Shouldn’t they have been doing this 6 months ago?

Agreed – but they focused too much on Parliament then, not enough on outside campaigning. I suspect that was because of Healey too.

The second reading of the Health and Social Care Bill was completed in the House of Lords on Wednesday 12 October.
The House defeated Lord Rea’s amendment seeking to halt further progress on the Bill, and Lord Owen’s amendment for extra scrutiny of the Bill by a select committee.

The Bill has already reached day 4 of the committee stage in the Lords.
http://www.parliament.uk/business/news/2011/november/health–social-care-bill-cmttee-stage-day-3/

The complaints highlighted on ‘drop-the-bill’ are old hat – in other words health bloggers have been warning the public about them for months, so what has finally woken the opposition from it’s slumber?

About time.

Just briefly and in passing:

“The Bill will break up the NHS and create an unfair postcode lottery” No it won’t. There’s already a postcode lottery – if I live in Orkney and my child falls ill there’s unlikely to be an NHS pediatrician at hand.

“Longer Waiting Times” This is nothing to do with the essence of the bill, and could easily be addressed by invigorating NHS targets.

“Privatisation” No, the bill does not turn the NHS into a full-blown commercial market. That’s just silly. And lets not forget that every single independent study shows that the competition in healthcare introduced by the last Labour Government has had a beneficial effect on health outcomes.

“Damaged Doctor/Patient Relationship” On the contrary, the Bill is holistic in proposing that the Patient/Doctor (GP) relationship should be paramount, as opposed to the present system where patients are moved from doctor to doctor like so many slabs of meat.

“Waste” Here I agree that such a wholesale reform is de-motivating and wasteful, and that an incremental approach would be preferable. But I find sneering references to managers completely unacceptable – someone has to ensure the day to day operation of such a gigantic concern, and the idea that medical professionals must be fetishised over and above the people who ensure that (for example) hospitals aren’t cut off for not paying their electricity bills is counterproductive to proper debate.

[5] “And lets not forget that every single independent study shows that the competition in healthcare introduced by the last Labour Government has had a beneficial effect on health outcomes” – can cite any such study?

When the NHS is finally privatised (as it surely will be) the public will look back and think, blimey, how did that happen – the answer is stealth …….. stealth, and lashings of ignorance, or indifference.

While I agree with the sentiment, Labour complaining about “postcode lotteries” is a bit rich given that term was basically created to describe the NHS under them.

@5 – Doctors will be in charge of directly denying care to patients. Fine, I and many others will be utterly unable to trust them.

@ A&E Charge Nurse: I’m happy to cite sources.

“Death by Market Power: Reform, Competition and Patient Outcomes in the NHS” by Martin Gaynor, Rodrigo Moreno-Serra and Carol Propper (NBE 2010) concluded that “the effect of competition is to save lives withour raising costs” and that “patients discharged from hospitals located in markets where competition was more feasible were less likely to die, had shorter length of stay and were treated at the same cost.”

“Does Hospital Competition Save Lives? Evidence from the English NHS Patient Choice Reforms” by Zack Cooper, Stephen Gibbons, Simon Jones and Alistair McGuire (LSE 2010) concludes that “using AMI mortality as a quality indicator, we find that mortality fell more quickly (i.e. quality improved) for patients living in more competitive markets after the introduction of hospital competition in January 2006, Our results suggest that hospital competition in markets with fixed prices can lead to improvements in clinical quality”.

I hope this answers your question.

It’s too late, which means that either the party’s timing is horribly amiss, or that this is empty, gesture politics. Let’s leave aside the fact that Blairites actually approve of much of the content of the Bill, at leaast in principle if not the exact implementation, and the dispiriting overtures made by some to the govt to merely take the edges off the Bill rather than fully oppose every damn bit of it.
It’s too late, by months and months and months: the changes have happened. PCTs are ghost ships, SHAs sizing up to be behemoths doing Nicholson’s bidding, CCG pathfinders are out there, her and now, wrestling with the impossible. Labour took its eye off the ball while the Bill has been implemented at ground-level, blitzkrieg style, well in advance of little niceties like it going through parliament.

[9] thanks for the links – I’m having a problem accessing the full studies.

Looking at the abstract from the paper by Cooper, at al, they appear to use a single condition (acute myocardial infarction, aka heart attack) as a proxy for activity within the NHS?

I do not really understand the use of the terms ‘competition’ or ‘markets’ here.

NHS hospitals have been reorganised so that some, but not all, offer 24/7 primary angioplasty – in other words if a member of the public develops chest pain and their ECG demonstrates elevated ST segments that are taken directly to a cardiologist for angioplasty.

I do not see how this can be construed as competition until the day there are two neighbouring angio-suites and ambulance crews can decide if they take patients to the one that (for example) is cheapest, or has the lowest complication rates – as far as I know, no such arrangement exists.

[12] managed to locate the Bristol paper – 50 odd pages that skates over some big themes and complex phenomena – would need time to read and digest before being able to critique.
http://www.bris.ac.uk/cmpo/publications/papers/2010/wp242.pdf

@5 – No, it does worse than provide a commercial market, it provides a captive market, allowing undercutting and closing of NHS services, with no way to enforce provision afterwards. With added bureaucratic costs thrown in.

There have been limited gains seen from strictly limited competition, further competition acts like in well-studied scenarios in America (costs rise), and those gains are largely because the NHS was still shaking down it’s increased budget.

(11) You are quite right. The LSE study did indeed use AMI as a proxy for activity within the NHS. As the NHS Confederation commented in response to this study:

“AMI is used as a general indicator of outcomes – the idea is that as clinical quality and management improves in clinical systems there is a spill over into other aspects of delivery. So the hypothesis is that getting smarter at elective care in response to choice impacts on general quality systems across the hospital. A confounder is the development of heart attack centres in London.

The conclusion is not perfect, but robust: MORE COMPETITION DOES SEEM TO IMPROVE RESULTS FOR PATIENTS”.

But here’s a personal example. A few years ago I developed acute chest pain, discomfort in my arms, breathlessness, and an inability to walk more than a few yards at a time. This was immediately diagnosed as heart disease by my GP and in fact I had a completely blocked coronary artery.

Naturally my GP referred me to my local hospital (I live in London). My questions to you are:

1) How long do you think it was before I saw an NHS cardiologist?

2) How long did it take the NHS to put in the required stents?

[14] 1) How long do you think it was before I saw an NHS cardiologist?
2) How long did it take the NHS to put in the required stents?

Obviously that is not a question I can answer although I hope you were seen sooner rather than later.

The prevalence of ischaemic heart disease is impressive
http://www.patient.co.uk/doctor/Epidemiology-of-IHD.htm

The broader question is would private firms do better than the NHS – this item suggests maybe not?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1488784/

The Health and Social Care Bill is just phase 1 of long held Tory plans to privatise the NHS. It will bring about the end of equal access to healthcare on the baisis of need and not the ability to pay.
The availability of more and more treatments will reduce or disappear completely.

This must not be allowed to happen.

The bill must be defeated.

we call on the government to drop the health andsocial care bill

I guess choise is great in theory, in practice it wastes time though.
I had to be referred for my wisdom tooth to be removed, it took nearly 2 months for the refferal center to send me a letter asking me to ring them as they needed to discuss my needs.

“Ok” I thought, fine, sure… I ring them up they’ll probably want to know meds days etc… No I ring up, he asks me which dentists I want to go to, out of three I’ve never heard of, so I pick the one that has a localish sounding name.

Wait two more weeks for letter from them, drive down for 8 in the morning, wouldent be much of a problem but our household is a night shift one, 8 in the morning doesent exist when you don’t get to sleep till 5am 😀

Basically when there I fill in a questionaire and get another x-ray taken becuase apparently my dentists x-rays where not high quality enough. (Again, the two systems being seperate causes extra work load here.) Then it’s another 2 weeks…

I guess 3 months of pain killers and local soothants isn’t THAT bad. :/
If it hadn’t been a wisdom tooth I know my local dentist could have done it, but it really doesn’t sound like there will be more to my extraction than any decent dentist should be able to do anyway, but regardless to that…

The ”choice” would be all well and good had I had an opinion, but I didn’t, of course. But even without the illusion of choice if I had had an opinion on a certain surgery you could’ve been sure I’d have let it been known.

((A anecdote of a friend who : on breaking his leg, through the pain and the pills just kept chanting, “don’t take me to queens!” ))

The patient choice thing is largely a illusion, I don’t have any choice, if I get sick they take me to hospital, around here it’s probably queens, I COULD ask to go to another hospital, but what would be the point? Surely they know where is best to get me to in an emergency around here, I expect every hospital to be capable of giving the same treatment especially for A&E.

So if hospital choice is fairly arbitrary to most patients, what does competition really mean? It means cutting services that aren’t considered to be profitable, we are already seeing a rise of this, sometimes figures have been purposefully meddled by shifting patients around or otherwise pushing them through without proper care, the current system is all about speed and cost efficiency over patient care, something that I doubt will get better with further privatisation. And there’s no reason it couldn’t be made better without privatisation, opening more hospital services to public domain is a gamble, one I could do without.

As for GP’s we’ve had ‘choice’ of those for years, inconsistent funding, premises and staff regulation leaves some people blessed by forward thinking surgeries and others stuck with ones that haven’t improved since the 80’s…

I think at the bottom of it it’s the constant ‘reforming’ that causes so much problems, there’s never a chance to really settle a system in and actually find out how to tweak and improve it, the best bet with a system is to choose one and run with it, consistency is key. Instead of trying to force major changes in every few years.