Alastair's Blog

Return to:  Blog | Articles | Videos RSS feed

For Lansley, the hard part is still to come

Posted on 13 July 2010 | 1:07am

As the World Cup withdrawal symptoms abate (hugely helped by that abomination of a Final, over which the Dutch should stop whingeing about the ref and go kick someone their own size) I tuned into Newsnight and was pleasantly surprised by the depth and nature of the debate on the Tories’ health reforms.

I say Tories, because the Lib Dems have been quietly shoved aside on this one, as health secretary Andrew Lansley gets his way, with market forces coming in from all angles, and George Osborne gets his, with cuts and sackings a less voluble part of the overall plan.

Well done to Mr Lansley for putting himself up against a range of NHS professionals; and well done to Kirsty Wark for getting on top of the detail as well and as quickly as she did. As her interview went on, I could sense Lansley’s irritation rising. This was not, as is often the case with politicians and interviewers, because she was missing the point; but because she was getting unerringly TO the point(s) and he didn’t much like having to defend the nature and the possible effect of some of the changes.

‘More power to GPs’ is one of those no-brainers for a government trying to show its commitment to healthcare. Even in our culture of negativity, GPs remain among the most trusted and respected members of the community, so a minister saying he would take power from politicians and managers, and hand it to a nationwide network of Dr Finlay consortia, is superficially onto a winner.

But the qualities that make for a good GP may not be the same as the qualities required to handle that extra power, and the managerial and bureaucratic duties that go with it. That impression was rather borne out by the studio discussion. Added to which, any time I visit my surgery, the GPs seem pretty overwhelmed by the workload already.

Lansley looked and sounded more on top of his brief than Michael Gove has managed to do on schools, yet there were also too many unanswered questions to erase the impression that this policy was, a bit like free schools, being made up as it goes along, or that the driving forces remain cuts and growth of the private sector within the NHS.

And the really big unanswered question, which had Mr Lansley wriggling last night, is what happens when a new GP consortium or a foundation trust goes bust. I cannot believe they have not been asking that question, so it seems odd that there is no clear answer, or even the beginnings of one.

It will also be fascinating to see how managers who know they are likely to be out of work will help introduce the changes that are designed to lead them to the dole queue. Yesterday Mr Lansley did the easy bit – setting out a broad vision for a radical change. Making it happen won’t be quite so straight-forward.

*** Buy Prelude to Power here at Amazon.

  • Terry Daniels

    You have raised an issue which seems to have been ignored so far in all the discussions on cuts, reducing bureaucracy and cuttung over management – who will be undertaking these cuts etc. if not the managers and bureaucrats themselves. I suspect people will lose their jobs, but the managers will somehow miraculously retain their jobs. The Tories seem to be completely unaware of the theory of unintended consequences, that by trying to do one thing, either the complete opposite happens, or something completely unforseen.

  • BrickBone

    There appears to be no recognition of the fact that this is a re-hash of the early-90’s GP Fund Holding…which was a disaster. How does Lansley reconcile consolidation and efficiency of hospital services whist fragmenting the commissioning arms. Its crackers.

  • Cuse

    It’s the beginning of the end for the NHS. Within 3 years we’ll have standard fees to access basic NHS services. What happened to all the promises of “Front-line services will be protected” from the Mighty Cleggeron?

    The NHS doesn’t want this change – apart from a minority of GP partners who have already established links with companies such as Assura, Serco, Capita + Atos and who would be happy to levy fees to raise their personal incomes. How do I know? My wife’s a GP working in such a practice. Patient outcomes are absolutely secondary to Practice income. Medical procedures will be prioritised according to profitability.

    This is Thatcherism with no controls, dressed-up under the idealogue’s refrain of “the defecit must be cut”.

    Isn’t it odd that despite Gideon’s warnings that a down-rating of the UK’s AAA credit rating would send the Earth spiralling towards the Sun and the only way to deal with it is to take 40% out of departmental budgets, it’s going to happen anyway if Standard + Moody’s views are to be believed?

    This can’t go on. Labour must quickly find a way to regroup, attack and break up this shameful Coalition. We are getting closer to realising Thatcher’s dream.

  • Bob Vant

    Please excuse this ‘vague” posting, which I’m putting on as many sites as I can think of.

    There was a Tory MP (80’s?90’s?) who really let the cat out of the bag by saying summat on the lines of “Working in the public sector is an excuse for doing nothing.” Danged if I can find out who it was, but if we can trace the details, it’s a beaut of a quotation for showing what these shysters really think of, eg, NHS workers.

    Any ideas where to look?

    Bob Vant

  • Andy

    Have to question the generalisation “GPs remain among the most trusted and respected members of the community”

    I lost ‘my Respect’ years ago when the GP I was under failed to diagnose my brain tumour and the surgeries solution to complaints was to remove me off their patients list.

    I now have a barely audible foreigner who is that bad I actually wait for an appointment with the Locum in the hope they will be able to speak English in a manner that can be understood which at the moment is very rare.

    What will also happen is that many of what critics call the “useless/bureaucratic/parasite/insert insult here” managers currently in the NHS will move to the GP practices (thereby proving that they are required in the private sector model, too….but that’s ok “cos they’re in the private sector, innit?”…. even though they are still effectively being funded by taxpayers).

    Said managers will team up with the half-GP/half-entrepreneurs hybrids who thrived under GP fundholding and will then work the system like a dream (perhaps even in collaboration with a US-style multi-national health company). Outcome: a multi-tiered system akin to the GP fundholder shambles in the 90s. (And to think that people believe the current postcode is abhorrent….)

    As you say, everyone takes their cut and the patient is left hoping they:
    1) get a financially-rewarding disease (something simple and easily treatable) and not a tricky, long-term profit-averse disease (dementia/mental health or other long term pisser of a condition)
    2) live near/luckily register with one of the more astute entrepreneurial GPs, who gets excited at the site of profit charts and spreadsheets (who cares if he’s not as good a clinician – what’s that got to do with it now!?)
    3) hope that the “cut” going to profits doesn’t outweigh the “efficiencies” of the new system, otherwise that is to all intents and purposes a real terms decrease in health funding.

  • Filiz

    Not really worth my posting, is it AC? £ posts prior to this have not been printed. I was not offensive to any poster. Just pointed out that Gove has Private Eye support on cancelling the expensive, wasteful PFI programmes and another when I pointed out to an AC fan when he said on Iraq, mocking others, that we got rid of a tyrannt, that regime change is illegal.
    But letting AC fans know tha truth is not

  • Charlie

    Call me naive, but there does seem a fairly cynical link between Care UK’s donations to Lansley’s campaign funds and his subsequent “Hold on lads, I’ve got a great idea.. I’ll write one myself,off the top of my head, who needs evidence? ” approach to rattling off a white paper scuppering the NHS.

    I know they said transparent government, but being this obvious takes all the fun out of spectating.

  • Adam Toms

    The Tory’s attempt at misdirection is almost as breathtaking as the media’s willingness to follow their agenda. The DH press release dangles the fact that GPs are to take control of a huge chunk of the NHS budget…and the press pack has bitten. It’s just too tempting — and easy — a target; it’s not so much low hanging fruit, as fruit that’s been picked, washed, peeled and presented on a nice dish from Habitat. Nice story…easy to cover…good local angles — next!

    But tearing our eyes away from the big ‘GP shiny thing’ for a second, these changes are to be at the expense of primary care trusts. Managers (the bete noir of the tabloids) will be sacrificed in their thousands, saving squillions of ‘wasted’ pounds. It’s a bit like airlines seeking to save money by asking pilots to sort out air traffic control for themselves. I hope it’s not just my blood that’s running cold at the thought.

    And then there’s the small print the media’s helping us to ignore (either through bias or indolence). Do the following proposals remind anyone of anything?

    • Hospitals are to be moved out of the NHS to create vibrant local industries
    • NHS hospitals are to aim for far greater income from private work
    • Poorly performing hospitals will be allowed to go bust

    I’m no economics expert, but it sounds like the ‘P’ word to me. We’re still gawping at the GP shiny thing, and all the while we’re ignoring the possibility that the NHS is being PRIVATISED. This is big news, no? Bigger than the GP shiny thing?

    The media focus on the GP shiny thing is like making ‘cracked paving slabs’ the lead story during the blitz. And I know Mr Burnham is engaged in a leadership contest at the moment, but Labour’s ‘gamble’ response seems hideously weak and to be missing the point. A gamble can pay off, no matter how unlikely the odds, but it seems that it’ll only be NHS profiteers who will hit the jackpot with this one.

  • Alex

    Surely, this is just another attempt to link the clinical decisions made on a day to day basis to the costs associated.

    We are now trying to do this in a financial rain storm with wide ranging cuts. This is a terribly tough situation.

    GPs can retain the trust of patients where it exists and rise above the money wrangles – nice idea but not sustainable in the whole.

    GPs can step up to the plate and engage realistically with balancing the day to day clinical need with the financial situation. This has been the challenge of fundholding, PCGs, PCTs & PBC. GPs had accountability in fundholding but the sweetners and system were inequitable and unbalanced the NHS. In PCGs & PCTs front line clinicians failed to take the challenging accountability to a level where they were in control of clinical care and finances.

    Politically, the politicians can not afford to talk about financially failed trusts and GP consortia. But surely these must exist in the proposed structure.

    We can not incentivise GPs financially, as they would get slaughtered by the media. Failure, is a bigger fear for politicians, NHS admin / managers than it is for clinicians – ‘front line services will always be protected’.

    I suspect GPs will not engage with the challenge, at an effective level and therefore the impact will be as tepid as PCTs & PBC. I fear failure now, will be a step towards the end of a universal NHS.

  • Brian Hughes

    If GPs had wanted and/or had the aptitude to be managers they’d spent three years at university studying business instead of five years plus mastering medicine.

    An ongoing frustration in my little life has been the inability of any ‘big hitters’ to challenge the populist “common sense” attack on managers and administrators. As with engineers alas, snobby ‘team UK’ doesn’t recognise their skills as skills.

    Harks back to the days when only oiks went into ‘trade’ and/or comes of having too many lawyers, accountants and others from similarly ‘respectable’ professions, most of whom have never run anything more complicated than a bath (ho ho), in charge I ‘spect…

  • Jacquie R

    Andrew Lansley was certainly tetchy and poised to pounce in Newsnight. Kirsty did a brilliant job in handling an excellent debate on pretty complex issues. Like many, I fear the entry of more market forces into the NHS and also have concerns about the staggeringly different degrees of competence of our GPs. Without sufficient safeguards, mixing the two together could be quite toxic.

    To Filiz and others on blogs. I find AC and most political bloggers are prepared to post a range of comments and views – including, sometimes, unpleasant, personal rants. Yesterday, however,for the first time I visited the site of a highly articulate journalist who frequently expounds what I consider absurd views. After a blog in which she made bonkers assertions, I noticed that ALL the comments posted were in support of her stance. I sent a very brief counter, and it was ignored. As a test, a friend sent a meaningless sentence of support, which was posted. This is the worst type of censorship, a practice the journalist in question no doubt abhors.

  • allybob

    Hi AC – always defended your name in debates and arguments – but that c-list bash you were at for Piers Morgan was questionable. I know he is generally okay politically, but not taking the opportunity to abuse a few other people Alastair, is an opportunity missed. Coulson, Dacre and assorted rotten eggs who have put this government in power? shame on you laddie, every wedding needs a fight and you blew it big time – also, why didn’t you give Clarkson a smack? you’ve gone down in my book. Us mere mortals just have to bear the brunt of these rabid Tory attacks. The Newsnight ‘debate’ on NHS was pointless – not once was the main issue of an ideological assault upon the foundations of the NHS and collective provision mentioned – which is typical. Gullible dimwits. Tories win again. come on AC – liven up, its not a bloody game.

  • picard1109

    Lansley is a former Civil Servant and, according to his own website, comes from a family of ‘public servants’. Ironic(al) then, that he’s trying to put so many other public servants out of work.

    But then, a lot of public sector workers must have vote for this shower. You can bet your life that they won’t be volunteering their own jobs for the chop…it’s all those others who waste public money, innit?

  • john

    This is about getting rid of layers and layers of managhement with associated costs. A very good thing provided the gap is fillewd responsibly, efficiently and economically. Give it time – lets see if the practices can manage their business and patients without top down ‘help’.

  • davidk

    Re Lansley on Newsnight: I thought KW had a hard time pinning him down, wasn’t commanding enough and allowed Lansley to tur the tables on her by questioning the accuracy and sources of her assertions. I bet Lansley wouldn’t have agreed to go head to head with Paxman. Still, at least a Minister from this coalition actually turned up to face the Newsnight interrogation, something quite a few have been running scared of.

  • Graham Jones

    It seems a strange time to roll a dice with the NHS. How Andrew LAnsley has come to the conclusion that this will work, I have no idea. Something tells me that he has forgot to factor in the cost of administering the new system.
    What is likely to happen, is that there will be a rather large public bill, used to pay-off and make redundant all those unwanted managers. The GP’s will find out that they can’t cope with, or don’t like the responsibility of administering a large budget. They will demand more money, either for themselves, or to re-hire the same managers who were deemed surplus to requirements by Lansley. One way or another, this will cost more money, and likely to result in a less efficient NHS.
    It seems that Michael Gove isn’t the only hapless minister in the cabinet; they’re starting to stack up. I wonder who will join them next week!?!

  • Barry D

    The NHS will not be the same under the new changes that’s for sure ! Had a conversation with a senior member of a regulating authority today and he confirmed that the targets and performance indicators have been eliminated. For example, from GP visit to treatment was eighteen weeks. That target has been smashed by the Tories. Anyone remember waiting 3/4 years for treatment under the last Tory Government ? Let there be no mistake this is how this it is going to turn out. As usual, it will be the disadvantaged who will suffer. Under the new arrangements, there will be job cuts of course but the Strategic Health Authorities will merely transpose into a new Commissioning Body and the managers from PCT’s will have urgent appointments at their GP’s as they jostle for jobs in the new consortia(s) who will administer it.

  • davidk

    @ Graham Jones – I doubt the government will stump up the cash. The onus will be on doctors short changing their patients in terms of referrals etc. This is the price Britons will pay for doctors (led by the BMA) cooperating with this coalition scam.

  • Robert Jackson

    Same voodoo healthcare as the Tories proposed when they were prepared to go along with the lies about MMR a few years ago.

    They said then that parents should have a choice about having their children inoculated against measles mumps and rubella. The Tories put weight on the wholly unfounded scare stories.

    With what consequence?

    Increased levels of potentially dangerous illnesses that were virtually eliminated from the UK generations ago.

    Tory healthcare? Don’t get sick!

  • Lottie

    Give the power of decision making to the people who actually understand the difficulites of the job in hand! And while they are at it, lets do the same with Animal Health (state vet. service, renamed by the labour gov, for what reason, i am not sure.) Just before labour went out, AH had been given twice the number of managers, most of which are not vets and struggle to comprehend what happens on farm and the pressures our farmers are under.

  • Graham Jones

    davidk – I fear you may be right regarding GP’s. They have been conned by the tories, and their patients will suffer likewise. You would think there are enough doctors around, who remember what it was like under the tories the last time, but apparently not.
    I’m not sure Kirsty was that bad on Newsnight though. She’s no Paxman, granted; but she was actually ok, for once. Still, it might be a good idea if the BBC had Paxman on for the next few weeks, as the tories are likely to keep unveiling one ridiculous poicy after another. There’s a new one every week, and the Labour party have to be all over them.
    Ed Balls led the way, by destroying Michael Gove’s credibility, and forcing him into one groveling apology after another. That story still isn’t finished either; it’s got legs, as they say.

  • Nicky

    @ Jacquie R: I’ve also noticed that left-wing blogs tend to allow most contrary comments through (unless they’re extremely defamatory/offensive) whereas many on the right pre-mod any differing views. That seems to point to a fear of the weakness of their arguments being highlighted.