Too far, too fast?
David Blackburn 9:02am
It is hubristic of David Cameron to talk of his ‘legacy’ at this stage in his premiership, not least because he invites
criticism that the government’s public service reforms are going too far, too fast. The leaders of six health unions have reacted to the imminent publication of the Health and Social Care
Bill with a concerned letter to the Times (£); they argue that price competition is divisive and that the
reforms promote cost above quality.
Dissent has spread far beyond the usual union suspects. Dr Sarah Wollaston, the Tory MP for Totnes, has expressed her misgivings and there have been numerous accounts of GPs’ reluctance to embrace commissioning reforms – GP consortia are going to handed nearly 80 percent of NHS funding to manage and spend. Local government is to be involved in the local wellbeing boards, which will regulate local health strategy, is yet to complain with any conviction but can only be a matter of time – they are being asked to share responsibility and therefore the blame as well.
So, our national religion is as strong as ever. The Today programme’s spin is that the government is divided, suggesting that Andrew Lansley ‘ran away with himself’ and that Cameron is now trying to ‘row him back’. Speaking to Today (in a difficult interview), Cameron reiterated that his politics revolve around those three letters: NHS. He expressed his conviction that patient choice and inter-service competition would improve standards, ending the false hope offered by targets. He endorsed Lansley’s argument that these reforms are evolutionary not revolutionary – the culmination of market reforms introduced by Kenneth Clarke, Virginia Bottomley and Alan Milburn over the last 20-odd years. He also described them as immediately necessary, citing an OECD report that damned Britain’s cancer survival rates and coronary care, as well as raising the spectre of budget black holes and ever more expensive treatments. There is no more money; there can only be reorganisation. But the pace and scope of change is very much open to debate.
Previous
stephenDC
January 17th, 2011 9:15am Report this commentIt was an awful interview, probably the worst Cameron has done, certainly the worst I have heard him do.
He seemed to be playing buzz-word bingo with little idea what changes he was defending and certainly no clue about how and why he was supposed to be defending them.
I suspect Cameron will come to regret pinning his Mr-NHS reputation to this poorly thought-through reorganisation
Naomi Muse
January 17th, 2011 9:23am Report this commentCameron's even mentioning his 'legacy' at this stage implies hubris is already setting in, and that is bad for all of us.
There also appears to be a top down reorganisation which is what the coalition said it would not do, so it's communications are a bit suspect, or its actions, or both.
Maybe Andy Coulson is preoccupied with fire fighting on the NotW front?
Fatbloke on tour
January 17th, 2011 9:23am Report this commentDB
Is it possible for a messiah complex to go an ego trip?
Dave the Rave really is a muppet.
Where is DD when you need him.
His silence is all a bit too Napoleonic for my liking
arnoldo87
January 17th, 2011 9:27am Report this commentThe government is treading on thin ice here. There is no doubt that the NHS is in a better place than it was in 1997. The money spent by Labour was almost certainly done in a profligate manner but, from the patient's point of view, waiting times and quality of service have improved.
Time may prove that Lansley's reforms are just what are needed to take the NHS to a new level of efficiency.
Given the size of the deficit-reduction task, though, you have to ask if this is the time to introduce them, or if it is worth incurring the undoubted wrath of the voters if the project fails.
Maggie
January 17th, 2011 9:28am Report this commentPlease supply the quote where David Cameron uses the word "legacy". So far I've only seen it used in print by his enemies and I have my doubts about whether he would ever use such a word.
David
January 17th, 2011 9:32am Report this commentI am fed up with all the left wing bias in this country complaining about every policy and every cut, one page of the newspapers it says we need to make cuts and do this and that but on front page knock it.
It time to let the government get on with it.
Vulture
January 17th, 2011 9:37am Report this commentHubris and vanity PR puffball Dave go together like fish and chips. Nemesis will arrive shortly.
The last person to take on the combined might of the BMA and the health unions was Nye Bevan when he introduced the NHS in the first place. But Cameron is no Nye Bevan.
Wyrdtimes
January 17th, 2011 9:49am Report this commentTerritorial extent?
It's England.
JohnOfEnfield
January 17th, 2011 9:53am Report this commentWhy should we want to save an NHS that killed up to 1400 people at just one hospital? The cover-up has been total. As yet no one has been brought to justice.
Yam Yam
January 17th, 2011 9:56am Report this commentArnold - "The money spent by Labour was almost certainly done in a profligate manner but, from the patient's point of view, waiting times and quality of service have improved."
Sounds a bit like being charge £20,000 over the odds for a new car that is no different to your existing one, except it has jazzier alloy wheels and a more upmarket stereo.
Besides, are most patients not also taxpayers?
Holly ......
January 17th, 2011 10:01am Report this commentPeople accused Blair of being right wing.
People accuse Cameron of being too much like Blair.Yet say he is too left wing.
The entire media is left wing and are fighting Cameron tooth & nail.
Granted they shove in the odd praise here & there,but not much.
The unions,the media,the blogs are all running scared.
If the whole public sector blew up it would land better than it is now.
Council bods moaning at the services being cut,while they allow the top bods to rake in the pay and squirrel money away,OUR money,Not theirs!
Fighting and winning the left is what this governments 'legacy' should be about.
What point would the blogs serve,if at the next election the majority of taxpayers are
okay with the previous four years?
The media,whatever its form,is fighting for it's reason for being.
It is all very well trying to get rid of the coalition,but what do we have to replace it with?
Ed & Co?
Olaf
January 17th, 2011 10:04am Report this commentHis 'legacy' might yet be Tunisia style rioting if petrol, energy and food prices keep rocketing. Just wait till the bank starts ratcheting up interest rates and the number of people struggling to pay mortgages, driving to work and feeding their kids reaches its tipping point.
Mike Hobday
January 17th, 2011 10:04am Report this commentFrom the perspective of Macmillan Cancer Support, there's lots in the reforms to welcome - the shift from process measures to outcomes targets, the relative freeing up of clinicians, in many areas the growing influence of GPs.
But there are areas that still cause widespread concern. Call them cuts or efficiency savings, the english NHS has to find £20 billion of them over the next four years. Cancer prevalence is rocketing as society ages, yet no one things cancer spending can or even should do the same.
So the challenge of doing much more (and improving quality) for the same amount of money is a massive one, and made tougher when we are cutting heavily into management expertise/ (or overhead) at the same time as we are reorganising.
In the true sense of the phrase, this is a business risk.
tomdickandharry
January 17th, 2011 10:33am Report this commentdoes no one else see the rank hypocriscy in complaining that the Police are swamped in paperwork and should be left to 'do their job', then introducing these NHS reforms that will only serve to drown doctors in beaucracy? Furthermore, after years and years of training in medicine (not business), why are we wasting doctor's times with so much financial work?
And yam yam, better wheels and stereo are for vanity, better services and shorter waiting times led to improvements in health outcomes and the patients' relationship with the NHS. To argue that the NHS didn't improve under labour is disingenuous. It may not have done so proportionately to the amount of money put in, but there are several reasons why that is the case... under-funding by previous government, necessary increase in pay for nurses and doctors, increased demand on NHS and of course, constant tampering and top-down reforms that are costly but don't improve services... which is exactly what Cameron and co are doing now.
michael
January 17th, 2011 10:41am Report this commentThe State : -Everyone wants the money, everyone wants the power, everyone wants the kudos when hunky dory abounds.
-The slightest issue however, is like the last night of the proms...the orchestra hits a bum note the 'proms' bob down as one yet no one dare be the first to stick there head back up again.
-Ultimate responsibility is completely taboo, there's no BONUS in it.
th
Holly ......
January 17th, 2011 11:17am Report this commentOlaf.10.04.
Even if the government lowered the tax on fuel/raised interest rates,the cost would STILL rise.
As with other things,ie cotton wheat etc,
the weather in producing countries also plays a part.
So the tax goes down,leaving the treasury with less to close the Labour deficit,and the price to us STILL goes up.
May as well do the country MORE good down the line,than the usual Labour tinkering,
that has cost us so heavily.
You see for short term headlines and the fact it is NOT their money,Labour would lower the price of fuel.
If you had £600.00 per month coming in and your outgoings were £800.00,would you seriously borrow every month to bridge the shortfall?
If so...not long to bankruptcy.
This applies to ALL incomes.Whether personal
or governmental.
Labour caused the deficit,by spending too much and borrowing during the 'boom' years.
Bad party,bad policies,bad ministers.
PayDirt
January 17th, 2011 12:06pm Report this commentToo far and fast, personally I think the Govt should print some more money and pay the nurses more. After all it helps wonderfully to see nice attractive nurses adorning the wards, improves recovery rates no end, and worth waiting for.
TomTom
January 17th, 2011 12:08pm Report this commentEarl Howe, Health Minister formerly of Barclays Bank. No wonder bankers are gleeful. With NHS Insurance demanding Co-Payments for treatments at PFI Hospitals they are going to be onto a winner with Surgery Loans and Top-Up Insurance Schemes.
This is the new goldmine for Bankers
arnoldo87
January 17th, 2011 12:25pm Report this commentJust watched Dave's speech on public service reform. He was mightily impressive even though he could be accused of showing the naive optimism of an enthusiast.
Most interesting was his recognition that his political positioning combines the best of Thatcher and Blair. This indicates the potential, in the medium to long-term, for a new party comprising the Cameroons, the Blairites and possibly some right-wing Lib-Dems.
It probably cannot coalesce until the advent of full P.R., but if and when it does it should be the natural party of government for many years thereafter.
Commentator
January 17th, 2011 12:54pm Report this commentTomdickandharry regurgitating the nonsense that all the NHS ever needs is more money. It is a second-rate rationing service which no longer provides universal healthcare and is not the envy of the world.
AngloWelshDragon
January 17th, 2011 12:58pm Report this commentI don't recall DC ever referring to his legacy. Please supply the relevant quote.
local local
January 17th, 2011 1:12pm Report this commentHumphreys was his usual bullying self, but Camerone missed two crucial arguements he could have made.
First, that NHS productivity improved between 1990 and 1997 when GP Fundholding was increasing, but plummetted after 1997 when it was scrapped - and it did not improve when PCTs were introduced.
Second, the fuse on the demographic timebomb is burning and if we delay reforms it might well blow up in our faces.
If it were done, when 'tis done, 'twere well it were done quickly!
Olaf
January 17th, 2011 1:23pm Report this comment@Holly ......11:17
Which would be acceptable if so much money wasn't being wasted on pet projects, financial bombs left by the outgoing administration and the EU.
At the moment being a 'good citizen' is becoming uneconomical.
HJ
January 17th, 2011 1:52pm Report this commentCan 'tomdickandharry' explain why he feels that the large pay increases for doctors and nurses were necessary?
Medics were already well paid in the UK (thanks to the power of the BMA). On average, it's easily the best paid occupation (substantially ahead of city traders or bankers in general). After the increases, we have by far the best paid medics in europe (as a recent OECD report pointed out). Our GPs are paid twice the western european average. There has never been a shortage of well qualified people wanting to train as medics in the UK, so pay wasn't putting anyone off. We have a shortage because access to training is artificially restricted (which suits the unions) and now we couldn't afford more anyway, so highly are they paid.
Nurses haven't done as well as medics, but they're now pretty well paid. They were always better paid than most people realised. The official average total salary for NHS qualified nurses is £34,200 - which is not bad, as 80% aren't qualified to degree level.
samson
January 17th, 2011 2:48pm Report this commentThe majority of RGNs earn far less than this unless they go
into management.It amazes me that even after having 4 children
Cameron still doesn't seem to understand the difference between a
midwife and a maternity nurse! This really undermines the midwifery
profession.
tomdickandharry
January 17th, 2011 3:52pm Report this commentHJ - ... You're right that nurses pay NOW isn't bad at all... but that only serves to prove my point. Part of the money Labour spent on the NHS was on improving wages of staff. In 1997, the average nurse would be paid around £12k annum... which is shockingly low. Now it's a respectable level as you said... around 34k. All I suggested is that while nurses are 'pretty well paid now' they weren't when Labour came into power, and the process of increasing pay of thousands of nurses from 12k and annum to 34k is obviously costly.
Commentator - I really don't think that all the NHS needs is money, don't put words in my mouth. I'm fully aware of the difference structural changes can make and the pros and cons of the internal market. I just pointed out that the NHS improved under Labour, and that the improvements were costly. As a proportion of GDP Britain has historically spent less on health than our OECD equivalents so if we expect a world-class service, we're going to have to spend money. However, there are a lot of improvements that can be made without spending money (e.g. allowing patients to book appointments directly with a specialist, rather than having to go through a GP).
alexsandr
January 17th, 2011 4:16pm Report this commentsave money on NHS?
Make people with diseases that entitle them to free prescriptions pay for those prescriptions that have nothing to do with their qualifying disease.
If they have a lotof prescriptions, they buy a pre payment certificate to the amount is restricted to under a tenner a month. And if they are really poor they get free prescriptions anyway.
You would have to find some mechanism so conditions caused by the main disease were still covered.
(Bear in mind that one chronic disease, asthma, does not get free prescriptions which is unfair)
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