• Today's agenda
• Timeline: NHS reforms
• NHS reforms: who are the key players?
• NHS reform jargon explained
• What are the key issues?
5.45pm: For those who missed the roller coaster on the NHS blog today, here is a bit of a summary:
• Shadow health secretary John Healey called for the bill to be scrapped this morning, and Randeep was there live blogging the whole thing with scrambled eggs.
• Nick Clegg then said the health bill was going back to committee, delaying the legislation for over six months. The news was broken by Nick Watt for the NHS blog first here after the deputy PM made the second speech of the day.
• Our specialist health correspondent Denis Cambell was sitting a few feet from Nick Clegg at the time and gave us his political insight in this five minute interview here. We also had reaction from the NHS Confed, high profile Lib Dem Evan Harris and the Department of Health.
• James Meikle then emailed us an interesting story about how the department of health went ahead with plans for competition without seeing appropriate consultation from the EU.
• Then this afternoon we had another live Q&A with the government's head of the listening exercise Steve Field GP.
Keep your eye on the blog tomorrow where we'll be having a special focus day on integration. How can health and social services work better together? Do the proposed health reforms - assuming they still go ahead - help or hinder this collaboration?
5.19pm: Thanks very much to Steve Field for his contribution. The government's listening tsar has now signed off, but please feel free to continue the debate below the line.
4.55pm: Benneyboy asks:
I think it is sad yet again political football has broken out with the NHS....If it (Nick Clegg's speech) has been choreographed, why weren't Dept Health kept in the loop???
SteveField responds:
Thanks Benneyboy for the query re the NHS and the politics. I am staying out of the political to-ing and fro-ing, as I am focusing on producing an independent report, and it is then up to the Government to respond. I look forward to hearing what they say
Blindpathfinder says:
I am a member of a pathfinder executive. I discharge my executive responsibilities by working through lunch hours, tea breaks, and in the late night after the family have all gone to bed. I cram in the background reading to the detriment of my personal life and my clinical education. I am exhausted by this and am thinking of throwing in the towel. The emperor has no clothes on - the reforms are breaking my morale. Give us a plan that is realistic and properly resourced!
SteveField responds:
Clearly what you describe is unacceptable. You need time to do this role which is very important, and your PCT / cluster may be able to support you better.
If the system is truly to be clinically-led, clincians need to have the support to be able to provide the leadership. This is something we have heard. We had a meeting with pathfinders this week and we will feed these concerns back into the DH
In response to a question from Gordi about privatisation, SteveField says:
I have heard those fears from many people around the country, and I believe I do have some ideas in our report which will help safeguard against 'privatisation' but what is coming out very strongly is that patients want more choice and more involvement in decisions made about their care. For example, many patients and health prifessionals have said that there should be more choice in where people die, and they would like to see a greater role for the voluntary sector, and organisations like hospices
4.22pm: Gwledig says:
Just wondering if Steve has any comments about his previous remark that the reforms could "destroy" the NHS and are unworkable.
SteveField replies:
I was reflecting concerns I have heard that unbridled competition could adversely affect the delivery of some essential NHS services. I believe that we will be able to make suggestions which will on one hand ensure that patients get choice in the broadest sense, while essential safeguarding NHS services.
Tomjam asks:
I'm very curious about the listening exercises - first can we hear how they were arranged, who came (were invitations needed?) - that is doctors, other experts, public, and were they advertised at all to the public? Why were no press allowed as witnesses? How many exercises were there? Of course - most importantly - what happened?
A more general question - I see that it is still being claimed by the politician's that we want choice - with the possible exception of choosing between several equally distant GP surgeries (hardly the case for all of us) - we don't.
Steve Field responds:
We have so far spoken to around 5,500; held meetings with stakeholders, patients and healthcare professionals, including an open forum held by the Guardian. We have heard many views, lots of solutions, and it isnt simply a question of who agrees or not with 'the reforms'. The debate has been much richer than that
Regarding choice, I think some people have a simplistic view of choice - many believe it is just about which hospital a GP refers a patient to. Whereas in reality, choice includes the first contact with a health professional - in fact, where they choose to go, a pharmacist or a particular GP.
3.59pm: Steve Field is about to come online to answer your questions from 4pm - 5pm. Please keep posting your questions for him below the line.
3.42pm: Our health correspondent Denis Campbell has been sniffing about trying to get a sense of what Clegg's speech today means for the timing of the bill. Here's what he says:
A health policy expert who I spoke to, who is a bit of a know-all on Parliamentary procedure, has just given me his take on timings... The government responds to the NHS Future Forum's final report, which Professor Steve Field is due to deliver next week. Then it "recommits" the Bill to the Commons and sets out a schedule of amendments to the Bill, making good all the changes agreed between the coalition partners. The reconvened cross-party Public Bill Committee of MPs meets, probably for no longer than two weeks. It should be pretty easy to fix the problems, e.g. it may take no more than changing one sentence of the Bill to clarify that Monitor's role is to promote collaboration rather than competition, as even Andrew Lansley now accepts. Such changes would command widespread consent and, so, the super, improved, de-toxified Bill would pass its Report Stage and Third Reading before the summer recess starts on 19 July.
Procedurally I'm sure said expert is right. Politically, though, I think Clegg's underlying message today was so unmistakeable - we need to take as much time as needed to get this right - coming hard on the heels of him recently declaring that "no Bill is better than a bad Bill" - plus the lack of urgency from anyone to get this huge and complex legislation back into the Commons - that a summer sign-off from the elected members is inconceivable. Mr Knowall and I duly agreed to back our respective hunches with a fiver. My betting record is rubbish, but I think this one's safe money.
3.19pm: With all the excitement around Nick Clegg we have neglected to bring you the stories of the day. While many readers will want to tackle Prof Steve Field on the implications of the proposed delay to the bill others might consider:
• Shocking stats show alcohol-related hospital admissions at record high. Our colleague James Meikle says Alcohol Concern is now demanding an overhaul of Licensing Act after alcohol-related admissions in England top 1m in a year.
Diane Abbott MP, shadow public health minister, says that Scotland Alex Salmond is pushing ahead with minimum pricing policies (for alcohol) and contrasts this with England where "there is a deafening silence where a substantive strategy should be".
• Terrific post by the Jobbing Doctor on the Care Quality Commission's report into the appalling treatment of the elderly in some hospitals. The Indy's take was
Doctors caring for elderly patients in hospital are being forced to prescribe water for them in order to ensure they have enough to drink.
The blogger, who is a GP, says this is down to a commercialisation of healthcare which has resulted in:
1) Hospitals are gearing themselves up for making profits.
The ratio of properly qualified nurses to patients is very bad in UK hospitals, and the nurses there are spread more thinly. This is one problem. As a result of this, the wards are increasingly staffed by Health Care Assistants who cannot perform some nursing duties, but who look like nurses to the lay person. That puts more pressure on qualified staff.
2) As there are fewer hospital beds, all the in-patients are iller, and require more nursing care. Also, as soon as one patient leaves, then another one gets put in their bed,
3) The requirements of the hospital legal departments are such that the paperwork is phenomenal, and each admission and discharge results in reams and reams of paperwork, much of it 'cover-your-ass' paperwork.
4) When a hospital becomes a trust,
The management is much more aggressive, and there is much less of a feel of a community of people working for their local hospital, and a feeling of pride in your hospital.
• The Nothern Doctor worries that too much is being made of the entrepreneurial instincts of family doctors.
Practices do make a profit but in most cases it is a modest one that pays GPs and their staff a reasonable salary. Most practices can't make a significant profit above this but the quid pro quo is that they are unlikely to go bust. Don't be persuaded by the straw man argument that GPs are already private providers and the NHS reforms are a natural development. We only need to pull a few small threads to unravel the whole fabric of our primary care.
• Big business still wants a slice of the NHS. At a conference today NHS Partners Network director David Worskett said the NHS must not put "internal convenience" ahead of patient care.
Responding to critics of the "Any Qualified Provider" policy, David Worskett said that NHS patients must be able to access the best quality care available at NHS prices - whether it is state, charity or private sector.
There are now those who are expressing doubts about the Any Qualified Provider policy. They are suggesting that if use of a new provider might destabilise other NHS services, which cross-subsidise each other, in a hospital for instance, then choice of the new provider may need to be restricted.
That view is incompatible with the government's goal, restated by the Deputy Prime Minister this morning, that patients and quality must come first. If the government really means that, it needs to recognise that the "destabilisation" argument is tantamount to saying that patients may only be able to access second or third rate services if that is the way to protect existing cross-subsidies and inefficiencies. If a new provider offers the best value and quality, working to NHS standards and prices, the patient must be free to choose that provider.
2.43pm: An interesting titbit of information comes our way from our colleague James Meikle about the government's lack of planning in its proposals to introduce competition to the NHS:
The Department of Health did not commission outside separate advice on any possible impact its Health and Social Care Bill might have in relation to EU competition law. The evidence comes in a DH response to Lord Owen, the crossbench peer and some time Labour health minister, who asked what advice it had regarding EU competition or procurement law over its intention to offer greater choice of healthcare providers under its proposed NHS changes. Owen had used a Freedom of Information request in an attempt to find out the implications of allowing "any willing provider" (now "any qualified provider") to offer services were.
The DH effectively told him to get stuffed. Laura Stocken, one of its Freedom of Information team told him "any qualified (now willing) provider" was "a policy intention" and not the subject of clauses in the Bill. She continued:
"It may be useful to know that legal advice was integral to the department's advice to ministers on the introduction of the Health and Social Care Bill. However no separate legal advice was commissioned by officials on the impact of the Bill upon the application of EU competition law to the NHS."
"Advice was sought (in 2007) on the application of EU competition law during the process of establishing the Cooperation and Competition Panel. The Health and Social Care Bill does not change current EU competition legislation or procurement legislation. The 2007 advice cannot be released on the grounds of legal professional privilege."
No legal advice is held by the DH either on the change from "willing" to "qualified" provider either, wrote Stocken. Premature disclosure of such protected information could prejudice the working of government and the neutrality of civil servants, she said.
As for any policy advice on this issue, the DH is not telling: "We have concluded that the public interest in withholding this information outweighs the public interest to release."
Owen is complaining to the Information Commissioner Christopher Graham saying this matter should be cleared up before the "listening period" on the NHS changes ends.
2.33pm: After pushing the Department of Health about whether the health bill will be recommitted, we have just received this response via email:
We won't decide that until we have received the NHS Future Forum report and have responded to that. As the Secretary of State told the House of Commons on 4th April we would ensure proper scrutiny of the Bill - we have done that so far and we will continue to do so.
And crucially the Department of Health added:
Recommittal can include specific amendments, not necessarily the whole bill. It need not add greatly to the Parliamentary timetable.
2.26pm: Responding to Nick Clegg's speech on NHS reform, the Chief Executive of the NHS Confederation Mike Farrar has emailed us this statement:
We are encouraged by the Deputy Prime Minster's speech, which suggests that the listening process is beginning to move in the direction the NHS wants. Both the overall narrative and policy content appear to reflect the views we have put forward.
One of the reasons these reforms have run into trouble is there had been insufficient amounts of listening with those who are responsible for implementing them. Now this appears to be being addressed, and we would encourage the Government to keep this dialogue going, in particular as the detail emerges.
We have to get these reforms right and we need to ensure they have a proper political mandate. But the government must also have an eye to how long the legislative process will take. The NHS is under enormous pressure and we need the clarity quickly in order to make it easier for the NHS to deliver financial stability and high quality services for patients.
2.19pm: Leading Lib Dem Evan Harris, who proposed the motion in March that signalled Lib Dem opposition to the bill sent these comments to the blog:
Everything that Nick Clegg said today, and indeed in previous public statements, about the changes to the Health Bill that he is promising are consistent with what the party's conference voted to demand. The party rank and file will be pleased about that and will expect that in later announcement the other changes called for are also to be delivered.
These include a bar on the outsourcing of commissioning, the co-terminisity of commissioners with with social services local authority boundaries, a clear barrier to the undermining of existing services by contracting away some of their workload and income, the need to ensure - if no councillors are to be on commissioning groups - the strongest possible democratic oversight of health care by Health and Wellbeing Boards and Scrutiny Committees. That means "no mandate, no vote" on those bodies.
The reason the bill will need to be recommitted are:
1) changes so great that speaker might insist on re-commital anyway
2) re-committal will actually be time-efficient compared to a mauling in the Lords which they will do if there has been no proper scrutiny on the Commons
3) Lib Dem party don't want to see Lib Dem MPs and peers vote at repprt stage for something rushed at them or where some changes only available in the Lords
Re-committal proposed by Lib Dems internally long before John Healey put down his reasonable motion requesting it.
1.16pm: Here's an update on what the rest of the media are saying about Clegg's speech - all slightly behind this blog's coverage of course!
The Evening Standard reports that Clegg is setting out to be a "champion of the NHS":
In setting himself up as the champion of the NHS against too-radical Tory reforms and a too-rapid implementation of them, Mr Clegg is, of course, doing himself a service with his own party.
And Janet Daley in the Telegraph blogs that, to her own surprise, Clegg has made an "important and useful contribution" to the health debate/
The Guardian's Jackie Ashley agrees: describing his speech as "a measured, progressive and welcome description of what needs to happen and what must not happen to our National Health Service."
1.09pm: The BBC's article on Clegg's speech is raising questions about what happens to health services on the ground whilst the bill is delayed further:
Redoing part of the bill's Parliamentary passage could delay the timetable of reforms scheduled for 2012 and potentially risk the billions of pounds of savings that have to be made by the NHS by 2014.
The blog has also been asked about this on Twitter by @gamesignora. Our readers should all know we've put in a number of calls to the Department of Health about this, also asking about the future of the health secretary, and we'll let you know as soon as we hear anything.
12.44pm: The Guardian's chief political correspondent Nicholas Watt asked Nick Clegg the killer question about the bill being recommitted - and has filed an early version of his story for us here:
The government's troubled NHS reforms will be delayed by at least six months after Nick Clegg announced today that the health and social care bill is to be sent back to MPs for detailed examination.
In a speech to patients and medical health professionals at University College London Hospital, Clegg said it would be wrong to "bounce" the bill through parliament.
The deputy prime minister, who buried Andrew Lansley's 2013 target for the changes by rejecting "arbitrary deadlines", said that a revised version of the bill would be sent for MPs to examine at committee stage. The health and social care has already passed that stage and was due to complete its final stages before the summer recess in the commons before being sent to the House of Lords.
Clegg made clear that he believed that it was important to give MPs a chance to re-examine the bill after the government's "listening exercise" which is due to end next month.
He said: "I don't think it would be right for us to hold this listening exercise - to make big changes to the legislation - and then to seek to bounce it through parliament. It is very important that MPs, who represent millions of patients up and down the country, have the opportunity to really look at the details that we are proposing.
"I think we will need to send the bill back to committee. I have always said that it is best to take our time to get it right rather than move too fast and risk getting the details wrong."
12.36pm: Our health correspondent Denis Campbell was sitting just a few feet away from deputy prime minister Nick Clegg when he announced that the health bill will be going back to committee. Here are some of the key points from our full audio interview with Denis below:
- Clegg's admission that the bill will go back to committee stage effectively kicks the bill into the "political long grass". There is unlikely to be sufficient time for MPs to scrutinise the bill again before the summer, so it will be pushed back after party conference season.
- Denis says there were so many changes announced in the bill he wondered whether Nick Clegg had actually squared the changes with the prime minister, and it "doesn't surprise" him that the Department of Health doesn't seem to know what's going on. He says there is "intense political roller coastering" behind the scenes.
12.29pm: Shadow health secretary John Healey agrees with Nick. The Labour frontbencher has emailed his response to the deputy prime minister's announcement that the health bill will be sent back to committee stage for fresh scrutiny.
I welcome Nick Clegg backing Labour's motion to send the Health Bill back to the House of Commons to re-run its committee stage. The Government's plans for the NHS need to be radically rethought. If fundamental changes are going to be made to the legislation, they need full and proper scrutiny in Parliament.
12.23pm: When John Healey, Labour's health spokesman, spoke this morning about the opposition tabling a recommittal motion "for the Health Bill to go back to square one for fresh scrutiny in the Commons" he could not have possibly thought his advice would be accepted so quickly.
As Andrew Lansley hinted to the blog this week the coalition are considering such substantial changes to the government's National Health Service bill that it may have to undergo fresh scrutiny by MPs. This would delay considerably its passage through parliament.
MPs have already taken a line-by-line look at the NHS and Social Care bill during committee stage – but the legislation has been stopped in its tracks until the conclusion of a "listening exercise" with medical professionals and the public.
When the bill is recommitted, it will be a first in nearly a decade. The last time anything close to it happened was 2003 on the hunting bill when the house voted to fundamentally change the bill at report stage – banning fox hunting rather than licensing it. But that was very different, not least because it was a free rather than whipped vote. Before that legislation was recommitted in 1951 with the mineral workings bill and two years earlier with a criminal justice (Scotland) bill.
A health insider told the blog that they had heard rumours of a "recommital" had been doing the rounds all week.
The changes must be so large that the PM thought that the Lords would spin this out for ages. Peers don't like to originate flagship bills so they would have combed through this bill. Downing Street and its lawyers must have decided the bill ought to undergo renewed scrutiny by committee. Retracing its passage through the Commons might be the less worse option. But it would add months to the timetable, and would put in doubt the planned abolition of strategic health authorities in April 2012. It also begs the question whether (Andrew) Lansley could actually stand at the despatch box and sell the bill again - after all Labour would ask why they should believe him now when they couldn't believe him before.
12.07pm: The Q&A with the deputy prime minister is still ongoing. Here are a few more tweets from Rethink:
Rethink says:
"Clegg: health and wellbeing boards need more powers than currently set out in the health bill #OurNHS"
"Clegg: there should be no arbitrary deadlines when it comes to NHS reform - better to take our time and get it right #OurNHS"
Meanwhile over on Guardian politics, Andrew Sparrow has produced an excellent summary of Clegg's speech.
11.59am: There's some confusion at the Department of Health over whether the bill will be "recommitted" to parliament.
The BBC's Laura Kuenssberg tweets:
"Dept of Health source says there no decision yet on if bill will be delayed by committee stage - is Clegg trying to bounce them into delay?"
Also Rethink the mental health charity tweets:
"Clegg being heckled by patients - they're upset he's taking too many questions from journalists not patients"
11.38am: Nick Watt tweets to say:
"Clegg announces major change to health and social care bill. It will go back to ctte stage #nhsblog"
Wow. So here are the key changes announced by Clegg this morning:
• The changes to the health bill are so large that the bill is going back to parliament for fresh scrutiny.
• Monitor to promote collaboration and competition
• No fixed timetable for GP consortia
• Health Secretary will have a "public duty to ensure a comprehensive health service, accessible to all"
11.37am: Nick Clegg has confirmed that there will be no forced timetable of change towards GP commissioning - something that Sir David Nicholson made clear in this interview with Health Service Journal earlier this year.
So, yes, family doctors should be more involved in the way the NHS works. But they should only take on that responsibility when they are ready and willing, working with other medical professionals too. We aren't going to just sweep away tiers of NHS management overnight. NHS managers will carry on doing the commissioning in areas where GPs aren't yet ready. And there'll be no sudden, top-down opening up of all NHS services to any qualified provider.
He adds that competition will come in a "planned, phased way". Basically Clegg is trying to reassure the public that the reforms are not being rushed through.
11.33am: DPM makes a big concession - saying that the secretary of state will still have the duty to provide a comprehensive service for all. It's been a key concern.
I've heard people suggest that our reforms could lead to politicians washing their hands of our health services, because of the way the Bill is phrased. So we need to be clearer – the Secretary of State will continue to be accountable for your health services. This is your NHS; funded by your taxes and you have a right to know there is someone at the very top, answerable to you. With a public duty to ensure a comprehensive health service, accessible to all.
And he says that certain national targets and systems will stay in place:
Finally, we're making sure that our reforms protect your rights, as set out in the NHS constitution. Like the right to treatment within a specified waiting time. The right to drugs and treatments recommended by NICE for use in the NHS, if your doctor says they are appropriate for you. And the right to be given information about your treatment.
11.32am: Nick Clegg is moving on to his final big theme - patient voice. He says that many people "feel powerless over health services in their area":
We know that when people get involved in their care they get better results, and they manage long-term conditions more successfully too....
Yet still feel powerless over health services in their area: having to stand by while changes and closures take place, with no explanation and no way to intervene.
11.30am: One of main sticks used to beat the health bill has been that it will "fragment" the NHS. Nick Clegg seeks to defuse this by talking about integration. So he understands the worries but says
GP consortia will have to work closely with others..."crucially, they will also have to work closely with social care services, with hospital specialist services, with children's services - joining up your care."
11.29am: Clegg confirms what Andrew Lansley told this blog earlier this week that the "main duty" of Monitor "will not be to push competition above all else":
Monitor's main duty will be to protect and promote the needs of patients instead using collaboration and competition as means to that end.
11.28am: The deputy PM praises Labour for the NHS constitution and but uses today's report of poor elderly care to make the case for change. He then goes on to say there are three things he's heard people want through the listening exercise:
From everything I've heard over recent weeks, I would say three big things: peace of mind, the best care, and a say in the decisions that affect them and their families.
He says that providing choice "isn't the same as allowing private companies to cherry-pick NHS services": "(Choice) is not the same as turning this treasured public service into a competition-driven, dog-eat-dog market where the NHS is flogged off to the highest bidder. Competition can help drive up standards but it is not an end in itself."
11.25am: Clegg makes the case for taking the NHS back to its (Liberal) Beveridge roots.
When Beveridge first proposed a nationalised health service in 1942, he didn't prescribe exactly how it should work. He called for a comprehensive service to ensure every citizen can get "whatever medical treatment he requires in whatever form he requires it."
Nick Clegg emphasises that the NHS will remain free at the point of use, based on need and not ability to pay. He knows he has to come out strong here:
No government worth its salt – certainly, no government of which I am a part – will ever jeopardise that.
11.22am: Rowenna says that Nick Clegg is trotting out a familiar line onwhy the NHS needs reform: treatments are advancing, the population is ageing, long term conditions are becoming more common, budgets are tightening... He says that there are more pensioners than teenagers in Britain.
"The Coalition is protecting NHS funding but, even with that protection, our health services face huge financial and demographic pressures in the future."
And he addresses concerns that health workers might think that the need to change might be an implicit criticism of their work:
"Everyone knows our healthcare professionals are some of the most passionate, dedicated and talented in the world. The need to reform isn't a reflection on them; it isn't a criticism of the NHS."
11.18am: We are not so liveblogging as crowdsourcing the Clegg speech. Our health correspondent Denis Campbell texts to say that University College London Hospital has been turned into a
Pure made 4 TV event. Audience is a health charity reps - and lots of political and health journalists. Clegg is introduced by Macmillan charity CEO Ciaran Devane
11.16am:Rowenna's also looking at the Clegg speech:
Nick Clegg opens his speech by acknowledging again that there were mistakes on the health bill: "we didn't get all of the substance right" he says, "we now need to make changes – in some cases, significant ones."
The deputy PM is having to walk a difficult balance in this speech. He's got to make the case for change, whilst also respectfully distancing himself from some of those changes his government has proposed: So I'm here today to reassure people: yes, there will be reform of the NHS. There must be reform of the NHS. But not change for change's sake.
11.12am: Nick Watt of our political team is tweeting the speech for us live. Follow him at @nicholaswatt or #nhsblog
Clegg: no 'dog-eat-dog market' where NHS 'flogged off' to highest bidder
Clegg: NHS managers will commission 'where GPs aren't yet ready'
Clegg: 'no sudden, top-down opening up' of NHS to 'any qualified provider'
10.48am: The deputy prime minister Nick Clegg is due to make a speech at University College London Hospital at 11am. Keep your eye on the blog for live updates.
10.38am: We were emailed the following statement which is doing the rounds in Sheffield hospitals. In just one hospital - the Royal Hallamshire - it has been signed, according to one medic there, by "150 staff including almost 30 Consultant Surgeons and Anaesthetists who are extremely angry and appalled by the future direction of the NHS as laid out in Lansley's Health and Social Care bill".
Sheffield is important because the teaching hospital is one of the largest Foundation Trusts in the UK, employing 13,500 staff. As our mole points out "the Trust has been awarded the title 'Hospital Trust of the year' in the Good Hospital Guide twice in three years. We are also in Nick Clegg's back yard"
The statement reads:
Is this the end of the NHS? We believe the coalition governments Health and Social Care Bill will be a disaster for the healthcare needs of the people of England.
With a devastating analysis of Andrew Lansley's bill, Professor Allyson Pollock and Senior Fellow David Price have exposed the true intention of this legislation in the 9 April 2011 British Medical Journal Vol 342 p800.
This bill abolishes the secretary of state's 'duty to provide' a comprehensive service and is replaced with a duty to 'act with a view to securing' comprehensive services. Taken with other changes this will inevitably result in the marketisation of health care along American lines, where investors and shareholders come before patients.
As health professionals in Nick Clegg's home town of Sheffield, we condemn this bill and agree with Professor Pollock, " The bill as drafted amounts to the abolition of the English NHS as a universal, comprehensive, publicly accountable, tax funded service, free at the point of delivery " and we call for opposition by any means necessary to defeat the bill.
Not good news for the deputy prime minister one suspects. Although he won't be there hundreds are protesting at his non-appearance at Newcastle civic centre where he pulled out of making a keynote speech. Instead he's giving it at University College London Hospital. We'll be live blogging it soon.
10.15am: Here's a round up of this morning's health reform news:
• The Times editorial writes in staunch defence of competition in the health bill, describing Britons' wariness of private companies in healthcare as an "irrational" obsession.
The editorial argues that David Cameron and his health secretary are giving up too much to the Lib Dems who are opposed to competition on "ideological grounds". Behind a pay wall the Times writes:
Keen to shed this perceived toxicity, and keen to throw a bauble to their coalition allies, David Cameron and his Health Secretary, Andrew Lansley, now show worrying signs of relenting on competition and focusing their efforts instead on the second (and, in fact, far less well-considered) aspect of their NHS reforms, which is the scrapping of Primary Care Trusts in favour of GP commissioning. This is precisely the wrong calculation
• The Times' comments come on the back of the second part of a report into the NHS by Camilla Cavendish. In her article today Cavendish talks to Ali Parsa, the ex-Goldman Sachs banker who founded Circle and who has appeared on this blog. He makes some pretty hardline comments on competition in the NHS:
"Incumbents don't innovate by themselves," he says. "IBM would have said it was the best — until Microsoft — until Google." He talks passionately about revolutionising public services: "In the 1970s it was manufacturing. In the 1990s it was telecoms."
Cavendish also looks at the Spanish model which she says could work well in the UK. She points out that in Valencia, a quarter of the population is now covered by hospitals that are privately run but publicly owned, with some of them delivering excellent outcomes.
To be fair, Cavendish also points out a few problems with competition in the health bill as it stands - particularly in regards to cherry picking - but concludes that "competition needs a rewrite, not abandonment".
• Interestingly, Julian Le Grand, a former health adviser to Tony Blair, argues in today's Financial Times that the bill should be scrapped for the opposite reason the Times gives – in order to protect current elements of choice and competition in the NHS.
• The BBC covers news that the British Medical Association, the union representing British doctors, has once again called for the health bill to be scrapped.
• Over in the Guardian our colleague Denis Campbell sets the scene for Nick Clegg's speech later this morning saying that:
The deputy prime minister will outline the substantial revisions he expects to see made to the health and social care bill to ensure that his MPs feel able to support it when it returns to parliament.
• Denis also covers news that the NHS is failing to provide basic care for the elderly. According to the NHS watchdog the Care Quality Commission, three out of 12 hospitals in England where standards of dignity and nutrition for older patients were assessed in spot checks were not meeting the basic standards.
• And our colleague Ben Quinn covers Labour's warning that the government might be moving away from abortion rights.
• Oh, and Left Foot Forward have covered Healey's speech that we live blogged earlier here.
9.23am: Two opposing views from the floor: a neurosurgeon asks can we afford the NHS - and don't we need this bill? A Nurse says we need to get rid of this bill - and suggests a letter writing campaign to save the NHS?
Healey says nothing rattles an MP more than constituents turning up with concerns about the NHS. He says Lib Dem grassroots are restive because they don't believe their leadership over the NHS. To the neurosurgeon he says sure we need reform but are these the right ones? No. The cost of the re-organisation is £2bn. It's too much - a real waste of money claims Healey.
That's it.
9.19am: Healey takes a question on the loss of patient privacy because of the bill. He has not thought about it in detail but he does make a point about commercial confidentiality - that health service transactions will be in the private domain and beyond public scrutiny. It's a way of tying in privatisation with Lansley's reforms.
There's another point about a lack of election manifesto commitment to the re-organisation of the NHS. The British civil service were caught out, says Healey. There are still drawing up the regulations. He's making the point that rushing results in poor policy.
9.16am: Healey takes questions. A doctor stands up and says nurses aren't up to commissioning and neither are managers. It's a little bit of a rant. A retired surgeon says the NHS is as important as national security, so why not have a little more consensus?
Healey wants to says he is ready to offer the government his support over social care changes. The public put the NHS above winning the second world war! The British love the NHS, admits Healey. There are some incredibly talented nurses that don't think management talent is the preserve of doctors.
Labour's man makes a point about reorganisations. In the 13 years of Labour rule, they worked out that reorganisations achieve less than you think, cost more than you think and take longer than you think. That's why Labour had a freeze on reorganisations.
9.09am: Healey now lists fellow travellers in the road to opposition to the bill: the BMA, the NHS Confederation. But this is not about opposition for opposition's sake - Healey says Labour wants reform, just not this one. Healey calls to scrap the bill - and he says he has tabled a recommittal motion for the bill to be submitted for fresh scrutiny. Doing so would essentially put the bill back by a year - and make Lansley's position untenable. Healey has 40 amendments - again enough to wreck the bill. Healey's quiet delivery is meant to convey sympathy with reformers but the words are meant to stop the reforms.
"A heck of a speech... great speech..." is the instant response from my fellow breakfasters.
9.03am: Healey now breaks down why the 85 clauses that create Monitor are so dangerous: they remove the protection the NHS has as a "public service" from EU competition law. This point is in dispute. He says Monitor will have to enforce the Competition Act on the NHS. This act has never been used by the Office for Fair Trading because it has been "a publicly managed system". Healey says that the ability to "plan properly and commission confidently" will be undermined because managers will be watching their backs for a "legal challenge". Healey is pushing the case because he knows that NHS managers themselves are worried about the proposed power of Monitor.
8.57am: Labour's health spokesman now gets on to accountability. This is smart territory to argue on as the Lib Dems say they want to close the democratic deficit. But Healey says the consortia will be secretive bodies, the health secretary will no longer be accountable to parliament (amazing for someone poring £110bn into the NHS), and there'll be no independent expert public health agency. He says eight charities have complained that instead of closing the democratic deficit it will widen it.
8.54am: Healey gets into the policy detail here: he notes that there will be five new commissioners in Lansley's plans. Local councils, GPs, consorita, the national commissioning board and its regional arms. This is interesting because Healey is pointing to a period of chaos - perhaps a kind of creative chaos that policy wonks love but patients hate.
8.53am: Healey says Lansley's NHS plan is a coherent, consistent comprehensive policy. This is not a good thing as the Labour politician says that the aim is to break up the national health service: "patients will increasingly see a postcode lottery in care".
8.52am: Healey calls to scrap the bill: the King's Fund say its the "biggest upheaval" in the NHS. Clare Gerada, chair of the royal college of GPs, says it would "irreparably damage" the service. Healey makes the case that the bill will end the NHS. The Labour politician is making the case that the coalition cannot be trusted and that their plans will destroy the NHS. His opponents will call this scaremongering.
8.48am: Healey is now warming to his theme: Don't believe the Tories when they say 'I Love the NHS'. Healey says the bill will:
- Break up the NHS
- Remove accountability
- Turn the NHS into a free-market
Healey has dug out Andrew Lansley's first speech in 2005 as shadow health minister where the then Tory MP said "maximizing competition" is the "guiding principle of NHS reform". He then points out that Lansley claims the PM and he go back 20 years on the issue of the NHS. He's is tying Lansley to the toxic "marketisation" of the NHS.
8.47am: Healey says consult first, then leglslate and then implement third. This process has been reversed says Healey. The Labour spokesman is making the case the government is incompetent over the NHS. Cameron has failed to get a mandate for change. It's a point about procedure, but it's a good one.
8.45am: Healey makes the case that Lib Dems have backed the bill: Nick Clegg signed the white paper, his MPs backed the bill through committee. Healey says Nick is selling out the safeguards of the NHS. It's an attempt to reclaim the mantel of opposition from the Lib Dems.
8.44am: Healey argues that the Lib Dems have backed the bill: Nick Clegg signed the white paper, his MPs backed the bill through committee. Healey says Nick is selling out the safeguards of the NHS. It's an attempt to reclaim the mantel of opposition from the Lib Dems.
8.42am: Healey makes a good point about the pause allowing space for criticism against the government - essentially to fill the vacuum caused by the listening exercise. It's bad politics. Healey says the test for Steve Field is how much of the criticism he takes on. He says the bill is at odds with the NHS's ideology. Healey is setting a series of key tests for Field. How much will he be listening to Labour is Healey's point.
8.39am: The speaker introducing Healey quotes Mark Twain, "No word was ever as effective as a rightly timed pause"....
Healey says that to understand the PM's pause you have to understand the politics. He says he's been in the job for six months so he will offer his view on politics, the ideology and the answers. Labour have produced 40 amendments - a new health bill... Healey's been extremely busy.
8.34am:I am at the splendid Royal Society of Medicine's Edwardian Baroque central London building sitting at a networking breakfast. We're waiting for John Healey, shadow health spokesman, to start his keynote speech. It's a power meal so the Guardian is liveblogging from a table with medics and professors. I can report the Salmon is fresh and the scrambled egg is very good.
8.30am: It's another highly charged political day for the NHS, and we'll be covering it all. Here's the line up:
Shadow health secretary John Healey will be giving a big speech on the NHS this morning. Randeep is already down there now and will be posting live updates over the course of the next hour.
At 11am Nick Clegg will be making a speech at University College London Hospital about the reforms. Our health correspondent Denis Campbell will be down there reporting the gossip and we'll be live blogging updates.
Steve Field GP, head of the government's listening exercise on the health reforms, will be will us from 4pm - 5pm this afternoon answering your questions live online.
As ever, if you have any questions for Dr Field or comments to make on the speeches or the debate, please do start posting them below the line now.
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