Would the national health service survive 2 terms of conservative government asks Andy Burnham?
The’re is a fork in the road. Fragmentation. End of national pay. That is what markets deliver, not the integration we need.
Stephen Dorrell says what Andy wants is the only way integration with social care and housing. But denies that fragmentation will happen. Elderly people need to be enabled to lead fuller lives with fewer hospital admissions.
Dorrell says then health reform will not be nearly revolutionary as either the government or labour claim
Claims against GPS are increasing rapidly says Medical Protection Society. Heavy handed regulation counter-productive
Darrell says it’s the culture. Quality can’t be inspected in. Culture needs to be open.

Francis report will be sobering when arrives says Andy. The market is not always the way to go. We need whole person care., not fragmented and episodic. A fee for year of care. Incentives to keep people out of hospital
NHS needs service redesign not structural redesign..
The NHS should lead on provision. Councils should lead on commissioning..
When people raise issues about quality of care NHS organisations often fail to respond effectively. How could that be improved? Asks Dr Fisher

Autonomy doesn’t always deliver higher standards says Andy. The system didn’t prioritise the things the public cared about. Especially how clinicians treated them. In some places there are very outdated models care usually with very low paid staff. Dorrell says local clinicians are also often not listened to. The purchaser provider split has not delivered a local voice..
Will choice reduce inequalities asks Cathy Warwick. Should women be able to opt for a section when not clinically needed and deprive others of resources. We should ensure appropriate choice is available to everyone.
Dorrell says choice is not an absolute. But we should work with the patient. They should be involved in decisions about their own care. Commissioners should exercise choices about what represents good quality care. That is the whole point of the commissioning process. If there is a budget there are choices to be made..
Andy says choice was a cover forr competition and privatisation.. We didn’t offer the sort of choices patients wanted. Is choice just an excuse for marketing.?

Andy says NICE is one of the best things we did. Politicians should not be making those sort of decisions. Lobbying should not be the basis for decisions. Not very enthusiastic about personal budgets in health.

Delivering a sustainable health and social care system has big resource implications.. How can social care be funded?

If we are going to remove the residential care levy we need cross party agreement. Dorrell and Burnham agree. The options are difficult and scary.

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