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Public Services for All > Published by Shamik Das, February 28th 2011 at 10:30 am

Baroness Williams hits out at NHS reforms

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-Shirley-Williams 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.

http://twitter.com/johnedginton/status/42169952102260736 John Edginton

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/mudlarklives/status/42171159474749440 Clay Harris

saw Shirley Williams in the pub last night (she'd probably also been to Parsifal). Glad she's said this RT @leftfootfwd http://bit.ly/fAuq5x
http://twitter.com/paul_r_kenny/status/42172205982810112 Paul Kenny

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR
http://twitter.com/iannellin/status/42175324364083200 Nicola Iannelli

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/smithattheedge/status/42175747158310913 Chris Smith

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/alexioskomnenus/status/42176247861739520 Will James Slater

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR
http://twitter.com/smithattheedge/status/42177042552340480 Chris Smith

Baroness Shirl Williams has just made health sec Andy Lansley's Monday/life that little bit more tougher http://bit.ly/fAuq5x
http://twitter.com/westernshores/status/42178829019516928 Pen

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR Privatisation, accountability, cost etc. Good points.
http://twitter.com/economy7/status/42181037773553664 economy7.co.uk

News: Baroness Williams hits out at NHS reforms – Left Foot Forward: Left Foot ForwardBaroness Williams hits out… http://bit.ly/hRsttb
http://twitter.com/falseecon/status/42186610892214272 False Economy

RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/bendygirl/status/42186797731553280 BendyGirl

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/nyebeverage/status/42187554329460736 nyebeverage

Let's not see Shirley Break A Vow #coalitionmusicals #savethenhs http://bit.ly/fAuq5x
http://twitter.com/curlyminx/status/42187653180956672 Debs

But will anyone listen? I hope so. RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/frdragonspouse/status/42188215104454656 Jill Hayward

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/visceralwriting/status/42188310822522880 Pauline Kiernan

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/ladywolfcub/status/42192728590794752 wolflady

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/hellsbells265/status/42201201382670336 Helen Thomas

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR
http://torylies.blogspot.com 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.
http://twitter.com/hospitaldr/status/42201419767492608 Mike Broad

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/oldmankelv/status/42203310706532352 Kelvin John Edge

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/personagratia/status/42209192374706176 Susan Ackroyd

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR
http://twitter.com/oldmankelv/status/42210481242517504 Kelvin John Edge

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/oldmankelv/status/42210535441317888 Kelvin John Edge

RT @BrokenOfBritain: RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/nickbloke/status/42211106457911296 Nick H.

RT @BrokenOfBritain: RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/nickbloke/status/42211129824378880 Nick H.

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
http://twitter.com/unitonehifi/status/42215282311307264 chris star

Baroness Williams hits out at NHS reforms
http://bit.ly/f46Bbb
#ukuncut #demo2011
http://twitter.com/savethenhs/status/42215548217462784 Save The NHS

RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
http://twitter.com/unisontweets/status/42215612021215232 UNISON – the union

RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
http://twitter.com/unisonmv/status/42215678266056704 UNISON MillionVoices

RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
http://twitter.com/walthamfrank/status/42215777650081792 Frank roper

RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
http://twitter.com/joe380/status/42220535236661248 Joseph O’Brien

RT @unitonehifi: Baroness Williams hits out at NHS reforms
http://bit.ly/f46Bbb
#ukuncut #demo2011
http://twitter.com/ashke50/status/42220816699621376 Abi O

RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
http://twitter.com/moorlandmiss/status/42223449489276928 Eleanor Checkley

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/eurodocstar/status/42225985168490496 Essy

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/lewsosnhs/status/42227696742305792 lewsosnhs

RT @SaveTheNHS: RT @falseecon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs
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…
http://twitter.com/ldtuc/status/42279893257551872 L DTUC

RT @leftfootfwd: Baroness Williams hits out at NHS http://www.leftfootforward.org/2011/02/baroness-shirley-williams-coalition-nhs-reforms/
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…
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’
http://twitter.com/staffsunison/status/42382118122295296 Staffordshire UNISON

RT @FalseEcon: RT @leftfootfwd Baroness Williams hits out at NHS reforms http://bit.ly/fAuq5x #savethenhs #falseeconomy
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.
http://twitter.com/pigreen/status/42570368971579392 pigreen

RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut
http://twitter.com/fairywishes/status/42575688099831808 Elly Hase

RT @pigreen: RT @leftfootfwd: Baroness Williams hits out at NHS reforms: http://bit.ly/fAuq5x @UKUncut // it's irreversible – help!
http://twitter.com/jesseboucher/status/42667351564488704 Jesse Boucher

RT @leftfootfwd: Baroness Williams hits out at NHS reforms http://bit.ly/ea1vMR <This addresses many concerns felt by those in the party
http://www.leftfutures.org/2011/03/where-are-the-social-democrats-now/ 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 [...]
http://www.leftfootforward.org/2011/03/andrew-lansley-price-competition-healthcare/ 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 [...]
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.
http://www.leftfootforward.org/2011/04/is-andrew-lansley-really-listening/ 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 [...]
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.
http://www.leftfootforward.org/2011/09/baroness-shirley-williams-coalition-nhs-reforms-criticism/ 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 [...]