This means that the standards set by the Care Quality Commission.

As the NHS is based on a system where the vast majority of healthcare is free at the point of use, one of the biggest issues around cross-border healthcare is how to determine domestic costs. The text states that each country should have a transparent mechanism for calculating the level of reimbursement a patient is entitled to if they receive healthcare abroad, but the detail of this is left for each country to determine.

For healthcare which is not covered by an NHS tariff, defining the level of reimbursement could be particularly challenging when prices are set by commissioners or subject to negotiations between commissioners and providers, and therefore subject to significant local variations. Furthermore, a tariff may cover a package of care, rather than a simple procedure, and therefore costs may need to be ‘unbundled’ if a patient receives a different package of care in
another EU country.

Regarding the costs to be charged to incoming patients, the Directive states that providers apply the same tariffs they apply to domestic patients in a comparable medical situation or, when this is not possible, a price calculated on
the basis of objective and nondiscriminatory criteria. ‘In the event that waiting times were to increase for certain
treatments under the NHS, we could expect a larger number of patients seeking cross-border healthcare going forward’

Patient choice beyond borders: ‘At a time when the NHS is moving to a system allowing for greater variation at local level on which treatments patients are entitled to receive, a key issue with the implementation of the EU rules will be to ensure that commissioners have a clear ‘list’ of which types of healthcare they allow (or do not allow) their patients to receive’

Information to patients on cross-border healthcare : The Directive requires each member state to make information
about travelling for healthcare easily available to interested patients, including by setting up one or more national contact points for cross-border healthcare to assist both incoming and outgoing patients.

The role of national contact points is to provide patients, on request, with information on their entitlements to healthcare or procedures for accessing and determining entitlements. They will also be required to provide
information on the quality and safety standards that apply in their country and a list of the providers which are subject to them.

Furthermore, they should provide analysis of implications for commissioners. Whilst it is impossible to predict
how patterns of cross-border healthcare will change in the future, it is broadly recognised that most patients prefer to be treated as close as possible to home and therefore, in principle, we do not anticipate a large expansion in the volume of cross-border healthcare within the framework of the Directive.

Nevertheless, it should be emphasised that one of the main reasons given by patients for seeking cross-border healthcare is the opportunity to receive treatment more quickly. Therefore, in the event that waiting times
were to increase for certain treatments under the NHS, we could expect a larger number of patients seeking cross-border healthcare going forward.

As patients may only receive reimbursement for healthcare abroad that they are entitled to receive under the NHS, at a cost which is not higher than the NHS cost, cross-border healthcare is not expected, in principle, to have major implications for NHS budgets. Nevertheless, as authorisation cannot be refused in cases of ‘undue delay’, there
could be some implications in terms of commissioners’ ability to plan and prioritise. This could, in turn, have implications for health inequalities by allowing certain patients to receive treatment more quickly than patients who
are in greater medical need.

Another challenge for commissioners relates to determining domestic prices for healthcare, especially for those procedures which are not covered by a tariff and are subject to significant local variations.

On the positive side, the Directive will reduce the uncertainty commissioners currently have on what rights NHS patients have to receive treatment abroad and how to handle requests from patients for cross-border healthcare.

As the NHS is expected to move to a system allowing for greater variation at local level on which treatments patients are entitled to receive, a key issue with the implementation of the EU rules will be to ensure that commissioners
have a clear ‘list’ of which types of healthcare they allow (or do not allow) their patients to receive. This will be crucial to avoid uncertainty for both commissioners and patients, and to reduce the risk of legal challenges from patients
trying to access treatments abroad which are not routinely available under the NHS.

At a time when the UK Government has put forward proposals to extend patient choice and to diversify providers in the healthcare market, the Directive will have the effect of extending patient choice beyond national borders.
It should be emphasised that patients will have the right to access treatment from any healthcare providers abroad,
including private sector providers.

Patient choice beyond borders : ‘The proposed removal of the private patient income cap, which currently reduces the ability of some foundation trusts to treat a greater number of non-NHS patients, will allow these trusts to take full
advantage of the opportunities emerging from the EU rules’ ‘In the current economic climate, NHS trusts could
be interested in exploring opportunities to provide health services to European patients to diversify their income’
information on liabilities and complaint procedures in the event that the patient suffers harm.

Cooperation between providers across Europe : The Directive seeks to promote cooperation between providers and centres of expertise through the development of ‘European reference networks’, notably in the area of rare diseases. Hurrah! At last Cameron and Lansley’s mantras “health care is better in Europe” are becoming boring as they DON’T DO anything. This way, Patients can demand that something is done t bring treatment, particularly for cancer, up to European standards. Why should be have to go abroad to access their superior treatment? Why shouldn’t UK cancer patients have same life expectancy as Europeans post cancer?

These networks will concentrate knowledge in medical domains where expertise is rare and foster progress in the diagnosis and treatment of rare conditions.

The European Commission will develop a methodology for the setting up and operation of these networks in the run-up to the implementation of the Directive. We will monitor this process and contribute NHS views to maximise
the opportunities for NHS trusts.

The briefing notes state: It should also be emphasised that NHS tariffs are often higher than tariffs applied in other member states and that this could impact on the ability of NHS trusts to ‘attract’ EU patients.

Next steps
The Directive is the first genuine example of EU legislation specifically in the area of healthcare services.

The information above has been kindly supplied by the European Office of the NHS Confederation.

CONTACTS

Email european.office@nhsconfed.org
http://www.nhsconfed.org/europe
Further copies of the notes above or alternative formats can be requested from:
Tel 0870 444 5841 Email publications@nhsconfed.org
or visit http://www.nhsconfed.org/publications
The NHS Confederation is a Registered Charity no: 1090329.
EUR01401
OR/ if having problems accessing treatment, probably best person to help is your MEP.
The NHS European Office
The NHS European Office has been established to represent NHS organisations in England to EU decisionmakers.
The office is funded by the strategic health authorities and is part of the NHS Confederation. EU policy
and legislation have an increasing impact on the NHS as a provider and commissioner of healthcare, as a
business and as a major employer in the EU.
Our work includes:
• monitoring EU developments which have an impact on the NHS
• informing NHS organisations of EU affairs
• promoting the priorities and interests of the NHS to European institutions
• advising NHS organisations of EU funding opportunities.
To find out more about us, and how you can engage in our work to represent the NHS in Europe,
visit http://www.nhsconfed.org/europe or contact european.office@nhsconfed.org
References
1. Regulation EC 883/2004, which repealed Regulation 1408/1971.
2. The NHS (Reimbursement of the Costs of EEA Treatment) Regulations 2010 – S.I. 2010 No.915.
The NHS (Reimbursement of the Costs of EEA Treatment) (England) Directions 2010.

Nick Clegg teaches Grandma – instead of listening

Leave a reply

Paul Burstow was there Wikipedia

Nick Clegg needs reminding that ‘Consultation’ or Listening meetings are to hear patients’ views.

University College Hospital (UCH) in London hosted the latest ‘consultation’ on the Health and Social Care Bill – but whoever thought to involve hospitals in this exercise?

Silly me – why did I ever think that the Dept. Health actually wanted to hear Patients’ views about the proposed Health Bill?

I should have realised that this ‘Consultation’ is just a massive PR exercise to bolster the Coalition’s flagging ratings. I have been to two of these events, and each time the Minister arrives late, because the hospital CEO can’t resist the chance to show off their latest equipment.

These are supposed to be events for Ministers to listen to PATIENTS, not photo-opportunities for the hospital newsletter, and of course the essential platform for a Minister to be filmed for TV News.

Ranged across the wall of the meeting room at UCH were banners highlighting participating charities, from Age Concern to Diabetes UK, and including Breakthrough Breast Cancer, who were out in force. These banners cost about £300, and are invaluable for fund raising events. But it did seem OTT when an accolite arrived with two boring banners saying “Working together for a stronger NHS – funded by HM Government“, and proceeded to try and slot them into the well-organised line-up from the charities.

There was a crash as she pushed over two of the banners, and the relevant charity workers sat up to defend ‘their’ property. We watched as she managed to make a real mess of putting her two banners up, but eventually she had displaced the other charities’ property, and Nick Clegg could now be photographed in front of hers. Even though, the event had been organised by the charities. Sad thing, after spending £600, no-one was interested in taking his photo.

Grandma didn’t need lessons in sucking eggs – but wanted to put over points

With patients in the audience coming from far and wide, primed to get their say in about problems they saw with the Bill, it was counter-productive when Clegg launched into a long speech explaining what is the bill about. Everyone in the room had read and re-read the document, but they had genuine issues with statements they had discovered in the wording, and were there to ask questions. And hopefully someone would take notes; however, yet again I couldn’t see anyone recording the session (I hope they were).

His fellow Minister, Paul Burstow, was also present, and is fully on the ball. But he sat back and said nuffin’ – letting patients do the talking. And that is how it should be.

Eventually one patient got very vocal and said that they hadn’t had a chance to talk – then questions came fast and furious. Everyone who spoke had genuine concerns; no-one was banging a drum for anything in particular, they all were looking at the wider picture of how NHS was going to handle patients in the future and genuinely involve them in their care. One patient, probably called Jackie Allen, asked how will patients be involved in commissioning – but one wonders if her valid question will be noted.

Eventually Clegg said “we’ll need to send the Bill back to the Committee”, but one wonders if that is going to address all the points put over. He put over the usual cliche re “making sure the NHS is world class”, but one knows that when you take this back to Dept. Health to ask who is person, or which is department, tasked with this – the DH gets shirty and won’t give an answer.

Improving Patient experience

We were told that under the Bill we would get improvements, but when asked, weren’t assured that this would be written into the Bill. “The right type of reform starts at the patient”. Yippee – but I could see and hear mutters about ‘suppose the reforms aren’t helpful’. Continually we were given the mantra of ‘no decision about me without me’, and Clegg said “it’s the patients that matter”.

Eventually we were hearing what we knew – but wanted reassurance on – Clegg admitting “we didn’t get all of the substance right …and didn’t get a substantial amount of the Bill right”. Some of the audience got quite excited when he mentioned that politicians could wash their hands of the service – but then sank back again when he assured us “we will always have a (Health) Minister”.

Throughout the talk/talk, it became obvious that if Clegg had his way the Bill would be sent back to Committee, to hopefully picked over and improved in line with what Patients want.

But there must be a massive civil war going on behind the scenes at the Dept. Health, and many in the audience felt that the Bill will go through, with minor ammendments; then (as is usual custom), two years down the line whichever Minister is in post will announce “a radical shake-up”.

At the end, one of the patients asked what about commissioning? Clegg said NHS managers will carry on commissioning until GPs are ready to do so. But then what happens to these people when GPs say they don’t need them any more? Do they swan off with redundancy payments that will help bankrupt the NHS? We weren’t told.

There didn’t seem to be any clear message to show if the Bill is going to be changed in line with what the public suggests – or if Clegg promising “the right type of reform starts at the Patient” will produce patient involvement – or not.

The message from those in the audience to Nick Clegg was loud and clear:

Patients want to be involved.

P.S. All was revealed on TV news that evening. Nick Clegg was filmed standing in front of the NHS banners – delivering a speech about the implications of the Health Bill. For that, we had all travelled far to be present, and were obviously required as background to make it look as if he was addressing a large crowd.

Will Health and Social Care Bill be Cameron's Poll Tax moment?

Leave a reply

: Image via Wikipedia

The government is to publish details of the biggest planned overhaul of the NHS in England

Having fought the election on a platform to reform the NHS, the coalition Government seems on course to upset even those who acknowledge ‘something must be done’ about our health services.

The Health and Social Care Bill, which will be laid before Parliament later, paves the way for GPs to get control of most of the NHS budget by 2013.

Unions warn the plans could undermine the health service, while MPs say they have taken the NHS by “surprise”.

But having set out their stall, Cameron, Lansley and everyone at the Dept. Health argue that changes will improve services.

Unless you get these officials away from their office, and as one admitted to me last week, “we are very unhappy”.

NHS overspend

Anyone who runs a business looks around their NHS hospital and almost certainly notices where NHS money is being wasted. But instead of throwing out good and bad systems together willy nilly, in a massive nationwide reorganisation schedule, why on earth don’t Hospitals consult their patients who bother to sign up for ‘Foundation Trust Membership’, and ask them where cuts could be made?

The way the change is going to happen now is already providing concern amongst staff = worried about their jobs = less attention to patients whilst they wonder if they are going to have a job soon.

If you are waiting to see your GP, or for tests, or even for an operation, reports from all over country are saying that waiting lists are getting longer.

And the NHS Confederation warns that hospitals could go bust as the plans include opening up the NHS to “any willing provider”.

The BBC quotes Dr Helena McKeown, a GP based in Wiltshire, describing herself as a sceptic. She believes one danger is that consortia may decide that some of the more marginal services are not a priority for funding. “Patients could see local bunion services go, for example, or orthodontics.”

She is absolutely right – I have already been told this by my local NHS GP’s surgery in central London.

She also fears local hospitals could be hit as private sector providers look to win more NHS contracts. She gives the example of ophthalmology departments which rely on cataract operations as a vital source of income and an area for eye surgeons to gain experience for more complex work.

“Private firms will want the cataracts as they are less risky and less complex, but the consequence of that is the local hospital department could suffer.

Again – I have to have regular eye tests with dye drops. As I also have an eye ulcer, I need anaesthetic drops first. The company that has just taken over this service (previously run very efficiently by Sally – a senior nurse) ‘forgot’ to include anaesthetic drops in their costings. Result is I have to have test done by doctor – what extra cost is that?

Business Experience

Critics have also questioned whether GPs have the experience and skills to handle such huge budgets – about 80% of the NHS budget.

Ministers point out that more than 140 groups of GPs have put themselves forward for the pilots. In the words of a certain ‘lady’, “they would, wouldn’t they?” There is obviously money to be made there.

And Peter Carter, of the Royal College of Nursing, says: “This reform programme could come off the rails, as people concentrate on saving money rather than delivering quality care.”

This is simple economics : whenever you change a system, in an office, a business or a service such as the NHS, this costs money.

Sometimes it has to be done – and sometimes it is done on the principle “we’re going to change this, so let’s do everything at once”. Currently, that seems to be the way things are going in the NHS.

Politician Diane Abbott suggestsa regulator: OFSICK perhaps?

Letter to The Times

3 Replies

: Image via Wikipedia

LETTER TO THE TIMES

The Times newspaper’s Letters column has long been used as a reliable platform to inform the public. Here is a copy of a recent letter, signed by many important medical bodies – which concerns us all:

Letters Editor

Dear Sir

Radical reform of the NHS in England is expected to come a major step closer this week, with publication of the Health and Social Care Bill. As unions and professional organisations representing the 1.3 million staff who make up the NHS, we are extremely concerned that the government is not heeding the warnings about key elements of the proposals. We recognise the need to provide NHS services more cost-effectively, but we believe this can and must be achieved without taking unnecessary risks and damaging care.

One of the major concerns, is the role that the NHS’ economic regulator, Monitor, will be given to ensure that any willing providers, including NHS and voluntary organisations, and commercial companies, are able to compete to provide all NHS services. In addition, the 2011/12 operating framework for the NHS, published last month, revealed that providers will be able to offer services to commissioners at less than the published mandatory tariff price.

There is clear evidence that price competition in healthcare is damaging. Research by economists at Imperial College shows that, following the introduction of competition in the NHS in the 1990s, under a system that allowed hospitals to negotiate prices, there was a fall in clinical quality. With scarce resources there is a serious danger that the focus will be on cost, not quality.

Enforced competition will also make it harder for NHS staff to work collaboratively in multi-disciplinary teams, across organisational boundaries, to create the integrated care pathways that patients want and need, and that will help make services more efficient.

Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, whilst at the same time being tasked with making £20 billion of savings, is extremely risky and potentially disastrous.

Yours sincerely

Dr Hamish Meldrum, Chairman of Council, British Medical Association

Dr Peter Carter, Chief Executive and General Secretary, Royal College of Nursing

Karen Jennings, National Secretary Health, UNISON

Karen Reay, National Officer, Health, Unite the Union

Professor Cathy Warwick CBE, General Secretary, Royal College of Midwives

Phil Gray, Chief Executive, Chartered Society of Physiotherapy

This letter was sent to me by the BMA.

It has been quoted on TV News Channels, in other media, on radio, etc.

It is important for all of us – so let me have your comments – send to verite@greenbee.net

More info on http://www.bma.org.uk/healthcare_policy/nhs_white_paper/index.jsp

Comment from the invaluable

NHS Managers.net

Food for thought

~ for the Future

You CAN make a difference

But Macmillan’s conference preaches

~ to converted

Two hundred Patients, Supporters, Carers and Staff gathered at this year’s Cancer Voices Conference, held at Gatwick. It’s Macmillan’s 100th anniversary, so expectations were high.

But many delegates had attended before, had found their feet, and were wanting to get out there and get active to improve services, particularly for patient services.

Highlights for me were Mitzi Blennerhassett promoting a survey on what we think of medic’s communication skills (not a lot), and the chance to catch up with old friends.

There were some new stands, including one that highlighted the role of Hospital Chaplains, and how they aren’t just there for prayer, but are a very effective voice to help patients bridge the gap between medical treatment and finding information.

Latest on Un-Healthy Bill

And keep up momentum for change

Thanks to the huge outcry against their original NHS plans, the government has been forced to make some changes to the Health Bill – but not enough.

Implications of the recent EU Directive on cross-border healthcare

EU law clarifying the right of patients to receive healthcare in EUmember states adopted

Directive will extend patient choice for medical treatment beyond national borders….

but will take some time to take effect, particularly as in UK the outcome will certainly be a significant amount of patients wanting to be treated abroad – whereas other EU countries know that they could gain income from NHS patients.

Nick Clegg needs reminding that ‘Consultation’ or Listening meetings are to hear patients’ views.

University College Hospital (UCH) in London hosted the latest ‘consultation’ on the Health and Social Care Bill – but whoever thought to involve hospitals in this exercise?

The message from those in the audience to Nick Clegg was loud and clear:

Patients want to be involved.

The government is to publish details of the biggest planned overhaul of the NHS in England

LETTER TO THE TIMES

Follow “After Cancer”