13th February2012 

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Seven simple truths       

News and Comment from Roy Lilley


Over the weekend the cacophony surrounding LaLa's Looney Bill reached something of a crescendo. Will he stay, will he go? Will he get the sack, will he do the right thing and recognise he is doing the wrong thing. All of that.


There were acres of analysis why the Bill is wrong; too complicated, poorly communicated, unnecessary. All of that.


Very good up-sum of the main points here.


When jobbing journalists and columnists, used to writing about the politics and happenings of the day, are asked by editors to 'have a look at the NHS/Lansley thing' you know there is serious political trouble ahead. Downing Street is giving the impression they are going to tough it out but they can't. There is a welter of opposition to the Bill from front-line staff who really don't want to do it, see no benefit in it and won't break sweat to try and make it work. I am told there is more grief to come LaLa's way this week.


There were phone-ins, talk-shows, politics programmes and acres of news-print. The TV seemed to be running out of LaLa-ites. The NAPC and the Alliance have deserted him. Third-Degree-Burns is probably burned-out following the exigencies of Friday's media storm and was mercifully missing. Shame because every time he opens his mouth another couple of reasons to oppose the Bill pop-up!  


Sunday morning the BBC's 'shout-at-each-other-show' paraded a shrill woman from the private sector who talked about 'marginal costs' and a bloke with sticky-out ears who talked about 'market dynamics'. I do hope the BBC uses them again!


However, in amongst this bedlam LaLa's protagonists still don't seem to have a clear narrative why they are against the Bill. They have said nothing that will worry Marge. It is true, there are good reasons to oppose the Bill on just about every page. That's the problem; there are 364 pages of this tripe.


It seems to me there are seven reasons that can be put into plain English that wavering MPs, jobbing journalists and the public will understand.

  1. The Bill replaces three levels of management (DH, SHA, PCT) with Seven; (DH, NCB, 4 Clustered SHA, 50 Commissioning Support groups, 300-ish CCGs, Clinical Senates and HealthWatch.)
  2. GPs cannot 'do commissioning'; it is too complex, they can't fit it in part-time and look after patients. They can and should influence local commissioning decisions.
  3. The complexity of buying healthcare is recognised by the DH who have invented Commissioning Support Organisations (not in the Bill), to help. They are intended to be private companies who will decide what healthcare we can have and pocket any savings.
  4. The Coalition has not saved millions in bureaucracy; they have shifted costs by sacking really experienced people who are now being re-hired to commission care on behalf of GPs.
  5. No one is really worried about the 'private sector' per-se. But, if you spend �100 on healthcare in the NHS you get one hundred quid's worth of healthcare less about 5% management costs. In the private sector you'll get a hundred quid's worth less 3% management costs, 5% profit, 12% to pay bank loans and charges, plus a chunk for bonuses, dividends and return for investors. And, no provision for what happens if they go broke or get fed up.  
  6. There is no increase in patient choice; we are all stuck with our local GP who is stuck with his local CCG who are stuffed into CSO's who will decide what we can have and when we can have it. All the decisions about us are being made without us.
  7. The NHS will function perfectly well without the Bill; it is performing pretty well now and can coalesce around what it is doing. But, waiting times are on the way up and we are getting fatter and older. The Bill does nothing about any of that and the Service should be allowed to concentrate its efforts to meet those challenges.

Seven simple, uncomfortable, irrefutable truths you can pass on if you are of a mind to!


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Dr Paul Lambden
The last of the three ugly sisters
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RCN and the Public Health Agenda
Great Conference
17th Feb - London.
This looks like a really timely conference given the palaver PH is going through.
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News and Stuff
News boy
>>  McKinsey - hijacked the NHS.  Mad-Dog Monitor has been out on the p*&& with his old mates.  He declared it but ouch!  This is not the actions of the man regulating the market, is it?  
>> Conservative Home - blog that caused the kerfuffle over the weekend.
>>  And another Tory Blogger - calls for the Bill to be dropped.
>>  Should LaLa go - Simon Hughes opens his mouth and puts his foot in it!
>>  Secularists campaign to throw Chaplains out of the NHS - the Chaplain at Fabulous Frimley Park was great to us when Les was with them; it'd be a shame.  I understand that most hospitals have multi-faith facilities these days - all out of the same budget.
>>  This is where the 'Nicholson Challenge' came from - McKinsey, working for Labour.
>>  Who are the three Tory Cabinet rebels - Micheal White says; Pickles, IDS and Gove.
>>  Nutrition - Interested Parties letters and other good stuff.
>>  Does any one have any ideas on who will be the National Director of Patient and Public Engagement, Insight and Informatics - tell me here, please.
>> GP's petition to drop the Bill - reaches 60,000
>>  Reform Think-Tank - scorecard for policy reforms.  Health doesn't come out too well.
>>  Working in the NHS - like bereavement.
>>  Mergers don't work - two turkeys don't make an eagle.
>>  Health reforms - where they stand. List of RC's and their position.
>>  Health expenditure  list of countries; interesting data from OECD and WHO
>>  Learn to speak like LaLa
>>   Whitney Houston - found dead.
>> 'Mad-Nad' on the reforms - apparently No10 wanted to smear LaLa, or some such!
>>  Partnership[ Forum - this is a group of the DH and the employers and the Unions.  In the light of the fact that community staff now all work for SEs or the private sector and FTs will soon start doing their own pay and conditions, why does it exist.  Central pay bargaining is the last bastion of a nationalised industry that the Coalition is busy trying to de-nationalise.