NHS 63rd Birthday - 5 July 2011
Happy Birthday NHS - 63 today
http://www.dailyfinance.co.uk/, 5 Jul 2011
The National Health Service was 63 on 5 July 2011. It was brought into being by Labour Health Minister Nye Bevan on 5 July 1948 when he opened Park Hospital in Manchester and introduced the principle of a health service free to all and financed entirely from taxation. It is an iconic part of British life.
The NHS was a fundamental part of the post-war Labour Government's commitment to build a better post-war world, a New Jerusalem in the lofty descriptions of the time, and the principle upon which it is based has endured in the popular consciousness.
For the first time, doctors, nurses, pharmacists, opticians and dentists were brought together in a single service to provide care that was free at the point of delivery. Previously, millions of people had little or no health care they could afford or rely upon.
Conservatives and BMA
At the time, the establishment of the NHS was opposed by the Conservative Party and by the doctors' professional organisation the BMA. After the bill proposing the NHS was published in 1946, one former BMA chair described it as "the first step, and a big one, to national socialism as practised in Germany".
The doctors were concerned that their professional independence would be compromised, and that their salaried income would mean they became 'just' civil servants. Bevan described the doctors as "a small group of politically poisoned people".
Eventually he bought the backing of the doctors by allowing them to work inside the NHS while still carrying out lucrative private practice. He also legislated to ensure they did not become salaried civil servants, but did remove their right to buy and sell practices. He said won by "stuffing their mouths with gold".
Bevan
By 5 July 1948, 90% of doctors had signed up, but the Tories had continued their opposition, voting against the NHS bill on its second and third reading. Bevan called them "lower than vermin" and said "I do not see why we should forget this."
The NHS has gone on to become an iconic and cherished institution, and residual suspicion of the Conservatives' attitude to it has lingered. The government of Margaret Thatcher could not add it to its list of 'reforms' and the current government's plans are embroiled in controversy.
Now, doctors are at the forefront of those arguing that the measures Health Minister Andrew Lansley is proposing will undermine the basic principles of the service, and many see the mouths that could be stuffed with gold as belonging to those private sector companies eyeing the national asset.
Outsourcing
Earlier this year, health expert Ian Kirkpatrick estimated that up to £12bn a year from the total hospital service annual budget could be contracted out under Coalition plans, ramping up the outsourcing trend started by Tony Blair's labour Government.
He also quoted a report from the Office for Public Management that said outsourcing was "primarily driven by political will" and which struggled to find any conclusive evidence that private sector involvement in the running of services provided value for money. In many cases, it said, it may be a burden.
When the NHS was launched it had a budget of £437m (about £9bn at today's value). In 2008/09 it received more than £100m. Around 60% of that budget is used to pay staff, 20% pays for drugs and supplies and the remaining 20% is split between buildings, equipment, training, cleaning and catering.
Value for money
The 2008/09 NHS budget equalled a contribution of £1,980 for every man, woman and child in the UK, according to the NHS choices website. That seems to stack up very nicely against the cost of private healthcare, or when you consider a private hip replacement will set you back around £9,000.
It would be wrong to say there are no problems in the NHS. Much of the service is still stuck in a paternalistic mindset and there are real questions to be raised about the relationship between drug companies and some of the doctors who prescribe their drugs.
But the bottom line is that, when it's really needed, the NHS is there. Anyone who has seen its maternity service or how its emergency units cope cannot fail to be impressed and thankful for what we have. That's why the NHS remains a great British achievement and why so many are celebrating its birthday today.
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The NHS is 63 tomorrow, but will it reach 64?
http://www.rightsandwrongs.co.uk/, 4 July 2011
The National Health Service marks its 63rd birthday on 5 July 2011, but unions and campaigners have warned that unless the government abandons hostile reforms it could be its last.
Public-sector union Unison warned that unless the government listens to their concerns, plans set out in the Health and Social Care Bill will lead to the break-up of the NHS.
Unison general secretary Dave Prentis said: "For the last 63 years hardworking health service staff have saved millions of lives and built it up to be the national treasure it is today. The government wants to tear all this down and turn the NHS into little more than a logo.
"Plans set out in the Bill will simply turn the NHS into a business, where more of our taxes will pay for profit-driven companies to provide our healthcare. All of this when satisfaction of the NHS is at an all time high."
The union is calling for services to be kept in the public domain, the retention of a cap on private patient income, jobs protection and greater openness and accountability.
Northern TUC regional secretary Kevin Rowan said now was the time to ensure that "mercenary motivations and ideological cuts" did not destroy the service.
"The National Health Service is a deeply valued national institution and is the epitome of equality, ensuring those who need care receive it irrespective of gender, ethnicity, disability - or ability to pay," he said.
"We wish the NHS a very happy 63rd birthday and hope for many happy returns to come, and that mercenary motivations and ideological cuts don't destroy what is - and should remain - a right not a privilege."
Unite, which has repeatedly called for the Bill to be scrapped and for an independent commission to be set up to look at the long-term demands on the NHS, also issued a warning.
General Secretary Len McCluskey said: "Public and health professionals will have to battle very hard against the coalition politicians who want to privatise the NHS, putting shareholder profit before patient care.
"Already patients and service users are experiencing reductions in services and increasing waiting times for operations because of the £20 billion worth of so-called 'efficiency savings' from a Prime Minister who laughably pledged that the NHS was safe in Tory hands."
His view was shared by Labour MP and leading health campaigner Grahame Morris.
Mr Morris urged a continuing campaign against the government's Health and Social Care Bill which he said threatened "the very foundation" of the NHS.
The Easington MP is a prominent member of the Commons committee which is now debating government changes to the Bill.
He declared: "Labour created the NHS, lifted it off its knees in 1997 and it has fallen to the Labour Party to protect it from a hostile Tory-led government once again."
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The NHS is 63 today – health workers speak out
As the NHS celebrates its birthday, health service staff tell of their experiences and the challenges ahead.
False Economy, 5 July 2011
Gill, ward housekeeper from East Midlands
Speaking as an NHS Housekeeper, I dread what this government is doing to our NHS. We are back in-house after seven years of failed contracting out. We don't want to go back to that awful feeling that we are no longer part of the NHS and having other staff look down on us for being "just contractors, what do you expect?”. They did not understand that we had lost so many hours from each ward, and that was the real reason that standards plummeted.
But, at least we could rely on a pension. If we are contracted out again, the company will be able to undercut any in-house bid by not providing us with a pension. The government has sweetened the deal for private companies to come in and make a mint out of the lowest paid members of staff.
I worry about what is happening now with the cost savings. Morale is so low across the Trust I work in. A lot of staff wish they could retire now – they are so worried about the future. I believe that if my department and others in our hospital get privatised, and people lose their pension, or the pensions schemes are made much worse, staff will leave in their droves. On top of the pay freeze, threat of job cuts, the spending cuts, and the cost of living going up so much, who will want to carry on working in the NHS? Having a pension to rely on at the end of it helps to keep you going in the bad times.
If I retire next year, after working in my hospital for 21 years, my NHS pension will be less than £1,800 per year, thanks to contracting out. Hardly gold plated, but so important to me. I don't want the taxpayer keeping me.
Mary, ward housekeeper from the West Midlands
Today, on the NHS's birthday, I would like to pay tribute to everyone working hard to keep our health service running – and all who have done so over the last 63 years.
Health workers are part of a team – no one person or profession is more important than another. I see every day what a difference every person makes – it is naive, let alone totally wrong, to think you can draw a neat line between the front and back office.
I am a ward housekeeper. Without me or the hospital cleaners there would be no patients – wards have to be cleaned. Take the hospital porter away and patients would have to make their own way to x-ray. Without the catering staff there would be no meals for health workers or patients. And without the housekeeper – my job – no meals would be ordered. How would patients recover without food?
And what about the healthcare assistants? They get patients up and dressed, and help them to eat if they need it. And then there are the x-ray and phlebotomists staff, ward receptionists, occupational therapists, the estates staff who keep our buildings in pristine condition, and many more.
All of these jobs might not make the front page – but they are a vital cog in the wheel that delivers patient care and they deserve our thanks today, and every day.
Eleanor Smith, Unison President and theatre nurse from the West Midlands
The NHS's 63rd birthday comes at a pivotal moment for our health service. As a theatre nurse, I know that the health service, and health workers, are being squeezed from all sides. £20 billion of efficiency savings are piling on the pressure, and the huge cost of this government's top down re-organisation will take its toll. The cost of sacking Primary Care Trust workers will run into hundreds of millions of pounds – money that should be going towards better patient care.
It's not even a matter of time before patients feel the effects of all this – many already are suffering from Tory control of the health service. Waiting lists are getting longer, so-called non-essential operations are being cancelled – leaving people suffering in pain. Health workers are losing their jobs. As a nurse I know that healthcare is delivered by a team, so take any one away and patient care suffers, making it only a matter of time before another Mid-Staffs healthcare scandal hits the headlines if all this continues.
Equality, and equal access to healthcare have always been huge issues for me. The prospect of a postcode lottery emerging, and people missing out on what should be a basic right in this country – healthcare – really worries me. There is already enough inequality dividing people, without healthcare joining the list.
When the NHS' next birthday comes around, I hope that trusts will still be respecting national agreements on pay, terms and conditions. Some trusts have started dipping their toes in the water of making their own arrangements, and this will just spark a race to the bottom. We cannot have nurses, paramedics, healthcare assistants or admin workers getting different rates for the same job – it is a recipe for a recruitment and retention crisis, and seeing low morale getting even worse.
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Spending cuts will mean longer waiting times, say NHS managers
The Independent, 6 July 2011
Hospital waiting times will grow and patients' access to treatments will be limited because of the squeeze on health spending, more than half of NHS chief executives and chairmen believe.
The warning from the heads of nearly 250 health providers comes as the NHS sets out to save £20bn from its budget over four years. Yesterday Andrew Lansley admitted that the NHS would have to find £4bn of savings next year because of the increased demands on the service.
"We are taking steps to cut the costs of administration and focus resources on the front line," he said.
But in the first survey of NHS organisations since the Government's efficiency drive was implemented, managers said reducing administration costs alone would not be enough and that tough decisions on cutting and merging services would have to be made.
One in five said they believed the quality of care their institutions offer will decrease over the next 12 months while almost a third thought care would get worse over the next three years.
Nearly 50 per cent said the financial situation facing their organisation was "the worst they had ever experienced", while an additional 47 per cent said it was "very serious".
The head of the organisation representing NHS employers warned that unless hospital managers were able to merge or cut under-utilised services the effects on patient care would be even greater. "We have to get politicians to understand and support the case for reconfiguring hospital services," said Mike Farrar, the new chief executive of the NHS Confederation.
"I can have a conversation with an MP in private where they say they back plans to reconfigure services – but in public they feel compelled to go to the front of the march protesting against them." At the Confederation's annual conference later this week Mr Farrar will call on the Government to stop attacking managers and referring to them as "bureaucrats".
"We face an unprecedented financial challenge ... unwarranted attacks on managers, unprecedented confusion over policy and unprecedented nervousness about how we can deliver what's asked of us," he will say. "We need recognition of the enormous job we face and action to help, rather than hinder us in delivering it."
Managers also warned that cuts to local authority budgets would have a significant knock-on effect on demand for NHS services – as people were increasingly sent to hospital rather than being cared for in the community.
Eighty-six per cent said there would be a delay in patients being discharged from hospital while 63 per cent said they believed cuts would result in more emergency and acute admissions.
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Heart tsar quits with attack on ministers
The Independent, 6 July 2011
One of the Government's most senior health advisors is to leave his role – in part because of his anger over Andrew Lansley's health reforms.
Sir Roger Boyle, the Department of Health's heart tsar, said that claims by ministers that parts of the NHS needed to be abolished because services were over-managed was "baloney".
He added that the Government appeared not to be interested in which parts of the NHS were working well and was intent on wholesale reform regardless of the consequences.
"This government has been so busy condemning what's happened before that...they haven't been prepared to look at things that have worked well," he told the Health Service Journal.
"To say that we're over-managed is complete baloney. To abolish all management and hand it over to a microcosm of smaller commissioners...we've done smaller commissioning in the past and tried bigger commissioning and settled for something in between and that seems to be the best compromise.
"I'm very worried about where we're going to over the next few years because corporate memory will be lost. I've nothing against clinical engagement but we could have done it without abolishing large chunks of the NHS."
Sir Roger, who as national director for heart disease was responsible for strategies for the treatment and prevention of heart attacks, also criticised the abolition of strategic health authorities and primary care trusts.
"What we need is stability, not more change. Where we know we have tried things and they have worked, great. But we have also tried things that haven't worked and we need to learn from that as well, otherwise we... just re-learn the same lessons time and time again," he said.
He added: "I'm partly leaving because I'm opposed to this substantial reorganisation of this service I love deeply and which is regarded across the world as one of the best."
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Leaked paper says new NHS board with £20bn budget will direct health reforms
The Guardian, 5 July 2011
Confidential document says body will employ 3,500 staff, taking over duties currently performed by 8,000 people
Sir David Nicholson, chief executive of the NHS, drew up the proposals for an independent NHS commissioning board.
A new NHS commissioning board employing 3,500 staff and with a £20bn commissioning budget will oversee the government's reforms to the health service, according to a leaked Department of Health document.
Labour said the document showed the government was planning to create a new layer of NHS bureaucracy, raising questions about the health secretary Andrew Lansley's claim to be streamlining the management of the health service.
The document, which carries a warning "confidential draft – not for circulation" – was drawn up by the NHS chief executive, Sir David Nicholson, as he outlined the duties of an independent NHS commissioning board.
Nicholson said the new board will:
Employ about 3,500 staff. It will have a chair and five non-executive directors. A chief executive will head a team of five executive directors – the four others will be a nursing director, a medical director, a director of commissioning development and a director of finance, performance and operations
Directly commission £20bn of services and hold about 33,000 contracts for primary care services
Oversee the new clinical commissioning groups across the country that will take responsibility for £80bn of the NHS budget.
England will be split into four "commissioning sectors" – with London as one of the "distinct" areas, raising questions about whether strategic health authorities are being reconfigured.
Nicholson proposed that the new board should be called NHS England, though he admitted that this might be a step too far.
The chief executive added in his report that his proposals would lead to savings because the board's 3,500 staff would take over the duties currently performed by 8,000 workers.
Liz Kendall, the shadow health minister, said: "The government is wasting precious NHS resources on its huge re-organisation.
"Their original plan was going to cost at least £2bn. Their new plan will cost even more as the number of NHS organisations balloons from 160 to more than 500."
Kendall also criticised Simon Burns, the health minister, who told the Commons committee examining the health and social care bill that it was premature to comment on staffing levels.
She added: "Today the minister Simon Burns told me it was 'premature' to say how much their new super quango, the NHS commissioning board, will cost and how many staff it will employ.
"Yet we now know from this leaked document it will employ at least 3,500 staff. The government must now come clean and spell out the true costs of their chaotic NHS plans."
Burns told the committee that he would not comment on a leaked report.
The document, parts of which were reported in the Health Service Journal, was leaked after David Cameron came under fire in the commons last week over the £852m costs of making staff redundant under the government's plans.
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Fairness In Healthcare Commissioning
http://www.patientexperience.com/, 5 July 2011
Welcome to our latest guest blog from Mark Drury, Associate Director of Engagement and Stakeholder Management at NHS Oldham in Greater Manchester. He is interested in the idea of fairness in healthcare provision not just in the UK and the NHS but also globally. Please read his blog and let us know how you think tax payers money should be spend on healthcare provision? In short we want to know what you think is fair?
Mark is an advocate for bringing patients and clinicians together to co-produce better healthcare. Previous roles include Service User and Carer Involvement Lead for the NIMHE Mental Health Act programme and 11 years working at charities for blind people.
For many people in the UK,the National Health Service is the embodiment of fairness. Treatment where and when you need it,free at the point of use – what could be fairer? And most of us think we know what we mean by fairness – surely it's self evident what is fair and what isn't. Isn't it?
The NHS,like any health system,is presented with many needs competing for their share of finite resources. Commissioners who decide on priorities and how services should be delivered,are faced with difficult choices. Which clinical areas should they invest in – cancer,mental health,respiratory or something else? Should they prioritise investment in deprived areas with poor health or spread provision evenly? What is fair?!
The NHS spends an enormous amount of money on behalf of the public,who rightly expect decisions made on their behalf to be fair. Given that money can only be spent once:
- Should we spend £30,000 on cytotoxic drugs to give someone an extra three months of life?
- Should we spend £100,000 trying to keep a very premature baby alive when it is likely to have a low quality of life if it survives
- Should people with alcoholism receive liver transplants?
- Should the NHS fund gastric bands for obese people?
- Should we be funding In vitro fertilisation?
Far from having a common understanding of fairness,answers to questions like these suggest there is a wide range of public opinion about fairness in health.
NHS Commissioners and health ethicists have long struggled with issues such as these. General Practitioners are now starting to take on new commissioning responsibilities at a time when funding is being squeezed and difficult choices are having to be made.
In Oldham,the GPs were keen to have an early dialogue with the public to try to come to a common understanding of fairness which could inform their decision making.
They decided to form a Health Commission –a Citizens Jury made up of a reflective sample of 12 members of the public. The Commission met four times over a two week period to listen to a series of expert witnesses,ask searching questions and debate the issues in-depth.
The Commission then produced a provisional report to help guide the GPs on acting fairly. Some of their findings included:
- Rejecting the idea of deserving and non-deserving patients.
- De-prioritising treatment of patients who repeatedly choose not to follow clinical advice (majority view).
- Tackling health inequalities by spending more in neighbourhoods with the worst health.
- Gradually changing the balance of spending away from treatment and towards prevention
You can see all the evidence on video, access background information, and add your own comments which will be incorporated in the final report at:
http://www.oldhamhealthcommission.org.uk/.
To take part in the research blog please simply go down to the bottom of the page and add you comments in the box provided. Alternatively you can reply to the comments and experiences of others.