NHS reforms live blog
Today's agenda
Timeline: NHS reforms
NHS reforms: who are the key players?
NHS reform jargon explained
What are the key issues?
11.22am: Rowenna says that Nick Clegg is trotting out a familiar line onwhy the NHS needs reform: treatments are advancing, the population is ageing, long term conditions are becoming more common, budgets are tightening... He says that there are more pensioners than teenagers in Britain.
"The Coalition is protecting NHS funding but, even with that protection, our health services face huge financial and demographic pressures in the future."
And he addresses concerns that health workers might think that the need to change might be an implicit criticism of their work:
"Everyone knows our healthcare professionals are some of the most passionate, dedicated and talented in the world. The need to reform isn't a reflection on them; it isn't a criticism of the NHS."
11.18am: We are not so liveblogging as crowdsourcing the Clegg speech. Our health correspondent Denis Campbell texts to say that University College London Hospital has been turned into a
Pure made 4 TV event. Audience is a health charity reps - and lots of political and health journalists. Clegg is introduced by Macmillan charity CEO Ciaran Devane
11.16am:Rowenna's also looking at the Clegg speech:
Nick Clegg opens his speech by acknowledging again that there were mistakes on the health bill: "we didn'! t get al l of the substance right" he says, "we now need to make changes in some cases, significant ones."
The deputy PM is having to walk a difficult balance in this speech. He's got to make the case for change, whilst also respectfully distancing himself from some of those changes his government has proposed: So I'm here today to reassure people: yes, there will be reform of the NHS. There must be reform of the NHS. But not change for change's sake.
11.12am: Nick Watt of our political team is tweeting the speech for us live. Follow him at @nicholaswatt or #nhsblog
Clegg: no 'dog-eat-dog market' where NHS 'flogged off' to highest bidder
Clegg: NHS managers will commission 'where GPs aren't yet ready'
Clegg: 'no sudden, top-down opening up' of NHS to 'any qualified provider'
10.48am: The deputy prime minister Nick Clegg is due to make a speech at University College London Hospital at 11am. Keep your eye on the blog for live updates.
10.38am: We were emailed the following statement which is doing the rounds in Sheffield hospitals. In just one hospital - the Royal Hallamshire - it has been signed, according to one medic there, by "150 staff including almost 30 Consultant Surgeons and Anaesthetists who are extremely angry and appalled by the future direction of the NHS as laid out in Lansley's Health and Social Care bill".
Sheffield is important because the teaching hospital is one of the largest Foundation Trusts in the UK, employing 13,500 staff. As our mole points out "the Trust has been awarded the title 'Hospital Trust of the year' in the Good Hospital Guide twice in three years. We are also in Nick Clegg's back yard"
The statement reads:
Is this the end of the NHS? We believe the coalition governments Health and Social Care Bill will be a disaster for the healthcare needs of the people of England.
With a devastating analysis of Andrew Lansley'! s bill, Professor Allyson Pollock and Senior Fellow David Price have exposed the true intention of this legislation in the 9 April 2011 British Medical Journal Vol 342 p800.
This bill abolishes the secretary of state's 'duty to provide' a comprehensive service and is replaced with a duty to 'act with a view to securing' comprehensive services. Taken with other changes this will inevitably result in the marketisation of health care along American lines, where investors and shareholders come before patients.
As health professionals in Nick Clegg's home town of Sheffield, we condemn this bill and agree with Professor Pollock, " The bill as drafted amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery " and we call for opposition by any means necessary to defeat the bill.
Not good news for the deputy prime minister one suspects. Although he won't be there hundreds are protesting at his non-appearance at Newcastle civic centre where he pulled out of making a keynote speech. Instead he's giving it at University College London Hospital. We'll be live blogging it soon.
10.15am: Here's a round up of this morning's health reform news:
The Times editorial writes in staunch defence of competition in the health bill, describing Britons' wariness of private companies in healthcare as an "irrational" obsession.
The editorial argues that David Cameron and his health secretary are giving up too much to the Lib Dems who are opposed to competition on "ideological grounds". Behind a pay wall the Times writes:
Keen to shed this perceived toxicity, and keen to throw a bauble to their coalition allies, David Cameron and his Health Secretary, Andrew Lansley, now show worrying signs of relenting on competition and focusing their efforts instead on the second (and, in fac! t, far l ess well-considered) aspect of their NHS reforms, which is the scrapping of Primary Care Trusts in favour of GP commissioning. This is precisely the wrong calculation
The Times' comments come on the back of the second part of a report into the NHS by Camilla Cavendish. In her article today Cavendish talks to Ali Parsa, the ex-Goldman Sachs banker who founded Circle and who has appeared on this blog. He makes some pretty hardline comments on competition in the NHS:
"Incumbents don't innovate by themselves," he says. "IBM would have said it was the best until Microsoft until Google." He talks passionately about revolutionising public services: "In the 1970s it was manufacturing. In the 1990s it was telecoms."
Cavendish also looks at the Spanish model which she says could work well in the UK. She points out that in Valencia, a quarter of the population is now covered by hospitals that are privately run but publicly owned, with some of them delivering excellent outcomes.
To be fair, Cavendish also points out a few problems with competition in the health bill as it stands - particularly in regards to cherry picking - but concludes that "competition needs a rewrite, not abandonment".
Interestingly, Julian Le Grand, a former health adviser to Tony Blair, argues in today's Financial Times that the bill should be scrapped for the opposite reason the Times gives in order to protect current elements of choice and competition in the NHS.
The BBC covers news that the British Medical Association, the union representing British doctors, has once again called for the health bill to be scrapped.
Over in the Guardian our colleague Denis Campbell sets the scene for Nick Clegg's speech later this mor! ning say ing that:
The deputy prime minister will outline the substantial revisions he expects to see made to the health and social care bill to ensure that his MPs feel able to support it when it returns to parliament.
Denis also covers news that the NHS is failing to provide basic care for the elderly. According to the NHS watchdog the Care Quality Commission, three out of 12 hospitals in England where standards of dignity and nutrition for older patients were assessed in spot checks were not meeting the basic standards.
And our colleague Ben Quinn covers Labour's warning that the government might be moving away from abortion rights.
Oh, and Left Foot Forward have covered Healey's speech that we live blogged earlier here.
9.23am: Two opposing views from the floor: a neurosurgeon asks can we afford the NHS - and don't we need this bill? A Nurse says we need to get rid of this bill - and suggests a letter writing campaign to save the NHS?
Healey says nothing rattles an MP more than constituents turning up with concerns about the NHS. He says Lib Dem grassroots are restive because they don't believe their leadership over the NHS. To the neurosurgeon he says sure we need reform but are these the right ones? No. The cost of the re-organisation is 2bn. It's too much - a real waste of money claims Healey.
That's it.
9.19am: Healey takes a question on the loss of patient privacy because of the bill. He has not thought about it in detail but he does make a point about commercial confidentiality - that health service transactions will be in the private domain and beyond public scrutiny. It's a way of tying in privatisation with Lansley's reforms.
There's another point about a lack! of elec tion manifesto commitment to the re-organisation of the NHS. The British civil service were caught out, says Healey. There are still drawing up the regulations. He's making the point that rushing results in poor policy.
9.16am: Healey takes questions. A doctor stands up and says nurses aren't up to commissioning and neither are managers. It's a little bit of a rant. A retired surgeon says the NHS is as important as national security, so why not have a little more consensus?
Healey wants to says he is ready to offer the government his support over social care changes. The public put the NHS above winning the second world war! The British love the NHS, admits Healey. There are some incredibly talented nurses that don't think management talent is the preserve of doctors.
Labour's man makes a point about reorganisations. In the 13 years of Labour rule, they worked out that reorganisations achieve less than you think, cost more than you think and take longer than you think. That's why Labour had a freeze on reorganisations.
9.09am: Healey now lists fellow travellers in the road to opposition to the bill: the BMA, the NHS Confederation. But this is not about opposition for opposition's sake - Healey says Labour wants reform, just not this one. Healey calls to scrap the bill - and he says he has tabled a recommittal motion for the bill to be submitted for fresh scrutiny. Doing so would essentially put the bill back by a year - and make Lansley's position untenable. Healey has 40 amendments - again enough to wreck the bill. Healey's quiet delivery is meant to convey sympathy with reformers but the words are meant to stop the reforms.
"A heck of a speech... great speech..." is the instant response from my fellow breakfasters.
9.03am: Healey now breaks down why the 85 clauses that create Monitor are so dangerous: they remove the protection the NHS has as a "public service" from EU competition law. This poin! t is in dispute. He says Monitor will have to enforce the Competition Act on the NHS. This act has never been used by the Office for Fair Trading because it has been "a publicly managed system". Healey says that the ability to "plan properly and commission confidently" will be undermined because managers will be watching their backs for a "legal challenge". Healey is pushing the case because he knows that NHS managers themselves are worried about the proposed power of Monitor.
8.57am: Labour's health spokesman now gets on to accountability. This is smart territory to argue on as the Lib Dems say they want to close the democratic deficit. But Healey says the consortia will be secretive bodies, the health secretary will no longer be accountable to parliament (amazing for someone poring 110bn into the NHS), and there'll be no independent expert public health agency. He says eight charities have complained that instead of closing the democratic deficit it will widen it.
8.54am: Healey gets into the policy detail here: he notes that there will be five new commissioners in Lansley's plans. Local councils, GPs, consorita, the national commissioning board and its regional arms. This is interesting because Healey is pointing to a period of chaos - perhaps a kind of creative chaos that policy wonks love but patients hate.
8.53am: Healey says Lansley's NHS plan is a coherent, consistent comprehensive policy. This is not a good thing as the Labour politician says that the aim is to break up the national health service: "patients will increasingly see a postcode lottery in care".
8.52am: Healey calls to scrap the bill: the King's Fund say its the "biggest upheaval" in the NHS. Clare Gerada, chair of the royal college of GPs, says it would "irreparably damage" the service. Healey makes the case that the bill will end the NHS. The Labour politician is making the case that the coalition cannot be truste! d and th at their plans will destroy the NHS. His opponents will call this scaremongering.
8.48am: Healey is now warming to his theme: Don't believe the Tories when they say 'I Love the NHS'. Healey says the bill will:
- Break up the NHS
- Remove accountability
- Turn the NHS into a free-market
Healey has dug out Andrew Lansley's first speech in 2005 as shadow health minister where the then Tory MP said "maximizing competition" is the "guiding principle of NHS reform". He then points out that Lansley claims the PM and he go back 20 years on the issue of the NHS. He's is tying Lansley to the toxic "marketisation" of the NHS.
8.47am: Healey says consult first, then leglslate and then implement third. This process has been reversed says Healey. The Labour spokesman is making the case the government is incompetent over the NHS. Cameron has failed to get a mandate for change. It's a point about procedure, but it's a good one.
8.45am: Healey makes the case that Lib Dems have backed the bill: Nick Clegg signed the white paper, his MPs backed the bill through committee. Healey says Nick is selling out the safeguards of the NHS. It's an attempt to reclaim the mantel of opposition from the Lib Dems.
8.44am: Healey argues that the Lib Dems have backed the bill: Nick Clegg signed the white paper, his MPs backed the bill through committee. Healey says Nick is selling out the safeguards of the NHS. It's an attempt to reclaim the mantel of opposition from the Lib Dems.
8.42am: Healey makes a good point about the pause allowing space for criticism against the government - essentially to fill the vacuum caused by the listening exercise. It's bad politics. Healey says the test for Steve Field is how much of the criticism he takes on. He says the bill is at odds with the NHS's ideology. Healey is setting a series of key tests for Field. How much will he be listening ! to Labou r is Healey's point.
8.39am: The speaker introducing Healey quotes Mark Twain, "No word was ever as effective as a rightly timed pause"....
Healey says that to understand the PM's pause you have to understand the politics. He says he's been in the job for six months so he will offer his view on politics, the ideology and the answers. Labour have produced 40 amendments - a new health bill... Healey's been extremely busy.
8.34am:I am at the splendid Royal Society of Medicine's Edwardian Baroque central London building sitting at a networking breakfast. We're waiting for John Healey, shadow health spokesman, to start his keynote speech. It's a power meal so the Guardian is liveblogging from a table with medics and professors. I can report the Salmon is fresh and the scrambled egg is very good.
8.30am: It's another highly charged political day for the NHS, and we'll be covering it all. Here's the line up:
Shadow health secretary John Healey will be giving a big speech on the NHS this morning. Randeep is already down there now and will be posting live updates over the course of the next hour.
At 11am Nick Clegg will be making a speech at University College London Hospital about the reforms. Our health correspondent Denis Campbell will be down there reporting the gossip and we'll be live blogging updates.
Steve Field GP, head of the government's listening exercise on the health reforms, will be will us from 4pm - 5pm this afternoon answering your questions live online.
As ever, if you have any questions for Dr Field or comments to make on the speeches or the debate, please do start posting them below the line now.
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