A question of trust for Andrew Lansley

perdix

It's not surprising that the medical unions don't want anything that appears to challenge the status quo.

Russell

I can assure you the public who pay for the NHS(which excludes taxpayer funded public sector employees and their Union cronies, labour party MP's, Labour & LibDem Lords)only care about the service they get from the NHS which they pay for.

All NHS employees care first about their jobs, including their pay and pensions, before their customers(patients).

Try carrying out a poll amongst the only people who pay for the NHS, along with all the other public services.

Axstane

You can lead a horse to water but you cannot make it drink.

Colin Forster

The YouGov question is hugely loaded and I find it truly staggering that only 60% of people got the right answer.

THOMAS KNIGHT

The Health Bill is toxic waste for the Tories. Cameron's duplicity - 'No top down reorganisation' - will not be forgotten - Cameron has hitched himself to failure.

Carry on Regardless may seem like a clever strategy but it's higher risk than it may appear from the Downing Street bunker.

ellis000

Ask the1.2 million people who work for an organisation and the 50 million or so who use it for free whether it should change and you will get what as an answer? It is about time we secularized the NHS and stopped listening to the vested interests who imbue the preservation of the staus quo with all the fervour of religious zealots Machiavelli said "There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things". He knew a thing or two about taking on vested interests. As I type this I am watching Sky News distort the debate by parading the usual suspects from the unions, professions and hysterical haridans. I doubt the BBC are any different. If we stay the same we will never get out of the mess we are in - if only Machiavelli was whispering in Cameron's ear.

Slim Jim

Good article, Peter. One can only be left wondering who on earth we can trust to reform the NHS. One thing is for sure - it does need reform. An organisation as large as this can never be as efficient as we would like.

starfish

Hmm

Perhaps they should revise the question?

Somnething along the lines of:

Given the stupendous and ever increasing proportion of national resources being devoted to the NHS, and the facts that demand continues to rise and outcomes are not particulalry good when compared to similar sized economies should we carry on as we are (as the unions for the workers, nurses and doctors demand) or try to find a way to put a brake on expenditure and look at altentative ways of providing healthcare free at the point of delivery?

Quite why people who have been implacably opposed to change should object when the govt invites in people who are prepared to discuss it beats me.

John

The real question is whether you trust that McKinsey and KPMG, the authors of much of the bill, and the private healthcare companies bankrolling the Tories really have your best interests at heart.

OwenPD

I've been a GP for a long time. Cameron's claim that reduced use of A and E attendance­s in 2011 provides evidence of benefits of NHS reforms in 2011 is both rather pathetic as well as completely flawed. The figures simply indicate that the NHS isn't broken (yet, despite considerab­le existing disintegra­tion of services and profiteeri­ng) and although barely holding its own the last thing it needs is an even more extreme disintegra­ting top down shake-up. Integratio­n requires people working together not competing for profits. The USA system is a humanitari­an disaster, the last thing we want for the UK. Get rid of this inhumane and destructiv­e bill - get back to basics, let GPs have real influence backed up by good management and experts on evidence combined with transparen­cy on rationing. Personally I would be happy to forgo expenditur­e on much preventive primary care aimed at 'lifestyle­' (such as anti smoking, Cholestero­l reduction, obesity campaigns etc) in favour of spending on those in acute need, the ill or those in need of operations­, care of older people in the community or mental health support. Let's focus on the needy, and resist a free market approach that will lead us directly to a USA style abominatio­n.

Davey L.S

I don't think I would necessarily trust doctors more on this or not, but as I have said on a previous post I don't really know what the "reforms" will do, will they make the service better, and how will this be done. I am not taking on trust from any politician that this is the case, who is going to explain it. I would imagine many in the NHS are also confused. I would have thought a degree of working with NHS is required for the reforms to work.

wrinkled weasel

Never mind a religion, the NHS has the status of a cult. It's employees appear quite prepared to commit mass suicide in it's name. If you want to see how dysfunctional it has become, just read today's headlines. 3000 women have gone crying to the NHS because of alleged faulty breast implants and for the most part the NHS has fallen over and had its tummy tickled.

Until an element of competition is brought in, managers have no incentive to pick and choose and the British worker will have to pay for the consequences of failed vanity surgery. Hardly "frontline" is it?

daniel maris

Ellis -

I am not sure you would get a "it must change" answer from the public. They'd probably ask for more resources, as long as they don't pay for them.

Richard Blogger (@richardblogger)

It shows that the whole affair has been incompetently presented and implemented. The blame is not on Lansley - who has never been known to speak in a way that most people can understand - but in Cameron and, significantly, in Steve Hilton. Nowhere on the grid does it say cockup, but that is exactly what this is.

DavidDP

"The USA system is a humanitari­an disaster, the last thing we want for the UK."

Okay. And who is proposing the US system? Because it's certainly not anyone in the current Government.

BlueonRed

Owen PD:

When you talk of profiteering in the NHS are you talking about GPs also?

Mr Oulton

The question is - from whom would you rather buy a second hand car. Andrew Lansley or your GP? Given his paymasters, sorry - funders of his office - I know I'd choose the latter.

TomTom

Typically mediocre thread full of the usual claptrap. Camaeron and Crew have NO mandate. Before the election he did not want top-down reorganisation now he does.

This is pathetic and doomed to failure. The Org Chart shows the mess and McKinsey which screwed things up under Keith Joseph is in the thick of it.

This has the potential to be the disaster that sinks the Conservatives forever and commitments to windmills, gay marriage, and £9000 tuition fees won't save them.

It is actually quite funny to think this regime could collapse and never get anywhere near power ever again; not because they propose NHS changes, but because they are so incompetent and inexperienced. They are a laughing stock

OwenPD

Profiteering in the NHS and a US style disaster in the making: it seems to be human nature to make selfish decisions and history shows us that GPs have profited from previous NHS reforms (e.g. Fundholding GPs capitalising on state funded surgery improvements in the early 1990s.) Hence it is important to minimise the conflict of interest that arises when GPs can commission their own services, and to regulate it where it is possible. Otherwise trust between patient and GP is eroded. With a free market approach to health, as in this bill, profit will be king. Providers will cherry pick those conditions where there is money to be made. Private healthcare will expand as providers sniff out more profit. Insurers will only
insure those without 'pre existing' conditions etc and hey presto we're in the war zone that is USA healthcare. Not what I want.

philip747

Pensions-  problems,misunderstandings and a solution.

In the Times on Saturday Dr Hamish Meldrum, chair of the BMA, said that the government pension changes were “a  very thinly disguised tax on public sector workers – continuing the  BMA claim that the government makes a profit out of the NHS pension scheme, an allegation which does not help to create an atmosphere conducive to rational discussion over NHS reform.

In January of this year the BBC reported pension consultant John Ralfe as calculating that the controversial increases in retirement age yielded no financial savings to the taxpayer because of increases in accrual rates to as much as 1/54 annual salary for each year worked.In March 2011 Dr Ros Altmann told the public accounts committee that in the private sector public sector pensions would cost between 30 to 50% of salary but that the value of these pensions was not appreciated or understood by the workforce.
 
Until the recent introduction of  Whole of Government Accounts, the Treasury made no provision for unfunded pension liabilities, on the basis that future governments could change their minds and not pay the pensions -- an assertion which enabled some to claim that the pension schemes were little better than a fraudulent Ponzi scheme, taking money now from workers against an illusory promise of future payment.
 
 So we appear to have the worst of every world -- a scheme which is much more expensive than we think from the taxpayer's  perspective,and  which is undervalued by the workforce.
 
Some light was cast on this problem by the appearance of Sir Nicholas Macpherson KCB permanent Sec HM Treasury on 5 December 2011 before the Public Accounts Committee and  published on 7 November 2012 in their report on the WGA.
 
On pensions Sir Nicholas opened his remarks by saying he had got his chief micro-economist to write him " a very good piece of paper" I think that this is code for "I don't know too much about this topic”.
He said:-
“ At the current time, gilt rates are very
low indeed. If we were using current gilt rates to set
contribution  rates, they would be very much higher.”
Which is correct.
A few moments later, he said ” Say the economy really began to pick up and gilt rates moved back to their normal level of around 5%. That would result in a doubling of contribution rates.”
Which is completely wrong.
 
The discount rate is used to calculate the amount of money needed now to pay a pension in the future, so the higher the discount rate the less money is needed today. What worries me is not so much that Sir Nicholas got himself somewhat mixed up, but rather that the PAC, who are usually rather good on pensions, did not spot his mistake, which found its way into the evidence attached to the February report
This level of uncertainty over a liability estimated at £1,132 billion as at 31 of March 2010 is clearly a problem.   Is there a solution?
 
I think there is. The office for National statistics is now producing, on an annual basis, as required by EU regulation, a note including unfunded pension liabilities.. So that all EU countries do this on a comparable basis the discount rate is specified at 5%. Now that the truth has to be out in the open, this is a wonderful opportunity to take a more sensible approach to these liabilities. At the moment current contributions are used to pay past liabilities -- i.e. existing pensioners, and any surpluses kept by the Treasury and used for current expenditure. However the liability to pay the pensions remains with the taxpayer, the point overlooked by Hamish If it was decided to move the unfunded schemes to a fully funded basis over a period of say 40 years, it would be possible to introduce a substantial dose of realism into the actual costs. Of course this would involve paying the current pensions and also providing for the full cost of pensions going forward, but if the pension fund was invested in capital projects, otherwise to be funded out of general taxation, this would not necessarily increase government spending. Such investment has been suggested for private sector pension funds, and using such a fund to replace the discredited PFI initiative, and to fund projects with a long-term value such as used to be done with the local authority housing projects, which were funded on a 40 year sinking fund basis in my younger days, could provide a useful boost to the economy.
 
Such a change would mean that workers could be told the true cost of the pension schemes, and be assured that the Treasury will not just be taking a profit in some kind of Ponzi scheme as some now believe. The government would find that the trade unions would be easier to negotiate with -- in fact they live in the real world and some have had substantial pension deficits of their own. They also know that there is a limit to how much pay their members wish to defer into a pension scheme.
 
It may take longer for common sense to break out at the BMA. Many doctors of my acquaintance have believed the BMA line, but they are intelligent people and it will be up to the government to communicate clearly any new arrangements. One of the problems with pensions seems to be that responsibility is distributed around Whitehall and clearly  the Chancellor of the Exchequer will need to take a firm grip of the situation to initiate change. He may not want to ask Sir Nicholas to deal with this.