NHS changes – how much power do GPs need, anyway?

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Andrew Lansley, Clinical Commissioning Groups, cluster headaches, Coalition, Conservative, David Cameron, Department of Health, doctors, Dr Phil Hammond, Google, government, GPs, health, Health and Social Care Bill, Health Secretary, healthcare, Heresy, intervertebral discs, Liberal, Liberal Democrat, migraine, Mike Sivier, mikesivier, National Health Service, NHS, NHS privatisation, Parliament, people, politics, privatisation, Tories, Tory, undemocratic, Wartenberg's Neuritis, Wikipedia

This might be controversial but it occurred to me that ‘comedy’ David Cameron and Andrew Lansley have been pinning much of their hopes for the Health and Social Care Bill on a perception that local doctors – GPs in their parlance – are best-suited to direct where spending on healthcare actually goes.

I’m not convinced that’s true. Why are people at the entry-level of the NHS being acclaimed as experts?

I suffer from a condition known as cluster headaches. Every couple of years, I get fast-onset, extremely painful one-sided migraine headaches at a rate of four or more every day, for a period lasting up to three months. It’s a rare condition – only around 50,000 people in the UK get it, which means very little research has been carried out.

When I went to my local doctors’ surgery with it, the GP I saw thought it was just a severe headache and told me to take some aspirin.

Aspirin won’t touch cluster headaches. By the time the drug takes effect, the headache is far too well-entrenched for it to make any difference at all. If I had accepted that doctor’s advice as being the best, most expert diagnosis available, I would have condemned myself to spending a quarter of a year in agony, every two years.

Instead, I went back, got properly diagnosed, and was put on injections of a substance that costs something like £25 a shot – which also raises questions about how much GPs will be willing to spend on a patient when they hold the budget.

Mrs Mike has a condition whereby the intervertebral discs – the shock absorbers between vertebrae – at the bottom of her spine have disappeared. There is an operation available on the NHS that would replace these discs with artificial ones, but this was never mentioned to her and I only found out by typing ‘intervertebral discs’ into the search box on the NHS website. Now, there might be a good reason for keeping this from her, but I doubt it.

Now these examples could be shot down by any critic as anecdotal, but there is evidence that this sort of thing is widespread.

Dr Phil Hammond, speaking on the Radio 4 show Heresy, tells us: “If you go to Dr Google, or his friend Professor Wikipedia, you have a 58 per cent chance of getting it right. Doctors are marginally ahead at about 75 per cent.”

And they tend to look up your ailment on the Internet as well! “Doctors use search engines too; it’s quite common for doctors to use Google,” said Dr Hammond on the same show. “If you look at their computer screen, you’ll actually see them typing… I had a mate who was a pain specialist… and he was teaching a junior doctor and a women came in who had Wartenberg’s Neuritis. He was looking at his notes before she came in and said to his junior doctor, ‘Look, I’ve never heard of this; let’s look it up on Wikipedia.’ They look it up, they make notes, and this woman walks in and says, ‘I’m terribly sorry; I was waiting outside and I heard you say to your junior doctor, you’ve never heard of Wartenberg’s Neuritis, you were going to look it up on Wikipedia. I thought I ought to warn you – I’m the person who wrote the entry.”

So we should not be hailing GPs as the experts who need to have control of NHS budgets. They’re not the experts. The experts are the consultants, surgeons or whoever, to whom they pass you if they find they can’t write a prescription to get rid of you.

The Bill must be scrapped. If we let the Tories make fools of us, it may be the last thing we do.

NHS London risk register exposes Tory threat to healthcare

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and Report, Andrew Lansley, Clinical Commissioning Groups, Coalition, Conservative, Department of Health, Early Day Motion, government, health, Health and Social Care Bill, Health Secretary, Information Commissioner, Labour, Liberal, Liberal Conspiracy, Liberal Democrat, London NHS Risk Assessment, Mike Sivier, mikesivier, National Health Service, NHS, NHS privatisation, Parliament, people, politics, privatisation, Risk Register, Tories, Tory, undemocratic

It seems the London NHS Risk Assessment that was sent to the central Department of Health civil servants drawing up the Risk Register & Report (the document that Andrew Lansley refuses to publish, contrary to a ruling by the Information Commissioner), has been leaked and is now public knowledge.

According to the information in this document, London NHS’s Risk Register explicitly warns that the financial viability of the Tory NHS Bill is seriously questionable, predicting “deteriorations in the financial positions of one or more NHS organisations”.

Practices could go bust or require central intervention to prop up their financial position.  The Risk Report also warns of economic ‘slippage’ & ‘cost pressures’ arising.

The London NHS risk report categorically states that commissioning groups run by GPs may “not be able to secure [services] […] within the running cost range”.

This means the “quality” of health care may be “poor”.

Please ask your MP to sign this Early Day Motion calling for the Risk Register to be published.

The Cabinet splits – are we looking at another Torygeddon?

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Andrew Lansley, Coalition, Conservative, Conservative Research Department, ConservativeHome, CRD, David Cameron, Downing Street, Europe, government, health, Health and Social Care Bill, Health Secretary, John Major, Labour, Liberal, Liberal Democrat, Mike Sivier, mikesivier, Miliband, National Health Service, New Labour, NHS, NHS privatisation, Oliver Letwin, Parliament, people, politics, Poll Tax, Prime Minister, privatisation, Reform, The Guardian, Tim Montgomerie, Tories, Tory

It seems David Cameron didn’t make such a good job of revitalising Conservatism after all.

Three Cabinet ministers have gone to Tory Blogsite ConservativeHome to vent their frustration at the comedy Prime Minister’s refusal to listen to their concerns about Andrew Lansley’s Health and Social Care Bill. “One was insistent the Bill must be dropped,” the blog post by Tim Montgomerie states. “Another said Andrew Lansley must be replaced. Another likened the NHS reforms to the poll tax,” which was disastrous for the Tories in 1990.

So you see, they’re all in it together (as the saying goes) when the going is easy, but once the headwinds start coming in, the rifts start to show.

And now we have three Cabinet ministers splitting from their PM and his Health Secretary. Does anybody remember a time in the mid-1990s when John Major had a similar problem with three members of his Cabinet? He said at the time: “You have three… members of the Cabinet who actually resign… I could bring in other people. But where do you think most of this poison is coming from? From the dispossessed and the never-possessed. You can think of ex-ministers who are going around causing all sorts of trouble. We don’t want another three more of the b*st*rds out there.”

That seems to be exactly what Comedy David has to deal with, though: “Three more of the b*st*rds”. From his point of view, at least.

His loyalty to his Health Secretary (and former boss at the Conservative Research Department) might be praiseworthy in another context. Here, it seems likely to split his party – because, when members of the Cabinet start to rebel, the writing’s on the wall.

Look at Major’s premiership. With him, the problem was Europe. Right-wingers in his Cabinet caused disruption that became an ideological rift, at a time when New Labour was on the rise. Ministers were caught having extramarital affairs and accepting cash for questions. His party became associated with greed and arrogance and the public deserted it, leaving it in the backwaters of British politics for more than a decade.

One only has to glance at the ‘Comments’ column of Mr Montgomerie’s blog to see that the rifts are still there; Cameron only ever succeeded in papering over them.

The Health Bill is hugely divisive: “Abandoning the bill is not an option – it’s philosophically right, and killing it would give Miliband a huge boost,” claims one (deluded, in my opinion) correspondent.

But another says: “It has suffered death by a thousand amendments. It has become an incoherent mess.”

Another simply asks: “Is the bill the new longest suicide note in history?”

Many have taken the opportunity to voice their opinions about other issues; once a split has been identified, they’ll pour all their grievances through the gap.

Europe remains a hot topic: “The Conservatives have already lost the next general election because of the EU and the false promise that Cameron made to get votes for his party. It is quite plain now that he did not intend for there to be a referendum on the EU and has reneged on the voters – they won’t vote for him again,” according to one correspondent.

The popularity (or not) of individual members of the government is still creating splits: “The fact that [Oliver] Letwin was so heavily involved does, and has, worried me,” writes another. “The guy is very bright, but not in a way people on the street would appreciate, or like. He was also heavily involved in ‘bomb proofing’ the Poll Tax legislation was he not?”

The crucial problem for the Conservatives now is the harm this has done to their electability – a problem that was due to worsen with the publication of a report by the right-of-centre thinktank Reform, saying the government’s entire ‘reform’ of public services is being undermined by the Department of Health’s management of NHS changes.

According to The Guardian, “The Scorecard report on 10 government departments with responsibility for different areas of public sector reform also singles out the prime minister for criticism for personally intervening with detailed promises on issues such as waiting times and nurses visiting patients’ beds every hour. The criticisms by Reform will be particularly damaging because they accuse the health bill of causing exactly the opposite of what it is intended to achieve – holding back reform of the NHS and damaging services for patients.”

Tories like power, and they’ll turn on anything that might get in the way. “The plan needs to be to win a working majority in 2015, and prevent Prime Minister Miliband,” as yet another ConservativeHome correspondent put it.

But Mr Cameron likes power too – even the semblance of it that he’s got now. So, even if he can’t get his legislation passed with any degree of confidence in it, he’ll cling on to what he’s got for all he’s worth.

I reckon we’re looking at another three years of ‘lame duck’ leadership before the electorate can take him out and (metaphorically) shoot him.

As the saying goes.

Carving up the NHS is Cameron’s vanity project

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Andrew George, Andrew Lansley, British Medical Association, Cabinet Secretary, Coalition, Conservative, Craig Barrett, David Cameron, Downing Street, Egremont, Faculty of Public Health, government, health, Health and Social Care Bill, Health Secretary, House of Lords, Jon Trickett, judicial review, Labour, Liberal, Liberal Democrat, Lords, Mike Sivier, mikesivier, National Health Service, NHS, NHS privatisation, Parliament, peers, people, PMQs, politics, Polly Toynbee, Prime Minister, Prime Minister's Questions, privatisation, Royal Assent, Royal College of GPs, Royal College of Nursing, Shadow Minister for the Cabinet Office, Sir Jeremy Heywood, The Guardian, The Times, Tories, Tory, undemocratic, Wales

The more we find out about Andrew Lansley’s Health and Social Care Bill – his bid to privatise the NHS – the more childish it all seems.

This has been a week of shocks for the architects of the Bill, starting with the revelation that a Conservative ‘insider’ had described Mr Lansley as “a disaster” who, far from winning over critics of the Health Bill, has managed “to further annoy and alienate NHS staff”, and that a Downing Street briefing had called for him to be “taken out and shot”.

“Health reform should have been carried out by stealth,” said one strategist, according to an article in The Times.

It seems that many of Mr Lansley’s changes could have been carried out without primary legislation, thereby avoiding the glare of the public spotlight and all the adverse publicity that has come with it. Nevertheless, the idea of fundamental changes to our greatest national institution taking place covertly is outrageous and Jon Trickett MP, Labour’s Shadow Minister for the Cabinet Office, has written to Cabinet Secretary Sir Jeremy Heywood, seeking reassurance that “there will be no such covert attempt to bring about fundamental change in the ethos or the care offered by our National Health Service”.

In fact, changes have already been implemented by the government – at considerable cost to the taxpayer – without waiting for the Bill to finish its passage through Parliament and get Royal Assent. Apparently these things are mere formalities for our Coalition leaders (who, let’s not forget, are composed of members of two political parties who could not win the confidence of a majority of the electorate on their own).

But a judicial review, to establish the legality of these moves, is now a distinct possibility.

The decision to implement as much as he has without waiting for the bill’s royal assent is a “flagrant flouting of parliament”, according to Polly Toynbee in The Guardian. But while a U-turn would be embarrassing, failing to do so would be worse, she argued.

Andrew George, the Lib Dem MP and member of the health select committee, put it like this: “It will now cause havoc either way, but going ahead is even more catastrophic”.

Even Tory commentators have turned on the Bill. Craig Barrett, writing in Tory blog Egremont, said: “The fact that many of the reforms do not even require primary legislation makes the resulting headache look embarrassingly self-inflicted. Without a proper mandate, it looks undemocratic.

“For the good of the NHS, Andrew Lansley must admit defeat and head to the backbenches.”

Hundreds of thousands of doctors, nurses, midwives and others have called for the government to abandon this proposed legislation before it does great harm to the NHS. The British Medical Association and the Royal College of Nursing have voiced concerns, and the Royal College of GPs wrote last week to Mr Cameron to ask for the bill to be scrapped. The Faculty of Public Health became the latest healthcare body to call for the Bill to be dropped, “in the best interests of everyone’s health”.

Downing Street has insisted that Mr Lansley and his reforms have the Prime Minister’s full support, though.

At Prime Minister’s Questions, Mr Cameron said his government was increasing its spending on the NHS, while the Labour administration in Wales was making cutbacks. It is easy to dismiss this criticism, though – the cutbacks in Wales are entirely due to cuts in funding from Mr Cameron’s own Westminster government.

The government has offered more than 100 concessions in an effort to get the Bill passed, but this did not stop the House of Lords passing another amendment when peers discussed it on Wednesday.

So – as one can see – there’s a huge amount of opposition to this Bill. It is seen as undemocratic. Only a tiny minority of healthcare professionals want to see it implemented, and they tend to belong to the administrative side – the bean-counters and pen-pushers, rather than the medical practitioners themselves. And Mr Lansley’s time as Health Secretary has been a “disaster”.

Why, then, do both he and our comedy Prime Minister persist with it?

Well, it’s their vanity project, isn’t it?

It’s their attempt to write their names into the history books – the biggest change to the National Health Service since it was created in 1948 and, they hope, the blow that will lead it into a long-drawn-out death, to make way for private health companies and block millions of people from receiving health care of any kind in the future. You just won’t be able to afford it.

In short, they want to graffito “David and Andrew were here” across the face of Britain’s biggest and best-loved national institution, and they’ll do it at any cost.

Childish.