Working together for a stronger NHS: How to get involved

There will be events running in every part of the country over the next two months. This will give people a chance to get involved – from specific events for NHS staff, to others involved with the NHS, and those already involved in making change.

You will also be able to post your comments and questions here on this website.

We’ll be posting more on how you can get involved shortly, including specific questions on the areas that we’d like your help on:

  • The role of choice and competition for improving quality
  • How to ensure public accountability and patient involvement in the new system
  • How new arrangements for education and training can support the modernisation process
  • How advice from across a range of healthcare professions can improve patient patient care
In Working together for a stronger NHS | Tagged

78 Responses to Working together for a stronger NHS: How to get involved

  1. ruth marsden says:

    Please be mindful that patient-groups, volunteers, LINk members and other service users are not working together 9 – 5, all week, every week, and will need maximum time to be alerted to this initiative, notified of opportunities to comment/ engage/amend.

  2. Michelle Smith says:

    Hello,

    Can you work with the country’s leading health charities who are bringing together the views of patients? the Bill lacks sufficient opportunities for patient and public involvement, and it would be great if you could listen to those of us on the frontline as to what would strengthen it.

    Find more about what the charities are saying here:

    http://tinyurl.com/3ttd7uj

    Patients need a say in the new NHS too, not just professionals.

    Thanks,
    Michelle

  3. Polly says:

    Hi,

    By ‘others involved with the NHS’, I hope this means listening events for patients.

    It’s vital that during the Government’s listening break, that the views of people who use NHS services are actively sought and listened to.

    NHS reforms need to ensure local people will have a say in their local NHS – find out why lot’s of patients are worried about current plans: http://www.rethink.org/how_we_can_help/campaigning_for_change/fair_treatment_now/fair_treatment_now_.html

    Thanks!

  4. Dave Neary says:

    Accountability:
    How will the Secretary of State be accountable for the NHS and the nation’s health? It is not acceptable that these decisions are passed onto the National Commissioning Board.
    How will GP consortia be accountable for the decisions they take in commissioning health care services in local areas? It is not acceptable that commercial confidentiality is used as an excuse to prevent taxpayers from knowing how and why our money was spent.

  5. Antonia Borneo says:

    I’m shocked that there is no apparent intention to invite patients to give their views. Who better to ask how the NHS should be accountable? I don’t think the Government realises how engaged the population is and would be in local health service design, given the chance. Surely this can only create a more effective health service?

    • Steven McDonald says:

      I am in agreement with Antonia! The Government has launched a listening exercise but I can’t see how the outcome will be a different than before unless you engage with a fresh set of stakeholder and wouldn’t it make more sense to actually ask the people effected most – the public! Surely the public have the right to determine and common sense to know what is best for them while working alongside clinicians.

  6. Isla Dowds says:

    I sincerely hope that you are going to promote and publicise these events widely, with special attention to how to make these events accesssible, inclusive to seldom heard and overlooked groups, from ethnic minorities to working age adults, and that it is not going to be exclusively promoted through the interent. The initial consultation was very poor on all these fronts.

  7. Natalia says:

    Specifically my concerns over the change in NHS are:
    GP consortia:
    * the GPs are trained to treat patients, not procure services and manage budgets
    * how are patient interest going to be safe-guarded? Now the financial issues may drive GP decisions to a greater degree than before making GP make choises of treatment based not on what’s best for the patient but what’s less expensive
    * how are patient interest going to be safe-guarded? The treatment that the patient receives will to a greater degree depend on the experience and caring of each individual GP.
    * how are patient interest going to be safe-guarded? GP consortia will vary in their financial management and consequently in levels of services that patients will receive. Some will be better at it whilst some less so. More postcode lottery.
    * what happens if a GP consortium is in a loss position?
    * how is decision integrity going to be ensured?

    Specialists are more often better placed to decide what’s best for the patient rather than GPs, due to the nature of their experience. How are they going to participate in deciding what’s best for the patient?

    • Sue says:

      Disagree entirely with your statement that specialists are better placed than GPs – hospitals have the biggest financial incentive of all in PbR!!

  8. Tony Brooks says:

    Make the GPs commissioners or the replacement organisation accountable by putting a percentage of their income 10 – 15% at risk for the decisions they make.

    Give the buildings housing hospital services over to the commissioning body and allow them to commission the services from the foundation trusts to go in those spaces. Only then will you get truly integrated services and the services that are required for the local population. Any provider NHS, social enterprise, private could provide the services within the buildings.

    Have the DoH put together contracts with reward and penalties that drive progression, inclusion and quality improvements that are reviewed every three to five years.

    Link the acute and all primary sector providers to demonstrate education and learning across there all areas and disciplines and make this a condition of their payments system. This will integrate the systems, allowing primary care providers to retain more of the simple cases and ensure that acute sector focuses on the more challenging cases.

  9. Carol-Anne Partridge says:

    I would like to know any events in the south west. I am a mother of a disabled child whose GP hasnt got a clue how to treat her or even what her condition is. GP’s are not specialists in Neurology or even complex conditions and I certainly wouldnt trust them to do the best for my daughter. Not least her complex epilepsy means that generic drugs or “cheaper” drugs that may be prescribed would compromise her seizure control.

  10. LD says:

    Please raise the quality of your debate and stop the attrition of dedicated and hard working NHS staff who are not ‘professionals’ or clinicians, staff which for the purpose of political grandstanding are grouped as ‘bureaucrats’. For the most part, the NHS cogs, in whatever way they are reformed, will not function without the talent, skill and experience of such people. To achieve the aims of reform staff groups and organisations must work in partnership with mutual respect – the caricaturing of ‘bureaucrats’ is disrespectful and harmful. It’s about time ALL staff groups were treated with equal respect.

  11. sue says:

    It seems to me that the ordinary person in the street is going to have no say in the future of the health care service that we will pay for and use but the government says I wants people (the big society) to be more involved in the running of our nation but not in this I wonder why? What are they trying to hide? It would save money if people had a day now as what people have a real say in. People are more than likely not to abuse so in the long run more appointments keeped not wasted so it will cost less to run.

  12. David Kirk says:

    I am an experienced Foundation Trust Public Governor and I am pleased that the Government is taking the time to listen and find ways of improving the proposed legislation to achieve the necessary NHS reforms. My particular interest is in the second of the four key areas of focus –
    “how to ensure public accountability and patient involvement in the new system”.
    I look forward to the opportunity to be heard.
    Please ensure that the “ways of getting involved” are well publicised.

    • Dr Richard Grimes says:

      I too am a publicly elected FT governor and I would like to know the answer to your question.

      Explaining FT membership is difficult, and consequently it is not easy to develop FT membership. Once someone is an FT member you would have thought that most of the work is done, but my experience is that if the trust is well run and there are no issues then the membership see no reason to engage with us. So ensure “patient involvement in the new system” is not a simple issue. Unless, of course, we yet again rely on self-selected patient groups (which, by definition, are not representative).

      Two months is simply not enough time to investigate that issue.

  13. Ian Wilder says:

    Having been at today’s launch of the listening event, I was disappointed not to hear any mention of the role of FT Governors. I have been privileged to be an elected public Governor for the last 6 years and was recently re-elected to serve for a further three years and proud to be associated with a very successful Trust.

    My concern is that previously published proposals envisage a greater degree of responsibility, including a statutory duty, for Governors in holding Boards, and particularly Non-Executive Directors, whom they currently appoint, to account for the Trust’s performance. Given that Governors are volunteers, I worry that having greater responsibility will equate to a greater commitment of time and that one potential consequence of that will be that the only people who can afford the time to be Governors, particularly of hospital Foundation Trusts, will be those who are retired. FTs have an obligation to have a membership which is representative of the local community and ideally Governors should be representative of that membership. Whether other FTs, such as Mental Health Trusts also have concerns about increasing Governors’ responsbility is also something which needs to be considered.

  14. Janet Roberts says:

    Its too late to consult, the dismantling of SHA and PCTs is already advanced. If GPs are going to commission care they will not have time, while doing what they are really qualified to do, so they will start to re-employ people who the NHS has just made redundant.

    It is false to think clinical posts are protected the4y are already being lost to meet finacial targets; not by comp redundancy but vacant posts being declared redundant.

    Privatisation of services will be inefficient, clinical specialists need to manage a whole range of simple and complex conditions to effectively use time and create an appropriate staff skill mix. The privatisation of out-of-hours services demonstrates that it escalates costs not make savings.

    Health care is an integrated and organic system which is being ruined by the current dogmatic, top-down and politically motivated changes.

    Change may be needed but this approach does not engage the staff or patients. GPs do not have a good record of being consultative or responsive. The notion that GPs know their patients is well out-of date. My GP has no idea who I am.

    • YS says:

      I agree with Jane – the plans are not in real terms being ‘paused’. i work for a PCT and the directive we have been given is that the development of the local consortia is continuing.
      GPs dont often know what is best for their patient – and also alot of practices where i live are owned by private companies like Serco – therefore in my practice i see a different GP everytime i go – how would this be GP led commissioning?
      if this is a real listening exercise this government needs to demonstrate that through actions not words!!!

  15. To be honest, if reform means earlier intervention in stress at work paid for through private business insurance Im all for it. I think the state still needs to insure us (nationally/internationally?) against risks to public health and safety thpugh (e.g. the-man-on-the-street scenarios). These are not mutually exclusive options and as the effectiveness of the former increases, the costs of the latter will decrease, over time. Its a mixed economy solution but one that means politicians should leave the NHS well-enough alone – if it aint broke dont fix it – doctors orders!

  16. Jack says:

    Are you able to say how these events over the next month will interact with purdah due to local government elections?

  17. SH says:

    It is totally shameful in your propaganda leaflet that NHS managers are coloured black whereas saintly doctors and patients are coloured white. If this Government wants its reforms to have any chance of working it ought not to keep treating these dedicated staff who really care about the NHS as pariahs.

  18. jessica says:

    Please come to Wiltshire would love to come along and find out more. Definately going in the right direction.

  19. Alex Scott-Samuel says:

    The Health Select Committee’s recommendations re NHS Commissioning Authorities should be implemented in full.

    The Any Willing Provider policy should be withdrawn and replaced by one that only permits private sector provision of NHS clinical services when public sector services are unable to cope.

  20. Julie Gibson says:

    One has only to look at UK national rail services to see what happens when a national service is fragmented…I despair at hte lack of common sense in this.

  21. Jennie Atkinson says:

    Privatisation of the NHS is not acceptable to most. When will the government learn that people are losing patience, and unless they do really listen, we will let them know our thoughts at the next election!

  22. David Palmer says:

    A consultation exercise was already carried out before the Health Bill was published, but the Government chose to ignore the results, leading to revolt in the Lords that prompted this listening exercise.
    Will listening be part of this listening exercise?

  23. David Palmer says:

    The Government ignored the results of the consultation exercise carried out before the bill was first published.
    Does it intend to listen as part of the listening exercise this time around?

  24. Paul B says:

    I have had real problems in my area with mental health services being very poor and my not having any opportunities to speak out and change anything.

    Having used many different parts of the NHS and social care my views are informed by a range of areas, not just the narrow part that my GP or specialist know of. As such, I and many like me have a great deal to contribute to debate and to commissioning plans.

    I’m very disappointed that the Government is so fixated on pleasing doctors and staff, rather than giving any thought to who the NHS is actually for – patients and service users. Even in their PR they are forgetting to even mention patients, let alone actually do anything more meaningful to listen to them.

    Please listen to us too!!

    ps. thanks to Rethink Mental Illness via Facebook for mentioning this site.

  25. Maggie Whitlock says:

    Why not attach the GP consortia to PCT Commissioning?

    Why are Local Authorities controlling LINK/HealthWatch budgets?

    Who commissions the advocacy and complaints service for local HealthWatch?

    Why obtain services from the private sector when these services are mostly available in the Public Sector?

    What happens to patient choice?

    What happens when the Consortia say we will pay x for this but the Foundation Trust Hospitals say we can only do it for y and the patient says I want it done there?

    How will GP Consortia empower patients?

  26. Cornelius says:

    The Health Secretary must stop using the terms “bureaucracy” and “managers” interchangeably. No one would disagree that excessive bureaucracy in the NHS must go, but you can’t deliver a £100bn service, or transform how it works, without top quality management, and lots of it.

    You wouldn’t say to Rooney and Tevez, “Here’s a load of cash, now buy yourselves 15 mates, devise a strategy and go and win the premier league.”

    Managers are already leaving left, right and centre. If Lansley’s not more careful with the language he uses he might find he doesn’t have enough management resource to deliver the reforms anyway.

  27. Stella Valerkou says:

    You ask about choice and competition in relation to quality, what about integrated care? Why not make the integration of services around the needs of patients, part of commissioners’ duties under quality improvement?

    What matters to patients is that their services are joined up around their needs, so duties in the Bill for integrated working should also recognise this as the goal

  28. christine hancock says:

    When are you going to consider merging Health an Social Care so that patients have an holistic assessment of their needs and access to the right re-habilitation programmes to enable them to live independantly.

  29. Angela Watson says:

    This is just a pr stunt and nothing else.

  30. Tracy Thirlwell says:

    When do we find out where and when these events will take place. Lets hope they are not all held in major towns and cities at obscure times. As a hard working member of the NHS (Midwifery) it would be nice to be asked our views, BUT more importantly it would be amazing to be listened to. We do the job we do for a reason but want to do it safely.
    Please listen to everyones views, we know some changes are needed, but do not compromise pateint care.

  31. Claire Johnston says:

    Hello,

    Does “those involved with the NHS” include Newly Qualified Speech and Language Therapists who as a direct effect of the cuts are unable to get jobs despite the NHS paying for our training and the desperate needs of the population?

  32. Dr Richard Grimes says:

    In the leaflet we are told that there will be events around the country.

    - Will these be invite-only events, in which case what is the point? You’ll only “listen” to what you want to hear
    - Will these only be in cities, in which case you’ll be excluding people from rural and suburban areas with different needs. The changes will affect all areas, so all areas need to be consulted.
    - Will you make an effort to have a representative group of people to “listen” to? People of different ages, different backgrounds and different ethnicity need different things from the NHS, yet we all pay for it. You should make every effort to “listen” to all of us.
    - Two months is far too short. You’ll only be able to “listen” to a select group of people in that time. If you genuinely want to listen, you need to have 6 months or more. It is is bizarre that a “once in a generation reform” is being based upon just two months of hurried consultation.

  33. Dr Richard Grimes says:

    If you want the electorate to believe that you have listened, you must provide a list afterwards of what was said and what changes you have made in response. Going into this process with an attitude that “you do not understand, so we will explain it to you” means that *we* have to listen not *you*. The responses to the White Paper consultations appear to have been dismissed out of hand (which is why the Royal colleges and professional groups are still against the Bill), don’t do the same with this consultation process: demonstrate that you *have* listened. If you listen, you may even like what you hear, but please LISTEN.

    And please drop the dodgy stats. Everyone who uses the NHS knows that it is dynamic, it is always changing. You do not have to talk down the NHS, its outcomes and staff, to make a case for change. GP groups are being pragmatic rather than enthusiastic about these policies, they are forming consortia to minimise PCT debts which, from April this year, they will be liable. It may help your case if you acknowledge things like this.

    • Bob says:

      Cameron and Clegg should visit Ward 308 at the Royal Derby. The care sevices to a good friend of mine are poor. Tablets/drugs not given at the right times of day (he has diabetes), lack of appropriate toilet facilities (he is large and without part of one leg and is unable to use the ward toilets without assistance), insufficient staff to provide assistance when required urgently. Diet: timing and provision of the correct food is abysmal. Clinical staff not making appointments. All this is making him even worse. Patients should not have to manage the ward staff for their own needs: there should be adequate attention to patient care. Changing the structure of the NHS will not overcome the inability of ward and clinical staff to give adequate care service. It is the process of this care that is crucial. The system is not designed as patient-centred – this is the key area for reform. The Lansley changes will cause so much structural disruption that it is very likely partient care will deteroriate further. My wife was at Nottingham City 3/4 years ago: same issues back then! So, what chance in really improving patient care?

  34. John Wallace says:

    One of the overlooked elements in the Bill are the clauses that abolish the General Social Care Council and the transfer of some of its functions to the HPC. In view of the current work of the Social Work Reform Board and the implications of the work of Professor Eileen Munro, it would seem appropriate for this decision to be looked at again. It appeared out of the blue as a cost-cutting exercise, rather than a clearly thought out policy decision. Whatever the faults of the GSCC in the past, there is significant work to oversee in a statutory froamework in respect of Social Work Qualifying and Post-qualifying Education. The HPC does not regulate or oversee standards in the same way, nor does it hold curriculum or framework structures. Even if some of these functions are eventually placed within the College of Social Work, the College at the present time is nowhere near ready to undertake these tasks and I fear that much of the good that has come out of the PQ framework will be lost in the transition.

  35. John Kapp says:

    The problem with the NHS is that the treatments (drugs) generally don’t work to cure patients, and do more harm than good because of side effects. I support opening up the market to Any Willing Provider because that will allow SME’s to contract with
    GP corsortia to provide NICE-recommended complementary therapies, such as the 8 week Mindfulness Based Complementary Therapy (MBCT) course, and spinal manipulation by chiropractors for low back pain. See my website for details. This will remove health inequalities, because the rich can and do pay for these treatments, and the poor cannot afford them, so suffer 18 years more long term conditions, and die 9 years earlier, as the Marmot report found.

    • Des King says:

      In the Western world, it is accepted or rather believed that “we are the best”. In view that China are the world leader in medical research and have a much better ethos as they look at the whole being not just the issue, when will we ( the westerners ) accept that complementary therapies do help and indeed can be better than western medicine and often are !!!!

  36. David.Brown says:

    the idea that GP’s can commission healthcare in isolation to their secondary healthcare colleagues is mistaken in my view. Surely this process should be a co-operative one between GP’s and hospitals so consortia boards should surely include representatives from secondary care such as consultants, nurses, hospital managers and should also include properly elected councillors as public health will now sit with Local Authority’s. More importantly consortia boards must include patient’s from within that consortia area. The idea that clinicians should commission care is entirely correct but secondary care must have direct input into that process.

    In order for primary care not to fragment then shouldn’t dentists, opticians and pharmacists also be administered by consortia. They are all important primary care providers and have a role in the provision of healthcare both now and in the future. they can also provide commissioned services much more cheaply than secondary care.

  37. David.Brown says:

    Here is a thought

    Schools are overseen by boards of governors who are parents/members of community and political appointee’s. The head teacher runs everything but reports to the governors. Why shouldnt a similair model apply to consortia? please do not tell me that healthcare is to complicated for this sort of arrangement.

    oversight is the most important issue facing these reforms, without proper arrangements for consortia to be accountable to the populace they serve then all the talk about empowering patient’s is meaningless.

  38. Catherine Coe says:

    As the new bill will provide additional opportunities for GPs to make a lot of money and as they are all self-employed business people, will the government consider saving the public purse a substantial amount of money by ensuring that the same self-employed business people do not also recieve state-funded NHS pensions when they retire?

  39. Seamus Breen says:

    Care pathways for many people entails receiving support from health and social care inc voluntary sector.
    Promoting good health and investment in prevention requires input from a range of agencies including voluntary sector.
    Shifting from an over reliance on acute provision and the creation of alternatives requires both health and local authority creative solution finding and accessing the new opportunities provided by telecare, telehealth and the capital assests of the market.
    In other words the time has come to end the old thinking of seperate health commissioners. Think whole system integrated solutions shaped by whole system creative commissioners. The future of the NHS does not lie in the NHS alone.

  40. Sarah says:

    I manage children’s community services, that work with children who have significant levels of disability and their families. Most GPs have only one or two of these children on their caseloads in their whole careers – much of their complex care is taken on by community paediatricians. It worries me greatly that these services will continue to be ‘cinderella services’ under GP commissioning, struggling to compete with the stronger call of care for adults with coronary heart disease, cancer etc. It has taken time for us to develop the relationship with our current health commissioners to a level where there is a good understanding of the needs of these children and it grieves me to think that we will have to start over.

    I agree with others that it is time for the Government and the media to stop the campaign against managers in the NHS. I’ve worked for the NHS for 23 years, the first 15 as a clinician in the area of care I now manage and with the children I am now advocating for with commissioners. It is my commitment to improving the services available to these vulnerable children and their families that keeps me in this post and that commitment is what I see in most of my colleagues.

  41. Ros Taylor says:

    The need for changes to the NHS is a constant. However, there are other ways of acheiving it than this wholesale change,which seems particularly reckless when budgets are being cut so drastically. Reorganisations take time,money & attention away from the main business, in my experience previous changes have taken at least a year to settle down & it is ironic that a change which seems to emphasise localism is being driven by the centre against the will of most of us. More could be acheived by asking staff & patients about possible change rather than alienating them.If you persist in maintaining a health market in this country then you will need people with contacting skills, while you have legislation designed to ensure safe services ,you will need people to inspect that this is happening. These people get labelled beaurocrats, GP purchasing consortia will need them, as GP’s don’t have these skills, or in my experience, the interest. You will have PCT’s by another name, so why dispose of them , bound to cost?

  42. Archie says:

    The biggest cause of money being diverted from patient care is the current marketised system and having to finance everything that props it up. The current proposals will only make things worse meaning public monies being diverted into private shareholders pockets. It is clear that a financial surplus is obtainable from public healthcare otherwise these private sector vultures would not be interested. All available public money should be reinvested in the NHS to enhance front line delivery of care, it should not be allowed to be taken out of the system.

  43. peter davis says:

    I would like a cast iron,definitive and categorical statement from the P.M. Deputy P.M. and the Health Secretary -

    ” That the Health Service will continue to be FREE for all at the point of neeed”

    I never want to revert to the 1930′s and 1940′s when we could not afford to call a G.P. as did not have the money to pay him.

  44. Anthony Rodriguez BSc Health Sciences (Hons) says:

    Where does mental health fit into this plan? It’s already a Cinderella arm of the NHS. The other great faultline in the Lansley vision is that with GPs controlling the NHS budget, they are bound to cherry pick funds for primary care at the expense of hospitals and mental health units.

    PS It would handy if contributors to these threads picked up on other’s points more and developed a debate, not just a series of similar statements saying much the same thing.

  45. Francesco Palma says:

    Two month’s listening and reflecting will allow for due weight of consideration to the voice of the working from within the NHS but will the voices of the patients,public,service users and carers be given due equity of consideration.
    We await the quality requirements of the NHS Outcomes Framework which will cover the domains of clinical effectiveness, Patient Safety and importantly Patient experience, these changes should benefit users of services but it is the system redesign that appears to be the problem, coupled with the forthcoming report from the Law Commission on changes to Social Care reform and those just started with the DWP with respect to Incapacity Benefit etc it does feel personal. Given that the outcomes are for users of the NHS should it not read ‘Nothing about me without me’, That being the case please move to a bottom up approach.

  46. Neil Chadborn says:

    This is not consultation part 2 – the reorganisation has already started with redundancies (‘frontline’ as well as ‘managers’) and ‘clustering’ of PCT’s. This is PR, but merely for the record, a few things from the flash new ‘leaflet’:

    ‘No change is not an option’ (not because the country is in debt, but because of pensioners etc). Why did Cameron say no more top-down reorganisations then – what’s changed?

    I haven’t read the whole thing, but I’ve searched for a few keywords, which I think are important qualities of a health service. I haven’t managed to find the following words: quality, sustainable, waiting, accountable, value, reliable, resilient, transparency, equality (or inequality).

    I did manage to find: personal (as in budgets, not care), morale (bureaucracy bad for…, not reorganisation bad for…)

  47. Kathryn Mears says:

    I do not think that all GPs are as trusted by their patients. Many GPs are basically small business men/ women who will try to maximise their profit at the expense of their patients.
    A consortium will not necessarily focus on what is needed by patients in their area but what interests / profits its members.
    Is NICE still going to exist in this brave new world of medicine?
    As for regulators, I know what has happened in the water supply, transport, gas and electricity supply costs, and they all have regulators.

  48. Corinne Camilleri says:

    When did ‘to listen’ become ‘to explain to you why you don’t understand I’m right’? If this exercise is to mean anything the current rush to abolish must stop immediately while we take a good hard look at what is needed.

  49. Corinne Camilleri says:

    The recent Health select Committee Report addresses many of the concerns i and others have. Why is it not being taken more seriously?

  50. Janet says:

    The NHS Reform bill as it stands is pure ideology. GP’s are providers of health care – not commissioners. They will be put in a conflicting position. Any willing provider, what about EU rules, we would be open to competition from European private health clinics, this could result in local hospitals being closed. Not to mention the prospect of litigation. Commissioning boards need represenation from a wide range of health professionals so that decisions are being made based on expert knowledge. The NHS is the envy of the world, why would we want to adopt an American model based on ability to pay rather than health need

    • GA says:

      GPs definitely are commissioners of care.

      Currently they commission care for their patients – it is called a referral.

      One of the weaknesses in the current PCT commissioning arrangements is that GPs control the spend by referring or not referring their patients to Hospital Trusts.

      No matter what PCTs do today, GPs can blow the budget by referring more patients for outpatients and/or investigations. That is why GPs have to be at the heart of the new arrangements.

      PS I am not a GP; I have recently left a PCT as a Commissioning Director!

  51. Mike Townson says:

    There is a great need to widen decision making beyond Dr’s and Nurses who, in the most part provide the traditional medical model of health care. There is a need to engage with Allied Health Professionals (AHP’s) such as podiatrists, who are developing innovative and transformational roles such as foot surgery, prescribing and prevention of foot ulceration and amputation. For their sake lets use this thinking time to reduce any chance of conflict of interests for GP’s so that they can commission based on need and best value without the complication of incentives. Lets focus on collaboration not competition please.

  52. Andy McAllister says:

    To say ‘no change is not an option’, and then argue that the only alternative to ‘no change’ are these reforms, is very dishonest. This might not be full privatisation or a ‘US style health insurance system’ yet, but they are great strides towards that goal and that is clearly the direction the government is going in.

    There are also no clear plans for accountability in the proposed system, and there is no evidence that it will cost less than the current system. And the mantra that ‘competition improves performance / quality’ is just a myth – there is no evidence that this is the case, and in fact the evidence from previous privatisation of public services shows the opposite, ie that quality is severely reduced (e.g. social services, trains) and the cost to the taxpayer is greatly increased (utilities, water, trains).

    Nobody denies there is a need for reform, but market reform and creeping privatisation is not the answer. Nobody wants these reforms, and nobody voted for them, so they need to be ripped up completely and replaced with clear evolutionary change that is built on greater co-operation NOT more competition.

  53. Helen says:

    Two points
    1. promises to ‘protect frontline staffing’ ignore the reality that if the ‘backroom’ staff go but the tasks they were required to undertake remain, the frontline staff have to spend some of the frontline time doing backroom’ tasks less efficiently than their admin colleagues and there is even less time for clinical work.
    2. working in children’s mental health, I am concerned that the new proposals will leave an already poorly understood and resourced service even worse off since the difficulties children experience are not often ‘fixable’ employing an individualised or medical model or quick fixes through drugs. The systemic and team approach may appear expensive to a consortia looking short term but the costs of failure to help effectively will be felt not only by the child but by all who are or become involved for their life. Who has the strategic responsibilty in this system?

    • Corinne Camilleri says:

      I completely agree with this. As a medical consultant I make a very expensive filer.

  54. YS says:

    I’m a nurse who is now a commissioning manager working for a PCT – it is absoulutely disrespectful and de-motivating the way in which managers like myself who are hardworking and have really dedicated ourselves to working in the NHS are being typecasted by this government. I just have one message getting rid of the ‘managers’ does not ged rid of the the bureaucracy!!! that will exist regardless…..

  55. Corinne Camilleri says:

    Why has the Chief Medical Officer been nominated as the Public Health expertise on the Forum? she has no public health training or experience. Surely the Faculty of Public Health should have been asked for their nominee? Or, at the very least, a trained public health professional should have been nominated?

  56. george wyatt says:

    It was announced today to the volunteers and patients that the Day Centre at Hayward House Hospice will cease in its present form on 1st September this year. No more patients are being accepted after the 1st April. I as a volunteer was totally dismayed by the news. I know the patients were very upset. Many of them rely on this service as it gets them out of their home for a few hours and for some its the only time they get out. They also have the opportunity to talk to medical staff about any problems they are experiencing which is very important to them. How anybody can treat the very ill in this way is beyond belief.
    This unit has been supported by volunteers and many donations to make it the excellent facility it is and I am sure they would continue to do so if it remains open.

  57. CG says:

    As a nurse I have seen first hand over the last 10 years how the NHS has changed for the worse. What is needed is to stop the blame game and to start looking forward. Most managers in the NHS are good at their jobs but are restricted in a case of the left hand not knowing what the right hand is doing.
    The NHS has changed dramatically from its original purpose and thats a great thing, but staff everywhere are feeling de motivated and put upon, to the point of near burn out.
    The NHS is in drastic need of reform but the way in which its gone about is completly wrong, cuts are made on a reactive basis without the concequences being considered whilst obvious ways to save and even bring in revenue are ignored because they dont have immediate results.
    We almost need to wipe the slate clean and start again. Managers front line staff and patients of all professions within the NHS need to be involved from cleaners to paramedics, Doctors and Managers and Nurses and HCAs as well as the patients and politicians and this needs to be a process without political gain, impossible I know but I can dream!

  58. Angela says:

    Radical change will not improve the NHS. Try these instead. Closer scrutiny of Executive Managers’ expenses. Collective purchasing to drive down prices from greedy suppliers. Charge all drunks in A&E for treatment. I am sick of hearing about the “ageing population”. It has become a stock phrase. What about drug addiction? What about (as before) drunks clogging up A&E? What about health tourism? What about the increased population now that millions of foreign nationals entering the country (they need healthcare too)? What about the shocking increase in GP salaries leading to a reduction in working hours? These are the ways which money can be saved in the NHS, not the loss of frontline staff and an unnecessary radical overhaul which could lead to many deaths due to refusal of treatment when funding is low.

    • Des King says:

      Perhaps if the Government reformed the drinking laws and reverted back to 10.30 weekday closing except w/ends,then maybe the savings from the extra Policing of ; A&E, drunks, anti-social behavior,noise etc. etc. etc. could be spent on more realistic care in the NHS ( a bit off topic but I think it could help)

  59. linda says:

    Here is a radical thought…….why dont we sack all the many levels of management that push paper stats all day and use the money to employ more doctors and nurses to look after patients properly. As soon as there is savings to be made they are the very ones that sit there and make decisions on how to save thier own fat cat saleries whilst targeting frontline staff!

  60. Carolyne McKinlay says:

    The government has stressed again and again the problems and difficulties faced by the NHS eg aging population, increase in medical technologies et etc.

    As part of this exercise I think it would be helpful to share with the NHS, patients etc the evidence which shows how the proposed changes will sort all of the problems, including the stress tests they have been subject to.

  61. Short notice cover says:

    Good idea to consult.

    In order to facilitate full concordance with consultation GPs will need time away from clinical commitments.

    In order to minimise disruption to patient care during consultation the government should fund locum cover for practices so they can hire staff to cover the clinical sessions missed.

    GP Locums who attend a consultation will miss a session of work that would otherwise generate income. Locums ate often booked several months I’n advance & it would be unprofessional for us to cancel a clinic at a practice that has been agreed in advance. Will funds be provided hybrid government to cover loss of earnings incurred through attendance at the consultation? Will funds be provided to the Locum to reimburse the practice for cancellation of clinic & provision of alternative cover for the practice?

    Will workplaces allow patients time out to attend consultation meetings? And how will this be arranged/funded?

  62. Diane says:

    I have been told by my doctor that I cannot receive treatment for my mental health problem on the National Health and must pay for private treatment. I explained that I cannot afford this and he reluctantly referred me for an assessment with a mental health nurse. I asked her if I could get treatment and she informed me that there was only one clinical psychologist working two days a week for the whole area and he wasn’t taking any new referrals. Why waste the time of myself and the nurse if there was never going to be a chance for me to be treated?

  63. philip nolan says:

    How about stopping health care professionals, nurses, doctors, cleaners etc paying for the privilige of parking at work that would be nice, and really boost morale. Do the Police force pay to park at the station ? do teachers pay for parking at their school ? and i bet MPs dont pay for parking at their surgeries when they are there ?
    I really hope this isn’t another publicity stunt and change for change sake. Remember making the ‘NHS Modern and Dependenable’ all those years ago turned out Makeshift and diabolical.
    The Patients Charter, I like that we are all patients at some point, but what about a Nurses Charter to help us stop being abused and blamed for the poor service we have to work in. Seriously I am no longer a Community psychiatric nurse more like a Computer psychiatric nurse because i have to spend 80% of my time at a desk nursing defensively and filling in statistics and admin that I never see the results from. So some bearueacrat somewhere can say how we are doing.

  64. Professor Paul Bywaters says:

    So where are these events, then? A week into the eight week pause and there are no events posted on the site yet.

    And why the need to listen any further – all the experts and the public have made it abundantly clear over the last nine months that the plan to reform the NHS (for which there is no electoral mandate) should be withdrawn.

    In the meantime while Andrew Lansley and David Cameron plan to privatise the NHS, the £20b cuts are already eating deep into current services. Safe in Tory hands? I don’t think so.

    • web editor says:

      Thanks for your comment. We will publish details of the events once they have been finalised.

  65. Emma Kean says:

    The nurses have spoken…are they listening?

  66. web editor says:

    Thanks for all your comments, which will be fed back to the NHS Future Forum.

    Comments on this page are now closed but please continue to send them via our Listening exercise: how to get involved page. They will all be fed back to the Future Forum.