Poll: British people think the NHS is now better than the competition

YouGov has published this poll that demonstrates that the years of investment in the NHS may have finally impacted on general public perceptions of the standard of health services in the UK.

In the mid 2000s, academic research demonstrated a disconnect ('perception gap') between patients' (service users') improving view of the NHS and those of the public at large, who may not have had recent experience of the service, which tended to be more negative.

However, this most recent YouGov poll found that almost half of respondents believe that health care services in the UK are better than those in other developed countries, compared to only a quarter who believe otherwise. Clearly, the cumulative impact of improving standards and impact on patient experience has managed to overcome the media portrayal of the service, which remains overwhelmingly negative.

Coupled with recent research on standards in the NHS and surveys on patient satisfaction with the NHS, it shows the mountain that Lansley and Cameron have to climb in persuading the public that their health care reforms are borne out of necessity rather than ideology.

Dentists join the queue of professionals opposed to the 'Big Society' NHS

This blog has posted before about the hidden (and not so hidden) dangers of Cameron's push for public service staff to form autonomous mutuals.

As mutuals they would run the risk of becoming less accountable to service users, less efficient and more open to corruption. To add to this is a bigger risk: in the free market vision that the Tory Party has as its endgame, they would almost certainly lose the battle for contracts to large private companies. Mutualisation can therefore be seen as a staging post - more acceptable to a sceptical public - for the real aim of the privatisation of public services. The hope, from the political right, is that taking smaller steps will make the logical next step to an open free market of for-profit providers of health, education and other exiting services more palatable.

Well, Andrew Lansely - currently enjoying the kind of reaction that other Government ministers can expect as this 'Big Society' project expands into other parts of public services - can add dentists to the list of people whose view of mutualisation is not far removed from the argument posted above.

The British Medical Association, meanwhile, puts it well:

‘It is hard to see how the NHS can operate effectively if lots of bits of it are in private hands – even if they are those of former employees....New mutuals could quickly find themselves in conflict with each other and at risk of being out-competed by private healthcare giants. The consequence could be financial and operational chaos.'

In government, the Lib Dems are revealing their inner contradictions

Evan Harris, one of the leading left-of-centre Liberal Democrats behind the recent challenges to the Governments NHS reforms, has launched this critique of what he described as the 'Orange book brigade' and their views on the health care reforms.

In his article for Liberal Democrat Voice, Harris addresses some of the key (and misleading) attack lines that Norman Lamb has used against the NHS, including the (oft-repeated) statistics on heart disease survival rates that were criticised by the British Medical Association.

In his piece he states that politicians should be 'honest enough to explain to the public that effective but expensive treatments can only become available on the NHS when there are increases in real terms spending. I hope that the Lib Dems, when economic circumstances allow, will always give the public the option of voting for more NHS spending through fair taxation'.

Norman Lamb himself appears to lie somewhat in between two factions of the Lib Dem Party (his own 'Blairite' position is clearly distinctive from that of Clegg and Cameron). On one side, you have the likes of Evan Harris - and probably the majority of grass roots members - that are broadly of the centre-left.

On the other side, you have those such as David Laws, who in terms of their views on taxation and the economy are indistinguishable from most Tory MPs. An article he wrote for the Independent back in 2002 gives an interesting glimpse into the kind of future government he was later to become a part of. During the article he writes:

"We make a profound error when we try to pretend that funding is the source of all the problems in our public services...As a party, we have not, I fear, been leaders in securing the consumer interest. We do not, for example, consider how the public can be more closely connected to the health services they receive, for example, through a more social insurance based model".

Other examples of this strand of thinking can be found amongst those such as Julian Astle from CentreForum, who castigates the 'Old Labour' wing of the Liberal Democrats, adding that 'the Lib Dem-Conservative coalition is pressing ahead with the most radical reforms to our public services since they were founded', which he describes as 'a testament to the political leadership of Nick Clegg and the intellectual leadership of David Laws'.

It is entirely reasonable to think that a fair number of the 'Orange Book' tendency on the right of the Lib Dems would have joined Cameron's (more socially liberal) Tories had they existed when they entered politics. In other words, you have a collection of people in Clegg's party (and probably Nick himself) whose main objection to the Tories of old was their social illiberalism, rather than their right-wing economic policies.

In opposition, the Liberal Democrats could gloss over these inherently different political viewpoints - although its long been acknowledged that they have campaigned on different platforms depending on the audience and on geography. In government, with practical policies to implement, these contradictions are becoming more and more evident.

NHS: Clegg makes some ambiguous demands

Lansley's reforms: now in Clegg's hands?

The signs aren't great. What has been billed as a 'listening exercise' on the NHS looks worryingly like an attempt to delay in the hope that pressure on the Government over the proposed reforms ebbs away.

The Guardian has, quite rightly, pointed to the recent communication by NHS Chief Executive David Nicholson, in which he said this:

"It will not have escaped your attention that the NHS has been the subject of considerable debate in Parliament and the media. My message to you is simple: whilst we cannot help but be interested in these debates, especially when they potentially affect our own futures, we must not allow ourselves to be diverted from our core purpose and responsibilities in the year ahead".

For those who were hoping the massive opposition from across the health professions might have persuaded the Government to drop their reform programme, it doesn't look particularly positive, even with the Prime Minister's warm words (particularly as Cameron's 'consessions' seem to basically involve continuing with the same proposals, but at a slightly slower pace).

However, it looks like the Liberal Democrats might be finally waking up from their post-election slumber. Nick Clegg - up until now looking very out of step with his own party on this - has now issued this ultimatum to his Conservative partners:

• quality not price should drive competition;
• services should not be commissioned by family doctors alone;
• GP consortia if unprepared, should not go ahead in 2013;
• the NHS constitution principles must be protected;
• GPs need to work together with councils.

These are all welcome suggestions - but are the least that could be expected given the pressure that Clegg has felt from his grass roots supporters. In fact, it could equally be concluded that Clegg is trying to satisfy his party members but by conceding the minimum possible. He did, after all, allow the existing Bill to get through the Commons intact until the Sheffield Lib Dem conference vote forced his hand.

 

If these are as far as they go, Clegg's suggestions aren't enough. The silence on one issue is almost deafening: privatisation. Nowhere does he oppose one of the central problems that so many people have with the Health and Social Care Bill - that they will allow private companies to take over NHS commissioning services, and grant them even more of service provision.

 

Asking that "services should not be commissioned by family doctors alone" or that GPs "work together with Councils" are potentially not much stronger than the 'concessions' Lansley has been promising. Private companies could still be the beneficiary of outsourced commissioning work. Private providers could still massively increase their influence throughout the service. 

 

This, ultimately, is the 'red line' that Clegg is going to have to address. His own party members reflect the views of the majority of the British people on this one: allowing the privatisation of the National Health Service isn't something that will command support in the country, no matter how many Tory MPs and their media allies want it.

 

It also is a useful indicator (particularly coupled with the forest privatisation fiasco) just how difficult it will be for Cameron to undertake his far-reaching plans to facilitate the outsourcing of all other core public services. If the PM had thought that the principle of a genuine 'public' sector was one he could quietly drop, then he almost certainly doesn't now.

Labour releases critique of Health and Social Care Bill as nurses vote 'no' to Lansley's reforms

In the wake of the Royal College of Nursing passing a vote of no-confidence in Andrew Lansley, Labour have produced a detailed document highlighting the key flaws of the NHS reform bill as it currently stands.

It is telling just how badly the reforms have progressed to date that, with the full use of the civil service (or, 'enemies of enterprise', if you prefer) to help it, the Government have managed to produce a fairly weak riposte to the charges laid at their door.

The truth is Government have - as the outcomes of the elections of 2001 and 2005 must have underlined to the Tory leadership - forgotten that the electorate isn't as right-wing as its press likes to believe. They are simply not willing to countenance the privatisation of the NHS. And they aren't willing to buy the line that giving private companies control over delivery of services and allowing for the outsourcing of health commissioning to private companies is somehow not the same as privatisation.

It is, and people know it.

Tory voters want to tax the rich, increase the minimum wage.. and regulation on unpaid internships

Towards the end of last year, a poll demonstrated overwhelming levels of support for higher taxes on wealthier people, an increased minimum wage, better rights for temporary workers and more taxes on the banks amongst the general public. Interestingly, in each case, this included the significant majority of Tory voters.

Well, yesterday a YouGov poll demonstrated that Conservative voters are also supportive of better rights for interns. It found that the majority of supporters of all the three main parties supported the payment of at least the minimum wage for interns and government intervention to regulate internships. It also found a clear majority believed that internships give an unfair advantage to those with wealthy parents:

 © YouGov 2011

Norman Lamb threatens to quit over NHS reforms

Click to play video - BBC iPlayer

Cameron's NHS debacle grinds on

Cameron must know how much he has misjudged the NHS reform plans when Norman Tebbit objects to them for going to far.

In an article for the Mirror, Tebbit - a former chairman of a charity supporting a hospital actively involved in medical training - highlights the dangers of private sector cherry-picking on the viability of NHS hospitals:

"One problem is that within the NHS there are teaching hospitals, often centres of excellence, which apart from treating patients, also have the responsibility of training doctors and nurses. That all takes time and costs money. Private hospitals are under no obligation to do training and do not have to carry those costs... Even worse for the teaching hospitals, if the private hospitals can hoover up all the straightforward routine surgery, like hip joint replacement, where can the young surgeons gain the experience which would allow them to move on to more difficult surgery?...Another problem for the NHS hospitals is that they cannot refuse to treat patients. Whether it is a drunken fool with a cut face from a street brawl, or a young mother with cancer or a heart attack, no one can be turned away, but the private hospital can pick and choose."

This reflects an earlier piece he wrote for the Telegraph, in which he concluded:

"The public and private sectors are very different animals. They cannot just be told to compete. There are many parts of the public sector which are high cost, flabby and inefficient. But it also carries the costs of services which the private sector is not required to provide".

The question that many must be asking is how - when it was clear from a very early stage that these reforms would be hugely controversial and unpopular - Cameron managed to so woefully misjudge the situation?

UPDATE APRIL 10

Anthony Wells, over at UK Polling Report, has detailed analysis of the latest YouGov poll. One startling statistic is that only 3% of voters think that the government should continue with their reforms as they currently stand - including only 5% of Conservative voters.

Wheels come off government's NHS 'listening exercise' barely a week in

The passage of the Health and Social Care Bill is now looking close to disastrous. With opposition to the Bill rife amongst professionals from across the NHS, even normally sympathetic papers are questioning the way the reforms have been handled:

• The Telegraph has described the exercise so far as a 'fiasco', arguing that the suggested reforms were "not part of the Coalition Agreement, and it is fair to say that few ministers anticipated such complex changes to the health service at a time when the Government is committed to so many other public service reforms".
• The Mail, whilst supporting the principle of the reforms, declared that "countless Britons believe the Health Secretary is rushing his pet project through with far too little warning or consultation... During the election, the Tories gave almost no inkling of the revolution they had in mind for the NHS. Since then, Mr Lansley has appeared determined to brush aside all objections – as if he is afraid of proper scrutiny".

Cameron no doubt thought the 'listening exercise' launched earlier this week may alleviate some of these problems. But there have subsequently been a number of worrying signs that the Government intends not to listen, but rather to tinker with existing proposals, presumably because Cameron and Lansley believe the problem is one of presentation rather than substance. Hence the surfacing of a confidential memo drawing red lines around the core parts of the reforms and signs that Lansley will be selective with regards to who he speaks to during this so-called consultation.

The Government has a big problem here. Firstly, this attempt to delay and re-present the policy won't persuade the countless numbers of people opposed to the Bill.

Secondly, the rank and file of the Liberal Democrats are clearly not going to let the reforms go through without substantial changes - illustrated by the petition by the left-leaning Social Liberal Forum that would radically alter the core of the reforms. This petition proposes that the Bill should:

a) ensure the Health Secretary has a duty to provide a fully comprehensive and free health service, with no gaps and no new charges;
b) provide more local democratic accountability for the health service;
c) curb the market obsession of the proposed reforms to prevent quality being relegated behind price and prevent the cherry-picking of profitable services by the private sector undermining and fragmenting existing provision;
d) slow down the pace of change so that the NHS, facing its toughest settlement for decades, does not implode from the stress of another massive reorganisation.

The significance of the choices that the Government makes cannot be underestimated politically - and are certainly crucial for patients. Nick Clegg is not in a position to let the reforms sail through with only minor amendments, despite the fact that he and his fellow Lib Dem MPs were minded to let this happen prior to their party conference.

Lansley, meanwhile, is increasingly looking like he is on borrowed time.

Top Tory telling us something we all knew already

Delivering a line like "we are making cuts that Margaret Thatcher...could only have dreamed of"with a smile on your face is never a good look for a Tory politician.

NHS reforms - is the Government finally thinking again?

We already know that swathes of health groups, medical professionals (including GPs) MPs (encompassing both opposition parliamentarians and members of the yellows and blues) and large numbers of the general public are opposed to the direction of Andrew Lansley's NHS reforms.

We also know that Cameron is getting jittery. Well, the Independent claims today that he is set to give Lansley the Spelman treatment and announce a rethink of the proposed reforms. A leading article in the same paper (which had previously given the Government the benefit of the doubt on the issue) argues that the path that the Health and Social Care Bill has taken "poses alarming questions about competence at the heart of government".

Meanwhile, David Owen has penned an excellent piece in the same newspaper, which he sums up as follows:

"It is a tragedy that the NHS is being subjected to this inept, ill-conceived and damaging legislation. It has to be drastically amended and given much greater scrutiny...Without such sustained scrutiny and a deliberate slowing down of the procedures, the NHS is heading for a train crash and David Cameron, as the train driver, and Nick Clegg, as his guard, will forever be held responsible".

If the Prime Minister is going to put a stop to Lansley's plans, then good. A 'u-turn' here may be of consequence to Westminster watchers (and indeed this does have political ramifications for the Government, not least the Lib Dems), but it pales into insignificance compared to the consequences for millions of British people of not re-thinking the plans as they stand.

Osborne's Corporation Tax cut - a huge cost to the UK, with little benefit

When Osborne proudly announced that the government would be squandering what little money it has chosen to spend on a cut in Corporation Tax, he was supposedly bolstered by the announcement from advertising firm WPP that it was to relocate its head office back to the UK in response, having jumped ship to Ireland a few years earlier.

This, Osborne could now claim, justified his surrendering of billions of pounds of revenue to fund  reductions in the tax. He could now dust off and wheel out the classic neo-liberal line that lower tax rates on businesses always increase revenue by encouraging investment (and by discouraging companies from relocating abroad).

However, there are two problems with this story. The first concerns WPP and second the wisdom of cutting UK corporate taxes.

First, lets take WPP. It's announcement was met with gleeful back-slapping amongst Osborne and his friends at the Treasury. However, its press statements omit a central fact: WPP's head office is Ireland barely qualifies for the term - it's almost non-existent in fact, with what appears to be a measly eight employees. It's original 'relocation' to Dublin has, unsurprisingly, been described as a 'tax dodge'.

In other words, relocating its head office back to London, where it already houses its far, far more employees, will make no discernible effect. Accountancy Age backs up this view, describing the tax cuts as "a £6.7bn gamble to attract businesses to the UK".

"...any relocation of its tax base will result in few, if any, jobs being moved. The same is true of publishing company UBM, who are also likely to move their tax base back to the UK, and pharmaceutical company Shire. As with WPP, their moves to Ireland did not affect their UK workforce numbers to any meaningful extent and a move back will have the same effect".

Secondly, what about cutting UK Corporation Tax? Well, this was already, before the current Chancellor had his seat at the Treasury, the lowest amongst the G7.  Furthermore, there is evidence - provided by the Treasury itself -  that very few companies actually relocated for tax reasons since 2007/08. And, amongst those that did, their tactic was often to relocate in name, but actually then continue to retain a significant staff presence in the UK.

The fact is that George Osborne has, in the face of huge spending cuts to frontline services that will affect millions of British people, handed billions to some of the largest multinational corporations on the planet - and potentially for absolutely no benefit.