Saturday, May 21, 2011

A consultation on the Health Reforms

Hat tip to Seth O Logue at "Political Betting" for drawing my attention to an audio recording on the Guardian site of a Q&A session with Professor Steve Field in 16th May. Field leads the NHS Future Forum, the ad hoc group set up by Cameron to listen to health industry professionals on the Health and Social Care Bill and report back to the government with proposals for change by early June.

The audio recording can be found at ""

The description and opinions below largely reflect Seth O Logue's post at Poltical Betting, with some minor editing.

The group assembled for Field are broadly hostile to the reforms - polls taken before his arrival showed circa 70% against the main proposals. Field handles the 80 minute session well: he is clearly not interested in partisan political debate and focussed only on health issues.

The audience consists of mostly of Guardian readers, and it shows. Badly.

The first 3 minutes and 25 seconds of the recording should be skipped, it basically consists of the meeting getting under way, slightly late, with various apologies for the delays getting everyone assembled and starting due to problems with London traffic. After this point the highlights are:

03:25 - 08:48 Introduction. Field’s experience and qualifications. His values and assumptions. Work, structure and goals of NHS Future Forum. Independence from government stressed. Main issue to date is the balance between patient choice vs. protecting key NHS services (i.e. competition). Next it the need to widen patient and clinical engagement in commissioning process. Education and training important but not urgent.

11:19 - 16:15 GP commissioning. Answer to first question on mental health commissioning but more general views on commissioning given first. Additional clinical and management expertise to be added to GP Consortia but basic Lansley reform of closing PCTs and moving to GP commissioning is supported. Need to develop networks of consortia to share specialist resources and for national commissioning of some clinical services. A good introduction but long winded and slow to get going.

19:15 - 22:24 Question on Ovarian cancer. Interesting as the question and Field’s answer shows that there are real problems with current NHS service provision. Those wanting to “save our NHS” should listen carefully. Field also gives balanced views on NICE standards, highlighting strengths and weaknesses of standards driven commissioning.

23:25 - 26:56 The need to improve the quality of Primary Care (GP services). A clinical (rather than political) definition of information sharing, integration and collaboration. Diabetes care used as example. Another eyeopener for anyone unaware that there are things we need to improve.

28:40 - 31:08 Field on “cherry picking”, accessibility and quality of GP services, greater use of nurses and pharmacists in treating long term illnesses.

33:23 - 36:40 Co-operation vs. collaboration. Competition can expand capacity in market, but improving collaboration and integration within NHS must be a priority. Patient choice is primary consideration and must be expanded and protected. Need for private hospitals to subsidise training in NHS hospitals. Looks like Field will recommend that private sector provision and competition between service providers is retained but ‘hidden behind’ patient choice.

37:45 - 39:55 Simon Leyton, a former Labour County Councillor from Copeland who was defeated in the Distington ward in this year's Copeland Borough Council elections, puts a question about GP commissioning which includes one good quote: “We need to reduce the number of marches so we can get on with the job”. From 39:05 Field gives reasons for success of Cumbrian GP commissioning: clinical leadership, management support and scrutiny. These will be Field’s key recommendations for changes to GP commissioning process.

40:19 - 44:50 Hackney GP in diatribe against the Lansley reforms. Every word could have been penned by a Labour spinner. After she damned the proposals, it turns out her own practice has signed up to participate in the GP Pathfinder pilot project. Cue the justification: “Just because people get into a lifeboat doesn’t mean that they are in favour of sinking the Titanic”. A very good defence line to remember if you're caught out in an action which doesn't match your words, but I'm not sure that the argument is 100% valid in this instance.

58:34 - 60:44 A ‘constructive proposal’ by a woman who believes Lansley should be done for “criminal insanity”. She wants democratic governance of the NHS by setting up elaborate elected commissioning bodies who then elect a “lay chair”.

62:48 - 63:20 Retired Health Professional: “In the interest of democracy and accountability the Secretary of State must have a legal legal duty to provide NHS free at the point of need [?]“. Lansley is proposing to move the commissioning of NHS Health Services out of the direct control of the Department of Health and to transfer it to an arm’s length body, the NHS Commissioning Board. Lansley justifies the move as getting politicians out of the business of micro-managing the NHS, whereas opponents believe it lets the government off the hook of statutory obligations and democratic accountability for NHS performance (e.g. decisions on closing hospitals will no longer be ‘political’). Note Field’s silence in response to the suggestion. Either this aspect of Lansley’s reforms are outside his terms of reference or they are written in stone or he fully supports Lansley’s decision.

71:25 - 75:20 Field on Mark Britnell (insurance and opportunities for private sector providers), top-down reorganisation, the ‘kitchen cabinet’ conspiracy and David Cameron’s real care and love of the NHS. Cue much weeping, wailing and gnashing of teeth as the Guardianistas discover that Field trusts Cameron on the NHS reform and that he sees his role as being supportive of the government and that he is not about to sink Lansley.

76:43 - 80:22 Field concludes with his vision for the NHS’s future. He emphasises the need for the NHS to make productivity savings in order to free funds for the increased cost of new drugs (Herceptin used in cancer treatment as example) and other technological advances. Looks like Field’s main recommendation will be to slow down pace of change to reduce risk of destabilising the NHS.


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