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all people will receive universal access to a comprehensive health service based on need and not ability to pay.

That should please barristers and The High Court......don't ever dare deny me treatment or operate a postcode lottery or you will be sued to death.....so the only requirement for treatment is need......without any budget constraints whatsoever.

That should cause the health budget to explode

we have ruled out subsidies to private health care.

This is again an invitation to litigate. The ISTCs are paid to conduct operations at a price higher than the NHS.......so the fact that the NHS can do the operation cheaper but that GPs are compelled to use ISTCs and spend 15% budgets on private health providers..........suggests Subsidy.

ISTC

Already posted in the daily comments section, but added here in the light of the introductory wording about 'doctors to be more accountable to patients': -

"GPs' salaries to be linked to the success of the treatment they deliver and the extent to which patients are satisfied with the experience" - Guardian.

If there is anything of the kind within these proposals, it would be singularly lacking in common sense. We cannot seriously be wanting to promote a "how's my healing" culture. GPs often have to tell patients that if they wish to get better, they must take nasty medicine or refrain from inflicting harm upon themselves in the name of pleasure. GPs might also decline to prescribe unnecessary drugs or to sign sicknotes for skivers. The list is endless. Putting GPs at the mercy of unmeritorious complaints would be pointless and damaging.

As a GP's husband I'm sure I can safely say that what GPs want above all is to be set free from targets, bureaucracy and unnecessary centralised IT projects, and to be left alone as far as possible to exercise their professional judgment, in return for a level of pay that reflects the commitment they have always given. While many of the proposals may lead to a vast improvement on the way things are, there is no need to introduce a woolly concept of "patient satisfaction".

Does this mean that the Tories are going to remove the charitable status of private hospitals? Surely this is a subsidy? Have these neanderthals never visited France and Germany where much better healthcare and patient choice is delivered through a diversity of providers? Who are the Little Englanders now?

And are they going to abolish NICE which is simply a pseudo-medical facade for a Stalinist rationing system which makes a mockery of the NHS being comprehensive and based on need rather than the ability to pay?

so the only requirement for treatment is need......without any budget constraints whatsoever.

"Universal access... on need and not ability to pay" doesn't mean that there's no budget constraints. It simply means that, within the NHS, rich and poor have equal access.

whose NHS are they talking about?

"Universal access... on need and not ability to pay" doesn't mean that there's no budget constraints. It simply means that, within the NHS, rich and poor have equal access.

Posted by: Mark Fulford | June 20, 2007 at 13:32

That's the considered opinion of Mark Fulford, QC or Mr Justice Mark Fulford ?

The emphasis in the Skeleton delivered to The High Court will be on "Treatment" and "Need" and that makes clear money does not enter into the equation........treatment is available purely on needs basis.

I suggest you read that clause together with the Human Rights Act and Charter on Fundamental Rights

This seems generally sensible stuff to me. In a sense it is a bit of a cop out in that politicians are divorcing themselves from day to day mananagement decisions so cannot be blamed when things go wrong. But as we have seen in the last 10 years it has proved impossible for Health Secretaries to micro manage the NHS. My thought though is that I suspect politicians will still be blamed by the electorate should things go badly whoever is nominally in charge.The pressure to throw money at problems will still be as intense as ever.
Michael, am I not correct in thinking that there are no private hospitals in France?
I suppose it is too much to expect for Tomtom to refrain from taking the mickey as usual. So easy to do that, so difficult to post any meaningful constructive idea of your own eh Tomtom?

That's the considered opinion of Mark Fulford, QC or Mr Justice Mark Fulford ?

LOL. And your comment "...so the only requirement for treatment is need......without any budget constraints whatsoever", which is really rather a silly interpretation, is the considered opinion of a learned human rights lawyer?

A bit of a curate's egg this. Focusing more attention on measuring outcomes (e.g. 5-year survival rates for cancer) as opposed to outputs is very welcome. I also like the emphasis on individual budgets for long-term conditions.

The NHS Board is a concern though. It will have responsibility for distributing the overall budget and for prioritisation/resource allocation. These are intensely political issues. The independent board reduces, rather than enhances democratic accountability, allowing the Secretary of State to hide behind the Board's decisions.

The relationship between the Board and local primary care commissioners will also need clarification. How much local autonomy will commissioners have, if they are forced to comply with the commissioning guidelines issued from the central board? There is a balance to be struck - and that will determine success here.

The proposal for local authorities to agree local plans with their primary care commissioners is an interesting one. I would have preferred it if overall responsibility rested with the local authority, but this might be capable of achieving a similar result. The problem will be if both sides blame each other for an unpopular local decision, leaving the public none the wiser. If it is proposed that local authorties have a veto - which the CCHQ summary suggests might be the case - then that might be enough, as local electors will know that their local authority has had to consent to a particular decision.

I suppose it is too much to expect for Tomtom to refrain from taking the mickey as usual. So easy to do that, so difficult to post any meaningful constructive idea of your own eh Tomtom?

Posted by: malcolm | June 20, 2007 at 14:24

Malcolm if you cannot refrain from demonstrating your stupidity.......

This policy will be laughed out. It shows typical half-baked thinking from Lansley and shows why Labour will flatten the Conservatives unless the quality of analysis improves.

Every country RATIONS health care - in the USA it is done by HMOs and the Blues who decide how money is spent; in Britain it is The Treasury; and if a Conservative Government were ever stupid enough to enshrine in law a right to healthcare regardless of cost based solely on need - the Courts would have them for breakfast.

The fact that you have no idea how either the legal system or the NHS functions leads you to engage in your ignorant sneering at those who do.

LOL. And your comment "...so the only requirement for treatment is need......without any budget constraints whatsoever",

It is exactly what the statement listed makes self-evident - ability to pay - means only one thing in English......that if you receive goods or services irrespective of ability to pay, you have a de facto right which will soon be de iure

In a sense it is a bit of a cop out in that politicians are divorcing themselves from day to day mananagement decisions so cannot be blamed when things go wrong.

Absolute drivel. The NHS takes 20% Public Spending I doubt any Treasury will leave it to inflate to 25% or 30%......and politicians do not have day-to-day management at present - The Kremlin in Leeds is supposed to do that........but in actual fact the NHS is a demand-led service.


It would be better if Lansley concentrated on the 12000 + Doctors who will be unemployed by the end of June and whether the NHS hospitals shut down on Health & Safety grounds on 1 August 2007 and cancel all operating lists

Malcolm, I believe that in France, Germany and the Netherlands, there is a mix of hospital providers: some state-owned, some run by charities and some run for profit. Users of the universal state health insurance system can in principle use any of these hospitals.

I'm afraid that a lot of this smacks of Andrew Lansley playing to the gallery. It is simply incredible to promise, if indeed he is promising, to write a blank cheque for healthcare. If he is not promising that, just what is he promising on healthcare spending, given an ageing population, a cross-party consensus on unrestricted immigration and the inalienable right of the Scots to more healthcare spending per capital than lesser mortals south of the Tweed?

Having glanced at the proposals, I can't see any definition of "comprehensive" there. What is a "comprehensive health service based on need"? Isn't that one of the key questions? It surely can't mean that the country's entire GDP would be devoted to researching a new cure for some teenager's long-term disease - though on the most literal definition of "comprehensive" this would indeed be what it meant. So given that it can't really mean to be literally comprehensive, what not-quite-comprehensive sense of "comprehensive" is really meant?

I suggest that a key first step would be for the NHS to establish a set of (annually-revisable) commitments - things that we buy through our NHS taxes - to which was attached a property right. That is to say, you would own a right to a certain level of treatment, so that if you didn't get that, you wouldn't write to your MP, you'd go to your lawyer.

TomTom, you and I both know that any legislation won't create legally enforceable rights to specific care for patients. This rhetoric is about words to set out the aspirations of the NHS and which will underpin the details of legislation. At its highest it would effectively set out that ability to pay is an irrelevant consideration in when and whether to grant specific care.

Now, I can fully accept that in one respect these pronouncements can't be right - because access to good healthcare will always be based upon ability to pay, that is the ability to pay to go private. The problem is that we will not win the next election if we try to push that line. So much better to come up with a policy which prevents Labour painting us in the public's mind as a monster which will devour the NHS and which allows us to introduce genuine competition and patient choice to streamline and improve the service. I think this helps us do it and will help us not only run the NHS better than Labour but also to move it in a conservative direction.

If that's the best you can do Tomtom it's really really poor. Not one constructive point from you can I remember in the many hundreds of items you have posted on this blog. Just endless sarcasm and sneering.No wonder you don't like to reveal your real name here.

"While many of the proposals may lead to a vast improvement on the way things are, there is no need to introduce a woolly concept of "patient satisfaction"."
Considering the patient pays to receive a satisfactory service they should be allowed to comment on it whether to praise or criticise it.

Ensuring that money put into the NHS goes into improving the NHS for everyone and is not wasted on red tape and pen pushing.

Easy to grandstand with fine-sounding words. Much more difficult to make sure it happens, especially now that government control over such matters is much less direct than it once was.

I seem to recall that much of the 'management explosion' throughout the public service took place under the last Conservative government. This lot have simply carried on where we left off.

Edward@15:31

Why couldn't "legislation...create legally enforceable rights to specific care for patients"? I don't see this at all. Health insurance companies around the world make contracts with their customers to provide defined healthcare under defined circumstances. What makes you imagine that this would be impossible for the NHS to do?

Really good stuff again from the leadership.

If we are going to win the next election it has to be done by exposing Labour's broken promises, Labour's mistakes and most importantly on the centre ground.

Keep up the good work.

For this once at least, I think Patricia Hewitt is absolutely right about the NHS.

With control by "an independent board of management", the likelihood is that the NHS will become as responsive to customer pressures as the old nationalised industries were prior to privatisation.

Some of us still remember how difficult it could be to get a new telephone line from BT in the 1970s.

And remember the boards of the public corportations, which ran the nationalised industries, all had statutory obligations to run their industries in "the public interest".

Under the present structure of NHS management, MPs can put down PQs and health ministers are ultimately sensitive to media pressures if not exactly to Parliament. I doubt any of that will work if the NHS is managed by an independent board.

The fact is that Britain's NHS has the structure of a Stalinist monolith. Most independent surveys of European healthcare systems rate the system in France as the best:

"The Euro Health Consumer Index 2006 identifies the most consumer-friendly health care system in the European union, as rated by 27 Index indicators. The 2006 Index includes all the 25 EU public healthcare systems plus Switzerland for reference.

"France emerges as the 2006 winner of the Euro Health Consumer Index, 'with a technically efficient and generously providing healthcare system'. France scores 576 out of 750 maximum points. 2005 years winner, the Netherlands, now takes the silver position, followed by Germany. Estonia and Slovakia gets the highest ranking in the category 'value for money'."
http://www.finfacts.com/irelandbusinessnews/publish/article_10006355.shtml

For details of country marking in the index:
http://www.healthpowerhouse.com/media/EHCI2006.pdf

I reckon Cameron has had another bad idea. Remember, Nicholas Ridley opposed privatisation of the railways and that certainly wasn't because he opposed privatisation on principle. His objection was that railways would always require subsidising on a large scale and that required political supervision and accountability.

Andrew Lilico said: "Why couldn't "legislation...create legally enforceable rights to specific care for patients"? I don't see this at all. Health insurance companies around the world make contracts with their customers to provide defined healthcare under defined circumstances. What makes you imagine that this would be impossible for the NHS to do?"

I'm not saying it would be impossible, Andrew, just that I don't see that as what the proposal entails (apologies if it's in the detail - haven't had time to read it all yet).

Whether that would be desirable or sensible in a tax-funded system or not I am genuinely undecided on. I can see great impracticalities: the private insurance system is much more dynamic and personalised than any public system with such depersonalised contributions as general tax could be. Plus, spreading risk by reinsurance *would* be all but impossible. It would be very hard to assess risk as there is basically no information as to potential risk of each taxpayer who may rely on the NHS. Added to which, as part of what TomTom said, there are all sorts of problems with not only legal action but the sheer uncertainty connected with any likely NHS system which the Government would be desperate to retain - for example prescription charges.

All in all, I think a system with a basic *principle* like this for the NHS and a direction of travel is just what we should be proposing, what will gain the country's confidence and what could well lead to great improvements.

Edward@16:41

I don't think that the idea of defining what the NHS will provide is in Today's proposals at all, except in the unhelpful form: "We will write into law the underlying principle of the NHS that all people will receive universal access to a comprehensive health service based on need and not ability to pay".

The reason that this form is unhelpful is that it is not a commitment of finite extent - there is no limit to what a "comprehensive" health service could mean. Humans are mortal, and there will always be the possibility of spending the entire country's GDP in an attempt to keep people alive for five extra minutes. There is no logical possibility of providing a "comprehensive" service, except in the sense that we would devote all of the country's resources to do what we could - which would be a ridiculous waste of those resources.

Instead, all health services everywhere do (as they always will) delimit the healthcare provided to something practical and reasonable and/or defined by some contract with the patient. Until we have some idea of how today's proposals plan to delimit the health care promised, we can have no conception of what they would mean in practice.

Two points (i) I am glad to see that dentistry will be considered in due course (this is a glaring failure of the NHS at present that hasn't attracted enough attention from the opposition) and (ii) the management of hospitals. If Andrew Lansley and DC did not watch the three part series with Gerry Robinson analysing the managerial incompetence in one northern NHS hospital (and his proposals to improve matters), they should do so.
If the tories largely want to improve the model they eventually take over, then these programmes suggest a number of ways of doing so without going back to square one.

"all people will receive universal access to a comprehensive health service based on need and not ability to pay."

is repeated about 20 times a year by various politicians/journalists and always means the exact same thing:

People will receive care based on need not ability to pay because it will remain free at the point of use.

It's not rocket science.

Jon Gale@19:32

(a) Being said by politicians has rarely been offered as a secure criterion for being meaningful and feasible, but I'll give you the benefit of the doubt on that one...

(b) Being said by politicians is something quite different from being written into law, which is the proposal here.

I'm not suggesting that the proposal to write into law something that (more-or-less roughly) translates as "universal access to a comprehensive health service based on need and not ability to pay" is necessarily a bad idea. It's just that it seems to me that the devil is precisely in the detail here - it could be a good idea if that "thing that translates as [.]" is correctly specified, and a bad idea if it is badly specified. So, at the moment, I can't say whether that element of today's proposals is good or not. I might be. I just don't know, yet.

OK, let's see how meaningful the above is by reversing them:


* Ensuring that money put into the NHS goes into harming the NHS for everyone and is wasted on red tape and pen pushing.

* Expanding the top down target culture and taking Ministers out of day-to-day decision making in the NHS.

* Giving patients less information and choice.

* Expanding pointless reorganisations in the NHS.

Come on, who could possibly disagree with such vague warm words? No-one would take the opposite view as that would be absurd, so the original statement is meaningless.

Come on, who could possibly disagree with such vague warm words? No-one would take the opposite view as that would be absurd, so the original statement is meaningless.

But could anyone argue that the aims of the original statement are being effectively delivered now? I don't see the value in defining a policy on the basis that people have to disagree with it! Far, better, surely, a policy around which we can build the broadest support!

And if you think that these are vague warm words, then consider that we've lead polling on the most trusted party on healthcare. Perhaps a little hand-holding has worked - this was one of the issues where rightly or wrongly it was definitely needed.

"Come on, who could possibly disagree with such vague warm words?"

Exactly. Some here might be interested in specifics - as I was - for example, to learn from this recent BBC report how the healthcare system in France achieves the best survival rates in Europe with cancer treatments. Britain has an outstanding international reputation for the calibre of out cancer specialists but the healthcare system in France gets better results. How come?
http://news.bbc.co.uk/1/hi/health/6660665.stm

I think it's time we looked around to see how other countries run healthcare systems when those systems achieve better health outcomes.

Of course, one reason the healthcare system in France may attract better consumer satisfaction ratings is because there are apparently almost twice as many physicians per head of population there compared with Britain. It seems the medical schools there in the 1980s and 1990s were producing more doctors each year than the medical schools in Britain. But why was that?

I'm not myself convinced that these particular warm words are totally unarguable, but in any event there's nothing wrong with warm unarguable words provided that they are attached to some policies or positions that do actually mean something. And today's proposals do include significant content. I disagree with some of it, agree with some of it, and consider some of it not-quite-the-way-I'd-do-it-but-okay, but then in itself that's the way of most politics.

In this are if there's a concern it doesn't seem to me to lie in the specifics. Using Monitor as an economic regulator for the NHS is an interesting idea and unlike certain other contributors here I'm pretty sure it could be made to work. My concern, such as it is, lies in the big picture: Why are we trying to close the gap with Labour on this issue when Labour's approach is widely acknowledged as having failed to deliver; when employing Labour's approach isn't in line with the preferences of either our intellectuals or our ordinary party members (though these differ considerably in their preferred solutions - e.g. lots of ordinary party members would prefer opt-out systems, user charges, or even privatisation, whilst the intellectuals would not prefer these options); and when it manifestly isn't what we would actually do if we won (our members aren't going to believe that - except the most virulently anti-Cameroon; the voters aren't going to believe that; and our leaders don't really believe that, either). Why don't we argue about, and then for, the sorts of things we actually believe in, instead of this silly charade of trying to pretend that we would be just like Labour, really, honest guv', we're pretty-straight-kinds-of-guys??

PS. I appreciate that the angle we are trying is: Labour centralising; Conservatives decentralising. But even if we mean that (which perhaps we do), voters aren't going to believe it - who's going to believe that, once in power, a politician will actually choose to exercise less power though retaining the right to do so. And would Monitor really represent a decentralised approach? The elected politicians would, perhaps, have less influence. But they would be replaced by more influential mighty centralised bureaucrats. Perhaps that's a good thing - I'm not trying to criticize the idea; I actually consider it rather good (and, in fact, it seems to me about 80% certain that Brown will fall in behind it within the year).

Politically, the overall effect is that we are involved in worthy tinkering about a system concerning which we and Labour have achieved consensus. But does the voter want us to have consensus behind the current system, or could he be persuaded to believe in change (which is, in truth, what is required).

Using Monitor as an economic regulator for the NHS is an interesting idea

All Monitor does it to task an Accounting Firm of Consultancy to carry out its remit. I do not see how that improves on the basic fact that NHS administrators are low-grade especially in the Finance function and the Chief Executives are so busy managing Whitehall and its Directive flows that little attention is paid to managing the internal processes.

Health insurance companies around the world make contracts with their customers to provide defined healthcare under defined circumstances.

No they do not. They list exclusions, and cap total budget, and you require their permission before treatment begins, and the hospital has a consent form which makes the patient liable should the insurer not pay.

So whe your child needs surgery and you put your house on the line as surety for treatment, don't complainif the call-centre in India is slow in responding to your claim......The County Court provides the hospital with full redress in declaring you bankrupt for any sum > £7500

TomTom, you and I both know that any legislation won't create legally enforceable rights to specific care for patients.

Really.... your clairvoyance is remarkable.

ARTICLE 35
HEALTH CARE
Everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.

Charter of Fundamental Rights of the EU which should be part of British law by 2009 and certainly will be used by the ECJ irrespective of Britain's attitude.

You have a remarkable faith in Judges not to widen the parameters of any declarative statement in any legal document......and you have no evidence to support your view, the HRA alone disproves your complacency since it has been used extensively in health care cases

TomTom@07:04

I hadn't been assuming that the definition took the form of a positive list. There are differences between positive lists and negative lists, but a list of exclusions defines circumstances. Surely you don't disagree with this?

And it isn't true that these things are always bureaucratic and slow and require complex consent in advance. For example, I lived in New Zealand for a while and had a Southern Cross Ultracare policy. If I attended the Southern Cross clinic, then I just presented my voucher and there were no further questions asked. I never waited more than 15 minutes to see a doctor - and that was after turning up without an appointment.

These kinds of systems can deliver healthcare that is comprehensive and free at the point of need. But the issue I am raising in this thread is just how to define what "comprehensive" means for the purposes of the NHS, which I am guessing would be different from that for the Southern Cross Ultracare policy - e.g. I'm not imagining that NHS doctors are going to see us within 15 minutes...

The reason why the speech had the portion about ability to pay not being the primary concern was to distance the new Tories from our old policy of health vouchers which could be transfered to the private system.

Yes but this country has been taken on a rollercoaster ride by politicians who do not think things out. They want to enshrine things in statute that then come back and cause real problems after the courts have finished interpreting them.

In the old days you could then pass a statute to prevent that Case Law overriding Statute, but with the ECHR and EuroCharter you cannot and the Case Law then overrides Statute.

I do not mind saying these things but I am against enshrining a Constitutional Right to healthcare based on need without any constraint.

Currently it is prohibited for any NHS doctor - viz "contractor" - to require payment from any NHS payment for contracted services. He therefore has no interest in asking if people are eligible for free services or are foreigners who should pay, because he would be in breach of equality directives if he discriminated; if not EU directives then NHS and DoH directives.

There was a big difference between having the ECHR and implementing it word for word in UK Law. I doubt any other Member of the Council of Europe - and there are 40 countries or so has implemented the entire Charter into domestic law.

Most countries simply have Constitutions in conformity with the ECHR. The EuroCharter conflicts with the ECHR in certain areas and Art 35 could well establish a constitutional right to treatment for foreigners or EU Citizens in the country in which they reside.

There is nothing to stop Romanians immigrating to Britain and claiming their right to treatment at NHS expense as an EU Right guaranteed in law.

People on this site rave on about the EU and the ECHR but seem unable to see the steamroller coming down to roll them flat. The EU must be central to thinking on every policy issue.....it is the major political force in Britain today.

Tomorrow we shall know how many British doctors are unemployed - this too is a British Government action which introduced MTAS to make it easier for EU doctors and non-English speakers to work inside the NHS by removing CVs or References from selection in favour of a 150 online essay.

It will not be Germany or France that suffers when operations are cancelled after August - it will be British patients - yet noone seems to have recognised the disaster that is unfolding........except the Yorkshire Post

Recruitment crisis sparks 'mad panic' in the NHS

NHS

NHS

This is a disaster. Nye Bevan must be rubbing his grubby little socialist hands together as he watches this from hell. Must we become socialists in order to get elected? Is it worth it?

Andrew, thank you for coming up with a real live example to show the parochial among us that civilisation as we know it has not come to an end for those unhappy foreigners who have to use social insurance systems rather than the Marvellous NHS.

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