Wednesday, 12 October 2011

Listen to Murphy not 38 Degrees

38 Degrees is being typically dishonest with its latest online petition (complete with "Sign or the baby gets it" photo).

Dear Members of the House of Lords,

Please make sure the Health and Social Care Bill doesn’t put our NHS in danger. Please support Lord Owen’s motion for more scrutiny of the new laws when you vote on Wednesday.

  • These changes weren't in any manifestos and the public has never had a chance to vote on them.

  • These changes weren't given proper scrutiny in the House of Commons so we need the House of Lords to look at them properly.

  • Unfortunately they have managed to dupe 116,042 people into signing up as of this morning.

    The opponents of the bill keep trying to suggest that the Coalition has no mandate for the bill and this is reflected in 38 Degrees' petition. The Tories said in their manifesto:

    Give patients more choice

    We understand the pressures the NHS faces, so we will increase health spending in real terms every year. But on its own this will not be enough to deliver the rising standards of care that people expect. We need to allow patients to choose the best care available, giving healthcare providers the incentives they need to drive up quality.

    So we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers. We will make patients’ choices meaningful by:

    • putting patients in charge of making decisions about their care, including control of their health records;
    • spreading the use of the NHS tariff, so funding follows patients’ choices; and,
    • making sure good performance is rewarded by implementing a payment by results system, improving quality.

    We will strengthen the power of GPs as patients’ expert guides through the health system by:

    • giving them the power to hold patients’ budgets and commission care on their behalf;
    • linking their pay to the quality of their results; and,
    • putting them in charge of commissioning local health services.

    So choice, any willing provider and GP commissioning are all there in black and white.

    The LibDems approach was slightly different but implied equally radical change and the idea of any willing provider which was also in Labour’s own plans.

    • Empowering local communities to improve health services through elected Local Health Boards, which will take over the role of Primary Care Trust boards in commissioning care for local people, working in co-operation with local councils. Over time, Local Health Boards should be able to take on greater responsibility for revenue and resources to allow local people to fund local services which need extra money.
    • Giving Local Health Boards the freedom to commission services for local people from a range of different types of provider, including for example staff co-operatives, on the basis of a level playing field in any competitive tendering – ending any current bias in favour of private providers.

    Lord Owen's motion is essentially a blocking motion as it demands open ended scrutiny. The House of Lords is a revising chamber and it will exceed its powers if it succeeds in frustrating the House of Commons in this matter.

    Yesterday cross bench (non-aligned) peer Baroness Murphy said in the debate:

    Seldom have so many health policy folk fought so many pre-Bill skirmishes over what in the end has proved to be rather modest changes intended to preserve and improve the NHS based on the principles of the NHS constitution, and rarely have I received so much misinformed lobbying about a Bill. I hear that the Bill heralds the end of the NHS as we know it; I read that armies of evil capitalists from the United States and the Middle East are geared up to zoom into the UK like the hordes of Genghis Khan to hoover up our favourite hospitals and services. It is twaddle. In fact, this Bill contains no privatisation at all, it does not transfer any assets to the independent sector and, if we build on the contribution of the independent sector of 1 to 2 per cent per annum, we shall be doing quite well. We have been building on the expansion of existing policies that have been in place and developing slowly over the past 20 years and introducing a new level playing field for providers from all sectors.

    As another noble Lord said, this is a vast improvement on favouring the independent sector treatment centres. I quite understand why that had to be done in the early days, but this puts everybody on a favourable, equal footing. It will sharpen NHS commissioners to get the quality of care improved and, crucially, will improve productivity, which has fallen quite catastrophically as investment has risen in the past decade. This Bill improves the contribution of clinicians to the planning and management of services and shifts a hospital system chained to central diktat towards a regulated emancipation to manage their own affairs. In my view, the most important aspect of this Bill is the introduction of the independent regulatory framework for providers, with the tools to promote a sharpening of competition and co-operation that will promote the kind of integrated care across primary community and specialist services that we all want.

    Those of us who were at the meeting last night heard Sir David Nicholson repeat what the NHS Confederation has constantly stressed: that any delay will be profoundly depressing to the service, which now wants a clear steer and direction of travel. We have had two years of delay already. Almost all the features of this Bill are familiar to us: clinical commissioning; foundation trusts; a regulatory system; competition and collaboration between qualified providers; and patient choice. They have all gone before, so the new Bill builds on what has been learnt, especially by ensuring that competition is based on quality not price. There seems to be a widespread misunderstanding that we are basing these new proposals around price. That is absolutely not the case, and I would not support this Bill if it did.

    Some people talk nostalgically about the demise of PCTs and SHAs, but the demise is in an orderly fashion, and as a former chair of a strategic health authority, I can only say "Hurrah". In fact, clinical commissioning groups are what primary care trusts were supposed to be in the first place. For those who can recall primary care groups, those were also what clinical commissioning groups were meant to be. The difference is that we have a national framework to support and empower them that will not be diverted into the provider system.

    Murphy is one of those rare creatures an experienced doctor and administrator. Maybe we should listen to her and not 38 Degrees who are playing politics and do not have a viable alternative.

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