Editor’s Opening

This issue is largely devoted to our first attempt at

a vision for a future health policy. The Labour

Health Team has been completely pre-occupied

with fighting the Health and Social Care Bill for

the last year, and it will still be many months

before the Party really starts to think about the

policies on which we should fight the next election.

Much may change before May 2015, and the

leadership are understandably wary of committing

themselves to ideas which might be used against

them.

The Director of the Socialist Health Association

has a place on the Labour Party‟s Health Policy

Commission and that is now starting to think about

key policy areas, starting with social care and

public health and moving on to the lessons to be

learned from the successes and failures of Labour

Government policy over 13 years.

We have had long arguments over markets, choice

and privatisation. The view of the majority is that

patient choice of provider is helpful, where it is

possible, but the amount of NHS expenditure

which is susceptible to patients making choices is

small, probably less than 20%. Few patients are

enthusiastic about making such choices. We cannot

make this the central principle of the NHS. Patients

are more interested in how they are treated than in

where they are treated. We are not against

independent service providers in principle where

they have something better to offer which the NHS

cannot provide, but we do not see the commercial

sector ever playing a large part .

This isn‟t an agreed statement of Socialist Health

Association policy, but a contribution to debate.

There are many issues it does not deal with and a

number of issues about which members will not all

agree.

The key points we need to stress are:

The futility of structural reorganisation

Socialism and HealthSocialism and Health

the magazine of the the magazine of the

Socialist Health AssociationSocialist Health Association

July 2011July 2011

The importance of integrating health and

social care

Active involvement by patients in their own

care

Stress on prevention and the wider

determinants of health

Commissioning to be under the control of

democratically elected local authorities

Move towards Best Value

Shift resources out of hospitals and towards

integrated services

Aligning the incentives for clinicians and

organisations with the interest of patients

Genuine debate about the benefits of the

service model adopted in Wales and

Scotland

Editor Irwin Brown

22 Blair Road Manchester M16 8NS

0161 286 1926 irwin@sochealth.co.uk

Please send contributions or ideas for articles

Contents

P 2 The Plot Against the NHS:

book review

P3 The Impossible Challenge:

A Model for Future Care

P7 Still Dark: The state of

the Health Bill

P9 Focus on Liberal Democ-

racy

P10 Timetable of Events

The Plot Against the NHS

Merlin Press 2011

Colin Leys and Stewart Player

This brief exposition of the situation

facing the NHS is both clear and

frightening. The first five chapters

describe the changes made by New

Labour during its period of office

including the hugely expensive Private

Finance Initiative projects,

Independent Sector Treatment

Centres, Payment by Results and the

creation of Foundation Trusts. This

marketisation laid the ground for the

Coalition’s Bill to jump start their

determination to fully dismantle and

privatise the health service and leave

the NHS as a ‘kitemark’ for those

organisations commissioning and

providing the service.

These so-called reforms created a

finance led system rather than one

designed to meet health needs. The

authors, Colin Leys and Stewart Player,

show clearly with full references that it

is private companies, required by law

to meet shareholder returns, who

benefit to the disadvantage of

patients. Chapter 7 describes in detail

the health policy lobbyists who have

been such a strong

influence on

government, indeed to

the point of showing

how ministers, Labour

and Conservative, have

strong financial links

to private companies

driving this agenda. In

the UK there is no

register of lobbyists

and therefore no

public control.

In dealing with how

the market will operate

the authors show in

great detail the range

of companies involved

and the influence of the US system of

healthcare. But they also expose the

real danger of competition, in reality

based on price rather than quality of

care. The costs of the market, borne

by the taxpayer, are shown: huge

transaction costs (up from 5%

administrative costs in the ‘70s to 14%

by 2003 and rising) plus shareholder

returns and executive salaries.

Removing the market (as in Wales and

Scotland) would save £10 billion a

year, resolving the problem of saving

£20 bn over the next 3 to 4 years.

This well researched book should be

read by all those involved in and

concerned about our NHS. It is a wake

-up call. Whilst the NHS has never had

a higher approval rate by the

population, provides excellent value

for money in comparison with most

other countries and must be the

highest on equity of provision, the

proposed changes, even after the

coalition’s marginal climb down, leave

it seriously at risk. Of course, like any

large and complex organisation, it

needs improvement but this should be

to the benefit of all.

John Lipetz

evidence-free consensus that somehow competition

is the only and best force for good. Our alternative

to the market approach is based on a new version

of clinical professionalism, on coproduction sup-

ported by information provision, integration, and

democracy with a political settlement where there

is an accountable Secretary of State for Care; not

for Health.

We need to move to active care. Active as patients

feeling more confident to look after ourselves and

share decisions with clinicians. Commissioners

embracing a proactive approach to public account-

ability, co-production and community develop-

ment. Active communities guiding the develop-

ment of local services. Clinicians seeking actively

to respond to needs and offering proactive care to

people with long term conditions. Active providers

working in collaboration (not in competition) and

sharing best practice; working with patients and

commissioners to develop the services required.

Active regulation to ensure problems are identified

early, support is provided where needed but firm

action is taken if that is not enough.

Health Joins the Family – A Na-

tional Care Service

Health care, through the NHS, has always been a

separate empire or rather a federation of powerful

vested interests. It needs to be incorporated into the

family of public services most especially ending

the artificial barrier between social and health care.

We need to move to a national care service so pa-

tients only undergo one needs assessment process

on a national basis, with simple rules for eligibility

and one national, and so portable, standard of enti-

tlement. Over time personal social care should be

made free as with health care; the argument that

this is justified by risk pooling through social soli-

darity (as applies to health) is unanswerable. The

rising costs of providing quality care for a growing

elderly population should be met out of general

taxation.

Involvement and Choice

We must all be encouraged, educated and sup-

ported to take more shared responsibility for our

own wellbeing and the professions must be better

trained in how to bring this about. The many barri-

ers which face those most likely to suffer poor

health need to be addressed in ways which encour-

age involvement. The principles of coproduction,

where care professionals and patients work to-

gether, must feature more in medical training and

professional development.

Choice and involvement must be built on better

access for patients to their medical records and on

Impossible Challenge

The healthier we are, and the more we spend on

care, the greater the demand for care services.

Care costs rise faster than GDP, driven by expecta-

tion, technology and demographics. A free, com-

prehensive health service where there is equality of

access and where the risks are truly shared through

social solidarity is the mark of a civilised country.

In our vision care remains free at the point of need

and paid for out of general taxation. The aspiration

of equal access and equality of outcomes remains

and the gap between reality and aspiration must

begin to close.

Key problems faced by our NHS are unacceptable

variation, increasing inequality, and fragmented

services designed round organisations not patients.

We know hospitals suck in resources and primary

and community care is too weak to enable the shift

of care closer to home. Public health, dealing with

prevention and education, is sidelined. The market

system still does not align financial incentives to

the outcomes required. There are issues around

“inefficiency”, poor productivity and a lack of fo-

cus on patient experience. None of these are new

yet repeated attempts to deal with them through

organisational change and financial incentives have

largely failed.

Direction and Culture

The NHS focus needs to change from providing

episodic acute care in hospitals to managing long

term conditions, where patients need social as well

as medical care. Patients must feel they are cared

for by one system not passed from one organisation

to another. The inward looking culture must move

to a patient orientated approach highly intolerant of

poor care with systems for open reporting and rapid

remedial action, tackled through leadership from

care professionals. The top down prescriptive bul-

lying management style must be replaced by genu-

ine alternatives, the Empire broken up.

Rather than some magic bullet solution we need to

reach a broad consensus on what the problems are

and then accept collectively the profound changes

necessary to have an NHS fit for the current era.

We need to get the improvements in outcomes and

efficiencies to match the increased investment of

the last decade. We have to do this during a period

of reducing funding and do it without the constant

upheaval and reorganisations that never appear to

work.

A New Vision for Active Care

For at least two decades there has been a lazy and

simple, officially sanctioned, information about

care and treatment options and care pathways. For

the less able, such as the frail elderly or children,

support and agency will be offered to enhance

choice and involvement. An information revolu-

tion is still required, years after the “project” com-

menced. Portable electronic patient records, with

access controlled by the patients, will not only

drive process efficiencies but offer other avenues to

personalise care and make it independent of organ-

isational boundaries.

Increasingly patients should be offered choice over

where and when they can access advice, support or

care, with the minimum of waiting. But this is

choice about how care is provided as part of per-

sonalisation of care, not choice of provider organi-

sation as a device to force market solutions.

Care Closer to Home

Increasingly care should be provided in the home

or closer to home, making use of a much more dis-

persed model for care provision but also of the

emerging technologies around telemedicine and

monitoring, with knowledge transfer permitting

patient-led processes. Over time investment in pri-

mary and community care and the merging with

social care will accelerate the closure of acute fa-

cilities: less beds, less in-patient procedures, more

ambulatory care and more day case surgery. This

is not a cost cutting approach and indeed can only

happen after considerable investment in capacity

building outside hospitals. But it has to overcome

the vested interests and political interference.

Communities need a greater say in local services,

especially when reconfiguration or closures are

planned but based on engagement rather than one

off and artificial consultations – but the trade-off is

that the harder decisions can still be made in the

wider interest. An alliance between clinical leader-

ship and local involvement is essential for the ex-

tensive reconfiguration of services, such as closing

an A&E or a birthing centre.

All key decision making bodies must provide, as of

right, places for patients and public. Health educa-

tion and illness prevention has to be tackled at

community level with leadership from local au-

thorities; and tackled in ways which, for example,

treat the issue of family breakdown as seriously as

we once took public health issues around slum

clearance and sewerage.

Commissioning Care

Commissioning is the process where decisions are

made about how public money is spent and on

what priorities are set and what standards apply,

since we can never fully address all care needs. It

is also about how we get best value for our public

spending. In the general view health commission-

ing has been largely weak and ineffective in bring-

ing improvements.

Across all local and central government commis-

sioning has been separated from providing so deci-

sions are not unduly influenced (though they must

be informed) by provider power or conflicts of in-

terest. This is hard to achieve in health care as the

only place much of the necessary knowledge and

expertise can be found is within the providers, so a

more collaborative style to plan and then procure

services is needed.

Increasingly care commissioning should be the re-

sponsibility of local government, through elected

representatives, as it is (directly or indirectly) for

all other local public services. They take responsi-

bility to provide a comprehensive universal local

service with specific access guarantees, reinforced

by the NHS Constitution. Some specialist services,

rare conditions, will be commissioned either re-

gionally or nationally – nothing new for authorities.

Population needs analysis and the strategy for well-

being is already the responsibility of local authori-

ties. Public health responsibility will soon (rightly)

go back to local authorities.

There is already a good basis for this approach as

mental health and learning disabilities show many

excellent models for a shared, partnership approach

to care provisions across NHS and local authorities.

The shift to comprehensive local authority respon-

sibility could only be achieved over time but

should start with local NHS commissioning bodies

being coterminous with authorities, collocated and

sharing back office functions. Many local initia-

tives which deliver better integrated care should be

encouraged through shared posts, pooled budgets,

and the success of approaches like Total Place can

be built on. Funding systems must encourage and

incentivise local integration. The bottom up ap-

proach should lead the organisational change rather

than the other way round.

Integrated Commissioning

With integrated commissioning there is clear re-

sponsibility for whole populations, and considera-

tion of protection and prevention resides alongside

remedial care. All services in community, primary,

social and acute care are in one structure; physical

and mental health; all informed and directed by the

clinical professionals in combination with patients

and citizens - with public health, actuarial and

health economics expertise resident in the same

structure.

The key to effective commissioning would still be

having the right information and evidence on

which to base decisions, which would include ac-

curate information about the actual cost of service

provision and the reasons for its variation across

providers. Getting this information is best ad-

vanced through investment in a Care Information

Centre, with involvement of clinical professionals

and the professional bodies, with all providers to

the care system having a duty to provide data.

For greater strategic coherence there would still be

a regional structure (as there always has been) deal-

ing with rare conditions, overseeing major recon-

figurations, looking at major capital schemes and

arbitrating on disputes. They could also play a

leading role in training and development and re-

search, and host functions such as the Deaneries.

Service Design and Procure-

ment

Care pathway redesign, prioritisation of services

(and restrictions), and clinical service specifica-

tions are best undertaken by the appropriate mix of

clinicians at whatever is the appropriate population

level; which varies by condition. It should be seen

as a normal part of a clinician‟s professional role to

be involved in these decisions when required but

not as full time managers. Some of this work could

be done once as a national template; and it is work

that only needs to be done periodically (in reality

much of it has already been done).

The financial systems must be aligned so that they

do not inhibit good pathway and service design and

in many cases this will imply a move away from

the constraints of a fixed tariff and payment by re-

sults (volume).

In stark contrast other components of commission-

ing - procurement, contracting, market manage-

ment and contract management processes are more

effective at a higher level, and apply continuously,

and must be informed by the clinical models. It is

unlikely that clinicians would want to work full

time on these functions, and most experts on pro-

curement and contract management are not clini-

cians. The separation of these functions should be

explicit and would mitigate conflicts of interest.

Preferred Provider – Best Value

Commissioning will continue to be based on the

implicit assumptions that the NHS is the preferred

provider and that integration of services is best

achieved through partnership and collaboration not

competition. The best value approach long ago

adopted by the rest of public services allows the

risks and wider considerations of using non NHS

providers to be objectively taken into account.

The best value approach still requires an objective

approach and should deal with issues where third

sector providers are denied opportunities to offer

services or to get a fair assessment when services

are required. Best value starts with consultation

and engagement of service users.

There should be best practice guidance, and exploi-

tation of the many opportunities to leverage the

vast scale of care procurement. The general rule

would be that commissioners are free to use what-

ever methods are appropriate, without any fear of a

regulator, the Courts, or prescriptive performance

managers interfering. We could identify care ser-

vices which should not be subject to economic

competition – most mental health care, long term

conditions, and most emergency and urgent care.

For commissioners relationships with providers

must be strong and there must be flexibility to

bring stability through longer term or block con-

tracts for service, even though this might limit

competition. Integration of services takes priority

with, for example, commissioning of whole path-

ways or for whole periods of care. Lead providers

would be free to subcontract parts of the pathway

or aspects of the service, but how they achieve this

need not be prescribed.

Some services would be simple enough to have a

“tariff” and payment by volume, but this would not

apply to all or even most services. The level of

tariff would be set nationally based on objective

evidence on real costs experience by good quality

providers; and price based competition would not

be permitted.

Other Provider Models

Some services, where these is enough information

to be able to judge quality, and where there is a

high degree of independence from other services,

could be open to an „any willing provider‟ ap-

proach. A patient could choose to get the service

from any provider which had demonstrated it could

meet the required standards (like eyes and teeth and

pharmacy).

When an existing provider is unable to deliver a

service to the required quality or where a new ser-

vice is required then there could be formal procure-

ment and either a single supplier or a framework

panel awarded the contract. There would be an

overriding requirement to ensure that the interde-

pendence of care was considered; simply awarding

a contract for one service whilst ignoring the possi-

ble consequential impact would not be permitted.

Private providers would play a part, as they always

have, but the share taken would be small, as now,

based on niche provision and adding capacity. All

providers would be subject to the same level of

scrutiny and could not hide anything behind com-

mercial confidentiality. Supplying required infor-

mation and paying a fair levy to cover their opting

out of NHS training development and research

would be part of the contract. A social solidarity

model with most commissioning and provision

within the public sector will keep the care provi-

sion parts of the NHS outside the scope of domes-

tic and EU competition Law.

Integrated Providers

Benefits should come from the rise of integrated

providers, such as a single provider for all urgent

and emergency care and this could extend to a

whole population approach where one organisation

effectively accepts a block payment and delivers all

care for a defined population. Whilst such arrange-

ments are obviously anti-competitive, competition

is a tool to be used when appropriate and no more

than that.

New Professionalism

Change has to be led by clinicians. There should a

greater role for Royal Colleges in improving prac-

tice and in supporting, but if necessary retraining or

deregistering, professionals. Colleges could lead

on the definition, collection and analysis of mean-

ingful and accurate information to allow variations

to be identified and peer support deployed.. Use of

peer support, National Service Frameworks and

the National Clinical Advisory Team would be de-

livered through the colleges. The combined col-

leges should be required to use their role to drive

up quality in a more general manner, rather than

just in professional silos.

Public Health – Keeping us Well

Looking after our wellbeing and ensuring

decisions are based on good evidence re-

quires public health professionals to be at

the highest levels of decision making

within local authorities, leading on joining

up services, on predictive support, and on

wellbeing - linking together housing, edu-

cation, and environmental health issues.

There is a significant strategic role lead-

ing on needs analysis and guiding prioriti-

sation of resources, working with other

clinicians, actuaries and economists. Over

time the balance of funding for public

health would increase as investment in

future health overrides paying for reme-

diation of past underinvestment.

Providers of Services

Health care provision is badly fragmented and

would be made worse by further competition. The

organisations which manage hospitals are separate

and wield disproportionate power: power which

often prevents a rigorous approach to poor per-

formance. Organisations set up to deliver primary

or community care are generally smaller and less

visible. Previous attempts at integrated trusts saw

acute services swamp the rest. These cultural bar-

riers must be removed but only clinicians can bring

this about, working collaboratively and ignoring

any artificial organisational barriers; impossible if

competition is the driving force. Realigning finan-

cial incentives towards collaboration will help.

The “Foundation Trusts” which provide NHS care

will be all shapes and sizes; from specialist tertiary

providers to integrated care providers covering all

needs of a defined population. They would be part

of the NHS whilst under moral ownership of the

local community, not set up as an excuse for a dif-

ferent business model led by accountants and mar-

keting experts. They would work with commis-

sioning colleagues to help develop appropriate

pathways and services. They would be able to

merge, demerge, federate and partner, if they had

local support and their local owners (governors)

agreed, (but not be free to dispose of NHS assets).

As now they would be subject to local overview

and scrutiny arrangements.

If these organisations get into trouble as most do

from time to time they would be able to call on

support and even additional resources. There may

be conditions attached to support and there may be

changes in management but this is not supporting

failure: it is ensuring continuity of vital services.

The alternative, that they are business entities

which should be left to go into insolvency and ad-

ministration, is unacceptable.

Alongside these trusts would be many other forms

of providers to the care service; social enterprises,

third sector and private sector.

Given a high degree of autonomy in exchange for

effective stakeholder governance trusts would still

be subject to ultimate intervention and in extremis

could be taken back into being directly managed

General Practice

There will be our quaint but effective system of

semidetached GPs but with the local authority as

commissioner carrying out the performance man-

agement; something both will find uncomfortable

but essential to the eradication of poor performing

GPs effectively outside any proper performance or

contract management. There is considerable varia-

tion in performance but little understanding of why.

GPs have mostly become office hours providers. A

more active model for primary care requires a

genuine 24/7 service which is far easier to access,

and a model of the GP at the heart of a local com-

munity (with a defined practice area) rather than

just the gateway into other services.

Support and guidance to authorities from the Royal

College, supporting a clear determination to drive

up standards, would be invaluable.

Quality at the Heart

The fundamental importance of quality should be

accepted through the powerful role assigned to the

independent quality regulator, one adequately

staffed with clinical expertise. (There would be no

“economic” regulation, as this is not an economic

system!) Better definitions of what quality means,

greater public access to accurate, timely and rele-

vant information, active involvement of patients

and communities, and clinicians intolerant of poor

performance will drive quality and improve out-

comes.

A Better NHS

Such an NHS, within a care system, would be

faithful to the founding principles and values, a

genuinely national service. It would shift care

from acute settings, integrate all care in one sys-

tem, use competition and non NHS providers only

where they add value, and the focus would be on

continuing the improvement of NHS providers es-

pecially through better information, greater clinical

involvement and leadership.

Patients would have the central role but not as con-

sumers nor as the product which is competed for.

Still Dark

Briefing on the Health Bill Amend-

ments

The Health Bill still rests on the view that competi-

tion is the answer and it must be allowed to flour-

ish, free from anti-competitive behaviour. The Bill

sets out the framework which brings in a regulated

market system, and all the necessary components to

do this remain. The timetable, constrained by real-

ity, has been slowed down.

The role of the Secretary of State has actually been

weakened further. The amendment 174 says the

Secretary of State “must exercise the functions ....

so as to secure that services are provided”. This

replaces the current duty “to provide or secure the

provision of services”.

The end of the comprehensive NHS is signalled as

the current duty that the Secretary of State “must

provide (NHS services) throughout England” is

replaced by “A commissioning consortia must ar-

range for the provision … to the extent as it consid-

ers necessary”.

Local commissioning is fragmented. There is even

greater scope for confusion now between the roles

of the NHS Commissioning Board, The Quality

Board, the NHS Constitution, Monitor and the Care

Quality Commission. The system architecture is

now far more complicated than it has ever been.

The NHS Commissioning Board represents major

centralisation. It is the biggest quango in the world

and gets additional powers, contrary to the concept

of autonomy. It retains the role of commissioning

local services such as GPs, Dentistry, Pharmacy,

contrary to any idea of local control. The role is not

changed except to introduce some new duties

around promoting the NHS Constitution, involving

patients, carers and representatives, and around

integration (not defined).

The preferred provider approach is outlawed.

There must be no exercise of functions for the pur-

pose of causing a variation in the proportion of ser-

vices provided by the public or the private sector.

However, the clause is impossible to apply as no

definitions or measures of current proportions exist

and the “purpose” is different to any outcome.

The issue of coterminosity with local authorities is

not addressed. Consortia should not cross local au-

thority boundaries but need not be coterminous

(but not in the legislation). GP practices have to

become members, there is no opt out.

Top down prescription for consortia. Consortia

must now have a governing body which will be the

subject of guidance by the NHS CB and many

regulations . They could also have Boards making

them like Foundation Trusts. It appears that GPs

still have to be regulated by Monitor as providers,

as well as consortia.

There is no formal provision for clinical networks

or senates and no requirement (apart from a very

general one) to have regard to what they might rec-

ommend. The hierarchy between NICE, Networks,

Senates and Health and Wellbeing Boards all of

whom may have different views and all must be

taken into account by consortia, is not addressed.

A wider range of consortium board members.

There will be a mandated role for two lay people, a

nurse and a secondary care clinician and scope to

involve others, but subject to unseen regulations.

There are now members of the consortia and mem-

bers of governing body which is confusing.

Money can still be distributed to members, includ-

ing the lay members. The quality premium, which

allows payment for effective financial manage-

ment, is retained but subject to further rules.

250 plus consortia has become more likely. The

issues raised by the Health Committee are not ad-

dressed. Nothing has been said about the commis-

sioning support suppliers which are being devel-

oped.

Patient and public involvement is strengthened

with a new requirement for commissioners to con-

sult over any changes in services (which is unwork-

able).

The full role of scrutiny is not restored but could

be if as suggested designation is removed from the

Bill at a later stage.

Choice and competition are reinforced. The duty

to promote competition is replaced by a duty to

prevent anti-competitive behaviour. The involve-

ment of the Competition Commission and the com-

petition acts remains, as does the licensing regime

which allows Monitor to regulate the system. The

intention to continue with the current rules around

cooperation and competition and to keep the Coop-

eration and Competition Panel has been stated.

No changes are made around designation or the

failure regime (insolvency provisions) – but further

changes later are likely. The end of “designation”,

which is where a service cannot be closed down

because there are no reasonable alternatives, has

been signalled.

The intention to prevent price competition and

cherry picking may or may not be resolved. There

are many changes to the proposed Tariff system

and around setting prices, the impact of which will

depend entirely on how they are implemented.

There is no mention of the use of “best value” in

relation to contracting for non tariff services.

No change is to be made to Health and Well Being

boards. The ability to disagree over commissioning

plans is retained but there is no dispute resolution

process or any requirement to reach agreement.

The many-to-many nature of the relationship be-

tween consortia and Health and Well Being board

remains.

New clauses have been introduced the purpose of

which is unknown. The duty of the Secretary of

State to keep the effectiveness of the system under

review links to the reduced duty only to exercise

functions so as to secure that services are provided.

There is a new requirement that appears to force

choice of any provider which would also include

choice of GP Practice.

Any willing provider is enhanced. A new concept

of a “fair level of pay” for providers gives scope to

vary payments according to the different costs pro-

files of providers, but how this might be operation-

alized is unclear. The same clause also seeks to

enforce moves to standardisation of health care

specifications – all of which looks to be supportive

of the drive to any willing provider type models.

There is no recognition of the role of the Coopera-

tion and Competition Panel. Although this may be

there by inference, it is not put on a statutory foot-

ing. The duty of candour is not brought in, and

other assurances given in response to the Future

Forum are not implemented.

It‟s a mess.

Some concessions have been made to improve

accountability, down play the role of competition,

reduce the active role of the regulator and to stress

the need for greater patient and public involvement,

for integration of services and for proper regard to

the NHS Constitution.

But there is far greater bureaucracy, little cohesion

in the architecture, a very prescriptive regime for

the consortia and still the emphasis on moving to a

market system with many providers competing for

the patients.

Focus on Liberal Democracy

Now the Health Bill has completed the com-

mittee stage it's time we started asking Lib-

eral Democrat MPs whether they are going to

support it when it comes back to the Com-

mons on 6th September. Though the Liber-

als have succeeded in making the structure

more complicated the essential dismantling

of a planned National Health Services and

its replacement by a regulated market still

appears to be the central policy.

Can you help? We need local activity in the

places where Liberal Democrat MPs are. We

need their constituents to raise questions, and

we want letters in their local papers. It will

also help if people contact Liberal Democrat

councillors. There is clearly a battle going

on inside the Lib Dem party over this and we

might be able to affect the outcome.

If you live (or can pretend to live) in a place

where there are Liberal Democrats would

you like to write to them, or to the local pa-

pers? Or go and talk to them? We need

members in Wales and Scotland to help too

even though the legislation doesn't apply to

them because the Government will rely on

Welsh and Scottish Lib Dem votes to get this

through.

The obvious issues to raise are:

NHS no longer comprehensive....

Waiting times up....

People have to pay....

There will be a market & conse-

quences..

Your local hospital will be allowed to

shut...

EU competition law will apply...

But don't restrict yourself to those is-

sues. Local and personal stories are what

make a difference.

Timetable of events

2011

6th &

7th

Sept Report and 3rd reading of Health Bill in the commons

17th

Sept Lib Dem conference in Birmingham

24th

Sept SHA Council Liverpool

25th

Sept Labour Party conference Liverpool

2nd

October Conservative conference Manchester

5th

October Lords resumes. Health Bill goes to Lords.

NHS Commissioning Board established in shadow form.

SHAs to be clustered

30th

Nov NHS Alliance conference

2012

10th

Jan Parliament returns.

Lords concludes discussion of Health Bill and it goes back to the

Commons. (date not yet known)

April Any Qualified Provider starts

3rd

May Local Elections England, Scotland, Wales. London Mayor, GLA

30th

Sept Labour Party Conference Manchester

October NHS Commissioning Board is established

Monitor starts to take on its new regulatory functions.

HealthWatch England and local HealthWatch established

2013

April Commissioning groups established. SHAs and PCTs abolished

NHS Commissioning Board takes on its full functions.

Public Health England established

2nd

May Local Elections English County Councils and Unitary Authorities

September Labour Party Conference Bournemouth

2014

Jan Value-based pricing for new drugs.

June European (and probably local) elections and London Boroughs

September Labour Party Conference Manchester

2015

May 7th

General Election, NI, Scottish and Welsh parliament elections,

English districts

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