Nurses for Reform Blog

I am really pleased to see that David Cameron and Andrew Lansley are continuing to push ahead with their plans for NHS reform.

The realities of how the private sector will work with the NHS are now being explained and, in truth, they are just an extension of what has been before.

I remember when opticians were first allowed to see patients/customers in high street shops instead of NHS facilities.  There was a brouhaha about whether quality would be maintained.  Now none of us think of going to the NHS for our glasses or contact lenses.  Whether we go to SpecSavers, the internet any other of the competing brands, the people who have their eye care free at the point of delivery continue to do so and the rest of us get good quality eye care, a huge choice of frames and, most importantly, great value for money.

When I think back to the 1970s when children who wore NHS glasses were stuck with two choices for frames (horrible pink or blue plastic!) that always broke and were repaired with a sticking plaster, I am so pleased that that is now a distant memory. What I want to see in the near future is the evolution of other NHS services so that NHS customers can receive their healthcare in places that are convenient to them.  Where they don’t have to wait in overcrowded waiting rooms to be seen by doctors who behave as if the patients are an inconvenience and yes, if small, inefficient and poorly functioning NHS facilities are forced to close or are taken over by better performing providers this can only be for the good of the patient.

On Tuesday afternoon I was interviewed on the BBC’s Three Counties drivetime show to discuss the progress of the Coalition Government’s healthcare reforms.

The points that I made were:

1. The core of these healthcare reforms have always and will always build upon the key reforms of Tony Blair in the early 1990’s.  Through the concordat with the private hospitals, the introduction of Independent Treatment Centres (ITCs) and the desire to have Independent Foundation Trusts and Public Private Partnerships it was Tony Blair and the last Labour Government that brought to an end the counter productive war between the NHS and the independent healthcare sector.

2. No-one in the coalition government has ever proposed an American-style healthcare system.  Clearly, what David Cameron and Nick Clegg want is to deliver a more open, innovative and diverse NHS that fully uses all expertise and resources available whether NHS, mutual, charitable or for profit.

3. NFR is critical of the tories as for too long they did not explain what they were attempting to achieve for the NHS and this led to Unison and the BMA scare mongering.  I think that we should be greatful to Nick Clegg for having forced Andrew Lansley to better communicate the reforming messages in a non-threatening way.

4. While NFR would like to see a more radical and market oriented approach that is even more patient focused, we are confident that NHS provision will become ever more independent.

5. NFR also sees these reforms as an opportunity to increase efficiency and competition in the independent sector and are delighted that the government plans to remove the cap on NHS pay beds.

6. In time NFR would like to see the following changes made to the NHS:

• Hospitals and healthcare professionals being allowed to advertise their services to enable the establishment of trusted brands.
• All NHS hospitals to be returned to the Independent sector. No NHS funded patient should have to be treated in a state owned or run hospital
• Planning laws must be changed to make it easier to build new hospitals and clinics.
• The government must abolish collective pay bargaining.  Pay must be negotiated at local levels.

7. Finally, NFR believes that Andrew Lansley’s NHS reforms have never been revolutionary, they have been evolutionary building on the work of Tony Blair.  As the unions were wrong to scare monger that his reforms were privatisation in the 1990s, they are wrong to cry wolf now.  NFR wants an honest and open debate, we want to see the end of vested interest groups such as Unison and the BMA misleading the public.  Because these reforms are patient focussed they must be supported.

This letter today in The Daily Telegraph is a great move forward from the medical profession in support of Andrew Lansley’s NHS Reforms.

Not only do the GPs support the reforms but they point out the most important part of them, the benefits to the patients.  For Nurses for Reform this is the most important reason for the reforms.  That patients can work together with their family doctors to chose how and where their healthcare is delivered.

Another article in the Telegraph questions that the GP’s letter does not mention the use of the private sector for healthcare provision.  Could this possibly be because GPs and patients do not mind who owns the hospital in which their care is delivered?  What is important to them is that the care they receive is good quality, value for money and that they do not contract healthcare associated infections or become malnourished during their hospital stay.

This morning I was interviewed on LBC Radio’s Breakfast Show to discuss the Government’s healthcare reforms

This is a shocking but unfortunately not surprising report about the way in which the UKs elderly population are being failed by the NHS.

Our elderly generation is the one that was promised all healthcare from Cradle to Grave, and it is certainly having its journey to the latter hastened in appalling circumstances.

What is truly awful though is the lack of upset that this story has caused. No government ministers have been calling for enquiries or promising to get to the bottom of this. Andrew Lansley, the Secretary of State for Health, has made no comment that I can find, this story has been allowed to die and the UKs elderly population will continue to pay the price of a National Health Service that is not fit for purpose and that requires urgent and radical reform.

Nurses for Reform is delighted with the breaking news that the government has rightly decided to scrap the exorbitantly expensive, inefficient and frequently useless NHS Direct helpline.  NFR has long campaigned for the ruthless dismantleing of such pseudo-services instead preferring wholesale privatisation.

On the downside, NFR is hugely skeptical of the new 1-1-1 Helpline currently being piloted in the North-East of England.  Instead of such state funded monopolists NFR prefers a much more open and diverse approach to healthcare advice.

I know that I have recommended this book before, but I make no apology for doing so again.  Working Class Patients and the Medical Establishment: Self-Help in Britain from the Mid-Nineteenth Century to 1948 written by Dr David Green of Civitas, is one of the most influential books that I have read on the provision of healthcare before the establishment of the NHS.

Given the changes that are coming our way with the NHS reforms proposed by Andrew Lansley, many opinion formers and indeed Union Officials could do with brushing up on some history!

Following Andrew Lansley’s announcement last week that he will be cutting a number of NHS quangos including the Health Protection Agency (HPA) I have spent some time thinking about what can be done to stop these agencies reinventing themselves.

For this is actually one of the biggest challenges that the Government faces.  As I have already commented, the Food Standards Agency have been the first organisation to get the better of the politicians.

To enable the Health Secretary to counter the appeals that are going to come his way he only really has to look to the market.  For example one of the responsibilities of the HPA is to collect statistics on Healthcare Acquired Infection, well, Dr Foster does that, and much more, far better and has been doing so for many years.  If NHS trusts want to attract custom from the commissioning GPs and from consumers (patients!) they will quickly learn to publish the information that people are interested in. It’s called marketing!  The HPA also provide infection control advice put again, private companies have been doing this for years and can be contracted by commissioning GPs as and when required.

The message to Mr Lansley is simple.  You have lost the first round to the FSA.  Don’t let the rest of these state funded bodies follow in their wake.  Be ready, be ruthless and make the NHS Reforms worth much more than the paper they are written on!

This story from the BBC announcing a reprieve for the Food Standards Agency  (FSA) is, if true, very worrying for a number of reasons.

Not only will the Government have gone back on its promise of abolishing Quangos, but it will also have fallen soundly at the first hurdle in its bid to reform the NHS.  For this move will send out signals to Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs) that if you make enough noise to justify your existence and roll with the punches to reinvent yourselves,  you will be saved.

One can imagine the mutterings in the SHAs and PCTs about being seen to support the changes as long as they do not go so far as too get rid of any “our” jobs or layers of bureaucracy!

It is vital that Andrew Lansley and his health team recognise the forces that they are up against.  They have lost the first battle against the FSA, they must now regroup and begin to close down all avenues that could allow the SHAs and the PCTs to have any chance of survival.  Otherwise all talk of reform and the ‘Big Society’ will be dealt a blow from the outset.

Nurses for Reform is pleased with today’s reports that the Government is soon to launch a white paper on the NHS.  NFR heard of these changes a few weeks back and we are supportive of the idea of introducing a shadow toll system whereby money follows the patients via their GPs and in a much less bureaucratic NHS structure.

NFR has long believed that Strategic Health Authorities and Primary Care Trusts should be scrapped. NFR also believes that the NHS should be a funding mechanism but that no hospital, care home or clinic should be owned or run by the state.  While initial reports of the white paper are positive it is vital that it spells out that the state will never build another hospital again and that our existing stock embrasses diverse forms of ownership, including cooperative and not-for-profit, and that all provision is independent.  No-one in this country should ever have to go to a state run hospital again, moreover, the staff who work in these hospitals should be similarly denationalised.  National collective pay bargaining should be replaced by a more dynamic and responsive labour market and monopoly authorities such as the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC) should face stiff competition from a raft of competitors offering competing standards and ways of doing things.

In this context Andrew Lansley’s white paper is unlikely to go far enough.  Still trying to make socialism work NFR suspects that he will chicken out of necessary labour market reforms and will remain on side with elite legislative favour so beloved by the GMS and the NMC.  As such NFR is only likely to give next week’s white paper 3/10