GP, writer, comic and broadcaster Phil Hammond 1 shares some of his insights from the latest NICE annual conference.
The medical conference season usually gives me a chance to get up close and personal with the biggest cheeses in the NHS. I’ve chaired the NICE conference for six years now, and the Patient Safety Congress for three, and they usually attract some heavyweight speakers to interview. Up first was Professor Malcolm Grant, the new chair of the NHS Commissioning Board. Prof Grant had previously described the Health and Social Care Bill as ‘unintelligible’, a sentiment shared by any poor sod who’s tried to read any one of its heavily amended versions. In defense of Andrew Lansley, Grant observed that he was one of the few Health Secretaries who really wanted the job. Alan Milburn was another. And maybe Virginia Bottomley. But generally it’s seen as a fast track to career ruin.
Grant comes across as slick and self assured, but detached from his audience. His remark that a patient couldn’t get seamless NHS care because his GP was ‘out playing golf’ went down like a cup of cold sick. Sure, the odd GP plays golf in his or her own precious time. The GPs in the audience at a NICE conference are generally workaholics struggling to combine their new commissioning roles with running a busy front-line practice. A hundred hours a week doesn’t leave much space for teeing off when you’ve factored in sleeping and eating. They were not amused.
I have no doubt about Lansley’s desire to do the job and his impressive knowledge but I’ve yet to be convinced he’s in it for the NHS and these closer health links between private business and government don’t help.
Next was Andrew Lansley, in what would have been our first public outing since last year’s stormy Question Time encounter. Sadly, his office refused to allow me to interview him. Whatever happened to the pugnacious MP? If I’d have turned over Alan Milburn on TV, he’d have been eager to come out swinging ant put me in my place. Lansley had just come from a bit of booing at the nurses’ conference but NICE is one of the few conferences where you get to have a decent discussion based on the evidence. We were all keen to hear about the evidence-base and political mandate of these massive reforms but perhaps they don’t exist.
Lansley knows the NHS inside out, which is perhaps why he comes up with ridiculously complicated and expensive solutions to simple problems. [...] Never has so much time, energy, money and anguish been spent getting back to where we started.
I did manage to bump into Lansley in the toilets, where he was his usual polite and surprisingly pucker self. He claimed to have no knowledge of my late withdrawal and then delivered a carefully rehearsed speech about the role of NICE in the future. He was giving it independence from government, on a par with the National Commissioning Board, but taking away its power to directly decide whether the NHS funds a drug under his proposed value-based pricing system.
Slashing our pensions won’t just save money, but it’ll make private provision of healthcare more likely as companies won’t have to pay such high staff pensions.
Lansley knows the NHS inside out, which is perhaps why he comes up with ridiculously complicated and expensive solutions to simple problems. The NHS could have been improved by clustering together PCTs and putting more clinicians on the board to drive clinically-led commissioning with smaller groups of clinicians feeding ideas into it. Sorted. Instead we create a National Commissioning Board the size of the department of health, commissioning support organizations the size of strategic health authorities and clinical commissioning groups the same size – and in many cases with identical names – as the former PCTs. Never has so much time, energy, money and anguish been spent getting back to where we started.
The trouble with NICE is that is has only been able to give yes or no decisions, rather than bargain over the price and drive it down like the equivalent body in Australia does. Lansley just needs to give NICE this bargaining power, rather than letting NICE adjudicate on effectiveness and leave some shady government committee to agree on a price.
Doctors have been very badly treated over pensions but the trouble with any industrial action is that it only takes a couple of patients to claim they were harmed for it to become a public relations disaster.
The suspicion with the Conservatives is always that they shrink the state and replace it with private providers partly because of the directorships and consultancies that will then pick up when they leave office. I have no doubt about Lansley’s desire to do the job and his impressive knowledge but I’ve yet to be convinced he’s in it for the NHS and these closer health links between private business and government don’t help. Slashing our pensions won’t just save money, but it’ll make private provision of healthcare more likely as companies won’t have to pay such high staff pensions.
If he [Andrew Lansley] doesn’t get back round the table, my guess is that either he’s punishing doctors for opposing his Bill, or setting them up to fail as commissioners so the private sector can take control of the £60 billion pot.
Doctors have been very badly treated over pensions but the trouble with any industrial action is that it only takes a couple of patients to claim they were harmed for it to become a public relations disaster. Mr Lansley knows this and so does Hamish Meldrum, the BMA leader. Dr Meldrum is doubtless praying that the Government will get back around the table before June 21 so the strike can be averted. But Lansley could sit back and watch the BMA self-destruct.
Lansley has a few bridges to build if he doesn’t want the workforce to descend into demoralisation and chaos. Let’s hope that’s not his secret plan.
If he doesn’t get back round the table, my guess is that either he’s punishing doctors for opposing his Bill, or setting them up to fail as commissioners so the private sector can take control of the £60 billion pot. The NHS can only function with a united workforce and a health secretary we can trust. Many doctors were tempted to vote Conservative because of the specific promise of no big NHS reforms, only to be presented with a structural reorganisation so huge you can see it from space. Lansley has a few bridges to build if he doesn’t want the workforce to descend into demoralisation and chaos. Let’s hope that’s not his secret plan.
- Phil Hammond has been Private Eye’s medical correspondent since 1992 and a regular guest on several shows including Have I Got News for You and Countdown. He presented five series of Trust Me, I’m a Doctor on BBC2 and his Radio 4 sitcom about GPs struggling with the NHS reforms - Polyoaks - has been re-commissioned for a second series. Author of three books - Medicine Balls, Trust Me, I'm (Still) a Doctor and Sex Sleep or Scrabble? - he also has two DVDs. Phil launched a website to encourage NHS staff, patients and relatives to speak up when they come across poor care. He had a passionate argument with Andrew Lansley on BBC 1's Question Time, describing the Health and Social Care Bill as 'unreadable' and '358 pages of wonk'.