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With the fact that the GP's will now hold the budget, how can we be sure that any medical decision of the doctor will not be influenced by the cost of the medication? For example if NICE do not accept the use of medication because of costs, will the doctor be in a position to go against such advice?
Do we think that we will be subject to medical care on the basis of the cost of care rather than the necessity of the correct care?

Forgive my naivety, but have the general practitioners received training on how to manage? If not, it would seem quite bizarre to through them into the deep end like this. And if not, would it not be wise to use the present managers to 'train-up' the GPs in order to make them more proficient?

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They'll have to hire private corporations to administer budgets and commission services on their behalf .... that's the whole point.

Having just googled NHS reforms Scotland the references on the first page all go back to 2003.

May I assume this discussion is irrelevant to me and my close neighbours?

On Tuesday we'll discuss what his changes mean for patients.

Do his proposals allow patients to (a) choose the type of care they receive, and (b) where they receive it (in most cases, I'd assume they'd choose somewhere local rather than somewhere 150 miles away that had a slightly better rating)?

It wouldn't surprise me if in time they try to roll out the concepts of Personalisation, Self Directed Support and Individual Budgets to the NHS...

Hi Eddy Mair,

I tried to send this as an email question but too long apparently for your email clienjt to accept so posting it here instead.

I have worked on the NHS Mental Health Front line for 30 years,a difficult ,stressful, responsible job working with suicidal, depressed, traumatised and wounded people. For most of the 30 yrs I have been paid a pittance. I have usually worked more hours each week than contracted unpaid in order to mdo the job it is necessary.

I would ask that you dont use my real name used because I know I would be sacked for sending this email.Bringing the service into disrepute etc

I was once very committed too and proud to work for the public NHS.
Now like many, many colleagues I feel sad and sick seeing our NHS, in which we have invested our lives, love, compassion and labour, being broken up, defenestrated, privatised, sold off and sold out.

Business and the Profit motive now trump all other concerns and values, the profit magin and bottom line are all that counts and these Lansley Privatisations will just complete the Marketing of the NHS.

The higher managers of the NHS Trusts are out of touch, out of control, unscrutinised and unaccountable.The culture within the Trust is chaotic, bullying and secretive. Managers who have never seen a patient are making decisions about, cutting and closing down services. Staff are fearful of speaking out. Only Drs have had any real involvement in the massive privatisation Mr Lansley is forcing through.

As far as I am aware there was no and has been no manifesto commitment, no consultation process, no discussion with the electorate or any one else about these changes. I as an NHS Worker have no say in any of these changes, none whatsoever.

The same culture prevails in the Trusts, Staff are given a list of Cuts and told to implement them full stop. This process of cuts to front line services is known, in a phrase Orwell would have loved, as a Benefits Realisation Project.

Many colleagues want to take retirement as early as possible or take redundancy to get away from the awful culture of bullying, pretence and double think that the NHS managers have foistered on them. Lansleys changes untested, no consultation, no discussion just fiat, top down change are the death knell of a public, co-operative NHS


My Questions for Andrew Lansley

The CEO of Derbyshire Mental Health Trust told the local paper , Derbyshire Evening Telegraph, last week ,see link below, that 400 full time posts will be cut from the Mental Health Trust over the next 4 years aproximately 20% of the workforce.



This CEO is paid 150k plus per year withsalary increasing every year, this NHS Trust are now planning to cut front line post from Childrens Services, Adolescent Services, Elderly Services, Psychotherapists post from Specialist Psychotherapy services and cut other Nurses and Therapist post in the next few months. These cuts will undermine frontline services and leave vulnerable patients without a Nurse or Therapist.

At a time of high unemployment we know peoples Mentalk Health suffers, we know that rates of Mental Health problems are increasing particularly among our kids and a growing Elderly population throw up needs for increased services.We know that patient want Psychotherapy and some patients need very specialist psychotherapy which often takes a long time

I belive people will be damaged and die as a result of these cuts, the loss of services and treatments.

What should I do as a committed Mental Health Worker when I am told my job is at risk, vital services are being closed or cut back and I know that patients will suffer?

What would Mr Lansley suggest I / we do?

Should we fight back through our Unions, take action, demonstrate, use peaceful civil disobedience or should we just shut up accept the cuts and privatisation go along with Lansley and see our NHS wrecked and our people, those who need help left to suffer?

See also this massive waste of money and front line staff

Woody1122 (2):

Frankly, I'd rather GPs continued being GPs and spent their time with patients and reading up on the latest medical literature than training to be management and getting drowned in paperwork.

If we *must* have "choice" forced on us, then I choose to have a professional doctor look after me, not a part-time doctor moonlighting as a manager/administrator.

Lucien (3):

Because adding a layer of external management - which as a commercial enterprise is duty-bound to make a profit for its shareholders and will just soak up money that is currently going towards healthcare - is such a good idea when money is tight.

Not only do I simply not understand the reasoning behind the Tories' kind of thinking, it almost looks sociopathic.

On Tuesday we'll discuss what his changes mean for patients.

Like mittfh (5) I would like to know why Mr Lansley (and in fact the entire cabinet) feel that it is better to promise me a choice to go elsewhere for public services than to improve the local public services that I already have access to. This policy thread is distressing enough in education and social care, but as a parent and patient deeply concerns me in regard to health. Why not focus our limited resources and great expertise on improving the existing NHS?
As others have posted elsewhere on this theme, there is little or no evidence that managerial reorganisation improves quality, and even where it does the scale of benefit realisation (their term, not mine) anticipated by this administration is mind-bogglingly optimistic.
Please ask Mr Lansley what risk mitigation measures are being put in place and what his Plan B is, just in case.

Please PM get Lansley to talk to Robert Winston, he knows what he is talking about.



"This document’s honeyed tones and warm aspirations are sweetness and light – but those expressions of good intentions will easily deceive those of us that are less well informed.

The one thing that most health professionals agree is that the NHS does not need another reform."

And... "We have already learnt about the trustworthiness of this Government. It is introducing great swathes of legislation as rapidly as possible, for which it had no mandate from the electorate."

This is the thin end of a very large wedge which is ultimately about privatisation and the introduction of markets into health care. Hopefully the public will be wise to the threats posed by these plans and get involved in organised resistance. We should all make every effort to come along on the proposed national demonstration on the 26th March in London and other protests at a local level. Ideally this will involve constructive alliances between concerned citizens, service user groups and trade unions and send a strong message to Lansley and his governement that his plans for the NHS are not needed and not wanted.

I wholeheartedly agree with 5, mittf and 9, suziebells.

Please make my local hospital the best it can. As with schools, parents don't have the promised choice as the most popular are over subscribed. The same with hospitals the most popular will become more expensive and will have longer waiting times, while the GPs will be sure to send the less knowledgeable in the stats, ie those lower down the social ladder, to the cheaper option so that they can maximise profit. What I have noticed is that given the chance, maximising profit always trumps quality.

Saltley Gates (6) - As you say, mental health services are likely to become more necessary soon. Sadly, those seriously in need of said services are currently planning to reform the NHS.

The key reason why GPs are signing up for pathfinder status is that they are being paid £2 ph by the Department of Health to do so. No payment is made to them if they do not apply. That is why at least half the country has GPs who are moving to pathfinder status.

(14) When I was involved in setting-up a Health Centre, the only time we could get to see the GPs was in the evening. Does this mean the GPs will spend their evenings running the health service for £2 per hour (or was it per head)? That can't last long.

Most people are probably unaware that the majority of GP's are not salaried (unlike hospital consultants) but independently hire themselves to the NHS. This allows them to set their own income levels for themselves by dividing up practice 'profits'. Any 'surplus' not spent on patient care can be diverted into 'profits' and in various complex ways diverted to their own income. This creates a rather perverse incentive system especially for those who are more skilled at financial management than other aspects of being a doctor. The magnitude of the new reforms therefore bring me to pose four questions to Mr Lansley:
1. Knowing human nature, can doctors who are incentivised in this fashion be considered safe with the direction of the NHS?
2. Can GP's truly be considered to lie within the NHS or as they are currently contracted will they be on the outside pulling the strings?
3. What safeguard will there be to cap GP incomes (which as the media has shown us has no upper limit at the moment) and prevent profiteering at the expense of their local NHS services?
4. How can we be sure that 'patient choice' and 'getting the best service for patients' is not a front for potential kickbacks from private non-NHS providers?