Baroness Williams hits out at NHS reforms

Senior Lib Dem peer Shirley Willimas has said she can't support the government's NHS reforms, calling the scale of the reforms "too great" and leaving "too many questions unanswered".

Senior Lib Dem peer Shirley Williams has said she can’t support the government’s NHS reforms, calling the scale of the reforms “too great” and leaving “too many questions unanswered”. Writing in this morning’s Times (£), she questions the cost of the reorganisation, the accountability of the new GP consortiums, the role of the private sector and patient choice.

Baroness Williams says (£):

What is the cost? The Government must reduce public spending from 2011- 2015 by £80 billion. If it can’t, its strategy will have failed. The NHS accounts for a third of England’s revenue budget and 11 per cent of its capital budget. It faces relentlessly growing demand.

David Nicholson, the chief executive of the NHS and now of the National Commissioning Board, noted in 2009 that the NHS must find £15-£20 billion in efficiency savings in the next four years. But he himself believes that “to do so will require clear and effective management every step of the way”.

Key to this is a 40 per cent cut in management costs. Already hundreds of managers have left Primary Care Trusts at a cost of about £1 billion. The impact of this is not yet known, but GP commissioning consortiums are bound to look for good managers, some of whom will be hired from outside the NHS.

They are likely to cost more. Some 20 per cent of the savings will come from moving patients from specialised hospital care to treatment by GPs or nurses in the community.

The final 40 per cent will have to come from clinicians and hospitals, an estimated £2 billion a year. Such huge savings will almost certainly entail an element of rationing. Waiting lists for routine operations are lengthening, and in some cases they are being postponed or cancelled. As the National Audit Office observed: “Government reorganisations … frequently entail higher costs than anticipated”.

Accountability: What arrangements are there to hold GP consortiums accountable for quality of care? Primary care trusts (PCTs) were accountable to Strategic Health Authorities and, ultimately, to the Secretary of State. They were overseen by local authority committees. Meetings were held in public and the minutes made available.

The new consortiums, responsible for about £80 billion, are not obliged to meet in public. Local health-watch groups may scrutinise them but have no power to hold them accountable.

Suggestions for adding knowledgeable lay people, members of other medical professions such as clinicians or nurses and elected local representatives have come from many quarters, but it will be up to each consortium to decide for itself.

Accountability upwards will be to the Secretary of State via the NHS Commissioning Board, but the board has no powers of oversight.

The private sector: What are the Government’s intentions here? Private medical practices work closely with NHS colleagues and were encouraged by Labour to bid for contracts at a price determined by the NHS tariff. Competition for these contracts depended on the quality and effectiveness of service. There is a cap on the proportion of private beds in Foundation Trust hospitals, which varies according to earnings from private patients and is much higher in London. Last year the private sector treated 220,000 patients.

The Government is now preparing to remove the cap, renegotiate the tariff and require the National Commissioning Board to promote competition. This will open the door to competition on price, not just quality.

Many clinicians fear that the private sector will skim off profitable routine operations, leaving expensive, complicated treatment to the NHS.

The body that will license health providers is Monitor, which oversees foundation trusts. Its chairman, David Bennett, wants healthcare exposed to competition like gas and rail. British Gas raised energy prices by 7 per cent last year, while making £700 million in profits. Since rail privatisation, the UK had paid the highest fares in Europe. Should this inspire confidence?

Patient choice: How does the Secretary of State reconcile this with the need for large savings? Mr Lansley puts great emphasis on the involvement of patients in their own treatment. That’s good but achieving it in practice is hard. Articulate and self-confident people are likely to benefit, but elderly or busy patients will have little basis for their choices beyond rumour or GPs’ advice. Choice must be balanced against the realities of a publicly funded service.

Underlying the debate about health is another about values. For some of us, health care is a public service, strengthened by partnership and co-operation, the model in most Western European countries. For others, it is a market in which price determines quality, the US pattern.

A June 2010 study of 11 health systems by the US-based Commonwealth Fund said of the US system:

“Compared with … Australia, Canada, Germany, the Netherlands and the UK, the US system ranks last or next to last on five dimensions … quality, access, efficiency, equity and healthy lives.”

The NHS was the second least expensive per person after New Zealand, and came first on effective care, efficiency and cost-related access, and second on equity and in the overall ranking. Why we should dismember this remarkably successful public service for an untried and disruptive reorganisation amazes me. I remain unconvinced.

Her comments echo concerns she expressed in the run-up to the Liberal Democrat party conference in September, when she said:

“I’m profoundly worried about the white paper on health, we have a health system which is notably improved, the outcomes have come right up to the best European standards.”

And earlier this month, a number of health organisations expressed serious misgivings about the coalition’s NHS reforms, including the King’s Fund, NHS Alliance, NHS Confederation, Royal College of General Practitioners and The Nuffield Trust.

50 Responses to “Baroness Williams hits out at NHS reforms”

  1. John Edginton

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  2. Clay Harris

    saw Shirley Williams in the pub last night (she'd probably also been to Parsifal). Glad she's said this RT @leftfootfwd //bit.ly/fAuq5x

  3. Paul Kenny

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR

  4. Nicola Iannelli

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  5. Chris Smith

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  6. Will James Slater

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR

  7. Chris Smith

    Baroness Shirl Williams has just made health sec Andy Lansley's Monday/life that little bit more tougher //bit.ly/fAuq5x

  8. Pen

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR Privatisation, accountability, cost etc. Good points.

  9. economy7.co.uk

    News: Baroness Williams hits out at NHS reforms – Left Foot Forward: Left Foot ForwardBaroness Williams hits out… //bit.ly/hRsttb

  10. False Economy

    RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  11. BendyGirl

    RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  12. nyebeverage

    Let's not see Shirley Break A Vow #coalitionmusicals #savethenhs //bit.ly/fAuq5x

  13. Debs

    But will anyone listen? I hope so. RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  14. Jill Hayward

    RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  15. Pauline Kiernan

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  16. wolflady

    RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  17. Helen Thomas

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR

  18. Richard Blogger

    Note that the Health Bill will also remove the “asset lock” on Foundation Trust hospitals. This is the green light for asset strippers to plunder our NHS.

    Lib Dems should be ashamed to be part of a government that has produced this Bill.

  19. Mike Broad

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  20. Kelvin John Edge

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  21. Susan Ackroyd

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR

  22. Kelvin John Edge

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  23. Kelvin John Edge

    RT @BrokenOfBritain: RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  24. Nick H.

    RT @BrokenOfBritain: RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  25. Nick H.

    RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  26. chris star

    Baroness Williams hits out at NHS reforms
    //bit.ly/f46Bbb
    #ukuncut #demo2011

  27. Save The NHS

    RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs

  28. UNISON - the union

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  29. UNISON MillionVoices

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  30. Frank roper

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  31. Joseph O'Brien

    RT @unitonehifi: Baroness Williams hits out at NHS reforms
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    #ukuncut #demo2011

  32. Abi O

    RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs

  33. Eleanor Checkley

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  34. Essy

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  35. lewsosnhs

    RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs

  36. Anon E Mouse

    Richard Blogger – How can one “asset strip” an organisation with no money?

    Where were you in 2004 when Labour started outsourcing NHS operations? You should be ashamed of a government that did that…

  37. rhys

    This will not be happening in Wales because of devolution.

    Something most of the liberals supported.

    And many of the “great” labour figures like Kinochio opposed.

    Next Thursday if you live in Wales there can be only one way to vote…..

    Say Yes to Wales…

  38. Mrs Diana Rae

    I believe many people in England are afraid of the proposed NHS reforms, because they do not know what the consequences will be. At the sme time we know quite a lot about our current NHS and while it is far from perfect it generally works well and many of us have family and friends who have had good experiences in their treatment by the NHS. How then can we be happy by changes which drastically abolish this health support? The Liberal Party must oppose this reform. It must do so vocally and vigorously so that the whole of the English public see and hear this opposition. How different then will be the standing of the Liberal Party in England! Opposing the frightening NHS reforms will mean that the Liberals will begin to regain some of the respect that they have lost because many of us believe that in the last year they have not supported causes which deeply affect our everyday lives. The NHS does deeply affect our lives – it matters to many of us more than almost anything else the Governments of our country have responsibility for. Many politicians have Private Health Insurance – but even if they do they have responsibility for the millions of us who do not. Tell Nick Clegg – this is his chance – his reputation in the eyes of many has been seriously damaged. Just as David Cameron admitted he was not happy about the ‘forest sell off’ and in doing so destroyed that Policy, let Nick Clegg say ( in the light of all the submitted opinions of important Health organisations and individuals)he is not happy about these NHS reforms. Overnight he will again by a ‘champion of the people’

  39. Staffordshire UNISON

    RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms //bit.ly/fAuq5x #savethenhs #falseeconomy

  40. Mr. Sensible

    Join the queue…

    Diana I think you’re right; if the Lib Dems ditch this it won’t make people fall in love with them again, but it might be a step in the right direction…

    As you say, public opinion forced the government to ditch the woodland sell off. Lets do the same for these NHS reforms.

  41. pigreen

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut

  42. Elly Hase

    RT @pigreen: RT @leftfootfwd: Baroness Williams hits out at NHS reforms: //bit.ly/fAuq5x @UKUncut // it's irreversible – help!

  43. Jesse Boucher

    RT @leftfootfwd: Baroness Williams hits out at NHS reforms //bit.ly/ea1vMR <This addresses many concerns felt by those in the party

  44. Where are the Social Democrats now? | Left Futures

    […] break-away of the early 1980s: Andrew Lansley, for example, now a Tory dismantling the NHS, and opposed by his former colleague, Shirley Williams, now in the Lib Dems. Danny Finkelstein advised one Tory […]

  45. Lansley’s retreat on price completion for healthcare deceit | Left Foot Forward

    […] as Shirley Williams said, in criticising NHS reforms in a column in The Times (£) this week: “British Gas raised energy […]

  46. Keith James

    One danger is a post-code lottery of treatments because different GP consortia could have different priorities.
    I wonder whether retired NHS consultants could be organized on a voluntary basis to ensure that the specialist diagnostic and treatment services in their areas met a national standard. I would certainly be prepared to do this and I don’t think the current specialists would object as it would almost certainly reinforce their arguments. Communication could be organized perhaps through the Royal Colleges and the internet would allow communication and discussion within each specialist group.

  47. Is Lansley really listening? | Left Foot Forward

    […] list of those opposing these reforms continues to grow, and includes an ever increasing number of Lib Dems and Tories like Lord Tebbitt. They join a growing list of leading […]

  48. EVA HOLMES

    The Lib/Dem position on the Lansley reforms to the NHS is bewildering, and,
    judged against their ‘practice’ while in the Conservative led coalition not
    to be taken seriously. Nick Clegg’s pompous assertion that the Reforms will
    not go ahead unless he is ‘satisfied’ is laughable (pity its so serious an
    issue) since he alongside Cameron and Alexander, signed off the NHS Reform
    Bill apparently withour knowing what was in it, as did all the LIB/Dems.
    Having lost so badly in the locals, the AV referendum, and credibility on
    so many other pledges, they have latched onto the NHS to try and salvage
    something of their long gone progressive reputation. Increasingly it seems
    to me that you cannot be too cynical about the Lib/Dem leadership. I feel
    sure that Cameron had already decided to make small amendments to the reforms
    with big PR to pass them off as substantial changes. It will be interesting
    to see if the Lib/Dems are able to listen to Shirley Williams who, alone,
    managed to read the small print, unearth the malign intent at the heart of
    it ie the prepartion for the break up and privatisation of the NHS in England
    with the removal of the Dept of Health from all responsibility for the
    provision of healthcare, and to go public with her findings. Lansley had
    hoped that the huge amount of print would deter scrutiny. He nearly got away
    with it. I hope it is not too late however, as here in Wilmslow, Cheshire
    I learned in my local rag. that the healthcare centre where I have been a
    patient for decades is now a ‘pathfinder’, already implementing the changes
    at breakneck speed, no patient consultation,under the democratic radar, they
    are going ahead with fundamental changes without a mandate. I am enraged
    about it hence this comment.

  49. Baroness Williams: Coalition “bewitched by a flawed US system” | Left Foot Forward

    […] in February, Baroness Williams said she couldn’t support the NHS reforms as they were then, calling the […]

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