Toynbee Hall 28 Commercial Street, London E1 6LS - nearest tube Aldgate East
10am - 3pm Saturday 2nd December 2006
The Labour Party National Policy Forum consultation document on health has been released, and this will be the basis for our discussions. Submissions are to be sent in by March 2007 to pip3.health@new.labour.org.uk. Anyone can send their comments, but we hope that a clear well argued submission from us will carry some weight.
With Prof Nick Bosanquet, Consultant Director of Reform and Dr Jacky Davis, Keep our NHS Public
Labour Party Health policy seminar
2nd December 2006 Toynbee Hall
rearranged to put points together, rather than as they were raised, reduce repetition and to make clearer what was meant
Nick Bosanquet: Where do we go from here?
The NHS was established with a military style central command structure which is no longer appropriate. Large public sector monopolies are no longer a popular way of providing services. The world has changed. Life expectancy has risen enormously. Society is much more diverse. The problem now is to provide care for people who in earlier times would not have survived, like the 60,000 people alive with kidney failure. Central planning has not been very successful in dealing with these challenges. Large amounts of extra money pumped into the NHS have provided disappointing results.
We have three levels of nationalisation - Funding, Resource allocation and Provision. Reform is in favour of continued funding through taxation (not in favour of an insurance system) but wants to see a more pluralistic system of service provision. An increase in funding to nearly 10% of GDP has led to an increase in costs - new hospitals and LIFT schemes. What we need is a patient driven high quality service. A pluralist approach, better communications and possibly more direct payments could deliver this. Pluralism has been a success in optical services. New providers have emerged, prices have fallen and there have been more choices of spectacles available for the poor since the service moved into the high street. Compare that with audiology services still inside the NHS, delivering a slow service and not responding the technical innovation. It has worked in pharmacies. Maybe we need a system whereby services complementary to the NHS can be provided.
There will always be rationing of services, but waiting times and queuing are a very unsatisfactory mechanism for doing it. We need mechanisms which encourage innovation. And now we need to separate service redesign from measures to reduce deficits. Alternative services need to be in place before existing services close.
Lots of new providers want to come in. Considering the money spent on the NHS waiting times are still too long, and we are seeing reductions in services and increases in costs. Centralised planning has not succeeded in shifting resources out of hospitals into community services. What we need to do is build up the power of patients and GPs. Already the NHS plan is out of date - we are building too many expensive new hospitals with inflexible PFI schemes. We have expanded our medical schools but there will not be sufficient jobs for all those who qualify.
Connecting for health will be an expensive failure because it is centrally planned and directed, it fails to build on existing IT developed by GPs. And it doesn't have a financial component.
Wendy Savage: Nick spoke about evidence based policy and then mentioned the
Adam Smith institute report of 1999 which showed reform was needed not more
money but it is wrong to judge the NHS on results in 1999 at which point there
was no extra money as New Labour had stuck to Tory spending plans. Expanding
and developing services takes time and a stable environment. There have been
several reorganisations which destabilize the NHS and are expensive. The government
seems ideologically in favour of private rather than public services but is
the private sector more efficient than the public sector? Did I mention recent
health care commission report about private hospitals?
Most people when asked want a good local hospital service, not more choice.
Forcing PCTs to buy up to 15% of services from private providers last year has
contributed to deficits We need to establish community services before closing
hospitals.
Doesn't accept that there will be a shortage of jobs for new doctors.
25% of doctors on medical register come from overseas many of whom came in 50s
and 60s and are due to retire soon. It is surely right that a rich country like
the uk should train enough of its own population in medicine rather than poaching
doctors from developing countries?.
Government seems to dislike doctors. 30 year PFI contracts are not Good value
for money 5 billion spent will cost 10 times that by end of contracts and locking
hospitals into 30 year contracts whilst transferring services to community does
not seem like 'joined-up
Thinking'. The NHS in the past was a co-operative not a competitive Environment
with very low administrative costs about 2% before Griffiths re-organisation
in 1984. Now co-operation is obstructed by bureaucratic systems and administrative
costs have risen considerably to an estimated 15%. Too much money is spent on
managerial trappings and management consultants-last year almost as much on
management consultants as all the hospital consultants in England. I have seen
how Patricia Hewitt's eyes lit up when an American inspired hospital orthopaedic
centre modelled on a New York facility was mentioned at a conference but the
USA is not a model we should be following 47 million uninsured, high administrative
costs and fraud is endemic.
The NHS is not an industry it is a service and if the present changes continue
it will end up as a logo with private companies providing the service and they
have to provide profits for their shareholders. We do not want to regard the
NHS as selling a product. In the past the NHS may have been unresponsive but
this was more to do with insufficient staff-5 min consultation time for GPs
for example and underfunding which has been present since the NHS began but
it is a tragedy that for the first time that there is sufficient money it is
being wasted on paying the private sector 11% extra money for doing operations
whether or not they perform them and constant reorganisations. The consultation
for Our Health Our Care Our Say was flawed because of the questions asked and
the idea of a 'patient-led NHS seems to owe more to spin than substance.
We need a halt to change and to let things settle. Deficit crisis this year
is completely unnecessary. Gordon Brown floated the idea of an NHS board but
it seems unlikely that with such a large proportion of GDP spent on health that
the government would be willing to relinquish control although one problem is
political interference.
General discussion:
Most of the population do not understand the present situation of the NHS. Much NHS consultation is phoney and ineffective. Choice is always a mirage, always limited by resources and the choices on offer are not those we want.
This discussion is really about England. Different paths are being followed in other parts of the UK and they merit discussion.
How can the NHS respond to patients and to new possibilities without involving the private sector? In the past the NHS was cheap but not responsive.
We should not separate primary from secondary care. We need better mechanisms to drive up standards in General Practice, and we need to provide incentives to providers to develop innovative cost effective care.
The NHS has sometimes delivered a better service to the middle classes than to the poor.
We do want to see more services locally provided and out of hospital possibly run by GPs. We see significant differences between services provided by profit making firms and not for profit organisations. There might be a role for both. And possibly for worker co-operatives.
The essence of socialism is the way services are delivered. Privatised services are not always worse. Competition may induce changes in behaviour.
More patient choice means more travelling and disruption of local relationships with social services. We need more vigilance inside the NHS on value for money.
We need to minimise the involvement of national level politicians. We want more local democracy and accountability and less central control. This will imply more local variation in services and probably a central core of services which must be provided everywhere. There will always be rationing. The only question is how it is to be done. But the need for healthcare is not infinite, though demand might be.
Present mechanisms for local accountability - patient forums, PCT boards, local scrutiny committees - are weak, lack expertise, resources and muscle. A fig leaf over the indecency of lack of democratic accountability. Accountability should be broadly defined. Not a bad idea to separate services currently directly provided by PCTs into separate organisations.
The idea of an NHS constitution or board merits consideration. It could separate the NHS from the electoral cycle and embody NHS values, if we can agree what they are. Public health should be given back to local government.
Introducing pluralism now could mean the subsequent development of monopolies. Social enterprises may be more resistant to take over than commercial organisations. European law may have an impact on the development of pluralism. A directive is to be expected early in 2007. The plan that 15% of elective surgery in each PCT must be provided by the private sector appears to have been dropped. There is now no minimum or maximum for private work.
What we want to see in the next Labour Health Policy (these are individual ideas, not all discussed):
" Restoration of democracy to local labour parties, power to local authorities
and commitment of a Public NHS
" NHS administered by an independent board separated from politics and
accountable to Parliament
" Individual contract between citizen and health practitioner about healthy
living and mental health
" Independent health service apart from politics like BBC
" Adequate funding for effective treatment of cancer and heart disease
- an end to postcode lottery
" Scrap payment by results
" Development of more local democratic control of PCTs
" Care free at the point of entry to the NHS
" Community development as a force in PPI
" Co-operation to replace competition in the NHS
" New socialist view of health
" Withdraw from all contracts with private sector and stop funding discrete
projects and give money to front line
" Reduce inequalities with attention to poverty and sufficient income for
healthy living
" Joined up thinking across health and other Depts - eg choice of school
discourages walking and after school activities
" Greater balance of principles of choice over good provision for all
" Greater honesty over what is possible - realistic expectations.
last updated 6/12/06