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The recent BBC2 series "Can Gerry Robinson save the NHS" gave the startling figure that consultants employed privately were on average twice as efficient as when the same consultants were employed by the NHS.

Anyone with even a smattering of economic knowledge will immediately recognise the failures of a monopoly situation without competition and the need to turn a profit.

A big part of the problem was that the official management was both constrained by government dictats over funding, salaries and working hours, and no market incentives for them to do better.

Without competition, the consultants ended up running the show, to the detriment of everyone except the consultants.

If Lansley and Cameron are not going to liberate the supply of hospital services and set hosptials free to operate in a competitive market free of most except the most vital regulation, then they will not really begin to solve the problems of the NHS. And from what you've announced, it looks like it's still more of the same failed "producer capture" story...

Editor - perhaps you could get Mr. Lansley to respond directly and in writing to this and some of the other comments that this thread will spark?

Personally I think that the NHS is a socialist dinosaur which cannot be turned round by anybody in its present state.

What we need from the Tories are radical alternatives. Apparently Cameron devised the "Patient's Passport" so presumably he should be able to dream up something worthwhile instead of the current hypocritical socialist rubbish which is coming out from CCHQ

We need a man of courage who is prepared to take a surgeon's knife to the NHS. Forget that clown Lansley.

That will be just in England then. How are they going to sort it in Scotland and Wales?

Do we detect EPP forked tongue here?

Thats all very well but tinkering with failed NuLab policies will achieve nothing. the electorate are looking for some radical change to teh mire we find ourselves in. Whilst I applaud the policy and it MUST be better than the current one but then thats not hard is it.
If its a straight fight between doomed NuLab and a set of Bliar like policies it will mean another wasted 5 years whoever wins as they struggle with no real mandate from the public. The more we look like a middle ground party looking for policies that are not controversial and simply look to win the Bliar protest vote we will be viewed as "the same as that lot". Why is it so hard to address the issues the public want to hear about?

If there is a bigger plan I am mising then apologies, point me in the right direction.

I agree with Steve and with all his comments above. Unfortunately, and despite listening to him speak at the Bournemouth conf., Lansley hasn't performed well at Health. The Party has generally been unresponsive. Instead of trying to provide serious opposition to Brown we are continuing to mess about on the fringes of the debate.

A better idea would be to indicate support for "Remedy UK" - a new pressure group, I think - who have correctly exposed the major problems with the "training and representation" of young doctors, and who have attacked the BMA, accurately, as little more than another government body.

Worse still, as I said in a talk in Bournemouth, the attitude of the leadership to this seems to be that the problems can be solved by tinkering about with candidates and personalities. If the Party in its present state does indeed find it "so hard to address the issues the public want to hear about", isn't it high time that candidates who might do a better job are given a fair crack of the whip? Wouldn't that be to the ultimate benefit of everyone in the Party?

The last thing we need is a second Blairite middle ground Party coming to power with little real idea of what it wants to do.

"In place of centralised targets, doctors would be given their own budgets and would be rewarded for the individual health outcomes of their individual patients."

I think this is an excellent policy. This makes the NHS truly patient focussed which is frankly what everyone should want and would want when using it.

Those that argue lets privatise to drive down costs through competition are not living in the real world. It would be fair enough for example if in the small town where I live we could build 5 or 6 hospitals which would then drive costs down, but that is not going to happen and even if it was possible would you really want to build hospitals and infrastructure on land that could be used for housing.

The other point about producer capture is nonsense. If doctors are rewarded for putting patients interests first then that is producer capture dealt with as there is now an incentive to put patients ahead of your own comfort zone.

Personally, I want the consultants in a hospital to run the show as I (and you would if you were in hospital) want patient care not profit as the main priority. I would therefore de-layer management (and their own little empires) which would hopefully remove some of the conflict and I would put not just consultants but everyone - from the chief executive through to cleaner's & porters - on performance related pay. Finally I would have an ofsted style best practice regulator to ensure techniques are staying up to date.

The Labour government has overloaded the NHS with ever-changing change. On coming to power the best thing we can do for the NHS is to give it some peace and quiet. Remove the target culture and then allow it a period of quiet stability to recuperate.

Structural changes to the NHS are necessary in the long-term, but in the short- to mid-term the NHS will not be receptive enough to get them working.

The European healthcare systems are having financial difficulties and the American system would never be voted for over here. Yet it is clear that our own system is a shambles. I've raised this question before - how viable are healthcare models from the Far East?

I'm a great believer that if you want socialist policies you vote for a socialist government.

The NHS is socialism run mad. We didn't exactly make a good fist of running it last time we were in power and so I frankly don't give much for our chances of improving on Labour's mishandling.

Staff recruitment and retention must return to local responsibility ASAP.

I would prefer to see each hospital set its own targets and be assessed on one relevant to its resources and services.

Targets are necessary but they should be agreed locally - that is the principle of Management By Objectives - to have people agree on the measures not used as a form of Taylorism.

There are too many nationally imposed PFI structures and systems. What is needed is local teams of Frustration Reduction working to improve Workflow

voreas06: "Those that argue lets privatise to drive down costs through competition are not living in the real world. It would be fair enough for example if in the small town where I live we could build 5 or 6 hospitals which would then drive costs down, but that is not going to happen and even if it was possible would you really want to build hospitals and infrastructure on land that could be used for housing."

It wouldn't be necessary for competing providers to have to build their own hospitals to enable competition. If the existing NHS infrastructure was privatised it would be possible to require the operators of the hospitals to provide access to competing providers using the same infrastructure. One of the many interesting things from the Gerry Robinson programme was seeing the underutilisation of operating theatres- at least at Rotherham (and I'd be surprised if this didn't hold for many other hospitals) there is the physical infrastructure already in place to do many more operations. Many hospitals have empty wards which are mothballed due to lack of resources to run them. Again, this is dead space where the investment in the buildings and equipment has already been sunk and where the cost of that investment acts as a drag on the NHS operating the rest of its services.

Perhaps the model for privatisation would be to split service provision and infrastructure. This might compare with the model from BT's undertakings to Ofcom where they have structurally separated the underlying communications infrastructure as Open Reach and the wholesale and retail service provision by BT using that infrastructure. Obviously this is not a simple process as the privatisation of the rail network has shown, but it is not beyond the capabilities of man.

The use of PFI for building many hospitals over the past decade or so may in fact make such structural separation much easier than it has been with the privatised utilities where there are serious economic complexities in determining fair returns on investments already made by the utilities prior to the opening of competition. The opening up of the ability of PFI operators of hospitals to have a wider range of healthcare providers as customers would potentially benefit not only these competing providers but also the operators, their NHS customers (who might actually find the cost of using "their" facilities falling due to greater efficiency due to full utilisation and the NHS not needing to foot the whole bill for a hospital they were only using a % of) and most importantly patients.

Anyone know if KKR succeeded in its bid for HCA ? With 75% Us health insurance market dominated by 3-4 major insurers and hospital chains like HCA being bought up by Private Equity I guess US healthcare is no longer an election issue now that it is affordable and availale to most Americans

Well said, Angelo. I had thoughts on similar lines myself, recently.

James Bartholomew emphasises in his book The Welfare State We're In that a recurring characteristic of NHS provision is the ever diminishing number of hospitals throughout the country.

When the UK was a much freer country than it is today, there were many more hospitals than now. I doubt that voreas06 is correct when (s)he makes mocking comments on the potential for competition and expanded provision from a greater number of outlets.

It is so sad that after nearly 10 years out of power, the Conservative party still hasn't been able to put together a coherent, market-based, comprensible and attractive policy on healthcare.

Anoneumuse 08.52 - Why are you obsessing about EPP when we are discussing the NHS?!!
Of course Scotland and Wales will do their own thing - that's what they voted for. So let them swim in their own mess. BTW having seen your vulgar attack on Cameron today, I had previously deleted your site from my favourites - you obviously have run out of ideas.

It's good to see Angelo Basu putting forward genuine radical proposals on the NHS.

At present all we have are timid proposals by both Labour and Tories for tinkering about with this bloated monster.

There's no guarantee that any of these proposals will bring about any improvement at all, though you can be sure that the usual Pavlovian canines will bark for which ever set of anodyne managerial proposals happen to get stamped with the Cameron label.

What this country needs is a radical restructuring of the NHS based on sound market principles.

A dose of old-fashioned Thatcherism in other words.

With regard to the comment "So let them swim in their own mess" - I think that people should pay more attention to the successes devolution has had on the Party in Wales, Nick Bourne's Conservative group is doing exceptionally well and you can read about NHyeS our mini manifesto launched last week. See the recent post on my blog and www.abercf.blogspot.com

The switch of emphasis from targets to outcomes is welcome and a definite step forward.

We still need an underlying narrative to show how we would spend resources more effectively to ensure better outcomes. If Brown is the roadblock to reform (not that we have heard that quite so much recently) what are the reforms he is blocking - and what would genuine commitment to localism, in the form of either elected health boards or local authority commissioning, mean for party policy?

Up until the last European Union Parliamentary Elections, I had always voted Conservative. As a matter of fact, for 33 years, I have been a member of the conservative party and I have always been proactive and voted for the party at every local or general election. (this is about to change) and I am not 'concernedabit'

The only political idea I have ever expressed is that of libertarianism and that any elected Government of the UK should be able to govern the UK within the constitutional law of the land and absolutely.

I served 9 years in HM armed forces, thrice in conflict zones. Once internally, and twice internationally, hospitalised in one and traumatised in two.

Today I am devastated, I have been removed from 'Perdix' favourites list.

A great policy. Nothing matters to the public more than the NHS. Labour admitting they got the pay settlement wrong this weekend was very significant.

"A dose of old-fashioned Thatcherism in other words."

I seem to recall that fund holding G.P.s were a thatcher policy. Can we keep our feet on the ground here. Any "privatisation" proposals from the Tories wouls immediately bring down fire and brimstone speculation from Labour, Lib/Dem, the medical profession and most of the media lead, of course, by the BBC.

"In place of centralised targets, doctors would be given their own budgets and would be rewarded for the individual health outcomes of their individual patients."

I'm not sure if I am fully understanding this statement - what, for example, would be the rewards in the case of terminally ill patients?

As a medical and specialist adviser to local commissioners, it is myself and my colleagues who would under this proposal be setting the local agenda with our practices. I partly welcome this. I believe that people who have the skills and experience on the ground should be setting the agenda as regards health and health care.
However, ultimately we have to be accountable to the public, and unless the NHS is responsive to the public's needs, and we have a vehicle to have a proper public engagement on health, this will not work. THis can be developed further from this proposal however.
My policy (100 policies) was on localising the NHS and integrating with social services (either via local government control, or through patient choice of a health provider (as the American HMO system which is a more cost effective alternative to insurance)). This is the only real method that I believe would bring this accountability to the patient and at the same time provide a service that is actually manageable in size (which the current NHS is not).

I do think it would be helpful if posters could remember that the NHS is not just about acute hospitals, but about primary care, community care, research and education. That's what helps to make it the bloated, unmanageable monster that it is.

It is also based on the lie: "free at the point of use". It isn't free, since every taxpayer contributes, and then if, for instance, you need dental or optical care
you make a substantial contribution.

I tend to bore for England on this, but Lansley could have been using the last year to discuss how to provide a health service for the 21st century. He could have used the statement recently made by a hospital consultant who publicly apologised for having voted Labour in the last 3 GEs. He could have cited the appalling bollix of PFI, the overpayment for pharmaceuticals, the costs of NHS Dire(ct), the doctors' salaries contracts, the Junior Doctors' working times directives. He could have had the courage to have open discussions on alternative methods of health provision that only involve the state in setting standards and funding those incapable of work.

He didn't, he hasn't, he is a waste of space.

"Lansley could have been using the last year to discuss how to provide a health service for the 21st century. He could have used the statement recently made by a hospital consultant who publicly apologised for having voted Labour in the last 3 GEs. He could have cited the appalling bollix of PFI, the overpayment for pharmaceuticals, the costs of NHS Dire(ct), the doctors' salaries contracts, the Junior Doctors' working times directives."
- Well made points, sjm, and agree with them all. I do think Andrew Lansely however is in a very difficult position - can't be seen to be privatising a sacred cow (BBC will distort the message), and also any really detailed or radical policy proposals that are appealing or sensible now will be nicked by Gordon Brown in his first few months.

Further to: voreas06 | January 22, 2007 at 10:56

I also think this is an excellent policy. Focusing on outcomes has to be the most efficient method of driving up standards. Outcomes will need to be assessed using tools that will be significantly more sophisticated than targets.

These assessments will however bring detail that will help both the service provider and the commissioner work together to improve standards in a far more meaningful way, than in the commissioning round, AND significantly should include the view of the patients.

It is here that the pressure of the market force can be brought to bear. If part of the outcome measure includes patient satisfaction as one of the outcomes and this is then linked to the final amount that a provider is paid, the provider will have to listen to the views of its patients and seek to improve patient satisfaction wherever they fail to impress.

Doctors and nurses truly want satisfied patients, linking provider income to satisfaction will give them the tools to implement the changes they would like to see.

A further major benefit is that this allows for local variation and flexibility in the provision of a particular service, recognizing that there is frequently more than one way to achieve a desired outcome. This removes the negativity of ‘the post code lottery’ while allowing the commissioner/ provider partnership to work with and build upon current structures and processes as they move towards the desired outcome, rather than compelling them to perhaps unnecessarily comply with centralised diktats which results in unwarranted changes for the sake of conformity. Community Matrons being a good example of this.

Through payment partly linked to patient satisfaction as out lined above the provider will now be ‘naturally’ acting as the patient advocate in its negotiations with the commissioners.

Also innovation in service delivery is not checked by unnecessarily centralised conformity, thereby giving professionals greater flexibility and ownership of service developments

Rachel, thank you, but if the BBC or others started yelling about the Tories privatising the NHS, we'd only have to give them a long list of all the back-door and inefficient privatising that NuLab has been doing over the last few years - oh, and of course get an effective and articulate spokesman to present them!

I don't think I can add a great deal to the excellent posts of Bruce and Rachel above - their experience in the health sector obviously far exceeds mine. I haven't had chance to do any detailed reading on the policy work, I've just seen the headline presentations this evening.

I do wonder if a greater degree of democratic accountability to go alongside the "professional responsibility" we espouse in this would be welcome. In a recent Westminster Hall debate on community hospital closures, the point was repeatedly made that under the current structure PCTs are only accountable to the Secretary of State, who had repeatedly shirked that responsibility by refusing to meet MPs such as Graham Stuart who were losing all community hospital provision in their constituencies.

The issue that I can't yet solve is where this responsibility should lie in the proposed model if it is to be brought closer to the people the system serves. Would pushing democratic responsibility for healthcare provision into local authorities alongside social care cause problems rather than solve them? Where else might it fit? Health authorities under the same model as police authorities doesn't seem an improvement, and would anyone vote for a local Health Commisioner along the lines of the proposal for directly-elected police chiefs?

The only thing that will really shake up the NHS is giving proper power to the patient. As Mr Robinson has shown most hospitals are woefully inefficient.
Social insurance is not the answer - look at the USA which has the highest cost health service in the World and cannot treat large numbers of its people properly. Doctors have to ring an insurance company bureaucrat to find out whether they will fund a test or operation. One Paediatrician in California, I knew, had a full time member of staff whose sole job that was.
We should create Health Accounts for patients banking money on a credit card for every patient and let them spend it as they think best and top it up tax free if they overspend. Compulsory critical illness cover would top up the card for serious chronic illness eg cancer, diabetes or MS. The NHS would no longer consist of doctors or hospitals but 56 million health accounts. People would be much more careful about spending "their own" money.

None of this is relevant now of course. You cant go into a GE arguing for health reform or you will be monstered by Labour and the LibDems. Lansley should spend the next year pouncing on all the Labour failings highlighted above as Mandelson did in 1995. Then if we get elected we should set up a Royal Commission in Year 1 and legislate in Year 2 after a referendum approving the proprosals. That is if we're serious about reform. There are too many of nature's administrators who will always want to keep a hold of nurse...

None of which, however, excuses Lansley from being quite so invisible, until this week.

Jonathan - at some stage, we have to have the courage of our convictions and stop worrying about being monstered by

a. a completely discredited Labour
b. a lost and directionless LibDump

Cameron is a smart cookie, let's see him pull out some of his effective communicators (there are some in the Party) who are savvy enough not to get hostile to the Humphries and Paxos of the media, but strong enough to get some points across.

The finest way to avoid getting drawn into the kind of discussion that starts 'but what would you do about the three little old ladies who have wooden legs and live in the Orkneys and need a rare and particular drug only made in the high Andes on the 2nd Tuesday in Lent', is to say that that would have to wait until we (as the new Govt) had a chance to see the real facts and the real financial books.

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