Is the NHS really safe in Tory hands?

First topic message reminder :

Here is a news item from North Yorkshire which never made it onto the national headlines

A York-based practice has written to its patients offering them a range of minor treatments privately, claiming they are not funded by the local NHS.

Doctors' leaders said this could be the start of a worrying trend due to the squeeze on finances and NHS overhaul.

The letter, seen by the BBC, said local health chiefs had stopped funding a range of services, but added they could still have them done privately at a number of clinics, including one owned by the practice.

These included removing skin tags from £56.30 to treating benign tumours for £243.20.

Dr Richard Vautrey, of the British Medical Association, added: "The dire finances of many trusts means that many more NHS treatments are likely to become unavailable in the future".

The above will not come as a total surprise to Motorists. In 1934 the government of the day introduced the Road Fund Licence (Tax Disc) which has escalated regularly in cost ever since.

Very little of the revenue raised has ever been spent on Road-building or maintenance, as the majority has always gone straight into the Consolidated General Fund.

In order for money raised for a specific purpose to be used exclusively for that purpose, it must be "Hypothecated". Government legal-draughtsmen try to avoid doing that.

Only this bunch of thieves could in the same breath decline all responsibility for maintaining a health service and nick the proceeds of National Health Insurance.

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What I’m about to write about isn’t a secret. It’s on the parliamentary record, and the occasional web or print news article has touched on it. But, as far as it possibly can, the government keeps it very much under the radar. So it may well be, esteemed visitor to this blog, that you’ve never heard about it.

If you’re a regular (esteemed) visitor, you’ll know that I’ve written frequently about the NHS and I’ve written at length about the government’s attacks, current and future, on it. I don’t work in the NHS, but I do recognise the enormous importance to our society of healthcare ‘free at the point of need’ and the doctors, nurses and other staff who provide it. I also recognise that it’s a prime target for the Tories’ state-stripping ideology.

In the course of my research for various articles over the past couple of weeks, I’ve been reading through some of the written evidence submitted to the Commons Health Select Committee on NHS funding. It’s in the course of this research that what I’m going to tell you now really came to my own attention, and I keep a close eye on NHS-related developments, so it’s entirely understandable if you weren’t aware of it until now.

I’ve written recently about the readiness of Tory MPs, including Health Secretary Jeremy Hunt and treasury minister Sajid Javid, to lie in Parliament or to the electorate via their websites, about NHS funding. I’ve also noted how my prediction that Hunt’s next attack on the NHS would be based on prioritising funding on (wealthy) areas with more elderly people has unfortunately started to be fulfilled, and how the Treasury is quietly stealing (they call it ‘clawing back’) a massive amount of money that the NHS has saved, and which the government had promised to reinvest in frontline health services:

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If you’re a regular reader, excuse me repeating all these points, but I try to consider first-time readers and the importance of context for properly understanding what this government is up to.

Hunt’s and the Treasury’s measures are aimed at eroding the performance of, and therefore public affection for, the NHS in order to prepare it and us for the break-up and sale of our health service to private interests on the (carefully-created) grounds that the NHS needs to be ‘saved’, and that it’s all for our good. And they do it, by design, in ways which give them ‘plausible deniability’ – that allow them to say ‘the NHS is safe in our hands’ and ‘we’re protecting NHS spending’.

The extent of the Treasury’s clawback in the last full financial year was at least £1.4 billion – 15 times more than the total deficit of all the NHS’ financially-struggling hospitals – even if you don’t offset the surplus that the remaining hospitals generated against it. The NHS does not have a financial problem, and no hospital has to be allowed to struggle and fail. There is plenty of surplus to cover the debts of a few, to pay the salaries of each of the 7,000 nurses that have lost their jobs under this government, and still to have most of it left over. The government chooses to treat each hospital trust in isolation and make it swim, or sink.

But that’s not the limit of the government’s back-door robbery. The same amount again – in fact more – is being quietly bled off by the Dept of Heath (DH) to very partially mitigate the effects of swingeing cuts in another area.

In evidence presented to the select committee the DH itself, as well as various other bodies, advised that funding of around £1 billion a year is taken from NHS funding and allocated to local authorities to spend on social care. Here’s a table, from the evidence presented by the Local Government Association and the Association of Directors of Adult Social Services, showing the details:

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As you can see from the table header, this money is supposed to be spent on measures which will support social care and benefit health. The DH’s own report underlines this:

The new funding will further support and promote more joint working between health and social care. This will enable local areas to transform their services and to deliver better integrated care that saves money across the two systems.

But this isn’t happening at all. The NHS Confederation – hardly a defender of true NHS principles – gave evidence that says the money is merely being used to ‘paper over the cracks’ caused by cuts to local government funding. They’ve even written a book with the title of ‘Papering over the cracks: the impact of social care funding on the NHS’.

The RCN, meanwhile, noted that local authorities do not even have to spend the money on social care at all:

since social care funding is not ring-fenced there was no guarantee that this allocation would be spent on social care, particularly in light of the pressures of local authorities’ budgets

But the government isn’t content with stealing just £1 billion from NHS funds. In its evidence, the DH advised that it will be taking:

a further £300 million over and above the funding set out at the Spending Review for the period 2013–15. The new funding
will further support and promote more joint working between health and social care. This will enable local areas to transform their services and to deliver better integrated care that saves money across the two systems.

Again, these funds are supposed to save the NHS – and us – money, but as both the NHS Confederation and the RCN pointed out, this just isn’t happening.

So, we’re up to £1.3 billion so far – almost as much as the Treasury euphemistically ‘clawed back’. But the government isn’t finished yet.

In spite of the theft – let’s be kind and call it a ‘re-direction’ – of funds that should be providing treatment for sick people to offset massive budget cuts imposed on local government, the cuts are so massive that local authorities are still being forced to make huge cuts in spending on social care, even after they’ve made every possible cut in less essential services. The Association of Directors of Adult Social Services (ADASS) reported that – in spite of the £1bn ‘windfall’ from NHS funds:

£1.89 billion has already been taken out of adult social care budgets over the last two years

The pressures caused by these massive budget cuts in social services have resulted in a phenomenon of ‘delayed discharges”, where patients who do not really need hospital treatment are left in hospital beds because local authorities either can’t find a care place for them, or else are using delaying tactics to eke out their budgets by shifting the cost of caring for these stranded people onto their local NHS. The NHS confederation told the select committee:

delayed transfers of care already cost the NHS £545,000 per day (approximately £200 million per year

However, they are almost certainly dramatically underestimating the cost, as they based their assessment on a costing provided by the DH, which has a vested interest in downplaying the figure to keep the spotlight off the issues that the government’s cuts to services are creating. The NHS currently treats some 3 million patients per week, from a budget of £104 billion, or £2 billion per week. £2bn divided by 3 million comes to £667 per patient, per day.

It’s a very rough measure, but it gives an indication of the what it costs to treat people in hospital. According to the the Kings Fund, on any given day there are around 4,000 patients unnecessarily in hospital because of delayed discharges caused by lack of social care provision. £667 x 4,000 comes to a daily cost to the NHS of almost £2.7 million, or £973 million a year.

The NHSC’s estimate of £545,000 per day, divided among these 4,000 patients, would mean a cost of only £136 a day, which seems unrealistically low. There are, of course, fixed costs that don’t vary with the number of patients, so the real figure will be somewhere in the middle, but in any event it’s a vast cost that is little appreciated outside the healthcare system – and the government is quite happy for it to be that way – and that includes ignoring the effects on waiting times for those who do need treatment, who consequently suffer longer and unnecessarily.

But for the sake of argument, let’s use the Confederation’s figure of £200 million a year, so no one can say I’m exaggerating. Put that together with the £1bn taken every year from NHS funding to shore up social services that are falling apart because of cuts in other areas. Then add the extra £300 million the government has added to the ‘social care drain’.

That makes a figure of £1.5 billion per year that is being covertly slipped out of the NHS, on top of the sum of at least £1.4 billion ‘clawed back’ by the Treasury. The £1.5bn is supposedly to integrate the two care systems so that they operate more efficiently – but the evidence given to the committee indicates that this integration is:

unlikely to produce major cost savings or improvements in patient experience outside of a small group of conditions

Instead, this money is being taken away from front-line care for patients who need it, in order to inadequately ‘paper over the cracks’ – cracks that can only widen following Eric Pickles’ announcement this week in Parliament of further cuts to local government funding of 3-8% (although he factors this down to an average of 1.7% and calls this a ‘bargain’!). If he stays true to form, the higher cuts will fall on poorer areas because they will never vote Tory anyway, so that their effect on already-wobbling services will be catastrophic.

These twin moves of Treasury theft and quiet transfer of funds to partially offset massive spending cuts in local government and therefore in social care are a massive con designed to allow the government to claim (though according to the UK Statistics Authority it’s untrue even then) that it is ‘protecting’ and even increasing NHS funding, when the reality is that significant percentages of the NHS’ funds never make it through to benefit patients or provide the staff and care that they need.

It’s absolutely essential that the public starts to understand what’s going on. So spread the word and let’s counteract the propaganda and expose the con-trick.

Bobby, the key attribute of being in charge is that your Party are, well, IN CHARGE.

I think that our Parliamentary system of elected delegates is well past it's best before date now that everybody has instant communicatoin through the internet.

All I see instant communication is, a means to get their lies out even quicker.

The Exciting New Tory NHS

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" Wonderful news, Mr Plebb - you've won the draw for the bedpan this week..."

bobby wrote:But you'll have to wait till tomorrow for your cup of tea.

No - that's for it to be emptied!

Private NHS providers in line for corporation tax exemption.

Private companies providing NHS services could be exempt from paying corporation tax on their profits under proposals being considered by a government-commissioned review of competition in the health service, the Guardian has learned.

Monitor, the NHS's economic regulator, argues that as public sector hospitals do not pay corporation tax and VAT on supplies, whereas private firms do, the result is an "unfair playing field" in healthcare. The regulator was asked to look at the issues as part of a review into NHS competition, and will report to the health secretary, Jeremy Hunt, later this month.

Hunt's predecessor, Andrew Lansley, produced analysis which said "the majority of the quantifiable distortions work in favour of NHS organisations; tax, capital and pensions distortions result in a private sector acute provider facing costs about £14 higher for every £100 of cost relative to an NHS acute provide".

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The other big difference is Private= for Profit V State = Not for Profit......

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Restricted McKinsey paper portrays grim future for health service

A set of restricted-circulation papers prepared by private health consultants McKinsey in 2010 for the NHS in Northern Ireland includes measures that depict a grim future for the NHS’ founding principle of healthcare ‘free at the point of need’. The measures offer a glimpse into the way that government and private consultants see the future of our NHS in Northern Ireland – and, most likely, in the rest of the UK.

The documents are marked

This document is solely for the use of personnel in the Health and Social Care Board and Public Health Agency of Northern Ireland. No part of it may be circulated, quoted, or reproduced for distribution outside the HSCB or PHA without prior written approval.

However, they are stored on a publicly-accessible area of Northern Ireland’s Department of Health, Social Services and Public Safety (DHSSPS) website, and are therefore in the public domain – perhaps either through oversight or hubris.

The documents can be accessed by entering a specific page address, or by doing a site search for ‘McKinsey’ – but no links to them appear to be available on any of the site index pages. It seems likely, therefore, that they were stored on the site for ease of access by remote personnel in the expectation – ill-founded, as it turns out, that no one else would notice their presence.

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The documents are extensive, and heavy going in many parts. However, some sections are very clear. The first, under a heading that says:

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begins with a preliminary paragraph warning that the measures about to be suggested would

challenge the principle that the NHS is free at the point of delivery

but that the report’s content

suggests that such options may need to be considered.

So, what are these measures that will challenge the founding principle of the NHS that treatment should be free at the point of need, but that McKinsey’s report suggests are necessary? The first may not seem so bad to those of us who live in England:

We could generate revenue through co-payment by the service user, an opportunity estimated to be worth £0.1 billion -£0.3 billion p.a. by 2014/15.

– Bringing co-payment protocols into line with the rest of the UK could be worth ~£50-80 million by 2014/15.

Co-payment means requiring the patient (‘service user’ in the more commercial jargon) to pay part of the cost of treatment, such as prescription charges or dental treatment tariffs. Since people in England already have to pay such costs, it might not seem unreasonable to impose the same regime in Northern Ireland. However, McKinsey don’t stop there:

In addition to this, other co-payments such as are used in other European countries – or beyond that – could potentially be introduced, if there was need and will. For example, people could pay for attending A&E (as in Republic of Ireland); for access to primary care (as in Germany); for inpatient stays (as in France).

The introduction of any of these measures would do far more than challenge ‘free at the point of use’ as an NHS principle – any one of them would mean its immediate end, and a massive burden on people at their most vulnerable moments.

A careful reading of the figures indicated by the report show that the underlying intent is to implement the wider range of ‘co-payments’, and not just to bring Northern Ireland into line with the system in England.

The report indicates that merely bringing NI into line with England would save between £50m and £80m. But the introduction to the section outlines an ‘opportunity’ of £100-300 million per year. The aim is clearly to save the higher amount – which would mean the complete destruction of the founding principle – and a massive theft of an entitlement which we rightly regard as an essential element of British life.

McKinsey’s recommendations go further still. The report outlines the ‘opportunities’ for reductions in staffing numbers as follows:

• a reduction in the number of consultants by 234

• a reduction in non-clinical staff of 4,300

• 12,600 fewer staff overall (clincal and non-clinical) compared to previously-expected 2015 requirements

Not only does the report recommend reducing staff numbers, but advises a saving of £100m per year by 2014/15 by freezing staff pay.

The grim news isn’t finished yet. The report outlines some of the likely results of having to achieve ‘further savings’ – which will certainly be required as government continues to squeeze funding:

If further reductions in funding were to prove necessary, beyond the identified improvements in productivity and quality, and the changes to income and staff costs described above, then..We would need to restrict access to services and treatments, for example by:

- Enforcing tougher eligibility criteria for treatments, e.g., hip replacements only for the over 80s, social care packages only for the acutely-ill, asking people who need it to buy their own equipment
- Introducing means-testing, i.e., making people pay for care if they can afford to
- Denying treatments that are high cost per Quality-Adjusted Life Year (QALY), e.g., high-cost end of life treatments such as chemotherapy
- Reducing funding of services seen as ‘non-core’, e.g., voluntary and community groups – which currently substitute and/or prevent need for statutory care.

Such actions would ..involve further bed closures and workforce reductions, of ~150 beds and ~1,200 staff per £0.1 billion further reduction in 2014/15 funding.

And, just in case we still need ‘icing on the cake’, the report recommends (but doesn’t quantify, that I can see), the closure of whole hospital sites and of large parts of others.

It’s no surprise that the NHS in Northern Ireland didn’t want these papers in general circulation – and quite a slip to put them into the public domain.

We should be thankful that they did slip. This report gives a frank view of the future of our NHS under this coalition government that robs the poor to enrich the wealthy, and which admits in private, no matter what the public pronouncements say, that the Tories’ long-term aim is not just to privatise the NHS but to eradicate all public services.

This particular document may only pertain expressly to Northern Ireland, but without question the cost-cutting, staff-cutting, service-cutting measures it recommends reveal the nightmare vision that this Tory-led government has for the NHS – one of the greatest achievements of our society.

It has to be resisted, its progress stopped – and the damage reversed by the next Labour government, no matter what it takes.

The 1200 deaths due to poor care happened in 2006 at a pure NHS hospital (Staffordshire).
Germany lets private companies run their service on behalf of the state as does France. It seems to work for them.

tlttf wrote:The 1200 deaths due to poor care happened in 2006 at a pure NHS hospital (Staffordshire).
Germany lets private companies run their service on behalf of the state as does France. It seems to work for them.

Nobody claims the NHS is perfect, and poor care is poor care. However, under a private regime you'd simply hide the problem - people with complex conditions with a low chance of successful treatment wouldn't be treated, because failure would spoil the figures and be considered too expensive.

Staff in a privatised hospital would also be paid less and fewer in number, and therefore have lower morale and be more prone to error. 65% or so of the costs of an NHS hospital are pay costs, and if a private provider wants to provide services more cheaply than a non-profit organisation, it's going to have to cut pay levels and staff numbers to carve out a profit margin.

The situation under private providers would be worse, but less visible. Winterbourne View was a private facility, suffered exactly the problems of low pay and poor staff quality/engagement - and look what happened there but was only exposed by investigative journalism.

The 1200 deaths due to poor care happened in 2006 at a pure NHS hospital (Staffordshire).

tlttf. Totally misleading, as we have come to expect from you. For a start, who the hell are you to quantify “deaths due to poor care” as opposed to deaths which would have occurred anyway? Secondly, the various press reports on this case talk of “between 400 and 1200 more patients dying between 2005 and 2008 (not in one year) than would be expected for the type of hospital”. Thirdly, such ‘excess’ death statistics did not appear in the final Healthcare Commission report, because as I’ve said, they are unable to separate them from deaths which always happen in hospitals.
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The privatisation of hospital cleaning by the Tory governments of Thatcher and Major, with long-term contracts, wouldn’t have helped with accountability for cleanliness. Nevertheless, what happened in one hospital in and around the middle of the last decade, however awful, is just anecdotal evidence in the context of a national system of health care. More relevant is that before this despicable government came to power, waiting times for operations had been reduced on average from two years to four months and patient satisfaction was at an all-time high of 88%.

The privatisation of the NHS, for which the Tories have no mandate, is being undertaken quietly (with a news blackout from the BBC, now that the corporation is in the hands of Tories such as Chris Patten). The Tories aren't interested in public healthcare; as with so many other state assets, they're flogging off the NHS to party donors, in a move which is nothing short of corruption and for which Cameron should end up in the dock one day. Most Tory politicians and their wealthy supporters use private medicine; they hate the NHS. They opposed its creation, causing Nye Bevan to call them “lower than vermin”. They see it as socialism and so they‘re ideologically opposed to it.

The Tories have undermined the NHS at every opportunity, and papers released recently show how Thatcher would have loved to have abolished it. John Major neglected the infrastructure, leaving hospitals in an appalling state and with such a shortage of nurses (because the pay was kept ridiculously low), that when Labour came to power they brought in 12,000 from the Philippines to fill the gap while new British ones were trained. So I for one won’t take any lessons from Tories on the NHS, especially those who play fast and loose with the truth.

Sorry Ivan that it took 3 years to kill the vulnerable and not 1 year. Speaking of privatisation how many hospitals are now on the verge of bankruptcy thanks to Labours PPI system?

Tlttf what a twisted comment......."Sorry Ivan that it took 3 years to kill the vulnerable and not 1 year".

Are you suggesting that there was a prolonged campaign of neglect against a group of individual patients with the sole aim of causing death?

Wasn't it Major who introduced PFI scheme's as a way of repairing the years of neglect to hospital buildings?

tlttf wrote:Speaking of privatisation how many hospitals are now on the verge of bankruptcy thanks to Labours PPI system?

In reality? Zero.

The NHS ran a surplus in the last financial year of £1.6bn - and that's on top of the £2.5bn or so that the Treasury either 'clawed back' or siphoned out of the NHS to prop up the social care system that is collapsing because of their cuts to local government.

The idea that a particular hospital is bankrupt, or unsustainable, or failing or whatever other buzzword we hear touted is an entirely political construct, not an actual reflection of reality. It makes perfect sense to treat the NHS as a whole - after all, it's still officially one entity.

The decision not to is a political expedient not an inevitability.

tlttf wrote:Sorry Ivan that it took 3 years to kill the vulnerable and not 1 year. Speaking of privatisation how many hospitals are now on the verge of bankruptcy thanks to Labours PPI system?

In 1992 PFI was implemented for the first time in the UK by the Conservative government of John Major.

Now this is more worrying for the nation if this manages to happen.

You couldn’t make it up

January 15th, 2013 by Susannah Compton

**UPDATE: Within minutes of 38 Degrees members starting to contact Monitor, they told the Guardian they’d changed their position and “will not be recommending that private sector providers should be exempt from paying corporation tax.” That’s a brilliant win! But so far they’ve only ruled out exemptions for Corporation Tax – keep contacting them and demand they rule out ALL tax breaks for private health companies.**

Revealed: private health companies taking up NHS contracts are lobbying hard for special new tax dodges. You couldn’t make it up, but that’s what a new government review of competition in the NHS is considering.

More of an issue than nitpicking individual hospitals and systems.

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Hunt: "Paperless NHS in five years"


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No mention of what Jeremy *unt plans to do when ObamaCare becomes fully established and all former NHS Medics have fled to America.

"Paperless NHS in five years"

Wasn't that the idea of the much critisied Labour NHS computer system of a few years back?

oftenwrong wrote:-
Thatcher would have liked to privatise the NHS, but feared Civil commotion. What made Cameron decide that he could get away with it?.

Firstly, by gagging the BBC with the help of his stooges like Chris Patten. There was a virtual news blackout on the passage of the NHS Bill through Parliament. One lady on Twitter was in the 'Question Time' audience on one occasion and was told not to ask any questions about the NHS.

Secondly, Cameron hasn't privatised the NHS all at once but by stealth, piece by piece, so that we don't notice any sudden changes. The NHS logo will no doubt continue to be displayed for some time to come.

I remember this being discussed on the MSN boards before the last election, when it transpired that Cameron had had a secret meeting in Westminster with 'Nurses For Reform'. The plans for privatisation had been worked on for years by Lansley, who even received donations from a private healthcare firm for his own office. The Tories told us nothing of their intentions before the election because, as Michael Portillo said on 'This Week', they'd never have got in if they had.

The Latest from Eastleigh Infirmary

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" There - full frontal lobotomy complete. He be voting Conservative in no time..."

Popularly described as the "Conscience Removal" procedure.

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As you can see on the Open Democracy site, and on Shibley Rahman’s excellent blog, the government is trying to slip through a catastrophic and previously-denied NHS measure into law.

Exploiting provisions written into last year’s much-despised Health and Social Care Act (HSCA), along with a little-known Parliamentary procedure, the government is attempting to slip its competition measure into legislation ‘under the radar’ of public awareness so that by the time we know it’s happening, it’s too late to do anything about it.

Then-Health Secretary Andrew Lansley’s HSCA contained a provision that the NHS Commissioning Board (NHSCB) and Clinical Commissioning Groups (CCGs), who commission health services, must not

use anti-competitive behaviour which is against the interests of people who use such services.

In response to concerns raised about the risk of coercion to introduce competition, Lansley sent out a letter to prospective commissioners that included the following, very clear statement:

I know many of you may have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case. It is a fundamental principle of the Bill that you as commissioners, not the Secretary of State and not regulators, should decide when and how competition should be used to serve your patients’ interests. The healthcare regulator, Monitor, would not have the power to force you to put services out to competition.

The new regulations, which will force almost all services to be put out to competitive tender, show this assurance to have been a shameless lie.

In order to push these new rules into law with minimal resistance, current Health Secretary Jeremy Hunt is using a Parliamentary ‘dodge’ to bypass the usual democratic processes of debate and voting. This procedure, known as ‘negative resolution‘, means that the new rules do not need to be discussed or voted on. Instead they will automatically become law 40 days after being laid down, on 1. April.

However, all is not yet lost. MPs have the right to request a motion (a procedure known as ‘laying a prayer’) annulling the change within the 40-day period – and if this ‘prayer’ is supported by enough MPs it could force a Commons debate and vote.

But this is not easy to achieve – according to Open Democracy it is 10 years since it was successfully done in the House of Lords and 30 years in the Commons. We need to galvanise massive Parliamentary support to achieve it – and at the same time to use every other available tactic to stall or subvert the new set of rules that the government is dishonestly attempting to sneak through. Here are some ideas (feel free to add your own via the comments function!):

Write to your MP

First and most obviously, in order to achieve the groundswell of support for a motion to annul this anti-democratic move, we need to let MPs know that the public is aware of the government’s sleight of hand and that we want it blocked. Go to [You must be registered and logged in to see this link.] enter your postcode and it will provide you with the details you need to write to your MP and demand that they take action. No matter which party your MP belongs to, please do this – if even one or two Tory MPs can be persuaded to do the right thing, it could make all the difference.

A Labour commitment

If the government succeeds in forcing through this legislation, it’s essential to minimise its effects between now and the next election. If Ed Miliband and Shadow Health Secretary Andy Burnham make a firm, public commitment now to overturn the rules and cancel any and all contracts awarded under the new rules if Labour are elected in 2015, it may discourage some private companies from attempting to win them in the first place, knowing that they won’t have time to profit from them.

Whatdotheyknow.com won’t allow you to contact the Labour leader and his Health colleague via the site unless you live in their constituencies – but you can still email them at the addresses below to call on them to make a solid, public pledge, so they know that they will have public support if they do so:

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Please write an email today and address it to both.

Closed tenders

The new rules state that any new contracts must either be awarded to ‘any qualified provider’ (AQP) or put out to competitive tender. But there may be an option to minimise damage to the NHS until the rules can be overturned. I’ve worked with competitive tenders and I know there are two varieties of competitive tender: open and closed.

If the rules require CCGs to put all services out to competitive tender, they should still have the right to issue a closed tender – one in which only invited bidders can participate. They can then invite only true NHS bodies to bid for the services. As long as more than one bidder is invited, this should still meet the definition of ‘competition’ – and keep the services within the NHS whichever bidder wins.

You can download a list of prospective CCGs along with the populations they’ll commission for and the Primary Care Trusts (PCTs) they’ll be replacing here. Find out who will be your local CCG(s) and write to them, telling them you expect them to stand up for the NHS in this manner or any other that will achieve the required goal, and that putting out open tenders or using the ‘AQP’ route is not in ‘the interests of those who use [these] services‘.

If these options are not successful or not feasible, there will be other routes that are. We must expect creativity, commitment and courage from our politicians and the CCGs (primarily made up of GPs under the HSCA) to defend the true principles of the NHS by whatever means necessary until this robber-regime can be ousted.

Please act now to get the message across.

Just off out to a meeting with Andy Burnham, our local MP and the Labour candidate for a nearby constituency in 2015 to talk about Labour's stance on, and plans for, the NHS. I'll let you all know how it goes.

I'm sure a negative can be found, though it will take some serious looking!

Transformed: The failing NHS trust taken over by private firm has one of the highest levels of patient satisfaction

Hinchingbrooke Hospital is ranked one of the highest for patient happiness and waiting times
It was on the verge of going bust when it was taken over by Circle last year
It is the first NHS trust to be run entirely by a private firm

By Peter Campbell and Sophie Borland

PUBLISHED: 00:37, 23 February 2013 | UPDATED: 00:39, 23 February 2013

The first NHS trust to be run entirely by a private firm has one of the highest levels of patient satisfaction in the country.

Hinchingbrooke, a hospital in Cambridgeshire with 160,000 patients, was on the verge of going bust when it was taken over by Circle last year.

But NHS figures show it is now ranked as one of the highest for patient happiness and waiting times.
Hinchingbrooke Hospital, the first NHS trust to be run entirely by a private firm, is ranked as one of the highest for patient happiness and waiting times

Patient satisfaction: Hinchingbrooke Hospital, the first NHS trust to be run entirely by a private firm, is ranked as one of the highest for patient happiness and waiting times

The company running the trust has slashed losses at the hospital by 60 per cent and will soon begin to pay off burgeoning debts built up over years of mismanagement. The takeover deal, which saved the hospital from closing down, is seen as a blueprint for the future of many NHS trusts.

The George Eliot Hospital in Warwickshire is already considering adopting the model.

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At a guess Ivan will state "still more lies from the mail" (words to that effect).

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A more local, and possibly more accurate account - showing that there is still a significant measure of doubt as to whether this model is really going to be the best in the longer term.

Personally, I would never accept any single newspaper's account of anything - it's always better in my view to check several accounts if you want to be reasonably confident that you understand the situation; and the Mail IS notoriously biased and not famous for its intelligent comment.

Sorry, I seem to have lost my miraculous ability to post hyperlinks, but the link is easy enough to find on line

BTW ttlf, I think you may find that the verbatim quoting of a newspaper article breaches copyright.

BTW ttlf, I think you may find that the verbatim quoting of a newspaper article breaches copyright.

boatlady. Under fair use rules, it’s possible to use quotations or excerpts, where the work has been made available to the public, as long as no more than is necessary is included, and the source of the quoted material is mentioned, along with the name of the author:-

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However, not for the first time, tlttf is giving us cause for concern over copyright. I’m not happy with his latest post on three counts, but if we delete it there will no doubt be shouts of bias.

Firstly, all quoted material should be posted in italics or a different colour to indicate that it is a quote and you’re not trying to pass it off as your own work. Quoting is okay up to a point, copying isn’t, it’s called plagiarism. If in doubt, just post one or two sentences and a link.

Secondly, quotes must be no longer than 14-15 lines. It’s not entirely clear in tlttf’s post what is quoted and what are his own words. As this is a marginal case, I think we can let it stand.

Thirdly, good practice is to write a post using your own words and maybe adding a quote to support an argument, not to replace it. I must confess that sometimes, usually for reasons of time, I just post an extract from a source along with the link, in order to try and stimulate discussion.

I must urge all members to make themselves familiar with the rules before quoting from external sources, which are likely to be copyrighted:-

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Nice to see that nobody (boatlady excluded) actually reads the message but hey lets shoot the messenger.

Boatlady, if you check on the internet you'll find lots of info regarding the hospital, the fact that I chose one source is neither here or there, the message is a private hospital (more of a co-op actually) is outperforming the NHS hospitals and doing it cheaper.

tlttf wrote:I'm sure a negative can be found, though it will take some serious looking!

Transformed: The failing NHS trust taken over by private firm has one of the highest levels of patient satisfaction

I'd be very interested to know what the staff satisfaction is like. If that side of the equation is wrong, patient satisfaction won't last.

I don't think anyone is saying that a private company can't know how to treat patients and keep them happy. What I at least say is:

- a hospital can treat more patients if it isn't taking out a profit margin
- if it's going to treat the patients at the same cost as a non-profit hospital, it is extremely likely to do so by cutting staff wages, numbers or both
- the missing question is 'who's not getting treated?' An entity wishing to make profit is inevitably going to face the temptation not to treat those whose condition is complex, chronic and/or expensive to treat, in order to maximise those profits

I have other objections, but those three are enough to convince me that the profit-motive has no place in health at the sharp end.

tlttf
I think the point I was making is that the Mail is not necessarily the optimal source in this situation - i would have been more impressed had you cited additional sources as the Mail's reportage is notoriously one-sided. I did, in point of fact also look at the Mail's coverage - nicely written, but failing to report any of the negatives as far as I could see.
Unison members working in the hospital clearly take another view (and I guess their opinions also have relevance as they see how this is playing out 'on the ground')
Also, it's quite possible that the new owners have invested big and slashed deep in order to make a good showing at the end of the first year - it remains to be seen whether this 'improvement' can be sustained in the long term.
I would also want to look into Steve's question above - who's NOT being treated? Some conditions are chronic, expensive and unrewarding to treat, but in a good health service one would expect that those conditions too would receive excellent care - again, this is something that will emerge in the longer term, hence my comment that it is not yet clear that private ownership of hospitals is the way forward.
I guess the litmus test would be if patient satisfaction was at the same high levels and the hospital remained financially viable after 50 years or more - at any rate I need more than a year to convince me.

Let's face it, privatisating the NHS (which the Tories didn't dare to mention at the last election) is just right-wing ideological dogma and a means of rewarding some of the financial backers of the Tory Party. By the time that Labour left office in 2010, patient satisfaction with the NHS was at an all-time high of 88% and waiting times for surgery had been reduced from two years to four months.

Anyone who believes that private healthcare for all is a good idea should talk to somebody who lives under such a system. You could start by listening to what Shirina has to say about medical care in the US:-

Even in a nation that charges a 50% tax rate on income to pay for all of those free services, no one will ever find themselves owing more taxes than they can pay and then being denied services. This means that even the poorest among those citizens can still walk into any doctor's office or hospital and receive the care they need, not just the care they can afford. When health care costs are a product of market forces rather than taxation, sick citizens are faced with a flat fee which, by its very definition, is regressive. The result is that health care services costs X, and if you can't afford to pay X, then you're essentially screwed. That, if nothing else, justifies NHS.

There is absolutely NOTHING about our system that is superior to yours in Britain unless you're sitting in the higher echelons of the executive food chain. To those fat cats counting their money, a for-profit system is utterly brilliant ... but not so brilliant to the 13 year-old who died because of an infected tooth. Did I mention that America's health care system is horrifically inefficient, too? A massive chunk of the expenses incurred by patients are due to administrative costs. Yeah, that's right ... the cost of shuffling papers around. If you want a job in America, become a medical biller. There is such a huge demand for people who write and send bills to the patients that patients have to pay extra for their care in order to pay for the huge numbers of people employed to ... wait for it, wait for it ... bill you!! I mean, seriously, how stupid is that? And you think NHS is inefficient?

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If Private medicine were to receive the column-inches enjoyed by the NHS in media such as The Daily Mail, people might not be quite so desirous of exchanging it for the status quo ante.

FACT 1. Most Doctors and Nurses working in Private Hospitals are NHS-trained.

FACT 2. Most Doctors, technicians and Nurses working in Private Hospitals also have NHS contracts.

FACT 3. If something goes wrong in a Private Hospital which they cannot treat, the patient is transferred to an NHS Hospital.

FACT 4. Private Health Insurance becomes more expensive with the onset of old age.

FACT 5. Private Health Insurance is only ever for twelve months at a time, and may not necessarily be renewable.

FACT 6. Private Health Insurance NEVER covers pre-existing complaints.

FACT 7. Private Health Insurers are in business to show a profit. They are not a Public Service Organisation.

7 bullet points that I can get right behind

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Along with many others, I’ve written recently about the Tories’ covert attempt to slip through ‘secondary legislation’ (Statutory Instrument 257/2013 or SI257) under the Health and Social Care Act 2012 that will force Clinical Commissioning Groups (CCGs) to consider private providers for all health contracts, in spite of emphatic assurances during the passage of the then-Bill that CCGs would not be forced to do this.

I’ve also written about how Labour are fighting this undemocratic stealth-move, which will be a disaster for a truly-public NHS if it passes.

Yesterday, Labour made one move in its bid to get these regulations killed at the Parliamentary stage – an ‘early day motion‘ (EDM) calling for them to be ‘annulled’. LibDem MP and Health Select Committee member Andrew George deserves credit for supporting the motion, which vastly increased pressure on Health Secretary Jeremy Hunt and his health team. If more of his party colleagues showed similar backbone the NHS would be in better circumstances.

Here is his contribution to yesterday’s Commons debate (emphasis mine):

In spite of my right hon. Friend’s earlier comments, I am afraid that the regulation that implements section 75 of the Health and Social Care Act 2012 does not maintain the assurances previously given and risks creating an NHS that is driven more by private pocket than concern for patient care. Will the Secretary of State please withdraw that regulation and take it back to the drawing board?

Health Minister Norman Lamb responded:

We are looking at this extremely seriously. Clear assurances were given in the other place during the passage of the legislation, and it is important that they are complied with in the regulations.

On the back of this statement and later comments from ‘government sources’, the newspapers are reporting this as a reprieve:

government sources said Hunt was prepared to review the regulations to satisfy the Lib Dems

However, this is by no means the reprieve that some appear to consider it. At best, it’s a lull – but the motion did not go to a vote and an EDM would not have been binding on the government even if a vote had taken place and gone against them.

Lamb’s statement that the government is taking the matter ‘extremely seriously’, and Hunt’s decision to ‘review’ SI257 to ‘satisfy the LibDems’ in no way mean that the government has given up on its aim to carve open the NHS for its private backers to feast on.

The Tories have ‘form’ for giving assurances that would then be ignored. At the launch of Lansley’s NHS Bill, the government promised that its changes to the NHS would be driven by the wishes of clinicians. Yet when every association of NHS professionals except one (and even the one was doubtful) said his Bill would be a disaster for the NHS – the Bill was forced through anyway.

In terms of securing the NHS against the government’s planned ‘carve-up’, a comment about ‘reviewing’ SI257 is not worth the breath it took to say it.

Hunt – for whom the phrase ‘a fox in the chicken coop‘ might have been written – will simply seek some form of wording that will allow the LibDems to acquiesce while achieving as much as he can get away with of the government’s obvious aim of forcing privatisation on the NHS.

Earlier in the debate, Hunt made the following statement (just after his ridiculous attempt to equate private health providers like Virgin, Serco and Circle with children’s and mental health charities):

The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

Does that sound like the statement of a man who is in two minds about what he wants the result to be, or who is taking seriously the resistance to his secondary legislation?

Jeremy Hunt and his party will never back down willingly on SI257 – their financial backers would never tolerate it. They will abandon it only with their collective arms twisted so far up their backs that they can scratch the tops of their heads.

So it’s absolutely essential that all those who care about the NHS as a public service that will be there, free at the point of need, for us and the generations to follow, continue to resist, and to apply pressure in every available way.

Given that Hunt’s immediate aim has to be to find wording that will preserve the key aims of his legislation but will let the LibDems toe the line, our immediate aim has to be to put pressure on every LibDem MP, to make sure that they don’t settle for being fobbed off with some conscience-salving ‘weasel words’ and instead advise Hunt that they will vote against his measure if he proceeds with it.

So, if you live in a constituency with a LibDem MP (or a pro-NHS Tory, for that matter, if such a thing exists now), please email him or her urgently and tell them that you expect them to resist this damaging legislation designed to line the pockets of private health providers.

You can find out the contact details of every MP here. Jump in!

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It’s been announced this afternoon that Monitor, the regulatory body for NHS Trusts, has begun the process of putting Mid Staffs NHS Foundation Trust (MSFT) into administration. Once this process is approved, which may only take a couple of weeks, the administrators of the Trust will have 150 days to come up with proposals from a range of options including the complete closure of the Trust. One option that is not included, however, is the continuation of MSFT in its current form.

Reports on the decision focus on the Trust’s financial struggles and Monitor‘s statement that MSNHS needs to cut costs by 7% in order to be financially viable.

Sounds like a serious situation, doesn’t it? But as its Annual Report almost a year ago showed, Mid Staffs was already embarked on a Cost Improvement Programme (CIP) to save 6-7% a year – and had achieved its target of £6.4m in the 2011/12 financial year.

Not only that, but the Trust’s board had already agreed a Clinical Services Implementation Plan (CSIP) to save 6% per year from 2012 to 2015. Cumulatively, this process would save far more than 7% – and, crucially:

within the plan is a three year financial strategy from February 2012 through to March 2015. The CSIP and financial strategy has been supported by the Trust Board and was approved by Monitor, Commissioners and the DoH at a meeting on 30th January 2012

Just over a year ago, Monitor approved the board’s 3-year plan – yet now it has changed its mind and considers MSFT ‘unsustainable’.

Without question, MSFT is a ‘struggling Trust’ in financial terms. But it has been working to – and achieving – a plan that would bring it to a stable financial footing. A plan that was approved by Monitor and the Department of Health for 3 years and is now being cut short to put the Trust into administration.

This sudden change of ‘heart’ (if such a word can be applied to an organisation of which a witness at the Francis inquiry said ‘Monitor misses nothing – as long as it’s financial’) clearly gives away the intent behind the government’s apparent humility concerning the events at Mid Staffs, which was worrying from moment David Cameron ‘ate humble pie’ in his Commons statement about the Francis report.

Reports on MSFT unfailingly mention the myth that basic care failings at Mid Staffs resulted in ’400-1200 avoidable deaths’ in the Trust’s hospitals – even though this claim was completely unfounded from the moment the Daily Mail and Daily Telegraph began to trumpet it, and even though the Francis Report itself does not support it.

Even the BBC have propagated the myth. The BBC News channel’s announcement of the administration decision began by referring to the Trust as a place where ‘hundreds of needless deaths’ took place, while the article on the BBC News website which I’ve linked above states:

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This constant media focus on something that never actually took place is carefully fostered by the government in its language and stance – because it forms the cornerstone of a modus operandi, a method of operation, that the government is going to add to its general and pervasive assault on the NHS as a national, public institution.

The failures at Mid Staffs took place over a period that ended 3 years ago. The Trust now scores better than the national average in terms of its clinical outcomes and mortality statistics (correcting its statistical coding meant that it scored better than average on mortality even during the ‘problem’ period).

Yet only now, less than 3 weeks after the publication of the Francis Report, is Monitor choosing to put the Trust into administration – a decision that makes it extremely likely that the Trust will be broken up (or other Trusts around it will be broken up, as the government insanely did to Lewisham because of failings at South London).

Once the break-up is achieved, the hospital will either be handed over to private health companies to ‘save’, or else its services will be downgraded to simple, profitable ‘production line’ services such as hip and knee replacements (just as Jeremy Hunt announced will happen to Lewisham‘s successful hospital) – making it perfect for private companies to acquire and make money from without having to provide the complex, expensive treatments that we’re entitled to receive from true NHS hospitals.

If you’ve been wondering why Hunt and Cameron wrung their hands over the Francis Report and announced that 14 more hospitals have similar ‘death rates’ to Mid Staffs (though the stats for these are probably no more reliable than they were for MSFT) – wonder no more.

The over-eager rapidity of the decision to put into administration a Trust that is recovering in both financial and clinical terms betrays the government’s real agenda – the real reasons for their tactical posture on MSFT so far.

With an adverse spotlight once again on MSFT, and colluding media constantly ignoring the actual findings of the Francis report to foist the ‘unnecessary death’ myth onto a public that is ignorant of the facts, who is going to care if Monitor decides to put the Trust into administration. ‘Surely we’re better off without it, anyway?‘

Mid Staffs now. Then one by one the other 14 Trusts that have been targeted for the ‘unnecessary death’ slur will be systematically tarnished in the public consciousness by the collusive media, while ministers ‘regretfully’ advise that

we have to take steps to protect the public!

and, one by one, those Trusts too will come under Monitor’s baleful gaze.

Illusory problems will become ‘fact’, agreed 3- or 5-year plans will be trampled on, and we’ll suddenly find ourselves down by 15 hospitals – almost 10% of the total.

There are many fronts in the government’s all-out war on the NHS, but this one – the opportunity to take out 14 NHS hospitals that belong to us, the public – is a ‘wet dream’ for a party that has lusted for the destruction of Labour’s (and the UK’s) greatest achievement since it was founded.

Bevan said that the NHS would survive as long as there are people prepared to fight for it. This dishonest smear-campaign is the latest phase in the Tories’ attempt to distort the perception of the British public until there are none, or too few to mount an effective resistance.

We must not – must not – fall for the lies. Stafford is the battleground – and for all our sakes we need to stop the plan from succeeding there.

As widely anticipated ....

NHS trust may face administration

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Hunt's NHS: coasting?

My wife came home from work last night ‘too tired to chew’. She’s a nurse, and she’d just completed a ‘double’ shift – leaving home at 6am and getting home at 9.15pm after a solid shift of almost 14 hours on a ward full of ‘dependent’ patients.

She came in, and I asked if she wanted me to warm something up for her to eat. ‘No, I’m too tired to chew‘, she said – and it wasn't humour. She then warmed up some instant porridge that she could eat with minimal effort before having a quick bath and then going straight to bed. She’s on another ‘double’ today, so she couldn’t do anything else before sleeping in order to be ready.

It hadn’t even been an unusually busy shift – just ‘par for the course’ on a ward that has about 8 patients for every qualified nurse, and almost all of them with conditions that make them ‘high-dependency’, needing help with even the most basic functions.

Earlier today, in a speech to the Nuffield Trust, Health Secretary Jeremy Hunt criticised NHS hospitals for ‘coasting’. In his considered opinion,

too much of the NHS is focused on doing just that ['not coming last']. Not on achieving world class levels of excellence – the gold medals of healthcare – but meeting minimum standards, the equivalent of ‘not coming last.

and

The weeds of failure grow more quickly in a garden of mediocrity.

Hunt was comparing the NHS to Olympic athletes. Since it was unthinkable, he was saying, that an Olympic athlete would train with the aim of ‘not to win, but to not come last’, we should also expect NHS hospitals to aim for not only excellence but constant improvement.

The thing that strikes me most about the whole, fatuous speech – and it really shouldn’t, because it’s entirely normal in the way this government treats the targets of its measures – is the blatant skewing of any semblance of truth or sense, but stated as if it’s the most unarguable, self-evident thing in the world.

Elite Olympic athletes are singled out, given support, funded - everything is set up to give them the best possible chance to shine for personal and national glory. The best training facilities are provided. And when the government wants a greater chance of success, funding is increased – often massively.

How far would Olympic athletes get in pursuit of excellence if they were underfunded? If their fellow team-members progressively disappeared and their coaches were removed? If they were forced to compete not just in their chosen specialism, but to stretch themselves to cover 2, or 3, or more related events – if every sprinter, for example, was forced to become a decathlete?

This NHS is under sustained, multi-fronted attack by a party whose ideology simply cannot tolerate the existence of healthcare free to all at the point of need. Only politics prevents the Tories from immediately abolishing the NHS. As former Tory minister Michael Portillo put it:

They did not believe they could win an election if they told you what they were going to do.

So the attack has to be multi-faceted, progressive and ‘kept under the radar‘ as much as possible – and it involves a constant ‘drip, drip’ of poison in the ears of the British public to erode support and affection for the NHS, with occasional intensification to prepare the ground for a new phase of the assault.

You see, the Tories want Olympic glory – so they’re prepared to pay for it. They don’t want an NHS free to all – so they’re not.

Elite athletes work hard – but everything is set up to give them the best chance of success, and they are lauded and feted in front of the country. The NHS, by contrast, is starved of funds (no matter how the government tries to twist the figures), under-staffed – and vilified by craven government ministers whenever it’s politically convenient or possible to do so.

Hunt spoke of a need for ‘continuous improvement’ and said that it’s just not good enough to be ‘good enough’. He even dared to use Mid Staffs as an example of what happens when hospitals settle for ‘mediocrity’ – even though the real story of Mid Staffs is one of gargantuan efforts on the part of health staff preventing an increase in the death rates in spite of desperate under-staffing and cuts.

The daily reality of the NHS is one of constant, untrumpeted hard work that routinely goes ‘above and beyond the call of duty’ - in spite of being treated as a punchbag by politicians who’ve never known hardship. Or hard work, in many cases, for that matter.

Nurses and other healthworkers give their best on a daily basis – without glory, without high financial rewards, without the support that they should expect as a right from those at the top, and usually without even recognition or thanks.

Here are some examples that are known to me personally – and which deserve a wider audience, just like the millions of other such acts of dedication that I don’t know about:

• a ward manager who was asked by the the hospital’s senior matron to release a nurse from her ward to help out another ward that was struggling. The manager knew that her own ward was already overstretched – so after a 10-hour shift she went up to the other ward and worked another 4 hours to help out. Unpaid.

• a healthcare support worker who, at the end of a 13.5 hour shift, stayed another hour rather than leave a distraught, bereaved relative before her family could arrive to grieve with her.

a nurse phoning her ward at 3.20 in the morning, in spite of only finishing a late shift the previous evening, to make sure a patient’s belongings had been brought up from Accident & Emergency.

a nurse working on a ward where the patient to nurse ratio is regularly 12:1 - double the recommended level, but battling hard to keep things from collapsing altogether.

• a nurse (my wife) who regularly cries quietly into her late-night cup of tea over the death or fear of a patient with whom she’s ‘connected’ in order to provide some human contact and comfort, even though she knew they were terminally ill.

• and it’s not just nurses and healthcare assistants. 2 doctors – SHAs or ‘senior house officers’ who regularly stay back 3 or 4 hours after the end of their shifts, to make sure that everything is done that needs to be done.

I think you should hear from a couple of those people in their own words. First, our HCSW who phoned the ward in the middle of the night:

Something so trivial yet it worried the hell out of me, I couldn’t sleep thinking that he won’t have anything in the morning and his bag may get lost. Lol. I had actually took it up with him, DOH! but when your busy, your heads trying to think of a billion things to do. I’m a HCSW..I’ve been kicked, punched, verbally abused and bitten, yet nothing is done about it, just recorded and that’s it! I sometimes wonder why on earth I do this job, but the simple fact is I love it. I love interacting with the patients, caring for them no matter how vunrable they are. Sitting with a dying patient and comforting them through their final hours and most of all saving someone’s life. These are the most rewarding things about my job.

And our nurse who faces caring for twice as many patients as she should be:

it is virtually impossible to provide the sort of care that everyone should be able to expect. I have to prioritise on a daily basis and I very rarely go home feeling that I have done a good job. I never leave work on time, my breaks are unpaid (except for a 10 minute tea break) and as I don’t get time to take more than a sandwich on the run break, I am giving the Trust my time every day for nothing.

The reason I carry on working is that I consider myself to be a good nurse, and I try to make a difference to some-one’s life every day. However, I can’t begin to tell you how angry it makes me to see the demonisation of the NHS and nurses in particular as if we are the main reason why the NHS doesn’t always perform as well as it should. There are few jobs where people would put up with the conditions that we have to work in under a constant barrage of criticism. The danger as I see it is that people will be put off going into nursing – I know many colleagues who have left to go into other jobs where they don’t go home at night worrying about the dear old chap in bed 1 who may not be there when you go in for your next shift.

(If you want more examples of the real story of the NHS, I’ve written two ‘day in the life of an NHS nurse’ posts, which were two of the most-read posts on this blog last year – you can read them here and here.)

The weasel words and self-serving distortions of Jeremy Hunt and his ilk are on our TV screens and in our news media every day. The words of the people he denigrates and undermines are not. But there’s no doubt about which should be listened to and trusted.

Hunt and his party are seeking every way possible to kill the NHS in a ‘death by a thousand cuts’. Whether it’s downgrading Lewisham because of problems at another Trust, or propagating a death-myth and then putting Mid Staffs into administration even though the Trust has stuck to a plan agreed with Monitor and the Department of Health – or making an utterly spurious comparison between athletes and the NHS as justification for whatever he’s planning next – it’s clear that the Tories’ aim is the end of the NHS as we know it.

The NHS is not ‘coasting’. It’s sinking.

Holed beneath the water-line by by a hundred Torypedoes – as the Tories then mock, deride and impede the heroic efforts of those who are trying to bale out the water, keep our national flagship afloat, and to keep things ‘good enough‘ against all the odds.

And those efforts are heroic. Olympic athletes achieve great things – but they do it for their own glory and fulfilment.

The real heroes are the hundreds of thousands who give their time and hard work – at great emotional cost and for little reward or recognition – because they care.

We fund and fete our athletes to give them the best chance of success. If Mr Hunt wants more from the NHS, he needs to put his money where his mealy mouth is and stop trying to cut the legs out from under the heroes who really matter.

SK. as you are may be aware I am also a nurse but now working in a private nursing home after 28 years in the NHS the last 10 being as ward manager.

I like to think that I led the ward team by example, there was never a job or task that needed doing that I didn't do, even down to taking out the dirty laundry...I strongly believed that if staff saw me doing they couldn't say it wasn't their job....

I also remember the time when I didn't leave work at the right time, of waking up in the middle of the night worrying that there was something I hadn't done or because I had suddenly thought of some thing that I needed to do the next day....

You wife has my deepest admiration for carrying on under the increased pressures this government has put on the NHS...I retired 2 months after they came in 'power'.....

As I said earlier I now work in the private sector in a nursing home for the elderly, I am contacted to work 30 hours a week and my shifts are all 12 hours long with 60 minutes of unpaid 'breaks' so I work from 7am to 8pm...we have just one trained nurse on duty for a 20 bedded ward.....

Last night I got home at 10pm I live 10 minutes walk from where I work but I had called out a doctor, the second visit of the day (Different surgeries though), to see one of my elderly patients how had developed a severe chest infection and I knew she would be the 10th on the ward to be put on antibiotics and that it was vital that the be started immediately so I stayed, rather than leave it to the night staff.. The doctor came at 9.10pm and wrote the prescription which I then went to the local 24 hour chemist and collected it....

This was the 6th, 12 hour shift I had worked since last Friday....

Earlier in the day I had the dismemberment of being bawled out, by the new 'operations manager and new home manager, both of whom only started in the home on Monday, in the corridor of the home for the failure of the delivery of some medication from the local chemist, which should have been ordered on Wednesday (my only day off)...This was right out side the room of the patient whose medication (food supplement) had not been delivered, at the time the relative was in the room with the door open.....I must admit I took two steps to walk away, not only from the managers but also the job, but no I stepped back and had to listen to criticisms of my performance....

Am I a bad nurse? Am just coasting? Do I really care about my patients?

Do any NHS staff have to put up with the remarks of someone who has never worked in the NHS or even healthcare?

Jeremy Hunt career profile..
After university Hunt worked for a short period of time as a management consultant, and then decided to pursue life as an English language teacher in Japan. Whilst living in Japan he became a proficient speaker of the Japanese language and enthusiast of modern Japanese and other east Asian cultures.
On his return to Britain he tried his hand at a number of different entrepreneurial business ventures, including a failed attempt to export marmalade to Japan. Hunt joined Profile PR, a public relations agency specialising in IT which he co-founded with Mike Elms, a childhood friend. With clients such as BT, Bull Integris, and Zetafax Profile did well during the IT boom of the mid-1990s. Hunt and Elms later sold their interest in Profile to concentrate on directory publishing. Together they founded a company now known as Hotcourses, a major client of whose is the British Council. Hotcourses has subsequently provided financial support to Hunt's parliamentary office.

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When the kids were small, she worked in a private care home for a few years - fortunately one run by decent people. The bad examples in the private care sector are a clear demonstration of why it's far better to have health and care in the public sector.

I'm sorry you've had to put up with crap from know-nothings - unfortunately, throwing crap is a standard know-nothing tactic to cover for the fact that, yes, they know nothing. Hunt is a perfect example.

And one nurse for 20 beds is insane - another reason to keep things public and properly regulated.

Interesting, irrespective of the source!

Blame Labour for Mid-Staffs scandal... says ex-Labour Health Secretary Frank Dobson who warned Tony Blair against introducing targets and competition in hospitals

Warned against 'mad rush' for more competition and targets in hospitals Says Blair ignored him and gave his job to crony to force through change
Successors Milburn and Hewitt were 'obsessed' with breaking up NHS

By Simon Walters

PUBLISHED: 23:18, 9 March 2013 | UPDATED: 23:20, 9 March 2013

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Warning: Frank Dobson told Tony Blair of the risks of his NHS reforms

A former Labour Cabinet Minister broke ranks last night and disowned Tony Blair’s government for the ‘reckless’ NHS shake-up blamed for the Mid-Staffordshire hospitals scandal.

Frank Dobson, Health Secretary from 1997-99, said he warned Mr Blair that a ‘mad rush’ to bring in more competition and targets in hospitals could harm patients. But Mr Blair ignored him and gave his Cabinet job to a crony who agreed to force through the changes.

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