Rebuild the NHS as a publicly-owned, publicly-run service...

Governments, especially Tories, do not like Resident Doctors, (JDs), GPs or partnerships!

Steve Barclay said "PAs, AAs, are to pulp the BMA and dilute Doctors-whose pay is 29% down over forteen years-requiring a 35% uplift to restore levels.

Labour have been very clever!

By their manifesto trickery-asking for "change" and getting a big majority

but-people were desperate to evict the Tories-

they can now claim they have a mandate to change anything...

even a publicly-owned and run NHS, for a privatised model...

In an election-there could be referendums for

private or public health

for or against Rwanda

net zero policies

road tax for EVs

proportional representation etc

as in the US...

(How would PR work? Still have constituencies? % of seats according to % vote?)

Tax

Iceland and Norway seem to run their countries,and their NHS far better: tax oil, tax the rich slightly higher!

The UK tax bands ensure a higher tax take every pay rise: the net cost of Full Pay Restoration is low...

GPs and Consultants fear working longer hours will result in a nasty surprise tax demand: both could have tax concessions until more Consultants and GPs are allowed training: stop PAs, AAs taking their training places...

[Now I've heard it all...Edward Leigh suggests defeated Tories let Farage be leader...!!!!!!!]

Despite all the long- neglected problems, Remember all theNHS frontline staff have allegiance to our NHS-and perform miracles every day!

Question: Have the Tories, Labour, LibDems all been in a cosy love-in with the same aim from the right wing Institute of Economic Affairs and right wing Tufton Street??

-ie Slowly atomise, dismantle and privatise our NHS and Social Care?

-Doctors do not require training...!

Election result:

In essence, we voted primarily to evicts the corrupt, lying, incompetent Tories,
not FOR Labour policies, especially NOT for Blair-on-steroids privatisation…

The challenge now is to fight against
-outsourcing, privatisation...
The IEA, the secretive ultra right wing think tank (Doctors require no/less training…)
Thatcher-Regan : Sod the Poor
Foundation Trusts as Businesses...
Marketisation
Purchaser-provider
Blair: Any UnQualified Provider

Milburn and Corrigan-PFI, Any UnQualified Provider-taking taxpayers' money from the real NHS...
Lansley Atomise, dismantle into privatised fragments
PFI 10 times the cost, bankrupts Trusts
We vote primarily to evict the corrupt, incompetent Tories

https://en.wikipedia.org/wiki/Alan_Milburn

https://en.wikipedia.org/wiki/Any_Qualified_Provider

https://www.nhsconfed.org/system/files/2021-05/Any-qualified-provider.pdf

Some might say it would be good to actually take suggestions and strategy from the people at the sharp end, not politicians and civil servants-who are "here today, gone tomorrow" (Robin Day)

Sunak, Hunt, Barclay, Palentir, Redwood, Letwin all want to privatise the entire NHS: strategy is to under fund it, run it down, demoralise, decimate and dismantle-then claim privatisation is the only solution- as Letwin and Redwood described in 1990 "Privatise the World"
Australia, the US might respect and pay doctors and nurses better-but if the poor have no insurance, they get no treatment.
Lynton Cosby advised the Tories NOT TO TALK about the NHS...

Read Keep Our NHS Public’s post-election statement on Labour’s win and the new challenges faced by NHS campaigners...
After an uninspiring six-week-long election campaign we now know that Labour will form the next government.

Following fourteen years of punishing Conservative rule, and with a sizeable parliamentary majority, it is time for Labour to repay the electorate with a real commitment to improve people’s lives.

Expectations are high, especially for those who have been directly impacted by the NHS crisis, not least the families of those who have lost relatives unnecessarily, waiting for ambulances or languishing on the 7.5 million-long NHS waiting lists. The NHS must be set back on its feet once more.

For this to happen, health services must be restored in line with the founding principles of the NHS and social care needs radical transformation. However, it is of great concern that this does not appear to be the vision for the NHS put forward by Starmer and Streeting throughout the election, and we call on the new Labour Government to declare an immediate national emergency in health and care, as have the BMA and the RCN.

We also note that some independent candidates have won seats advocating for a fully public NHS, a fact which vindicates our belief that NHS privatisation is a key concern for many voters. This includes Jeremy Corbyn, one of KONP’s national patrons.

The Greens now have 4 seats and call for the largest increase in NHS funding. The Lib Dems with over 70 seats are calling for an emergency budget for health and care.

Today marks the 76th anniversary of the historic creation of the NHS on 5th July 1948. Labour should reflect on the ambition and boldness of the 1945 Attlee government, undeterred by record debt and the ravages of war. Now, just as then, a strong health service is a prerequisite for social and economic recovery – if we allow our NHS to fail, the economy will fail with it.

If Labour’s overworked slogan of unspecified ‘Change’ is to have any meaning, it must encompass a move away from neoliberal orthodoxy. In its place must come investment in public services, promotion of social justice, poverty reduction, wealth redistribution, care for the environment and a focus across government departments on reducing health inequalities.

The Conservative party is being pushed further to the right by loss of power and the growth of Reform. The stakes are high and there is an urgent need for ‘deeds, not words’ if, as Keir Starmer has recognised, the alarming rise in the populist right taking place in France is to be halted in Britain.

Delivering on health care is a good place to start, and it is an urgent priority to fully invest in the NHS, including committing to full pay restoration for NHS staff.

Much more is demanded of Labour than relying on tinkering reforms and tired old claims that shifting care into the community, preventing illness and greater reliance on technology will, in the absence of funding, deliver a rapid transformation.

We hope our constructive comments on these lacklustre manifesto promises will be listened to. For those who still persist in claiming that the NHS is a bottomless pit and needs reform not more funding, we remind them that under the Blair-Brown government NHS performance was improved by investing in staff and increased funding, allowing the NHS to be one of the best services in the world.

Since then growing demand and damaging austerity policies have seen a cumulative funding gap over 10 years of £362 bn deficit. To match per capita spending on health by comparable European neighbours we need around £40bn more each year. Lack of capital investment has resulted in crumbling estate and outdated equipment, which together with staff shortages drive inefficiency, lack of productivity and poorer outcomes.

However, as we have previously emphasised, it is not just money that is needed but also a change in how politicians see the NHS and an end to the policy that invites profit-taking private healthcare to come in and undermine the NHS.

To achieve effectiveness, equity and resilience we need to build consensus on the essential good of a fully public and universal NHS based on values of the right to healthcare, security, justice and compassion. Myths of un-affordability and the efficiency of privatised services need to be dispelled and the vital role of public health reaffirmed.

Policies must be based on an understanding of evidence of the level and nature of health needs. Health and care services should be seen as an asset and not a drain on resources. This is the only way to bring about real ‘change’.

Let this NHS anniversary and this new Government be an opportunity to restore a truly ‘People’s NHS’ as its founders in the Labour Government in 1948 intended.

July Messages slideshow

Main messages please view slideshow

When politicians say "The NHS is broken", it is only a prequel for further dismantling and destruction. Chomsky-Defund, denigrate, privatise.

Full pay restoration for all frontliune workers is essential

and rises for other groups outlawed.

The Doctors and Dentists Review Body should be totally independent-with absolutely no input from Treasury: government will cut their award anyway...

Tony Blairs' hitman, Milburn, has been brought in to promote "Any UnQualified Provider" and Community Hubs-taking profits at every level from NHS taxpayers cash.

Darzi's polyclinics were a disaster-privately owned, privately run: extremely expensive, cancelled...

Alan Milburn

Milburn, Privatisation and PFI

The US style UnAccountable Care Organisations, DisIntegrated Care Boards-all to ration care and make a big profit

Accountable Care Organisations 1 PRESS & HOLD, OPEN IN NEW WINDOW...

Accountable Care Organisations 2

The wind blows this way: Many new Private Health Insurances and Services advertised...

Telegraph Health website

Private health treatments cost our NHS.
Private treatment by hospital chains takes NHS taxpayer's money
They are paid above the NHS tariff
Takes teams and surgeons from the real NHS-which loses the money.
Reduces NHS capacity-whole speciality departments close down, reduced training for real Doctors and Surgeons.
NHS treats complications
Covers malpractice compensations
Costs more
Worse results
Not enough capacity
The private chains also treat more patients privately as NHS waiting lists lengthen-they also still get profits from treating patients privately
Many JDs and Consultants do not want to work for private outfits...

CHPI reports

The General Election result last week provides an important opportunity for the incoming Labour government to invest in the NHS and social care
and to prevent the emergence of a two-tier system where healthcare is only
available to those who are able to pay.

Our latest report on the outsourcing of NHS eye care covered in The Guardian

The issue of a two-tier system was at the forefront of our minds when we produced our latest report into the impact of the outsourcing of NHS cataract care on NHS eye care departments which was covered in today's
Guardian.

(https://chpi.us8.list-manage.com/track/click?u=3D4504f0136cd08ea= aa5f7db1d2&id=3Dbdf8c3f459&e=3D9e24b2bf2b)

Whilst some people argue that bringing in the private sector assists NHS hospitals to treat more patients our research found the opposite.

This is because the mass outsourcing of cataract care to private companies
has meant that NHS hospitals have lost income, staffing and also training opportunities for the next generation of ophthalmologists.

This means that there are fewer resources to treat emergency cases children and those patients with eye conditions that can lead to irreversible sight loss.

Research from the Health Foundation200 ophthalmologists
-60% -ve on staffing, 62% -ve staff training, 46% harmed ability to treat more complex
-consultants, nurses, optometrists to private sector
-70% said -ve impact, 45% large -ve, 16% small -ve

Budgets increased by only 15% at 43 Trusts, spending up by 52%

leaving poor service for poor people…
training harmed
fewer resources for glaucoma, wet macular degeneration less for treatment
20% fewer
21% reduction in income

(https://chpi.us8.list-manage.com/track /click?u=3D4504f0136cd08eaaa5f7db1d2&id=3D1f08d8f22d&e=3D9e24b2bf2b)
also shows that NHS patients being treated in the private sector for cataracts tend to be healthier and wealthier, meaning that the NHS is left
to look after those who are poorer and sicker but with fewer resources.

The report which was based on a survey of almost 200 NHS Ophthalmologists
and an analysis of financial data from 50 NHS Trusts can be found here

https://chpi.us8.list-manage.com/track/click?u=3D4504f0136cd08eaaa5f7db1d2&= id=3D37e56a6460&e=3D9e24b2bf2b) .

It shows in detail the amount of income and activity which has leaked out
of the NHS to the private sector and the significant concerns amongst some parts of the eye care profession about the future of NHS eye care.

Our first report showed how the NHS was likely to be paying around 9 million more than it needed to for complex cataracts delivered by the private sector and you can read further coverage of this research in a long read article in The Observer published just before the election

https://= chpi.us8.list-manage.com/track/click?u=3D4504f0136cd08eaaa5f7db1d2&id=3D54= acf5841f&e=3D9e24b2bf2b) .

With some parts of the NHS considering outsourcing all aspects of NHS eye care services not just cataracts - our recommendation is that the outsourcing of eye care to the private sector should be paused until a full impact assessment has been taken by NHS England and the Department of Health and Social Care.

Lobbying
Many meetings with private health companies
Donations-wanting return- contracts, NHS work
Tories and Labour want to curry favour with industry and thus push privatisation deals
Many ex DHSS now work for and lobby for private
They all want a chunk of £150bn NHS taxes,, and want profits, CEO and director, shareholders payouts, not best patient care
Many JDs, consultants do not want to work for them,
Not with PAs, forced on them…

Many say return to Bevan
The universal, equal, equitable service to everyone kept business out-so it had to be breached
Many say end Trusts, end purchaser provider
End American US style Accountable Care Organisation-which a merely a prequel to insurance providers…
CCGs, ICBs, are simply renaming to sound as good as Momma’s apple pie...
Huge costs of coding, bidding, contracts, legal.. and collecting copayments, top ups, refusing treatment and appeals, negotiations
Return Public Health England-dissolved as a scapegoat for Covid.
Bring back Strategic Health Authority-to plan properly-with funded Workforce.

DDRB should be totally independent- no Government input whatsoever...

Government cutting salaries

Governments ever since 1948 have always wanted to spend as little as possible on the NHS
1948-the backlog for Dental treatment was vast: government panicked and cut the fees
Later-Bevan resigned when patient charges were introduced for dentistry:I believe 30 shillings for dentures
Governments have cut and cut NHS dental fees, cancelled the agreed recalculation of averaged expenses, raised and raised charges, rationed by RDO, rationed by Unit of SDental Activity-UDAs
Those dentists who could-went private and will never return to the punitive, low quality, high speed NHS.

I had a white acid etch large filling-two hours of expert treatment-but £270...To take dentistry at university-we are urged to get good A levels: Chemistry, Physics, Biology
At dental school, we are taught to perform extremely high quality dentistry-with rubber dam, not leaving decay under a filling, diagnosing accurately (translucency under a margin), fibre optic lighting, not ignoring decaying buccal pits, not leaving palatal pits under a crown, not leaving ledges around fillings, prevention with ohi, fluoride, fissure sealants, taking time to use surface anaesthetic etc.

and shown dentist’s surgeries, houses, equipment-as a standard to aim for…
not to use endomethasone, not to use ultrasonics near pacemakers, to administer GAs safely...

One local dentist, (like many others) was fined for not doing all the fillings required for dental fitness.
Others are criticised for being conscientious and thorough.

In practice-we buy good equipment (Kavo Cubit, Cavitron, Kavo chairs, Kavo operating lights, Little Sister autoclaves,

but find we need to gross £100 every hour to make target gross, and, after expenses, somewhere near target income…

If we do crowns etc-expenses rise above 54%, leaving less than 46% as income-before tax...

We learn to save teeth with root treatments, crowns, replace teeth with bridges and chrome dentures-the best we can provide…

but also the elastic definition “dental fitness”-deliberately vague
“they” can fine us for providing the best-more expensive- treatment-root treat, crowns, chromes

but really “they” want the least expensive
extractions, plastic dentures, no crowns, bridges, veneers, chromes

and analyse our treatment costs wanting us to be average…
and ejecting us if we try to be too good ie expensive

Blair refused to specify “core treatment”-to say "no crowns, chromes, bridges, veneers..."

but governments keep the fees low, ration treatment with restricted Units of Dental Activity-Yoodahs…

Expenses should be individually reimbursed-not averaged… if devoted to the NHS. Governments refused…

Hospital frontline

Governments have repeatedly knobbled the DDRB, knobbled pay for nurses, midwives,

Now the right wing IEA says Doctors don't need training...

let PAs, AAs run the NHS

Community Hubs-loads of PAs in privately owned premises, privately run, no supervising real Doctors...

Fundamentally stupid strategies:

Thatcher formed a “sod the poor” strategy with Regan.
Thatcher wanted to end the NHS, substitute US style private health insurance.
She thought the NHS should be a business: the clue is in the name-SERVICE…

She asked Roy Griffiths, Sainsbury’s manager to report:
Managers in every department at every level...
To become Foundation Trusts, hospitals have to save money and balance the books-
Mid Staffordshire cut spending, reduced Doctors, Nurses, Beds to become a Foundation Trust-which led to poor care.
They then spent money to improve-and were taken into special measures.

Foundation Trusts were stupidly urged to sell land, or be charged notional rent.
A hospitals most valuable resource, after staff is land-owned to build new hospitals, departments, wards, flats for JDs etc: if sold, later they have to buy land, (not near main site) more expensively due to land price increases.

Foundation Trusts should provide better care, not morecare to increase profits- they have to provide more throughput, ,not better quality. They cut outgoings- fewer beds, doctors, nurses- have to buy land when required.

PFI the most stupid way to finance a hospital- costs ten times the initial capital cost, index linked over thirty years-unaffordable outgoings....

PFI hospitals were smaller -too small for their demand and catchment, fewer beds, doctors, nurses

Purchaser provider- costs 15% of budget- coding, contracts, admin

ACOs are in fact, rationing by Government and their puppet, NHSE, able to blame doctors ICBs same

A sum of money is given to a corporation, allowed to keep whatever they can after reducing costs of treatment.

Lansleys' Monster Act 2012, and 2021 Health (not NATIONAL) and Social Care Act

Devolution- stupid to split the NHS by country: Northern Ireland, Scotland and Wales have no daft experiments: no Purchaser Provider, no privatisation.
England is a totally stupid experiment to let private profiteer corporations into NHS tax monies https://t.co/geGhkIRyjv

Keep Our NHS Public

The Lowdown:

Few campaigners or union activists appear to have noticed or commented upon Labour’s Manifesto commitment to roll back privatisation in public services. Some of Labour’s manifesto promises go further than many union activists and campaigners have realised.
The Manifesto promises (under ‘Kick start economic growth’) to “introduce legislation within 100 days to implement in full” Labour’s ‘Delivering a New Deal for Working People’. This specifically includes steps to:
“end the Tories’ ideological drive to privatise our public services, extend the Freedom of Information Act to apply to private companies that hold contracts to provide public services, exclusively with regard to information relevant to those contracts, to ensure any outsourced contracts are transparent and accountable  …
“The next Labour government will also examine public services that have been outsourced as part of our drive to improve quality, design better services to meet changing needs, ensure greater stability and longer-term investment in the workforce, and deliver better value for money. …
“In most cases, the best time to achieve value for money for publicly run provision will be when existing contracts expire or are broken through a failure to deliver. Before any service is contracted out, public bodies must carry out a quick and proportionate public interest test, to understand whether that work could not be more effectively done in-house. The test will evaluate value for money, impact on service quality and economic and social value goals holistically.
“We will also reinstate and strengthen the last Labour government’s two-tier code to end unfair two-tiered workforces. The scope of the two-tier code and the public interest test will apply to wholly owned subsidiary companies.”
This should mean Wes Streeting – directly or indirectly – stepping in to halt moves by trusts like East Suffolk and North Essex FT to outsource cleaning catering and other non-clinical support services, or further moves to outsource clinical care and diagnostic services.
It also means all NHS Trust bosses should also be instructed to review all existing contracts as they come up for renewal, and required to prove they could not be more effectively done in-house before they even consider outsourcing services to private contractors.
However there are strong reasons for believing that Streeting’s instincts, reinforced by the advisors he has surrounded himself with, are in the opposite direction. Many, including the Lowdown, have criticised Wes Streeting’s repeated ill-judged commitments to use “spare capacity” in the private sector to reduce waiting times.
However there are strong rumours in the right wing press that among the Blairite figures from the New Labour government that are being drawn back in as advisors to Starmer’s new cabinet, former Health Secretary Alan Milburn, now a multi-millionaire after prolonged lucrative involvement with the private sector is expected to play a leading role.
Milburn, who served as Health Secretary from 1999-2003, worked with Tony Blair’s advisor Simon Stevens to develop the notion of creating a competitive market in clinical care. In 2000 as health minister Milburn signed the Concordat with private hospitals to treat NHS-funded elective patients (at much higher than NHS prices).
Under his watch the first APMS contracts opened up primary care to commercial takeover; the basis was established for the first for-profit “independent sector treatment centres” to treat NHS elective patients – with guaranteed volumes of patients and payment some 15 per cent above NHS tariff costs. Milburn also pushed through the creation of foundation trusts with maximum autonomy from the NHS, including the freedom to make up to half their income from private medicine and commercial activity.
Milburn also drove an expansion of the building of hospitals through the Private Finance Initiative (PFI), vastly increasing the size (and cost) of projects and saddling many of today’s NHS trusts with hefty and still rising annual payments.
With Tony Blair himself also still pressing from the sidelines for greater reliance on the private sector as the way forward for the NHS, and apparently advising Streeting, there are real dangers that instead of implementing the progressive elements of their Manifesto, the Starmer government could again be side-tracked into even more new, costly and wasteful experiments with privatisation that delivered such wretchedly poor results in the 2000s.
With these advisors in the wings, the lack of NHS capital to tackle the maintenance backlog or build the promised new hospitals also creates new fears that a version of PFI (which collapsed with the bankruptcy of Carillion, one of its major corporate players in early 2018, leaving hospitals half-built in Liverpool and Birmingham) could be in the offing.
In 2018 Tory Chancellor Phillip Hammond announced that the Conservatives would not sign any more PFI deals: and under Jeremy Corbyn the policy was clearly rejected, with plans put forward to stem the flow of PFI profits into private, often off-shore, coffers.
But six years later, would Starmer’s government really want to risk a stand-up fight with the unions to give PFI – and extensive use of the private sector – a new lease of life?

Phil Hammond, Private Eye's MD, is an essential read:

Treasury, and Governments, would like to end the NHS and SC: always, since the start of time, want to cut funding-Doctors, Nurses, Midwives, Hospitals, GPs, Dentists-whoever...
and get away with bare minimum, not make wise, investment to stoke up the economy and improve living standards of health!

Particularly, training of JDs and Consultants...

Phil Hammond “I’m still a Doctor” brilliant read…

Misinformed Consent 20 June 1997 A study of unsupervised surgical training published in the British Medical Journal has confirmed what many doctors, and very few patients, suspect: two-thirds of all operations performed by surgeons-in-training are unassisted.
Senior house officers are left alone to do their first salivary-gland excisions, hernia repairs and stomach, spleen and gall bladder removals with senior ‘support’ not even present in the hospital.
One rung up the ladder, surgical registrars are doing complex and life-threatening surgery of the liver, gall bladder and pancreas, often in emergency situations.
Emergency bowel resections, leaking aortic aneurysms and kidney transplants are all done for the first time unsupervised.
The list for head-and-neck surgeons is so unsettling as to be almost unprintable (e.g. radical neck dissection), and even consultants had to perform operations they hadn't witnessed before. The analysis is shocking: Training must be overhauled!!!

One rung up the ladder, surgical registrars are doing complex and life-threatening surgery of the liver, gall bladder and pancreas, often in emergency situations.

Emergency bowel resections, leaking aortic aneurysms and kidney transplants are all done for the first time unsupervised. The list for head-and-neck surgeons is so unsettling as to be almost unprintable (e.g. radical neck dissection), and even consultants had to perform operations they hadn't witnessed before.

6 July 1995 Mrs Bottomley's last-gasp announcement as health secretary that the intake to medical schools is to be increased by 10% by the year 2000 may have come too late to solve the medical manpower crisis. It costs the taxpayer £192,000 to train a medical graduate, but up to a quarter of newly qualified doctors now give up or disappear abroad. Many parts of the NHS only function thanks to the efforts of overseas doctors, who occupy 26% of the training grades. In some specialties such as anaesthetics, psychiatry, paediatrics and general practice, there are often no applicants for jobs advertised in the British Medical Journal. Increasing the student intake is unlikely to have any effect if the working conditions remain so poor. As one of this year's Birmingham graduates put it: ‘When I first went on the wards in 1992, all the junior doctors told me to give up now and all the consultants said it would be alright in the end. Now everyone's telling me to get out.’ Just as alarming is the national shortage of consultants. There are 150 national consultant vacancies in anaesthetics alone, with trusts resorting to head-hunting, poaching, overseas recruitment and inflated salaries to fill posts. Dr Julia Moore, clinical director of anaesthetics at Merseyside's Wirral Trust, claims trusts are no longer advertising vacancies in the UK because they know there'll be no replies. As health minister Gerry Malone put it: ‘I disagree with the words “manpower crisis.”’

FRANK DOBSON May 1997–October 1999 Dobson was a surprise replacement for Chris Smith, who was publicly against the private finance initiative and made a rash pledge to save Bart's Hospital. Dobson was hardly ‘new’ Labour, promising to abolish the internal market but then not being allowed to. Gordon Brown did, however, honour his commitment to stick to Tory spending plans, and so much of Dobson's term of office was taken up with fire-fighting stories of scandalous waits and lack of resources. Dobson was committed to improving quality and reducing inequality, and was persuaded by lobbying parents to hold a public inquiry into the Bristol heart scandal (but not until after the GMC had tried to save its skin first). Dobson generally got on well with everyone, until he took his shoes off. But he pissed off a few doctors by saying on Newsnight that he wouldn't let Janardan Dhasmana, the Bristol heart surgeon suspended from operating on children, operate on him. Blair saw him as a night watchman, to lull the electorate and Old Labour into a false sense of security before unleashing Alan Milburn. Dobson was set up to fail, sent in to bat for the NHS without a helmet, box or pads. Or a bat. With no extra money, he just had to take the flak for the ‘epidemic of hospitals short of beds, doctors hunting for beds and patients turned away’ that he'd railed about in opposition. Dobson has since found a second wind as backbench opposition to the commercialisation of the NHS, where he speaks with passion and zeal but very little influence.

The problem lies in what the surgeons actually do. In 1995 the Audit Commission discovered that an average full-time NHS surgeon does just 3–6 hours at an NHS operating table per week. This compares with 20 hours a week in most other EU countries. Indeed, if NHS surgeons operated on NHS patients for just fifteen hours a week, then no-one would have to wait more than six days for an operation. The NHS would become just as fast and remain a lot safer and cheaper than the private sector, removing the need for the current, grossly iniquitous system. So why hasn't

The private system in the UK allows insurance companies to write policies that cherry-pick easy acute cases in healthier people, leaving the NHS to provide for the chronic, difficult cases and the very sick. In addition, the NHS has for years acted as a free safety net to bail out private hospital disasters. The response has been not to improve the free service so as to make private care unnecessary, but to invest in additional NHS pay-beds to try to undercut private hospitals. At present, the NHS employs a large number of consultant surgeons at £50–£70,000 a year (plus pension and perks), who are given the ridiculous operating resources of half a day a week. Teaching, research and administration take up more time, and outpatient clinics can be one never-ending cattle market. But there's also some paid thumb-twiddling and absconding to private competitors. A better solution for surgeons who want to commit to the NHS would be to offer them full operating and audit facilities throughout the year, and pay them to be genuinely full-time (i.e. no private work). Their work could then be targeted at areas of greatest need – like giving old people the gift of sight.

ALAN MILBURN October 1999–June 2003 Alan Milburn, affectionately known as ‘Bastard’, was in the ideal situation to break a few windows. He had a clutch of medical scandals (Bristol, Shipman, Alder Hey, assorted rogue gynaecologists) to use as evidence to tighten control over doctors, and enough money to sweeten the pill of a market reform programme that was beyond Thatcher's dreams. He was the Marmite health minister – loathed or loved. Milburn's baptism was one of the worst winters on record, but the bad press included Lord Winston's tirade about his mother's treatment which bounced Blair into announcing that NHS funding would match the European average. He pushed through Labour's NHS Plan on the pretence that it was built around the needs of patients, rather than a veiled invitation to let private competition into the NHS. Doctors didn't spot the deception until too late, because we didn't understand management jargon like ‘additionality’, ‘contestability’ and ‘introducing diversity into provision’. Milburn's undoing was his attempt to micromanage the NHS from the centre with impatient haste. He threw so much shit at the walls that some of it had to stick, but as none of his reforms was piloted or evaluated, it's hard to say which bits. Lots of tough targets were set, and lots of figures were fiddled to meet them. Thanks to the Bristol Inquiry report, Milburn introduced standards, inspections and some measure of quality control into the NHS, but it was aggressively, centrally imposed. Many doctors saw him as a bully and he struggled to get them onside, which could be one reason why he suddenly gave up to spend more time at home. The lesson? You can't run the NHS or a family from Whitehall. And doctors want time for their children too.

JOHN REID June 2003–May 2005 The alleged response of Dr John Reid on seeing a panicked Tony Blair on reshuffle morning was: ‘Oh fuck, not health.’ The response of many NHS staff was: ‘Oh fuck, not John Reid.’ One self-deluded macho reformer gets replaced with another. But despite the bluster, Reid was far more of a glazier than a window-breaker, largely because he wasn't that interested in the detail and hoped his reward for stepping into the health furnace would be a timely move to defence. Things looked grim at the outset, with the Commission for Health Improvement announcing a record number of ‘zero-star’ hospitals and negotiations for GP and consultant contracts in stalemate. But Reid proved very adept at pressing the flesh, and amazed everyone by getting both sets of doctors to sign up to new deals. The secret? Offer them lots of money and let someone else figure out how to pay. Reid was on a spending spree. He may as well have invited Elton John. He paid private companies over the odds to cherry-pick easy NHS operations and, to cap it all, they got paid top-whack whether they fulfilled their contracts or not. Lots more ludicrously expensive Private Finance Initiative contracts were signed off, and a new system of Payment By Results allowed hospitals to hoover up money. Despite the record investment, the English NHS was heading for record debt, but at least Reid realised it. On his departure, he allegedly advised Tessa Jowell: ‘Don't go to health. I've spent all the money.’ Reid may have had a PhD, but it wasn't in accounting. Expenses Update John Reid used his allowance to pay for slotted spoons, an ironing board and a glittery loo seat

Meanwhile, £17.5 billion of NHS funding is being put aside for the private sector for absurdly expensive and inflexible PFI contracts and £6.2 billion has been committed to an NHS IT superhighway that has thus far delivered very little. Indeed, according to its boss Richard ‘£250,000 a year’ Granger, it is ‘in grave danger of being derailed’. Here's a thought. Give the money back to patients.

Given that Wales is theoretically served by the same National Health Service that Blair had promised to turn around it seemed a brave call, and one that caused huge embarrassment to Welsh Labour MPs. But the Welsh Assembly has chosen to take their NHS in a different direction from Blair's relentless focus on competition and privatisation in England. In Wales, the emphasis is on tackling the causes of ill health, rather than trying to micromanage the NHS. So who'll have the last laugh? Instead of spending hundreds of millions of pounds abolishing community health councils, setting up a Commission for Public and Patient Involvement in Health and closing it down again, Wales simply kept the CHCs. It has invested in free breakfasts for primary school children and free prescriptions for all. Devolved parliament in Scotland has funded free personal care for the elderly, whereas in England thousands of elderly patients are denied nursing care on the NHS because their medical needs are artificially reclassified as ‘social’ and they have to sell their homes to pay for care. The Scottish Parliament also managed to reconfigure its health services with broad support from the public and health service staff, in marked contrast to the divisive battles over privatisation that the English NHS is enduring. In Wales and Scotland, the ethos is more to trust professionals to do their jobs out of a sense of vocation, rather than rely on market forces and excessive regulation to do it for them. PCTs, payment by results, star ratings, compulsory choice and practice-based commissioning do not even exist in Wales or Scotland. And the hugely bureaucratic raft of proposals that Sir Liam Donaldson introduced to revalidate doctors only applies to England. The downside for Wales and Scotland is that their left-wing, increasingly nationalist approach has ducked the politically combustible issue of hospital closures. In Wales, the mindset is that each area should offer uniform services, which is neither efficient nor cost-effective. In Northern Ireland hospital activity is 26% lower than England per bed. Scotland is using the private sector to get waiting lists down, though much less so than England and only when there is a real need (as opposed to the English stance of competition for the hell of it). Scotland's reform programme seems to be the most co-ordinated, with its focus on networks and partnerships. In Wales, first minister Rhodri Morgan is aiming for ‘clear red water’ between Cardiff and London and the Lib Dems are too supine to object. In England, the volume and haste of new initiatives, some of which directly contradict others, has meant that not even senior managers are clear about what they're supposed to be aiming for. What is clear is that there is no UK focus in health policy, and there are huge disparities in entitlement and treatment across four countries. This is completely contrary to the notions of equity and treatment according to need, and it'll be some years before we discover who got it right. The three smaller countries at least have the advantage of watching the English NHS crash and burn, and then cherry-picking the good bits. In the meantime, go to England for quick operations, Wales for free prescriptions, Scotland for long-term care and Northern Ireland if you don't like change.

Reconfiguration 2 November 2006 Why has Labour failed to win the hearts and minds of doctors for its reform programme? For a while it won their silence, by stuffing their mouths with gold and cutting waiting times for surgery. But last week, in the fag end of Blair's administration, hundreds of members of the most politically apathetic profession donned catchy ‘Working for a better NHS’ scarves and marched on parliament, mumbling ‘NHS SOS’. There is a groundswell of opinion amongst doctors that the Government has badly screwed up its ‘£100 billion a year’ chance to save the NHS, at least in England. Its biggest error has been to become so preoccupied with attracting private business that it has neglected to reconfigure the NHS until hospitals are deeply in debt. So even rational decisions about which hospitals and services need to close or merge for safety reasons are clouded in protests about finance and privatisation. Add in the political sensibilities of closures in marginal constituencies, and the most important reform is doomed to failure. Since exposing the Bristol cardiac disaster in 1992, I have argued that specialist, hi-tech services have to be centralised in fewer centres where resources are concentrated and there is a sufficient caseload for safe training and meaningful audit. The Eye has exposed a succession of scandals where surgeons were doing highly complex operations occasionally, and often badly, and successfully campaigned for children's liver surgery and cleft palate repair to be restricted to fewer, accredited centres. As technology has advanced over the last fifteen years, and the European working time directive kicked in, the centralisation argument has applied to more specialties. There are too many district general hospitals in the NHS and too many small casualty departments and paediatric units. This was evident when Labour took office and if they'd used the goodwill of the initial cash injection to get NHS staff and patients to agree on how local services needed to change, they might have succeeded. Instead they threw the money at ill-conceived PFI deals, private surgical contractors, pointless quangos, the destruction of GP fundholding, the creation of 300 PCTs, the destruction of half of the PCTs and the reintroduction of GP fundholding. The attempt to introduce market competition and get money to follow the patient kicked off with a disastrous tariff system that didn't compensate hospitals for the risk and complexity of their work and led to record debts and the resignation of the chief executive, Nigel Crisp. The 2007–08 tariff has just been announced, and trusts will have to spend an enormous amount of time trying to ‘unbundle it’ (i.e. fight with each other to make sure they get paid for all their bits of treatment). As in America, a hospital's survival will become entirely dependent on the success of its coding and debt collection departments, which are a hugely expensive, administrative cash drain. Contrast this to the tariff-free NHS in Scotland, which is well down the road of reconfiguration thanks to a clear national plan, extensive parliamentary debate, cross-party support and the involvement of staff and patients. Markets and fragmentation don't work in healthcare; consultation and co-operation do. Alas, it's too late for the English NHS.

But Labour's health reforms are not evaluated with the same rigour as new treatments. If Patsy Hewitt really wants to convince the public about NHS reconfiguration, she needs to publish detailed service planning and a rationale which can be supported by evidence. Alas, all she has is ideology. Crippling hospitals with PFI debts and throwing money at Independent Sector Treatment Centres (ISTCs) to cherry-pick easy operations has no evidence base, other than the splintered, debt-ridden service it has spawned.

Doctors have also voiced concerns about the quality of care provided in Independent Sector Treatment Centres (ISTCs). This was dismissed by the Government as protectionist scaremongering but on the day Hewitt went for the GPs' jugular, the Healthcare Commission announced that the data on the clinical quality of ISTCs was ‘incomplete and of extremely poor quality’. So what's the story? GPs fulfilling their contracts and collecting their payments, or expensive, unfair, under-performing and unaudited private treatment centres? The healthy sums paid to GP partners were entirely predictable. Dangle a big carrot in front of intelligent, ambitious small businesses and it tends to get eaten. Unlike ISTCs, GPs have now contributed a huge amount of data to be entered into the NHS IT programme, should it ever deliver on its (under-performing, hugely overspent) contract. What's harder to assess is whether the GP contract will radically improve patient care and provide value for money. There are early signs that diabetic care is improving, and perhaps the care for patients with heart disease and stroke, but it's hard to prove because there was very little comparative data prior to the contract.17 Removing out-of-hours obligations from GPs and carving general practice up into targets is merely a way of introducing privatisation. The blame heaped on GPs for doing what was asked of them will further fuel the argument for more competition. Companies who have saturated the healthcare market in their own countries are using the NHS as a gateway to Europe, waved in by Labour. The Government recently published its NHS Operating Framework, which makes an interesting comparison to the ten core principles that they set out in the 2000 NHS Plan. Seven years ago, they pledged that ‘Public funds for healthcare will be devoted solely to NHS patients.’ This pledge has now been quietly shelved, as public funds for healthcare are increasingly devoted to the shareholders of private companies. The latest game is to privatise outpatients by littering the country with Capture Assess Treat and Support (CATS) centres. Patients referred to hospital will be caught in Netcare's net whether they chose to be or not. White-elephant PFI-indebted hospitals won't be able to compete and will try to cannibalise surrounding hospitals, which are already running over capacity. And demand from an ageing population will rise year on year. The latest delusion is that transferring hospital services to GPs with special interests is cheaper (it isn't) and will reduce demand. The more you train GPs, the more they realise what is possible and the more they refer to hospital. The NHS is heading for meltdown and once again, it'll all be the GPs' fault. Doctors Not To Be

Doctors Not To Be 8 March 2007 Are the careers of eight thousand junior doctors being stuffed up on purpose? The rushed implementation of the Modernising Medical Careers (MMC) programme looks like just another Labour cock-up, but its consequences are suspiciously advantageous to a Government intent on busting the medical cabal. The failure of the Medical Training Application Service (MTAS), a centrally-controlled computerised bun fight, was predictable to anyone with a passing knowledge of NHS IT programmes. It was flawed in its content, an unvalidated bullshitters' paradise that has allowed erudite disaster zones to get jobs at the expense of much better doctors, and flawed in its delivery. Making so many doctors apply at the same time was bound to lead to persistent crashing of the site, lost applications, interviews offered for specialities not even applied for and interviews at both ends of the country on the same day. The Government has been able to ignore earlier concerns that the new system was unfair and unworkable, safe in the knowledge that doctors are finding it hard to get public sympathy. Greedy GPs and consultants, rather than privatisation and target-chasing, have been cleverly fingered as the prime cause of NHS debt, and junior doctors bleating to the media that they may have to become lawyers, work in the City or move to Australia will have Patsy Hewitt chuckling in her cornflakes. The shit has finally reached the fan, thanks to West Midlands surgeons suspending their junior appointments, but health minister Lord Hunt was unfazed: ‘MMC was devised with the help and support of the Royal Colleges, the Academy of Medical Sciences and the BMA.’ So it's all their fault. But what's in it for Labour? Having acknowledged they were stuffed by the BMA over consultant and GP contracts, the Government – having increased doctors' numbers – now wants to get by with as few as possible. Doctors have priced themselves out of the market, so medicine is being broken down into simplistic tasks that can be hived off to private companies employing lowest common denominator health workers. Having 30,000 junior doctors compete for 22,000 jobs creates sufficient anxiety and insecurity for those with a job to work illegal hours covering holes in the NHS without whistle-blowing. Junior doctors aren't going down without a fight (support them at www.remedyuk.org) but is seems unlikely that enough would resign en masse to panic the Government. A more likely scenario is that they'll cancel their memberships of the BMA and Royal Colleges, a situation that would delight Labour. The GMC has already been stuffed by Liam Donaldson's ludicrously bureaucratic re-licensing plans, and taking out the rest of the medical establishment would make doctors even easier to control. The Department of Health has announced a review of MTAS, but not suspended it. Thousands of juniors have joined up at Remedy UK, and are planning a protest on March 17 from the Royal College of Physicians to the Royal College of Surgeons. But to get public and media support, doctors need to explain how their personal misfortune will affect patients. For the NHS to thrive, it has to ensure the best and brightest doctors are given the right jobs. MTAS doesn't appear capable of ensuring this. When I'm finally dragged kicking and screaming into an NHS ward, I want to be treated by a doctor with sufficient wisdom, skill and motivation to do the job properly, not a dumbed-down generic health worker reading from a guideline. Cutting down the supply of good doctors may well balance the NHS books in time to save Hewitt, but the long-term consequences will be dire for patient safety.

What Should Gordon Do? 15 June 2007 What should Gordon Brown do with the NHS? He may want to put his ‘unique stamp’ on it, but Blairites are working around the clock to progress the market reforms beyond the point of no return. The great con of Blair's NHS was to preach the rhetoric of patient power whilst handing over control, and a vast sum of public money, to the private sector. To argue that this is not privatisation of the NHS is nonsense, but then Blair excelled at that. The tipping point for the NHS will come if Labour pushes through its plans to outsource up to £64 billion worth of commissioning to multinational corporations such as United Health. This would suit Blair's friends at McKinsey, who can charge a fortune to the NHS for brokering the deals and also represent many of the US companies who stand to gain. At least one senior executive at McKinsey has a staff pass at the Department of Health. In return, Blair will have ample boot-filling opportunities in America. In Blair's absence, Patsy Hewitt is rushing through his agenda before her exit, aided by David ‘Nibbler’ Nicholson, the surprise choice as NHS chief executive, who leapt up the shortlist after a meeting with Blairite health guru Professor Paul Corrigan. Nicholson in turn has appointed an NHS management team that is putting intense pressure on strategic health authorities and PCTs to outsource their commissioning. The idea that PCTs will retain ultimate control (and hence keep the NHS public) is a myth. So what is Brown to do? Clearly a return to the Old Labour Stalinism of diktat by bureaucracy is impossible. And yet Blair's model is equally didactic, suggesting market competition is the only way forward and peppering it with promises of choice, when patients only get to choose what the Government (or United Health) wants them to. The junior doctor selection crisis is the most extreme example of this – thousands of doctors who have worked for seven years or more in the NHS are allowed only one choice of job, in many cases only specifying a region (e.g. Scotland) rather than a hospital unit. Stalin invented the internal market, the Tories introduced it to the NHS and Blair is polishing it to imperfection. The NHS works because it is a one-stop shop – once you're in it, you get all the care you need. Contrast this to America, where patients who have brain tumours removed are sent home the next day if the insurance package does not include continuing care. If American managed-care corporations unleash their ‘expertise’ on the NHS, only an American system can result. Profitable patients are cherry-picked while unprofitable patients are dumped. Brown must reverse this without seeming to be Old Labour. The solution is to deliver what Blair and Hewitt have pretended to promise: ‘a devolved NHS where 80% of the decisions are made locally’. Working in the NHS is like pulling people out of a river without bothering to look at who's pushing them in. If Labour really wants patients to get involved in shaping services, it has to move the money upstream and stop the dysfunctional schism between top-down marketing and local decision-making. Most NHS resources now go on managing chronic illness, and many patients manage themselves perfectly well for all but three hours a year, when they're hanging round the surgery or outpatient clinic. Tapping into this expertise and getting patients to help other patients in their communities is the best hope of stopping the log-jam downstream. The message is simple. Local partnerships between patients and NHS staff work, market reforms don't. But will Brown swallow it? 10 www.plosmedicine.org May 2005; Volume

so much money has already been wasted on NHS change that he'll have a job convincing the staff of the need for more. He's proposing polyclinics to do much of the work done in district general hospitals, but we've already invested £1.4 billion in Independent Sector Treatment Centres that were supposed to do the same. ISTCs were encouraged into the market with guaranteed contracts paid above tariff. Last year, they were paid for 50,000 more operations than they carried out. The vast majority of waiting-list reductions were carried out in existing NHS hospitals and a huge sum has been wasted on unnecessary competition. The NHS already has a competitive market under Payment By Results. Or rather activity. Hospitals can only survive by sucking as many patients as possible through their doors. ISTCs couldn't attract the custom, not least because they failed to submit sufficient outcome information to the Healthcare Commission to enable them to be audited for quality and safety. Polyclinics may well have the expertise to treat patients closer to home but whether they can stand up to the might of desperate hospitals remains to be seen. To get the support of NHS staff, Darzi doesn't just need to consult them, he needs to publish evidence showing his reforms would work. The Academy of Medical Royal Colleges has performed the most comprehensive review of the reconfiguration plans and agrees that highly specialised services such as major trauma, heart and brain surgery need to be specialised on fewer sites. But it found no evidence to support the centralisation of the non-complex, high-volume work done in district general hospitals. There is, however, evidence that patients feel access to GPs has improved in the last few years, which makes Brown and Darzi's peculiar focus on extending opening hours puzzling. The review smells strongly of hastily assembled populist opinion. Clinical medicine has been reformed in the last twenty years by focusing on the evidence, not the expert. The same needs to happen with NHS reform. Don't change the system until you can prove you've got something better.
IT expert put it: ‘Scotland and Wales are smaller communities, with more collaboration and co-operation than the market-obsessed English NHS. They assume that NHS staff are generally trustworthy and have developed ‘higher trust’ IT systems that are simpler and easier to access, and have managed to gain the consent of patients. Contrast this to England, where no-one can be trusted and the media is paranoid about leakage of confidential data. So you've built hugely complex programmes with military grade security to block the few bad people but which take ages to log onto, navigate around or swap user. At their worst, they stop you practising medicine, rather than enable you to do the job better.’ Granger's parting shot from the IT programme was to boast at how tough his

More Staffing Problems 8 April 2009 A key question for the investigation into the appalling standards of emergency care at Mid Staffordshire hospital is: ‘Why did no member of staff blow the whistle sooner?’ In a 2006 Healthcare Commission survey, only 27% of the Mid Staffs staff said they would be happy to be treated in their own hospital, a powerful indication that standards were unacceptable. And after Bristol, the General Medical Council deemed that doctors had a duty to speak up when the service becomes so unsafe that patients are being harmed. However, the experience of Dr Rita Pal in nearby North Staffs suggests that whistle-blowing in the NHS remains a thankless task. Dr Pal identified serious shortcomings in the nursing and medical care of patients on Ward 87 of City General Hospital, Stoke on Trent, when she started working there in August 1998. These included a lack of basic equipment such as drip sets, a lack of adequate support and supervision for junior doctors, a gross shortage of staff and repeated ‘do not resuscitate’ notices. As a result, patient care was often poor, with a lack of baseline observations and routine blood tests, and there appeared to be an unacceptably high mortality rate. In November 1998, Dr Pal articulated these concerns to senior nursing and medical staff, and put them in writing. As a result, she was bullied and victimised. She was wrongly accused of causing a needle-stick injury and inserting the wrong date on a drug sheet, and she found out that her previous consultant had been contacted to ascertain whether she was ‘capable of doing the job’ (i.e. flying by the seat of her pants with inadequate support and resources, surrounded by hostile nursing staff and patients dying unnecessarily). She requested leave because she (quite reasonably) felt unable to care for patients in this environment. Subsequent investigation found that Dr Pal's allegations had been spot on. A review in May 1999 by Mrs T Fenech from the Infectious Diseases Unit found ‘serious deficiencies in nursing practice’ and that ‘the level of care demonstrated for some patients on the ward at the time of my audit was nothing short of negligent.’ In 2001, an internal report concluded that the directorate failed to take appropriate action when the allegations were made by Dr Pal and that patients had suffered from poor standards of care. And in March 2002, the Commission for Health Improvement still found ‘serious deficiencies’ particularly with ‘the level of supervision, workload and work patterns of junior doctors working within medicine.’ So not only were Dr Pal's initial allegations accurate, but four years later very little had been done to address them. Dr Pal took her concerns to the General Medical Council and – eleven years after first raising concerns – is still embroiled in a fight to ascertain the true extent of the harm done to patients on Ward 87. A mature and safety-conscious NHS would have thanked her for raising concerns to help improve patient care, and acted on them. Instead, she has been bullied, falsely accused of malpractice and repeatedly denied access to key documents to help support her case. Last week, Sir Ian Kennedy, retiring chair of the Healthcare Commission, spoke of the bullying culture in the NHS that still ‘permeates the delivery of care.’ Those who are brave enough to speak up about deficiencies in care are being pilloried and silenced. In such an environment, patient safety can never flourish. Dr Pal has lobbied (via her MP Andrew Mitchell) for the Commons Health Select Committee to investigate the problems faced by whistle-blowers in the NHS. She has also started a support network for whistle-blowers and can be contacted at: dr.ritapal@googlemail.com Struck Off and

Labour's Pains 24 June 2009 New health secretary Andy Burnham does a fine line in cheesy tributes, describing his predecessor Alan Johnson as ‘the postman who delivered for the NHS.’ But Johnson got out just in time, leaving Burnham (39, Capricorn) to pick up a number of suspicious packages: The swine flu pandemic, a predicted Summer heat-wave, a staffing crisis caused by the 48-hour week for junior doctors and a projected five-year shortfall in NHS funding of £20 billion. Alas, his maiden speech at the NHS Confederation conference did little to inspire confidence: “Can we do more to get through the challenge and to the next level, going from good to world-class?” He also promised to “unlock the 1.4 million people working in the NHS” and “create a truly people-centred NHS – which genuinely empowers patients and carers as experts potentially backed with control over funds, moving on heath promotion and physical activity, helping people to lead full happy lives, working with public sector partners to wrap care around patients and to place quality at heart of everything”. Burnham is clearly au fait with new Labour bullshit, but can he stop the NHS going tits up in the recession? The NHS has undoubtedly got better over the last decade, but there are still huge variations in the quality of care, and plenty of commercial secrecy and petty rivalry disguising poor practice and waste. Lord Darzi has been frantically encouraging doctors to get more involved in management, and it certainly makes sense for a clinical service to be run by clinicians. But the English NHS is stuck with a market which hasn't delivered a good enough service because nobody knows how to spend £100 billion a year without wasting half of it. The solution was supposed to be word class commissioning (WCC), a phrase dreamt up by Mark Britnell, the self-styled NHS director general for commissioning and system management. Britnell also came up with the FESC framework to encourage the private sector to take control of the purse strings. Britnell was the golden boy of the department of health, voted third most influential person in the NHS by the Health Service Journal, a chief executive in waiting. Until he jumped ship this month to join KMPG, one of the companies involved in FESC. The revolving door from NHS policy maker to the private health provider is hardly new (Simon Stevens, Alan Milburn, Patricia Hewitt, Lord Warner, Baroness Jay, etc.) but for Britnell to time his escape as Burnham arrives does not bode well for the NHS or for Burnham.

and here is how Allyson Pollock described it back then:

“The Darzi report is simply a glib advertising campaign on behalf of the healthcare industry and a new generation of greedy healthcare entrepreneurs.”

If you’re not familiar with Allyson Pollock, she is a Professor of Public Health and NHS campaigner who predicted many of the problems we see now in the NHS, and much of the expansion in privatisation which has occurred in recent years. I trust Allyson, and so I’m nervous to see Lord Darzi placed in a position of prominence again. I’m not only nervous however, but confused. I wrote a newsletter several months ago explaining that there was a huge amount of concern about the low productivity in the NHS at the moment, and about the two separate reviews that had been started to investigate the problem.

Why is he focusing on this issue first, when he could be focusing on emergency investment into the crumbling NHS hospital buildings, or providing immediate support to the NHS workforce? And why is he involving Lord Darzi?

Concerningly, I suspect it is because Starmer’s Labour party have already decided they want to reform the NHS through the involvement of private companies, and they need a report to back up their plans. Politicians are incredibly adept at deciding on the answers they would like from reports like these, and then approaching the “right” people to write them, and on this occasion Lord Dazi appears to be the right man.

We will have to watch Starmer, Streeting, and their allies from the Blair / Brown era closely. Many people defend Tony Blair’s record for the NHS because he brought down the NHS waiting lists, but he and his team did so while wreaking havoc on the infrastructure of our health service. Their Private Finance Initiatives (PFI) left many NHS trusts with enormous debt, costing the taxpayer billions; the final debt not set to be paid off fully until 2050.

Further bios of Hunt, Javid, Coffey, Barclay, Atkins cwould show a desire to beat the BMA, and Doctors, into a pulp by forcing PAs, AAs into subtitution of real qualified Doctors...

We will have to watch Starmer, Streeting, and their allies from the Blair / Brown era closely. Many people defend Tony Blair’s record for the NHS because he brought down the NHS waiting lists, but he and his team did so while wreaking havoc on the infrastructure of our health service. Their Private Finance Initiatives (PFI) left many NHS trusts with enormous debt, costing the taxpayer billions; the final debt not set to be paid off fully until 2050.

We finally have a chance for a fresh start after 14 long years of Conservative governments undermining the NHS. This opportunity to turn things around should feel fresh too; it should not be a rehash of old plans – plans that didn’t help patients, and which put a lot of money into the pockets of private company shareholders.

We need things to improve, not change, and we don’t need any more NHS privatisation!

I’ll keep you up-to-date as things develop… Phil Hammond

Care homes and Social Care

Wages must increase to recruyit and retain staff

Overseas workers should be welcomed, and given UK citizenship after one year

Pay grades and training must have progression, linked to NHS grades and payscales

A new tax beginning at age 40 to pay for social care

It is wrong to force sale of a house, bought out of taxed income, to pay for Social Care