It is all over now. The Health and Social Care Bill has been passed. The politicians have moved on, content to leave professionals and managers to pick up the pieces. Whichever side of this exhausting, divisive, and passionate argument you favoured, we are in a different place now. It is no longer a question of should we or shouldn’t we? Instead it is: how do we make this radically different NHS work for our patients? And how do we avoid reasonable fears about the bill from becoming a reality? more…

David Cameron and Andrew Lansley assert that a large majority of GPs support their bill. Is it true? Where is the evidence? Is the profession lined up in willing support, eager to take on responsibility for managing the NHS through its greatest crisis? Perhaps we all took the King’s Shilling while in our cups in the taverns and only now are waking up to find ourselves press-ganged aboard a merchantman across uncharted seas in the government’s service. more…

The e-petition calling on the government to drop its Health and Social Care Bill has now reached 153 000 signatures to become the second most popular campaign on Number 10’s official petition site. It already qualified for a debate in the House of Commons, when it passed the 100 000 signatures milestone. Some 90% of general practitioners, celebrities including Stephen Fry, Rio Ferdinand, and Jamie Oliver, three Cabinet ministers, and a good part of David Cameron’s own party (see Tim Montgomery’s blog) don’t want the bill. Rarely have doctors, nurses, and the public been so united on a political question. Sadly, David Cameron is closing his eyes and ears. more…

The Prime Minister’s summit on implementing the NHS reforms has provided a new focus for debate about what the reforms will mean in practice. The government’s critics maintain that competition will undermine the core values of the NHS to the detriment of patient care. Some of these critics go further to claim that competition will result in the privatisation of much healthcare provision and the end of the NHS as we know it.

History suggests the need to treat these claims with caution, if not scepticism. Ever since the Conservative government introduced the internal market reforms in the early 1990s, opponents of choice and competition have warned that the future of the NHS is under threat, and yet it is performing better today than ever before. And as Nick Timmins showed in a recent analysis for the Financial Times, the private sector’s share of the market for elective care for NHS patients has remained stable,  giving the lie to the argument that widespread privatisation of provision is inevitable. more…

Despite the widespread concern and opposition to the coalition government’s NHS reforms, the Health and Social Care Bill continues on its way towards royal assent, which is likely to happen in the spring of 2012. Opponents of the reforms, including the BMA, are concerned that the legislation will lead to increasing commercialisation, fragmentation, and privatisation of the NHS. The recently leaked DH document on commissioning confirmed fears about privatisation of commissioning support, which led to the BMA Council taking a decision to oppose the whole bill and abandon its “critical engagement” policy. The ongoing issues around the duties and powers of the Secretary of State to provide a comprehensive service, which has been deferred to the Lords report stage next month, also raises serious concerns that denationalisation of the NHS is an intention of the reforms, as described in a recent BMJ article by Pollock and Price. When seen from a wider political perspective, it is clear the intention of the bill is to replace large swathes of the public sector with the private sector. This is also in keeping with the recent White Paper on public services reform. more…

Every two months I get to sit down with the GP Chair and Chief Operating Officer from each of the Clinical Commissioning Groups (CCGs) in Lincolnshire. Ever since the reforms were announced we have retained a focus on delivery. We have thought of the development of the CCGs as revolving around delivery. There is no point to a CCG unless it is driving delivery. At the meeting we look at delivery and the development of the CCG. more…

Last week marked a “humiliating climbdown” for the Health Secretary. Apparently. “Andrew Lansley is now in open retreat and is being forced to cave in on issues he previously fought to the hilt,” said his Labour nemesis Andy Burnham.

And so why does his acquiescence to an amendment demanding he take ultimate responsibility for the NHS feel less like a U-turn and more like a cup of tea at Charnock Richard services on a steady journey up the M6? Time and time again the amendment of this bill has been met with at worst a shrug, and at times a warm embrace. more…

A frequent refrain is “we mustn’t recreate PCTs.” Increasingly, when I hear or see it said I want to ask five why’s. 
Let me give you an example. 
“We don’t want to recreate PCTs.”
Why? 
“Because they were bureaucratic.”
Why?
“Because they made people jump through loads of hoops to get anything done.”
Why?
“Because of the regulations and law they had to abide by.”
Why?
“To ensure there was openness and transparency in the way they did business and to avoid conflicts of interest.”
Why?
“Because otherwise you have the potential for the misuse of public funds and suspicion that people are doing things for their own personal interest rather than for the public good.” more…

Someone I know, who is not a health care professional but has dedicated most of their working life to supporting improvements in health and health care, recently shared with me their observations about general practice. Rather than focussing on poor performance they studied the good to find out what it was that made them different. They studied readily available data and looked in detail at a number of practices who consistently delivered high quality services, which patients appreciated, whilst using fewer resources than most other practices. more…

“What we are doing, through amendments to the legislation, is to make it absolutely clear that integration around the needs of the patient trumps other issues, including the application of competition rules.” more…