LMITransactions&Report2014-15

LMI Transactions and Report 2014 - 2015
exist is 5 years…”, quoting Oliver Letwin.
The talk then considered the new concept of
Manchester devolution. The Treasury deal, signed
with councils in Manchester, covers 1.7 million people.
The deal was secretive and there was no consultation
whatsoever with anyone. The devolved budget is £6
billion, to cover health and social care. There are
mixed feelings about the plans but it is clear that
Government will not be involved. Is this the end of
the NHS with the new MHS? Is the money enough to
sustain the service demands? Dr Wrigley noted that
social care alone is a significant cost and members of
the audience raised the point that this move might
risk a blurring between health care and social support.
On a positive note, this devolution takes healthcare
away from Government into the powers of the local
population. However, is it undermining Labour
signing up with Labour councils?
After the election, the outcome is uncertain. Health
policy differs between the contenders but the
Conservatives will continue the same way. Labour will
repeal some of the Health and Social Care Act, such as
market mechanisms, giving us the NHS first option.
Monitor will go and Health and Well-being Boards will
be run with local councils.
LibDems will continue as before while the Greens have
a policy making the NHS entirely publicly provided.
The SNP are anti-market anti-PFI, anti-Trident and
UKIP are difficult to assess.
In concluding, the speaker raised the issues for the
election and what can be done in the lead up to it. He
encouraged the audience to talk to MPs about the
NHS and health policies and write to local papers as it
can have an impact. The BMA is campaigning to try to
get political interference away from the NHS. But it
was also noted that the Lobbying Act is effectively a
way to stop anyone campaigning on government
policy and is effectively a gagging bill.
The Pollock Roderick NHS reinstatement bill is laid
before parliament and it will be interesting to see
where this leads to. 38 degrees and Keep NHS Public
are active as well.
Dr Wrigley concluded by saying “Power to the
people!” A range of questions were raised from the
floor.
Issues discussed included the merits of a national
service for providing healthcare as opposed to private
provisions – namely that a national service is joined up
and talks to itself, and private provisions are risky,
inconsistent and driven by profitability, with the profit
not necessarily being re-invested in the health service.
Market contracting is complex, bureaucratic and
secretive, covered by commercial confidentiality. The
role of CCGs was further explored, with some noting
that CCGs could be very difficult to access from a
doctor’s perspective, and lack of transparency and
consultation could lead to inappropriate decision
making and poor direction for patients.
The group pondered the future for education and
training, which is not covered by the private sectors
and is something the NHS does quite well. Where
training has suffered following a takeover, such as in
Nottingham, consultants have resigned in protest!
However, social reform is also needed to achieve
anything.
Some regretted the trend of disappearing GP
partnerships, and the emergence of short term APMS
contracts which offer little security, and would have
liked to have seen more action from the BMA and GPs
to help keep partnerships alive. Also, patients
favoured continuity and would not get it out-with a
partnership agreement.
The conversation turned to the role of managerial
staff and whether it was justifiable to say there was
an over-provision of managers in the NHS. It was
noted that more are needed as complexity develops,
with the appointment of supporting staff, and the
figures bear this out. The NHS is efficient for its size,
and the number of managers is relatively low.
The vote of thanks was given by the President, who
alluded to the excellent content and illuminating
delivery.
Peter Dangerfield
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