Why can't Lansley leave GPs alone?

Are they capable of taking over the role covered by GPs? Probably not. Here's a list of what PCTs do. It is a PDF that is a list that goes on for 14 pages. Today Roy Lilley at nhsmanagers.net posted a communication from an NHS manager of what PCTs do:

• Cooperate with local authorities.
• Members of safeguarding children boards.
• Equalities and human rights.
• All the stuff to do with continuing care.
• Compliance with NICE decisions.
• Individual funding requests.
• Dealing with complaints.
• Public access to public bodies’ meetings.
• Freedom of information.
• Employment law.
• Corporate manslaughter.
• Medicines management regulations
• Etc Etc.

Read the full list and then try to work out how your local GP will be able to do it all.

Why can't Lansley leave GPs alone to do what they do best: medicine? Why does Lansley insist that they have to become managers?

Public Sector Pay

We are constantly told that the public sector has to be slashed because that is what has happened to the private sector. To justify this, the Conservatives give us examples of the worst private sector employers who are sacking staff or cutting pay and then saying: "if the private sector has to do this, then so should the public sector". But have private sector workers been hurting? The answer is no.

Incomes Data Service is an independent research organisation providing information and analysis and their data shows that private sector workers have not fared as badly as the Tories tell us. For example, this press release in March says that: 

The median pay settlement in the public sector during 2009 was 2.1 per cent, only slightly above the median figure for the private sector, of 2 per cent.

Further, things are getting worse for public sector workers (July press release): 

The median pay settlement level across the whole economy for the three months to the end of May 2010 remains at 2 per cent, unchanged from the three months to April. ... Pay settlements in the private sector continue to be centred on 2 per cent, which is the median level of awards in both manufacturing and private services. The median in the public sector, however, has fallen to 0.8 per cent, down from 1 per cent in the three months to April 2010. This is the result of an increase in the number of pay freezes and lower awards applied in the public sector over this period, ahead of the Government’s announcement of a two-year pay freeze from 2011.

So March to May the private sector had 2% increases and the public sector had 0.8% increases, less than half. Is this the message that you hear from the Tories and their friends in the Press?

Further, IDS say: 

In the private sector, pay freezes now account for just one-in-ten pay settlements, while in the public sector two-fifths of the pay reviews that took place in the three months to May resulted in pay freezes. Pay freezes are now the most common outcome of pay reviews in the public sector, with over 1.3 million public sector workers having their pay frozen in this three-month period. In the private sector, pay freezes recorded in this period were for the most part confined to care providers and electronics firms.

We are constantly told that the private sector is taking the pain of the recession and the public sector isn't. Yet just one in ten pay settlements in the private sector are pay freezes, but two fifths of public sector pay settlements are pay freezes. The actual figures show that it was the public sector that took the pain, not the private sector.

Franchising of the NHS

The Government is keen to break the NHS apart and scatter the pieces to the wind. Pulse now report that commissioning of care could be handed over to charities and pressure groups.

"Pulse has learned that at least one major charity has already held preliminary discussions with the Department of Health about taking on a commissioning role. It is understood the DH is sympathetic to the idea in principle, although it would be GPs’ choice whether or not to enter into such commissioning partnerships."

I have a chronic condition and I am a member of charity that is a support group for this condition. Do I want them commissioning my care? No. You may think this is an odd position, since surely a support group would want the best possible care for me? Yes, but they also want the moon on a stick. I recognise that it is possible to spend an unlimited amount of money on my care, I also recognise that often as you spend more you get less improvements, and there is a careful balance. I want my doctor to make these decisions, I want my GP to be my friend and advocate. I want my doctor to make the best decisions for me.

(A year or so ago I looked into how to get more involved in the governance of the charity and I found that it was inordinately difficult. Basically, the charity makes sure that only the "right" people can have governance positions. I am happy with that when it is simply a support group, but if they were to be commissioning my care then I would want to see far better, and more representative, governance.)

Handing over such commissioning to charities is heading for disaster.

Worse care is on its way

The Department of Health says that "within three years all NHS Trusts will become Foundation Trusts". As any NHS trust will tell you, a three year timetable is extremely ambitious, if not impossible. To be authorised as a Foundation Trust a trust has to prove that it has the financial stability to be able to handle its budget independently of the government.

The problem is that this is not as simple as it may seem. Hospital trusts have budgets in the hundreds of millions. Unlike the existing 129 Foundation Trusts, who were authorised at a time when there was adequate money in the NHS, the remaining 120 or  so trusts will be subject to rather savage funding cuts. The scandal at Mid Staffs occurred because (at a time of adequate NHS funding) they had to make efficiencies to meet the FT finance governance tests, and they allowed care quality to slip. In response to this, the authorisation tests were tightened to include quality measures too.

In times of adequate funding, the FT authorisation tests were tough, at a time of savage cuts in the NHS they are likely to be impossible. The government says that there is no option: NHS (acute hospital) Trusts will not exist in 2013. There seems to be only one way to square this circle: relax the criteria. Clearly, since there will be a shortage of money, it will be impossible to relax the financial governance criteria. So the only possible solution is that the care quality criteria will be relaxed. Basically, if your local hospital is an NHS Trust (ie, not a Foundation Trust) it will mean that in the next three years the deminishing numbers of managers will be desperately making cuts to try and keep to the squeezed budget and your care will suffer. There will be fewer clinical staff and waiting lists will lengthen.

After Mid Staffs we all hoped that such conditions would never happen again, instead the likelihood is that it will happen to at least one hospital in the next three years, and probably with worse consequences. The frightening thing is that it could be your local NHS hospital.

Incidentally, if your local hospital is already a Foundation Trust then they too are unlikely to continue to give high quality care. The reason is that they will be subject to the same straitened financial conditions and to balance their books they will have to compromise the quality of care. But, you ask, surely this will mean that they would be in breach of their FT authorisation? Indeed, and before Lansley got his greasy paws on the NHS such hospitals would be put on the equivalent of the NHS "naughty step" by being de-authorised as a FT and have the privileges of autonomy of their finances taken away. However, Lansley has said that he will legislate to remove the ability of de-authorising trusts. This means that once a trust is a Foundation Trust whatever it does it will always be a Foundation Trust.

It used to be the case that authorisation as a Foundation Trust was an accolade but now it appears to be precisely the opposite.

Moving closer to privatisation

HealthInvestor give an foresight of what to expect in the future. Cornwall & Isles of Scilly Primary Care Trust will not exist in 2013 because Andrew Lansley will legislate to close it down, so instead they have created a private company to employ their commissioners which they hope will contracted by the GP consortia in the future.

NHS managers in Cornwall have agreed in principle to the creation of a private company that would see primary care trust (PCT) commissioners spun out of the health service. Senior staff at the PCT will now proceed with establishing the community interest company, which would manage 2,400 workers, as the NHS starts to implement Andrew Lansley’s white paper reforms.

So does this matter? Well if you are a patient in Cornwall, ye it does because in the future rather than being treated by NHS district nurses, or having care in an NHS community hospital, you will have care provided by a private company instead.

The new venture will control an annual budget of £75 million and will manage 14 cottage hospitals, and a number of community services, such as district nursing.

This means that the hospitals will have been taken out of the NHS and the result of this will be that there will be no guarantee that they will survive. The private sector are licking their lips in anticipation of the rich pickings they can get. If the new "community interest company" goes into deficit, they will not be helped by the government. Instead they will do what any company in debt will do, and realise their assets. That means selling off hospitals. If a community hospital is sold off it will mean that NHS care will not be available in that area and hence the market for private care will be created.

UNISON and Unite are fighting the attempts to change NHS trusts (community services, PCTs or hospitals) into such social enterprises. It is quite amazing that at the moment only the Trades Union movement is willing to protect the NHS at the moment.

Ring fence, what ring fence?

We all know that there is no NHS ring fence. We know that "£20bn of efficiency savings" is actually £20bn of cuts spread over 4 years. That is not a ring fence. We can already see the effect of this cut because clinical staff are alre4ady being made redundant.

So what about the vultures, ready to pick the bones of what is left of the NHS? Of course, I am talking about the predatory private sector. HealthInvestor (advertising an event they are holding) say this:

The recession has forced Government to curb health spending, leaving an estimated “black hole” of up to £20 billion in health budgets up to 2014. Efficiency savings are likely to fall on acute care and GP services, with NHS Trusts tasked with making substantial savings and more efficient use of the NHS estate. 

 Black hole? Curb spending? If the Tories had said this at the election they would have been accused of planning cuts, but instead they lied and talked about a "ring fence". 

NHS Alliance says timetable is unrealistic

Pulse report that the majority of their members support the concept of GP commissioning, but not the timetable suggested by Lansley:

A survey of more than 200 GPs, PCT managers and practice managers – due to form a key part of the alliance’s response to the consultation on the health white paper - found 78% of them backed GP consortia taking over commissioning responsibility, with only 16% disagreeing.

But only 35% of respondents believed health secretary Andrew Lansley’s timeline was achievable, with more than 54% of those who took part saying they believed the handover from PCTs would take longer to achieve than the planned date of 2013.

The timetable is significant because the changes will be a huge upheaval and will result in the closure of some GP practices and hospitals. Lansley is desperate to get the changes made as soon as possible so that they are irreversible and to give the new healthcare market a chance to settle down before the planned 2015 election. If the timetable is lengthened then there is a danger that the election will occur at the height of the upheaval and the public will "reward" the Conservatives accordingly.