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nhs shake up
« on: July 12, 2010, 08:42:42 pm »

NHS 'to undergo radical overhaul'
Page last updated at 17:08 GMT, Monday, 12 July 2010 18:08 UK
E-mail this to a friend Printable version By Nick Triggle

Health reporter, BBC News
Health Secretary Andrew Lansley: "GPs will lead a bottom up design of services"
The NHS in England is to undergo a major restructuring in one of the biggest shake-ups in its history, the government has announced.

Hospitals are to be moved out of the NHS to create a "vibrant" industry of social enterprises under the proposals.

And, as expected, GPs are to take charge of much of the budget.

The move will lead to the abolition of all 10 strategic health authorities and the 152 management bodies known as primary care trusts.

Continue reading the main story GPs - Asked to get together in groups to take on responsibility for spending much of the NHS budget
Hospitals - Encouraged to move outside the NHS to become "vibrant" industry of social enterprises
Patients - More information and choice, including ability to register with any GP they want to
Managers - Strategic health authorities and primary care trusts face the axe
The new structure will be held accountable by an independent NHS board which would be free from political interference, the government said.

Meanwhile, responsibility for public health will be passed to local authorities.

In many ways, the plans outlined in a White Paper go further than expected. The coalition agreement had promised no top-down reorganisations.

But Health Secretary Andrew Lansley said he had decided to go further than first envisaged to rid the health service of bureaucracy.

He said the proposals would be challenging and turn the NHS "upside down" but in doing so help reduce management costs by nearly a half within four years.

He added: "The government's ambition is for health outcomes - and quality services - that are among the best in the world."

The GP move had long been championed by Mr Lansley - and in recent months the British Medical Association had indicated it was willing to work with him on the idea.

The plans mean GPs working in groups will be in charge of a vast collection of hospital, mental health and community services - although specialist services and dentistry will not fall under their remit.

Continue reading the main story
It had been clear for some time that Andrew Lansley was planning big changes.

But it is a mark of how far-reaching the White Paper actually is that many experts are still shocked by the scale of the proposals.

At a time when the NHS is having to find savings of up to £20bn by 2014, the proposals are being seen as a huge gamble for the service itself and the health secretary personally.

At the heart of the plans are GPs. They, Mr Lansley believes, are better placed than managers to make decisions about services.

Buffeted by years of criticism over what have been perceived as excessive pay rises, GPs now find themselves in the curious position of being given the keys to the NHS safe.

The question on everyone's lips now is: Can they spend it wisely?
Under the new system, the independent board will sit above as many as 500 consortiums of GPs to set standards and hold the groups to account.

Another key aspect of the changes involves giving patients more information and choice. To achieve this, a new body, HealthWatch, will be set up to compile data on performance, while GP boundaries will be abolished to allow patients to register with any doctor they want.

Mr Lansley also announced he expected all NHS trusts, which run hospitals and mental health units, to get foundation status by 2013.

He also said he would be relaxing the rules which cap the amount of income a trust can make outside the NHS, opening the door to them seeing more private patients.

He said this would allow them to innovate and widen the scope of what they did, but he also admitted it would mean those which were not financially viable could go under.

The government will now consult on its plans before rolling them out over the next three years.

Shadow Health Secretary Andy Burnham: "reorganisation is last thing the NHS needs"
Professor Chris Ham, chief executive of the King's Fund think-tank, said: "It is a very radical programme. We have never seen anything like this since the inception of the NHS in 1948."

But he said the moves were not without risk, pointing out some GPs would not have the skills to manage the budget.

Shadow health secretary Andy Burnham went further, describing the changes as a "political experiment".

"It is a huge gamble with a NHS that is working well for patients."

There was a mixed reaction from NHS staff. Unison said the changes could lead to "chaos", but the BMA said they could benefit patients and it was looking forward to working with ministers.

Katherine Murphy, of the Patients Association, called for more clarity over how and what information would be provided to patients.

"We need more details," she added.

Are you a GP? Do you work in the medical profession? What is your response to the proposals?

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« Last Edit: July 12, 2010, 11:27:53 pm by roger »


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Re: nhs shake up
« Reply #1 on: July 12, 2010, 11:22:28 pm »

The government announced its plans on the NHS in which they intend to transform acute hospitals into "social enterprises" which is the tried and tested half way house to privatisation and also make Trusts able to expand their private patient networks and let those that "fail" to "go to the wall." Having had the PCTs turned into "world class" comissioners by New Labour, as I predicted once the comissioning process is set up they are going to sack most of the comissioners and hand it over to a business of GPs and health board model which they hope will give even greater reign to the private sector.  

Of course New Labour is trying to paint this as a radical departure from their pay the rich attempts. What short memories. We remember how the previous conservative government was unable to make their brain child Private Finance Initiative in building new hospitals in the private sector to work and leasing them back to the NHS at a massive cost.  Of course New Labour came to power attempted to rebrand it as Public Private Partnership but then openly admitted it was PFI and made it pay the rich vast fortunes when the Tories could not make it work.  Similarly, New Labour having given birth to their brainchild "world class commissioning" and "social enterprises" had great difficulty in getting this new market economy in health care working in favour of the big companies. There was so much opposition and they wasted £billions on creating this monster which was supposed to police the NHS public and private providers.   Of course they left a funding system stacked massively in favour of the private sector. Our hospital is now overspending £250,000 a month because it is accepting patients that it does not get fully paid for because it is over the activity levels for emergency admission in 2008. It only gets 30% of the tariff for these patients whilst the private sector gets paid even more than the 100% tariff for all patients.  

Now the Con-dem government is poised to take this agenda forward on behalf of these US and European based health monopolies. The say in the report "Hospitals are to be moved out of the NHS to create a "vibrant" industry of social enterprises under the proposals". They think that they can utilise these brainchilds of New Labour such as a "commissioning led NHS" and "social enterprise to fully privatise the NHS. However, they are risking all because to go against history and turn health care into the stinking lyons den of market forces, when so many people still remember, via their historical family legacy, what paying for health care meant and this will unleash the  resistance.  

Of course the ruling circles hope that this will only mean a change of government at some point back to "next Labour". We must seriously dissapoint them and turn this movement into a consicous revolutionary movement to end their wrotten system once and for all and build the new society we all desire.   Safeguarding the Future of the NHS will certainly open path of progress for society under these conditions.  
« Last Edit: July 12, 2010, 11:30:15 pm by roger »


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Re: nhs shake up
« Reply #2 on: July 13, 2010, 10:45:27 pm »

12 July 2010
Lansley puts business at the centre of NHS, not patients

Responding to today's publication of the NHS white paper, the health pressure group, NHS Support Federation, accused the government of favouring commercial business over patients and cast doubt on plans to save money by restructuring.

Federation director Paul Evans said:

"Patient power will be overwhelmed by the influence of unaccountable companies. No matter what individual patients want, profit-motivated firms will now have a huge say in what care is available and much of the fairness, value and public trust in the traditional NHS will be lost."

"GP commissioning will create a spaghetti-like snarl of conflicting interests, where profit will inevitably come before patients. Paying companies to spend the huge NHS budget on other companies is a recipe for scandalous waste and the sort of shady deals that the public must be protected from."

"Savings from sacking local NHS managers are unlikely to be as large as the government predict, due to redundancy costs and extra GP payments. Few GPs have the skills or the time to do this essential job and the plan to use the private sector will be expensive and sacrifice public control."


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Re: nhs shake up
« Reply #3 on: July 19, 2010, 11:12:37 am »

NHS reforms: Is Andrew Lansley's brutal surgery really needed?

Denis Campbell The Observer, Sunday 18 July 2010

How does the Great British Public view the NHS? With appreciation, sentimentality, no little pride and recognition that not everything it does can always be great, but that many things are? Or is it with anger and deep frustration – at targets, a lack of choice and faceless bureaucrats allegedly obstructing clever doctors who always know best – and, from that, a deeply held desire to change it utterly?

The evidence – from surveys of patient opinion and experience, both by the NHS and others – suggests that, broadly speaking, most people are pretty happy with it most of the time. Yet Andrew Lansley, the health secretary, last week outlined plans for a major upheaval of the service in England that are clearly motivated by both intense unhappiness with the NHS in its current form and a belief that it needs emancipation from the dead hand of tickbox-obsessed penpushers. Hence the subtitle of the health white paper – "Equity and Excellence: Liberating the NHS". Lansley, it would appear, is its self-styled freedom fighter.

Politicians can't stop themselves from tinkering with the NHS. This is either the eighth or ninth "reform" of an institution that is one of the few remaining expressions of pan-UK identity. No wonder many who work in the NHS, especially at a high level, feel dizzy – and resentful – at the state of near-permanent revolution, and wish it would stop.

No chance. This time Lansley has certainly prescribed truly radical surgery for the supposedly ailing patient. The 152 primary care trusts (PCTs), which currently commission and pay for care for patients, are being scrapped, as are the 10 strategic health authorities. Between them, they employ 64,000 people. Patients will have much more information on who provides good and bad care, and will be encouraged to exercise enhanced choice to go wherever has the highest standards. Poorly performing hospitals, even if they are much loved by their local community, will be allowed to wither away. Competition rules, OK?

Instead of the current system, in which PCTs help decide what treatment a patient should have and where, in future England's 35,000 GPs will do that and become the most important people in the NHS. Instead of each GP surgery being given a budget to employ people – doctors, practice nurses and receptionists – and run its premises, the partner-GPs who run it will be handed a multi-million-pound budget with which to pay hospitals for treating their patients.

If Lansley drives through his plan, patients may not notice that many changes – apart from, with luck, the clinical outcomes closer to the norms in the rest of Europe that Lansley wants to see. The nation's doctors, never easy opponents, have yet to give a considered view of having big changes to their jobs forced upon them by Whitehall, and tension is likely over the private sector's inevitable role, extra money to implement the new set-up and, possibly, demands for more pay for complying. But make no mistake: the changes will dramatically reduce, possibly irrevocably, the state's control over the NHS and the NHS's control over those who actually care for us. That is a long way from both Nye Bevan's guiding principles, and the Tories' pre-election pledges to have no more "top-down reorganisations". As last week wore on, the more people pondered the white paper, from either the right or the left, the more holes they found in it. Dr John Marks, a past chairman of the British Medical Association, quoting Caius Petronius, warned that the revamp could end up "creating the illusion of progress, while producing confusion, inefficiency and demoralisation". On Friday both the Lancet and British Medical Journal published editorials that were unusually critical. Lansley may take all that as the death-rattle of the vested interests.

It may prove to be something else altogether: the start of a coalition of concern that blocks reforms that have precious little evidence to commend them. It is a brave politician who takes liberties with a national treasure – or a reckless one.