The Health and Social Care Second Reading Debate in a Nutshell.

It was long.

It started at 4.14pm and finished at 9.59pm; 5 hours and 45 minutes.

The government won.

By 321 votes to 235; a majority of 86.

Heroes

Andrew George, the only Lib Dem to vote against the government.

Villains

Most of the Lib Dems, who voted with the government, including Vince Cable, Nick Clegg and Menzies Campbell.

Notable Absences.

Charles Kennedy and Jo Swinson from the Lib Dems; all of the Scottish National Party; most of the other smaller nationals. Mark Durkan (Social Dem and Lab NI), Caroline Lucas (Green), Dr William McCrea (DUP) and Elfyn Llwyd (Plaid) all turned up and voted against the bill.

Labour were hoist by their own petard.

Mr Stephen Dorrell: (to John Healey)
“ Let me pose the question and I shall be delighted to give way. Which of the key themes does the right hon. Gentleman oppose? Is it the practice-based commissioning or the “any willing provider” model? Is it the introduction of private sector expertise into commissioning, which was first articulated in the world class commissioning programme, or is it the principle of the maximum tariff? Let me help him by quoting from the operating framework of 2009, to which my right hon. Friend the Secretary of State referred. It states:
“After 2010/11, we shall move to a position where national tariffs represent the maximum price payable to a commissioner, as opposed to the mandated price for a particular activity.”
With which of those four key policies does the right hon. Gentleman disagree?”

Some Lib Dems had a reason for not voting with Labour.

Gordon Birtwistle:
“I am pleased that the reconfiguration board is now studying a decision that the previous Government made to close my local hospital’s children’s ward. The Secretary of State is due to rule on that shortly.
A prime example of the authoritarian nature of primary care trusts can be seen in my constituency. Without proper consultation, we have seen our accident and emergency department closed and our children’s ward transferred to Blackburn. My constituency is seriously deprived, and the decisions made by managers in Manchester have had a disastrous effect on the health and well-being of thousands of my constituents, many being seriously ill children. The proposals before us will ensure that, for the first time, commissioners and all providers of NHS-funded services have to consult the local authority on the proposed substantial reconfiguration of designated services. In my eyes, that can only be a good thing..

Helen Jones (Warrington North) (Lab): The Bill allows private providers to undercut the NHS. What would the hon. Gentleman’s reaction be if an NHS service in his constituency disappeared because it had been undercut by a private provider?

Gordon Birtwistle: The service was removed by the hon. Lady’s Government, so I do not need to worry too much about private services.”

The ‘ Was I mistaken, or is care of the elderly going to be cut adrift from both the NHS and Social Services’ Moment?

Stephen Lloyd (Eastbourne) (LD): I agree that the issue of ageing patients is a fundamental challenge. Does my hon. Friend agree that domiciliary care, which is currently delivered through local authorities and primary care trusts, is a vital service that maintains many people’s health for the longer term and often prevents unnecessary stays in hospital? Does he agree that appropriate steps should be taken by the Government in the Bill to ensure access to high-quality domiciliary care for all?

Dr Poulter: My hon. Friend represents Eastbourne, which has a large elderly population. He is right to make that point. Under the Bill, health and wellbeing boards will be set up, which will deliver a proper partnership between GPs, hospitals and local councils. That will allow, for the first time, properly joined-up thinking about how we deliver social services care that is joined up with NHS care for older people. I am delighted that the Government will put in almost £1 billion to support that initiative, which can only be a good thing.

Last Word

Rosie Cooper (West Lancashire) (Lab):

I fear that today marks a watershed in the future of the NHS, and I say that as one who has proudly dedicated 30 years of my life to the service. Today is the day that the... Government will lead us down a path that, sadly, will end with a broken NHS.

The Hansard text of the debate can be found here.

Urgent! Second Reading of Health Bill this Monday!

Bunch of sly sleekit b****s. The second reading of the Health and Social Care Bill in the Commons goes ahead this Monday. If you haven't already contacted your MPs to vote, do so today.

I'm beginning to wonder if the reason the BMA chose to have its debate on the bill on the 15th March, was so that it would all be over by the time it happened. Anyway, I digress. Get on those phones now to your MPs!

Myth Busting and the Conservatives

Dr Grumble has had a letter from 'Call me Dave' regarding myths about the new NHS proposals. One would have thought that he had written it himself. He might have done but it is a cobbled version of a 'myth busting' document on Conservative Home. If you click here and then click on the 'Health and Social Care Myths PDF' to the right of the screen, you'll be able to uncover 20 myths about the NHS.

Warning; make sure that you are not holding anything hot or drinking anything, otherwise it will end up all over the computer screen.

A New Model is Needed for Care of the Elderly

Do have a look at 'Fighting Monsters's excellent article on a new model of care for the elderly.

The Human Face of the Cuts - National Day of Protest and Atos

Do take a look at Benefit Scrounging Scum's post on the National Day of Protest. Their particular target was Atos Origin, that has been doing disability tests for the government and seems to have adopted 'If you're warm, you're in' policy. Yes, they are related to Atos Healthcare, that's been taking over GP practices. I'm going to say more on this in another post, but in the meantime have a look at these pictures and weep.

She Must Be Mad(3) - Letter on GP Commissioning

Got this letter printed today in the Herald (one of Scotland's broadsheets)on GP commissioning. It is done from the Scottish perspective and the attempt here to try and introduce private companies into GP practices. For those of you who don't mind signing in to read the letter (it's free for the Herald) the link is here. Otherwise, here is the text of the letter below.


In March 2007, just a couple of months before the May elections, a small but significant fight over the future of the NHS took place in Scotland. SERCO, a utilities company, attempted to take over Harthill GP practice. It was unsuccessful, partly because it was publicised and partly because an election was looming. This was the first attempt by a private company to take over a GP practice in Scotland. Since then, legislation has been passed by the current Scottish government to prevent future occurrences of this nature.

England has not been so lucky. For some time now, companies like United HealthUK (a subsidiary of United Health in America), Atos and others have been taking over the running of GP practices in England. When this happens, the next move is generally to ‘hollow out’ the practice by replacing partners with salaried doctors and doctors with nurse practitioners. Drugs companies often link up with these practices, paying large sums of money in return for use of the practice as a shop window for their brand of drugs. Astra Zeneca was partnered with SERCO for example. The old, the chronically ill and the disabled are not welcome at these practices, because they drag the profits down.

Now the final nail in the coffin has come in the shape of the NHS White Paper and GP commissioning. Handing over control of the NHS’s budget to GP practices might seem a great idea, until you realise that you are not handing it to GPs, but to anyone who happens to be running a GP practice. In England this can be a GP, or United Health or Richard Branson under the guise of Assura UK. This means that these companies, not GPs, are going to decide how hospitals, mental health and elderly care are funded and who is going to provide services such as pharmaceuticals to them. To this already toxic situation is added the possibility that the purchaser and the provider can belong to the same company. Serco run facilities management in Leicester Royal Infirmary and Norwich and Norfolk University hospitals; if they move into GP practices in the area they could be both commissioning care and providing it. As ordinary GPs cannot possibly run their practices and the whole of healthcare commissioning for their area at the same time, these companies will be brought in to do it for them and this conflict of interest will arise.

This bill, if passed, will mean the end of the NHS. It will be a franchise owned by myriad private companies, funded by public money. Strategic health planning and regulation will be a thing of the past as services get splintered between competing health care organisations. The recent divesting of NICE’s powers to regulate prescription drugs and the proposed lifting of the cap on private patients being treated at NHS hospitals will mean a market free for all. Although this bill is currently for England and Wales, nobody in Scotland should delude themselves that it would not cross the border if it was enacted there. Harthill is the proof of that. For anyone who cares about the NHS, now is the time to lobby MPs and take a stand.

Rationing - It's Here

A very important post by Witchdoctor. Rationing has arrived. Read it here.

Second Good Deed for the Day

If you really want your halo to shine and you've already had your say on the Beeb page, then you could sign up to this petition asking for the Royal Liverpool Hospital to be rebuilt using public funds, not PFI. Keep Our NHS Public has organised it..

Good Deed for the Day

If you have the time and if you can stop yourself from throwing your coffee over the computer in the process, you could log onto the BBC's 'Have Your Say' and tell the punters out there why GP commissioning is a Bad Thing.

So, What Are We Going to Do?

I've just finished reading 'A View from the Foothills'. This is an account of Tony Blair's government spanning 1999 - 2005 and is written by Chris Mullin, MP for Sunderland South. He's an intriguing character. He started off his career as a journalist and was involved in getting the Birmingham Six case reviewed. He supported Tony Benn against Michael Foot. He voted for the Iraq war on condition that it was approved by the UN. When it wasn't approved, he voted against it. He was one of the lowest claimers for expenses and provoked a few laughs when it was revealed that he had a £45 licence for a black and white telly. He refused to use a ministerial car on grounds of opulence and expense and had a running battle with his office over his non use of a pager. He's a very human person, not entirely a hero, but not belonging to the dark side. He's the type that if something unpopular were done, he would sometimes rebel, but if he didn't, he would drag his heels, leak a document and stick a spoke in the smooth wheel of government. He is, in short, like most of us.

One of the votes that I checked out of interest was the Legislative and Regulatory Reform Act 2006. It would take too long to tell you everything about this, but basically it gave ministers powers to exise laws from the body of legislature that had become outdated or unnecessary. However, the way that the original bill was worded would have in theory handed powers to the prime minister allowing him to abolish anything from not crossing the quad with a sword, to habeas corpus. Its nickname was 'The Abolition of Parliament Bill'. The Lords were responsible for its emasculation eventually, but it caused a storm in legislative circles.

Now here's the intriguing thing. Chris Mullin voted for this bill. This is someone who voted against 48 day detention, stop and search and so on; all the things you would expect a left leaning journalist and former editor of the Tribune to do. There's only one conclusion that I can draw from this; Chris Mullin didn't actually know what he was voting for. There was no reason for him not to rebel; by this time he had become a backbencher again. So why didn't he know what it was about? That's quite simple. It wasn't in the papers. It was not talked about. The bill was highly technical. It never made it out of the legislative chattering class. It wasn't on the radar, so it didn't exist. It was just a question of turning up for the vote and that was it. If he had known what it entailed, there's no doubt in my mind that he would have voted against it.

Was this remiss of him? Of course not. MPs deal with tonnes of stuff every day. They agree on most things; we only see the debates where they don't. And government is an ever shifting landscape. A cabinet minister is lucky if he stays in the same post for more than a year. That's nowhere near long enough to learn the brief. And if it's not in the papers, then there's only one other way that it would have been brought to his attention and that was through his constituents. It would have taken a lawyer to turn up and explain the implications of the bill to him blow by blow; then might he have understood what it was all about.

This is my fear about the GP commissioning bill. To put it bluntly, we are losing the media war on this. There is no way that we are going to get the public to understand the implications of this bill in time through the media. Half the media are biased,the other half don't understand and the third half are too lazy to find out. We are not going to do it in time through our blogs, although more curious souls will find accurate info on how this is really going to work. It is not going to be done through the medical colleges because they're still trying to get their s** together and it's going to be a feeble 'I protest' that you used to get from that poor prosecution lawyer up against Perry Mason. So what are we going to do?

There's only one way to tackle this now and that is to go behind enemy lines. Yep. We need to go to our MPs' surgeries. That is the only guaranteed means of delivering our message on GP commissioning. The media won't, the colleges won't and the BMA won't. We must do it. And this is how;


First, get a retired doctor to go to the MP. That way there's no backlash on someone's job.

Secondly, if possible, get a group of doctors to go.

Thirdly, take a one page briefing with the main points laid out in easy to read English and in bullet point style.

Fourthly, back it up with written letters and repeat visits to that surgery.

Now, this isn't going to work for all MPs. Some will vote for the government regardless. But I want you to consider this; of the 650 MPs who represent us, how many do you think have a clue what this is about? And of that 650, how many would vote against it if they understood the implications? I knew diddly squat about health politics five years ago and it's taken me a while to get my head round it. Why should it be different for anyone else who's not a medic?

One last point from Chris Mullin's book. The day before the vote on Iraq, he phoned round party activists and constituents who had come to him about it, because he was undecided as to whether he was going to rebel. Once he had spoken to them, he made his mind up and voted against the war.

Levinas said that it is the face that forbids us to kill. Snipers know this rule; they are more likely to shoot someone far away than someone at close range. Chris Mullin was wavering in the face of disapproval from the great and good in his party; but hearing the voices of those in his constituency kicked him into touch again.

Right now our MPs need to see the face of their doctor. Not the lazy overpaid Daily Rant version of doctors, but the ordinary one of their local GP who (in most cases) has treated their family from cradle to grave. And we need to remember that MPs have faces as well. Like most of us, they need encouragement to do the right thing. Conscience is not an individual choice, but it is influenced by those we know and those who love us. Formal battles take place in parliaments and palaces, but ultimately all struggles begin at home. And that is where we need take this battle now.

Looking for a Job?

Are you looking for a job? Do you often experience deja vu? I knew you were going to say that. Well, in a place not far away from me (Motherwell)there are jobs on offer for people with second sight. And it's on the Direct Gov website. Have a wee look here..

The NHS Consultant's Association Kick Ass (of the BMA)

There are stirrings of revolution going on. Here is an open letter to the BMA, printed in this week's British Medical Journal. The author is Clive Peedell(co chari of the NHSCA) along with 118 other signatories. It's basically telling the BMA to push or get off the can re the white paper. Here is the text of the letter.

Dear Hamish Meldrum, Laurence Buckman, and all members of the BMA General Practitioners Committee,

After the publication of the health white paper earlier this year, Hamish Meldrum wrote to the profession to explain that the BMA was going to ‘critically engage with the consultation process’ to defend the founding principles of the National Health Serice and the principles underpinning the BMA’s Look after our NHS campaign.

The consultation period is now over, and it is clear from the Department of Health’s response to the consultation that the BMA’s policy of ‘critical engagement’ has failed to persuade the government to alter its approach. The BMA responded with a damning press statement. ‘There is little evidence in this response that the government is genuinely prepared to engage with constructive criticism of its plans for the NHS. Most of the major concerns that doctors and many others have raised about the white paper seem, for the most part, to have been disregarded.’

In fact, Andrew Lansley’s plans are now even more market based. Within the new operational framework for the NHS in England, ‘price competition’ will be introduced, which fundamentally changes the NHS from a ‘quasi-market’ system of fixed prices (tariffs) to a more open market system. Hospitals will be allowed to charge rates lower than the national tariff, which sets prices for thousands of NHS procedures and covers roughly half of hospital income. According to Zack Cooper from the LSE, ‘Every shred of evidence suggest that price compettion in healthcare makes things worse, not better.’

The NHS Confederation shares this view. ‘ Economic theory predicts that price competition is likely to lead to declining quality where (as in healthcare) quality is harder to observe than price. Evidence from price competition in the 1990s internal market and in cost constrained markets in the US confirms this, with falling prices and reduced quality, particularly in harder to observe measures.’
Moreover, the BMA has stated that it has ‘concerns over the use of ‘best practice’ or deregulated tariffs in the NHS, because this system brings with it price competition, which can risk basing decisions on price rather than on clinical need.’

The white paper is still awaiting publication as the Health Bill, which will then need to be subjected to the legislative process before being enacted by parliament. We are therefore very concerned that the BMA and more specifically the BMA General Practitioners Committee is treating proposed policy (that is, a white paper) as if it is policy. For example, on 17th December 2010, the chairman of the General Practitioners Committee Laurence Buckman, stated in a letter to all GPs ‘Practices should now be working with other practices to make progress in setting up their embryonic consortia and electiong and appointing a transitional leadership.’
In addition, on the topic of general practice consortiums and commissioning, a recent BMA briefing paper stated, ‘The pace of change in developing commissioning must allow the vanguard to develop swiftly.’

The fact that market based policies have actually been strengthened by Mr Lansley goes against BMA policy from numerous BMA annual representative meetings and the stated principles of the BMA’s Look after our NHS campaign. The BMA should therefore withdraw its policy of ‘critical engagement’ with the government and engage more with its own membership. It is remarkable that despite ‘the most radical restructuring of the NHS since its inception, BMA Council recently voted against holding a special representative meeting of the BMA to allow its membership to debate the current proposals. This is in contrast with the BMA’s stance against the other most significant NHS white paper reforms, Working for Patients in 1989, when two special representative meetings were called.

Although the BMA hasn’t formally surveyed the profession about the white paper, surveys conducted by the King’s Fund and the RCGP have both highlighted the high level of concern among healthcare professionals, with fewer than one in four doctors believing that the proposed reforms will improve the quality of patient care provided by their organisation or practice.

We believe that the BMA has no mandate from the BMA membership to continue with the ‘critical engagement’ policy. Mr Lansley’s reform agenda has been widely criticised across the health policy and political spectrum as moving too fast, yet the current approach from the BMA could actually hasten the pace of reform because the association has effectively sent a message to the profession that the white paper is a done deal.

We have serious concerns that the proposed reforms will fundamentally undermine the founding principles of the NHS by creating a much more expensive and inequitable market based system. However, we also believe that the BMA could play a crucial role in saving the NHS from this fate, because according to the Health Service Journal, ‘From an influence point of view the BMA is critical because it could derail the coalition’s white paper reforms, which propose a clinically led system. If the BMA were to say no, then the whole initiative could grind to a halt.’

Thus the NHS really is in your hands. We understand the pressures you are under, but it is now time to mobilise the profession and stop these damaging reforms, which will not only destroy the NHS but also profoundly affect the social fabric of our nation.

This is a great opportunity for the BMA to achieve redemption for its opposition to the inception of the NHS in 1948. We urge you to take it and will support you 100% of the way.


Don't you just love that emotional blackmail at the end? Here's hoping it works.

Great Scot - Gerry Rafferty is Gone

This was not the post I wanted to begin 2011 with. Gerry Rafferty, Scot and song writer of the magnificently brooding Baker St, has died. Many things are memorable about this song, but it's the searing, sexy, sassy sax solo that is the soul of cool that makes it. Here's a reminder for younger people of what music sounded like when it wasn't a pile of merde.