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Can English health policy be advanced through signing petitions?
Today, the intensity of opinions of some parliamentarians in spitting bullets at 38 degrees was incredible.
In case you’ve missed what they were talking about, here it is.
Here was the first blast at ’38 degrees’.
Paul Burstow:I start by acknowledging the receipt of a petition handed to me yesterday, containing 159,000 signatures collected by members of 38 Degrees, expressing their concerns about the matter we are debating today. I know that a great many Members will have received e-mails about that and will have their own opinions, and I want to discuss the issues.David T. C. Davies:Will the right hon. Gentleman refresh my memory? Is that the same pressure group that a few years ago was saying that the NHS was going to be privatised, which is completely untrue, and which a couple of months ago was saying that it was about to be silenced by some Bill the Government were pushing through yet is now very noisily campaigning once again? Surely this cannot be the same completely unreliable group of left-wingers with links to the Labour party, can it?
And then there was more.
I listened with great interest to my hon. Friend the Member for Enfield North (Nick de Bois) but I will be supporting the Government 100% tonight because I have great confidence in what the Government have achieved with the NHS. I say that because I have seen the alternative; I have seen what has happened to the NHS when it is run by Labour, because that is the problem that I and many of my constituents face at the moment in Wales.
My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) came forward earlier with a petition from the left-wing pressure group 38 Degrees. Health campaigners today have been talking today about the amount of salt that we take but one has to take dangerously large pinches of salt with anything that comes out of that organisation. These people purport to be a happy-go-lucky students. They are always on first name terms; Ben and Fred and Rebecca and Sarah and the rest of it. The reality is that it is a hard-nosed left-wing Labour-supporting organisation with links to some very wealthy upper middle-class socialists, despite the pretence that it likes to give out.
It is 38 Degrees who were coming out with all sorts of hysterical scare stories a few years ago about how the Government were going to privatise the NHS. It took out adverts in newspapers, scaring people witless that that was going to happen. Of course the organisation has forgotten all about it now because there was never any intention to do that. We will never privatise the NHS because we believe in public services in this party. A couple of months ago, 38 Degrees came out with more scare stories about how it was going to be gagged because of another piece of legislation that the Government were putting through to bring about fairness in elections. It said that we would never hear from it again, and yet here we are a few months later with yet another host of terrible stories, scaring members of the public quite unnecessarily. I do not think that we have to take any lessons from 38 Degrees, nor hear any more about their petition.
But are petitions are good thing?
Critics of petitions say that petitions are too easy to organise because of the automated nature of mailing lists these days. Because of the ease in producing a petition, it can be easy to inundate people with many petitions, thus making it difficult to work out which are the genuine causes.
Consequently, due to ease of producing petitions, some feel that the volumes of signatures need to be massive before any impact is made.
And even if petitions have a large number of signatories, it can be the case that their effects are short-lived. After amassing many signatures for months for the #WOWpetition, the parliamentary debate was barely covered in the media; and there appeared to be little consequence from it.
Likewise, there was little coverage of the clause 119 debate on the BBC News 24 ‘rolling news’ service. Nonetheless, it did manage to surface as a web news story on the BBC News website.
The frustration for members of the general public is that many parliamentarians don’t appear to be listening.
There’s an inevitability about votes in parliament, where the arithmetic means that votes can be won completely divorced from the quality of the debate.
And parts of the debate were bad. Dr Dan Poulter’s debating content was incoherent, badly structured and full of ectopic odd partisan point-scoring. The style was vulgar and offensive, like a junior doctor presenting a garbled and incoherent history within the constraints of a long medical ward round.
Many Labour MPs, not least the Shadow Secretary of State for Health Andy Burnham MP, were clearly more than mildly irritated at the grotesque depiction of the clause 119 policy as a natural extension of Labour’s policy.
Grahame Morris, MP for Easington, made as ever excellent comments. Along with Andrew George MP, he is on the influential Health Select Committee. And yet Morris was given rather odd replies by Simon Burns MP and Stephen Dorrell MP, head of the said committee, which did not take the debate much further.
Burstow, a Liberal Democrat who is likely to lose his seat in 2015, produced an amendment and withdrew it. But being bought off (not literally) to chair a committee is apparently not uncommonplace for shennanigans such as these.
Jeremy Hunt MP in summing up used the term ‘whole person care’ which could be an unconscious display of waving the white flag when he could have simply said ‘integrated care’.
Throwing forward, it could be that clause 119 in some form could be just what the Dr ordered to facilitate the future reconfigurations necessary for implementation of integrated care in some form.
Patently Dorrell wishes to avoid the term ‘integrated care’, in calling it ‘joined up care’, to avoid any breach of EU competition law.
It’s trite to mention it, but the only petition that really counts is the General Election.
I received a direct message from somebody today to say ‘I am fucking fuming’.
He then asked, “Should I vote Labour or NHA Party?”
As they say – “the choice is yours”.
Anybody who expects the Liberal Democrats to ‘save the day’ over the hospital closure clause is frankly deluding himself
Some people believe optimistically that the Liberal Democrats will suddenly have a change of heart.
The chances though of the Liberal Democrats joining Andy Burnham MP (see tweet) in the opposition lobby is about as likely as an ostrich landing on the moon.
The construct of ‘collective responsibility’ means that Liberal Democrats in Government vote with major Coalition party. It was Nick Clegg who predetermined that the Liberal Democrats would go into office with the party with the most number of seats. That was a fairly safe prediction at the time.
It’s widely predicted that irrespective of whether there is a hung parliament on the morning of May 8th 2015 that Labour will have the most number of seats. This is particularly more likely given the boundary reforms which the Conservative Party failed to achieve. That being the case, it raises the possibility of Nick Clegg being the Deputy Prime Minister, and the Liberal Democrats in office, for about a decade despite having never ‘won’ two elections.
It also raises the possibility of Liberal Democrat votes being used to repeal legislation from the lifetime of this parliament, albeit that no party can legislate to bind its successors. But the idea of the LibDems suddenly having a change of heart, to differentiate themselves as per the “differentiation strategy”, is scuppered by three prominent issues.
Firstly, the major thrust of any Government is its economic policies, and the LibDems have already indicated that they can only sign up to aggressive deficit reduction. This could be fine of course if Ed Balls offers the same meat but with slightly different gravy.
Secondly, the recent history of the Liberal Democrats is more than clear. They have got rid of the “social” bit in “The Social and Liberal Democrat Party”. Nick Clegg, having trained under Leon Brittan in the EU, has a competitive neoliberal philosophy, and he mixes in the company with people who share his zest for that sort of thing. Like David Laws. He would with Chris Huhne. A neoliberal firestorm in closing hospitals down due to failure régimes, of the type seen to by clause 118 is entirely in keeping with this neoliberal philosophy, not a social democrat one based on local democratic power.
Thirdly, there is no basis for believing that the Liberal Democrats will suddenly ‘come good’ as the term of this parliament comes to an end.
On 20th March 2012, the Commons voted the Health and Social Care Bill through at 10.15pm, spending less than 6 hours debating the 357 amendments made in the Lords. The Labour motion on disclosure of the risk register was lost by 328 to 246 votes. Two LibDems voted with Labour, Greg Mulholland and Adrian Sanders and three abstained. Most of the Lords amendments passed and the government won most by about 80-90 votes as the bulk of the Lib Dems voted with the government. The unpopular Health and Social Care Act came into law under this Government, though.
Also, despite near universal professional opposition and strong political pressure, the Section 75 regulations that explicitly open up the NHS to competition law were approved in the House of Lords A three-line whip on Liberal Democrat peers ensured a majority of over a hundred, with Baroness Shirley Williams speaking warmly of “an exciting new direction” for the NHS. This is the same Baroness Williams whom Tony Benn alleges in his diaries wished to tax benefits in the Callaghan government of the 1970s. The unpopular Section 75 Regulations came into law under this Government, though.
In January 2012, the government fought off a fresh challenge to its controversial welfare reform bill, when peers rejected a proposal to delay the full introduction of slashed new disability payments after ministers offered concessions. The unpopular Welfare Reform Act came into law under this Government, though.
As the cabinet hardened its tactics by agreeing to overturn a series of defeats in the House of Lords, a cross-party group of peers failed to introduce a pilot scheme before a new regime for disability allowances can be fully introduced. But Lib Dem cabinet ministers agreed with their Tory colleagues to overturn the amendments when the bill returns to the Commons.
Whilst it might suit some with social democrat ‘roots’ to wish the Liberal Democrat Party to ‘come good’, there is no evidence at all that would happen. Attempts to bring out this simple fact tends to become squashed with the attack that ‘Liberal Democrat’ votes are all to play for, and that LibDem MPs reading a fair discussion of this might change their mind from the party line.
LibDem MPs don’t work like that. Their motto, ‘fair society, strong economy’, is reflected in the UK only having performed very badly for three years and with the decimation of legal aid and law centres.
The hospital closure clause gives Trust Special Administrators greater powers including the power to make changes in neighbouring trusts without consultation. It was added to the Care Bill just as the government was being defeated by Lewisham Hospital campaigners, in an attempt to ensure that campaigners could not challenge such closure plans in the future. But the new Bill could be applied anywhere in the country.
Writing in the British Medical Journal, Professor Allyson Pollock said that that the clause would “undermine equal access to care in England” and removes “checks and balances designed to ensure that changes are in the interests of the communities affected” with Trust Special Administrators only having to consider market money.
Neoliberal means neoliberal. It means free movement of capital such that multinationals can buy parts of the NHS. It means everything is put out for competitive tendering. A social movement to pull on LibDems heart strings, with the unflappable Baroness Williams, will be a waste of time, but I suppose one should have dreams.
But dreams ought to be realistic. The Care Act, with its ‘closure clause’, will come into law, again only made possible through help of the Liberal Democrats.
Why yesterday’s Care Bill debate matters to tomorrow’s decision about Mid Staffs
s. 118 is the contentious clause of the Care Bill.
An important question is of course whether the Labour Party, if they were to come into government in 2015, would seek to repeal this clause if enacted. The likelihood is yes. What to do about reconfigurations and reconsultations for NHS entities which are not clinically or financially viable is a practical problem facing all political parties. A practical difficulty which will be faced by all people involved in the TSA process between now and 2015 is that it is relatively unclear what Labour’s exact legislative stance on the future structural reorganisation of the NHS is, save for, for example, having strongly opposed the recent decisions over Lewisham (prior to the High Court and Court of Appeal.)
Draft recommendations for the future of Mid Staffordshire NHS Foundation Trust were published on Wednesday 31 July 2013 by the Joint Trust Special Administrators. Tomorrow will see the publication of the final proposals (and it is widely expected that interested parties will be informed about the outcome of the consultation process this evening.) Producing a long-term outlook for key services, including paediatrics, ICU and maternity, is going to have been a complicated decision-making process for all involved.
Stephen Dorrell MP, Chairman of the influential Health Select Committee, pointed out in the Care Bill debate yesterday afternoon that the competition debate about the NHS is usually presented as ‘binary’, and this is to some extent reflected in John Appleby’s famous piece for the King’s Fund on how there are both advantages and disadvantages of competition. What people agree on more or less is the need to move beyond fragmented care to an integrated approach in which patients receive high-quality co-ordinated services. The idea is that competition itself need not be a barrier to collaboration provided that the risks of the wrong kind of competition are addressed. This will involve considerable legislative manoeuvring in the future. In securing a more integrated approach, reflected also in Labour’s “whole person care” ultimately, commissioners are expected not be able to fund ever-increasing levels of hospital activity.
Trying to keep frail older people away from hospital, and to allow such individuals to live independently, has become an important policy goal. Trying to keep people in hospital for shorter stays is another key aspiration. Matching services to actual demand is a worthy aspect of any reconfiguration (and also providing the full range of relatively unprofitable emergency services locally.) All of these factors become especially important with the increasing numbers of older people in the population, some of whom have multiple and complex chronic conditions that require the expertise of GPs and a range of specialists and their team. “Integrated delivery systems” in other countries have previously embraced a model of multi-specialty medical practice in which GPs work alongside specialists, often in the same facilities. It is possible that this sort of approach will become more popular in future here in the UK. It is relevant to the NHS here, because of the need for specialists and GPs to work together much more closely to help patients remain independent for as long as possible and to reduce avoidable hospital admissions.
A frequent criticism has been that ‘competition lawyers should not be blocking decisions which are in the patients’ interest‘. The problem with this argument is that simple mergers may not actually be in the patients’ interest. While mergers to create organisations that take full responsibility for commissioning and providing services for the populations they serve have been pursued in Scotland and Wales, the benefits of this kind of organisational integration remain a matter of dispute.
It’s been mooted that stroke care in London and Manchester has been improved by planning the provision of these services across networks linking hospitals. They are reported ass “success stories”. For example, Manchester uses an integrated hub-and-spoke model that provides one comprehensive, two primary and six district stroke centres. Results include increasing the number of eligible patients receiving thrombolysis within the metropolitan area from 10 to 69 between 2006 and 2009.
The decision over the future of services in Staffordshire allows to put to the test the idea that health care teams can develop a relationship over time with a ‘registered’ population or local community. They can therefore target individuals who would most benefit from a more co-ordinated approach to the management of their care. For example, a “frail elderly assessment service” might well to act as a one-stop assessment for older people and take referrals from a wide range of sources to better meet the needs of the frail elderly. The ‘new look’ services in Mid Staffs could become a ‘test bed’ for seeing how information technology (IT) could be best used. IT could, in this way, support the delivery of integrated care, especially via the electronic medical record and the use of clinical decision support systems, and through the ability to identify and target ‘at risk’ patients
A clinician–management partnership that links the clinical skills of health care professionals with the organisational skills of executives, sometimes bringing together the skills of purchasers and providers ‘under one roof’, might become more likely in future. This might be particularly important for ensuring that patient safety targets are actually met in clinical governance, and corrective action can be initiated if at any stage deemed necessary. The engagement of actual patients would be very much in keeping with Berwick’s open organisational learning culture. Of course the Care Bill cannot set top-down commands for organisational culture and leadership. It was interesting though that these were discussed in yesterday’s debate. Effective leadership at all levels will be necessary to focus on continuous quality improvement. A collaborative culture will be needed which emphasises team working and the delivery of highly co-ordinated and patient-centred care.
So the future of Mid Staffs clearly represents an opportunity for the NHS, not a threat; it would be helpful if politicians of all sides could rise to the occasion with maturity and goodwill.
Machine politics by incremental soundbite is not a way for Jeremy Hunt to manage the NHS
Jeremy Hunt’s tenure at the Department of Health has so far been pretty inglorious.
Hunt tweeted on December 13 2013, “Shocking Labour not supporting measures in Care Bill that will prevent another Mid Staffs. Have they learned nothing?”
The Care Bill is however intensely complicated. The Government plans to widen the powers of trust special administrators face opposition both within and outside Parliament. There can, of course, be grounds for hospital reconfigurations where this improves the quality of patient care, however it is essential that this takes place with proper regard to due process.
And yet Jeremy Hunt has allowed himself to be completely at the mercy of health services journalists, some of whom are not particularly bright and who have little understanding of the English law. Specialist registrars in medicine, the rank below a Consultant, can only wonder whether they wish to become a NHS consultant working in such demanding conditions.
It is clear that the Secretary of State for Health, too, cannot have that clear an understanding of the current law, as he has now lost in the second and third highest courts in England and Wales.
However, by courting certain people, Jeremy Hunt has ensured that he cannot be attacked by key personnel in the clinical regulators.
The NHS would be nowhere without the opinions and views of patient campaigners, particularly in the discussion over reconfigurations. The quality of their work continues to be astounding. The news about the Mid Staffs Trusts reconfigurations is expected shortly.
A similar issue has arisen with NHS consultant cover.
If Jeremy Hunt wants a NHS Consultant to do 24 hours for example, he presumably will have to pay another NHS Consultant to act ‘as cover’ for the next 24 hour period. Otherwise, this will offend ‘patient safety’ so beloved of many who had themselves not prevented a Mid Staffs previously.
If Jeremy Hunt wants NHS Consultants to be there seven days a week, he will presumably also pay for the formidable army of dieticians, occupational therapists, physiotherapists, speech and language therapists, nurses, healthcare allied professionals, ward clerks, and so it goes on, too. The costing figures estimating what this might cost have been virtually non-existent so far.
If Jeremy Hunt wants a NHS Consultant to do the work instead of Specialist Registrars, he must ensure that they are adequately trained and revalidated on specialist procedures such as insertion of a central line, chest drain or pacing wires, and pay for this.
Otherwise, Jeremy Hunt is all talk and no action.
It’s been long known that Tony Blair wished the civil service to be more ‘innovative’ and not act like technicians. The deprofessionalisation which the NHS finds itself now is a genuine problem.
If private providers really want ‘an equal playing field’, is it not reasonable to request private providers such as Circle, Serco or Virgin to pay for Specialist Registrar training posts in their ‘NHS hospitals’? They are, after all, using the NHS logo.
Otherwise, despite the brand loyalty, the time possibly has to come where the ‘National Health Service’ gets rebranded as a ‘whole person care service’ (or similar). The NHS is unrecognisable to how it used to be recently, and the legitimised use of the NHS logo is simply causing confusion from members of the public. This is unless of course politicians can unit on re-framing the NHS away from a pseudomarket, but as a service which is comprehensive, universal, and free-at-the-point of need.
As it is, we’re left with Jeremy Hunt and some health services journalists, and the clinical regulators, trying to move policy incrementally by soundbite, often by completely ignoring the professionals who matter: the doctors, nurses and allied health professionals. They should spend less time managing the media, and more time managing the NHS.
It’s all gimmicks, gimmicks, gimmicks.
