26 January 2011

A letter to Dr Grumble from the Prime Minister

OK. The letter is not just to Dr Grumble. It is to all doctors in England. It is good of him to write. Perhaps he is getting a bit desperate. Here it is:

Dear Dr Grumble,

This month, we published the Health and Social Care Bill, which sets out our plans to modernise the NHS to help it deliver truly world-class care for people. Running right through it is a new deal: we want to give you - the professionals - much more freedom to care for patients in the way you decide is best. It's why we're scrapping the targets that interfere too often with your clinical decisions. It's why we're letting GPs - working closely with nurses, consultants and other professionals - take control of commissioning. And it's why we're taking out two whole layers of management infrastructure - freeing up more money for patient care, on top of the NHS funding increases we have already put in place.

But in return for this freedom from central control, we want the system to answer much more strongly to patients. By empowering patient choice, opening up competition and introducing new ways local people can get involved in shaping services, we want to give people, not politicians, the power to shape and improve the NHS.

This marks an important change in the way our NHS is run, so it's of course got a lot of media coverage. But as with any big change, some myths have crept in and people are understandably nervous about what it will mean for them. So I want to address some of these concerns here.

Myth number one is that no change is needed at all.
I disagree. Despite the best efforts of staff, the NHS does not consistently deliver the patient-centred, responsive care we all want to see. Too often, the decisions of frontline doctors and nurses are over-ridden by a top-down system which doesn't allow professionals the freedom they need. This is the reason that, despite spending the European average on health, some of the outcomes are poor in comparison. For example, someone in this country is twice as likely to die from a heart attack as someone in France, and our survival rates for cervical, colorectal and breast cancer are amongst the worst in the OECD.

In addition, the NHS faces enormous financial pressures in the years ahead - driven by factors ranging from ageing and obesity, through to the cost of new drugs and technologies. Sticking with the status quo and hoping extra money will meet the challenges is not an option. If we want to deliver better results for patients, we need modernisation. If we just carry on as we are, we would face a big crunch in two or three years' time. Change is needed because we are still behind the rest of Europe. We should aim to be the best.

Myth number two is that our plans have come out of the blue.
Again, I disagree. This is not a revolution. It's evolution. GP-led commissioning, patient choice, payment-by-results, Foundation Trusts - they have all existed in one form or another over the past fifteen years. The NHS has always worked with others from the independent sector too, be it social enterprises, charities or private companies. All these changes drew on some simple logic - that clinicians, not managers or politicians, are in the best position to understand the needs of patients. Our plans simply build on those advances.

Myth number three is that the speed of change is too fast; that we expect GPs to do too much, too soon, and we are not allowing time to trial the plans. But it is more than two years before GP consortia take on full responsibility for commissioning and we have put in place a leadership and development programme to help all GPs who want to take a leadership role to gain the skills they need. Many GPs of course, already have those skills, and 141 new GP consortia have already been set up, each varying in size and shape but all eager to take advantage of these freedoms. They now cover half the country and still more are signing up.

Myth number four is that commissioning will mean GPs spend their time on paperwork and negotiations instead of treating patients. Not true. GP consortia will be given the resources they need to secure the support and expertise to perform the extra managerial and administrative functions. And we know that not all GPs will want to play a leading role in commissioning - that's one of the reasons why it's commissioning by consortia rather than individual practices. Our plans simply mean the responsibility for clinical decisions, and for the financial consequences of those decisions, will be brought together. GPs commission care already, and they know best what their patients want, so it makes sense for them to have more control and responsibility.

Myth number five is that GP consortia will be 'forced' to use the private sector to help them commission services for patients. Nothing could be further from the truth. Already, the new GP 'pathfinder' consortia are working with the best staff in Primary Care Trusts and Strategic Health Authorities to ensure their skills and talents are put to use in the new system. But what we also want is for GPs to be free to get help from anyone they decide they need it from. In Cumbria, for example, GPs work alongside local charities to help ensure services are best able to meet the needs of their patients. That is precisely the sort of innovation we want to enable all over the country. GPs will be able to work with anyone they wish from specialists in hospitals to nurses in primary care.

I think people will soon look back at a time when doctors and nurses had to answer to the government machine and think: how was it ever like that? Our plans for modernisation will create an NHS that is more open, more local and more personal. They'll free you to deliver first-class, world-class, services. And they'll help make our National Health Service the envy of the world. That's a rich prize - so together, let's make it happen.

Yours sincerely,


It's the usual story. The health service is bad so it must be fixed. Governments have been saying this for so long that some people actually believe that it is true. It gives governments carte blanche to do what they want according to their political whim. In the case of the present government this is very much about the government washing its hands of health provision. The plan is to take no responsibility whatsoever for the delivery of health care. This will be handed over lock, stock and barrel to GPs.

So is the health service really as bad as Mr Cameron makes out? How do we really compare with other countries? It's a simple question. The answer is not so easy but the table below would suggest that we are not actually as far behind as our prime minister is trying to make out.


Anonymous said...

This letter makes me feel ill just reading it.

Rubbish from beginning to end, including current NHS performance.

Look at the commonwealth Fund 11 countries survey in which the NHS came out very well.

This Bill must be opposed absolutely
or it will be the end of the nHS

Anonymous said...

This article in the Guardian gives some insight into what we will end up with:


Anonymous said...

We all know where this is heading. It would have been fairer to the electorate to have made the direction of travel more explicit. But the ruling class don't want to do that.

A tragic end to our NHS is about to unfold. By the time patients realise what has happened it will be too late. The end result will be something very much more costly for the taxpayer than the NHS of old.

Some people are going to be made very rich following these changes but we wont' see a bigger bang for the taxpayer's buck. Probably quite the reverse.

Julie said...

Ah, Dr Grumble, I recognise this. It's from a 'myth busting' document on Conservative Home at the mo. If you click on this link and then look to the right of the screen theres a PDF document on myths of the NHS. Just make sure you're not drinking coffee or it'll end up all over the screen..


Anonymous said...

I was planning between paients, childcare, eating and sleeping to rebuff these myths one by one, but it's like trying to argue with a religious fundamentalist or a member of the BNP, there's just no way of getting traction when there are no facts. Probably just to treat it like a fundamentalist and ignore it.

Anonymous said...

Mr PM, I struggle to understand the point of your letter and felt that it was just another 'empty' political speech which the UK is used to. Unfortunately for you, your letter was addressed to well educated professionals who can read between the lines.

I feel the point of the reforms is just a way of setting up a mixed economy of public and privately owned providers- guess who will be the winner in the end?

Anonymous said...

Around 80% of all cancers in the UK are put on a cancer register, where as rates in other European countries vary from 1% (Germany) to 28% (Italy). In consequence the basis of comparison is flawed.

Anonymous said...

Message from London reads "The NHS Titanic is holed, don't worry we've got rid of the officers, and we are asking you in the engine room to navigate. And by the way, we taking on more passengers with more demands and cutting the amount of fuel to the engines. The band have been instructed to play louder."