Will the coalition defeat the roadblocks to reform?

DavidNcl

Well, since the collation isn't funded and controlled by the public sector trades unions - unlike the Labour party - I say it has every chance of succeeding.

CAW

Blair's plans for school reforms were nowhere near as radical as Gove's. Also he couldn't get them past his own party!

JohnOfEnfield

One Quango at a time.

Building Schools for the Future is obviously next.

Typically it is very small, VERY expensive, pays its "CEO" an unbelievable salary and can't even tell you the precise status of the 1500 or so contracts it was in charge of.

Will ANYONE dare to claim they will miss it? (Apart from Balls that is).

Simples. Next one please.

charles hercock

Fraser-you could not be more wrong.There is no better underlining of your erronious thought than your admiration for the flawed Alan Milburn.Stability and injection of efficiency into whatever process we have now is preferable to wasting resources on yet another experiment.Remember that in every reorganisation 25% of the money is wasted in the reorganisation process itself.Lansley tells us that £80,000,000 is at stake and therefore £20,000,000 is to be wasted. Sad

AndyinBrum

I just wonder, Fraiser, Maggie had the miners and the manufacturing unions to go for. Do you think the government is lining up the civil service union & the NUT as the next targets?

Use them as the scapegoats and barriers to reform and try & break them?

charles hercock

Sorry it is £80 billion at stake and £20 billion lost

Richard of York

Where is the mandate for NHS reform?
Nothing in the Tory or Liberal manifesto's mention reform or restructure of NHS.

If the people had known about this the outcome might have been very different either way and thus save a lot of people a lot of trouble with a coalition govt plus all the issues that brings.

ajs

Mr Hercock:
Would you quote some authority (apart from Prof Northcote Parkinson) for your assertion that "25% of the money is wasted in a reorganisation process"? What do you include? the capital cost of redundancy, for example?

Chris lancashire

Sadly, I think there is more than a grain of truth in what you say. Having run (private sector) organisations for over 20 years I do not underestimate the inertia built in to any system and the resistance to change. And that it is without large vested interests built in. The Government will find (like the last one) that pulling on the levers of power doesn't necessarily mean it's connected to anything.
I think the NHS reforms, at this time, are a step too far. Better to concentrate on the much needed cuts and get the economy going in the right direction before tackling the sacred cow. The opposition will attribute the first death they can to "Tory reforms".

PayDirt

Trust my GP, you’ve got to be joking. In my experience they are so overloaded with work they don’t have enough time to read my case notes properly, never mind being in control of some enormous budget. This Fraser is absolute utter bollocks and I am very very angry. The Conservative Party is just in hock to a bunch of ideologues who have little conception of how the real world works. The mantra of giving the patient CHOICE is so dumb, stupid, blind…… I am not about to go around shopping for my GP. OK, maybe with dentists I may change my dentist if I’m unhappy. But Christ, you think I’ve got time to mess with arguing the toss with my GP and walking out on him into the arms of some other poor sod who’s just as overloaded? Bollocks. If you want to reform the NHS, start with a proper reform with the National Insurance, as others have suggested in these blogs, as in France or Singapore. I repeat, I am very angry with Lansley’s inepitude, so he thinks his tinkering is going to solve the problems. Stupidity of the highest order and the LibCons will live to regret this nonsense.

Paul Round

Poor old RoY.He carries on like a stuck record (of the 78 rpm type)

David Ossitt

charles hercock

“Remember that in every reorganisation 25% of the money is wasted in the reorganisation process itself. Lansley tells us that £80,000,000 is at stake and therefore £20,000,000 is to be wasted. Sad”

Where is it writ?

What rule of commerce dictates that 25% of any given sum will be wasted?

Methinks this is total utter codswallop.

PayDirt

This is on a par with Brown’s calling that life-long Labour voter a bigot. It is that game-changing. It is shaping up to be a horrendous own-goal by the Tories.

MHP

GPs are overloaded with mountains of red tape electronic and otherwise.GPs spent a lot of time training and developing medical skills to enable them to look after their patients.The fact that they struggle to do so is because Byzantine paper shufflers are determined to ensure that the mountain of paper and other obstacles they create inreases to the disadvantage of patients and their GPs.There is no other reason for their existance. Paper shufflers are by nature unproductive, that is why they gravitate to the sheltered workshops Governments create and lavish these places with bucket loads of taxpayer cash.It is a surprise that GPs see any patients at all weighed down by the incessant demands from that lot. If Lansley has the stomach to rid GPs of the shufflers then GPs will be able to get on with spending their valuable time with their real job, seeing patients.I say go for it Lansley, no more talk, action please.

AG

I'm with paydirt.
The government is handing control of the NHS to the least qualified level of service of doctor and they in turn will be guided by the wishes of the man and woman in the street.
Public Health is the correct specialty of medicine to organise health care.
The proposals remind me of the French Revolution where the people were in charge.
That turned out well didn't it?

Mycroft

'Sorry it is £80 billion at stake and £20 billion lost.' Don't, it's drivel anyway; you can't seriously imagine that 20 billion (yes, billion) pounds will be lost in reorganiztion costs? That is what comes from working from an entirely arbitrary percentage. For one thing, the percentage lost on reorganization costs will vary enormously according to the size of the sums involved (let alone the specific nature of the reorganization). Silly debating points like this take us nowhere.

oldtimer

Decapitation of the existing power structure (ie the health Trusts etc) is one way to start. The cultural obstacles will, I imagine, also be formidable - by which I mean the transition from the monolithic structure of the existing bureaucracy to what I assume is intended to be a new, more decentralised, structure. Many will not want to leave the existing comfort zone for a more accountable world. Some will fail to make that transition. Has Mr Lansley worked out how he will deal with the failures?

Y Rhyfelwr Dewr

My prediction: nothing will really change. There'll be lots of talk, lots of action, lots of energy, and the occasional free school's launch fanfared, but in five years' time, things will be much the same as they are now. The government will go into the next election saying they need another term of office to finish the programme, but if they win, things still won't have changed much by the subsequent election.

This is because nothing ever changes much. I've been re-watching "Yes, Prime Minister." Few comedies are still funny when they're thirty years old. In the case of that one, everything that was an issue in the 1970's is still an issue now: NHS wastefulness, civil service bureaucracy, EU shenanigans, chaotic and over-priced public transport -- in thirty years, nothing has changed!

Plus, I remember how everybody moaned about the education system when I was a schoolboy -- actually about when "Yes, Prime Minister" was the hot, must-see comedy on TV. And still nothing has changed!

So I'm going to guess that Michael Gove is not going to achieve the miraculous, and in five years' time, we'll still be saddled with a hopeless and unworkable education system that everybody agrees is in desperate need of drastic reform.

And yes, in five years' time, there'll be another politician telling us he knows exactly how to do it. This is because politicians don't change either.

Simon Stephenson

Reading the Telegraph article, and the swoonimg over Blair, I'm reminded of an adage from a good many years ago. "Any clown can sell what isn't available", I was told, "the true test of a good salesman is to sell what is available".

And so it is with politicians, I think. It's not really much good dreamboats like Blair going round talking about what he'd like to happen - people such as this are two-a-penny. Real talent lies in those who are able to differentiate between realistic ambitions and impossible pipedreams, and for this it is essential that they have an acute sense of how they are going to go about ensuring delivery of the choices they have made.

But then, I'm aware that the stretching of logic in the 21st century has given rise to the lack of understanding that, to secure good outcomes, more is required than just vision and good intentions.

gordon-bennett

The NHS has to connect millions of patients with thousands of hospital doctors via GPs. It is not a medical matter until the two participants are connected.

Therefore, drop the silly preciousness of nulav's attitude to the NHS and get all the consultants to make their services available via Ebay.

A speedy and simple method of resource allocation and with a feedback system. What more could you want? Do it tomorrow.

Trafalgar

What has impressed me is the sheer speed at which the coalition is implementing reforms - an overhaul of welfare, education and health within two months of taking office is astonishing.

Cameron prepared for office well in advance of taking power and has made decisions rapidly, in stark contrast to Blair who wasted a full term before getting to grips with any meaningful reform - by which time it was too late.

All aided and abetted by the vacuum in the Labour leadership. Tactically, Cameron is playing a blinder.

David Bouvier

Charles Hercock - you need to appreciate the difference between pass-through costs and operational budgets. The PCTs nominally account for £80bn. But the cost is incurred in pharmacies and hospitals.

Would 25% of one years running costs of PCTs be a fair estimate - yes. The NHS frankly specialised in costing a lot more than this to achieve nothing material. But by abolishing a whole tier they stand a better chance of achieving real change at reasonable cost.

Richard - No mandate? What did you think cutting excess NHS managers and trusting frontline clinical staff meant? Just the usual guff?

Getting used to politicians who act as well as talk yet?

Paydirt - has it occured to you that you switch dentists because they are paid for what they do in a mixed economy of care. And you don't choose a GP because they are not. Cart before the horse methinks.

As some point out - the critical question is can this bunch actually deliver change in the bureaucracy. Do you remember after a couple of yearsd of Blair suddenly they got very concerned about "delivery" which unfortuatelym became delivering of statistics and headlines, not improvements in reality.

Hopefully our guys have started thinking about how to deliver change, including creating mechanisms and interests that will sustain change, so they achieve it. The creation of grass-roots support for free schools is an example where they seem to have thought it through. I hope there is more.

Simon Stephenson

Trafalgar : 11.21am

It's all talk so far. Don't go overboard.

Rhoda Klapp

You know, if you have animals, you can always get a vet, and veterinarian services, operations, medication, whatever is needed. There is no NHS for vets. Vets seem to manage budgets, and arrange premises, services, coverage and their own education and training and that of their staff. All on their bloody own. No AHA, PCT, NHS, ministry of vets, nothing (yes, I know there is a ministry of interference, but it doesn't plan anything), Which leads me to think that much of what is written above is the purest bollocks. The money only needs to go with the patient. Everything else will follow.

PayDirt

David Bouvier: this is where you are so wrong. The difference between dentist and doctor is that the dentist just fills in my teeth, the docter however holds the power to switch off my life support machine. If you cannot see the difference you should not be commenting on how to run the NHS.

AG

Rhoda.
The successful vets are very good at getting little old ladies to fork out a fortune to keep their old moggies and doggies alive with expensive drugs,immunisations, ops and the like. I'm not sure if this would satisfy the 'first do no harm' test on beast or human. Meanwhile down at the PDSA......
Welcome to the future of the NHS.

Rhoda Klapp

AG, I do not defend the vets, or their prices. I merely point out that it all happens without any of the bureaucracy required in the NHS. I could have mentioned all the countries that seem to have GP services without all that stuff, but there I would have been outside any personal knowledge. There are vets. They do not need area health authorities, nor primary care trusts, not vets flown in from foreign countries who get tons of dosh for out-of-hours coverage. They need no public funding to build their premises, or supply their training. I contend that this demonstrates those things could be done without for GPs, if we had started from a different place perhaps. Indeed the country was covered by GPs before there was an NHS. That makes it a stretch to claim that GPs, sad and dumb as they are, could somehow not manage to look after themselves and their funding, just to make an argument against change. I don't think the reform goes far enough, I want the money to go with me. Then we'd see about ringing for an appointment on the day, not before 0830, and they are all gone by 0845, except the phone is engaged for all that time, and I'm late for work because I had to stay at home in case I got in, never mind, try again tomorrow. Rant, if not over, paused for now.

balvennie999

The problem is that reform is not radical enough. Yet again we have a government beguiled by the sweet-talking tongues of the General Practice faction in the BMA. The real change that is needed is to abolish General Practice as it now stands and replace it with a system of local area polyclinics supported by regional hospitals. Commissioning should be in the hands of public health specialists, who are trained in population needs assessment. The white paper barely mentions hospital consultants who make the real decisions about patient care, develop new treatments and who are currently baling out the expensive mess that is the current primary care, especially out-of-hours.