Comments on: After the health bill: The end of the NHS as we know it

By: Beverley James

Beverley James — Mon, 23 Jul 2012 01:04:24 +0000

It’s a controversial elephant in the room, but here goes. Why is so much money spent by the NHS on lengthening the lives (often against their specific wishes) of the elderly and infirm, whose quality of life is negligible.

There was an article in the Guardian yesterday http://www.guardian.co.uk/society/2012/jul/21/mother-dementia-care-elderly-michael-wolff which kind of said it all.

Why is so much money spent on lengthening the lives of those who just wish to “go” in peace. What possible pleasure can there be in a “life” in which loss of bodily function control(and, consequently loss of dignity)and a permanent mental state of confusion and fear is the best case scenario ?

By: Caroline Molloy

Caroline Molloy — Tue, 01 May 2012 13:19:29 +0000

God, this is terrifying, and plausible. Nationally, we need to look at how much of the ‘worst case scenario’ above is provided for under existing legislation? All of it? Would any of these moves require further primary or secondary legislation? Be good to get the lawyers looking at it. A well informed person has suggested to me that next up, will be the hedge funds moving in to ‘hedge’ the commissioners against the risks of the uninsured. How did we get from ‘Freedom from fear’, to this? Colin I congratulate you on everything you are doing to bring these matters to light.
Locally, I have written a blog piece on False Economy about how people can try and find out some of the answers to what is going on, see here http://falseeconomy.org.uk/blog/keep-our-nhs-public-gloucestershire-campaign-guides

By: Martin Rathfelder

Martin Rathfelder — Sun, 29 Apr 2012 14:12:43 +0000

All healthcare, everywhere, always is rationed. In most countries its rationed by charging. In the NHS we have better ways of rationing care, based on cost-effectiveness. We don’t defend the NHS by complaining about rationing, or advocating that money be wasted on treatment which is not cost-effective, such as hip replacements before they are necessary. The weakness of the Croydon list is that ignores the much larger sums wasted on hospital admission when it isn’t required.

By: Richard Blogger

Richard Blogger — Tue, 24 Apr 2012 21:33:50 +0000

I wholeheartedly agree with Colin’s analysis, Personal Health Budgets are about rationing not personalisation.

As a patient with a long term condition, I am passionate about personalisation. I want patients to be fully in control of their treatment, but the way to do that is to have a culture shift towards co-production (where patients work with clinicians), not to hand patients the budget. Robin did not explain why it was necessary for patients to have a budget to get the personalisation they need and he ignores the dangers that Colin identifies.

If a patient has a personal budget, the patient becomes the “employer”. For example, a mental health patient was given a personal budget and her partner used this money to pay for a personal assistant. This is the personalisation we need, because the patient could choose the PA. Unfortunately, the patient attacked the PA who suffered injuries and the PA’s only route to obtain compensation was to sue her employer: the patient. This is unacceptable, but it is inevitable when patients are given the budget. The patient could have been involved in the commissioning process, and the local authority could then have employed the PA: this would *still* have been personalisation.

If we want personalisation, there is no need to require personal health budgets. Will patients be given the option of whether they have them or not? I think not. I think they will be compulsory because the government will argue that it will be too costly to run two schemes in parallel. It seems to me that the pilots that are being run now will be nothing like what we will eventually be forced to accept. The last report from the pilots showed that patients were allowed to spend their personal HEALTH budgets on laptops, smartphones and internet access. Can you imagine those items being available when PHB become policy? Really? Of course they won’t! But they are being offered now because it is how the pilots can get a positive response from patients in the study which the government will use to “justify” forcing all of us to have such budgets.

By: Jason

Jason — Mon, 23 Apr 2012 15:53:49 +0000

I worry about my parents. Both pensioners needing long term treatment for illness. What will become of them? A lifetime of hard work for what?
Does a percentage of my national insurance contribution go towards nhs treatment that I may need?
If the NHS goes private will national insurance go down?
We may need that portion of the money to fund our health insurance.

By: Gracie

Gracie — Fri, 20 Apr 2012 09:34:18 +0000

Robin if you really believe that many CCGs will not be left with a rising group of “uninsurable patients” sadly I think you are soon to be rudely awoken. This is something that has concerned me from the very first day I learned of the government’s intentions for reform of the NHS.

If CCGs are working to a fixed budget, even if they wanted to, they will simply be unable to treat people who would be deemed “uninsurable”. People presenting with more than one condition, this is usually the elderly and the disabled will receive substandard care, if they receive car at all. I can see health vagrants moving from one practice to another being treated under emergency provision but unable to find a regular permanent GP.

By: Social Investigations

Social Investigations — Fri, 20 Apr 2012 09:15:49 +0000

Finally if you want the Lords to not be allowed to vote with conflicts of interest as is the case with local councillors when they have a prejudicial interest, then please sign this petition: http://epetitions.direct.gov.uk/petitions/31991 – and pass it on.

By: Social Investigations

Social Investigations — Fri, 20 Apr 2012 09:14:00 +0000

The evidence is out there that the reason for the changes in how the NHS is structured is not about it becoming more efficient, but about the continued hand over of public money into the hands of the corporations who are increasingly making profits from running public services.

The list of Lords and MPs with financial links to companies involved in private healthcare is scandalous and reveals a massive flaw in our institutional democracy. 142 Peers have these links and the list of MPs is increasing as the research continues.

The Conservatives through their links to the U.S free market extremists who they connected to through the Atlantic Bridge, and what about Mark Britnall KPMG’s head of Global Health and advisor to Cameron who famously said: the NHS would be shown ‘no mercy’.

Lord Popat the founder of TLC group Ltd who runs private care homes, gave David Cameron a donation as a gift for £25,000 a week after the Conservatives’ unveiled their health ‘reforms’. David Cameron made businessman a peer shortly after getting into ten Downing street.

1 in 4 Conservative Lords have these financial interests – they were all allowed to vote on the amendments despite these interests.

This is about privatisation, and if you believe that the likes of Lansley et al are genuine, then I put it to you that you are not looking at the evidence.

This is the list of vested interests: http://socialinvestigations.blogspot.co.uk/2012/02/nhs-privatisation-compilation-of.html

By: Robin

Robin — Wed, 18 Apr 2012 22:24:52 +0000

It is a great shame that in putting the ‘worst-case’ outcome of the introduction of personal health budgets forward you are entirely ignoring the remarkable benefits that they have had for ordinary people who are using them. However much we seek to protect the NHS, we must recognise that some of the practices and restrictions that it has are actually harmful to people’s health and to their ability to live lives as equal citizens. The worst of these examples are those people who were receiving care and support from people they knew and trusted, sometimes for many years, but when their care needs crossed the threshold of ‘Continuing Healthcare’ were forced, often in the last weeks or months of their lives, to accept intrusive and highly personal care tasks being done by a new set of ‘NHS commissioned’ staff, who had no prior knowledge of them. Personal Health Budgets have enabled people in these situations to maintain their trusted carers. There are literally thousands of other examples across a whole range of health conditions where people have been able to retain or regain the level of control over their lives and their health needs which the majority of us are fortunate to take for granted.
I have no problem with you cautioning about the potential for personal health budgets to be used in the ways you describe (that chain of events is a possibility, but not an inevitability), but please do not cast them as simply a mechanism for achieving privatisation. That is simply wrong and does a great disservice to many people who are advocating for them (including many of those who use them and are personally benefitting from improved care and support, not to mention improved health in many cases) to improve the service the NHS can give. Yes, they will bring a change to how the NHS operates, but it has to change anyway. Far better that ordinary people take control of that change than we all sit back pretending the NHS is perfect until unwelcome changes such as you describe are forced upon us.
Like so many things, personal health budgets (which, incidently, the relevant Regulations prohibit being ‘topped up’) are not necessarily good or bad in themselves, they are simply a mechanism: it is how they are used which should be judged. At the moment they are enabling the NHS to provide better support to ordinary people. That seems to me to be a positive result for the NHS itself.
People are managing their budgets themselves, having their budget held by voluntary sector organisations, or having them managed by the NHS. Not a private insurance company in sight that I have ever come across as an ‘intermediary’.
There are many threats to the NHS that are real. Personal health budgets in themselves are not one of them.
With best wishes,
Robin.