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@andyburnhammp with @JustinonWeb: NHS bill has left service 'demoralised, destabilised and fearful of the future'



From this morning’s Radio 4 ‘Today’ programme, an interview by Justin Webb of Andy Burnham MP Shadow Secretary State for Health.

 

 

This transcript is to the best of my ability, and is (c) of my blog and cannot be reproduced without my express permission. There are precise words here in this particular transcript.

 

Justin Webb

Labour’s view is clear. Mr Cameron himself must show leadership, grasp the nettle, and drop the Bill. The Bill being the Health and Social Care Bill, the hugely controversial reorganisation of the health service in England, and that Bill being back before the House of Lords today, with Labour hoping to damage it further by getting the government defeated on crucial provisions – including a new rule which would allow hospitals to raise up to 49% of their income from private patients, provided that money were ploughed back into NHS services. The Government says that Labour is launching an opportunistic attack, with no real sense of a properly thought-through alternative. The Shadow Health Secretary is Andy Burnham, and is on the line now. Good morning to you.

Andy Burnham

Good morning.

Justin Webb

Can we deal with that 49% thing first – what is it that you object to? You allowed, didn’t you, hospitals to make some money from private patients, but it was capped quite low. The Government simply wants to raise that cap.

Andy Burnham

We did Justin. We did Justin but it was carefully controlled, activity at the margins of the hospital. This Bill would take it up to a whole new level allowing the hospital to earn up to half of its income from treatment of private patients, so that’s 1/2 of appointments, theatre times, beds, car park spaces, devoted to the treatment of private patients.

Justin Webb

But  no – they’d have to build extra to do it. They wouldn’t be taking existing NHS beds and turning them private?

Andy Burnham

That’s the point isn’t it? They wouldn’t have to. The effect could be that NHS waiting lists get longer, and people simply won’t accept that with hospitals built with taxpayers’ money which should be focused on treating NHS patients.

Justin Webb

Why would that be? They wouldn’t be focused on it, they’d be raising money from it which would be ploughed back into the NHS.

Andy Burnham

The Government’s Bill is producing a competitive market. They’re essentially saying to all hospitals that they’re on their own. You’ve got to find the money to survive. That’s a big break with NHS history. We’ve had a system which has been collaborative where systems support each other. They’re saying, with this Bill, to hospitals that they’re on their own – they’re saying to them that it’s a competitive market, you’re on your own, and you have to use these freedoms to protect your bottom line. My fear is that they would begin to devote more time for private patients squeezing NHS patients out, and that will be a return to the bad days of the NHS where people were told ‘wait longer, or go private’.

Justin Webb

But again, under Labour, independent sector treatment was introduced, wasn’t it? In NHS hospitals, treatment centres were introduced,  run by private organisations, some would say they worked rather well, an element of private competition introduced by Labour and working?

Andy Burnham

That’s true we did, and that capacity allowed us to deliver lowest-ever waiting times in the National Health Service. The context was different, Justin. Let me explain that. We introduced those providers within the context of a planned collaborative system, so that the extra capacity was managed. And by the end of our time in government, around 2% of operations were conducted in the private sector. That gives you an idea of the type of scale we introduced.

Justin Webb

Yes, but that’s terribly important. You say collaborative, but it wasn’t entirely collaborative, in that there was an element of competition – which was terribly important wasn’t it? The point of doing it was to “gee-up” the NHS, in order, in this specific case … to get waiting lists down, which it did, didn’t it? It wasn’t entirely collaborative, in that there was an element of competition then that was terribly important.

Andy Burnham

Competition was with controls, that’s my point. The Bill takes the controls away – takes the brakes away off the system. This Bill would throw up the NHS to the full force of NHS competition law where every contract which takes place will be open to competitive tender. That is a huge change from the NHS we left behind – we had collaborative NHS with good standards of care. That’s the question that I keep on coming back to: why on earth are the Government turning it upside down? They inherited a self-confident NHS, and in just 18 months they’ve turned it into an organisation which is demoralised, destabilised and fearful of the future.

Justin Webb

Here might be why. While there was increasing spending and waiting lists came down, there’s no doubt that productivity reduced? It is actually inconceivable that the NHS can carry on in the future in the way that the NHS is organised currently. We won’t be able to afford it, and if we want to be able to provide the health for ourselves, run the health service for less than 10% of GDP which you do as much as the Government does, we have to find a way of delivering the service in a better way, and a more productive way?

Andy Burnham

I am afraid I don’t accept the premise of your question. NHS is one of the most efficient systems in the world. That’s what the independent experts tell us.

Justin Webb

The National Audit Office in 2010 said that taxpayers were getting poorer value for money than 10 years previously.

Andy Burnham

Well, the Independent Commonwealth Fund makes a comparative study of health systems around the world, and repeatedly tells us that the NHS is one of the most efficient systems in the world. We do spend less than 10% of GDP, but that’s not the case in other countries in France, the Netherlands, and certainly not in the United States. That’s why market-based systems tend to cost much more, A National Health Service gives you an ability to control costs. If you break that, the market runs riot. More broadly, you mention efficiency. It was a catastrophic mistake, in my view, that, when the NHS is facing such huge financial challenge, they’ve allowed existing systems to disintegrate.

Justin Webb

In a word, then, you think the Bill can now be defeated?

Andy Burnham

Yes I do. All around there is a consensus that it is better to work through existing systems than to carry forward this dangerous re-organisation. The Government has abjectly failed to build a professional consensus behind the Bill. My offer still stands, Justin. I have no objection to building GP-led commissioning. This Bill will damage the NHS at this particular time.

Justin Webb

You’ve already introduced that in the past, haven’t you?

Andy Burnham

Yes I have. This Bill will damage the NHS at this particular time.

Justin Webb

Andy, we’ve got to leave it there. Thanks.

Burnham: NHS bill has left service “demoralised, destabilised and fearful of the future” (mp3)

Why David Cameron should share his iPad app with Ed Miliband



At 07.12 a.m. on Thursday, the BBC Radio 4 Today programme ran an item about the effects of adoption of technology. Sir Victor Blank believes that we communicate less in modern day society. He asked the BBC’s technology correspondent Rory Cellan-Jones to investigate whether innovations such as email and social media have hindered, rather than helped, communication.

The Telegraph newspaper reported recently on an intriguing adoption of innovative technology. Programmers inside the Cabinet Office are designing a new app that will bring together all the latest information from across Whitehall. The idea for the app came from a trip by advisers to the US. The software will allow the Prime Minister to see the latest NHS waiting-list figures, crime statistics, unemployment numbers and a wide variety of other data at a glance. It will also include “real time” news information from Google and Twitter, according to the Times. Mr Cameron is known to be an iPad devotee, using it to read newspapers as well as to tune into radio programmes, According to an article in the Huffington Post, the app is due to be unveiled in March. Officials say it may also be made available to the public, meaning it is unlikely the app will contain security sensitive government information.

I strongly believe in the thesis that technology assists innovative research, and that, specifically, the iPad is a godsend for people who engage in academic research like me.

Innovation is central to organisational growth and competitiveness (Tidd et al., 2001). Effective innovation can transform highly-functioning politicians into world leaders and ordinary organisations into stimulating environments for employees. Poor innovation within political parties could lead to poor morale both within H.M. Government and its official opposition, and ultimately stagnation and decline of the entire political process.

Organisations often face an “innovation paradox“; they must innovate in order to compete against one another, but in order to achieve the innovation, they may need to collaborate with organisations they compete against. In David Cameron’s case, this means collaborating with the app designers, sharing some of his ‘secrets’ about how he wishes ‘to do’ government. If Cameron succeeds here, he will have achieved a nirvana of the political process that he is said to be passionate about; including opening up a huge amount of stored information to the general public.

Traditionally organisations have been secretive of their innovations to protect any emerging intellectual property, but in this case also valuable information about how effectively the U.K. is being run. Over the years, such a secretive culture has been reinforced in the minds of other stakeholders, including M.P.s and voters, that the political environment is cut-throat and that innovation is how parties might gain competitive advantage over one other. Thus, the concept of open knowledge exchange with other independent organisations, even within a distributed innovation network, might be difficult for those people working in politics to accept.

This might result in members of the Conservative Party being apprehensive about exchanging knowledge with individuals outside their organisation, both within the Coalition and outside of it, in case of divulging information that was not intended to be exchanged. The presence of trust between individuals from the collaborating organisations is a key determinant in the success of collaboration.  However, a key advantage for the network was a dramatic lowering of cognitive distance and increased collaboration and sense of community within the consortium. The physical separation between the political parties, especially in Portcullis House, is also not that huge.

In summary, I feel that Ed Miliband should embrace David Cameron’s new app, and they should both embrace a collaborative, innovative spirit. Whilst it may not make for a massive competitive advantage for Cameron compared to Miliband, it might make the sharing of ideas and information a more interesting and challing one intellectually.

 

Reference

Tidd, J, J Blessant and K Pavitt (2001). Managing Innovation: Integrating Technological, Market and Organisational Change. Chichester: John Wiley & Sons.

David Cameron is wrong on the NHS corporate restructuring for these reasons



In an interview where David Cameron tried to tell John Humhrys he was wrong, Humphrys identified that Cameron was showing no leadership on the bankers.

The interview can be heard here:
http://news.bbc.co.uk/today/hi/today/newsid_9363000/9363655.stm

David Cameron is wrong about the NHS restructuring for the following:

It is wrong simply to focus on outcomes at the treatment end; much more could and should be done at the diagnosis end (health policy analysts find outcomes useful, but what they’re actually measuring are objective benefits).  Much of the fundamental issue for the next decade will be the early diagnosis of the disease especially cancer, and there needs to be some focus on the efficacy of screening methods at the other end too (e.g.for colon cancer, breast cancer, COPD).

It is no good just talking about length of survival times, because there has to be a proper analysis of the quality-of-life and well being of patients with chronic morbidity including dementia.

The Doctors were not asking for the changes – the BMA is opposed to it, and to my knowledge the Royal College of Physicians shows little interest in it in a very positive direction. The King’s Fund certainly think it is a calamity.

2-3 years is a very short time to produce ‘the biggest reorganisation’ in the first time; it will involve £1.4 bn in the first year. John Humphrys was right to correct the figures that Cameron produced on the basis of actual evidence from the Kings Fund.

Satisfaction is at an all time high now with the NHS – this cannot be divorced from the record spending by Labour in the last parliament.

David Cameron denied the NHS IS getting better. This must means that he thinks that all aspects of it are getting worse. THIS IS A LIE.

John Humphrys asked that the NHS was in fact changing to a Federal Health Service. Cameron saying that there are already regional variations is frankly irrelevant. Humphrys is correct saying that an analogy between GPs and free schools is an extremely poor analogy; I am shocked that David Cameron is idiotic enough even to suggest it.

There’s no point Cameron trade-union bashing, as there are many ordinary nurses, doctors and other health-professionals who are non-Labour members who are highly critical of his insane policy.

If Andrew Lansley is so well respected, why does the whole of RCN disagree with him? The man is not well respected amongst the health professionals.

Dr Shibley Rahman Queen’s Scholar; BA (1st Class), MA, Bachelor of Medicine, Bachelor of Surgery, Doctor of Philosophy, Diploma of the Membership of the Royal College of Physicians (MRCP(UK)); FRSA, LLB(Hons).

Member of the Fabian Society.

BBC R4 Today and the squeezed hard-working non-upper class



Friday morning with John Humphrys is not going to be an occasion Ed is going to forget in a hurry, because of an extraordinarily tough interview on the BBC Radio 4 Today programme.

Ed Miliband’s opening gambit was talking about aspiration, which has indeed been an enduring theme for Labour, certainly during Tony Blair’s time in the 1990s. John wished to pin down Ed on where he precisely he wishes to lead the country, and specific issues, such as the graduate tax and the inequality gap, were discussed, with regards to deficit reduction and fairness. It may seem like quite a sexy concept, “the squeezed middle” like a tube of toothpaste, but actually even the simplest of analyses provides that it is fraught with problems. For example, what are these pressures “squeezing” the middle? Surely not the State, which the Coalition feels is too big anyway.

The interview can be heard here.

John Humphrys – not Ed Miliband – brought up the discussion topic of the “squeezed middle” on the basis of the article he had written in the Telegraph that morning. However, Ed Miliband clearly ran into trouble in defining the “squeezed middle”, which was very heavily reliant on the definition of the middle class. It was nonsense attempting a definition of the “squeezed middle” without defining the middle class, which was a mistake of Ed, thus giving John Humphrys to give the impression that Ed was on an errant fishing expedition. Even his brother David has alluded to the “squeezed middle”, for example in the the 2010 Keir Hardie memorial lecture tonight in Mountain Ash, South Wales. He provided that,

“To reconceive our notion of fairness. In our concern with meeting peoples’ needs we seemed to sever welfare from desert and this led people to think that their taxes were being wasted, that they were being used. When we said fairness, people thought it was anything but. What emerged as a tribute to solidarity, the welfare state, turned into a bitter division. Many of the ‘hard working families’ we wished to appeal to did not view us as their party. We achieved great things but we did not bring people with us, and our motivation appeared abstract and remote.”

The problem was that the definition that Ed (sort of) provided seemed to be 90% of the general public, but when Labour has previously talked about “progressive universalism”, it really has been talking about the aspiration of non-upper class voters who are hard-working; the word ‘middle’ is far too large, but, then again a group of ‘of non-upper class voters who are hard-working ‘ is equally large. It might be better, once Ed has conducted his review, to outline solutions for select groups of the public, such as students who are disenfranchised from Nick Clegg or elderly voters who are worried about the provision of elderly and social care (for example). Like the II.1 class at Universities, this is too large as to provide an idea which voters can address. The criticism of this is that Ed wishes to be ‘all things to all men’, but it would have been helpful had Ed identified which groups of society he was particularly worried about. Maybe, it’s that Ed Miliband feels he doesn’t wish to dash the aspirations of nearly all of the country. I have blogged before on how Labour has been giving the image of protecting the super-rich, and this is dangerous. Obviously, Ed has to give the definition of the “squeezed middle”, having spoken about it so, and even if he alienates some of the “super rich”, I’m afraid.

At first, the “squeezed middle” started off as a fairly innocent parliamentary joke. The Comprehensive George Review saw George Osborne appearing to be perched on William Hague’s knee. The incident gave Ed a good line about Ken being part of the “squeezed middle”. But Cameron responded well by saying that unlike the Labour leader, Clarke has “bottom”. More seriously, making his debut at the Dispatch Box as Labour leader, Ed asked how it was fair for parents with one salary of £44,000 to lose out while those with two salaries totalling more than £80,000 could keep the benefit. Mr Cameron hit back by accusing Ed of expressing concern for the “squeezed middle” to cover the fact that he had been elected with the support of the trade unions. As it happens, however which you define the “squeezed middle” precisely, the benefit changes, which will affect those paying 40 per cent tax from 2013, mean that a three-child family with a single income of £33,000 after tax will lose £2,500 a year, the equivalent of 6p on the basic rate of income tax.

Ed is right in that the “squeezed middle” has become an emergent theme already in his opposition. Ed has has been leader of Britain’s Labour opposition for about a month now, but already he is identified with a cliché: ‘the squeezed middle’, to whom he promised his party’s support. The phrase has enjoyed several years’ currency on both sides of the Atlantic. But its use by Mr Miliband was followed by chancellor of the exchequer George Osborne’s commitment to remove child benefit from the better paid, and then last week by a report from Lord Browne recommending the uncapping of university tuition fees. Politically, one of the key questions about Lord Browne’s suggestion that tuition fees should be raised is how the middle classes react. Will a rise in fees be seen as another burden on those who work hard, play by the rules and are already bearing more than their fair share of the costs of the state? Both measures, together with looming tax rises, are bound to hurt the middle class, and have prompted a surge of debate about its plight. Rightwing commentators argue that prime minister David Cameron is breaching a cardinal principle of Margaret Thatcher by failing to protect “our people”, the aspirational Tory voters. Ministers respond that there is no chance of reconciling those at the bottom of the pile to spending cuts unless pain is seen to be shared across the social spectrum. They were by no means dismayed by cries of suburban anguish about child benefit curbs.

It is possible that Gavin Kelly at the Resolution Foundation has done a much better job. His broad definition is anyone who is “too poor to be able to benefit from the full range of opportunities provided by private markets, but too rich to qualify for substantial state support.” Even something this vague would have helped Ed. Kelly’s analysis shows what a genuinely important political problem the squeezed middle will be in the years ahead. Earnings are flat, and likely to remain so in real terms, while cost inflation is steep especially for healthcare, energy and insurance. House prices have fallen and interest rates are low, but in Britain a mortgage of three times earnings will not buy a home on the edge of a provincial city for even a relatively high-income family on say, £60,000 a year. Kelly calculates that stagnating pay and the rising cost of living will leave these households losing an average of £720 in 2012. That is even before the impact of cuts to tax credits are taken into account. Those who aren’t in the “squeezed middle” – who aren’t “super-rich” – appear to be doing well, and maybe it’s the case that Ed doesn’t want to alienate them either. More and more companies are opting out of offering employees healthcare or final salary pensions. Britain’s average individual earnings are just over £22,000, a pathetically low figure from which to demand that a citizen pays more bills from his own pocket. But that is how things are going to be

However, Ed is in good company in failing to provide a definition of the “squeezed middle”. David Cameron is faring no better than Barack Obama in the vastly difficult task of explaining to his nation, and especially to the “squeezed middle”, where they are going and what is in it for them. He must reconcile people reared in the belief that hard work and prudence will yield comfortable rewards to the new reality of our societies’ diminishing share of global wealth. Finally, Ed must show that he hasn’t forgotten the working classes. Whilst Labour seems to be engaging people in the middle classes, it is dangerous if it writes off the working class in having a share in Labour’s policy.

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