Nurses for Reform and David Cameron: the unanswered questions

Thanks so much Mike; your input is greatly appreciated.

Your organization is superb, and has great public support.

Wishing you much luck.

PS- What do you make of this article?!

Thankyou, Jo.

In response to some of the comments below, Macmillan nurses are part of the NHS. Indeed, they are NHS employees, albeit supported by Macmillan with funding, training etc.

Macmillan provides a wide range of support for people living with cancer, from the point of diagnosis, through treatment, support after treatment and beyond. We also campaign for their interests.

Mike Hobday
Head of Campaigns, Policy and Public Affairs
Macmillan Cancer Support

Back next week.

Guy, what you may not realise is that the private healthcare system is completely depdendent on the NHS for expertise and consultants, for example.

I have also worked in both settings; and in my experience, the NHS is far superior, in terms of expertise of staff, research, and most importantly, quality of care, and varied skilled staff.

I think the private system is useful for "topping up"- eg minor op waiting lists; but it certainly does not replace the provision of the NHS.

Yes- it has the luxury of hotel type facilities, and faster treatment- eg for minor ops/surgery- but it does not cater for emergency or acute care/longterm health conditions- eg as seen on medical wards.Also- from what I've seen- Dr's drafted in from the NHS.This is not sustainable for 99.9% of the health needs of population.

Yes, it is a vast system that needs efficiency measures; but at the core is its function to provide high quality health care and meeting the health needs of the population as a WHOLE.

Also- the vast majority can't afford to pay into private health insurance- surely that is blatantly obvious? A universal high quality system benefits ALL, not just the few.

Let's be open to new ideas about making the system more efficient- but NOT obliterating its whole founding principle and function, or pandering to wacky ideas that would apply its ideological principles to anything that is deemed "the state"- as if it is a dirty word!

Looking across to the USA (where I think these ideas emanate from,)- clearly a 2 tier health system has not worked for the majority of the population- and has resulted in gross injustices; hence Obama has been battling it out with far right factions to reform the system and make it fairer for all.(Hilighted by Dan Hannan's visit to Fox News, and announcing to the world our "NHS is a 60 year old mistake!") Who is he to speak up for the vast majority of the population in this country who support the NHS?!
He was simply abusing his position in my opinion...clearly David Cameron may be sympathetic to his ideas, judging by this article.
And yet we hear nothing of it in this election campaign- only bland ressarances that the "Conservatives are the party of the NHS"- and it's safe in their hands, etc etc.How completely misleading to the public!

This to me is pure politics, as applied to a whole variety of functions of the state; it appears as ideology above all else that is pragmatic and ethical.

You have a PhD in dementia?.. can you actually remember doing it stil?..

'Reading this thread and all the comments what becomes obvious is that the left refuses to ever enter into debate over the NHS.'

I'm sorry, but that is a misrepresentation. Debate is exactly what we are entering into. We just don't agree with your reasoning (or epistemology, if you like - there are certainly no ontological certainties in what you purport).

Guy

You better hope your not struck down with a pre existing illness-or a debilitating illness that Private medical insurance doesn't cover.


cheers

Reading this thread and all the comments what becomes obvious is that the left refuses to ever enter into debate over the NHS.

Any idea that in their mind is "different" and doesn't agree with dinosaur like central funding and control must be decried from the highest rooftop as a "threat to the NHS.

As a result the NHS will limp on, taking up vast amounts of the nation's wealth yet delivering a mediocre service in comparison with other nations.

Those of us who pay for private health insurance have long realised this reality and hence cover ourselves. As a result I can sit relaxed and say I don't really care that much as no matter how problematic the NHS gets I'll never have to be at its mercies.

Hi Richard- that sounds great! I'm certainly all for an "umbrella" approach- it makes sense for patients to have joined up thinking and services.I have huge respect for Macmillan nurses- their role is vital for supporting people to die in dignity at home with their families, where this is wanted.

Although frustratingly, I have to go for the rest of this evening, may I ask do you work or have involvement in a health care role/capacity?

I will check this thread and comments over the next couple of days.

Good night all. Jo.

Thanks so much again Dave.I certainly think the public should be aware this is the type of agenda being explored, considering the Tory's central message at present is that the NHS is entirely safe in their hands.This is not how the public envisage a future for their front line services!

Considering the public outcry and outrage following Dan Hannan's "attack" on the NHS in the summer(See We love the NHS- eg on facebook; nearly 20,000 people joined up in a couple of months to share testimonies of their experiences..)- this could be an interesting development.(And DC described Hannan as eccentric at the time, and not representing the Conservative's mainstream views.)

Maybe David Cameron is far more sympathetic to these ideas than we realise.

Jo, my local hospital have just opened a new ambulatory cancer treatment unit and they received some funding from McMillians. The McMillian nurses have their own rooms in the unit. There is clearly a lot of synergy between the two organisations.

It really is valuable to have the expertise of Jo and Richard, especially on this topic, but also others too, of course.

Ah, sense at last - thank you, Jo - you have not only rescued us from ignominy but also made a very, very interesting point - the language used is interesting, indeed. Where do we go from here with this? [That's not an invitation for levity]. Is there something that can be taken away from here, Alex?

I don't know where you get £16,000 for a hip replacement from. The Payment by Results tariff is nearer £7500. The tariff is calculated by taking the costs of a procedure in every NHS trust and applying a weighing for regional variations in costs (like cost of buildings and London weighting). Thus the PbR tariff is essentially an "average" cost of the procedure to the NHS. The current tariffs are published on the Department of Health website. perhaps you are quoting a figure that includes the cost of after care? If so, I would be interested for a link to the analysis.

I agree with the general sentiment of your contribution. The private sector serves a useful purpose in providing extra capacity. However, we pay our taxes for a universal healthcare system, so governments should be very careful about the balance between the private sector and the NHS. The basic principles of "healthcare according to clinical need" and "free at the point of delivery" should be tattooed on the forehead of any politician who takes up the position of Secretary of State for Health.

However- intersting the site is called "Nurses for Reform!"
Maybe that is an emotive title- seeing as most people think positively of nurses; as opposed to a title like "Libertarians for Reform."

I've certainly never in my entire career ever met any health professional who expressed these views.

So I repeat again- DC needs to ask people actually on the ground in the NHS for sensible ideas- across a wide spectrum.

Paul hit or miss etc- just seen your comment.Someone has touted on here that Helen Evans has a Phd in Health Economics- so it appears not a medical Dr, or even perhaps a nurse with experience of working in the NHS?

Tom here is also suggesting she is clearly affiliated with a Libertarian organization and other similar political think tanks.So hardly a representative view from professional workers in the NHS?

Hence my great surprise that David Cameron appears so selective in his research on policy ideas for the future.And his claim that the NHS is afe in the Tories' hands to win the election? A bit disingenuous I'd say...

I just hope the public at large realise what agendas are being explored.

David Postles

You are correct in your comment that if any party made radical(& introduce NFR ) changes to the NHS then there would be the biggest backlash from the people. The majority of People in the UK want & love the NHS

The following is from from Wikopedia shows how the Press & media in our Country is highly critical of the NHS & affects peoples perception of the NHS.

Although the NHS has a high level of popular public support within the country, the national press is perceived to be highly critical of it. This may have affected perceptions of the service within the country as a whole and outside. An independent survey conducted in 2004 found that users of the NHS often expressed very high levels of satisfaction about their personal experience of the medical services. Of hospital inpatients, 92% said they were satisfied with their treatment; 87% of GP users were satisfied with their GP; 87% of hospital outpatients were satisfied with the service they received; and 70% of Accident and Emergency department users reported being satisfied.[52] When asked whether they agreed with the question "My local NHS is providing me with a good service” 67% of those surveyed agreed with it, and 51% agreed with the statement “The NHS is providing a good service." [52] The reason for this disparity between personal experience and overall perceptions is not clear. It is also apparent from the survey that most people realize that the national press is generally critical of the service (64% reporting it as being critical compared to just 13% saying the national press is favourable), and also that the national press is the least reliable source of information (50% reporting it to be not very or not at all reliable, compared to 36% believing the press was reliable) .[52] Newspapers were reported as being less favourable and also less reliable than the broadcast media. The most reliable sources of information were considered to be leaflets from GPs and information from friends (both 77% reported as reliable) and medical professionals (75% considered reliable).[52] On many occasions, however, the uncovering of a scandal leads to changes which improve the service in many ways, and sometimes unexpectedly.

The following is from Wikipedia on NHS:--Politicisation

Most people would prefer to see gradual improvements within the current framework and be able to hold politicians to account for the service. This is the position of all the major political parties, none of which has an agenda to replace or make a wholesale reform to the system. The Conservative Party says its policies are aimed at "Protecting and improving our health service by putting patients back at the heart of the NHS, and trusting the professionals to ensure that they are able to use their skills to make the fullest possible contribution to patient care.
DOES THE ABOVE PHOTO & THE FRATINISATION WITH NFR FILL YOU WITH CONFIDENCE ABOUT THE TORIES PLANS FOR NHS?

Guy, who trains the doctors that treat you in the private sector? Indeed, who is the main employer of the doctors you use in the private sector? (The answer is: the NHS.) As I have mentioned upthread, the NHS has a beneficial influence over the private sector> When the NHS starts to fail private sector healthcare gets more expensive because they then compete with the NHS on quality (and as any business, they charge what the market can withstand), when quality in the NHS improves (as has been the case in the last decade) the cost of private healthcare drops because they have to work harder to attract business. That benefits you, the private sector customer.

If you wish to pay for private treatment that is your choice (I *know* that I get better treatment at my local NHS hospital), but at least acknowledge that you still benefit immensely from the NHS.

Guy, I think it is you who is being politically naive.

If there was *any* mass support for dismantling of the NHS wouldn't you think that a marketing man like Cameron would have jumped upon the idea? No, his focus groups told him that the public stick by the organisations it trusts, particularly in times when they feel insecure. The NHS is one such organisation (and so too is the BBC, Cameron has been very quiet about what he would like to do with it).

The fact is, no party could be elected in this country on a policy of dismantling the NHS, however much you would like that to happen. Cameron knows this.

There is one other thing to note. It is the "Richard Taylor effect". With the current electoral system a single issue politician can get elected if the public feel strongly enough about that issue. That was the case with Richard Taylor. Cameron is very much aware of the "Richard Taylor effect".

@Richard Blogger

I am not using Ivan as a political tool. It was merely a remark reflecting that I thought DC looked sincere in his praise of the NHS when talking about Ivan, but you're totally correct that GB NEVER talks about this at all. I am with you totally on not using dead children as a political tool - I would have tought that this was obvious? Anyway, it's an unnecessary distraction to the core debate. I don't think it's helpful to use language like 'the NHS is not safe in the Tories' hands' because the NHS has existed since 1945 even during Tory governments. The type of language is inflammatory and does not encourage discussion. "We Love The NHS" is open to Tories too. Please bear in mind when reading all this that I am a member of Labour, albeit a non-existent junior type!

Come on Shibley! I thought you were going to read me the NI act of taxation there along with the disease act and idleism?.

Hi, Tom was a little slow on this :-)

Liberal Conspiracy reported this meeting at the end of last year. It is work reading their article, and especially the comments, since Shane Frith from NFR attempts to justify their position and I get somewhat irate with the stupidity of their plans.

First, the NHS should not become "more customer focused" because it has patients not customers. The fact that you regard patients as customers speaks volumes about your position.

The state does not own "all the hospitals". In fact we have a thriving private sector in the UK, party through the work they get from the NHS as extra capacity. The "customer" (and in this case I am using it correctly) in private hospitals benefit from the NHS because the huge improvements in quality and the ever present pressure for efficiency in the NHS over the last decade has made private hospitals more competitive.

Finally, I feel uncomfortable when people use their children as political tools, but I feel sick when they use a dead child as a political tool. It is very bad taste and when someone uses such a political trick it really does cast doubt over their political judgement. Since you have mentioned Ivan Cameron's name, in an attempt to make a political point, I think it is also important to mention Jennifer Brown and James Brown, and to say that Gordon Brown has been statesman enough not to parade his disabled child as a show of his commitment to the NHS. I think that David Cameron and his image makers should learn from the dignity that Gordon Brown has shown.

Hopefully this will be the last time that you use the name of a dead child as a political tool.

Don your tin cap for the Bevy boys, for it's a working man I am and I've been down under ground!.

Most people who deal with the NHS are full of praise, that's the wonder of the institution but dont believe for one minute that the tories get it Shibley. The NHS will never be safe in the hands of the conservative destroyers.

Hi Shibley: you wrote "we need to discuss the problems in the NHS in the wide context of the funding of both clinical and social care". I totally agree: we often see health in terms of healing or managing physical sickness. But you're right - it is so much more. There shouldn't be a dividing line between clinical and social care. They are mutually dependent. From cradle to grave there should be a holistic care service: whether mental or physical illnesses; clinical or social needs; primary care or rehabilitation; giving birth or dying in a hospice.

Yes. Like the famous Beveridge Report.

Warning to Derek - Beveridge was a famous don 'from the other place' ie Oxford

I would be all up for that David.

I welcomed David Cameron's open consultation on it today. Whilstt we can again argue for Britain about its sincerity, my hunch is that David had a positive experience of the NHS when his son became criticallly ill. All the reports I've heard from him about St. Mary's NHS Trust have been glowing. Ivan is certainly no 'political football', in that he may have been 'private' for some or all of his life, but David Cameron seems to 'mean it' when talking about the NHS. There I think that he also genuinely does not see eye-to-eye with Dan Hannan, and, in fact, is quite glad to be shot of him.

Again I managed to side-track myself. I was in effect saying what David H was saying, in a different way. Whatever the next government (and - yes - 'it could be you', meaning the Tories), it's not going to be easy or quick. That's why I come back to the utter irrelevance of Tory blogging. Tonight, Iain Dale did a blog on how Gordon Brown's email was not written by him, but, according to a computer program, written by two different authors. Why do I find myself reading his banal childish crap when Iain Dale is an intelligent, very funny man in fact; however, we need to discuss the problems in the NHS in the wide context of the funding of both clinical and social care.

Derek, you've a strange way of putting words into people's mouths when they said nothing of the sort.

Personally I think that the NHS is too important to play politics with: so shame on both Labour and Tory houses. What I would like to see is a recognition that the NHS needs to be taken out of the political arena and also a recognition that there won't be enough money in the pot to continue with the NHS as it is for much longer. I would like to see the establishment of a genuinely well-balanced cross-party group who's role it is to look at best practice elsewhere; to ask the hard questions about what can be afforded and what can't in this country; to consult widely and effectively with those on the ground in the NHS who *really* know and understand the good and bad points of the system; and to propose a way forward which will be allowed a free non-partisan vote in the Commons.

H28,

If I could only comment on matters with which I have had first-hand experience then I would be struck dumb ;-)

Thanks for clarifying this, Jo - always a fount of wisdom and knowledge.

Maxm your local football team may be registered as a charitable cause, doesn't mean it's thrown into the real of for profit operation?. Jeez! broken arrows

Well thanks Max for adressing me with some respect.

I have very little time generally- but would very much like to read this whole thread at a later time, and will try to respond to some of the points.May I also say I tend not to comment unless I have first hand experience.

Thank you H28, for replying. I am always impressed to converse with someone who has first-hand experience of what they talk.

My knowledge of the NHS is only that of a long-term taxpayer. I am fortunate in that my and my family's callings upon NHS services has been minimal.

I'd be keen on your opinion on the proliferation of management/administrative roles in the NHS over the past couple of decades, and whether or not, you think (as I do) that a reduction of 50% of managerial posts would aid rather than harm the NHS.

Dave- Macmillan Nursing are a charity, and a wonderful organization caring for the dying, and families- mostly in their own homes.They also closely liase with the NHS, and organizations like hospices.An absoloutely invaluable service, which should be fully funded by statutory health care in my opinion.

I've only just managed to come back on here very briefly, and read a few random comments.Re Guy's earlier comments- why on Earth did you think I was aiming my views at you?If I wanted to address you I would have done so.

Max Septic- I have several professional qualifications, 25 + years plus working in the NHS(most recently a Health Visitor for 8 years working in deprived communities.Also 2 degrees, in Sociology, and Public Health/Community Nursing.)Just in case you're actually interested! How about you- any relevant credentials to this debate?

For some reason my previous post didn't get through, so here it is again:

Surely the act of individuals paying more for health care to provide treatment or level of service that a free for all NHS does not cover lead inevitably to different tiers based upon wealth?

How logically do you both accept private health and oppose a "two tier" set up?

@Max Sceptic

Of course, but it's not a private healthcare company like the ones that are being proposed - it is a charitable organization. That was my point.

From their website:

Macmillan Cancer Support is registered as a charity with the Charity Commission ( registered charity number 261017 ) and as a company limited by guarantee with the Registrar of Companies (registered company number 2400969).)

It is not part of the NHS.

There is life (and compassion) outside the all-powerful state.

'The patient must be in the driving seat' - the health of the patient and the inclusion of the patient in the appointment, consultation and treatment are paramount, but there must always be a large element of discretion left with the healthcare professionals - that's why they are healthcare professionals - no organization can be completely customer-driven.

I've always assumed, perhaps quite incorrectly, that the MacMillan Trust is a charitable organization in the tertiary sector. Am I wrong?

The potential issues about the expansion of two-tiers of health and welfare might include:

1 That the residual general health service actually becomes under-funded and a poorer service - unless there is a 'cast iron' (humph!) identification and ring-fencing of any potential savings - and that is a very, very uncertain element to be left to the discretion of a Tory government, IMHO.

2 Can we be absolutely certain of accurate and inclusive accounting of the correct cross-costings or viring of funding? I have no idea about what cross-subsidies are potentially there, except that in the past privately-funded operations have been performed in NHS operating theatres by NHS-employed consultants. How accurately is the use of plant and resources costed? Are NHS-employed consultants still allowed to have their private practices?

You see, some of us really don't feel we can _trust_ the Tories with this, as was demonstrated by the 'Save our NHS' campaign.

Peter!, the MacMillan nursing care for cancer patient is not a private firm?.

Peter! Bevin resigned from the goverment when prescription charges where introduced to fund the Korean war.

Yes! the NHS was opposed by the fraternal elite, what distributive services have the elitist not opposed?.

Apparently Tom Scholes-Fogg had a good response to something he wrote about Cameron's NHS plans

tscholesfogg (tweet)

Pleased my Cameron's NHS Privatisation article has had so many views from MPs to activists, thanks for your feedback! http://bit.ly/7KvGT7

Sorry to plug so blatantly but I thought I would bring something from the Tweetosophere (

Derek - Read Micheal Foot's brilliant biography on Bevin to learn about what actually happened when the NHS was formed rather than relying on folk tales and here say.

1. Bevin told Foot (his private secretary at the time) that the only way to bring the BMA Consultants on board was via their wallets
2. To do this he changed the NHS consultant contracts to enable consultants to elect to carry out private work on a maximum of two days in five for a pro-rata reduction in their NHS remuneration
3. Bevin told the BMA Consultants Committee that it was never likely that the NHS funding would meet all and everybody's needs and that by and large their private practice would not be effected.

The result is the current two tier system you rail against which was actually enshrined in the original agreement that set up the NHS because Bevin understood that NI and tax could never pay for a 'universal service'.

As for the 'differing standards of treatment' argument, that is also a load of bulls testicles. You will find the outcome comparison between local NHS and Private hospitals is much the same. Why? Because it is the same consultants and senior registrars carrying out the elective procedures in both hospitals to the same standard......

PS Derek - MacMillan Nurses are not part of the NHS, they are technically providing private care and support paid for by charitable donations from the public - check their web site.

'I personally would rather keep the 2p in the £ and spend it how I choose, which may well be on private healthcare.

Rather that than giving yet more of my income to a wasteful government to spend yet more on people who have not earned the right to have my efforts pay yet more things for them.'

Wow, now that's a surprise. No point in raising issues like economies of scale or countervailing tendency against the exorbitant profits of the pharmaceutical industry (generic drugs?)? No, thought not.

No David Honour, I want the NHS to continue, you want to dilute the services and undermine it by creating a bigger private health care based on the principle of those who can afford it will receive health care.See the lonely man! David, he walks a lonely route?.

Interesting debate, with some low points and high points. I am not a moderator. But it helps if none of the main parties trade insults. This makes it difficult sometimes for others to follow the main gist of the thread. [However, I am clearly being hypocritical in that I called someone who writes perfectly well but completely contrary to my opinions a 'Tory Troll', Apologies.]

LOL Derek. Anyway - thanks for the discussion. Got to go sledging with my daughter now...

Whilst I recognise that the NHS is not performing as well as it should the last thing it wants at this juncture is yet another reorganisation. I would like to see a period of consolidation with the objective of improving performance and getting better value from the service, then later on the fostering of private provision to bring about more competition in the market.
I have recent experience with the NHS and from what I can see there are masses of resources that do not seem to be co-ordinated or in communication with each other and the patient is often left in ignorance. The patient must be in the driving seat and this will only come about once he/she carries the budget.

Not sure who your post was aimed at David but there is a david plus david situation here, I have been debating with David Honour. Hope that clears things David if not david then the other david might have another david point.

Hi Derek - fair enough. So instead of releasing new funds by charging the rich for healthcare you want to remove funds from the service so that the NHS can become worse for everyone. Good policy. Not.

David, I'm going to shock you, Yes! in these times! efficiency measures in terms of the functions of the NHS not the principles nor the staff will have to tightend!ITC programmes and other material related areas will need shaving but the principle of care and staff levels will always remain paramount.

Comment deleted. Please clarify which user with similar names you are replying to in future. Thank you.

Hey Derek - I've got nothing against the NHS. But be realistic. It's not perfect. It needs continued investment. It needs improvement. It needs more resources year on year on year. It is currently over-stretched, over-managed, over-red taped. The required developments to move from good to great can't happen without a fundamental change to the way it is funded. IMO.

No it wont David, it will become like the private education system it will compete for patients on the grounds of fees and the public who use it might start to cry foul on NI payments.

Stop trying to be divisive? what have you got against the NHS?.

"It believes that the state should set free – through a range of full blown for and not-for-profit privatisations – all NHS hospitals and healthcare provision."
Erm, that kind of system was why the NHS had to come into being in the first place! People forget that the likes this doctor and various support groups like the BMA were totally against the introduction of the NHS and therefore the resultant massive increase in UK health and drop in huge levels of child mortality and so on, that it brought about. People like this are the modern equivalent. Apologists for profit over the interest of National Health and well-being.
Doctors, private health care companies and drug companes do very well out of the NHS. It is there that there should be more price competition to bring the cost of NHS care services down so that more can be done by it. Indeed perhaps drug production should be nationalised as well - remove the profit and need for share growth, drop the price. Not by turning the clock back 60 years and handing the massive infrastructure and monies the public has paid and fought for over to likes of Nurses for reform and their Tory cronies.

Derek: "why must we divide health care on the grounds of wealth?" Because 1) resources are finite 2) it will improve the NHS services for poorer people 3) it will ensure a sustainable NHS 4) it will provide funds to enable the NHS to be the best health service in the world.

How many more reasons to you want?

Peter. it's a simple equation if the rich want to pay more to the NHS system for ops and such thing then that plugs your simple maths. Why should their need to be a seperate system?.

McMillan nurses are exceptional at what they do and are an important part of the wider NHS system! both my parents received McMillan care when their lifes ended non of my parents ever used the private system.

Derek - it is simple maths, a hip replacement costs the NHS around £16,000 ish. The NHS has a fixed budget. Fewer people dipping into the NHS budget for elective surgery (like a hip replacement) means more operations are available for those who can not afford to pay.

Now if what you are disgruntled about is that folk who pay get treated faster then fine you are entitled to your view. Then again there is a lot of 'cross subsidy' from private health care to the NHS that goes on everyday, on the quiet, sometimes unblocking NHS beds to enable more people to be treated or reducing waiting lists for scans and other tests.

Are you against people supporting MacMillan Nurses as they are in effect providing 'private health care and support'(i.e. not funded by the NHS)? Would you have all the Maggies' Centres closed for the same reason?

No, I didn't think so. Like private health care they help take the stress out of NHS service funding provision.

David, re-read my posts! if the rich want to pay more for health care then that in my opinion that is a good idea but why must we divide health care on the grounds of wealth?.

Hey Derek. You can bandy insults as much as you want, but I won't rise to it. So, politely, I will reply: you haven't explained why it is morally wrong for the rich to be required to pay for their health care: even though this would have the benefit of releasing (and also generating) more funds to treat poorer people better, more quickly and with the most modern of treatments. The NHS is good. It could be great. Every other left-wing European government requires some sort of payment from those who can afford it. Why shouldn't we explore that direction? Why is it so heretical to suggest this?

It does not HAVE to be divided but the state can not afford to pay for all treatments can it?

So why can't some people go private and pay more of their own money for health care the state don't, can't or won't provide.

If you understood the NHS you would know that it already operates on a divided system with 'postcode lottos' in some parts of the country for example.

I might be going out on a limb here, but isn't one of our problems that the government and the Tories only discuss things with people wthey know generally agree with them in the first place.

In our case, we need to talk to those who've deserted Labour and look to the BNP, because unless we do,we won't really know how to draw them away from this fascist movement. The alternative is just to guess and hope it's a good couple of guesses.

Diversity of thought and background is just as important as diversity of ethnic origin, and gender. As a party we've forgotten that and the white working class has decided Labour doesn't care what they want, or think.

To be honest we might not like it, but best find out from the horses mouth whether there is any common ground still left to build on.

That isn't going to be aided by the attitude of slagging off any politician who speaks to someone who is dissaproved off. Even if it is Dave C, and he's talking to numpties.

Extreme example:
Hence we had Jaqui Smith making legislation on prostitution that was slated by the English collective of prostitutes. Which rather fits the image of government knowing best and not wanting to discuss it directly with those concerned.

Insignificant example:
I went to the SMMT seminar on the digital Britain proposals. The Dept of BIS made a speech and buggered off. the only person to make a presentation who did so and therefore avoided the general contempt the proposals received in the Q&A session. Even though most of those questions needed the government representative there to answer.

So when your car FM radio (& if you have one, your Tom Tom or other Navi system ) stop working, and there's am increase in accidents from people trying to navigate a complex DAB radio menu and drive, it will because the government has an attitude of decreeing after select discussions with like minded individuals who'll give the 'right' response and not developing regulations with everybody in mind.

BTW the summing up included the wonderful phrase about the Digital radio part of the Digital Britain report, 'written by the broadcast industry, for the broadcast industry'.

OK David, remove the hood, it's surpressing your vision!.

If the rich want to pay more for health care then good idea!
but why must health care be divided? David! take your time now! let it sink in......................Wow!.

Why can't you answer his very reasonable question?

Why do you change the subject and run away?

Why is it wrong for the rich to pay for their healthcare? Maybe it is but why can't you say?

LOL Derek. If you can't answer the question just say so. You basically stated that it is wrong that the rich should pay for their healthcare. Why is it wrong? You must have a reason for that belief?

Derek - just answer David Honour's question.

If you are able to.

@Derek

"If people want to pay more for health care then that's a good idea, if they can afford it but it's wrong to suggest that they have the right to divide health care on the grounds of wealth is wrong"

Surely by paying more for health care to provide treatment or level of service that a free for all NHS does not cover by its very existence leads to different tiers based upon wealth?

You have contradicted yourself.

David, stop throwing buns about, your really becoming irratonal now David.Try to be coherent and think more about health prevention methods rather than just ill thoughts.

The private banking sector had all the resources it required but hey ho! it wanted more and burst the bubble and now blames the public sector for it's growth and continued success.

David what have you got against the public sector? and the NHS in question?.

Hi Derek - for once maybe you could answer the question. I'll try again - why is it wrong for the rich to pay for their healthcare? This would release more resources to provide a better service for poor people. Wouldn't that be a good thing?

Generally we all pay for the continuation of health care at the point of no cost when neeeded David. The idea that you want to support the two tier system of health care is an affront to the worlds population and a selfish view to our fellow country men.If people want to pay more for health care then that's a good idea, if they can afford it but it's wrong to suggest that they have the right to divide health care on the grounds of wealth is wrong. Why cant you see that David. Health care is for everyone even Joseph Merrick!.

Derek wrote: Medicine and Medical care is universal and the idea it should be divided is just plainly wrong.

David asks: Derek, why is it wrong for the rich to pay for their healthcare? I don't understand why a Labour supporter would have a problem with that.

I'm not persuing anysuch thing Shibley I'm simply outlining the reality that most of the British public use and support the NHS.

Medicine and Medical care is universal and the idea it should be
divided is just plainly wrong.I hope that American can create a NHS system, I hope and pray that one day the third world will enjoy the fruits of care and medical help at the point of no cost's.On this issue let me be the cox Shibley just you pull to my voice. Thanks Derek.

@Dave

I personally would rather keep the 2p in the £ and spend it how I choose, which may well be on private healthcare.

Rather that than giving yet more of my income to a wasteful government to spend yet more on people who have not earned the right to have my efforts pay yet more things for them.

Yes, but by saying that Derek, you are pursuing the 'public' / 'private' divide, and some would argue so for no reason apart from dogma

Best wishes, Shibley (M), boater not cox

'If those of you on the left can't see that the NHS can't carry on as it is financially then I look forward to you having to deal with the problems some time in the future whilst I sit in my private hospital bed.'

Actually, I'm perfectly happy with the treatment that I receive now from my NHS dentist (who, incidentally, is committed to the NHS although he is only an associate not the owner of the partnership), for my long-term illness which has been treated extremely sympathetically by my wonderful health centre, and for my glaucoma for which I regularly see the consultants at the spanking new Loughborough hospital. If there is a need for more resources, I'm quite happy to pay another 2p in the £ income tax to sustain it, although I guess that would be stealing Lib policy. Quite honestly, I regard the little money that I have from my fortunate life as a resource for doing the little that I can for others less fortunate - not a lot, but I hope it makes a difference. No need to reply - you predictably will disagree - but that is the beauty and the curse of representative democracies (well, until the vitriol pours out as from Fox News).

Guy, we've had 60 years of the NHS, what makes you think we can't continue? you may promote your private mindness all you like, from your hospital bed but the general population will continue to work for each other and the collective sense of parity and support from Ellandroad will sing for the continuation of the NHS.

H28 ("I have worked as a professional in the NHS for 25 years+").

If you don't mind me asking, what was the nature of your professional career in the NHS?

Precisely. The idea that people can have personalised budgets has a number of technical considerations. For example, I became interested in certain neurological charities campaigning on free prescription charges. This seems indeed a wonderful idea. However, it was quickly brought to my attention that: if free precriptions, why not free social care? A patient with early dementia may have medical requirements which the NHS can cater for (but has to be paid for from somewhere), but will also have significant care requirements. Therefore, there needs to be a much greater coherence in our financial planning for clinical and social services. And while the numbers of the elderly and therefore people with geriatric chronic illness continue to explode, we do need patently a coordinated response. Unlike some of the trolls of the site maybe, I was pleased by the launch of the Tories' doing a wider consultation on the NHS today http://www.conservatives.com The online consultation will end later today on their website. I would prefer to believe that Cameron and Lansdale have NOT gone all 'libertarian' but this is a serious debate which, so far officially at least, the Tories and Labour seem to be treating seriously. I don't even know the name of the Liberals' Health spokesman/woman, which only goes to show how detached from reality I actually am!

@Dave Postles

"a government elected by 40% of the electorate should think very, very carefully about attempting to force fundamental change to the NHS"

Much like a government elected with 375 of the vote has been uncontroversial in its actions these last 5 years?

It hasn't railroaded things through with little of no parliamentary oversight has it?

With regard your comments over private healthcare, I don't really care if the NHS remains unreformed as it is not possible to fund it properly in its current state. I will continue to pay for private healthcare and as such will not be hit by funding cuts, waiting lists and the like that those solely relying on the NHS will face.

If those of you on the left can't see that the NHS can't carry on as it is financially then I look forward to you having to deal with the problems some time in the future whilst I sit in my private hospital bed.

We have got to get away from the nonsense that private means better.A properly funded NHS built on the priciples of it's fouders, care at the point of no cost, is and will continue to be the only option for Britain's health care needs.

Here is another area where we will rip the conservative agenda apart. Trying to strip Britains best asset apart by the division of wealth would be a disaster for the citizens of Britain. I would point to the dentistry division as the prime example.

Jo and Shibley (sorry, and several others too) have introduced the question of adjustment to an ageing population. This demographic and welfare issue cannot be approached only from the perspective of the NHS, I would have thought, but people will advise me. I assume that it is one of those issues which demands a coordinated response across the agencies: social services, care homes (including private organizations), particular input from gerontologists, psychologists and psychiatrists, and so on. That approach, I'm sure, will not be music to the ears of the libertarians, but I hazard it might be the case. I assume that I will be alright Jack, but I do wonder what will happen to the elderly poor and in particular the elderly poor with dementia.

@ Guy M re- Jo's comments (Hazico28) On the issue of the NHS, my opinion (no more) would be that a government elected by 40% of the electorate should think very, very carefully about attempting to force fundamental change to the NHS. It might well be folly, depending on the composition of the two houses. I would be surprised (but I'm guessing) that many in the multiple other parties would support such a change. I would expect (but again, I'm guessing) that the 'Save the NHS' campaign would be widely supported and vociferous it its extra-Parliamentary demonstration - and Parliament is not the final court on this one, I hazard.

I hope the labour party continues with it's knowledge based NHS where every single staff member employed within the NHS has and does participate in an employment of perpetual learning and advancements. Work must mean more than just a work base operation and continual knowledge is the progression chapter to better care.

Staggeringly unsurprisingly, I agree with all of what Dave P has just said.

The body which should presumably be consulted is the National Council on Nursing and Midwifery on behalf of the nurses, not some partisan organization which may or may not represent nurses' desires.

'There should be health insurance pushed as the norm for those who can afford it with the NHS free care used only for those in need.'

The question then would be how do you prevent what is essentially a two-tier system (privileged use private healthcare, rest of us use NHS on principle) from becoming a normative two-tier system on a larger scale, with most of the population with insurance healthcare and the under-privileged relegated to 'poor law' hospitals. Secondly, will the private health schemes compensate our hospital estate (we paid for the estate and buildings as taxpayers) on an economic scale or will the private insurances duplicate the estate by their own capital investment in new buildings? It would be interesting to have a national poll or referendum on this issue. I suspect that the 'Save our NHS' campaign would be very vigorous, although, of course, that's only my perception.

My naive opinion is that what the NHS needs is a period of consolidation after endless reorganizations which I perceive to have been incredibly disruptive, but wiht incremental change to adjust to new challenges. The pubic outcry against Hannan was, I think, demonstrative of public opinion: 'Save our NHS' campaign.

'We don't complain (much) about that when it comes to dentistry or optical health-care.' Those who can't afford it don't complain - they just don't go for treatment.

Don't let this become a discussion on morals, for crying out loud, it'll never end!

'I will allow you all to make up your own minds but indeed like H28 I am shocked; in my case, because the NHS saved my life. I wouldn't be sitting here otherwise, admittedly boring you all to death. To offer some partial defence, I did in 2005 obtain the Diploma of the Royal Colleges of Physicians of the United Kingdom, so a subtle dismantling of the NHS without cross-party discussion on the future of health and social care is NOT going to escape my RADAR I am afraid.'

Well said. Your insights are valuable.

'I have worked as a professional in the NHS for 25 years+, and ideas like these are utter madness.Clever, yes, but morally repugnant.'

It was important for you to say that, Jo - thanks.

Perhaps I'm being obtuse, but why did he meet this organization about pay negotiations? It's not the organization that represents nurses in these discussions, is it?

It's not unfortunately irritating for elderly patients who are housebound in a wheelchair, with a meals-on-wheels service that they can't afford, perhaps recovering from a deep vein thrombosis, and with impaired vision. You must have a weird sense of humour if you find this subject matter 'comical'.

I think several people commenting in this subject have picked up the ball and run with it... over the try line, out of the stadium into the park, accross the road, and into the next county.

More than this, the pathetic faux outrage starts off being comical, but then ends up being irritating!

Thanks for this Diana - excellent find. As I mentioned earlier, my Ph.D. was in fact in dementia, and I think that the sheer change in demographics alone probably justifies a wholescale review of the health and social care policies in the UK. This is critical if you become immersed in the talk of "personalised budgets" and "patient choice" (as I nearly did - not pleasant! ) think personally the nurses are the backbone of the NHS. The reason for this is that they spend the most time (in hours) talking to the patients themselves. I don't belittle the need for Consultants who take overall clinical responsibility for all medical decisions in the NHS, however.

@Hazico 28

"Why is Davis Cameron not consulting the thousands of NHS staff who have decades of experience working there, instead of "extremist" groups and individuals like these?" Err... she is a doctor, and she represents nurses.

I think what you really mean is "why doesn't he consult NHS staff who agree with me?". The answer to that is pretty straight forward. He disagrees with you and is casting round for ideas from the right.

This is the problem with the tinternet, you get lone nutters typing in their bedroom calling themselves a think-tank and people believe them. There's a nutty old woman doing an anti-teaching one too, can't remember what its called and then of course Muslims4UK_LOL is a nutter who can text a few mates. And Dave should ask Dr Helen about being a doctor - she has a PhD in Health Economics. Whatever that is.

Hi Hazico. How does it work in Scandinavia?

@Hazico

"but I believe there are extremist political ideologies out there seeking to dismantle the "state" at any cost"

So that would be the 40% of the electorate saying they will vote for a party that believes the "state" is too big, does more than it should and taxes too much?

You say my view of small state is extremist? I say your view of the state knowing best how to run my life, what I should eat, where I should work, how much I should drink, how i shold get my healthcare or education is "extreme".

To put it blunty Hazico you don't know one tiny thing better than I do in terms of how I should run my life. So how about you and your like butt out of my business and stop "advising" and "caring" for me. I don't want you anywhere near my life choices thanks.

This is a fundamental ideological difference between left and right and for you to describe it as "extreme" shows how politically naive you are.

Hi Diana, sorry this is brief.Nurses are human too- and portray an array of political beliefs.But from my experience with a nursing background, I believe 99.99% of my ex colleagues across all disciplines would totally reject this ideology.Perhaps DC should remember that when being very selective in who or what to adopt...I think this is pure politics.

You might find this very passionately argued blog on mumsnet interesting http://www.mumsnet.com/Talk/in_the_news/882987-Merry-Xmas-America-Health-Care-Reform-Passes?pagingOff=1 I think that the nurse who plays a very prominent part in that discussion would probably support many of the ideas advocated by NFR.

To my mind what all this points to is that there are real discussions that need to be had about how to make the NHS better and how to prepare for the challenge of the ageing population.

Nurses have a tough job. There are bound to be things they will see that they want to have changed. I think it is very important that they have effective ways of raising concerns and feeling that they can make a difference.
Without that we should not be surprised if they go looking for other people who they feel will listen to them.

I don't leave my health and that of my family to the whim of the NHS, I pay for private health insurance.

Health services run by politicians and having national pay rates are dinosaur structures long ready for overhaul.

There should be health insurance pushed as the norm for those who can afford it with the NHS free care used only for those in need.

If someone wants cosmetic surgery or a private room with tv etc. then let them pay extra for it not expect everyone to fund it through their taxation.

@Hazico

Calling this group "extremist" is your idea of "civil" debate is it? Pot, kettle and black maybe?

Roger and David- I agree it's healthy to look at other useful models- eg in Scandinavia- but this group hilighted is far from the way forward- in fact highly destructive and ideology driven!

No one is saying the NHS doesn't need reforming and improving- that is always necessary- it's a huge organization, and in many cases doing fulfilling an incredibly skilled function(ie saving lives by the thousands every day).That is why it needs 100% support and funding, now and in the future.

I've only got time to make a brief comment today, but I believe there are extremist political ideologies out there seeking to dismantle the "state" at any cost.The public do not support this in any shape or form; I think there would be a revolution if extreme measures like these, or Hannan's type of ideology were imposed on vital frontline public services in the UK.

I absolutely agree on that one though. I wouldn't go as far as to say 3rd rate, as it did save my life (I think its acute services are second-to-none, but we have a difference of opinion here before Roger in that I was talking about acute services predominantly instead of the rest of the NHS). However, it shouldn't be sacracant (spellng?) or a 'sacred cow'. I think that we must have cross-party talks on this now bearing in mind that too many conflicting opinions will mean that we get absolutely nowhere. I think the idea of the NHS as a genuine market is wrong, however, for reasons alluded to in the book review I quoted below. It is now 60 or so years at least following Beveridge. The Tories wished for a cross-party discussion on the War in Afghanistan; this is problematic as the Liberals don't agree with it at all. Therefore it was seen as a gimmick. However, there are many in both the Labour and Tory (and LD) party who want to see refreshing change on this. Alan Johnson may be able to "sign it off" but this may be one indeed for the Think Tanks that I have been unkind about of late, provided that they engage one particular group of 'stakeholders' - the general public.

Hi Roger - "I really do not understand why the NHS is sacrosanct": actually, me too. As it stands it is a huge unsustainable drain on the economy. Surely we could learn some lessons from successful models in other European countries? Free universal health-care is not a human right. If a person can afford to, why shouldn't they pay something towards their health-care? We don't complain (much) about that when it comes to dentistry or optical health-care.

I really do not understand why the NHS is sacrosanct as it's performance is less than average within the EU. The French and German Social Democrats do not seem to have a hang up with mixing private and public provision to obtain better performance. Why d we think Politicians are best qualified to make decisions with respect to how to organise and manage the provision of such services, as they are all obviously extremely limited in their real world on the job experience. If any of you really do believe in improving the quality of health services in this country then first you must take politics out of the NHS and put patients into the driving seat. The NHS currently is providing, on average, a 3rd rate service and can do much better for less money.

@H28 I am absolutely fuming about this.

Sure Cameron is a PPE graduate, but he is dangerously wrong.

The Libertarian approach has plenty of problems both theoretically and practically.

Read for example

http://content.healthaffairs.org/cgi/content/full/25/6/1740

I will allow you all to make up your own minds but indeed like H28 I am shocked; in my case, because the NHS saved my life. I wouldn't be sitting here otherwise, admittedly boring you all to death. To offer some partial defence, I did in 2005 obtain the Diploma of the Royal Colleges of Physicians of the United Kingdom, so a subtle dismantling of the NHS without cross-party discussion on the future of health and social care is NOT going to escape my RADAR I am afraid.

Good God.I am shocked by this Tom.Thankyou so much for bringing this to our attention!

I am not an expert, but I believe all this nonsense thinking and extreme right wing politics emanates from Republican factions in USA.
When I look back to Obama's healthcare debate, and Dan Hannan rushing to Fox News, opportunistically to tell the world our NHS was a "60 year old mistake"- followed by a propmotion from David Cameron to MEP in Europe- that said it all about a significant section of the Tory party.Is he now a back bencher- no doubt hoping to campaign for this type of thinking within the party?
Clearly he must have some sympathy from DC- judging by this article.

I am deeply worried by movements such as "libertarianism" in this country and emanating from USA. It has the potential to be extremely destructive and undermining to our frontline public services and welfare state.

Why is Davis Cameron not consulting the thousands of NHS staff who have decades of experience working there, instead of "extremist" groups and individuals like these?

I thought he was seeking to reassure the public the NHS are 100% safe in their hands?! Is this an example of that?

I think it is a scandal Tom, that this is a hidden agenda- and should be exposed on a programme like Newsnight- for all to see and hear.The public's top priorities according to polls are the economy; NHS, and education.That being the case, they might think twice about voting for a party that are so sympathetic to such extreme politics.

I have worked as a professional in the NHS for 25 years+, and ideas like these are utter madness.Clever, yes, but morally repugnant.

Tom, I am surprised by the tone of this post. Obviously, Cameron will have different ideas to Labour on the NHS. It is odd to start pointing the finger when he meets people whom you disagree with. You would be very busy if you did this every time he held such a meeting.

The most interesting line of the whole post is the last one. "And I think we should be concerned". Well, really? I would suggest that you would only be concerned if you thought the Tories were going to win the GE. To date, I haven't heard any Labour MP say that. Something you want to tell us, Tom?

"We're facing the revenge of Capital..."

I don't think so.

This model of Capital has conclusively and terminally failed. What we are seeing is a QE inflated financial bubble: Humpty will not be put back together again.

The problem we have had with New Labour has been that they have slavishly followed the Tories in representing the interests of this model of financial Capital. Blair and Brown out-Thatchered Thatcher in the way that they implemented the Washington Consensus.

Having said that, I don't believe that the State should be involved in running the NHS either. I think that the State - operating at networked local level - should act as custodian of NHS assets; set the standards of care; and facilitate best practice.

Co-operatives of staff and management should then provide the service to user groups of citizens and patients - not 'customers' - that is a word that exemplifies the Orwellian methods employed to facilitate the perversion of the system.

Any necessary investment may come from 'unitisation' of rentals paid in respect of capital invested in NHS property and from user charges. This involves the use of a partnership-based enterprise model, rather than Victorian-vintage Company law, or even more antiquated trust law.

Using a networked co-operative partnership-based NHS structure there is no reason why any payments need be made to unproductive shareholders at all.

Payments to shareholders are in fact an unnecessary cost to stakeholders, which would render the NHS uncompetitive.

Don't worry, if he's anything like Brown, the promises he makes to Evans now won't last beyond election night.

From this I would say that the NHS is certainly not safe under the Conservatives.

There may be problems in the NHS, but I still think it's a very good service to have. I can't even begin to think of the consequences of privatisation and setting up the NHS as a 'last resort'. Surely this would mean that they would be given a lower standard of care, especially if other people are paying for theirs. Also when given the choice, how many places will offer NHS care, if there is money to be made for them and their staff in the Private sector? Dentists would be a perfect example of this.

Areas of our country remain poor. I can think of very few people in my local area who would be able to afford insurance or self funding, doubtless the Tories would disagree with me. We need to be fighting for these people and keeping the NHS for all.

What a surprise! Companies are desperate to increase profits after the 'credit crunch' wiped out a lot of their business - and privatisation will help them do it. If the Tories win - and if we let them. Indeed, some patients might even back such proposals, particularly some middle-class Tories. We're facing the revenge of Capital....

Brown had a meeting with his military this week is he taking over the country in a military coup, so he does not need an election.

The meeting was about the pay bargains and the way they discussed wages. A lot of nurses are worried that labour will be offering very low wages increases which could end up putting nurses back on low pay.

It is sad that a simple meeting can end up causing this, while Labour has it's own serious problems with flogging off the NHS.

I think Brown should be doing much more to get the NHS dentist back.

But the idea the NHS is safe with labour is now plainly a lie it's not safe with anyone

With an ageing population and rising drug costs, it is essential to be pragramatic about how we ensure everyone in society gets access to the highest possible standard of health care. The Clause IV dogma that the state needs to own the means of production, or in this case, health care provision, should be behind us now, and we should instead focus on raising the quality of that provision through contestability, while guaranteeing that every one has the means to access it.

Healthcare should be managed and funded locally or co-operatively. Which was the advice that Nurses for Reform gave David Cameron when he went to visit them a few days ago. The NHS was very good at dealing with the health problems that exist in a poor country. Its brilliant at things like vaccinations and good maternity care, giving out false teeth and the like. We need a new model to deal with today’s challenges, to deal with age related illnesses and degenerative conditions; something which Cameron himself will be passionate about considering the impact the close relationship he has had with the NHS alongside his son Ivan over the last few years - as well as deal problems like stress, obesity and back-pain which will be important in the near future. The NHS certainly does need to become more customer focused. They should respect their patents more. why does the state have to own all hospitals from the centre?