Alliance calls for NHS providers to get priority

Posted on October 26, 2009. Filed under: News stories, Press/News Releases | Tags: , , |

Pulse | By Gareth Iacobucci | 26 October 2009

The NHS Alliance is urging the Government to slam the brakes on privatisation of NHS services by adopting new rules on APMS tendering.

Under its proposals PCTs would be barred from approaching independent providers unless they could satisfy detailed criteria that existing NHS services were not meeting quality standards.

In Scotland legislation has already been brought in to bar private companies from taking over the running of NHS services.

It also backs the Department of Health’s advice to NHS trusts to give current providers ‘at least two chances’ to improve where they are found to be under-performing, and for alternative providers to only be considered as a last resort.

In a paper entitled Rebalancing the Market, launched at last week’ NHS Alliance Conference in Manchester, the organisation backs the Government’s shift in emphasis, and recommends a revamp to the way services are tendered for.

For years PCTs have been encouraged to court private providers to bid for APMS contracts but the Alliance advises that in the future, PCTs should only invite private bidders in to bid to run services where there are no current providers of sufficient quality willing to tender.

It also calls on SHAs and PCTs to offer ‘formal support’ to NHS bidders during the tendering process, and recommends bidders be assessed on their ability to provide continuity of care and engage with local patient groups.

Dr Brian Fisher MBE, public and patient involvement lead, at the NHS Alliance, who presented the paper, said: ‘This will respect the importance of continuity in integration of local services and organisations that have historically provided a good local service.

‘It will encourage competition where services are of insufficient standard or too expensive, without destabilising primary care provision when it is already good.’

Market forces need to be put in service of patients

NHS Alliance | 21 October 2009

NHS organisations should be the first choice for commissioners as preferred providers, says the NHS Alliance. 

In a paper entitled Rebalancing the Market, which will be launched at the NHS Alliance 12th Annual Conference in Manchester, the organisation suggests two new approaches to tendering and commissioning that would improve cooperation and increase efficiencies. 

The paper states that tendering for services to include private bidders should be encouraged only when there are no current providers of sufficient quality prepared to offer extended services or conventional GP services at the right price. 

Dr Brian Fisher, National Public and Patient Involvement Lead, NHS Alliance, and the paper’s author, said: “Too often, the result of a business model is an NHS organisation that looks for increased income, which can come at the expense of patient care. The Alliance would like to see market forces better directed to improve the service to patients.” 

Although working with the independent sector has its advantages, it also poses many challenges, not least to the patient who, instead of being at the centre of healthcare planning, becomes part of a tug of war between primary and secondary care. 

Independent sector organisations may be more expensive and exit the market when the going gets tough. They may also decide to cut costs using short-term and/or inexperienced clinicians.

The paper also highlights that collaborative commissioning, programme budgeting and horizontal/vertical integration could be the answer to creating an environment where all partners have a common interest in improving care pathways and producing efficiencies. It says: “It may be that a cooperative approach works in some situations and not in others – there may well be a mixed set of approaches both within and between PCTs.”

For a copy of Rebalancing the Market or to arrange an interview with Dr Brian Fisher please contact the NHS Alliance press office on 07951204999/ 


Notes to Editors
1. For more information, please contact the NHS Alliance press office on 07951204999/ 

2. The NHS Alliance is the only independent body that brings together primary care trusts’ chief executives and other senior managers, doctors and practice managers, nurses, pharmacists and allied health professionals, along with board chairs and members. We are a value-driven organisation, with no political affiliation, which works in partnership with various bodies associated with the NHS to create a progressive health service that is free from the traditional tribalism of single interest groups.

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Revealed: NHS secretly wooed private firms over polyclinics

Posted on October 7, 2009. Filed under: GP-led health centres, News stories, Polyclinics, Providers | Tags: , , , , , , , , , , , |

Pulse | By Steve Nowottny | 7 October 2009

Exclusive: The NHS secretly courted private companies at a series of high-level meetings to encourage them to compete for the new wave of polyclinics and GP-led health centres, Pulse can reveal.

Directors, chief executives and other senior figures from a who’s who of private health providers were invited to regular off-the-record briefings, held every six weeks, to get their advice on tendering and procurement of GP-led health centres and London’s polyclinics.

Details of the meetings, at which no minutes were taken, emerged only this week after Pulse successfully won a nine-month appeal under the Freedom of Information Act.

Attendees included Atos Consulting, Assura Group, Care UK and Alliance Boots (see below).

The last in the series of meetings, which were hosted by NHS London and designed to reassure the private sector about the Government’s commitment to opening up the market, was attended by then-health minister Lord Darzi, as well as UBS Bank, PriceWaterhouseCoopers and Dr David Bennett, whose former roles include head of policy at Number 10 and at influential management consultancy McKinsey.

Companies invited to the meetings subsequently bid for and won contracts for dozens of GP-led health centres around the country and have been among those bidding for London’s centres, although NHS London is refusing to reveal how many they have won.

But a briefing prepared for Lord Darzi ahead of the last meeting on 19 August 2008 reveals: ‘This group of private sector CEOs and senior officials meets roughly every six weeks… to discuss concerns of the private sector market in general but specifically issues relating to London polyclinics and how London is handling GP-led health centres.

‘It is now a forum for the market to offer opinions and advice in the run-up to tendering and procurement of primary care services through both models.’

The briefing adds that one function of the meetings is to ensure the NHS is aware of the confidence required to ensure City backing for any ‘ventures’ in primary care.

‘Lord Darzi will be aware the City has grown deeply sceptical about markets in health given the reversal of much of the wave two independent sector treatment centre procurement,’ the report adds.

LMCs responded angrily to news of the meetings, pointing out that GPs had not been invited to similar meetings.

Dr Michelle Drage, joint chief executive of Londonwide LMCs, said: ‘We’ve had our suspicions but it confirms everything we thought must be going on. It stinks – it’s appalling.’

Dr Drage said Londonwide LMCs had found it impossible to organise meetings with NHS London at a similar level to the private sector briefings.

‘I’ve had one such meeting in the past year, with the chief executive,’ she said.

Dr Nigel Watson, chair of the GPC subcommittee on commissioning and service development, said: ‘To brief them like this is blatant and seems very strange when everyone is talking about level playing fields.’

And Dr Sally Whittet, a GP in Lambeth, south London, added: ‘This is wrong. It goes against my idea of the NHS.’

However a Department of Health spokesperson said: ‘The accusation that private companies were ‘secret wooed’ is simply untrue. We have repeatedly made clear that in setting up GP health centres PCTs are expected to carry out an open and transparent procurement to ensure the fullest range of providers can bid including existing GP practices, voluntary and independent sector providers.’

He added: ‘Lord Darzi spent a year working on his review of the NHS and engaged with over 60,000 people – the majority of whom were frontline NHS staff, patients and members of the public. However, given their interests in the future direction of the NHS this also included private sector healthcare providers.


• Alliance Boots
• Atos Consulting 
• Assura Group 
• Ashley House 
• Care UK
• General Healthcare Group 
• HCA International 
• Nuffield Hospitals 
• PWC 

The documents that revealed secret meetings between NHS and private sector

Pulse reveals today details of a series of high-level meetings held last year between senior figures in the NHS and leading private sector companies last year.

Read the Department of Health’s final response to Pulse here.

Read the briefing note prepared for Lord Darzi ahead of the meeting on 19 August 2008 here.

Read the full list of meeting attendees here.

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Chris Ham on increasing NHS co-operation

Posted on September 17, 2009. Filed under: Journals | Tags: |

Health Service Journal | By Chris Ham | 17 September 2009

Tighter budgets and more integrated care mean the co-operation and competition panel must change tack away from its old policy of relying on competitive markets.

Policy makers, like generals, are always at risk of fighting the last war. So it is with the health reform programme in England.

Just as the NHS co-operation and competition panel starts to flex its muscles in support of a bigger role for markets, so the policy emphasis is shifting to encourage increased co-operation between NHS organisations to deal with the financial challenges ahead. With NHS chief executive David Nicholson reportedly arguing that competition needs to be seen as a tactic rather than a guiding principle of health reform, the dangers of inconsistency are plain to see.

How did policy makers get into this fine mess? Part of the answer can be found in the time it has taken to establish the co-operation and competition panel. The genesis of the government’s market oriented reforms can be traced to publication of Delivering the NHS Plan in 2002 and yet it was six years before the panel was established.

Given this delay, there was always a risk it would be steering through the rear view mirror. So it has proved with the panel’s early work focused on promoting competition rather than encouraging co-operation.

Policy makers’ one eyed approach to health reform supplies another part of the answer. After the release of Delivering the NHS Plan, attention focused almost entirely on extending patient choice, stimulating greater plurality of provision and developing incentives to support a bigger role for markets.

To be sure, there was recognition that in some areas of service provision – urgent care is a good example – there needed to be increased co-operation between providers, but the levers and incentives to make this happen were not put in place.

Recent indications from ministers and senior officials suggest the importance of co-operation is now recognised. While the proximate reason for the change of heart is the prospect of much tighter budgets, especially from 2011 onwards, there are many other reasons why increased co-operation is desirable.

One of the most important is the need to develop integrated models of care for people with long term conditions. Integration is required to enable primary careteams to work much more closely with hospital based specialists and in the process to overcome the professional and organisational silos that risk patients experiencing a fragmented service.

Another reason is to reduce inefficient duplication of services. This is most apparent in relation to acute services in parts of London where hospitals working in close proximity are providing many of the same services in a context where this is simply not sustainable.

Rationalising services

Encouraging competition in these areas will not only make the rationalisation of services for the benefit of patients more difficult, it may also lead to further duplication as organisations seek to protect their own self interest without regard to the wider system.

Co-operation is also needed to improve the quality of care. Recent inquiries into failures at Birmingham Children’s Hospital and in the Baby P case have provided compelling evidence of the difficulties facing NHS organisations in working together to provide high standards of care.

It is, however, the need for NHS organisations to work together to rise to the financial challenges ahead that calls for an urgent review of the work of the co-operation and competition panel. This can be illustrated by reference to the Better Care, Better Value indicators produced by the NHS Institute, showing the scope for savings of around £3bn by reducing variations in length of stay, day case rates and similar measures of performance.

Many savings depend critically on co-operation. For example, cutting lengths of stay requires NHS trusts to work with primary care trusts to develop intermediate care.

Similarly, reducing delayed transfers hinges on the NHS working with local authorities to improve discharge processes and to enable people leaving hospital to move easily back to their homes or a residential facility of their choice. There is a long way to go in many areas to achieve the co-operation needed to release resources locked up in inappropriate service provision.

If the panel is to perform a useful function, then those steering it should fix their gaze on the road ahead rather than the rear view mirror. The work of the panel should reflect its title, with a much stronger focus on facilitating co-operation than has been the case so far. For their part, policy makers should provide a clear steer to the panel on the direction of travel, and move quickly to ensure the levers and incentives are in place to make co-operation a reality.

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Privatisation is ‘Trojan horse’ threatening NHS

Posted on September 15, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | By Neil Durham | 15 September 2009

Government-supported privatisation initiatives are the ‘Trojan horse’ that could severely undermine the NHS, according to Unite/CPHVA.


The union backed motions at yesterday’s Trade Unions Congress in Liverpool yesterday calling for an end to the privatisation of the NHS, urging services to remain within the NHS delivered by its staff.

Gail Cartmail, Unite’s assistant general secretary for the public sector, said: ‘It is clear that the not-so-subtle encouragement given by the government for the various privatisation initiatives, such as the private finance initiatives and the misguided experiment with social enterprises, are the Trojan horse that could lead to the fragmentation of the NHS.

‘To create these so-called market mechanisms – that the British people have repeatedly said in opinion polls they don’t want – will cost an estimated £20bn. This is money better spent on frontline services – more health visitors, more hip replacement operations and more day surgery.’

  • Are unions facing a losing battle with the government over the privatisation of the NHS?
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The NHS is about care, not markets

Posted on September 3, 2009. Filed under: ISTC, News stories | Tags: , |

Guardian | Comment is free | By Allyson Pollock | 3 September 2009

Downsizing the workforce is a business response to loss of profit – but it doesn’t account for the NHS goal of universal healthcare

The core goal of universal healthcare and services planned on the basis of need and not ability to pay is being jettisoned by the turnaround teams and management teams brought in to manage anticipated reductions in NHS budgets. Downsizing the workforce is a traditional response of business to loss of profit where businesses have to pay the costs of operating in a market and earn surpluses for shareholders. Unlike Scotland and Wales, the NHS in England is continuing to pursue market-oriented healthcare in its reform of the NHS. So it should be no surprise that management consultants firm McKinsey have come up with market-oriented solutions to anticipated budgetary shorfalls. They have advised ministers to cut 10% of the NHS workforce in England by 2014, a reduction that will affect services provided primarily to the old and the poor who have among the highest healthcare needs. But strategies to reduce the NHS budget need to pay attention to the role of market structures and how they reduce the ability of the NHS to pool the risks and costs of care across its population.

The diversion of health spending from patient care to paying for a market are not apparently McKinsey’s concern. Take for example the costs of the new market bureaucracy; for more than 40 years administration costs were in the order of 6% of the total budget a year, they doubled overnight to 12% in 1991 with the introduction of the internal market. We have no data today for England, but what we know from the US is that the introduction of for-profit providers increases administrative costs to the order of 30% or more.

So why hasn’t McKinsey advocated making savings along the lines of Scotland and Wales by reintegrating trusts into area-based planning structures and thereby abolishing billing, invoicing, the enormous finance departments, marketing budgets and management consultants, lawyers, commercial contracts? In this way one could project savings of anything from £6-24bn a year for England.

A second set of savings would be the high costs of PFI where the taxpayer, having bailed out the banks, is now paying almost twice as much as it should for some PFI hospitals through high rates of interest and returns to shareholders. The total money raised from private finance so far is £12.27bn but the NHS will pay out £41.4bn for the availability of buildings and a total of £70bn over the life of the contracts. The irony is that the patient and the public are rebuilding the banks’ balance sheets using scarce NHS funds intended for patient care and staff, especially in community-based services.

A third saving could be made by cancelling the contracts for the £5bn ISTCs programme – research in Scotland extrapolated to England has shown as much as £1bn has been wasted by giving money to for-profit ISTCs for work that was not carried out in the first wave.

Then there are all the other contracted out services including the pharmaceutical bill of £14bn. Are these contracted out elements part of the McKinsey scrutiny? It is doubtful since the company travels the world advocating market solutions.

And here we run up against the fundamental problem of retaining marketeers to advise on healthcare. Markets mean reducing the capacity of the NHS to pool the costs of care across the whole service, substituting instead hospitals, clinics and practices that have to pay their way like businesses and, like businesses, can fail. Needs-based planning, once the hallmark of the NHS in England, is being replaced by strategies to deal with artificially created market failure.

Solutions are sought from outside consultants and turnaround teams using unsubstantiated assertions that the NHS is inefficient and can increase productivity. What the selective use of data and evidence mask is the failure to view the system as a whole and to remember that its core goal is universal healthcare, not concocted operating surpluses.

In contrast to Wales and Scotland, England has established hospitals and services as competing trusts or firms operating in a market; competition has replaced the mechanisms which enabled health authorities to monitor and respond and direct resources to the needs of the populations that are being served. But markets create winners and losers – and the unpublished McKinsey report is an attempt at refereeing.

The moral is that if the Department of Health in England commissions private management consultants that derive their profits from markets you will get market solutions. It is the commissioning, not McKinsey’s report itself, that should give offence.

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Think tank calls for £20 fee for GP appointments

Posted on July 17, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 17 July 2009

Patients should be charged £20 for a GP appointment to encourage healthier, wealthier people to avoid using the NHS, according to independent think tank the Social Market Foundation. 8404F7B3-9CFB-69A4-6C6AE70281FB1A41

It says that anyone receiving tax credits should be totally exempt from these charges and from prescription fees, covering the poorest 30% of society.

It calls for a reform of the NHS charging system to reflect income not categories such as pregnancy or retirement.

It suggests that NHS charges for GP appointments and prescriptions should be capped at around £100 a year.

The Social Market Foundation also backs local contracts for GPs and consultants with a move away from national targets.

Co-author David Furness said: ‘The core principle of the NHS should be that it is fair. But fair is not the same as free at the point of use. Free care for all will end up making the NHS less fair. The alternative to getting people to ration themselves is a return to rationing by stealth – waiting lists, crumbling hospitals and poor quality services – which hits hardest the poor and sick.

‘The charging system should be completely overhauled to make sure that the poorest people get completely free care. Sir Fred Goodwin should not get free prescriptions, when he picks up his pension, while working people pay for drugs.’

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NHS privatisation worries older more than younger people

Posted on July 16, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | 16 July 2009

The public’s view on NHS privatisation differs depending on their age, according to a poll of over 1,000 people commissioned by the independent Social Market Foundation think tank. 7F1EC00D-AA11-768D-B81F9F95685BE4AD

It found that younger people viewed privatisation as a possibility but not necessarily as a negative.

Older people were concerned by NHS privatisation and feared ‘losing’ the NHS.

The research also found that while people say they want a nationally based NHS, when asked how resources should be allocated in their area the public supports locally tailored services.

David Furness, health project leader at the Social Market Foundation, said: ‘Our research shows that people will accept local variation in the NHS if they feel their views are taken into account – fears about postcode lotteries are largely misplaced.’

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BMA leader calls for end of ‘ludicrous’ NHS market

Posted on June 29, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 29 June 2009

The DoH must put an end to wasteful commercialisation of the NHS to protect resources as public funding cuts loom, the BMA chairman has said. 2B7D89E3-A69D-0589-636D7D4EF3A907F8

Dr Hamish Meldrum told the BMA’s annual representative meeting, which began in Liverpool today, that ministers should not shy away from u-turns on policies that had failed.

He called on the NHS to ditch costly management consultants, drop the use of private finance initiative (PFI) funding, and end the ‘ludicrous, divisive, expensive experiment of the market in healthcare in England’.

He added that NHS leaders should not listen to ‘siren voices’ calling for a shift to social insurance-based funding for UK healthcare.

‘It would seem particularly perverse that, just as it appears that President Obama wants to move away from that discredited system, some in the UK should be arguing that we move further in that direction,’ Dr Meldrum told the conference.

Meldrum urges Goverment to end market-led NHS reforms 

Pulse | 29 June 2009 | By Gareth Iacobucci

BMA chair Hamish Meldrum has urged new health secretary Andy Burnham to put a stop to the Government’s controversial market-led reform of the NHS.

Speaking at the BMA’s Annual Representative Meeting in Liverpool, Dr Meldrum appealed to the secretary of state to abandon the Government’s obsession with competition, and called for an end the ‘wasteful bureacracy’ of the market.

He said the looming financial hardship facing the NHS required a total rethink in priorities, and said there had never been a more pertinent time for the Government to review its commercialisation agenda.

Dr Meldrum also attacked the huge sums spent on external management consultants in the health service, as recently revealed by Pulse, and urged all delegates to sign up to the BMA’s anti-commercialisation campaign in solidarity.

‘We must look at how we can use scarce resources more efficiently, where we can cut out waste and unnecessary expense,’ he said. ‘The best advice of all Andy? End the ludicrous, divisive, expensive experiment of the market in healthcare in England.’

‘Never has there been a better time to abandon the wasteful bureaucracy of the market. Never has there been a better time for the various parts of the NHS to cooperate rather than compete.’

Dr Meldrum added: ‘You can cut out the waste and inefficiency of hiring expensive management consultants to try and solve the ills of the NHS. We can tell you what’s wrong with the system and we come a damn sign cheaper than McKinsey’s or KPMG.’

Meldrum’s keynote speech in full

Pulse | 29 June 2009

BMA chair Dr Hamish Meldrum delivered his keynote speech to the BMA’s Annual Representatives’ Meeting this morning. Here is his speech in full.

Welcome to Liverpool.

Last year we were in Edinburgh, the city of my birth. This year it’s Liverpool, the city that, for so many of my generation, provided the iconic musical and cultural background to our formative years.

I was tempted to toss a few Beatles’ song titles into my speech to see how many of them you might recognise but I was worried that the only one that might keep coming up was “Help”!

In any case, this is not a time to be dwelling on nostalgia, since I fear that the NHS and the profession are facing some of the biggest and most serious challenges ever, as we move from a period of sustained growth in resources to one of, at best, stagnation in funding, and at worst, stringency, hardship and even cuts, in our health service.

That, combined with a tainted and hamstrung political system, a devastating loss of public trust and confidence in politicians as a result of their perceived greed and corruption, and a government and a Prime Minister who, rather than leading, simply seem to be clinging onto power, does not make for a happy state of affairs. However, as I hope to point out, even the bleakest times bring with them possible sparks of optimism and opportunity.

But first, I want to pay tribute to all those who have supported me through another challenging year for the BMA – my deputy chairman, Kate, the other chief officers, and colleagues in the various committees of the BMA and, of course, the wonderful staff of the BMA. With them, the job is still difficult, but without them it would be absolutely impossible and I’d ask you to join with me in thanking them warmly for all their hard work and support.

I also want to apologise, in advance, to my colleagues in Scotland, Wales and Northern Ireland, that so much of what I am going to say is particularly focussed on the health service in England. In saying that, I’m not assuming that everything is hunky-dory in the Celtic nations but what I will say is, if you think you’ve got problems, you should see ours!

Before the world financial crisis hit last autumn, the BMA year began with the usual varied collection of issues and problems.

For our junior doctors, the difficulties of MMC and MTAS, though not completely resolved, had been largely replaced by the expressions of unpreparedness, by some, for the impending introduction of the European Working Time Directive. Whilst none of us in the BMA have ever underestimated the challenges and difficulties that the EWTD presents, we had decided early on that one solution which wouldn’t work was simply to stick our heads in the sand and hope that it wouldn’t happen!

Another solution we didn’t believe in was to cross our collective fingers, legs – and any other bits – and hope that, when it did happen, everything would be all right.

The BMA has worked tirelessly to try to ensure that this important piece of health and safety legislation can be implemented, yet, at the same time ensuring that we can protect the quality of junior doctor training and protect the safety and the quality of the care we give to our patients.

That means looking at the length of training, how we train, the apportioning of time between training and service, the selective and controlled use of the individual opt out and of derogation and the planned expansion of consultants in certain key areas.

There can be no excuse for those trusts that have spent the last decade dragging their heels. Our doctors deserve better and our patients must not be let down.

With leadership and cooperation – a theme I will be coming back to later – these problems can be overcome and I commend the work of Andy Thornley and his colleagues for the commitment they’ve given to this difficult task.

For our medical students, along with their ongoing worries about ever-mounting debts, came concerns about potential changes to the selection process into the foundation programme. Furthermore, the economic climate has set back hopes of widening access to medicine, adding new barriers to aspiring doctors wishing to pursue a career in medicine.

For their teachers, the medical academics, we have been dealing with the repeated threats to funding and to contracts as universities and deaneries try to balance their books. Yet I applaud the fact that their commitment to the profession, to their students, and to health care, never wavers.

For SAS doctors, there were the continuing delays and other problems – certainly in some parts of all four countries – about the implementation of their long-awaited “new” contract. For these doctors, who contribute such a vital role to our health service, such recognition is long overdue and the continuing delays are not acceptable.

GPs, having at last received a very modest increase in resources after three years of cuts, were hit by the seriously flawed patient experience survey which changed the basis on which their performance was judged and rewarded.

For their consultant colleagues, it was worries about the future of their hospitals – particularly in London – and that changes to the provision of services were being carried out simply for political or financial reasons rather than for good clinical ones.

Of course, the BMA itself is not immune to the effects of the recession but despite that, we are always trying to improve the services we provide to our members. In addition to looking at the quality of these services, we have continued our policy of increasing support for members in the regions and, if our regional coordinator pilots prove successful, will hope to roll these out during the coming year.

But this needs money, your money, and we can only make these improvements if we look for savings in other areas.

On the professional side, the BMA fought off the insidious Clause 152 of the Coroners and Justice Bill which threatened to derail the good progress that had been made on electronic patient records and confidentiality. Let’s hope that the new Home Secretary will not try to reintroduce that one!

In addition, we have pushed forward our continuing campaigns on a variety of public health issues including smoking, alcohol and climate change.

I know that some of our members wonder why we get involved in matters such as climate change, claiming they are not part of our core business, but if even half of what the experts say about this problem are to be believed, the threat to our health and that of our children and grandchildren could well be greater than HIV, malaria and pandemic flu put together and if that isn’t a reason for getting involved, I don’t know what is.

The BMA will continue to campaign on this issue, both separately and with others – at the same time doing everything we can to put our own house in order and trying to practise what we preach by reducing our own carbon footprint.

I mentioned pandemic flu and I certainly don’t underestimate the potential problems that this is causing and could cause in the future. So far, the preparations we have made and that the BMA has been closely involved in, have worked quite well, though there have been some problem areas usually when local trusts think they can do better by departing from national guidance.

I want to commend all the work that has been done but, particularly, that of Peter Holden in the GPC and Richard Jarvis from our public health committee. There has also been great support from Frank Wells and the Retired Members Forum, who have worked tirelessly to produce a list of our retired doctors who would be ready and willing to help out in an emergency.

As yet, we haven’t seen how well the UK will respond to the effects of a full-blown pandemic, but what I can say and where I can reassure the public, is that, whatever the crisis, you can rely on the doctors of the UK to step up to the mark.

Earlier this year we had the scandal of mid-Staffordshire and also the case of Margaret Haywood, the nurse who was struck off by the Nursing and Midwifery Council for taking part in a whistleblowing, Panorama programme. Now whilst I am not going to comment on the rights and wrongs of an individual case – particularly one which is under appeal – what I will say is this.

Such cases send out completely the wrong message to those health professionals who might want to speak out about unacceptable conditions in their workplace.

They also say a lot about the target-driven culture that has infested the NHS in recent years and that seems to put financial outcomes for trusts above clinical outcomes for patients.

I make this pledge today. The BMA will support any member who, through the proper channels, including the BMA, speaks out about unacceptable standards of care in the NHS. We have already produced guidance for our members and, through askBMA, have a dedicated advice service on whistleblowing. We will not tolerate a substandard service for our patients and we will not tolerate a culture of muzzling or bullying of our staff.

Revalidation is something that will affect all doctors and it’s something which, if properly implemented, can benefit both patients and the profession. The key is in the phrase “if properly implemented”.

We must ensure we have a system that has been tried and tested and is essentially the same in all four countries of the UK.

We must ensure we have a system which is equitable and fair to all doctors, irrespective of their area of practice or type of employment.

We must ensure we have a system that has minimal bureaucracy and doesn’t end up with half the profession chasing round the country revalidating the other half.

Above all, we must ensure we have a system that is properly resourced, both in terms of the individuals who will have to undertake it and the service that will have to implement it.

Let there be no doubt – the BMA supports revalidation for doctors, but not at any price.

I want to return to where I started – the financial and political crisis that is facing our NHS, how it may affect you but, more importantly, what we can do to minimise the impact on the working lives of doctors and the care of our patients.

From the profession’s point of view, there is no doubt that there are going to be those who want to put pressure on our incomes, the medical workforce and our pensions.

Whilst we should be realistic and not expect inflation-busting pay rises and an infinite expansion in medical manpower, I can assure you, that we are not going to allow doctors to be the scapegoats for the failures of the politicians or the bankers.

Last year, when we were an integral part of the conference on the role of the doctor, it was clear just how important and, indeed, how unique the role of the doctor is, the distinctive contribution we make to the delivery of health care and how crucial we are to the NHS. Whatever the problem is, cutting back on doctors is not the answer.

On a wider level, the profession is ready to work with whichever governments are in power, to look at the hard choices, to make the tough decisions but on the basis of evidence, fairness, equity and trust, not just as apologists for another round of failed policies.

And there will be hard choices.

But first, we need to do everything possible to protect the healthcare budget and not concede that swingeing cuts are either inevitable or necessary. But I know, and I think you know, that the days of plenty are over and that, above all we need to be honest with ourselves and, even more so, with the public about what the likely funding is going to be for healthcare over the next few years and to debate, with them, the difficult choices that will have to be made.

For too long they have been promised, as The Guardian journalist Polly Toynbee observed recently, “Scandinavian-style public services on US-level tax rates”.

But that doesn’t mean that we change the basis on which our NHS is funded.

We must resist the siren voices who claim that, by moving to an insurance-based system of funding, we will make the NHS either better or fairer. There is little evidence that such systems reduce demand; they are certainly more expensive to operate and it cannot be argued that they are fairer than raising money from general taxation.

However a health service is provided, one way or another, the public pays. In a system of social solidarity, which is one of the founding principles underpinning our NHS, taxation based on the ability to pay must be the fairest, the simplest and the best answer.

The epitome of insurance-based medicine is the US. It would seem particularly perverse that, just as it appears that President Obama wants to move away from that discredited system, some in the UK should be arguing that we move further in that direction.

Already some of Obama’s critics – on both sides of the Atlantic – are lining up to protect their commercial interests and trying to convince him that he should not try to change the US healthcare system. With exorbitant medical bills being the biggest cause of bankruptcy in the USA and at the risk of being presumptuous, I have just three words of advice to give to president Obama about US health reform; “Yes you can!”.

And here’s another reason we don’t want to move to an insurance-based system. Even with the much more generous mix of state provision and private insurance that they have in Australia, when I was there last month, I passed several people begging in the prosperous streets of Melbourne and Sydney with placards stating that they could not afford their medical bills. Conference, I NEVER want to see that on the streets of the United Kingdom!

But there are things that we can do to improve the quality of care for our patients and to try to reduce increases in demand.

First, we need to vastly improve the outcomes’ data for the services we provide. What drives quality in clinicians is knowing that they are doing a good job – even that they’re doing it better than their colleagues!

Second, we must look seriously at the issue of service redesign to provide care more efficiently. I know that will worry some of you and that you will think we are dancing to the government’s tune. No way! I’m talking about difficult decisions but ones that are made for evidence-based, clinical reasons not purely for political or financial expediency.

Third, we need to put a much greater emphasis on lifestyle services to reduce morbidity and hence need.

Fourth, it’s imperative that we adopt a healthy ageing strategy to reduce the dependency of the elderly population and narrow the gap between healthy life expectancy and overall life expectancy.

Just as with tackling climate change, we need a whole-system and across-government approach to improve the health of the public, with every citizen involved from the prime minister, downwards – or upwards, depending on your point of view! Only that way will we slow the inexorable rise in pressure on our National Illness Service and cope with the financial and clinical challenges that lie ahead.

Of course, none of these alone will solve the problems for the NHS and we must look at how we can use scarce resources more efficiently, where we can cut out waste and unnecessary expense.

So what nuggets of advice do I have for England’s new Health Secretary? Well, here’s a few for starters.

Andy, you can cut out the waste and inefficiency of hiring expensive management consultants to try to solve the ills of the NHS. We can tell you what’s wrong with the system and we come a damn sight cheaper than McKinseys or KPMG!

Second, Andy, you can cut out the waste and inefficiency of the Private Finance Initiative. A recent analysis by the University of East Anglia reckoned that the government could save £2.4 billion – yes £2.4 billion – if it bought out the private finance contracts in the NHS. Yet what do we see – the ludicrous spectacle of a government giving taxpayers’ money to private companies so that they can fund PFI contracts to build our public hospitals!

All because Gordon Brown wanted to keep public spending off one part of his balance sheet so that he could deliver on his golden rules. Well, like so many things with this government, the gold has turned to dust and the public and the profession have seen through their three-card trick.

Even Lord Darzi admitted last week that the government was “having a re-think” about PFI.

Ara – don’t re-think it – get rid of it!

But the best advice of all, Andy? End the ludicrous, divisive, expensive experiment of the market in healthcare in England.

Although we’ve been arguing against the market for years, some people have been questioning why we are upping our campaigning now. Well I’ll tell you.

Never has there been a better time to abandon the wasteful bureaucracy of the market. Never has there been a better time to ensure that we use scarce public money for quality healthcare, not for profits for shareholders. Never has there been a better time to ensure that we protect our scarce resources to train the future generations of doctors. Never has there been a better time to put the care of patients before achievement of rigid financial targets. Never has there been a better time for the various parts of the NHS to cooperate rather than to compete. Never has there been a better time to insist on a publicly-funded, publicly-provided and publicly-accountable NHS.

A health service of the people, by the people, for the people.

So my message is, don’t play around with our health service. It’s not a toy you cast aside and replace with the latest product off the shelf when you’ve tired of it. It needs looking after. It’s our NHS, make it yours too.

I also urge everyone in this hall and all doctors watching or reading about this ARM –

sign up to our campaign and to its principles and do it today.

I want to end with three more messages – one for the public, one for the politicians and one for the profession.

To the public, I say this. You have an NHS of which you can be proud. It is not perfect and it can be better and, working together, we can make it so. Like an old friend, there is a danger that you can take it for granted, expect that it will always be there for you and not work to support and develop the relationship.

We want you to be involved, to have your say in the services that you pay for, but not in a superficial, consumerist way, the way politicians seem to think matters, but as true partners in the care that you receive.

To politicians – of whatever political hue, because, in terms of their NHS policies, there’s little to choose between them – I say this.

Be honest with the public and the profession. Stop trying to outbid each other about who’s going to spend more or cut less. It’s not a very edifying spectacle and the public and the profession has seen through the charade that seems to happen every time an election is looming.

Give real and believable meaning to the phrases “Clinical Engagement” and “Clinical Leadership”. For too many doctors they are just empty rhetoric, paying lip service to medical involvement, appearing to seek docile followers rather than challenging leaders.

We have the talent; We have the expertise; We have the drive;We have the commitment; We have the belief; But we will not be taken for fools.

Above all, I say to the politicians, be bold, be brave – don’t cling to failed policies just because you think you might lose face if you are seen to have changed your mind. It’s a sign of strength, not weakness, to admit that new circumstances need new policies.

And, lastly, to the profession, I make no apologies for repeating the challenge I issued last year.

We have a choice. We can be cynical, pessimistic, worry about being tainted by association, and carp and criticise from the sidelines. We might keep our principles pure but I would suggest that it’s on the sidelines that we’ll stay – increasingly marginalised, increasingly irrelevant, increasingly ignored.

Alternatively, we can keep talking, keep involved, keep engaged, and take a leading role, not with some sort of blind and unquestioning acceptance but with our eyes wide open.

If we don’t show true leadership and get really involved, we leave the field open to others or, worse still, the good things that we want to see happen, will not happen. I don’t want that, I’m sure you don’t want that and I don’t intend to let that be the case.

Challenging times, hard choices, difficult decisions – for the NHS, for our patients, for the profession and for the BMA.

A time when it would be easy to dwell on our differences, to indulge in petty squabbling about the details, and lose sight of the broader picture.

Of course there are issues where we don’t all agree, but there are many more issues that unite us and it is on these we must concentrate this week if we are to have any chance of success, if we are meet the challenges, to make the right choices, to focus on the difficult decisions and to really Look after Our NHS.

Thank you.

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NHS provision ‘still preferred option’, says health minister

Posted on June 11, 2009. Filed under: News stories | Tags: , |

Healthcare Republic | 11 June 09

Health minister Ann Keen has reassured union Unison/CPHVA that NHS provision remains the preferred option if it offers the most value for patients.

She added that there would be no automatic default to outsourcing in a ministerial statement.

Mick Jackson, Unison’s senior national officer for health, said: ‘We are delighted that Mrs Keen has confirmed that NHS provision is still the preferred option, when it comes to the best value for patients, in a letter to Unison.

‘We now have a clear reassurance, in a ministerial statement, which is a small, but very important step.’

Mrs Keen wrote: ‘I can reassure you that the government’s policy has not changed.

‘It remains the position that, although World Class Commissioning encourages market testing, NHS provision remains the preferred option where it provides the best value for patients.

‘There is no automatic default to an outsourcing solution.’

Earlier this week Unite/CPHVA launched a campaign calling for the end of the privatisation of the NHS. Health B4 Profit appears to chime with the BMA’s anti-marketisation drive launched earlier this month.

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Unite to campaign against latest privatisation plan for the NHS

Posted on June 10, 2009. Filed under: Press/News Releases | Tags: , , |

Unite | 2 June 2009

Unite is launching a campaign against the latest ‘patchwork privatisation’ of the NHS entitled Transforming Community Services (TCS).

TCS requires every primary care trust (PCT) in England to draw up plans by October this year to establish ‘provider’ organisations separate from their current commissioner roles.

Writing in the June edition of Community Practitioner, Unite’s lead officer for nursing, Barrie Brown, said that “the TCS mantra promotes the myth that any provider will be better than a PCT provider”, whether they are social enterprises, or third sector and private sector options.

“The TCS agenda does not recognise what NHS staff have achieved or the future risks of having a plethora of different primary care provider organisations.

“NHS productivity has improved when measured by the growth in quality and volume of the treatment and care. Quality and volume have exceeded the increase in funding.’

Barrie Brown said that figures published by the Office for National Statistics last month (May) demonstrate that productivity has grown by up to 1.6 per cent a year.

“Why should PCTs in England look outside the NHS to provide services that are delivered so effectively by themselves and their staff? I think we should be told.” 


For further information, please ring:

Barrie Brown, 07798 531 022; Karen Reay, national officer, health 07798 531 004; David Fleming, national officer, health 07798 531 013 or Shaun Noble, communications officer (health sector) 020 7420 8951 or 07768 693 940

Unite campaigns for end of privatisation of the NHS

Healthcare Republic | 9 June 2009

Unite/CPHVA has launched a campaign calling for the end of the privatisation of the NHS.A545C0E1-9919-FA31-D5B11DBAF1BB2CA8

Health B4 Profit appears to chime with the BMA’s anti-marketisation drive launched earlier this month.

Unite has published a report titled ‘The Patchwork Privatisation of Our Health Service’ which highlights how private companies with government encouragement are taking over swathes of the health service with adverse knock-on effects for patients and staff employment conditions.

Karen Reay, Unite’s national officer for health, said: ‘Reading this document should make anyone concerned about the future of the NHS very angry indeed.

‘The myth that private companies can provide better services than the NHS is a giant experiment based on a flawed ideology that is failing on a daily basis, while costing the taxpayer dearly.’

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Unite campaigns against community service reforms

Posted on June 2, 2009. Filed under: Journals | Tags: , , |

Health Service Journal | Helen Crump | 2 June 2009

Trade union Unite has launched a campaign against Department of Health plans to separate primary care trust provider arms from commissioning PCTs.

Unite said the transforming community services programme amounted to “the latest patchwork privatisation of the NHS” and “promotes the myth that any provider will be better than a PCT provider”.

PCT provider arms will be able to turn themselves into social enterprises or community foundation trusts under the scheme, which is likely to result in increased competition in the community services sector.

Unite lead officer for nursing Barrie Brown warned against having “a plethora of different primary care provider organisations”.

“Why should PCTs in England look outside the NHS to provide services that are delivered so effectively by themselves and their staff?” he asked.

But the DH rebutted the claims. A spokesman said guidance on reforming community services issued in March had “stated clearly there was no prescribed national blueprint” for the changes.

He said: “The options are for local decision involving staff. To claim this is wide scale privatisation of the NHS is wrong and misleading.”

The news came as the British Medical Association stepped up activity to publicise its concerns about the creation of a market in healthcare with its own new campaign, Look after our NHS.

It is looking for examples of where public money has been “wasted” as a result of market-driven reforms, as well as “the adverse effects this has had on patient care and doctors’ working lives”.

BMA chairman Hamish Meldrum said: “A market economy is based on winners and losers. We’re not prepared to allow parts of the NHS to fail.”

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BMA launches NHS anti-marketisation campaign

Posted on June 2, 2009. Filed under: News stories | Tags: |

Healthcare Republic | 2 June 2009

The BMA has launched an NHS anti-marketisation campaign called Look After Our NHS. 9C653AEF-A9AA-87EC-1FA642BE22E02918

BMA chairman Dr Hamish Meldrum said: ‘A market economy is based on winners and losers. We’re not prepared to allow parts of the NHS to fail.

‘We want to get rid of the market in healthcare and allow our hospitals and GP surgeries to work together, not be forced to compete against each other for business. Worse still it leads to unnecessary duplication, encourages gaming and there is no good evidence that it drives up quality.’

The BMA is calling on doctors to sign up to a set of key principles that argue for an NHS which is publicly funded, publicly provided and publicly accountable.

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