Lansley's woes
Health Secretary Andrew Lansley's radical shake-up of the NHS, contained in his , could be summed-up in a Lenin-like soundbite: all power to the GPs.
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He wants to scrap the present Primary Health Care Trusts (PCTs) and put consortiums (consortia?) of GPs in charge of commissioning health services for patients in their area. The idea is that "clinical leadership" not central targets will drive local spending priorities in health. And the uber-wonkish health secretary, lauded by David Cameron as the man who really understands the NHS, has devised a new system which he believes puts power at the grassroots.
But when he appeared before the Health Committee to talk about his plans, he did so under a palpable cloud of doubt and fear. Many other MPs - and not just on the opposition benches - question whether his system will work, and whether, if it does, the public service ethos of the NHS - its soul if you like - would survive. The Health Committee, under one of Mr Lansley's predecessors, Stephen Dorrell, has been taking a long and (sometimes excruciatingly) detailed look at the NHS commissioning process.
The MPs gave Mr Lansley a long and sometimes tetchy going-over. And he noticeably declined to give Lib Dem Andrew George any promise that he would amend his bill to take note of Lib Dem concerns - expressed at their spring conference - about the "marketisation" of the NHS and the handing to GPs of control of billions of public money without sufficient democratic oversight.
One interesting question is whether that decision is any longer his to make. A reform that pitched the NHS into chaos would be political poison to the Coalition - and it's worth remembering that the Lib Dems say the Lansley proposals are no part of the Coalition Agreement - so they're not bound to support them. Which means that a bill which does not win their approval could have a tough time in the Commons and could be filleted in the Lords, where lurks Lady Williams (the artist formerly known as Shirley Williams) and a squadron of unhappy Lib Dem peers, who could yet amend the bill, and send it back to the Commons.
I must admit I felt a bit out of my depth listening to the debate on the arcana of NHS management. This is not a subject I know much about. But there did seem to me to be a bit of a comprehension gap - Mr Lansley wants a system so different, and so bottom up, that those marinated in the current system cannot imagine how it can function. I'm in no position to judge who's right - but the scale of the concern by the BMA and others is clearly causing serious concern in the Coalition high command.
The Health Committee may yet have a role. Some of its members are rumoured to be considering putting down amendments as a committee - the hot new fashion on the committee corridor. And their judgement on the plans could itself be vital in swinging opinion on the bill one way or the other. But, as happened a couple of times in the Blair years, we have a bill before Parliament which could be substantially re-written on the floor of the House.
One final thought. One of the main critics of the bill in the Health Committee is the Conservative Sarah Wollaston - the Totnes GP who was selected as a Conservative candidate by an "open primary" process in which all her local voters were invited to take part in a postal ballot. Her criticism of the bill has been notably independent and pretty fearless. Which may explain why the government seems to have lost its earlier enthusiasm for Primaries as a device to "reconnect" voters with Parliament. But she's doing just what the voters probably hope their MPs should do - and which they in fact to all too seldom.
I'm Mark D'Arcy and I'll be writing about what goes on in the chambers and committee rooms at Westminster.
Comment number 1.
At 23rd Mar 2011, TheGingerF wrote:The Tories have absolutely no mandate to do this to the England & Wales NHS - what people want is basic protection from the spending cuts for the NHS frontline. They dont want backdoor privatisation - there is a loophole in the current bill that allows GP surgeries to keep money they save. Additionally there is huge vested interests at play here that are also not completely proteced by the bill as it stands. GPs with interests in suppliers of medical treatments/resources could potentially recommend these in the treatment o their NHS patients.
This is a rushed bill that isn't needed, isn't wanted and has the LibDem mainstream and the BMA against it. Lansley may well be a resigning politician walking...
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Comment number 2.
At 23rd Mar 2011, vstrad wrote:Dear Ginge,
Could you please explain what you mean by "privatisation"?
There is already a great deal of private sector provision in the NHS. It was increased very enthusiastically by Blair, who boasted about using private hospitals' spare capacity to get NHS waiting lists down. When children, pensioners and pregnant women get their free sight tests on the NHS, these are provided by high street opticians, not civil servants. Anyone seen an NHS dentist recently? Not in my area they haven't.
I recently had an appointment at the newish NHS Treatment Centre nearby. It does day surgery and other procedures that don't need the full range of hospital facilities. It is run, perfectly efficiently, by a private company whose leaflet informs me that they run dozens of such centres across the country. Do you object to this model? If so, it's too late. The genie was released from the bottle years ago.
The NHS already has a wide choice of who it buys its drugs, medical supplies, stationery, food etc from. Why should there not be a similar choice of provider for surgery or radiotherapy etc?
And I'd rather trust my GP with these decisions than a faceless bureaucrat at the local NHS Trust.
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Comment number 3.
At 24th Mar 2011, CASTELLAN wrote:Doctor Doctor, I feel like a pair of curtains. Why is that asked the Doctor? Every morning I look up into the sky and tell the world that I am a beautiful person and that it is great to be alive. The Doctor opened the desk draw and took out a concise English Dictionary and thumbed through the wafer thin pages then paused for thought at SAD... seasonal affective disorder proclaimed the Doctor! It’s surgery for you followed by months of intensive care and occupational therapy and with any luck I will never have to see you ever again. The patient looked concerned and said is it really that bad Doctor? The Doctor yelled out pull yourself together man it's only theatre for you, picked up the phone and then asked the Nurse to send in the next patient.
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Comment number 4.
At 24th Mar 2011, TheGingerF wrote:vstrad - your views are different to mine and I accept your point that their is private involvement at present in both England/Wales and separate Scottish NHS too.
However, I think doctors should stick to what they are brilliant at - diagnosing, suggesting and carrying out the best treatment for their patients.
Anything else muddies the water and brings into play considerations that shouldn't be there for a doctor treating patients. This bill has holes big enough to shove a hospital through and runs real risks that patients will lose out and postcode lottery gets worse and worse.
As I said before, the BMA wants the bill stopped - I think I'll listen to the doctors rather than the ideology of Mr Lansey.
Politically the Tories have absolutely no mandate to push this bill through, but I suspect the LibDem MPs are preparing themselves to lie down yet again.
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Comment number 5.
At 24th Mar 2011, corum-populo-2010 wrote:Agree with post 04 @ 08:09am on 24 March 2011 - 'TheGingerF'.
Indeed, there is no legal, nor political mandate, for Andrew Lansley to force through his 'dictatorship' tendencies upon the NHS?
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