16/10/2011 The Politics Show East


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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


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