Focus on Health & Society Series: It doesn’t really matter who provides your healthcare

By Adebusuyi Adeyemi.

In the latest installment of the Focus on Health and Society Series by the Health Network, Adebusuyi Adeyemi argues it doesn’t really matter who provides your healthcare.

A few weeks ago the Health Network held a debate around the ideology of private sector involvement in the NHS. The best compliment I can pay (and it is a compliment) is that I had such a massive headache afterwards. Rarely has my mind been so stretched, by so many sharp minds. Or maybe it’s all the daytime Judge Judy turning my brain into slush? Regardless, arguments for and against the motion of whether it matters if [more] private enterprise supplies healthcare were keenly exchanged, whilst the House of Lords voted for Section 75 down the corridor. Can you can guess what end of the spectrum I sit on…?

The NHS has always relied on private contractors. Many GPs are self employed and hold contracts, either on their own or as part of a partnership with the NHS. Dentists, Pharmacists and Opticians are nearly all privately owned. Similarly, it is private contractors who provide almost all of the IT equipment, build the hospitals and make the drugs. All our health related data is held on private companies’ machines. Heck, when the government tried to deliver a coherent IT vision, it failed. Admittedly because the private sector had already delivered on a lot of it and fought hard to maintain its share. Still, ‘privatisation’, strictly speaking should be viewed as what it is: the transfer to the private sector, of services which were previously provided by a struggling public sector.

Not sure where I stand yet? How about if we consider the hypothetical of owning a clothes shop. This is the only clothes shop in the city. Our clients/customers have no choice but to shop here, irrespective of the choice and quality of clothes we offer. If, however, we find that another shop is opening next door to us, providing nicer clothes for the same price or cheaper, with more choice, then that will force us to change the quality of the garments and the level of service that we offer; otherwise we’ll rapidly go out of business as our competitors will take customers away from us. If you haven’t figured it out yet, I support the idea that it doesn’t really matter who provides your healthcare, as long provided (and regulated) well it is.

Now, for all my spiel of corporate involvement, I don’t worship at the feet of the private sector, nor advocate the full disembowelment of the NHS. ‘Slippery-Slope’ arguments aside, regulating private providers properly in any sector is the responsibility of the government and this must be done, and done well. We can’t trust the Coalition Government to regulate private providers so that only people in the south are looked after, or that health inequalities increase. Still, we must give the principle of private-provider involvement a fair hearing.

The Health Network and guests recorded a draw for the motion on the night, which was in stark contrast to the votes counted from the wider community online. As a strong supporter for the motion, I was pleased to see a few people warm to the philosophy of increased private sector involvement, proving discussion is key to advancing thought in this space.

Introducing competition will mean the NHS will be forced to increase the quality of the work that it does otherwise an external provider delivering a better quality service may be appointed instead. From a business perspective (and the government’s perspective) this makes sense as it weeds out poor performing providers, replacing them with better ones (and if there are no better providers, then the current providers will remain in place).

There are many caveats to add to this piece that time (read word limit) doesn’t permit. From ensuring the principles of greater equality of power, wealth and opportunity are maintained, to detailing how our value(s) of collective action and public service do have a place alongside a more competitive NHS, there’s more I wish I could say. But this brief piece is only to stimulate thought, I hope it does.

What if only one chain of universities supplied doctors? Or only one drug company was allowed to make N-acetyl-p-aminophenol (paracetamol #Geek)? Unions, Socialist Medical Groups and others are right to assert the Health and Social Care Bill will result in increasing privatisation of the English NHS. In fact, this is in keeping with the “supply side” economic policies of this government, which promote privatisation throughout the entire public sector (Royal Mail, Urenco and the Met Office to follow soon).

However, there is an idea that needs to be considered seriously, that it doesn’t really matter who provides your healthcare.

Adebusuyi Adeyemi is Chair of the Health Network.

The debate was organised by the Secretary for the Health Network – Lauren Milden and chaired by Ivana Bartoletti of the Fabians Women Network.

Focus on Health & Society Series: Can the NHS become a successful business?

By  Richard Stebbing with additional comments by Adebusuyi Adeyemi.

In the latest installment of the Focus on Health and Society Series by the Health Network, Richard Stebbing looks at whether the NHS can become a successful business.

If the NHS were a normal business, then given its tumultuous performance so far in 2013, its share price would have probably fallen. Of course the NHS is a business, but given it is in the business of protecting the nation’s health, with its fortunes so closely woven to that of the Government it is a unique one. We know that the NHS is underachieving in terms of productivity and it is under pressure to be financially prudent in the face of ever increasing demand; whilst the recent findings of the Francis Report on Mid Staffs have underlined how factors of care and compassion cannot be discarded. Therefore we must consider how the NHS can be a more successful for its customers, employees and employers. Its shareholders, customers and investors, try figure out who’s who! Answers on the back of a postcard.

Making sure people are good at their jobs and doing jobs that are needed

So, considering the NHS is like a modern business. Considering it rewards key staff for good performance and it evolves, developing new areas of business. One glaring deficient area is in retraining or making redundant staff that are no longer required in their present roles. Now the premise of cutting necessary staff from the NHS is one that rightly fills many with dread. However cutting unnecessary staff – well that is something that makes good business sense – especially good business sense when it is us that is employing them, and that this is public money that can be used for ‘better’ things. Ask almost anyone that works in the NHS and they will tell you that administration is bloated and can be reduced. A solution is restructuring and reappraising NHS non-frontline teams and making staff reapply for these new roles if reductions in team numbered are deemed necessary. If we are serious about the NHS being a productive, successful business, then unnecessary staff is an opportunity cost that has to be considered.

Adapting GP surgeries for the 21^st century

Most people now use the internet as the basis for all communication and arrangements in their social and professional life. Yet for most people the most advanced aspect of NHS services is receiving a text message reminder for that upcoming appointment or renewing their prescription online. Yes, yes, we know the more technologically savvy are messaging on other platforms like Whatsapp and Facebook. Still, there is significant inefficiency and wastage in not making adapting more services and logistics in the NHS to take advantage of internet technology.

For example, create a web-based GP booking as the default booking service. It is simply inefficient to have the default method of booking as phone-based when the technology for patients to complete web-based forms on their symptoms and select available appointment time slots exists online. Crucially this would mean that patients can book appointments 24/7 – i.e. when they fall ill – rather than when the GP surgery is open. This would reduce this burden for administrative and supporting staff in GP surgeries, especially in the 15 minute window when a GP surgery opens, and would mean that these staff are freed up to help the running of the surgery in other ways throughout the day.

Such a system could also be used to coordinate bookings with specialists and consultants, which if made more interactive, could help patients attend and cancel appointments they cannot make thus ideally meaning that these appointments could be allocated, say via email, to other patients in need at short notice.

Another simple idea is allowing patients to register with a GP online. When the process essentially involves proving one’s address via an official letter and completing a basic health questionnaire, why does this have to be done in the GP’s surgery? Doing this online would save time for the patient, who might otherwise have to take time out of the working day, and also GP surgery staff.

Using technology to aid patients in self-care

Another area where technology can be embraced is around patient self-care. In 2011 I (Richard) had the misfortune to contract Bell’s palsy for around 3 months. My GP at the time was helpful and gave me some printed information on the condition. However I received no information/advice around necessary items of self-care that I would need to undergo, such as taping one’s eye completely shut on a nightly basis.

I found useful information in this area, by a chance YouTube search after a few days, and research for this article demonstrates that similar information is also available for other conditions. Given that most patients do not master aspects of self-care on day one (for the record I was waking up each morning with my eye un-taped and open at first); technology here can help reduce patient follow-ups and can help them recover quicker and better. This also embraces technology; this form of advice needs to be more interactive than a piece of paper. So why not have health professionals email relevant self-care information to patients? I am not suggesting that patients are emailed arbitrary links, but why not have NHS-branded self-care videos either using actors or volunteering patients under supervision? It would be cheap and very useful to many patients. It would also save on GP printing costs! Isn’t the NHS in the business of being useful to its investors, shareholders and customers?

Richard Stebbing is a Young Fabians Member and Adebusuyi Adeyemi is Chair of the Health Network.

For more information on the Young Fabians’ Health Network email Adebusuyi: healthnetwork@youngfabians.org.uk.

Focus on Health & Society Series:Leadership and the NHS

By  Richard Stebbing.

In the latest installment of the Focus on Health and Society Series by the Health Network, Richard Stebbing looks at Leadership and the NHS.

Recent events in health policy, from the NHS Reforms to the Francis Report, have raised the question of how the NHS should be led in order to make the NHS truly world-class and to ensure that episodes such as the Mid Staffs scandal do not happen again. Whilst the desire for good leadership exists it appears that at the heart of many NHS institutions there is a considerable gulf between leading managerial staff and clinical staff which is causing bad decisions to be taken and for the morale of NHS staff to be broken in the process.

By now it is well known that the NHS is facing a desperate period financially. Record numbers of patients come through the doors of NHS buildings, and the health service appears to be ill-equipped financially to deal with such demand. The Nicholson Challenge of £15 billion in efficiency savings by 2015 – i.e. cuts to NHS services – has attempted to address this problem.

However it seems that the implementation of the Nicholson Challenge has been poorly led, without long-term thinking and clinical foresight with regard to the consequences of cutting key services. For example we know that since the Nicholson Challenge was introduced patients are facing longer waits for, or simply not being given, vital operations such as hip and knee replacements, cataract removal or hernia repair. This comes at an incredible long-term cost and risk – patients’ quality of life without these operations will suffer and as their body continues to not be repaired they may be unable to work and therefore contribute to the economy. Furthermore as conditions worsen the chance of needing emergency surgery increases, and the worse a condition gets, then typically a patient will require greater recovery time in hospital.

There is a logic to imposing financial restraints in the NHS to generate stability, especially when considering that shoddy financial management has blighted leaders in the NHS during the early 2000s – for example NHS Peterborough PCT which saw 4 Chief Executives in one year – however it seems ethically concerning that a Chief Executive should put the long-term health of patients and the NHS at risk by implementing such short-term cuts to services. Bad managerial decisions are being taken, often in isolation from clinical colleagues, which are likely to be running up a bill for the taxpayer in the long-run, whilst decreasing the quality of life of patients. Furthermore as we read last week with the case of Gary Walker, senior managers and Chief Executives in the NHS who refuse to make these bad decisions are being dismissed – bad decisions, again, being made.

As highlighted in the Francis Report this ‘isolationist’ style of management at Mid Staffs allowed a negative culture to develop which had a devastating impact on the quality of care on offer to patients, with clinical staff feeling unable to raise concerns and effectively feel decapitated from the running of their workplace. The positive performance outcomes of some Trusts[1], such as Cambridge University Hospitals Foundation Trust and the Royal Free Hampstead NHS Trust, during this period, however, illustrate that strong, collaborative management can yield positive results. In part, these examples often hinge on innovative solutions being generated between Board and clinical leaders which emphasise both efficiency and care-centric processes.

The current NHS Reforms will put GPs at the centre of NHS commissioning – however there are clear concerns that they do not want to be leaders[2], nor that they are adequately prepared for this role[3]. So what alternatives are there? If a detachment and a lack of teamwork and collaboration between NHS Board managers and clinical staff is the cause of a negative culture with the potential for serious implications on the quality of care provided to patients then this has to be addressed. In terms of leadership at the top of NHS hospitals, CCGs etc. then we need to be encouraging health professionals to take leadership/management roles and preparing them adequately, such as with health economic and management training. If we can develop leaders of this calibre, who ostensibly have a foot both in the camps of the ‘professional’ manager and the clinical staff then it is likely to help foster a positive working culture of collaboration and partnership between the managerial and clinical staff in a hospital. This is similar to the model often used in Europe where experienced clinical staff often move into running hospitals and this has happened successfully in the NHS. Dr Peter Carter (now leading the RCN) was a psychiatric nurse who later ran NHS North West London Mental Health Trust for over a decade having developed a skillset in management. It is these dual professionals who are best placed to effectively lead in the NHS and help generate the positive working environment necessary to address concerns raised by Francis and stimulate a progressive approach to making sustainable efficiency savings

Buckling up for NHS duel in 2015

By Adebusuyi Adeyemi.

When things fall apart, you can half expect some form of trouble-shooting to go down. Like the old westerns, the heroes stride into town, gather intel, draws guns at dawn and then saunters off into the sunset. In the world of computer hackers, the FBI browse hacker forums, recruit the best and the rest is declassified, possibly to be memorialised in a Hollywood film. However, with the NHS, well intentioned ‘heroes’ [read governments] often trouble-shoot in the wrong saloon, forget to consult the sage old bar managers or replace town sheriffs with bank managers. Envisaging and creating problems where there are few.

For example, the latest changes to the NHS from the Coalition Government have given way to a deficiency in experience at the NHS – particularly in managers involved in strategic planning. The new organisations will take time to get settled, notably, new clinical commissioning groups that may not be able to keep a grip on systems such as finances. For instance, the NHS Institute for Innovation and Improvement is just one of the many bodies that helped the NHS to improve performance but is now being dissolved. Things may fall apart even further. Don’t let the mid-term reviews fool you.

Besides being the title of the award winning African novel, when things fall apart is often the signal for trouble-shooters to start loading their pistols. But things aren’t always mended as soon as they fall apart. You live with my dad long enough you’ll realise that. You may also realise how long you can go watching ‘Downtown Abbey’ with a blue hue on a broken TV, but that’s by the by! It is not necessary everyone accepts the miss-firings of the coalition government, then hold up badly hit targets to the towns’ people. However, one must work in the trappings of a democratic society and one suspect’s opposition leaders see no electoral benefit in this fight right now. Although Ed Miliband challenged David Cameron over NHS spending last month, a real fight may be some way away. Labour’s shadow health secretary Andy Burnham did slam the Coalition’s record on the NHS but latest developments hint strongly at waiting for further mishaps from the coalition government before taking this issue up in earnest.  What exactly will fall apart even further?

Well, these latest NHS debate(s) have not matured yet, least because policy changes have not yet bought new evidence to analyze. This may explain why it hasn’t made headlines recently. Nonetheless, for those outside of the politicking, this should mean looking for the upcoming risks and the opportunities to make the best of a bad situation.

More liberal minds focused on the value of public service and collective action (a la ‘One Nation’) may say the expression “if it ain’t broke, don’t fix it” doesn’t apply to conservatives walking around with hammers. Sage NHS minds may agree (if they’re not the one and the same) and say the NHS hasn’t been helped with £1.6bn being diverted away from patient care to back-office restructuring.

It’s critical the best is made of a potential worsening situation and one of the opportunities this restructuring may provide is for reduction of health inequalities. At the risk of over-extending the Old Western metaphor, local authorities have been given bigger wagon wheels (i.e. greater roles). So, as a King’s Fund mid-term report puts it, ‘this could lead to greater efforts to tackle the wider determinants of health and reduce inequalities’.

It appears David Cameron was more concerned with changing the Tory brand and so made promises on the NHS he has no strong desire to fulfil. In the noisy and continuing debate over NHS reform, left-leaning minds with a genuine regard for a progressive NHS would do well to keep their trouble-shooting hats on and stay on the rodeo. Every commentator has a different take on how the new NHS will work and which new bodies will have the most power when it all kicks off in April 2013.

The Young Fabian Health Network aims to support the formulation of policies that will reverse any damage done by 2015, so let’s make our voices heard. Members of the Young Fabian’s Health Network have the passion, experience and ideas to lead this. If you have an opinion, do get in touch either giving your thoughts in the comments section below or dropping us a line at healthnetwork@youngfabians.org.uk. The Health Network works best by pooling the ideas and thoughts of many different stakeholders together, so buckle up and think about getting involved. Yeehaw!

Adebusuyi Adeyemi is Chair of the Health Network.

A new approach to public health

How much do the government and the market affect people’s ability to pursue a healthier life? In this Guest Post, Amrit Caleyachetty says ‘not enough.’

The Conservatives generally think that the answer is not much.  Andrew Lansley, the Health Secretary, believes that reducing nutrition-related chronic diseases such as obesity, coronary heart disease, type 2 diabetes mellitus, and cancer, can be achieved by individuals taking personal responsibility to eat less and move more.

In the UK, socioeconomic inequalities in avoidable illness and premature deaths for chronic diseases are directly attributable to socioeconomic differences in dietary patterns.  Research has demonstrated that lower income households generally consume more calorific, nutrient-poor foods and drinks compared to more affluent households, which are more likely to subsist on a diet of healthy fruits and vegetables, whole grains, lean meats and fish. Therefore, belonging to a lower socioeconomic group carries with it a greater likelihood of becoming overweight and obese.

At a time when Labour is thinking about developing progressive policies in the context of there being less money to spend, reducing the burden of NHS healthcare spending is an important consideration. Last summer, The Lancet reported that if the current obesity trends continue into the future, by 2030 there will be approximately 8.5 million incident cases of diabetes mellitus, 7.3 million incident cases of cardiovascular disease and more than half a million new cancer cases, with treatment costs approximately £2 billion per year.

The food and drinks industry’s response to this has a sense of déjà vu. The tobacco industry systematically undermined tobacco control policies, claiming that increasing the price of tobacco via taxation was regressive and that regulating tobacco interfered with individual freedoms. They aggressively lobbied government to endorse a policy whereby the industry would regulate itself free from state constraints. The current government has mollycoddled the food and drinks industry, suggesting that it will not let widening social inequalities in health frustrate big business’ pursuit of profits.

In upholding commercial interests over the public’s health, the Conservatives are at least consistent with their ideology. However, this does not mean Labour can be too pleased with its own record. The party failed to recognise that an unfettered market combined with loose government oversight was a recipe for enduring social inequalities in chronic diseases. When Labour left office, a sign of this unhealthy relationship was that 40 of England’s 170 NHS trusts had signed long term commercial leases to fast food restaurants and high-street coffee shops.

Reform is desperately needed to prevent an obesity epidemic in the future. An unhealthy food tax should be introduced, alongside marketing regulations that restrict advertising to children and put an end to confusing food labelling. The Institute of Fiscal Studies has recommended that rather than taxing fats and sugars, unhealthy snacks should be targeted with exemptions for products that meet certain threshold nutritional requirements. This would shift food purchasing behaviour towards healthier foods and encourage the snack industry to produce healthier products.

Given many low-to-middle income households are understandably wary of food price increases, a food tax may be considered regressive since individuals on lower incomes generally spend proportionally more of their income on food, purchasing more energy-dense, nutrient-poor foods than relatively affluent individuals. However, a tax aimed at unhealthy snack food and drinks combined with subsidies for fruit and vegetables or improving the nutrition of school meals, would not be regressive as there would be a range of cheap, healthier alternatives. Furthermore, a reduction in the consumption of less healthy foods would decrease the proportion of individuals with lower socioeconomic position suffering from nutrition-related chronic diseases.

Labour’s new generation cannot see the problems it sees and not try to change it approach to public health. There will be fierce opposition to any effective policies that aim to rebalance industry interests. But this is the time to find the spirit of past public health movements which responded to the widespread health problems created by rapid industrialization.

We must make the argument that effective government action to reduce inequalities in chronic disease is a pro-health and pro-economic choice. If public health is defined as what we, as a society, do to assure the conditions for all to be healthy, then clearly we have not done enough.

Amrit Caleyachetty is a member of the Young Fabians

Civil Society and the NHS

 Who is calling for a rethink on NHS reform? Why is the government not listening?

On October 9th, around 2,000 UK Uncut activists and Health Workers staged a mass occupation of Westminster Bridge in protest against the proposed Health and Social Care Bill, which goes before the House of Lords this week. The ‘Block the Bridge, Block the Bill’ demonstration was held to draw attention to the swelling tide of public opposition against government plans to reorganise the NHS.

In drama and scale, this protest was the most impressive so far, although it was by no means the only demonstration held against the shake-up. Marches, occupations and other protests have been held up and down the country this autumn.

Yet the Coalition continues to stay the course.

Has it simply become an uncomfortable truth that our elected representatives are no longer responsive to the demands of civil society?

A central feature of liberal democracy is the presence of a vibrant civil society that articulates the desires and demands of the people and conveys them to government. Our civil society is made up of academia, activist groups, trade unions, community partnerships and consumer organisations, among others. These associations operate outside of state and government, but are supposed to play a vital role in shaping the agenda and tutoring government.

At the moment, however, it seems that no matter how loudly civil society calls for a halt to NHS reform, the government just will not listen.

On March 15th, Doctors attending the British Medical Association’s special representative meeting in London voted overwhelmingly for the withdrawal of the Health and Social Care Bill, stating that “the current plans for reform are too extreme and too rushed and will have a negative effect on the care of patients”.

On April 1st, a variety of organisations held an “All Together for the NHS” day that witnessed a number of unions and campaigners take part in actions in Stafford, Warwickshire, Wolverhampton and Stourbridge in Dudley.

This autumn saw a clamour of expert voices join the already deafening chorus of those opposed to the changes.

On September 6th, Christina McAnea of Unison said the bill at present signals the “end of the NHS”. Her concerns were echoed by representatives of think tank ‘The King’s Fund’, which said there was a “worrying lack of clarity” on the issue of greater competition.

Earlier this month, 400 public health experts signed an open letter to The Daily Telegraph calling on the Lords to reject the reforms, stating: “The government claims that the reforms have the backing of the health professions. They do not. Neither do they have the public’s support.”

This is just the tip of the iceberg. Others who have demanded a halt to the Bill include the NHS Confederation, BMA Chair Dr Hamish Meldrum, representatives of the Royal College of Nurses, Royal College of GPs, Royal College of Midwives and even The Archbishop of York.

When these protests are all listed together, it becomes clear that civil society is sending a loud and urgent message to reverse course.

Yet the government continues to frustrate attempts to kill the bill by exercising its right to manipulate the legislative schedule. In a scandal that has received far too few headlines, the Coalition tried to restrict the time the Lords had to debate the proposals to a single day. This for a piece of legislation that had 1,000 amendments added since its last journey through parliament.

However, the Coalition has listened to the public before and changed policy accordingly. In February, the PM shelved plans to privatise public woodland after 300,000 people signed a petition in protest of the sell-off. Michael Gove’s plan to withdraw funding from 450 school sport partnerships was delayed after Olympic athletes, head teachers and Labour MPs united in opposition against him. These reversals were both forced by the pressure placed on government by civil society.

On the issue of the NHS, however, the government remains stubborn. The reform bill has become a centrepiece of the government’s programme, and the Coalition feels safe in the knowledge that the revolt of civil society has yet to affect their electoral base.

Perhaps it is because this bill has come to symbolise the Coalition’s entire legislative programme that the government feels it cannot yield to public demand. To retreat from this would be to retreat from the whole project of state reform and thus fatally undermine the government’s purpose.

This is a radical, ideologically-driven government facing an angry, well-organised civil society. An unstoppable force is about to hit an immovable object. What will emerge when the dust settles?

Louie Woodall is a member of the Young Fabians and Assistant Editor of The Young Fabians Blog

Middle East Delegation Travellog – Cinderella, where are your shoes?

As part of our Middle East delegation 2011 travellog, Tasmin James reflects on her experiences of the Israeli health system.

When I came to Jerusalem for new experiences, I hadn’t expected these experiences to include a ride in an ambulance and a couple of days board and lodging in an Israeli hospital. So I might have missed out on some extremely interesting meetings and events, but instead I got a crash course in comparing and contrasting health systems in the UK and Israel.

The ambulance was my first surprise. I’m pretty sure, although having never been in an ambulance, I can’t be certain, that I wouldn’t find my feet sticking out the back once I’d been wheeled inside on a trolley in the UK. However, at 5’10, I was too long for an Israeli ambulance. And for pretty much every hospital bed and wheelchair that followed. Even more surprising, the ambulance asked where we wanted to go. Surely they are in the best position to decide. And once at the hospital, the ambulance staff waited for my health insurance details to make sure they were paid. So it was rather more like a very fast taxi. Choice isn’t really welcome when all you want is to stop feeling horrific as fast as possible.

Hospital food was sadly not a contrast. At first I thought I was being a fussy foreigner but as I got talking to the other patients, I found out that it really wasn’t just me. While every meal arriving with two yoghurts or mini-cucumbers was obviously a cultural difference I failed to adapt to, it turned out that no one appreciated the dinner that was six bowls of gloop (and two more yoghurts).

Within the hospital there were no restrictions on visiting hours or mobile phone use. And chaos did not break out. Mobiles were everywhere. Doctors and nurses carried them at all times, answering whenever they rang with an impatient ‘Ken?’. And there were no restrictions on patients using them, which I thought was great, until I was woken one too many times by the Israeli equivalent of Crazy Frog.

I had reason to thank the doctors and their mobiles during my admission. I was cheerily oblivious at the time, but during my initial assessment, when the doctors had concluded that I needed to be hospitalised, the administrative side did not want to let me in until proof had been received from my health insurance. On paper. At 4am. It took a fierce phone call from the doctor sitting in front of me to get me through the door. At some point I witnessed a conversation that probably saved my life. For that particular aspect of the need for payment on delivery, I am very happy to remain absent from the NHS.

But to end on a happy note, an innovation that I would happily appreciate in the NHS is “clowns for all”.

Seeing them wondering around the hospital I’d assumed they were for children. But one evening, two clowns came to visit my ward. They came in, sang a song and made us balloon flowers. And for someone alone in hospital, with no family near by, it was great. This was much less confusing than the first clown I met, as I was being wheeled through the hospital. Feeling a bit groggy, I looked down and saw some giant shoes. The clown was also looking down.

‘You have no shoes.’ This was true, and something of a hospital faux pas. No one went beyond their bed without shoes. ‘Poor Cinderella, where are your shoes?’

I couldn’t answer. I was just wondering quite how strong the medicine I was taking was.

Tasmin James is a member of the Young Fabians and a delegate on the Young Fabian Middle East Trip 2011.

• You can follow updates from our Middle East delegation via Twitter by searching for #yfmep. And find out more about our Middle East programme by clicking here.
• You can view photos from the delegation on the Young Fabian Flickr channel.

NHS reforms lanced by a Boyle

This week the Young Fabians Science and Society Network met with John Healey, Shadow Secretary of State for Health, to share our views on the latest NHS reform proposals and to hear his on how Labour plans to defend the NHS.

The National Health Service remains at the heart of British identity, embodying the best of our nation’s political and social values. Health Secretary Andrew Lansley’s plans, even in their current watered down version, threaten the future of an organisation that regularly polls as more popular than either the creation of the modern welfare system or the end of World War II.

The NHS was 63 years old on Tuesday, having starting life when Nye Bevan opened Manchester’s Park Hospital in 1948. Since 1997, when Labour gained power, it has had its best years: funding was trebled under Labour; 90,000 new nurses were added; and waiting lists were radically reduced. In the face of a sustained trend of NHS improvement, Lansley is proposing a reckless revolution that vexes the medical establishment.

Sir Roger Boyle, government health ‘Tsar’ and National Director of Heart Disease, has just announced his retirement in disgust at the Tory plans. Boyle was on the Today programme this week. He has worked under six health ministers of different political stripes but simply felt he could not continue in his role as the government voluntarily places massive extra strain on the NHS at a time when it is ill-suited to take it.

Given the current fiscal environment, the coming years were always going to be extremely difficult for the NHS. This would be no different were Labour still in power. What worries me and Boyle is that the Tory-led government is choosing this most inopportune of moments to ratchet up the pressure on the NHS by forcing through a full scale organisational resign. Never mind that the Tory government won power on a promise to end top-down reorganisation of the NHS – you could see this one from space.

Boyle says that “he feels in his bones that the current plans are not correct”.

Me too.

Given the financial squeeze on all aspects of healthcare delivery, we should be maintaining and supporting existing structures to ensure stability and continuation of services. Instead, Lansley is breaking up the organisational infrastructure in the face of strong opposition from medical and patient groups. Even if you think the structural reforms are in themselves good- and I don’t- this is certainly not the right time to be implementing them.

At a time of unprecedented financial pressure on the NHS, we should be perusing a policy of progress through gradual evolution (quite Fabian that) rather than opting to restructure when this inevitably means NHS staff will take their eyes off the ball and start to fear for their jobs.

Daniel Bamford is Networks Officer for the Young Fabians.

Cameron: a reluctant Captain

What kind of Prime Minister is David Cameron? What does it matter for the future of his premiership?

The ongoing saga surrounding the passage of the Health and Social Care Bill has unwittingly revealed a great deal about the sort of Prime Minister David Cameron was, and the sort he is changing into. As the story of NHS reform has unfolded we have witnessed his transformation from Major-General, happy to oversee his ministers’ march against the opposition from a safe distance, into hands-on Captain, at the heart of the fight getting bruised and burned along with the rest of his government.

Cameron was undoubtedly sensitive to the fact that he entered office in a climate of hostility towards the “old politics” and, forced into a shotgun marriage with the bright young face of the “new politics”, was encouraged to conduct himself differently from his predecessors. According to the media narrative, Gordon Brown was the Machiavellian tyrant, who enforced his will by tantrum and the occasional thrown telephone; Tony Blair was the obsessive centraliser, the king of sofa government who selfishly prised his Ministers’ fingers off the levers of power; in contrast, Cameron chose to become chairman, rather than captain of his Cabinet.  He allowed his ministers plenty of freedom to run their own departments, an arrangement closely aligned to the ideal of Prime Minister as “first among equals”.

But it also had its costs. Many of the reforms contained within the Health and Social Care Bill appear to have been concocted by the Andrew Lansley, Secretary of State for Health, with little input from Cameron. Unison denounced the bill as a Lansley “vanity project”, and it is certainly true that some of his proposed reforms- especially those encouraging a competitive market in healthcare provision- did not reflect the policy goals of the Conservatives as outlined in their manifesto.

In recent weeks, Lansley has been heavily criticised for the Bill. But so has Cameron for letting his minister ‘off the leash’, and allowing poorly conceived ideas to escape the secrecy of the Cabinet and damage the coalition’s reputation. This led to embarrassing scenes for both men when Cameron publicly overruled Lansley on the pace of reform, and subsequently initiated a “listening exercise” on the legislation. The experience forced the Prime Minister to dive headfirst into the detail of the bill to restore the image of calm control he has so patiently cultivated.

His reputation as a domestic legislator may now sink or swim on the passage of the Health and Social Welfare Bill, as Blair’s did with the battle over academies six years ago.

There is nothing wrong with Cameron’s style of government. He is exhibiting a mature attitude by granting his ministers the freedom to develop policies within their own departments. However, he is now aware of the risks involved in letting Ministers’ pet projects wriggle from his grip.

No matter who the original culprit is, the PM is the one in the firing line when policies go awry.

Louie Woodall is a Young Fabian Member and Assistant Editor of the Young Fabian blog.

Happy Birthday NHS, you might not survive to see 64

Ahead of tomorrow’s Young Fabian Science and Society Network event with Shadow Health Secretary, John Healey, Young Fabian member Amanjit Jhund argues the Government’s reforms are just cuts by any other name.

On Tuesday the NHS turns 63. It’s a time for many of us to celebrate: for most of us it is difficult to imagine life without it.

Yet the Health and Social Care Bill is an attack on the NHS on an unprecedented scale. The concerns for many on the left and in the medical community is that while the aims of the coalition proposals are laudable they are simply being used to mask both spending cuts within the service and the increased privatisation of the NHS.

In fact,  many of the GPs that I have spoken to are fully aware that their budgets for commissioning will only be a fraction of those administered by Primary Care Trusts currently. One GP told me recently that “it’s just a way of pushing through cuts”. While most GPs are pragmatic about the changes and will do their best for their patients no matter which system they have to work within, it is vital that the coalition are held to account on this issue.

With David Cameron purporting to defend the NHS, we must expose the hypocrisy of his words as he presides over changes that will not only slash budgets but will also take the ‘N’ out of ‘NHS’.

Happy 63rd birthday NHS. I just hope you’re still around when I’m 63.

Further reading:

• NHS needs evolution, not Tory revolution
• Briefing: Exposing the continuing flaws in the NHS reorganisation
• NHS forum GP admits private patient doubts