16/10/2011 The Politics Show East

Here in the east, as the controversial health bill clears a

crucial hurdle in the Lords, we ask the Health Secretary about his

plans for a service where GPs control 80 % of its �108 billion

Apology for the loss of subtitles for 1481 seconds

budget, and competition is Welcome to the part of the

programme for us in the east. Andrew Lansley is here with us, and

later we will be hearing from some of the people working in the health

service he would like to ask him a question. We are concerned with

their health bill the Government is proposing. We believe we already

provide exceptional and efficient services.

After a pause for thought between April and June, the Health and

Social Welfare Bill is back on track. The Bill has been described

as the biggest shake-up of the NHS since it began in 1948. Primary

Care Trusts used to buy treatment for patients, but in future, GPs

consortia will hold the purse- strings, spending 80 % of the

Budget. We can reveal that in the East, only 12 practices are not yet

in a consortium. 749 surgeries have already joined the 36 newly formed

consortia. As part of the changes, this month has seen the merger of

the East of England strategic health authority which oversees the

PCTs, too become the NHS Midlands and East S h a. Both will be

scrapped in 23rd April -- 2013. One of the first pilots is underway in

Cambridgeshire. We have been back to see how they are getting on.

Other surgeries remain sceptical about the reforms.

Two GPs, both based in Peterborough, both of their surgeries have

already joined up with other practices Duke create clusters. Dr

Richard Withers is leading the pilot. It is the way forward. The

government has decided this is the strategy, and we are trying to make,

too implement some of the recommendations which have come out

from the review and make it work, on the ground. This doctor feels he

has been forced to join. We were all made to fill it would happen

whether we like it or not. Withers does not agree entirely,

but is prepared to make it work. For GPs are in a pivotal place to

understand. But it is not without its difficulties. No more so,

perhaps, because of the financial challenge facing the NHS pub --. It

is probably the worst time to pick up the reins. I cannot see any

extra benefit for the patients, unless we make extraordinary

savings. And I do believe that the whole recommendation is about

saving money. He is concerned there will be a conflict of interest.

when a patient is sitting in this chair, I do not want them to feel,

is the doctor thinking about my welfare or his Budget? These

decisions are not made by just GPs. A lot of time and effort is going

into the government's arrangements, so these conflicts of interest are

minimised. In the last year, changes have been made on the

ground, even though the legislation has not been passed. Dr Withers'

surgery offers a wider range of tests, and he no longer works as a

GP full time. Two days a week, he is organising the consortium.

a doctor. But I have a duty to help contribute, too utilise the

experience I have gained over the years of organising health care

services. This doctor has not made changes in the last year. He thinks

the government has made enough. Every time we have a different

political party ruling, we have another minister coming a long.

That needs to be stop. Both of them want the best for their patients.

Dr Withers believes the future is challenging, Dr Prasad once the

legislation scrapped. A number of issues raised in that

report. Let's talk about Dr Prasad. He has been made to join a

consortium. We understood there was to be no more top-down

reorganisation. This is top-down reorganisation. This is in order to

deliver better services to patients. He saw Dr Weather is in that report,

who captured exactly the important point. If we are to deliver the

best services for patients, general practices are uniquely well placed

to achieve that. They see not only their relationship they have with

patients and their families as individuals, they also see the

population health needs. I would say to Dr Prasad, I guess, you have

to be part of a group of your GP practices working together. But in

order from your point of view to be clear about what services you want

for your patients. I do not think that is anything other than

absolutely part of the role of the general practice. We put ourselves

in their hands of doctors and nurses to deliver our care. It is a

reasonable extension from that that we should expect them to be clear

about what services they will need to look after us. You said yourself

that we put ourselves in the hands of doctors and nurses. And yet we

saw that Dr taking a leading role, not very enthusiastically, and

saying he is losing two days a week to admin. It is not bad men.

Clinical leadership in the NHS, it is all very well to add menace --

dismiss it as administration. It is about clinical leadership. What he

will be doing in those two days is helping to decide and design what

services should be provided for his patients around Peterborough. That

is part of the clinical decision- making process. If you are a doctor

or a senior nurse and you are trying to decide how you should

refer your patients, what services should be available and where, you

have to be part of designing that process. What about the issue of

conflicts of interest? Willett not happen in such a way that patients

will at least perceives that decisions are being made on a

financial basis rather than on what is best for them? No. At the moment,

there is a greater risk that they are being made on a financial basis.

If you go to somewhere like Peterborough, the Primary Care

Trust, who were supposed to run the NHS there, in the early part of

last year they lost financial control. So a lot of decisions were

made on financial grounds. And it was GPs who were concerned about

the availability of services, but they have no control about how

services were going to be designed to deliver that. So actually, too

be fair, Dr Withers, who is responsible for their developing

commissioning group, he put it fairly. He said, we are putting it

in place of those conflicts of interest do not arise. It has been

a rocky road for the bill. How do you view that personally? It is a

personal blow to you, isn't it? I am only interested in an NHS

which is stronger, able to improve the outcomes that achieves for

patients, and where people in the NHS Bill that although they had

been a prose -- been through a process of having to build their

own structures, that gives them a sense of ownership and stability.

You cannot deny there has not been a backlash -- there has been a

backlash. One occasion, tell me an occasion in the life of the NHS

when anything changed and there was not a big argument. When it was

born there was opposition to it. In the early 1990s, the BMA used to

put up big posters saying, what do you call a man who does not listen

to Kent -- medical advice? Ken Clarke. In 2003, the legislation

was practically lost in the House of Commons on a vote that was very

nearly tied. People oppose change. Nevertheless, this particular

backlash has put you under pressure. The whole thing was stalled from

April to June. Stalled? That is pejorative, isn't it? We decided,

we said we were going to take an opportunity, not least because we

have got the GPs and others coming together in commissioning groups.

Last year, we had a full consultation on the White Paper. In

the intervening months we got these organisations coming together. We

had an opportunity to pause the Bill, put out there and opportunity,

a team of experts, hundreds of meetings and thousands of

contributions. Let's meet some NHS staff. We have been to the Norfolk

and Norwich University Hospital to speak to those working on the front

line of the national health service. Each of these people, a doctor, a

radiographer and union representatives who has worked in

accident and emergency, they each have a specific question. I am a

consultant anaesthetist by trade, I have worked in the National Health

Service since 1982. I have been a consultant here since 1994. My

question for the Secretary of State for Health is how he is going to

ensure that, with increased competition for health services in

England, their health services people rely on are not pulled apart

by the drive for competitive business to secure financial

advantage for itself? What do you make of that? First, because many

services will not be in that sense open to competition. He works in

emergency services. Clearly we are not expecting there to be

competition in accident and emergency, we are expecting them to

be commissioned to provide a service and continue to do so.

Second, there is already competition. It happens already.

The problem is that at the moment, it happens on the basis of price,

because people do competitive tenders for services. What we want

to do in future is extend a system that will set tariff prices,

uniform prices, and then there is competition on quality. But people

will make money out of those prices, will they not? There is a strong

body of opinion that finds that repellent, making money out of sick

people. If so you would like to arrive at a place where nobody

makes any money out of providing services to the NHS? No pharmacy?

General practice mostly consists of independent contractors who are

funded out of the profit they make. Let's be realistic. Hospitals

generate profit. They call it a surplus but they generate profit.

Why? Because they need to invest. They are a public service. Across

the NHS at the moment, the great majority of services make a profit.

That will be true in the future. How about this whole issue of NHS

patients been pushed to the back of the queue by private patients?

Because they cap the amount the hospital scan and... Know, it will

not happen, the legislation does not permit that. It only permits

Foundation Trusts to secure private income in order to meet their

principal purpose, which is to provide services to the NHS. None

of them will be treating private patients in any way that

disadvantages NHS patients why then has there been a concern issued

saying the decision to lift the cap mean that most of our finest

hospitals would become private and foundation hospitals would be

subject to competition. The latter is completely untrue.

The legislation does not change anything. For with respect to her,

she is completely wrong. There are 112 hospitals and trusts in our

region. You could go to bed for good or Harlow or Ipswich, or to

King's Lynn, they are all NHS hospitals. They are allowed under

existing legislation to have as much private patient income as they

like. The effect she describes does not happen. Privatisation is

clearly at the forefront of people's minds. I am an advanced

radiographer and work in the radiotherapy department. I spend my

time along with my colleagues caring for and treating patients

who are suffering from cancer. We are concerned with their health

bill that the government is proposing, as we believe we already

provide exceptional and efficient services. And we feel the

introduction of competition from the private sector will cause a

problem with this, and that they will not be able to cope with the

work like we can. My question to a Andrew Lansley is, do you think

that introducing more private sector provision will actually

improve the quality of care? What do you make of that? The bill does

not introduce more private sector provision. It places a

responsibility on the commissioning groups, which is like the GPs that

we saw in the earlier report. It gives them and their colleagues

their responsibility to commission the best possible services they can.

But if the cheapest option is from the private sector... You have

lapsed into precisely the fallacy, that it is competition on price.

There will be a uniform price established, the competition is

only on quality. Led's talk about added-value. What is to stop GPs

offering secondary services to their patients, something they have

a financial interest in? They can do that now a. What they have to do

is make sure there is no conflict of interest. Say there was a

physiotherapy service, and a GP practice wanted to offer a

physiotherapy service. There is nothing to stop them doing that, it

is just that the contract would be with the commissioning group, and

they would have to do it on the basis that patients could choose

that service or other services. Patient choice would be extended.

Finally, too the health workers' union. Harry has worked in accident

and emergency at the hospital. Here is his question. I have worked at

the Norwich and Norfolk hospital for over 12 years. I am now a union

representative. My question is based on what a lot of commentators

think the bill is going to do. They think it will restrict and ration

health care, privatise large chunks of the health service. And they

think it will destabilise the finances of many large general

hospitals. Is this why you were so keen to wriggle out of the

responsibility of this to provide a comprehensive health care system to

the people of this country? What about that responsibility? That was

interesting. That was a question constructed around four

propositions from Unison, all of which are totally wrong. The deal

is very clear that my responsibility and my successor's

responsibility is providing an securing the provision of a

comprehensive felt -- health service, free and based --

available to all. It does not permit or promote any privatisation.

It does not lead to any fragmentation. Indeed for the first

time in legislation for the NHS, there will be specific duties to

integrate services around the need of patients so there is no change

in the responsibilities? Either yourself or any successor?

practice, it strengthens the accountability. All the legislation

actually does is bring the bill in line with reality. I want to quote

line with reality. I want to quote Baroness Williams, quite she

fighting for the legal duties of the Secretary of State for Health?

the Secretary of State for Health? We have had very long conversations.

The position now have, we understand that the position is

this. Our I can deal with complicated -- I can deal with

complicated. I am apologising for being long-winded. For a long time,

the legislation was constructed around the proposition that the

Secretary of State would provide or secure services. The legislation

League side that provide bit. Why? Because the Secretary of State has

never provided, the Secretary of State has delegated that two other

bodies. And if we relieving that word in the legislation, up we

would have to have a mechanism. Instead, we are having a mechanism

for commissioning services. But the accountability to provide the

service is absolutely there. Would it not have been simpler to reduce

the number of primary care trusts to 50, change the boards so that

you put doctors in the driving seat and cap management costs? Job done,

simplification, not 329 pages. And something most members of the

public would find easier to grasp than this. A if you had gone out

and said to the public, do you know what a Primary Care Trust is, do

you think they could have answered? But they should be able to. They

should be able to. We are talking about patient choice. How can they

make a choice if they do not understand the system? To they did

not understand the system. They did not have choice. They will be more

empowered in future. There is nothing simpler than the

proposition that, if patients are registered with their general

practice, three their general practice in the area where they

live, and it might be as big as a whole of Northamptonshire, when

they do that, that they know that through their general practice,

their doctors, nurses and clinicians to look after them

equally have a responsibility for insuring that resources in the NHS

are used to deliver the services they are looking for. That is not

very complicated. In the past, we had this appalling system where

they were registered with the general practice, and they were

seen by consultants at the hospital, and when things were not right or

available or when decisions were made they did not agree with,

everybody pointed at the PCT and said they were doing it. And the

PCT said, we are accountable to the Secretary of State, and the

Secretary of State said, no, it is a local decision. So there was no