What your MP thinks about health shake-up
It is being described as the biggest shake-up of the health service since the NHS was created and MPs' mailbags are filling with letters from constituents concerned about the impact it will have.
Here the EDP asks your MPs what their views are on the reforms.
The Government has decided to 'pause, listen and reflect' to what health professionals and the public has to say about wide-reaching plans to change the NHS.
The unrest over the plans to hand the majority of the NHS budget to GPs and scrap primary care trusts reached such a fever pitch that the prime minister David Cameron and deputy prime minister Nick Clegg were forced to launch a series of 'listening' exercises across the country.
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Once the pause in proceeding with the unpopular Health and Social Care Bill had been announced, North Norfolk MP and former Liberal Democrat health spokesman Norman Lamb spoke out publicly about his concerns with the legislation. And last week he detailed exclusively to the EDP the changes and amendments he thinks are needed.
The sheer scale of the changes being proposed is immense and there are many points to be debated.
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The EDP put five key questions, aimed at eliciting a detailed and specific response, to each of the other 14 MPs in its area.
Two MPs have not responded, some added statements to their specific answers and others submitted statements instead of answers.
The questions the EDP asked:
1) Do you believe the new local commissioning groups should be solely GP-led or clinically-led? (i.e. with other health professionals involved)
2) What specific mechanisms of accountability do you think there needs to be as part of the reforms? (i.e. board meetings held in public, boards to include independent chairman or elected members)
3) Do you believe that GP consortia should be given the choice to 'opt in' to taking over commissioning when they are ready, rather than having to meet a deadline?
4) Do you have any concerns about introducing more competition into the NHS and more private providers to offer NHS care?
5) Do you think Health and Wellbeing Boards and local HealthWatch bodies are fit for purpose?
Further comment - please add in any further comments you wish to make about the proposals.
The answers from the MPs:
Simon Wright, Liberal Democrat MP for Norwich South
1) The consortia should include representation from a range of backgrounds. However, if groups of clinicians other than GPs are included, which I do think is desirable, then there must be strong safeguards in place to avoid conflicts of interests emerging e.g. where potential providers of care are also the commissioners of care.
2) The Government does need to consider how democratic accountability is maximised as a result of these reforms. Positive proposals include giving councils responsibility over public health and the creation of Health and Wellbeing Boards. In respect of the consortia, I would also like to see strengthened democratic accountability by requiring consortia to have annual plans approved by the local Health and Wellbeing Board, and membership of the commissioning consortia to include an element that is democratically elected (either directly or otherwise local councillors) to sit as non-executive directors. The presumption should be that consortia meet in public, with private sessions a possibility only where there is strong justification.
3) I think the most critical timing is in relation to those consortia that may not be ready by the 2013 deadline. We cannot allow the financial stability of the NHS to be jeopardised by rushing through consortia in areas where they are not ready to take on all necessary responsibilities. Financial risk could be kept to a minimum by looking at a range of options for the timescale of the introduction of the new commissioning arrangements, including allowing GPs to opt in when ready.
4) The previous Labour government introduced a much greater role for private providers in the NHS, to the extent of giving more favourable terms to new private providers. There must be a level playing field, so that all care providers are given a fair chance. Competition must ensure the long term sustainability of the NHS is not undermined by 'cherry picking' of the most easily provided services by private providers. Ultimately though, the only objective must be to deliver what's best for the care of the patient. Competition based on financial motive alone does not suffice. The final proposals must also recognise that collaborative working across a range of providers is key to the delivery of good local health and social care services.
5) The prospect of Health and Wellbeing boards operating within councils is attractive, as these boards will encourage a more united approach to health care, social care and public health. Local councils understand their populations well and deliver many of the services that are the levers for improving health in the communities they serve, such as social care, education, housing, transport and leisure. The Health and Wellbeing Boards will allow for greater joined up thinking, but to be most effective they must also have real influence over the GP consortia. HealthWatch will be a welcome addition as a champion for the local concerns of patients, and will also provide a means of representing local concerns at a national level.
Further comment - While introducing reforms to improve to improve value-for-money, there is also the clear opportunity to improve transparency and accountability in the NHS, which if implemented properly will give more power to patients over the care they receive. NHS reform must recognise the need for collaboration, co-operation and integration in the delivery of NHS services. We cannot rely exclusively on competition as the only driving force for improvement.
I do share some of the concerns raised by many about aspects of the Bill. However, I also welcome many of the aspirations – less bureaucracy, more local accountability, greater involvement of clinicians and a focus on health rather than chasing targets. The current pause in the process gives an opportunity to reflect on the current shortcomings of the Bill and to introduce strong amendments to the legislation to improve it. Forthcoming changes must carry both broad public and patient support and have the backing of those working in the NHS who want to see an even better service for patients.
Chloe Smith, Conservative MP for Norwich North
1) I trust GPs to do this job. I've used the NHS in Norfolk since I was three and from the soundings I have taken, I think today's GPs are both up to it and up for it. Certainly a Norwich consortium is already getting underway, as well as two thirds of the rest of the country which GP consortia pathfinders are already covering. However, I want other professionals involved too – such as nurses, who I spoke to only last month at the Norfolk RCN Conference. On the whole I welcome these reforms because they give control over NHS services to frontline doctors and nurses and take it out of the hands of ministers and managers. That's exactly what I campaigned to do at the General Election and it's what I'll stand up for.
2) Monitor and the Care Quality Commission should co-operate to ensure quality care and effective regulation. There should be a HealthWatch as a body of the CQC. I welcome Health and Wellbeing Boards at Norfolk County Council level because I have already been campaigning for social services (done through local government) and health to be better joined up. Health institutions locally already get local people involved – the N&N was out and about recruiting for new governors this weekend at Thorpe St Andrew's St George's Day Fete, for example – and this will and should continue. I welcome public, democratic accountability wherever possible, and I think these reforms are the best chance in a long while of actually giving power to patients.
3) Actually, I think GPs are ready. They have already come forward voluntarily, more than two years before the formal handover of responsibility takes place in April 2013. I don't think two years is a tight deadline. People want to see power to the frontline so I think Westminster can reasonably ask for that to happen by a given date.
4) I want all services to meet NHS standards and NHS costs so that everyone gets decent treatment, free-of-charge apart from taxes, and based on need, but I don't mind who a good nurse or doctor works for. Competition means people get the service they want. I have spoken to people who prefer the James Paget for their operations, and to people who prefer the N&N. My father sees an NHS specialist in Peterborough sometimes, because that's his best option. Equally, some prefer their own GP surgery, and some use the new health centre in the Castle Mall if they are in the city. People should be able to choose if they have the time and wish to do so. But, often you simply want good healthcare. When I broke my ankle near King's Lynn, I needed help at the QEH and that was that. I wouldn't have minded who put it in plaster so long as it worked.
5) Yes. I would encourage anyone who doesn't think so to stand up and get involved themselves.
Keith Simpson, Conservative MP for Broadland
The NHS is held in high regard by all my constituents who want to see the very best services made available. I support the principles of our reforms and along with all the Norfolk MPs voted for the Bill at every stage.
I want to see commissioning which is clinically-led, based around GP consortia and accountable to patients and local communities. HealthWatch and Health and Wellbeing Boards are critical elements of this.
I believe passionately in the NHS and and have seen how central it is to the lives of my constituents. But everyone acknowledges that the NHS has to adapt to changing circumstances and new medical innovations.
I welcome the government's decision to pause, listen and reflect, taking into account the views of medical professionals but also patients and carers, and then, where necessary, improve our plans for the NHS.
George Freeman, Conservative MP for Mid-Norfolk
1) I believe that the new commissioning groups should be largely GP led. This is because GPs are the gatekeepers of care and the primary point of contact for patients as they begin their care pathways. Giving GPs the bulk of decision making powers in relation to commissioning will ensure that their patients are set on the right path to recovery from day one, and allows GPs to utilise the relationships that they have built up, often over decades, with their patients, to determine the kind of care services they wish to purchase. That having been said, other clinicians, such as nurses and other health professionals clearly have a great deal of expertise in different areas that GPs should be able to draw on.
2) Accountability is essential, which is why the Bill makes provision for emerging GP Consortia to ensure that patients are involved in the planning and development of services and to promote and extend public and patient involvement and choice. To improve accountability, consortia will also be required to make public their remuneration arrangements, to hold an open annual general meeting that anyone can attend, make their commissioning plans available to the public, and publish an annual report that includes consideration of how well they have discharged their new joint arrangements with local authorities. The annual report will also be the place where GP consortia reflect the patient and public consultations that have taken place. The challenge is to find mechanisms of accountability which respect rather than second guess or distort clinical practice, and avoid overly politicising healthcare. Politicians should be focused on discussing and deciding on the major issues of health policy rather than the day to day minutiae of delivery.
3) Whilst I am wary of Whitehall rushing in reforms too fast in the past, and I do believe there is a case for introducing reform generally through pilots and on a more gradual basis with enough flexibility for different areas to evolve slightly different models, we should remember that over two thirds of the country, around 35m people, are already covered by pathfinder GPCs and beginning to benefit from the reforms. We need to push on - but with care and flexibility to cater for local circumstances.
4) In principle, there is nothing incompatible with NHS services being delivered by the voluntary or independent healthcare sectors. Indeed, large parts of the NHS already work closely with the private sector, and many patients are treated in private facilities through the NHS. Provided NHS services are delivered cost effectively, at the appropriate clinical standards, and to all regardless of personal circumstances, we need to move on from a narrow ideological concern with Public v Private. Indeed, given the exploding level of demand for healthcare we will need to encourage more and more of those people who care and can afford it to take more responsibility for their health needs, and build an NHS that can work alongside and with independent providers, not against them. In terms of these reforms, there will be no competition between NHS and private providers based on price. There will be a standard price for care services that both NHS and private companies will have to meet, which eliminates the potential for the NHS to be undercut by cheaper, and substandard, private providers. Instead, they will all have to compete to provide the best quality for patients, which is of course the most important yard stick for any health service.
5) Health and Wellbeing boards will act to bring together all those groups in a local area that buy services across the NHS, such as GP consortia, social care, and children's services as well as elected representatives and HealthWatch. HealthWatch itself builds upon existing structures and will function as a consumer champion across health and social care. It is right that both these bodies have a place within the new NHS and early implementers appear to be learning a great deal and doing a good initial job.
Further comment - In allowing GPs to target the NHS' resources directly where they know they are most needed and to protect the NHS' expenses from spiralling out of control, while at the same time protecting those aspects of the health service that we know are functioning most effectively at the moment, I believe these reforms are a significant step towards halting the NHS' relative decline in relation to the rest of the world.
Elizabeth Truss, Conservative MP for South West Norfolk
At present our system is too centralised and too much money is spent on overheads so I support removing tiers of bureaucracy. Between 1999 and 2009 the number of managers in the NHS increased by over 80pc; reaching a high of nearly 45,000 in 2009. Therefore it is right to reform the service; however this must be done with the support of the public and must be flexible so that West Norfolk can operate in a way that is right for here.
There is much positive collaboration between the Queen Elizabeth Hospital, Swaffham Community hospital and local GP surgeries. I want this service to be even more joined up so that those living in remote areas have better access to high quality care. Unfortunately, the current system is not accountable enough as recent problems over the Terrington St John Surgery have shown. The surgery has been based in temporary accommodation for months despite a purpose built building sitting empty nearby. I have urged the Health Minister to act - however the complex structure is preventing prompt resolution.
I think accountability should come in the form of a direct and immediate say in how local healthcare is provided and also by giving people much more say over how treatment is provided to each of us. I support the inclusion of private sector companies provided i) everyone has access to this medical provision and ii) that private providers are required to meet rigorous standards.
Many GPs in West Norfolk want to manage the overall health of patients by commissioning services and I think that this will work well with the current relationships with local hospitals. I think flexibility in approach is important and I would like to see a service in West Norfolk that reflects the needs people have here. Our local service should put its focus on keeping people well. Prevention is better than cure.
Henry Bellingham, Conservative MP for North West Norfolk
The NHS is currently too centralised with too much money spent on overheads and so this is why I support the Government's plan. During the time of the last Government the number of managers in the NHS increased by over 80pc; reaching a high of nearly 45,000 in 2009. I believe that reform of the service must carry public support and so the Government was right to pause and reflect. I also believe that 'one size doesn't fit all.' and every area should be looked at in accordance with its specific needs.
At the moment there is excellent collaboration between the Queen Elizabeth Hospital, King's Lynn and local GP surgeries. I am very keen for this to continue so that there is as much coordination as possible; this is especially important in remote rural areas.
I believe in strong accountability and that is why it is a pity that the last Government abolished the excellent Community Health Council.
I certainly support the idea of the NHS working in partnership with the private sector, so long as healthcare is always free at the point of delivery. It is also vital that all private firms are rigorously assessed.
I have spoken to many GPs in West Norfolk, and a significant number are attracted to the idea of commissioning services on behalf of patients. However, they have stressed to me that flexibility is important so that current relationships with local hospitals can be maintained where appropriate.
Brandon Lewis, Conservative MP for Great Yarmouth
1) I think that GPs are best to take the lead on commissioning. However, service commissioning also needs to have input from those who are specialists in their fields, as they are best placed to make decisions as to where money can be spent or saved within their speciality.
2) Local elected members to be allowed to sit on boards and more involvement of NHS users in holding their local NHS services to account.
3) I believe that the consortia will be able to meet the deadline of April 2013. Within my constituency the local GP consortia is part of the pathfinder project and is working hard to ensure a smooth changeover into GP commissioning well ahead of the deadline.
4) More competition is a good thing, it improves services and lowers costs. I believe that patients want a good quality service that is free at the point of service and they want the choice to decide where they are treated. I think it is important that GP consortia are encouraged to choose the best all-round option when commissioning a service.
5) Yes they are a good idea, encouraging local people and NHS users to be more involved in the services that they use. However, it is important that they are promoted to the public to make everyone aware what Health and Wellbeing Boards and Healthwatch do and how they can get involved.
Further comment - The NHS is very important to the UK, it provides healthcare free at point of service and is a huge employer. However, changes need to be made in order to address the ageing population and in order to keep up with the demands put upon the NHS. I welcome the chance to take a pause as it is very important that we get it right and don't rush it.
Peter Aldous, Conservative MP for Waveney
1) GPs should take the lead role, and other healthcare professionals such as nurses and secondary care doctors should be included in local commissioning groups where appropriate, but we have to be careful not to be too prescriptive; the healthcare needs of Waveney are very different to the needs of Ipswich.
2) It is vital that the commissioning groups are accountable to patients and local communities. The Health & Wellbeing Boards and local Healthwatch bodies have a vital role to play. It is important that all decision making takes place in a transparent way and is open to full scrutiny, though some commercially sensitive decisions or discussions over individual staff or patients may need to be held initially in private.
3) In Waveney plans for a GP Consortium are well advanced. With HealthEast being part of the Pathfinder Project, there should not be a problem in meeting the deadline of 2013 and it is likely that the transition to GP commissioning will take place in advance of this date. With regards to the position elsewhere, the pause and consultation which is now taking place will enable the Government to decide whether it is appropriate to adhere to the deadline.
4) It is vital that the NHS remains free at the point of delivery and that choice is provided. This is the first healthcare bill to put into legislation that healthcare should always be free at the point of delivery and that is a very good thing. In principle I do not have a problem with private provision of services so long as the patient benefits, but it is vitally important that services such as community hospitals are retained and have every opportunity to develop their services.
5) They have a vital role to play and will enable councillors, local people and patients to play a full role in the future of the NHS. Their structures and terms of reference are still evolving and it is important that their roles are promoted extensively so that everybody has the opportunity to get involved. We must have an NHS that is more responsive to local healthcare needs and local Healthcare and Wellbeing boards will help to achieve this. The healthcare needs of Norwich are very different to those of Lowestoft and it is time to properly recognise this through improving the democratic oversight of how healthcare is delivered locally.
Therese Coffey, Conservative MP for Suffolk Coastal
1) Clinically-led is okay but GPs need to form a majority to ensure that the clinical professionals closest to the patient and at the start of the treatment lead the commissioning.
2) No independents or elected members are necessary. Transparency of decision-making including commissioning decisions are necessary.
3) I think that if GPs are not keen to be in consortia, they will have to, as now, leave the decision on financing to others. In this case, it will be other GP-led consortia.
4) I think patients don't mind who gives them care as long as it is of very good quality that they should rightly expect.
5) Yes. It is early days and they will evolve as they develop.
One of the really good features proposed in the NHS Bill is that out-of-hours care will once again become the responsibility of GPs. This does not mean that they will have to do all the care themselves, but they will be fully responsible for organising their substitutes. This was a huge issue in the election last year, and a reform I hope will be delivered quickly.
David Ruffley, Conservative MP for Bury St Edmunds
1) I believe the new commissioning groups should be clinically-led but they must be clearly accountable. Current PCT commissioning is insufficiently accountable and does not have enough front-line clinical input into its decisions.
2) There must be an independent oversight committee and the local council should have a part in this.
3) I prefer a deadline, otherwise we run the risk of 'patchy' commissioning.
4) I certainly do have concerns, which I expressed on BBC's 'Newsnight' in early April. The private sector must not be allowed to undercut the West Suffolk Hospital on price in order to 'cherry pick' profitable procedures. That could lead to real pressure on the cash the local NHS hospital needs to keep itself viable. Mr Lansley has to spell out to me, to those who work in the NHS and to my constituents that he will not allow crude competition on price.
5) They need to be totally transparent to Suffolk people – lots of public meetings and hearings will be essential.
Further comment: -The bottom line for me is this: will the reforms mean that local NHS healthcare services, such as A&E and maternity care, will always be available in Bury St Edmunds – not a 60-mile trip away to Cambridge or Ipswich
Daniel Poulter, Conservative MP for Central Suffolk and North Ipswich
Dr Poulter's staff said he was unable to answer questions directly as he was in the process of moving house, so instead sent a copy of an article he has written about the NHS reforms:
Our NHS is one of our most important national institutions, yet in recent years the level of patient care it provides has not always been as high as it should be, both in Suffolk and across the country. One of the reasons for this lies in the endless layers of bureaucracy and red tape that have grown inside our NHS. I have spoken in Parliament about the importance of cutting NHS bureaucracy and investing more money into front-line patient care - which is one of the main purposes of the Coalition Government's reforms. At the moment �4.5bn is needlessly spent per year on NHS bureaucracy. This means that money that could be far better spent on front-line healthcare is instead being wasted on unwanted tiers of management. Now that people are living longer, particularly in counties such as Suffolk, the demands on our local NHS hospitals are growing all the time. In order to properly resource and care for our ageing population, it is therefore more important than ever for the NHS to cut back on unnecessary administrative costs to adequately fund the rising cost of patient care. This is precisely what the new health reforms will achieve; a locally responsive and modern NHS that puts patients before targets and removes the unwanted layers of management, paper-trails and bureaucracy.
As a doctor with years of experience working on the front-line of our NHS, I know it is this bureaucracy that all too often hampers front-line healthcare professionals. In Suffolk, previous decisions to remove vital cardiac and cancer care services from Ipswich hospital have been taken by the strategic health authority, against the advice of front-line professionals. Community hospitals such Hartismere hospital have been closed despite local GPs warning of the need for community hospitals to help look after the growing older population in rural Suffolk. These reforms will put medical professionals in charge of commissioning healthcare services for their own patients. This will prevent the unwanted interventions of managers and the need for expensive layers of bureaucracy which often get in the way of patient care. Instead, doctors and nurses will be directly accountable to patients for their performance, which will drive up standards and allow us to move towards an NHS which measures performance on patient outcomes and required patient care, not politically-motivated targets.
Stephen Barclay, Conservative MP for North East Cambridgeshire
The principles of our reforms are clear. We want to see commissioning which is clinically-led, based around GP consortia, and accountable to patients and local communities. HealthWatch and Health and Wellbeing Boards are critical elements of this. We want to see patients have the choice to be treated by the highest quality service - whether in the NHS, voluntary or private sectors - on the basis of a level playing field. We are taking the opportunity to pause, listen, reflect on and improve our plans to put these principles into practice.
We believe passionately in the NHS and are investing an extra �11.5bn into it. But the NHS needs to change so it can save even more lives and keep pace with the pressures of an ageing population and new technologies.
The EDP did not receive responses from Richard Bacon, Conservative MP for South Norfolk or Matthew Hancock, Conservative MP for West Suffolk.