Andrew Lansley today is pulling the punches on New Labour before the party goes to conference in Liverpool next week. As Paul noted, “Lansley has come to the shocking conclusion that PFI costs at 22 hospitals may be unaffordable.” Furthermore, Lansley has also announced the “dismantling” of the National Programme for IT – the £12bn NHS scheme erected in 2002 that included a national email system, electronic X-ray transfers and computised prescriptions.
But as with PFI, it’s not that Lansley is wrong for calling time on these items, but what he will do to “correct” them is key. For the IT programme he wants to move towards a “new system driven by local decision-making”. The new partnership with Intellect, an IT industry association, is set to promote smaller suppliers for government health projects.
Anything empowering the “local” is vogue at the moment, but as SA Mathieson has said today: “It does not spell the end of centralised IT work”. And nor should it. Moving towards an open source system, instead of locking into big contracts, could save money at an immense level, reduce the duplication by rolling out recycled assets across NHS systems (big contracts charge every time their programme is used, racking up bills), and remain in-keeping with the ethos to integrate health and social care by having a single portal for electronic care records.
The recent reports by the National Audit Office and Commons Public Accounts Committee respectively demonstrated that of the £12bn computer system, £2.7bn had already been spent on the transfer to electronic care records, and a further £4.3bn was in the pipeline. But utilising open source tools drastically reduces the cost of doing this. The evidence for this is there, but the culture in procurement has to change. As one person I spoke to told me: “No one got fired buying IBM”.
In spending money on this scheme, New Labour wanted something that sounded “sexy”. The programme – the largest civilian IT programme in the world – has done nothing but provide Lansley with extra ammo the week before Labour party conference. Today it has been given its final blow. But opening the doors for local authorities to make the same mistakes is the only solution Lansley has provided so far. The way government invests in its systems must change, and the future is open source.
You would not have been able to turn a newspaper page or log on to your social networking sites yesterday without reading more about the tragic death of Amy Winehouse, a well regarded singer, troubled soul, and just 27 years of age.
Her drink and drug problem were well known, and though it is not confirmed, is believed to be the reason for her eventual demise. The Mail have reported that Winehouse was spotted buying drugs from a well known dealer in Camden – where the singer lived – while friends told the paper they believe it was a dodgy Ecstasy tablet which caused her death.
Though tragedies such as this occur all too frequently with young people, it often requires a high-profile case to wake the government up in order that they act.
But this government are doing the precise opposite. The independent drugs monitoring body DrugScope have published a report, the findings of which show how increasingly hard it is for young people to access drug and alcohol help, now that youth services are being cut and young people’s treatment services are being closed down altogether – like in the London boroughs of Hammersmith & Fulham, Newham and Merton.
The Drug Education Forum will also lose its funding from the Department of Education (DoE) from November.
This is very revealing of the flawed approach this government are taking with regards to prevention services. It is almost universally uncontested that investment in early intervention for services like drug and alcohol help, saves money in the long run. The government’s own reports are producing these exact findings too. Research conducted in February by the DoE concluded that for every £1 spent on treatment between £5 and £8 is saved by the NHS and other agencies, including for mental health services.
How public sector finances are controlled needs a massive culture change from the one where long-term investment is considered far riskier than short-term solutions at short-term prices (cheaper in the here and now, but costlier in the long run). With stinging public sector cutbacks, this culture is here to stay, but at a cost to important services that stop people from falling through the net.
Tanya Gold wrote yesterday:
Thousands like Winehouse die every year, and they are not venerated, or even pitied. We will not educate ourselves about the disease, or reform drug laws that plunge addicts into a shadow-world of criminality and dependence on criminals. Winehouse got away with too much said one copper, after a tape of her using was released. Did she? Did she really? Winehouse walked barefoot through the streets because that is where the drugs were, and even as her bewildered face splatters across the front pages, drug support charities are closing, expendable in this era of thrift.
It should not take for something like this to nudge the government into taking action – not least because it highlights the strange role celebrity has in this country, and the industry of watching people run themselves into the ground for entertainment – but something needed to happen. The DoE should now concern itself with trying to reduce the many more tragedies that will occur as a result of their cuts agenda.
David Cameron is playing an interesting game at the moment. After promising to “cut the deficit, not the NHS” he went and did both anyway. In fact he went further still: NHS reforms include abolishing Primary Care Trusts and handing 60% of the NHS budget to new GP-led consortia.
In return for Lansley’s loyalty to the cause, Cameron has given the minister a cold shoulder.
Nicholas Watt put it this way:
In public the prime minister expresses support for the hapless minister. In private few are left in doubt that the minister has been placed on the naughty step or, in the case of Andrew Lansley, on the you-have-had-the-political-stuffing-knocked-out-of-you step.
The BMA stopped short recently of delivering Lansley a vote of no confidence, concentrating on his poor reforms only, but that’s not the message put out today by nurses who will debate a motion of “no confidence” – informed in part by Lansley’s refusal to address the Royal College of Nursing conference in Liverpool, instead limiting himself to a 45-minute Q&A with 50 select nurses.
If that wasn’t bad enough for the minister, his spats with Lord Owen – who has called on Cameron to “replace existing health ministers” – and Norman Lamb have caused a public embarrassment.
The influential Lamb, who has threatened to resign unless the government acts favourably upon a series of demands on the NHS reforms, joins a number of rebel Lib Dem figures who have proposed changes to Lansley’s plans.
Cameron has responded by saying he regrets “charging ahead” on reform without support – a change of heart which will not bode well for the health minister, who will be first in the firing line if Cameron wants to save face.
Clearly Lansley should be sacked on merit of his terrible reforms, which threaten the very heart and soul of the NHS, and aims only to swamp the service with pro-privatisation measures.
But we should remember the minister is merely the architect of the plans. The Tories under Cameron are only delivering the destructive ethos they know and love.
In a thinly veiled attempt to rock the boat a bit, Rawnsley asked on Sunday:
Andrew Lansley is clearly in trouble … Does Mr Cameron need to find himself a new health secretary?
This morning I read in the FT:
Andrew Lansley, health secretary, has opened the door to further concessions on the NHS bill, as the Liberal Democrat party overwhelmingly rejected his sweeping reform plans
This pertains to the decision by a majority of Liberal Democrats over the weekend, at their Sheffield conference, to vote for an “extensive and radical re-write of the government’s NHS bill”.
After this, the health secretary suggested he could “amend” his reforms.
Already a bad day for the UK health minister.
Then at around 11.45am, 15 March, the British Medical Association (BMA) “voted to call upon Andrew Lansley to withdraw the bill” adding that “any willing provider will hurt the provision of healthcare in the NHS in favour of private industry“.
Paul, in the comments thread of my last entry said: “Any resistance [re the health bill] will have to be from outside”. This is to suggest that the LibDem rebels will only manage to frame the ground with which they intend to rub up the coalition, which is not likely to bring it down. However, as acknowledged, this doesn’t preclude damage being made by the BMA.
The BMA SRM [Special Representative Meeting] is very interesting. This meeting will let off a lot of steam, but more important is what the BMA council will decide to do afterwards. If there is a decision not to take part in AWP [Any Willing Provider] then Lansley will be stuffed.
Today has shown that the BMA has little trust in AWP – it is possible, by Richard’s reckoning, that Lansley could be stuffed by this (if the BMA do stick to their guns with their opposition). However, Richard goes on:
is he likely to kill the Bill? I suspect not. He’s very much a bludgeon, he believes in AWP and so he will not remove it from the Bill.
If we (“the opposition” whatever that is) are to oppose Lansley, we have to attack and bring down his argument of “patient choice”. Either prove that patients do not want it (some do, many don’t care) or that it is ineffectual in delivering better healthcare (there is some evidence that shows this), or that it is more costly (IMO this would be quite a powerful argument if constructed properly).
The general attitude here is that though Lansley will find little confidence in his health bill, he is a firm believer in opening out provision to more private companies and may press on with that regardless. But moreover to what Richard suggests, a recent report by an organisation called Patient Opinion, found that provider choice was not part of a patients’ top priorities. I wrote regarding that report:
Ever since Andrew Lansley signed off the soundbite “no decision about me without me” journalists and bloggers have questioned whether it really is this vague notion of choice that could drive NHS improvement, or whether this is just another cover over our eyes, while slowly the national health system is privatised.
A recent report carried out by Patient Opinion (pdf file) – an online service to collate local concerns and praises of service – has added further doubt that Lansley’s line is a winner. The findings show that provider choice and inclusivity feature low in patients’ opinion, being trumped instead by concerns of care and staff attitudes.
Though it is vital people feel their wants and needs are being responded to, what is most important to the NHS is knowledge and quality provision. By focusing on something that it would seem patients feel less worried about, the health department have shown themselves to be out of touch on the issues, instead just pushing through ideology.
To add insult to injury, it has been reported by the BBC (at 12.06pm) that the “BMA is calling for Lansley to resign”.
Something about the Conservative tradition has been lost as time has passed, namely in that Edmund Burke was not simply against the French Revolution per se. Instead Burke was positively for the Monarchical tradition that preceded him, pleading at revolutionaries to explain why they were going to put into jeopardy a system of governance that had the benefit of tradition, for a new experimental system, benefits of which were not entirely known.
The knee-jerk opinion that Burke was simply a thorn in the side of revolutionary change has normally been the preserve of liberals, but the Conservative phobia of experimentation with evidently useful, treasured and existing elements of society has clearly been overturned by Andrew Lansley, the UK health minister, and his new health bill. So much so in fact that Liberal peer Shirley Williams declared her opposition to what she called the “untried and disruptive reorganisation” of the NHS, back in February.
Yesterday, during the Liberal Democrat Spring conference in Sheffield, party members (still able to change policy) voted for an “extensive and radical re-write of the government’s NHS bill”.
Williams, along with former MP Evan Harris, “tabled calling for proper accountability and safeguards against privatisation” which has thankfully paid off, and not without support from party leader Nick Clegg who accepted the “rebel” amendments.
What this will do in the short term is create deep ruptures within the coalition. The Liberal Democrats, and Nick Clegg – who has vowed not to let the “profit motive drive a coach and horses through the NHS” – have sent a message to the health minister saying that they do not support the inclusion of “any willing provider” in the NHS. But as Paul said recently on this blog, proposing amendments to the health bill may not stop the coach and horses so soon. The backdoor attack on the NHS:
has been in the form of the abolition (in 2013) of Primary Care Trusts, and the establishment of three waves of GP commissioning consortia, already covering 35 million people in England.
This has created the space in which most GP consortia, who have nothing like the capacity to commission their own secondary care services, will buy in what the commissioning PCTs used to provide.
This time it won’t be the PCTs who provide it, but private sector health management firms like Capita, Dr Foster and the US giants like McKinsey, who are already working with 25 consortia.
Sure, some ex-PCT staff will get jobs in these management firms, as their technical understanding of secondary care contract development and monitoring will be needed, but little will remain of the PCT’s public-health oriented, public service ethos.
Though many of us are unsure what will happen if the coalition collapses, we hope Lib Dem rebels pull something out the bag to shake things up for good. Many people I know were hoping for the floor to fall in over tuition fees, but to no avail. Hopefully enough courage from the Tories’ orange bedfellows will be plucked to tear apart this horrible political mess once and for all.
Perhaps even the British Medical Association will pass a vote of no confidence to really bollocks things up for Lousy Lansley. But amid all celebrations that the majority of Lib Dems have dealt an important split in the coalition, we must still remember that the pressure by the Tories to pursue round-the-back privatisation to the NHS extends further than this new bill.
(H/T Alex for information on the BMA)