Forum Report: Tues 31 October 2006: Health

Report on the Panel Session with Andrew Lansley CBE MP, Shadow Secretary of State for Health

The NHS is the number one priority for us, and for the general public. It’s not just about the amount of money spent in the NHS but how that money is spent. We now face a situation where patients are being forced to pay for health services they expected to be there for them. To get the most from the money, there needs to be more competition and choice – from GP surgery to the hospital. Government must do its job and allow health professionals to do theirs. Patients need information and consultation as well as clean hospitals and good treatment. We should develop a relationship where “the patient will see you now, doctor”. We should have:

• More competition to drive up service improvements
• An independent regulatory structure
• An equitable allocation of provision across the country – local priorities but equal opportunities
• A structure of choice and commissioning of services

The debate is not just about the National Health Service but the general health of the people in the nation. This means taking account of levels of deprivation, poor housing, environment, smoking, diet and exercise. It is not only Government’s responsibility but up to individuals as well.

QUESTIONS & VIEWS FROM THE FLOOR (Answers from Andrew Lansley MP)

Q: Why is it so difficult to get a home visit from my own GP out of hours?

A: Labour abolished GP out of hours responsibility entirely in the new GP contracts. There is little incentive for GPs to provide Out-of-Hours care and the current out of hours service costs twice as much as before.

Q: How would an independent NHS regulator work?

A: The NHS is both a commissioning and providing body. The independent regulator would be responsible for commissioning of:

• GPs – accountable to their patients
• PCTs – accountable to Local Authorities
• Service planning
• Appeals process

We would also need to ensure patients, as consumers, have a voice through ‘HealthWatch’ because at the moment they are not involved.

Q: The NHS is overrun by waste. What do you think about managers having a clinical background?

A: I’m in favour of managers having a clinical background. It gives them authority to get rid of unnecessary bureaucracy. Since 1997 it is good to see 33,000 more doctors and 83,000 more nurses, but there has also been an increase of 107,000 administrators. Currently, there are too many committees and not enough responsibility. We need to strip out the bureaucracy and put senior medical staff in charge from the ward level to the whole hospital.

Q: What can we do about medical tourism soaking up NHS resources?

A: According to a recent report in the Sunday Telegraph, there is a large proportion of overseas patient who should be paying for treatment but they don’t get billed. It is not the job of doctors and nurses to check eligibility for free treatment but administrators could.

Q: I’m a London GP and I spend hours each day, filling in forms. We have 3 factions at war – primary care, secondary care and patients. There is a merry-go-round of GP referral to hospital for tests and the patient being referred back to the GP to refer for more tests because it is then the GPs who pay. Also, how do we persuade individuals to take more responsibility for their own health?

A: The family doctor service is an essential priority for the NHS because GPs are in constant contact with patients. Not only are they excellent at making clinical decisions, they were also extremely successful in directing patients to appropriate hospitals and managing their budgets under the Conservative Fundholding system. Now, Labour is trying to stop GPs making referrals to hospitals. London hospitals have been told that a GP referral is not authority to treat the patient. We’ve also seen a fall in the numbers of health visitors and community midwives. The whole situation is condemnation of political interference. The system is over-controlled and distorted.

Q: We need more of an internal market. Health services should not be completely provided by the State and we should have a positive attitude to the private sector.

A: We need a system that includes private provision and some competition especially if the private sector can provide operations more cheaply. There is a good example with home dialysis which is being delivered in the community but is actually contracted to the hospital.

Q: I’m very worried about the long-term debts arising from PFIs and the lack of operational flexibility the schemes.

A: Unfortunately, a Conservative Government would not be able to cancel PFI contracts although there may be some scope, in some cases, for full or partial buy-outs.

Q: Clinical experience is important for managers but they need management training.

A: Agreed. It may be that we could look at some sort of staff college or leadership courses for NHS staff. At the moment there are some anomalies when people undergo new training – because of the Working Time Directive, some individuals are hit by significant cuts in salary when they change from one training position to another.

Q: What can we do about the situation in rural areas where I know of one patient who is being treated in 3 different hospitals for his different illnesses?

A: It is GPs who decides on the best place for treatment and they will usually want to select the lead specialist.

Q: I’m concerned about school health services. Why are children no longer weighed by school nurses, and why are vaccinations against TB no longer given – especially as TB seems to be on the rise?

A: We are seeing an increase in TB which is being imported from overseas. Unfortunately, these are new strains of the disease so the traditional school vaccines are not effective. There is a need to focus special effort in particular areas of the country. By the way, children are weighed in schools – but the school is not allowed to give the result the parents!

Suggested Further Reading:

• House of Commons Hansard, 11 Oct 06 (Health debate)
• House of Commons Hansard, 23 April 04 (Working Time Directive debate)