Nhs

Lansley's NHS revolution

Round n in the transparency revolution: Andrew Lansley has welcomed the publication of the latest Dr Foster hospital list, detailing post-operative failures in NHS care. The Observer reports: 1) Almost 10,000 patients suffered an accidental puncture or laceration. 2) More than 2,000 had post-operative intestinal bleeding. 3) More than 13,000 mothers suffered an obstetric tear while giving birth. 4) Some 30,500 patients developed a blood clot. 5) 1,300 patients contracted blood poisoning after surgery. Despite record investment and targets for standards, the NHS still suffers setbacks in the mundane that have severe consequences – according to the report, several hospitals have ‘dangerously high death rates’. A defender of the NHS’

A good day to bury good news

It’s not just the embarrassing and the difficult that will be buried underneath the Wills ‘n’ Kate coverage tomorrow – some good news will be too. Among it is the coalition’s plan to expand the provision of personal budgets. According to the Lib Dem health minister Paul Burstow, speaking today, some one million elderly people will be given control of their own personal care budgets, up from 250,000 now. As I’ve suggested before, this is a worthwhile idea. Personal budgets promise to be one of the most concrete elements of what the Tories used to call their Post-Bureaucratic Age agenda, but has now been stuck with the Big Society label.

The unions up the ante

The front cover of the Times (£) provides a dreary snapshot of what the coalition can expect once the cuts start to bite. Unison have responded to job losses in the NHS by arguing that the government is “conning” the public over the impact on frontline services. And they’re threatening to all get all litigious about it. As one of the union’s spokeswomen tells the paper, “If we are not happy with the [government’s reply], we are reserving the right to issue urgent judicial review proceedings.” You wonder whether they’d have done the same against Labour’s proposed 20 percent cuts. And this will be just the start of it. As

What you need know ahead of the Spending Review – Health

With this autumn’s Spending Review set to be one of the most important moments in the life of the coalition government, Coffee House has linked up with the think-tank Reform to investigate what could – and should – be in the final document. This first post, by Reform’s director Andrew Haldenby, is the first in a series of “What you need to know” summaries, looking at each of the main policy areas – in this case, health. Other posts will cover specific policies, examples from abroad and Reform events. We’re delighted to get the ball rolling… What is the budget? The NHS is the biggest public service budget in England

Governments' wasteful ways

It was inevitable that the government’s re-organisation of NHS management would incur a large upfront cost, but I didn’t expect quite such a large figure. £1.7bn has been siphoned off to pay for the re-structuring of NHS commissioning, seven times more than the planned target for management cuts according to the BBC. This is a godsend for the opposition, obviously. Insulating the NHS budget from cuts may have been a political masterstroke in 2007, and ‘I will cut the deficit, not the NHS’ may have been a sharp election slogan. But it is idiotic to ringfence the NHS simply to re-arrange the bureaucratic furniture and destabilise the system. We’ve been

A lap of honour for the Hatwoman

This is amazing. People could scarcely believe it. No less an organism than the Big Society was spotted briefly at PMQs today. Angie Bray, Tory member for South Acton, asked David Cameron to praise a voluntary programme which enables her constituents to share skills and expertise with their neighbours. ‘This is what the Big Society is all about,’ declared Bray, (with the quietly jubilant tone of one who knows her elevation to government will not be long delayed.) Cameron’s delight was palpable. He beamed at everyone. Then his eager ears picked up the groan of a Labour cynic opposite and he instantly switched into a mode of preachy dismay which

GP Commissioning will be good for patients and the NHS

Quite why people are surprised that Andrew Lansley has stuck to his plans to introduce GP Commissioning is a mystery.  I’m struggling to recall one of his speeches or policy documents in recent years where it wasn’t mentioned. Anyway, let’s be clear, widespread control of commissioning budgets by GPs was where the NHS was headed until Frank Dobson took over in 1997 and unravelled a decade’s worth of market based reforms.  Rebuilding that position has taken another decade of circular re-organisations to fix.  No wonder the NHS is ambivalent about reorganisation.   These proposals are, of course, radical.  But they are needed to address the fundamental flaws in the NHS

Will the coalition defeat the roadblocks to reform?

The biggest reform to the NHS since its inception since 1948. A move away from bureaucracy towards a proper internal market. GPs commissioning. A revolution, taking on the vested interests. Yes, there was so much to savour in the NHS Plan of 2000 – enough, Alan Milburn would later joke, that he kept re-announcing its policies for the next three years and getting headlines. Well, the Tories can play at that game too. Now, it has been reannounced by Andrew Lansley and called the coalition NHS White Paper. This is, in my book, a compliment to Lansley. In opposition, he sided with the unions and attacked Labour from the left

Ducking the issue?

As I wrote earlier, a large proportion of Andrew Lansley’s white paper had to be devoted to accountability. Much of it is, but little is explained. Patients are central. The creation of GP consortia is for their benefit and they will hold the consortia to account by excercising choice (4:21). Choice is the tyrannical panacea that does not exist. A patient can only improve a treatment if they are given it; and many GPs are closer to Doctor In the House rather than Dr.House. GPs are independent practitioners working within the NHS framework. For example, it is impossible for the patient to make recommendations about unavailable cancer drugs. In addition

The malleability of ringfences

Rachel Sylvester is on top form in the Times today, and I’d urge CoffeeHousers to delve behind the paywall (or borrow someone’s copy of the paper) to read her column.  Its central point?  That ministers are discovering ingenious ways to exploit and undermine the ringfenced health and international development budgets.  The Home Office is saying that drug rehab programmes should fall under health spending.  The Foreign Office is trying to pass off some of their spending as development, and so on.  And, crucially, the Treasury seems to be going along with it: “The Treasury seems to be tacitly endorsing this approach, with officials emphasising that departmental boundaries are artificial.” As

Dirtier tactics

I think we all expected this election campaign to be fought a few inches below the belt.  But, as Iain Dale and Dizzy say, Labour’s tactic of mailing scaremongering leaflets to cancer sufferers is some new kind of low.  I mean, just imagine how it would feel to receive, as a cancer patient or an immediate family member, a leaflet which politicises the problem to the point of suggesting that your care would be jeapordised by voting for another party.  And then imagine how it would feel if you have been specifically targeted because of your connections with the illness, as seems to have been the case here.  Well, it

Labour have moved on from the death tax for now – and so should the Tories

Labour’s plans for a national care service aren’t looking too sharp this morning.  Andy Burnham is expected to announce a cap on residential costs for the elderly later today – to be funded by freezing inheritance tax bands, raising the statutory retirement age, and (lo!) efficiency savings.  But the full, free-for-everyone-at-the-point-of-use service will have to wait some time – or at least until a new independent commission has decided on how it can be funded in the long-term.  In other words, the government has decided to park the death tax issue until well after the election. Presentationally speaking, this is proving difficult for the government.  I mean, just rewind to

Avoiding the Burnham Disincentive

One story which has been rumbling along in the background of Ashcroft and Chilcot – and, indeed, over the past few months – is the fallout from Andy Burnham’s claim that NHS bodies are now the state’s “preferred provider” of healthcare in this country. With those two words, in a speech last September, the Health Secretary appears to have pulled the process of reform back a few years – as private and voluntary sector providers have tried desperately to back out of a process which they now feel is weighted, impossibly, against then. Anyway, I’d recommend that you check out Nick Timmins’ excellent coverage of the latest develoments over at

Cameron steps up his game

There’s something about a trip to Scotland that brings out the best in Tories giving speeches, and David Cameron lived up to the occasion the other evening. He reprised his social justice passage – easily the best part of his 2009 conference speech. Listing how Labour has made the rich richer and poor poorer, and how the Tories are the party of Wilberforce etc. Promising a “radical zeal” Conservative party – Amen to that. “Some people will say ‘you can’t do things like that.  You can’t afford to take those risks.’ I say with so little money and so much failure we can’t afford not to.” That’s the spirit.  “Those

In response to CoffeeHousers

CoffeeHousers have left some characteristically forthright and thoughtful comments on the blog about my Keith Joseph lecture, and I thought I’d answer them in a post.   Tiberius says that I don’t mention voters very much – I talk only about ideas. The voters have been taught Labour ideas: isn’t this something the Tories have to deal with? First, I firmly believe that the public are open to persuasion, open to new ideas having seen the collapse of Labour’s ideas. But, in my lecture (full text here), I do mention voters quite a lot. As Keith Joseph put it, it is folly to seek the ‘middle ground’ between political parties,

Why winning isn't enough – and a response to The Fink

I delivered the Keith Joseph lecture last night, entitled Winning Is Not Enough. My point: that the Tories have adopted so many Labour policies out of tactical considerations that they are in danger of getting to office only to find they have signed up to continuing Gordon Brown’s agenda. The problem is not so much Gordon Brown himself, but his misunderstanding of government and politics: it’s his ideas that are so dangerous. If those ideas survive with a blue rosette, they are no less dangerous. And if a Tory government adopts these ideas then that’s not change. It’s more of the same.   By the time you add up all

Mike Bloomberg Seems to be Inspiring Tory Health Policy. Which is a Problem.

If there’s one thing Team* Spectator agrees upon it is, I think, that Tory health policy is utterly inadequate and desperately confused. One especially problematic promise, however, is the notion that what we need is a Department of Public Health. How will this work? Well, the inspiration would seem to be Mayor Mike Bloomberg in New York City. This is not Good News: First New York City required restaurants to cut out trans fat. Then it made restaurant chains post calorie counts on their menus. Now it wants to protect people from another health scourge: salt. On Monday, the Bloomberg administration plans to unveil a broad new health initiative aimed

Cameron has the positioning right - but fiscal questions remain<br />

Here, CoffeeHousers, is my take on this morning’s Cameron interview: 1. General demeanor: excellent, articulate, confident. The complete opposite from Brown. It does make you think that he should wipe the floor with Brown in the TV debates. 2. “Last week we saw William Hague and George Osborne going to Afghanistan together. First shadow Chancellor, the man who is going to be in charge of the money, on the frontline seeing what is going on in Afghanistan”. Indeed, but the NHS pledge and deficit cut pledge imply deep cuts to the military. To govern is to choose, and Cameron has made his choice: NHS spending before the military. If I

David Cameron's Immodest Belief in Government

David Cameron’s response to the Queen’s Speech was, of course, dictated by both convention and political nit-picking. Nonetheless, I agree with Sunder Katwala that it’s rum to see a Conservative leader complaining that the government isn’t proposing enough legislation. A useful reminder that whatever else they may be, Dave’s Conservatives do not take an especially modest or reatrained view of government. On the contrary: if there is a problem there must be a bill and damn the consequences. So Cameron, correctly, identified Labour’s approach as believing that “The answer to every problem is more big government and spending” at the same time as he demanded that the government do more,

Rod Liddle's Education Policy is Antediluvian Piffle

Rod Liddle reminds us that he’s no liberal. This will not, I imagine, trouble him unduly. Nevertheless, his disaste for the middle-classes gets the better of him when he writes: The mantra of consumer choice was co-opted by New Labour and applied to all sorts of perfectly unsuitable things. Children should go to their nearest comprehensive school, without right of appeal. If that school is failing then the local education authority, or the government, should take steps to ensure it no longer fails, by either sacking the headteacher, or spending more money on it. Middle class monkeys will still shift around from area to area looking for schools which they