Listening exercise: how to get involved

The NHS listening exercise finished on 31 May. You can read the comments that people made on the four main themes at the following links:

This page was closed to comments on 31 May, the last day of the listening exercise. Thanks for all your comments, which have been fed back to the NHS Future Forum to consider.

The Forum will submit its report to the Prime Minister, Deputy Prime Minister and the Health Secretary in June. The government will consider the Forum’s findings and then publish its official response.

You can keep up to date with the latest coverage and announcements on this website or by following us on Twitter.

If you have any specific questions about the listening exercise, email nhsfutureforum@dh.gsi.gov.uk
or write to: NHS Modernisation Listening Exercise, Room 605, Richmond House, 79 Whitehall, London SW1A 2NS.

In Conversations, NHS Future Forum, Pathfinder Learning Network, Working together for a stronger NHS

136 Responses to Listening exercise: how to get involved

  1. Frank Roberts says:

    I have just heard on BBC News 24 the most compelling reason for abolishing PCTs. 50% of them adhere to NICE guidelines whilst the rest either pay lip service or disregard them altogether. No wonder there is no standard NHS across the country.
    Perhaps the Nhs suited brigade are not the best people to carry out root and branch changes, they are not going to vote themselves out of a job.

    • timothy doust says:

      agreed
      a comment from my local mp east worthing

      ” so we can get services to as many people as possible with limited resources ”

      not everyone then ….
      i expect the suits will be ok in bupa

    • Rich Hamilton says:

      Frank – not so I’m afraid. NICE hasn’t adjudicated on over 50% of the healthcare delivered, and does not ensure the total spending on things it DOES recommend fit within the taxes that the public pay. Someone still has to prioritise. NICE put out 2 levels of recommendation. A Technical appraisal is legally required within 3 months. Clinical guidelines are not.

      Guidelines are not (nor are they affordable if all places do 100% of them), and what gets priority will depend on what your local patients, councillors, and doctors prioritise for development and change.

      Just pay the money direct to hospitals if you like, but don’t ignore the international evidence about how much more of your taxes you will need to get a comprehensive service

    • shelley wilson says:

      I respond as a nhs user/mother who, since reading equity and excellence July 2010, has followed the Health Bill closely, alongside impact assessments etc..
      I have come to the following conclusion this government did not have a mandate for the reforms, despite expressing in 2004 that the NHS would be de-nationalised in the next conservative govt. The govt prior to this exercise allowed a 3 month little published consult on the reforms to which only 6,000 responded (only 200 of those DRs) . The consult for GPs was confusing, lengthy and contained leading questions. The govt then used half quotes from these responses to make it appear the consult had had a positive result. Shocking that this was their attempt to meet the breaking of the NHS’s constitutional status. It further transpires that many private companies set to gain from the any willing provider and PCT abolishment are funders of the conservatives and there are strong links between tory party members and private health co’s as demonstrated at their conference and verified by claims made by some of these companies to totally de- nationalise our NHS. Not to mention changes health insurance companies are making in preparation for the new health system. The few positive aims of the Bill are not unjust but the Bill will not lead to achieving these effectively even my own apathetic GP acknowledged patient choice will become a non sense with GP commissioning. Where as now we have choose and book at least. GPs already do have input into the services PCTs purchase so no need to legislate for that reason. Scrap the Bill and fight for a public NHS a sign of an inclusive fair society.

  2. Liam Holloway says:

    These reforms should not be introduced due to the basic fact that the Minister has no democratic mandate from the British public to introduce these changes.

    Neither party in the coalition government included these reforms in their election manifestos, so the British electorate have been denied the opportunity to vote on these proposals.

    Most experts agree that the nature of the reforms will change the way the NHS works significantly, the majority of opinion being that it will seriously undermine the principles of the NHS. This is why it is important that the electorate should be allowed the opportunity to vote on these proposals.

    It is clear, the next step in the process should be for the reforms to be suspended until the issue is put to the country, in an election. To do otherwise is totally undemocratic and fuels the suspicion that the Government is reluctant to put the matter to the country for fear of the negative result.

    • John Harvey says:

      Seconded.

    • Ian K. Iles says:

      ‘Reforms’? Shome mishtake, shurely. These are changes, and they are deforms as much as they are ever reforms.

      When government is reduced to dodgy data, misrepresentation & lies to justify its actions, then we should be very doubtful of what underpins the proposed changes. When the plans now revealed were clearly established pre-election, we should rightfully question why they were kept so very quiet.

      No mandate for change from the British people, no evidential basis for the proposed changes, but plenty of blind assertion, misrepresentation & lies.

    • Jennifer Martin says:

      Thirded.

      The government responds to all criticism of this bill by saying that we must do something and that keeping the status quo isn’t an option.

      It’s like the classic Yes Minister quote, “Something must be done. This is something. Therefore we must do it.”

      But I don’t think anyone believes that the NHS is perfect and no change is needed, but where is the evidence that this change is the way to go? In fact the evidence shows that over the last 10 years we’ve had massive improvements in the NHS in terms of outcomes and satisfaction. Surely what we should be doing is building on what has been shown to be successful? And from what I understand, improvements have been largely down to clinicians / providers working together, not competing with each other. Oh, and of course – using the best evidence available to make decisions – where is the evidence that the proposed changes will lead to improvements.

    • Sam (Nurse) says:

      Absolutely! Not only was this not in the manifesto, but it was stated that no ‘top down reorganisation’ would happen. This is complete hypocrisy. Patients and staff are being hoodwinked.

    • Tanya Watson says:

      Agreed – they led us down the garden path and when we weren’t looking concreted it over behind us! Put it to the election and let the people decide.

    • NHS Manager says:

      There’s no way that these reforms would make it into a manifesto!!!

    • denise says:

      I totally agree with what you say.I would probably agree that reforms were needed if this matter had been voted on by ourselves we are the ones who are paying are we not?
      Handing the NHS over to GP’S ,who are General Practitioners their standing is in the name,GENERAL,I would personally prefer to see a SPECIALIST.

    • jelly says:

      I agree wholheartedly. These changes outlined in the Health Bill are the culmination of a covert and long term plan to privatise the NHS with the ultimate result of providing a very basic package of care for all and choice for those can afford to pay. It’s all explained here – please read!
      http://www.opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs
      As someone working in the NHS I can see this analysis is spot on. Talk about duping the public. We MUST NOT let this happen.

    • Lay Chair of MSLC says:

      As lay Chair of a Maternity Services Liaison Committee I am involved with the NHS as a user representative and am not an employee so have no axe to grind. I am concerned about the implications for service delivery and accountability (including in relation to users) if these reforms go ahead. I am highly suspicious of the drivers behind the reforms and would encourage everybody to have a look at this video outlining the relationships between politicians, lobbyists and private medical providers and insurers: http://vimeo.com/18907486

    • Angela Porter says:

      I agree. Everyone I talk to about this is very worried about what these proposals will mean for ordinary people. We have had no opportunity to debate them properly or vote for them in an election or referendum – and most people don’t even know that this “listening exercise” is going on. These are changes of huge significance, and should not be rushed through without full public debate followed by an election or referendum.

    • Val Speed says:

      I also think ”These ‘reforms’ should not be introduced due to the basic fact that the Minister has no democratic mandate from the British public to introduce these changes”.
      They are detrimental to the safe smooth continued running of the NHS.
      Reforms already made should be reversed as they have had an adverse effect on patient care.

    • magda says:

      i agree 100%

    • Geoff Smith says:

      Geoff Smith.
      PLEASE, Do not let this happen,!.

  3. Francesco Palma says:

    I would be grateful to receive details about applying to join the National Reform Forum in open competition as a patient representative unless of course a ‘Top down’ approach has been taken. Whatever the case please response.

  4. Robert Irving says:

    The Secretary of State should remain responsible for providing a comprehensive health service, as at present, not just for promoting one, as the Bill proposes.

    His Bill leaves each Consortium free to decide what services we should have, in light of what competing providers will offer at a given price. The universal right to a comprehensive service would disappear.

    2) The Secretary of State alone should be able to impose new or higher charges for health services, whereas the Bill allows Consortia to impose them. No more elements of care should be subject to payment via ‘top-ups’ – i.e. fees. The government should be responsible for maintaining the principle of free comprehensive care, instead leaving it to decisions of Consortia.

    Consortia should be responsible for providing services to everyone in a given area, and funded to cover everyone who lives in that area, whereas under the Bill they will only be responsible for people registered with one of the practices in the Consortium. This is essential to the preservation of a universal comprehensive service.

  5. Lucy Smith says:

    One of the issues I think that hasn’t been debated is the size of commissioning bodies. For example, a PCT that covers an Inner London borough surrounded by big acute foundation trusts has, in my experience, little clout. It is like David and Goliath. If we are continuing down the market route and concept of purchasing health services then only by having larger commissioning bodies can we improve quality and be more cost effective. GP consortia look like they are by and large mirroring PCTs in Inner London, so I don’t see any difference in purchasing power. Worst of all the decision making will come from people from the same profession rather than a diverse mix of stakeholders eg. those that sat on PCT Boards. I really don’t see how these changes are going to improve commissioning of healthcare or result in equitable decision making for our communities.

    • Brian Stewart says:

      I agree. Derbyshire’s proposed consortia will have populations ranging from 600,000 down to 60,000. How can the relatively tiny budget allocated for a population of 60,000 be expected to cope with the unexpected or unusually expensive treatments. Post-codery is going to be more prevalent and marked than ever.

  6. felix greaves says:

    Where is the best place to make comments about public health?

  7. Mark Loftus says:

    It’s a shame that this ‘listening exercise’ is designed with such painfully leading questions. If you are genuinely interested in listening then the questions should be phrased using neutral language and not assuming that there is support for increased choice when there is not.

    There is no evidence that increasing choice is the most efficient intervention to improve quality. Increasing choice decreases efficient delivery and effective use of funds.

    It appears that this listening exercise is a hollow PR sham.

    • Murmur says:

      Quite!

      I’ve responded anyway, but it does look like yet another one of those sham NHS “consultations” in which a decision has already been made and this is a PR fig leaf.

      Anyone else remember the “consultation” in 2000 over the NHS Plan? I attended one of the last staff “consultation” events and the damn` thing was published a week later: since when did the Department ever do anything that quickly?

    • margaret reeve says:

      I agree with your comments 100% this is an exercise to tick a box that says we have listned and consulted NO goverment has not listened in this instance.Continueous changes are expensive and unneccesary particularly at such a time where budgets cuts to frontline services have been so severe.By all means fix the bits that need it but lets stop the never ending saga of throwing the baby out with the bath water syndrome.Also to identify what could be improved we dont need a high powered expensive quango just ask patients WHAT THEY FEEL.

    • Tanya Watson says:

      agreed – the ‘pause’ at Westminster to undertake this listening exercise is just that a pause at Westminster. Everywhere in the country seems to be plowing on with changes even though the Health Bill is not through and shouldn’t be passed. What a load of rubbish – increasing choice – I don’t want to have more choice, some decisions are really hard to make as it is – I just want the best care, locally that I can get without having to travel miles and go somewhere I don’t want to just because it is cheaper – it should be a standardised charge across the country for each type of service so there is no ‘competition’. Cheaper doesn’t mean better.

    • Another NHS Manager says:

      I completely agree. I was going to respond but found the dialogue refered to the changes as a fait de accompli with only questions about the implementation of these proposals being asked.

    • Jim Kent says:

      Agree; but what exactly is meant by “choice”? Is this
      (a) the list of treatment options the GP offers me as an elderly patient
      (b) is it the range of clinicians from whom I choose one to treat me
      (c) is it the range of locations to which I travel for treatment
      (d) some combination of all of these or
      (e) something else altogether – e.g. any change in the range of ‘choices’ if I consider contributing towards the cost – or just NAAFI choice, perhaps?

      If (a) then I want to see the evidence that clearly shows ageism is not involved
      If (b) will any ‘outcome’ database give more info than “died” / “recovered” and over what timescale will the indication of any trends be shown?
      If (c) will rural practices offer a range of locations equivalent to that of urban ones and who will pay for the transport of low-income patients from e.g. Cornwall to Northants and back?
      If (d) how much time and effort will be needed by whom to compile the cost-benefit analysis of each combination?
      and if (e) this is the two-tier privatisation and inequality of treatment that would destroy our National Health Service

      Surely there will be potential for a conflict of interests between Localism empowered groups offering and seeking local variations within the larger (county-sized) PCT replacements that also risk the creation of further post-code lotteries? And on top of that I would not be surprised to hear of consulting room confrontations when patients feel they are denied choice and the trust between patient and GP breaks down.

      What is so hard to understand about “free at the point of delivery”? This has already been eroded with fees for dental treatment, eye tests, prescription charges, etc This is using the same slimy language you see in mobile phone adverts -”A free b……..y for only £20 a month”!

    • Faith Moulin says:

      I agree entirely about the leading questions. I certainly don’t want choice. We have had a taste of that in the Labour govt. introduced scheme. I was sent a list of consultants from which to choose one. I chose one and his secretary then rang me to say he was not the best one to choose. I would have preferred my GP to choose one for me! What a waste of paper and time that all was!
      I am appalled at what the de-nationalisation of our railway network has done to rail travel (and safety). We don’t need competition to provide a better service. Improve the service without handing it to businessmen to make money for shareholders, please!

    • Jen Williams says:

      I agree. I do not know anyone who wants choice or competition in the NHS. When my husband fell off a ladder and broke his back, he did not want to be asked which hospital he wanted to go to. He needed the nearest A&E.
      He could not answer anyway. From where we live now he could have been given a choice of Newcastle, Sunderland, Durham or Middlesborough. If competition came in, and A&E departments were closed down, he might have to travel 50 miles, by which time he could have been paralysed.

  8. Iain says:

    I am wondering ig the British government has ever looked at other European systems.
    The Dutch model at the present moment considered the best in Europe. It is a private/public operation having the private insurance companies at its centre. The governemnt has a very strict inspectorate will keeps control of the whole system.

    • Jonathan says:

      If we’re choosing to emulate the Dutch, the first thing we should take from them is an accurate appraisal of the costs of healthcare. An increase of roughly 13% will be required before fair comparisons can be made. However this would be anaethma to the current government with the current regime of spending cuts.

    • Aideen says:

      To “another NHS Manager” if you are the calibre of our managers, it is about time we cut the branches of the tree and left the roots alone – it is fait accomplie – no de (or should that be der or even better dumb dumb dumb dumb).

      Cut the “branches” of NHS management and save money for the “roots”, cut the roots and the tree comes crashing down, cut the branches the tree flourishes.

  9. Rachel R says:

    As a parent of a disabled child, I am terrified by the proposals. My child needs comprehensive, multi-agency, co-ordinated care. He is extremely expensive in terms of therapy, medication, equipment and time. No GP consortia, with its eyes on the finances, is going to want my child on its patient list. He simply does not make financial sense. Handing over the budget to the GPs will mean that children like him will be less likely to receive the care that they need because decisions will be made at a micro level rather than at the level of a district or a city where there is an understanding of just how many people like my child there are and the burden is spread more easily. All feels a bit like eugenics by health insurance to me.

    • Jo says:

      I completely agree with you. I, too, am disabled and am furious that the proposals will essentially mean that those in most need of continuous life-long care, will be sidelined, ignored or farmed out to the cheapest bidders, reducing quality of care and, essentially, quality (and quantity) of life.

      “Quick fix Coalition” is my new name for this bunch of lunatic ‘governors’. Unworkable, unethical, untenable changes in the NHS are not what is needed but solid building on successful NHS practices and reforms in the areas where there are improvements still to be made, are!

  10. Isla Dowds says:

    I have tried patiently and through various routes to get some information re’ There will also be events running in every part of the country during the next two months. ‘ No reply to my queries about how you are making this exercise accessible and inclusive. No information about events.
    Poor, poor show DH, how on earth do you expect people to engage and to have any belief at all in this process if you cannot even provide answers to specific questions about engagement opportunities, and the ways in which you will seek to make these equitably accessible.
    One more question – how are you going to demonstrate the impact of the contributions of those taking part in this process, by various means, on the proposals in the bill? How will these be fedback to the public?

    • web editor says:

      Hello Isla

      Thanks for your comments. We were not ignoring your previous questions, but are waiting for details of events to be finalised. When we have this information, we will publish it on this website.

      Regarding your last question, the Future Forum’s report to the Prime Minister, Deputy Prime Minister and Health Secretary will be made public. The Prime Minister has said that where there are good suggestions to improve the legislation, those changes will be made. Any changes will be publicised.

      Annelise@DH

  11. Murmur says:

    Another example of how much of a sham this “listening exercise” is:

    my partner works for another trust in our area and is unable to complete the online response linked to above at work as access is denied.

    How many other trusts are blocking their staff from commenting on-line? How will this distort the findings? Why is such censorship being tolerated by the Department?

    A copy was printed off and will be sent in the post.

    • ecp says:

      Murmur – thanks for taking the time to respond by post. Sorry to hear that your partner couldn’t access the site. We’ve done our best to ensure the site is made available to as many web users as possible, but we are not able to influence restrictions on website access that are in place at a local level. Tim@DH

  12. Tom says:

    These reforms are ill-considered, are being rushed through too quickly and seem to be miss-representing the truth, for what to my mind are ideological purposes: some of the facts and figures used in the health reform leaflet seem to have been taken out of context and misrepresent the true picture (e.g. the Cancer survival rates on page 7, have been taken from a study looking at data from 1985 to 1999 – over ten years ago – much has happened since then!)

  13. Emily says:

    So far this government has succeeded in performing miracles!

    My disabled mother has now been officially declared cured and downgraded her care package! A miracle!

    Along with herself and other friends in wheelchairs she no longer needs the care that was essential up to a month previous and mow without it there’s no chance at a march in opposition.

    • Jo says:

      Wow! Nice!

      Yes, that has happened to my friends too.

      These people must live in an alternate reality, surely?

      I mean, not that REAL miracles don’t happen, but government-conspired ones… not a chance!

      I am sorry that your mother has been treated so badly. I hope you get some support and action from your MP, I also hope you made/make a noise in the press…

  14. Mike Dalley says:

    A tobin tax would probably preclude the need for any cuts.

  15. C Roberts says:

    How does the consultation propose to reach those without internert access, and who are not in position to find out that there are alternative means of contributing, e.g. some pensioners for example may have not heard of consultation form and therefore wlll not have a say. Is there a media campaign, television and radio etc?

    • Kate@DH says:

      We are keen to reach as many people as possible and those without internet access can request a hard copy of the questionnaire if they contact the Department’s Call Centre. Details of how to write in or call the Department are available through this link: http://www.dh.gov.uk/en/ContactUs/index.htm

    • Lucy says:

      Hilarious!

      For those of people without internet access, please follow this this link on how to contact us?!?!

      1. how on earth will they know about this campaign without internet access.

      2. they don’t have internet access so couldn’t possibly follow a link.

  16. Helen Le Bretton says:

    I have read through quite a lot of the replys and I could’ent of expressed my feelings about the changes any more clearer than the replys, I quite agree with all opinions.Our NHS is a caring profesion so lets keep it that way, we are not a bussiness.

  17. D Ward says:

    The Guardian printed an interesting analysis by Ben Goldacre of the claims contained in the Listening Exercise leaflet on 16 April. Its in the ‘Bad Science’ column and concludes that “many of the figures [the leaflet] contains are misleading, out of date or flatly incorrect.” See
    http://www.guardian.co.uk/commentisfree/2011/apr/16/bad-science-goldacre-nhs-statistics

    • Ashley says:

      I was also shocked to see the crude use of black and white images to illustrate bad black managers and good white doctors! Together with the poor use of data and so-called facts, it should never have passed initial checks. Who edited this document and authorised it as fit for publication?

  18. D Ward says:

    The Guardian printed an interesting analysis by Ben Goldacre of the claims contained in the Listening Exercise leaflet on 16 April. Its in the ‘Bad Science’ column and concludes that “many of the figures [the leaflet] contains are misleading, out of date or flatly incorrect.” See
    http://www.guardian.co.uk/commentisfree/2011/apr/16/bad-science-goldacre-nhs-statistics

  19. Kate in Ringwood, Hampshire says:

    Let’s try to be a bit more positive.
    First, improve the working conditions of High Street healthcare staff so they stay in their jobs long enough to complete their training, then drip feed the changes one at a time.

  20. Christopher Smith says:

    “We are keen to reach as many people as possible and those without internet access can request a hard copy of the questionnaire if they contact the Department’s Call Centre. Details of how to write in or call the Department are available through this link: http://www.dh.gov.uk/en/ContactUs/index.htm

    This shows that the mandarins at the DH may be listening, but they are not hearing, I do hope that they will hear what is being said during this “listening exercise” and not merely be “listening”.

    The Rt Hon SoS for Health has no mandate for
    these changes and very little support from the staff at the front line. We hear that most of England is signed up to pathfinders but this is a misleading statistic which includes many practices who may not support the reforms, but who don’t want to be left behind, should they go ahead.

    Pause and listen, but also hear what is being said. Start by writing to every health user in the country, using snail mail, so that everyone is given a chance to comment during this “not listening exercise”. This will ensure that the sickest and most vulnerable in this
    big society, who may nor have access to a computer, are given the opportunity to raise their concerns.

  21. Pete says:

    I see changes all around, monies need to be saved, that I am aware. The thing that totally annoys me is that at this moment in time our Directorate is going through a consulation to reduce staffing levels but at the same time, the same Directorate is going out to tender for a Private company to take over. With the threat of “UP TO” 40 redundencies BEFORE the move away from the N.H.S surely NOT losing the jobs would save the N.H.S. so much more by letting the New company sort out the staffing levels when all have been moved over?

  22. Ernie says:

    Excessive use of commercial providers will destroy the NHS. When they provide say 40% of services they can dictate to the government. If there is another need to trim costs in future, they will decline to bid for contracts if they deem them not to be in the interests of their shareholders. The NHS provision will have been reduced to 60%, and will not be able to replace the withdrawn commercial provision. What will the government do? They will cave in, just as they did with the banks, just as they are about to do with the North Sea Oil Tax.

  23. Dr Tom Yates says:

    It is difficult to know what to do with this. I have elected to submit responses to the questions to prevent Lansley claiming support. However, I feel the consultation is deeply flawed and imagine many self-respecting people will boycott this exercise.

    As BigSocietyNHS have pointed out, the leading nature of the questions is outrageous. For example, on the question ‘Are we doing enough to make sure the NHS at a local level has the freedom it needs to take locally-based decisions?’, they point out ‘There are two possible answers to this question. Either you say the DoH are doing enough, and then they can write a press release saying “Our reforms supporting local decision making are supported by the population”. The second option is to say that the DoH are not doing enough, and then the poor DoH interns can write a press release saying “The public want us to do more to remove centralised planning in the NHS”. Either way, Lansley is leading you to the answer that he wants to hear.’
     
    The public, the BMA and the RCN have already roundly rejected the proposals. If Lansley had been listening, he would have heard. As Laurence Buckman has already pointed out “Having a large number of GPs signed up to consortiums doesn’t prove they are in favour of the reforms. Just because someone gets into a lifeboat doesn’t mean they support the sinking of the ship.”

    I have worked in the NHS in various capacities for almost a decade – currently as a junior doctor. I can think of numerous ways in which the service could be improved. None are in Lansley’s proposals. Whatever the conclusions of his hand picked panel or this rigged listening exercise, I urge the coalition to reject these hugely damaging proposals.
     

    • NHS Manager says:

      True, apart from the slight fact that in the final vote the BMA bottled it!

    • Peter Cusack says:

      This is like on Yes Minister. GIve choices, and both are rotten, or, give three choices, two are totally unacceptable, only the third is left which is still rotten.

  24. Peter Grand says:

    I worked in the NHS up to last month – now we are a “Community Interest Company”.

    I thought that I worked for, and was accountable to, the people of this borough.

    Now, I find that I am working for a set of performance management targets, and the managers pull my strings in the name of Finance.

    Any “expertise” that I had developed is worth nothing when all is worked out on paper up there.

    I used to have a vocation – now I have a job.

    • NHS Manager says:

      1. CIC’s are accountable to the local community.

      2. Without performance management the services provided cannot be held accountable to anyone

      3. With respect to targets….remember the 2 week referral for cancer….was that such a bad thing?

    • Ernie says:

      NHS Manager misses the key point. In the public health service quality of care is the priority, and finance is a constraint to be managed. In companies finance is the priority, and quality of care is a constraint.

  25. Ann Whyte says:

    I have not read one comment supporting these changes so far – does that not speak volumes and if the Government is truly listening to the public should they not seriously reconsider this Bill?

    I am a nurse working within the NHS for 32 years and certainly cannot support these changes.

  26. Jo says:

    Could we have an update on dates and how to attend the national listening events. We really need to give members of the public as much notice as possible.

    Many thanks

  27. Fi says:

    I see above that in response to a query the DH web editor says
    “.. the Future Forum’s report to the Prime Minister, Deputy Prime Minister and Health Secretary will be made public. The Prime Minister has said that where there are good suggestions to improve the legislation, those changes will be made. Any changes will be publicised.”

    This suggests that only alternative suggestions will be listened to and factored in any amendments as a result of the “Pause”. What about the many comments that have been made about how undemocratic the reforms are in the first place as the coalition does not have a mandate – That neither party in the coalition government included these reforms in their election manifestos, so the British electorate have been denied the opportunity to vote on these proposals. Will this be listened to so that a referendum can be held and we the taxpayer – whose healthservice this is – get to make a democratic choice about what we want to happen to our NHS.

  28. Kath Horner says:

    I work on the basis of using upto date evidence to support interventions in health service delivery. Everything to date that this Conservative led Coalition has done is not based upon evidence to support effectiveness of Lansley’s proposed interventions. It is ‘ideology led’. Privatise the NHS and we will get markets competing on price and the quality of care will not go up for patients.

  29. Dave O'Carroll says:

    I am incredibly proud to live in a country which provides healthcare free at the point of delivery. In this respect, we are quite rightly the envy of many many other countries in the world. I am very happy to look at the difference between my gross pay and my net pay each month and think, some of those taxes are being used to fund the NHS. However, I don’t live in a fantasy world, and as such, I know that every organisation has good points and bad points: in that respect, the NHS is no different to any other organisation throughout the world. It should strive to improve its good points, and reduce its bad points. But let me tell you, I’m also not arrogant enough to think that I personally know more than those people working in the NHS and healthcare sectors on how to get this balance right, and quite frankly, nor should Andrew Lansley assume that he personally knows more than those people working in the NHS and healthcare sectors. What is it with perfectly reasonable people, who suddenly find themselves in a position of authority, and then go power crazed?

  30. Tim says:

    Morning

    Today is referendum day on the future voting system. I suspect that there will be a notional turnout. If you you want a decent turnout, why not put these NHS changes to a referendum. People would be queing out of the doors to vote on that one.

  31. Howie says:

    We have already seen the impact that privatised care has on client groups especially those who have complex needs or who require end of life care – care provision and quality has declined considerably, therefore there is more demand on our NHS service to put the mistakes of these ‘so called healthcare providers’ right and to maintain public confidence in our NHS provision. GP’s unfortunately have there own agenda which often does not include cinderella services i.e. learning disability, mental health, child and adolescent care – therefore what will happen to these client groups/ services? The government have no idea what they are doing and how it will cost lives amidst all the chaos that will ensue from these changes. I have been a nurse for 20 years I didn’t come into this profession to watch patient care disintegrate under the wealth of paperwork, red tape and change – now money is the key agenda for all working in the NHS – where is the patient/ carer voice and why aren’t the government listening to those who are in the know and who are trying to deal with very ill clients on a day to day basis.

  32. Russ Neale says:

    Welcome to the new era of ‘You will just have to live with it Mr Smith. Our budget unfortunately won’t cover your OPD appointment/Operation/Diagnostic test ‘(delete where appropriate). Goodbye 18 weeks and hello hospital OPD closures.

  33. Kieran says:

    Communication is the key to any reform and I’m afraid this has been botched, unforgivable really.

    The Govt seem to have been in such a rush, once they’d received a mandate, to push this through, that they have forgotten (or never new) some basic principles.

    In fact the ‘listening exercise’ is a perfect metaphor for what should have happened and what needs to happen. With one hand the Govt are asking us to engage more with the public, with the other hand they were seeking to push reforms through without significantly engaging anyone.

    This pause is what was needed at the beginnning but the damage may have already been done, the perception has been formed.

  34. anjan bose says:

    this is the begining of the privatisation although for a long time the GPs have enjoyed public funds by keeping the money in their pockets that this wake up call is neccessary

    many surgeries donot employ partners because their patients are seen by out of hours for things like sore throat and even repeat prescriptions

    Quality Outcome Framework is another con in the name of quality service

    one has to just read the comments from Kings Fund about primary care and one will know the horrible condition

    Which business guarentees the interest on the building and a guranteed remuneration and at the end the Gp enjoys the money given from public funds

    What about the patients who never visit the surgery-why should the Gps be paid in advance for those patients and why access is so poor in majority of practices -the reason is there are not enough partners

    so a total audit and overhaul is required for the justified use of the public funds

  35. Sally C says:

    The Listening Exercise online form is a travesty – asking questions of the public about how governament should ensure robust governance arrangements and accountability. Surely this should have been thought through immediately after the ‘this sounds like a good idea on the back of a fag packet’ phase of the Health & Social Care Bill?

    • NHS Manager says:

      It has become evident that the government has a complete and utter lack of understanding about what actually happens in the NHS.

  36. Mr Hill says:

    As far as I can see, the changes to the NHS are carrying on unabated despite this ‘pause’ – consortia being set up, PCTs and SHAs being run down, plans for hospital trusts progressing, deep cuts to secondary care budgets etc. No wonder you have allowed us only to comment on four narrow topics. The general public should be aware that many of the Bill’s most controversial plans will actually be implemented long before it gets through Parliament. I do wonder what the listening exercise is really hoping to achieve – smokescreen perhaps? It will be interesting to see what small scraps emerge as ‘concessions’ to the public.

  37. Miss Jones says:

    Of course GPs and other health professionals need to be much more involved in local comissioning decisions, but it has taken years for PCTs to develop the necessary commissioning skills, not to mention the hundreds of thousands of pounds of taxpayers money. Why can’t the existing structures be used to acheive greater involvement of health professionals rather than starting again (very expensively) from the beginning? Surely it would be much less disruptive, much less costly, and would avoid GPs having to give leave their surgeries to the locum if the existing structures were used. It also seems to me that the plan to split commissioning into public health (undertaken by the local authorities) and primary care (undertaken by GPs) is a retrograde step. Both need to work together, preferably within the same organisation if we are to have an effective, joined-up health system.

  38. Mark Sharman says:

    If the government was truly concerned about cost savings, they would read this and act up on it

    Over recent years the Labour Government has invested millions of pounds per PCT location to create large single networks so that IT and other electronic data systems can be linked together and managed centrally – much more cost effectively than previously so.

    Now we have this non-democratic coalition, the Government have taken (amongst others) scores of Community Services and made them accountable to the local Acute Trusts, essentially back where they came from (and sensibly so) some years previously. Since then, in my geographic area, we have implemented current ICT systems that support clinical staff mobility / flexibility and as such improved their ability to provide excellent support to patients.

    It’s cost a lot in time, effort and funding but the results are fantastic for all concerned. The most effective way forward would be for those PCTs to simply add the handful of Acute sites & networks to those it already manages, so that we really did have all of the clinical / HR / Finance ICT systems under one roof.

    Data sharing, Electronic Patient record and other systems would be wholly integrated for the first time – now there’s something a Government could be proud of…. but no… at MASSIVE cost, we divide up the infrastructure and waste the millions already invested simply to appear as if they are doing something. It is simply criminal to waste public money in such a fashion.

    Two final thoughts… How can taking the £100Bn and giving 80% to profit making GPs be more beneficial to patients? Enforcing standards becomes even hardware while we replace a single PCT with multiple consortia; there is not even agreement between consortia locally, let alone nationally!

  39. Yvonne says:

    There should be no place in health commissioning for the profit motive – efficiency, yes – profit, no.
    Did I miss the Conservative and LibDem manifesto statements about these plans?

  40. Ian says:

    The Listening Exercise is a sham as we all know. Bottom line is that there is no mandate for this “top down reorganisation”.

    If the Tory led government were listening to the weight of opposition then perhaps it would change. However the logic of this will never make sense as it is an ideaological dictat — the change will happen whatever is said and done in the next few months.

    Actually all very Thatcherite in essence.

  41. Peregrine Sharples says:

    To give the GP’s the purse strings is like asking the Director of Finance to perform a tonsillectomy!

  42. Scott Durairaj says:

    The Key here is the GP; many are private business and self interested. Practice Based commissioning has been around for some time most GP didn’t take it up because they didn’t want to or know how. Seriously I think most PCT staff will end up being employed by GP clusters after receiving their redundancy from the NHS, or do you expect GP to be sitting around making commissioning decisions?

    20 years in the NHS has proved remove one level of bureaucracy to be soon replaced with another. The focus should be on the quality of commissioning and the sensibility rather than who is doing it. GP making commissioning decisions on their own will not lead to a better NHS, the Coalition plans will lead to very few NHS Trust as we know them. The NHS will be a brand by name only this organisation will no longer exist.

  43. Catherine says:

    My main concern is the complete lack of accountability back to the Secretary of State. I also fail to see how GP’s will commission some of the specialist services that many have little knowledge of; mental health, services for disabled children etc.

    • Anthony says:

      GPs were instructed by the ‘Government’ they had to join a consortia – this was not negotiable.

      Cameron then says GPs are behind these reforms because almost every single one has joined a consortia – thus indicating their support! How can we trust (or vote for) someone who blatently uses the facts for political gain like this?

      This is not only misleading but immoral or am I missing something?

  44. Harry Everett says:

    What is proposed appears to fragment the NHS, not integrate it. The public should have the chance to vote on these very major changes and the alternatives – what about a referendum? Or does the government think the public are not capable of understanding the choices before them? If so, they should present their case better, make it easier to understand. If they cannot, then perhaps this indicts the validity of their case.

    Public consultation shouldn’t be about just speaking to a few interested bodies, lobbyists and service providers as is the case at present. It should be about clarity and talking to and interacting with the public directly to make the government’s case and gain majority support for it. Or amend it or ditch it in this form if such support isn’t forthcoming.

  45. Edmund Gilbert says:

    The government has broken its Coalition Agreement promises on no top down reorganisations and on protecting the NHS budget. The reorganisation will cost £3bn at a time when the NHS has to make unprecedented efficiency savings of £20bn.
    Andrew Lensley said in a press release of the 11th July 2007 “The NHS needs no more pointless organisational upheaval. It needs no more top-down reorganisations”
    I do not comprehend how Andrew Lansley, the Heath Secretary, is pushing through his Bill with the continuing criticism: from patient groups, professional bodies and health experts, including the Royal College of GPs and the BMA. Has he decided to have selected deafness? Should his Bill be sucessful in Parliament, what will be the cost to the tax payer for the return to confidence in the NHS when his actions fail as I am sure they will?

  46. Anthony says:

    No democratic mandate from the British public to introduce these changes.

    Neither party in the coalition government included these reforms in their election manifestos,

    The British electorate have been denied the opportunity to vote on these proposals.

    Being pushed through with lies, damn lies and dodgy statistics.

    Lansley’s wife has a lot to answer for if she thinks she speaks for all GPs. He admitted this was her idea which she shared with him over the breakfast table. There seems to be no way out for him or the Government without some serious loss of credibility and face.

    It all seems to be a miasma of brinksmanship.

  47. Julian Baker says:

    I havn’t had chance to study the proposed changes in depth but I understand that G.P. s are to be given more power on medical rather than ecomic grounds. I am opposed to this. What about nurses, phamacists etc.

  48. alex says:

    I am writing in the strongest terms to voice my opinions on the reforms
    and to say an outstanding NO to these reforms

    1. This govt promised to protect front line staff, so why are hundreds of
    trusts up and down the country
    making front line staff redundant to save money, including my trust?

    2. Why are we reforming the nhs at a cost of between 2-3 billion when we
    are supposed to be saving 20 billion?

    3. This government promised no reforms to the nhs in their manifesto, but
    Andrew Lansley, after just a few months in office, announced the biggest
    change in the nhs sinceit was founded, yet another broken pledge??

    4. Groups of GP’s, nurses etc have voiced their concerns about these
    reforms, but nobody is listening!!

    5. Private companies will cherry pick the most profitable services and it
    will be a post code lottery for those who carn’t afford private healthcare

    This is privatisation by the back door, nobody I know wants these changes
    and I am voicing my opinion for what its worth
    I am under no illusion these changes will go ahead regardless of what
    people think, for whatever reason this govt gives

  49. James Saunders says:

    I don’t want competition in the NHS, a competition by definition has losers.

    As for choice, the vast majority of the electorate chose to not waste billions on yet another costly top down reorganisation of the health service, please listen to them.

  50. The major reorganization proposed has not been properly thought through. The very process of reorganization will certainly strain the NHS in the short term and is being carried out at a time when the NHS is under extreme pressure for other reasons. It breaks the pledge which the Conservatives made not to subject the NHS to new reorganizations.

    The eventual outcome of the reorganization is quite likely to be deleterious for the NHS. There is no reason why GPs are likely to do a better job of commissioning than professional commissioners. It is inevitable that a postcode lottery will be introduced. GPs will be put in the position of rationing care for their patients whereas previously they were advocates for their patients. The patients’ trust of doctors will be undermined. Cynically, it looks as though GPs are going to be expected to take the blame for deficiencies in provision which will be outside their control.

    There is no reason to suppose that the reorganization will lead to a more cost effective or equitable NHS.

    The overall lack of sufficient funding for the NHS is sure to cause problems for both patients, who will certainly receive a poorer service, and for staff, who will be blamed for problems at the same time as they face calls for pay restraint and uncertainty about their own future employment. The effects of restrictions on funding the NHS will be greatly exacerbated by the simultaneous cuts to social service provision.

    The increasing privatization of the NHS is very worrying. This is occurring at the same time as medical students will have to start paying large tuition fees. This will contribute to a commercialization of medicine in Britain so that doctors of the future will no longer feel an obligation to repay their debt to society but will be more interested in repaying their own debts and will be more keen to be remunerated at a market rate. This move towards privatization will make the provision of healthcare in Britain more expensive and less equitable.

  51. Harry Everett says:

    I have written to ministers involved and my MP and they say a listening exercise is taking place. It is but as far as direct individual patient voices are concerned this listening exercise seems to be a sham. The mechanisms for direct individual interaction with the process by members of the public, so that their views are heard by the decsion-makers, is almost non-existent, as it appears left to so called ‘patient representatives’ and ‘patient bodies’ to represent my views. How do I know or ensure that they do?

    What is proposed seems to be an unravelling and dismantling of the NHS. The plan appears to be to throw open the NHS to competition and in so doing suggests that it opens the road to an insurance based service – a de facto privatisation of the NHS.  The public has not had a real and substantial chance to have its say – so how do we know if there is an appetite for such changes? Weasel words about this proposal being contained, in part, in the Conservative and Liberal Democrat manifestos, as well as being outlined in the Coalition Agreement, don’t help. What is stated in those documents might point towards the general direction proposed but there are a number of roads that could be taken to achieve improved public accountability, devolving control to local levels and putting patents at the heart of decisions about their treatment and care.

    What is proposed appears to fragment the NHS, not integrate it. The public should have the chance to vote on these very major changes and the alternatives – what about a referendum? Or does the government think the public are not capable of understanding the choices before them? If so, they should present their case better, make it easier to understand. If they cannot, then perhaps this indicts the validity of their case. Public consultation shouldn’t be about just speaking to a few interested bodies, lobbyists and service providers as is the case at present. It should be about clarity and talking to and interacting with the public directly to make the government’s case and gain majority support for it. Or amend it or ditch it in this form if such support isn’t forthcoming.

  52. Jim Kent says:

    At a recent meeting with those charged with arranging the transition from PCT to GPCC, it was clear that the extent and complexity of current PCT functions and linkages had been inadequately explored and that new (possibly local) ones were still being unearthed.

    In particular, there appears to be little comprehension of the problems involved in workforce planning. Without a regional health body there will be little co-ordination of hospital staff appointments, assessment of skills, job descriptions etc. to maintain the desired balance. Who decides? Who appoints? Who assesses staff for training/promotion? How will the equivalent actions be carried out in the Voluntary sector? Is this the role of Monitor (besides encouraging the competition that few want) or will local decisions be made nationally by the Commissioning Board? i.e. top down control restored!

    If you pull all the pegs existing at County and Regional level, then the service will collapse – it will be less fit for purpose than what we have now.

  53. geum says:

    Most PCTs function reasonably well with an occasional hiccup – usually different in different PCTs. True there will be more of us in the older age bracket, but that is no reason for pulling the current system apart and re-jigging it to try to create a replacement, Dr Frankenstein.

    Colloecting all the failures together does not show the NHS is busted. our local PCT works qMostly what it needs is local adjustment, (maybe replacing the odd manager), but not wholesale destruction.

  54. geum says:

    Most PCTs function reasonably well with an occasional hiccup – usually a different failing in different PCTs. Collecting all the failures together does not show the NHS is busted. Our local PCT works well on the whole as do most others, so why destroy the whole system? Mostly all that’s needed is local adjustment, (maybe replacing the odd manager), but not wholesale destruction.

    True there will be more of us in the older age bracket, but that is no reason for pulling the current NHS apart and re-jigging the bits to try to create a replacement. Dealing with this forthcoming demographic change should build on the medicine that works well now and concentrate on tackling the finance as a separate issue which will have ramifications in other directions too. Now that Bin Laden has gone, how about scrapping Trident?

    Interesting too, that money was found for two “NO to AV” leaflets to every local house, but nothing explaining the NHS changes.

  55. Jill de Bene says:

    The more I hear and listen the more concerned I get. After 20+ years in the NHS and now working in healthcare as a hands on consultant I see the key issues to making changes in the NHS is sustainability and lack of partnership working. I am worried that the Bill does not help the partnership approach at all and with its emphasis on competition and divisions breaks down what has been achieved so far. I also agree that the HWBB are a missed opportunity. The current government may not have liked Total place but some proposals with teeth to make the geography placed solutions happen would be welcomed. I think if anyway can make some sensible changes Steve Field will be able to but in the meantime the NHS is loosing key people and wasting time developing plans a, b and c to try to achieve the finances whilst the plans are awaited.

  56. Arizona is proposing fining obese Medicaid recipients who do not comply with a diet. People are complaining that this represents a “nanny-state” mentality but if the state is providing your healthcare and you are behaving in a way which makes this more expensive, why shouldn’t the state try to recoup some of that extra expense?

    Fining non-dieters sounds impracticable but it would be fairly straightforward to allocate a specific cost to a wide range of activities which would tend to make people less healthy and hence to require more expensive healthcare. One could assign such a cost not only to each cigarette or each unit of alcohol but also each calory of food consumed. Thus there could not only be components of tobacco and alcohol duty which were badged as related to healthcare costs but also a health tax on food and drink related to calorific and salt content. As an example this would either make diet drinks cheaper than their sugar-containing equivalents or else the manufacturer would have to bear the cost, making it less attractive for them to produce and promote high calory drinks.

    A similar financial approach could be applied to other behaviours impacting on health. For example, getting a bus instead of walking or cycling reduces fitness. Hence one could impose a health tax on such journeys as well as having a specific component of duty on petrol badged as the health cost of driving instead of walking. Conversely, one could financially reward activities expected to increase fitness. For example, there could be a government-provided health subsidy for swimming tickets, gymn membership and purchase of exercise equipment and bicycles.

    We are told that the cost of providing healthcare to the population is rising and that one reason for this is that people make unhealthy lifestyle choices. The proposed approach makes explicit and fair the relationship between the state as the provider of universal healthcare and the citizen as the consumer. It says that people are free to make choices and can choose behaviours which will be on average increase the costs of their healthcare but that when they do so they should be expected to bear this additional cost themselves rather than expecting other members of society to do so. Implementing this additional revenue stream would be seen as fair and would alleviate the financial pressures which are claimed to be driving these reforms.

  57. Ernie says:

    There is a fundamental flaw in some of the statements being made by the government. It states that with an increasingly ageing population we cannot afford the health service, and there are hints that some co-payment system might be needed. Aiming to improve the efficiency of the NHS should of course be a permanent task of managers, as in any organisation, but given this, the cost of providing health care in the future will be what it will be, unless the government advocates shooting old people. The problem of asking tax payers to pay more in taxes will not be solved by asking taxpayers to pay more as a co-payment. All this does is to ask sick people to pay more than the average citizen. The real problem is that all governments are scared of being honest and saying that we must pay more taxes for the health service in case this is unpopular amongst voters who are not yet sick.

    The overwhelming opposition to the proposed revolution in this listening exercise must be reflected in major changes to, or abandonment of the proposals. If this is not done then it is clear that the government does not care what the people of this country think.

  58. sylv says:

    What are our elected parliamentarians doing about ensuring that their constituents views are sought during this listening exercise. They should be out their earning their wages and ensuring that all views are collected but I guess they are doing what they do best and sitting on their hands only to remove them to receive their pay slips and claim their expenses. We know wwat the majority of them couldn’t find even if they were sitting on it.

  59. Andre Renato says:

    Nobody knows what people go through when you’re a suffer of serve
    chronic illness.
    The cuts are good but I hope innocent or poorly informed people are
    properly assessed. The struggle continues!

  60. Stephen Hewitt says:

    Who commissions the commissioners?

    If we believe in devolving power and decentralising decision-making then why is the coalition government proposing that primary family health services (eg GPs, dentists, opticians and pharmacists) are commissioned nationally rather than locally.

    There has been a lot of public debate about the commissioning of hospital services by GP consortia, which to my mind has over-shadowed the question of who commissions the GP consortia.

    I have six monthly dental check-ups, see my optician every year or so and being generally in good health perhaps see my GP once or twice a year on average. I rarely have to go to hospital (well at least not yet). So it seems bizarre to me that it is only the expensive hospital treatments (that fortunately only a few of us need at anyone time) that will be decided locally by GP consortium – while in future the primary health services that everybody uses every year will be decided hundreds of miles away by some national quango rather than locally. Where is the patient choice in that?

    If primary care trusts are going to be abolished, then why not transfer commissioning of GPs, dentists, opticians, pharmacists to local authorities, along with public health.

  61. Norm says:

    It takes a certain type of person to drive the sort of change needed within a modern health service. Those GPs with the skills and interest were already involved long before these changes were mooted. The idea that the rest can be dragged into running mini-PCTs and will produce anything like a quality result is misguided.

    I don’t buy the idea that GPs have any special knowledge about the health needs outside of their own surgeries. Planning local services on the basis of anecdote, personal preference and the opinions of a few busy-bodies who attend local practice meetings is not the way forward.

    GPs should really come clean about their own strengths and weaknesses and exactly what role they feel they can play best in this process and what they absolutely cannot and should not do before the system they are relying on is totally dismantled.

    The view that these changes will cut costs simply doesnt stack up. There will be many more GP consortia than PCTs and more organisations cost more money (just look at the salary of an average GP compared with an average NHS administrator). You need scale to be able to deliver economies, not only in terms of the back room functions but in terms of purchasing power. The messages on this aspect are conflicted. On the one hand large support functions serving many consortia and on the other lots of little consortia making small, local and potentially very costly decisions. It simply doesn’t make any sense.

  62. Samantha Oxford says:

    I’m proud of the NHS. I would not like to see it opened up for further privatisation. When private companies are involved they will be concerned with making a profit and when hard times hit they will make cuts to the service they provide before they make cuts to their profit. Public services including the NHS should be kept public. There is plenty of money available to ensure that there are excellent services for all, however the government will not collect it from the super rich. I do not want a service that is concerned with my ability to pay rather than the fact that I’m a human being.

  63. Nicky Griffiths says:

    I have written twice to my Conservative MP who eventually replied telling me this is the correct way to give my views (he’s fed up with me writing to him I suppose). I just downloaded the form therefore in order to let the DoH know my views on the remodelling of the NHS as proposed by the Coalition Government. The questions are so loaded it is impossible for me to use to put my views forward. I am so angry and frustrated I am going to have to sleep on it and then when I am calmer think of some other way to shout and be heard.

    • NHS Listening Team says:

      Hello Nicky

      We sympathise with your frustration. The form and the suggested questions are only intended as a guide for discussion. If you would like to make a broader or completely different point you are completely free to do so by sending us an email at nhsfutureforum@dh.gsi.gov.uk.

      Thanks

      NHS Listening Team

  64. Christopher Keene says:

    Choice should not be an excuse to get the private sector involved in delievery of NHS services, as it has been by successive governments, including New Labour. Private sector involvement will inevitably increase costs because of the transaction costs and profits which will be taken away from patient care.
    We need to remove the private sector from the NHS, at the same time as reducing demand by cutting pollution, having a more equal society, reducing working hours for those in work, and decreasing unemployment

  65. Pam Vaughan says:

    Reading the comments already posted, it would appear that IF anyone is in support of Lansley’s proposals then they are either offline, embarrassed or perhaps confident that the proposals are going to go ahead anyway??
    If this listening exercise is worth anything at all, then at the very least the Coalition should be stopping the reform processes whilst it happens and not merely carrying on in the hope that we are lulled into a sense of being in a democratic society by it.
    These reforms should NOT go ahead for many reasons including the following:
    a) None of the experts (i.e. those working in health) believe that they will improve the service. Those that have signed up have done so out of fear rather than support.
    b) The reasons for the reforms are based on right-wing ideology thinly disguised as financial necessity.
    c) The NHS was created in the post-war recession, when the structural deficit was worse than it is now.
    d) Support for the NHS has never been higher – up to last year. This is due to the massive investment by the last government, who had to spend 13 years ‘clearing up the mess left by the previous government’ (familiar line?), who had tried to dismantle the welfare state.
    e) Few people are aware of the scale of the changes, and as has been stated many times above, many would have voted differently had this been on anyone’s pre-election agenda.
    f) Again, repeating many others comments, this listening exercise is intentionally limited in reach and therefore a PR exercise. Something as fundamental as this needs to be debated and indeed voted on by the funders and users of the NHS – i.e. the whole public.
    PLEASE CONTINUE TO USE WHATEVER MEANS POSSIBLE TO SHARE YOUR VIEWS BEFORE IT IS TOO LATE.

    • Lu Brown says:

      Pam I agree completely with all of your points – I too have read this thread looking for anyone out there who actually supports these proposals.

      Its a disgrace and a sham. I am appalled by the cheap spin and soundbites by suggesting that it is simply because the public disagree only as they do not understand because the Govt have failed to explain it properly – like the public are incapable of reading – silly fools that we are!

      Given nobody really agrees with any of the fully loaded questions posed on the ‘listening exercise’ I can’t wait to see how the published report on this ‘listening exercise’ reads.

      At the very, very least give us a referendum before the NHS is privatised, once its gone its gone for good…….

  66. Peter Cusack says:

    Medical are good at being medical because that is what they have trained to do.

    Administration is not part of any medical course I know in this country.

    To expect medics to make paperwork decisions does not make sense.

  67. A Bevan says:

    This ‘listening exercise’ is a sham. And according to YouGov polling 95% of the British public do not know how to get involved with the government ‘listening exercise’ and only 1 in 5 believes that health secretary Andrew Lansley wants to listen.

    If the bill was wanted or needed in the first place there would have been no need to pause its progress through parliament.

  68. Susie Archer says:

    How can we best ensure that competition and patient choice drives NHS improvement?

    This is a loaded question. Competition? I thought I was being asked to comment on the National Health Service not the Retail Industry.
    I don’t want choice, I want to be able to trust the hospital nearest my home. I want all hospitals to be funded well from our tax system. I want the hospitals to share best practices.

  69. Alexis says:

    Taking notice over the past few years, it seems like Government officials and Parliament are “going through the motion” and holding “talk-at me” hearings when it comes to making these kinds of decisions. Almost as a means of legality like it’s traditional just to do it.
    What I have noticed is that rarely what the people have to say about the situations gets put into place and the Government has already made the decisions as to what they are going to do on the matter.
    True patriots are critical of their nation.

  70. Janet Dickinson says:

    “We will listen to you but we know better than you so we’ll just ignore you”

  71. mandie says:

    I to am the parent of a profoundly disabled adult who has numerous complex health and social care needs. I have had to fight all her life to get her needs met but usually they have eventually been met. I have very major concerns that no one will want to commission services to meet her needs, therapy, medicines, operations. rehab, care needs etc because they see her as a very expensive case.
    I also have very major concerns that we will return to the bad old days of not doing everything for prem or sick babies etc as the commissioners will have one eye on the future health needs and therefore the cost of future care of these children. Many disabled people are well aware they are often looked at as having a less quality of life and I worry that in future this will be even more evident and decisions made accordingly.
    I have spent an enormous amount of time as a patient / carer within the NHS and in my opinion the government has very little idea of how things work and as such should leave it to those who do.
    It may not be perfect BUT neither I nor my daughter would be here today without it. Thank you.

  72. Michael Ross says:

    I have just read on the 38 degrees website that there have been public meetings up and down the country but I cannot find any details of them on this website. Did they take place? Are there going to be any more? were the public actually able to attend?

  73. Shaun says:

    I suffer from a progressive neuro-muscular condition, for which at this current time there is no cure. My condition will get worse, and so at present the only option is to ‘manage and maintain’ my health.

    How, will I be sure that I would not be considered a ‘drain’ on resources, and therefore suddenly find that I have been ‘removed’ from my GP’s list, and then not able to register with another GP as would be viewed as a ‘High Level Expenditure’ patient? If I am registered, how can I be sure that I will not be subjected to some form of discrimination ie ‘restricted appointment time’ allowance etc as from my understanding, far from being open and transparent, the new system of monitoring would be more ‘closed and secretive’ from external scrutiny.

    For the record, I PAY for all of my prescriptions, pay tax and national insurance through my EMPLOYER, and yet somehow I get the feeling that people who currently need, and those who in the future will need an NHS based on NEED and not if you are a ‘Low/Minimal Cost Unit’ will find that doors are closed, or you are offered a one way ‘Budget Airline Ticket’ to a private facility in Switzerland!

  74. K says:

    Who would have thought that this would happen when the conservatives got back in power? I certainly did not see this one coming a mile away. This is just the next logical step towards privatising the NHS and, as an NHS staff member I find it abhorrent. I came to work for the NHS as I believed in its values and practices and do not believe that they should be undermined in this way.

  75. judith garbutt says:

    I for one, do not think that any private involvement in the NHS is going to be good for it, and in the end, it will be damaged beyond repair. health care for the rich, while the poor are left to fend for themselves…

  76. Michael Burt says:

    I wish I had time to read all the comments most that I have read I agree with I have written to my MP Robert Waltyer Conservative opposing the changes , he has responded saying 90% of the country is covered byGP pathfinder consortia and a letterto the DailyTtelegraph indicates Gp support for the changes. He then goes on to tell me that the right way to make my views known are via this site which I find difficult to use , I thought we elected our Mp to represent us, if our representations are to be made via computer then savings could be made by getting rid of MP’s and the expensive trappings that go with them we could then properly fund the health service.

  77. michele says:

    The whole notion of choice and competition being in the same section is flawed. The choice that patients get once private competition breaks up services will be spurious. How are they to know which of “any willing providers” they should see? They can choose by place and time but will know nothing of the credentials of the providers and will not understand that, in many cases, they are simply having a delay put in their pathway of seeing a true specialist in the name of economy.

  78. Richard Worth says:

    Having recently retired as a consultant physician, it is depressing to see the NHS subjected to yet more turmoil. No one seems to dispute that reorganisations cost an enormous amount of money and yet here we go again with the biggest one yet since 1948 and at a time when the cash is shorter than ever. Even more important the government has NO MANDATE to introduce such far reaching change. This is breathtaking arrogance for a democracy.

    Furthermore, while all the focus is on management change, once again there will be a state of “decision paralysis”, probably for some years, regarding the real reason for the NHS – spending time on improving clinical services for patients!

    The response from my MP to my letter setting out my concerns is frighteningly complacent given the comment “there are some concerns amongst health professionals”!

    The fiasco of Stafford and lessons the Mid-Staffordshire Inquiry seems to have had no impression on the current government. Is is really wise to extend the powers of Monitor when it’s demand for financial savings played such a large part in the whole sorry saga? The ghost of Stafford will surely revisit this government if it fails to listen to the professionals who are warning of the huge risks of this legislation to safe and effective patient care.

  79. Emma Stewart says:

    I am deeply concerned about these proposals for the following reasons:
    - Govmt neglected to include proposals in manifesto yet we know now they were well developed at the time of last general election
    - Tory arm of Govmt no clear mandate to make such an overhall
    - Reason for change is not ‘NHS is broken’ but ‘we must spend less money because we’ve given it all to bankers’
    - Evidence of improvement in outcomes and satisfaction in NHS – logical conclusion is to build on this not destroy
    - NHS is for good of all not just those of us well off or articulate enough to represent ourselves
    - Nature of contracting to private sector not suitable for evolving field like medicine – if a new disease broke out, would we have to wait for amendments to contracts before we could be treated?
    - My GP is excellent I would prefer her to spend her time directly with patients not beaurocracy
    - Why introduce wholescale reform without trialling first? Could it be the trials would fail?
    - communication between parts of the NHS is bad enough now it would be worse if separate organisations were in competition with each other
    - privatising energy companies has made companies lots of money and left people confused by choice, with the most negative impact on the poorest
    - Why is this ‘consultation’ set up so it is hard to disagree with the principle of this change?
    - Nye Bevan said the NHS would only last as long as there were people to fight for it. Good to see there are so many people fighting.

  80. Debbie says:

    The questions and statistics that Number 10 have put out as part of the “Listening exercise” are as much lies as the ‘No to AV’ leaflets, since again this isn’t directed at any particular person or group so normal libel, slander and false advertising laws don’t come into effect.

    Ben Goldacre (who wrote the book ‘Bad Science’) has done a review of the worst bits (like going back 20-35 years to the 80s find the cancer survival stats they wanted rather than using the current ones and just lying about the results to questions that weren’t even asked on the questionnaires they’re citing to back up their claims).

    http://www.guardian.co.uk/commentisfree/2011/apr/16/bad-science-goldacre-nhs-statistics

  81. John Irwin says:

    Until two or three years ago we had an excellent patient centered organisation that was a powerful advocate of patients’ rights. Labour abolished it because it was too effective. If you want patient centered choices, re-instate this organisation.

  82. Keith says:

    There are many good, technical arguments against these NHS reforms. But very simply, why should the Government scrap these plans? Because they have NO mandate from the British public for anything like the changes being announced. If they are so confident it’s the right thing to do, dissolve Parliament and have a single issue General Election. No? Though not.

  83. NHS worker says:

    From someone who has seen the effects of cost cutting in the NHS over recent years, seeing progressively less staff trying to do more work, more quickly, with more mistakes and obvious patient safety issues, it is about time government realised that a proper injection of resource is required to bring the NHS back into a healthy state. To introduce commercial competition would be the last straw on the back of the NHS. One sure way to kill off the NHS for good. You either need to invest in quality or be happy with “smartprice” healthcare. I know what I would choose when it comes to people’s lives. This isn’t a supermarket you know!!!

  84. Patrick McCrossan says:

    This government want to run the NHS like a business but I’d question what business would disband the board and give purchasing power to local managers, it’s absolute nonsense.

  85. Paul Curtis says:

    These changes have taken seven years to think up .

    So if these changes are that good for the Nation , as we are told by Mr Lansley and Mr Cameron Why did we not have the chance to have this information at the general election . Oh we did the NHS is safe in my hands .

    After all they new what there plans where !!! and we could not have the voted on these plans .

    Now we have a minority making changes and decisions which affect us all .

    We remember when my wife had to have a scan after Mrs Thatchers changes , we had to pay to go private, as we told the wait could be a minimum of three months to a year. when we got to the Bupa hospital it was the same specialist .
    So the doctors know whats best for there patients
    Waiting time will go up .

  86. Clare Richardson says:

    I am appalled that the Government are wanting to basically privatise the most profitable parts of the NHS.

    The NHS is at least one thing that we in the UK can be proud of. I feel ashamed of our foreign policy and yet there is never any hesitation for spending billions of our taxes on invading other countries under the pretence of bringing “democracy”

    If there is a financial crisis going on in the UK at the moment, it is certainly not of the majority’s making and to use this as an excuse to seriously damage the NHS by privatising the most profitable areas I think is a disgrace.

    The British people fought hard to get their NHS. It is a precious public service within this ever-growing, selfish and consumerist society. The private medical industry has always wanted a bite of the most profitable cherries within it and we need to oppose these plans, as this is certainly the thin edge of the wedge.

    When private medicine decides to take on the expense of funding the training of doctors, nurses and other professionals, when it starts to invest in long-term care for those with mental illness, those who are elderly or who have chronic illness, then I may consider that private medicine is possibly a force for good. Until then I don’t want it undermining our public NHS!

  87. Non-contracted [unemployed mostly] GP in NW England says:

    I am a GP locum in north west England; when I can get work. My thoughts on ‘Choice and Competition’.

    A lot of GPs have been doing very well thank you since Labour abolished a lot of the out of hours and almost doubled income with a load of tick box targets now fulfilled not so much by conscientious medics but their [oft non-clinically qualified] staff some of whom are on the minimum wage. Already I see members of our local GP consortium – the usual suspects – poised, rubbing hands with glee, at the prospect of £150 million plus budget to play with.

    Guys who I’ve worked with/for at times then who’ve fired me too at the drop of a hat. And very likely including others, and their practice managers who have proved unable to reply to my applications to their advertised job vacancies on occasion. Trust them to act super-efficiently with massive budgets in the broader interests?

    So want some choice? How about choice of GP without having to re-register with all the hassle that entails, and of course no clarity that anything much will be very different. Why is it some GPs are so ‘hard to see’ in some places? When you ring it may be to be told ‘a nurse can ring you back’ or ‘you can have a telephone consultation nxt wednesday at 11am’ [it is a friend's GP offering this 'service']. A bit more competition here wouldn’t go amiss though I think we would all have to agree that with less money being paid to established GPs they might be excused a lot of [administatively hungry] target hitting and also remind the public just because they might feel ‘strongly’ that they need something is not reason why they should have it as there is such a thing as the wider public interest at which point it is for politicians to have enough backbone to say so [which was partly the point of NICE which was meant to be the last word but then messed up by being seen to be too detached i.e.heartless, with some near-terminally sick patients].
    ….(insert)………..A peon by the way for the ‘out-of hours’ doctors; these guys are brilliant [where they're safe as all should be of course and where 'not sure' will act 'to be on the safe side'] insomuch dealing with high stress situations where there has been no opportunity to build up [knowledge and] trust beforehand…….(insert end)….

    Which isn’t to say the PCTs are any better; overstuffed with staff they have done little or nothing for me when I’ve asked about, say, help to obtain a position in a district[s] where I may have lived and worked for a time or difficulties with an employer where they might be expected to have a view as some patients are going to feel abandoned if a [their 'new'] doctor suddenly disappears; their ability to issue or withdraw my ‘license to practice locally’ [the GMC already does this nationally] but with no obligation to educate or assist in professional development us part-timers – I feel kept in the dark as regards important circulars/ updates [not on PCT mailing lists] whether it is swine-flu, the new sick-notes that came out last year or [recurrent] measles outbreak strategies or even ‘killer cucumbers’.
    I thank my lucky stars I caught I the ‘Today’ programme often.

    And where it came [ I might be a little out of date here] to saving money e.g. on prescribing; plenty of advice, directions and getting pharmacists to have their six-pennyworth, it wasn’t anyone at the PCT who had to say to a patient ‘oh this is too expensive for what it is , we would like to change it, can we try this’ and risk ire and official complaint.

    I would just add that hospital specialists, and [e.g.] district nurses are excellent value in our health service and should not be sidelined. The latter are as important for primary care doing [most of] the hands on stuff for the chronically and terminally ill; the former , so often are some patients in and out of hospital, work as one with the ‘primary care team’ also. It is just plain daft to pick out any of the groups as having primacy, as it is unjust to the others to leave their voices unheard when it comes to BIG decisions of budget allocation.

  88. Louise Irvine says:

    The idea that people want “choice” has been over hyped. There has been research that shows that people value the availability of good local services more than “choice”. Choice is being promoted as it is required for the running of a market, not because it is seen as a good thing in itself. Most patients are not interested in choice. Few patients go home and look up databases to compare hospitals before deciding which one they want me to refer them to. They either base their decision on something very subjective and unrelated to actual quality or ask their GP what they think. Services have improved over the past few years and there is greater patient satisfaction but there is no evidence that that has come about through patient choice.

    The problem with introducing a more competitive market is that companies will compete to provide the easy and profitable bits (“Cherry-picking”) but if local NHS hospitals lose the right to provide those services there may be knock on effects and other parts of the hospital may not be able to function, because of the complex ways that hospital services and workers are integrated. Its like taking a card out of a house of cards – the whole thing could come down. This could mean that local services are unable to remain financially viable and will close and people will have to travel further to access the services they need. That will be more inconvenient and expensive and will favour the wealthier and more mobile people. So there would be less choice – losing your local service and being forced to travel further.

    Increased competition could lead to fragmentation of services and the loss of the collaboration and integration that have underpinned the progress that has been made in recent years in cancer, heart and stroke care.

    The first duty of for profit companies is to make a profit and to satisfy shareholders. That means that patients come second. Costs are cut by reducing the scope of the service, having a higher and faster through put (like a production line), reducing staffing levels and skills, and finding ways to exclude more complex or high risk patients from the service. This can adversely affect quality of care and access to care.

    The transactions costs of running a market involving thousands of procurement exercises, accounting, billing, monitoring, dealing with legal challenges etc will amount to about £20 billion a year. ( before 1990 when there was not even an “internal market” NHS administration costs were only 5% of the budge. In 2005 due to increased marketisation the administration costs had risen to 14% and they are predicted to rise to 20-30% if there is a full scale market as proposed by Lansley’s bill). This is money that is wasted. It is not available for the provision of services but disappears into the pockets of management companies, lawyers and accountants. Neither Scotland nor Wales has such a system and are not proposing to have one. They will not be wasting precious billions on transaction costs. We should follow their example. Increased competition will involve a huge waste of money at a time when the NHS has to make unprecedented savings of £4 billion a year. There are already cuts to front line staff and services. If we did not waste all this money on managing a health care market there would be more money available for health services and no need for cuts.

    Private companies will not be responsible for education and training of staff and NHS hospitals could find it more difficult to train doctors and nurses if several of their services have been lost. For example, surgical trainees need to be exposed to straightforward cases before they can deal with complex ones and if the simpler cases are no longer being treated in the NHS hospital but being provided by a private company then that could affect the quality of training.

  89. christina Speight says:

    Too many of these comments are from the ‘suppliers’ point of view. I am coming to the end of convalescence following a major vascular operation. The operation went well but I was forced to get myself free of the after-care ward because there was little after-care, no therapy, uneatable food and surly uncommunicative nurses.

    At home the district nurses have been excellent and more personal matters have been handled with love and care.

    My father was a doctor, my brother was a doctor and my grandson is a doctor – in New Zealand. What has happened to the dedication of NHS staff ?

  90. Michael Simpkin says:

    Having put comments on each of the categories I just wanted to record my general objections to the Bill for most of the reasons rehearsed above by others. There only two potentially good elements of it relating to healthcare are the improved integration of public health into local government (which may well be sabotaged by spending cuts) and the abolition of the ill-starred LINKs though there is no indication that Healthwatch will be any better. I never thought I would be standing in the streets to defend PCTs but it is a mark of the mistaken thinking behind the Bill (and the progress being made by PCTs) that this is what I have had to do. From outside the NHS it was difficult to see the point of SHAs but I think their problems have been more to do with command driven DH culture than their intended function – hence the likely growing role of PCT clusters. The Bill has already damaged the NHS – the ‘pause’ while welcome, has probably made matters even worse given the messages coming from David Nicholson. A further pause of months would be pretty awful too. Scrap the main elements of the Bill and look to what can be achieved within existing structures while they may still be salvageable. Over the past thirty years the main sources of wasted government spending have been disastrous procurements (NHS info not to mention the MoD), botched re-organisations and privatisations, and sell offs of assets well below value. All these are likely to be present in the proposed reforms.

  91. Rodney Yates says:

    All-pervasive competition is blazing a trail of destruction through very many health related activties. The main casualties of the Dogma include continuing care in mental health, where the presence of alternatives have spelt Closure for every facility providing continuing care country-wide, and is the chief source of distress, relapse and slide into misery for your clients – and the extremely wasteful closure of facilities which will only have to be re-opened later to reverse the damage perpetrated on the vulnerable people who rely on these services as their only sources of support and Hope to keep going in adversity.

    The paradox remains that offering choice boils down to Compulsion to remove people from and fracture the carefully laid channels of procedure for dealing with complexities in arrangements for contingencies to safeguard against relapse and a slippery slope back into acute distress. Closure of vital services is the main out-come. Those charged with our care need to Stop and Think before creating any further turmoil.

  92. web editor says:

    This page was closed to comments on 31 May, the last day of the listening exercise. Thanks for all your comments, which have been fed back to the NHS Future Forum to consider.

    The Forum will submit its report to the Prime Minister, Deputy Prime Minister and the Health Secretary in June.

    The government will consider the Forum’s findings and then publish its official response.

    Annelise@DH