The end of the NHS?

Andrew Lansley's white paper on the NHS made me feel pretty queasy, but then i read this article in The Pulse, a magazine for GPs. If you live in South Cambs you may want to consider writing to your MP who's proposing this. The rest of you should write to yours too, expressing your opposition to this:

Private firms prepare major initiative on GP commissioning

14 Jul 10

By Ian Quinn

Exclusive: A group of leading private companies is planning a major joint initiative to persuade GP consortiums to partner up with them, on the back of the Government’s White Paper on health, Pulse can reveal.

Health White Paper
Click here to read our full analysis of the health White Paper

UnitedHealth UK, Tribal Newchurch, Humana, Bupa and Aetna UK are drawing up a framework of potential services GPs will be able to ‘buy in’ from the private sector, with companies taking on a share of the commissioning risk.

They are confident the White Paper will hugely increase the scope for private firms, with one leading player claiming it will lead to the full 'denationalising' of healthcare in England.

Groups of private healthcare insurance, financial services and IT companies will offer GPs a raft of commissioning support services, following moves to hand them control of £80 billion of NHS cash.

These will include medicines management systems, IT systems, commissioning-support tools, back-office support and patient-management services, many of which have already been used by PCTs under the previous Government’s FESC framework and via individual deals with private firms.

Now the group of private companies, working with undisclosed leading financial companies, are turning their attention to GPs and will be offering to share the financial risk involved in setting up new consortiums, in return for potentially lucrative contracts.

However, they will also carry out tough vetting of potential GP partners.

The White Paper sets out plans to provide GPs with a maximum management allowance, including premiums for those who achieve high-quality health outcomes and for financial performance.

But Kingsley Manning, director of Tribal Newchurch, told Pulse: ‘My guess is that the management fee will be fairly modest and that it will mean the way that GPs will be able to run this is in a collaborative approach.’

He said offering GPs a chance to share the risk of the new ventures would be a major part of the private firms’ strategy, following health secretary Andrew Lansley’s warning of no ‘bail out’ for consortiums that fail.

‘We’re working on the assumption that there will be some element of risk transfer. Risk management is going to be a very, very important factor.'

‘There is undoubtedly some sense that there should be some pain involved. But by working together, private health companies believe they can draw up a series of packages which will not only be highly attractive to GPs looking to reduce costs and share the risk of failure, but fit what are expected to be ultra-tough quality standards demanded by the new independent NHS Commissioning Board.'
Click here to find out more!

Mr Manning said Mr Lansley’s plans could lead to the ‘denationalisation of healthcare services in England’, adding that the White Paper ‘represents the most important redirection of the NHS in more than a generation, going further than any Secretary of State has gone before'.

‘The old certainties are gone: the NHS cannot be protected from economic reality any longer,’ he added.

He said that Tribal Newchurch hoped to have its offer to GPs ready by the autumn when the Health Bill goes before parliament, and that each of the major companies would also be working with their own unique business partners.

‘We don’t want to give the impression that GPs are being strong-armed into working with us. They are of course free to do this themselves and indeed we will be fairly cautious as to who we work with. We won’t just be jumping into partnerships.’

The White Paper says: ‘GP consortia will need to have sufficient freedoms to use resources in ways that achieve the best and most cost-efficient outcomes for patients.

‘GP consortia will have the freedoms to decide what commissioning activities they undertake for themselves and for what activities (such as demographic analysis, contract negotiation, performance monitoring and aspects of financial management) they may choose to buy in support from external organisation, including local authorities, private and voluntary sector bodies.’

The Government has also unveiled plans to ditch Labour’s ‘NHS as the preferred provider' policy and switch to a principle of any willing provider, which will reduce the barriers to private firms.

Tony Sampson, director of external affairs at UnitedHealth UK, said: 'There's no doubt that the Government is putting GPs and primary care at the heart of its reform agenda for the NHS. The work we've been doing with GP commissioning groups has been to provide a series of support services, such as analytics, evidence based techology and contracting support. The opportunity to combine this with GPs' understanding of individual patients' needs provides a great opportunity to improve outcomes for patients and provide cost effective care.'

Although not involved in the new trade body, Virgin-owned Assura Medical, which runs 15 Darzi centres in England and has 30 GP companies involving 1,500 GPs, also said the White Paper would open up new opportunities, saying the plans ‘closely match its business model'.

'We are enthusiastic about the reforms proposed by the Government's health White Paper, said Bart Johnson, chief executive of Assura Medical.

‘GPs are crucial to the provision of services and are well positioned to manage the resources available to enhance patient care. We see this as a good opportunity to build upon our current work with GPs and the NHS to improve health outcomes for patients."

Shadow health secretary Andy Burnham, who brought in the preferred provider policy while in Mr Lansley’s hotseat, described his successor's plans as giving ‘the green light to let market forces rip right through the system with no checks or balances’.

He told the Commons: ‘Is not the handing of the public budget to independent contractors tantamount to the privatisation of the commissioning function in the NHS? Will there be any restrictions at all on the use of the private sector by GPs?’

Kings Fund chief executive, Professor Chris Ham, said the White Paper would ‘accelerate the trend’ towards further privatisation, adding that it would lead to ‘opportunities for private companies to support GP commissioning and increased opportunities for independent providers to deliver treatment'.

Yeah, I've been generally following this and it all looks incredibly depressing. 80 years to build a health service, but the Tories can dismantle it in one parliament.

Well in the name of balance, i should probably say that this has been going on since the 80s by stealth and New Labour did and awful lot of the damage, but this is a massive leap forward for the plans. Horrible stuff. I'd be interested to hear from anyone who works in the NHS here.

Yeah, I was going to say I'd be interested to hear Choapses take on it. Someone get over to Twitter and tell him to get his booty back on WAN.

I think he's on hols.

Deleted Post

Yes Malcolm?

He thought there was a free hospital up for grabs.

:) He could put it next to the computer desks.

I would like a cat scan if one is going ;-]

"The end of the NHS?"

Absolute tosh. Everyone knows that Thatcher ate babies, but she didn't kill the NHS. Blair and Brown made her look like a member of Militant, and they didn't kill the NHS. Considering how many people gave Labour a chance when they hadn't had a sniff of power for many years isn't it just possible to conceive that the Tories might actually have changed since the last time they were in power (when they invented world poverty, every disease known to man and Simon Cowell)?

Grabs, have you actually read the details of the white paper? Please note I said that Labour started this loathsome process. Lansley wants to allow hospitals to remove themselves from the public sector if they wish, taking the money (our money, seeing as we paid for the hospitals) with them. If Labour or anyone else was doing this then i'd be kicking off. This isn't down to party politics, it's down to the simple matter of what's in the white paper. Try again and please without the bit about anti-Tory bias.

market forces and making money out of illness by doing as little as possible... how nice... Aneurin Bevan is spinning in his grave...

and as for Thatcher and 1989 - we had the report entitled Working for Patients which proposed what became known as the Internal Market.

nice... hospitals become trusts... big idea was the creation of a market within the NHS so that some parts of the organisation would become providers selling their services to the others, the purchasers.

never mind widespread opposition and history panned out...

1. The whole NHS became fragmented, with each hospital in competition with the others.

2. Primary and Secondary Care were put in an adversarial position. (my mother got the blunt end of this...)

3. The ambulance services were no longer provided by the health authorities and each became a separate Trust (my cousin suffered from this)

4. Like all systems which employ market forces in health care it proved, because of its complexity, to be very expensive, doubling the administrative costs from the traditionally low level of 6% to 12%. FACT and documented.

5. The modest element of democracy in the Health Authorities was removed by taking away members representing staff and local councils and replacing them with government appointees, mainly with a business background

6. Each Trust had its own Board of Directors, not elected by or accountable to its local population and so resembled a private sector company.

source The NHS from Thatcher to Blair, by Peter Fisher and www.nhshistory.net and www.thewelfarestatewerein.com

Each Trust had its own Board of Directors, not elected by or accountable to its local population and so resembled a private sector company.
Mary Archer wife of former convict Jeffrey since 2002 is appointed Chairwoman of Addenbrooke's NHS Trust, Cambridge.

Don't forget in 1980 when the government made it more attractive to get private health insurance too. '30 years of fucking with the NHS - Thatcher - Major - Blair - Brown Cameron' - Not as snappy a book title...

"Try again and please without the bit about anti-Tory bias."

Rather missed the main point, eh? This "they'll kill the NHS" drivel has been around for a very long time, but we've still got it. After a while it get's like the boy who cried wolf. The NHS will still exist when Labour get back in, and the Tories after them.

The fact that the NHS also happens to be the favourite subject of Leftist scaremongering doesn't help.

Grabs, have you read the white paper? The detail is in there. I suggest you read it.

read the fing paper man... jezzze.

Bearing in mind that we're moving today, have a flat that's full of boxes and have to drive from one end of the country to the other tonight, I suggest I've got plenty to do for now.

I do stand by the fact that the NHS has been doomed, according to many, for as long as I can remember, but it's still here. With every "threat" to it, we were told "this time it's different, they're really going to do it now", but no-one has. Even during a very quick glance at the article you posted I noticed one thing that sounds worse than it is - "The old certainties are gone: the NHS cannot be protected from economic reality any longer". Now, this quote is from someone who works for one of the private companies who'd love to get their hands on the NHS. It's very much in their interests to paint such a future for the NHS. If it, somehow, convinces some that they're right then there would be less resistance to their hopes. This also applies to reducing objections in Westminster. They'd be insane to say "Quite frankly, the worst thing that could happen to the NHS is letting us cowboys near it".

Now, move completed and t'interweb connected.

SB__, I take it you read this in today's Graun -

Last week's health white paper has generated some serious heat. The commentary consensus is falling somewhere between a "radical shakeup" and just one stirrup short of the four horsemen of the apocalypse.

Headlines on Comment is free have gradually ramped up accordingly. The more measured early headlines around "accountancy" and an "adventure" have given way to the somewhat more eye-catching "end of the NHS", and the "conspiracy to privatise", culminating in the wide-eyed fury of "the NHS is being wired for demolition at breakneck speed".

Underlining much of the commentary is a feeling that this has happened out of the blue. David Aaronovitch wrote in last week's Times that it undermined the whole point of having a party manifesto. Sunday's editorial in the Observer admonished the Conservatives who "chose not to mention this before 6 May".

So you may be surprised to learn that the government's health plans were in the Tory manifesto. Pretty much all of them. You just need to read it. Putting GPs in charge of commissioning budgets? Page 46. Giving all NHS trusts foundation status? Same page. Allowing private firms to bid on an equal footing to the NHS? Page 45. You could argue that the abolition of all PCTs wasn't there but once you've removed their commissioning role, those NHS bureaucrats would have little to do except push pencils.

But manifestos are dry, tedious things. The phenomenon of collective manifesto-induced coma provoked a rather telling moment in the election leadership debates when Gordon Brown harangued David Cameron on GP access: "David will not give you the guarantee that you'll have a GP in the evenings and weekends," sneered Gordon. "Yes I will," David should have replied. "It's on page 47 of the manifesto: eight til eight and seven days a week." But sadly no party leader actually had any idea what was in the Conservative manifesto.

In fact, Andrew Lansley has spent years telling anybody who would listen that GPs should take control of commissioning budgets. He said as much last year and the year before that. It's just that nobody listens.

So how has such a "radical" plan gone unnoticed? Simply because it's not that radical. Much of what is in the white paper is a continuation of the last decade of health policy. Even if Labour had won the election, much of this was in their manifesto. "All hospitals will become foundation trusts," promised the Labour party. "We will support an active role for the independent sector," it said.

GP commissioning didn't even need to be in the manifesto. In the form of "practice based commissioning", it has been central policy for the last five years. "Achieving universal coverage" has been a target of this since 2006. The budgets involved are "indicative" rather than "real", but what this means to patients is, to a degree, academic.

And as for Labour's use of private providers, they have not just evolved a system to engage the private sector but set up a conveyor belt of advisors and ministers, who make the rules in government before enjoying them in the private sector. Simon Stevens is one of the best known of these advisors. He spent years moulding Tony Blair's health policy before moving to private bogeyman UnitedHealth. Patricia Hewitt was health secretary when the first GP service was created inside a Boots store. No prizes for guessing where she has a "special consultant" role.

Where the two big parties differ is the stated aim of Labour to protect the status of PCTs. But how big a change will this be in reality, particularly for the end user? Since their birth in 2002, which built on previous management structures, PCTs have been constantly reshuffled and as recently as 2006 there were 303 such commissioning bodies – not exactly a huge cry from the "several hundred commissioning consortia" envisaged by Lansley. And the change will be even less given the likelihood that these consortia will re-employ many of the same PCT managers anyway.

But, if I can't convince you that these proposals are planned and unradical maybe you can take solace in the fact that it is a white paper. That's all. It is a statement of intent, not a crystal ball. In the coming weeks it will go for consultation, and will be diluted. Then bits will become a bill, which will be compromised. And even if all that passes untouched it will hit reality.

The NHS has many merits but it also has a flexibility that makes oil tankers look like ballerinas. Despite the introduction of practice-based commissioning half a decade ago, many GPs are still twiddling their thumbs, working out how to avoid involvement – there's little to suggest these plans will be more successful, compulsory or otherwise.

Major NHS reviews come and go like government advisers to the private sector. This is the seventh in 13 years. Does this one close the book on the NHS as we know it? No, it's barely even a new chapter.

• This article was commissioned via the You tell us page. If you have your own suggestions for subjects you would like to see covered by Cif, please visit the page and tell us
B__, I take it you read this -

Yep, it was in his manifesto. Yep, Labour did start the process, but it's still rapidly accelerating the rate of private company involvement, which supposedly is to promote competition and choice, but will most likely increase costs.

Labour health secretaries feathered their nests nicely this way, as the article rightly points out, and a campaign to keep the NHS public was started while Labour were in office, but Lansley has been fairly shameless, as while in opposition his private office was even paid for by a private health provider. Labour's record is disgusting in this field, but does this mean I shouldn't criticise the Tories for it in case you accuse me of bias?

Choice is a dirty word in healthcare as far as I'm concerned. If its not proven most effective/cost effective then it shouldn't be paid for by the state. Personalized medicine is a real prospect but this wouldn't be choice in that sense.

Remember, this is just a statement of intent. By the time it's been watered down to get the bill to a form that would get passed it could be a very different bill.

The whole idea of choice is ineffable twaddle anyway. All anyone really cares about is being cured. No-one would actually choose a hospital a hundred miles away because they always wanted to see Coventry.

As for the bias issue (or not), I just think it's important to remember that Con-Lab (not a typo) are not exactly poles apart on many issues as they once were and that it's not really possible to criticise either of them on the NHS without accepting that the other is just as guilty (if not more).

I agree about the criticism of the two parties and have argued that point all along.

I hope you're right about it getting watered down, as in its current state it's deeply unpleasant.

Deleted Post

Deleted Post

so you are you denying Simon's allegation you are a troll.

Deleted Post

Simon says you top the troll poll ;-]

confirmation then. all done and dusted.

Just passed in the Lords. Utterly depressing. Can someone trip Lansley over for me next time you see him?

Well, that's it people. Britain is now officially 90% shit. It was only 40% shit before.

I am spectacularly angry about this. What were the numbers on the vote?

c.350 vs 220 or thereabouts.

i don't follow things very well , can somebody constructively sum it up for me ?

Could it get any worse, ?

Don't get ill, have accidents, have babies...should be OK then.

Remember, SG said it'll all be alright though ;)

Why are the Tories so selfish and cruel?

Genetics

Centuries of inbreeding?

The promise of money.

http://www.thisislondon.co.uk/standard/politics/article-24008861-lansl...