A wise man is one who knows he knows nothing
Okay, so I’m a woman, but I strive to be wise and here I am, risking ridicule, admitting how little I really know about the NHS and current conversation about the Health Reform Bill. But before you turn your nose up at my ignorance, please stop for a moment and give me some credit for a) daring to admit the holes in my knowledge and b) being proactive enough to try to change that, for that is what this blog aims to do.
I need your help
I am a fan of the NHS. I can’t imagine life without it. I’ve spent time in the US and am utterly gobsmacked by the reality of their (lack of) health system. Paying to see a doctor? It just doesn’t compute in my mind. I realise how lucky we are to have the NHS.
I know that there have been big changes over the last few years, but I don’t know enough about them. I know that there has been a lot of conversation about the management of the NHS, but I don’t know enough about the structure of the health service to know if these were positive changes. I’ve heard about postcode lotteries and a push to allow patients more ability to choose where they are treated, but I don’t know if that makes things better or worse.
I know that there is a lot of talk about the Health Reform Bill at the moment, but to my shame, I’ve not had the time to try to unpick what it is and what it means for the health service, or what it includes at all, if I’m really honest. I know there has been debate about shifting more decisions onto doctors: “they are on the frontline, they know better where the money should be spent” vs “they are doctors, they should be concentrating on using their medical training to treat people”, but I don’t know where we’re up to with that.
Twitter has opened my eyes to the unease of people in the medical profession, I follow a lot of people specifically because they have better insight and knowledge about subjects I care about. In fact it was this tweet this morning from David Colquhoun to @libdemlife that made me stop and think about just how little I know.
In my defence, I can’t be the only one, and that’s why I want to do this. I want to create a bridge between those in the know, and those of us who support the NHS, but don’t have all the answers. Who don’t have all the facts we need to put forth strong arguments against all the points raised, and if, as it seems, this Health Bill is worrying those who works for the NHS, I want to make sure that I am armed with enough understanding of the issues that I can explain it to others.
The Plan
If I can come up with a list of important questions (please feel free to suggest some) perhaps I can persuade some of those voices on Twitter to share their knowledge with me. It would be great if we could get some of these voices recorded so that I can put together a quick ‘Idiots’ Guide to NHS Reform’ podcast. Using Audioboo this would be very simple, and I’ll happily help with that side of things.
What I need to know
- Some general background to the NHS, why it’s such a good thing to have (sounds obvious, but for the sake of making a nice podcast, good to have)
- The current problems the NHS faces
- A bit about what the Health Reform Bill is
- What the split of opinions are, and who holds which
- Why people are against the bill
- What could happen if it goes through in its current form
- Why people should take note of what’s going on and what they can do about it
Can you help with any of these? Please get in touch if you can – either here in the comments on by sending me a tweet as @RadioKate.
I’d like to get a range of voices, and create a useful resource for those, like me, who support the NHS, but haven’t had a chance to learn all they should about what’s going on at the moment. I know I should know more about all this, but I feel a bit like it’s a hit TV series that everyone is talking about and I’ve missed the first few episodes, I need some people to help get me up to speed. Many thanks in advance.
RadioKate 
Hi. I’m an academic from Durham Uni (my blog is at t1ber1us.wordpress.com, twitter @ijgreener) who has strong feeling about the NHS (and the Bill). I’m generally better in word form, but happy to have a go at voice if you think it is the best of doing this (I’ve been on radio a few times before). If this is helpful, drop me a line.
Will try and call back and add something, but 2 I would immediately suggest you should follow on the twitter are Paul Corrigan, was advisor on NHS first to Milburn and then to Blair, and Roy Lilley, an ex NHS Manager not afraid to call a spade a spade, both of whom are in favour of ‘reform’ but against these specific reforms.
Hi Kate,
I’m new to blogging, both reading and writing (I hope to get my blog “Pride-in-nursing.wordpress.com up and running asap but it’s all a bit confusing).
I’m not new to the NHS though, having been a patient on and off for 57 years and having nursed for 35 years (recently retired). My husband is a recently retired doctor. We have suffered all the many changes politicians and academics have thrust upon us and the current proposals are the silliest yet.
In my opinion the politicians want to push the responsibility of running the NHS on to clinicians because they want them to fail. They want the NHS to collapse (it costs them too much) and they want to lay the blame at the Doctors door. There are some doctors who want to go along with this because they would make far more money if everyone had to go privately as they do in the USA. The NHS is a marvellous institution but we need to rethink how we as a nation fund it to provide a 21st century service.
My main concern is how nurses are trained ….. or not. I’m also very worried about the number of untrained and unregulated health care assistants are providing “nursing care” …. or not, in our hospitals. If the general public only knew their hair would curl.
Couldn’t agree more. You only have to look at what has happened to what we used to call long-term care – sure the physical facilities are better, own rooms, nice decor, but all the hands-on care is meted out by Healthcare Assistants, paid minimum wage, sometimes don’t speak English very well…. this is what the private sector means. Our NHS isn’t perfect, but of the 100s of interactions my famiy and friends have had only a very small minority have been poor quality. Many times the care has been excellent.
Hi dgjulie,
In case you’re interested I’ve got my blog up and running. Here is the address.
http://prideinnursingdotcom.wordpress.com/
Any support welcome
I agree that the real problem is fragmentation – lack of a coherent whole. We (those of us who work in the NHS) have striven over the years to make care pathways “seamless” so the patient didn’t have to know where organisational boundaries lay, but patients will soon be forced to know exactly who provides what – or more to the point – who doesn’t provide what they need.
Perhaps you are more of a legal expert than I, but I have relied upon the independent legal review commissioned campaigning group “38 degrees” and they advise that “The Secretary of State for Health will no longer be accountable to Parliament to secure and provide a comprehensive health service.” This is a very significant departure – the buck will be shoved elsewhere.
No much has changed since I wrote this last year: http://www.politics.co.uk/comment-analysis/2011/06/13/comment-listening-pause-was-too-little-too-la
A few other pointers I’d suggest (purely personally, not the views of my employers etc.)…
1) The ‘privatisation’ debate is a red herring. The NHS will still basically be there and still basically work. The real problem with the proposed reforms, in respect of communicating them, is that they are very technical. The best argument against them is that they won’t work terribly well.
2) The changes are happening, bill or no bill. Indeed a bill wasn’t really necessary, for most of the changes – the bill, too, is a bit of a red herring. PCTs have been ‘clustered’, the Clinical Commissioning Groups are being set up… it’s all happening, and like any NHS restructure mostly doesn’t need Parliament’s authorisation. So scrapping the bill, or sacking Lansley, will make no difference. Indeed, the smart thing to do would be to keep Lansley around to take the blame for the scandals, when they start…
3) Scandals? What type of scandals? Well, the NHS’s budget is being cut (the “protection” is only very technical; inflation for care far outstrips high-street inflation, which is the measure of the “protection”). So quality, performance and safety are starting to suffer. Somewhere there will be services in deep trouble; next winter we will have old people on trolleys in hospital corridors again. Or the scandal might be one of costs: with lots of new institutions responsible for commissioning services, there is bound to be confusion about who is responsible for commissioning what; but a lot of services will just keep happening – the NHS could lose control of its costs (again). And/or the new CCGs will fail to appreciate the importance of commissioning more specialised things like dedicated nurses for, say, MS; there could be a lot of services vanishing from the NHS in some parts of the country therefore.
4) Don’t overlook the importance of other services. Benefits and social care are both being cut; this is likely to have knock-on effects for people’s health, so the NHS will have to pick up the slack.
Hi – happy to talk, it’s too much to put in a tweet!
Jacky Davis
campaigning doctor, founder member KONP, fighting bill
for last 18 months etc
The privatisation debate is a red herring? ? what? Not only opening up healthcare to private providers – but forcing commissioners to go out to competitive tender. The main regulatory body (Monitor) will have as its primary purpose ensuring that competition does take place. As you have stated in point 2, changes are happening anyway. The critical differences if the Bill becomes law are that the Secretary of State will no longer have a duty to provide care, and that private providers will be able to get a stronghold. Hospitals and community services who get into financial difficulties will be bought up by the big private healthcare firms – so they won’t be NHS anymore. The GPs are not strictly speaking NHS anyway, they are contracted by the NHS. If the NHS hospitals are no longer NHS, the NHS commissioners (e.g. PCTs) are no longer there, Public Health staff will largely be in local authorities – what will be the residual be the NHS? Who will work in the NHS?
The points you raise illustrate exactly why it’s far more complicated than just being about privatisation. Competition and privatisation are not the same – you could have a load of public bodies competing with each other, after all. The CCGs (replacing PCTs, of course), NHSCB and its residual arms will all still be statutory bodies, the PCTs will linger on as ‘commissioning support bodies’ (and so do much of the actual commissioning in practice) and the service will still be tax-funded. Nor is it a simple case of private = bad, public = good; there are some excellent private providers out there and some poor NHS ones (though I’m sympathetic to the argument that profit and patient service are competing motivations).
The real problem is fragmentation and the complex phenomena that flow from it: the NHS is being transformed from a (more or less) integrated service into a nexus of commercial contracts. Care will not be integrated, costs will not be controlled, decision-makers will not be accountable, bureaucracy will not be reduced, quality will not be maintained. And yes, this will often manifest itself as private providers doing it cheaply and badly. These are enormous dangers. Boiling them down into one word is not adequate; even if it were, that word would not be ‘privatisation’.
On other specific points: it’s debatable whether the Bill’s duty on the Secretary of State is substantially changed, but the political reality is s/he will continue to be accountable, so don’t get side-tracked by that; public health staff were in local authorities until the mid-70s anyway.