Sunday, 23 September 2007

David Cameron on the NHS

This time last year I had a simple message for our Party Conference. I said I could explain my personal priority not in three words, as Tony Blair once did, but in three letters: NHS.

Since then, we have been translating that commitment into action.

Over the Spring and Summer, we campaigned with junior doctors who have been let down disgracefully by the shambles of their new medical training programme.

We have published the report from the Public Services Policy Group, and Andrew Lansley’s NHS White Paper – both of which contained specific proposals to improve the NHS.

And in August we stepped up our campaign over the future of district general hospitals.

No one should be under any illusion on the scale of closures and cut-backs the NHS faces. At least 29 hospitals face the closure or downgrading of either maternity units or A&E units - or, in some cases, both. Gordon Brown’s new health minister, Lord Darzi, has said that “the days of the district general hospital are over.”

Yet where is the evidence to support such an approach?

In the case of A&E, only 2 per cent of attendances need the highest level of specialist care. These cases should either be taken straight to a specialist centre or stabilised at a local A&E and then transferred.

Downgrading the local A&E unit won’t help these people. And it will mean that the other 98 per cent of attendances will have to travel further.

Yet recent research demonstrated that every extra six miles a patient has to travel to an A&E unit adds one per cent to the chance that they will die before reaching hospital.

In the case of maternity units, the Government can point to no clear published evidence to suggest that small consultant-led units have worse outcomes than larger units. Indeed, many parents opt for smaller units, because they appreciate what can often be a calmer atmosphere and more personal service.

This is presumably why some ministers appeared on picket lines claiming they were trying to help “save” their own local services – from themselves.

It is little wonder that even Gordon Brown’s own health adviser, Derek Wanless, recently questioned the Government’s approach on hospital reconfiguration – saying “question marks remain” over the “robustness” of the evidence it is using.

I think two factors are really behind these cutbacks.

The first is the dire financial situation in which many hospitals now find themselves – not through their own mismanagement, but as a result of the poorly negotiated GP and consultant contracts, the botched NHS computer, the Government’s endless costly reorganisations, and the red tape which results from Gordon Brown’s target regime.

Quite simply, local health services are paying the price for central government incompetence.

The second driver of these reconfigurations arises from the way doctors are trained, and the requirements of the EU Working Time Directive. In my view these are not legitimate reasons to cut local services.

We have set out five steps to stop the cuts.

First, there should be an immediate moratorium on closures to allow breathing space for the right changes to be put in place.

Next, we should scrap the top-down targets that have added so much cost to local NHS services.

Third, it is time for the Government to take action and delay implementation of the Working Time Directive, as it is permitted to do, and seek to amend the Directive so that it affects the NHS no more adversely than the majority of other European health care systems - as it has tried, but failed, to do.

We need to put GPs in the driving seat of the NHS, commissioning care on behalf of their patients - and thereby ensuring that services are driven by their needs rather than by the diktats of central government.

Finally, we need to give real freedom to hospitals and their clinicians to determine how to deliver services, including allowing them to work with colleagues in neighbouring hospitals to provide the relevant specialisms.

These steps illustrate the simple divide between the parties.

On the one hand, there is Labour’s top-down central control, seen in the blueprints for hospital reorganisation which they continue to impose from on high.

On the other, there is our tangible commitment to real devolution – seen in our commitment to empower GPs.

The NHS will be a vital issue at the next election. And, as in so many areas, there is a battle between Labour’s belief in state control, and the social responsibility and devolution of power which lies at the heart of the modern Conservative approach.

This is a battle we can and must win

Monday, 3 September 2007

Half of GPs condemn Labour performance

Almost half of UK GPs believe the Labour government's performance has been poor or very poor, according to a GP survey.

GP Magazine says

We all know the NHS has not fully utilised the huge increase in expenditure it has been given. Why is this?

It is easy to be critical but what are health professionals doing about it?

Thursday, 12 July 2007

Public Health Meeting

This week the Conservative Medical Society hosted an excellent meeting on Public Health-Changing Behaviour, the principles, practice and policies.

Prof Martin McKee from the London School of Hygiene and Tropical Medicine spoke on the "principles of public health"

Prof Robert West from Cancer Research UK Health Behaviour Unit spoke on the "practice of public health"

Andrew Lansley MP Shadow secretary of State for health spoke about Conservative Party policies on Public Health.

We were left in no doubt that changing public behaviour in regard to healthly lifestyles is important but represents a significant challenge for clinicians and politicians. Nevertheless it is essential if health care costs are going to be contained in the future.

The Conservative Party have just completed a consultation exercise on Public Health the results of which will be published shortly.

The CMS encourages debate and is independent of the Conservative Party. Yours views are welcome

Sunday, 25 March 2007


Following pressure by a number of different sources including David Cameron and Andrew Lansley MTAS application system for junior doctors system is being changed. Juniors will now be given a fairer chance by being able to submit their CV and having the guarantee of at least one interview. It is a pity that the fiasco was allowed to happen


Building on last week’s announcement, at a minimum, every long list able applicant who applied through MTAS and meets the eligibility criteria for their relevant specialty will be invited for an interview. Under this guaranteed interview scheme, candidates will be able to choose which of their preferences to be interviewed for in light of geographic specialty-specific and ST level-specific competition ratios which will be available on the MTAS website. We are in discussion about the implications
of this for the timetable.

The recruitment system has worked satisfactorily for General Practice and this will continue. In other specialities, there is evidence that the shortlisting process was weakand we will therefore eliminate this part of the process immediately. In contrast, the interview process has been working and therefore the revised approach will ensure that all long listable candidates will be interviewed. The Review Group believes that this new approach is the most equitable and practical solution available. The Group also recognises the enormous effort by the consultants, service and deans that has already taken place to ensure that the interview process has worked. The time and effort required for further interviews is recognised by the service and the time required will be made available. Therefore first choice interviews that have already taken place should not need to be repeated.

In accordance with the advice already issued, we reiterate that all interviews will be informed by the use of CVs and portfolios and probing questions.

In broad terms, this means that all eligible applicants at every stage of their training, whether or not they have already had interviews or interview offers, will be able to review their stated first choice preference and have the opportunity to select the one for which they want to be interviewed.

We will be discussing operational details over the next week and these may differ between specialties and between different parts of the UK dependent on local circumstances. We will also consult widely. Exact details for how applicants will be able to do this will be available week commencing 2 April on the MMC website at In the meantime, interviews will continue and applicants should attend unless they are confident that this will not be their preferred choice.

No job offers will be made until all these interviews have taken place. Discussions are taking place on the implications of this for the filling of General Practice training places. We expect that the majority of training places will be filled through these interviews. Unfilled vacancies will be filled through further interviews.

The Review Group has recommended the development of a programme of career support for applicants at all stages of the process. Further details to support applicants, deans and selectors through this process will be available next week on the MMC website. Future work will explore what the possibilities might be for doctors to change specialties.

Professor Neil Douglas

Sunday, 18 March 2007

Job Selection Shambles


"Yesterday I spoke to 12,000 junior doctors in London. I was joined by Shadow Health Secretary Andrew Lansley and we also heard from some of the junior doctors who are affected by the current online application system - it really is a shambles"

Listen to more on webcameron

Wednesday, 14 March 2007

The first centre-right, independent, stand-alone, web-based Think Tank for health and social care was launched on 1 October 2006. was partly inspired by some CMS members wanting to enable all professionals the opportunity to get involved in thinking on health and social care. It is also unique among think-tanks in wanting to form policy proposals from the grass-roots up, giving professionals the chance to have their voice, experience and ideas heard and valued.

Led by professionals, central to the work is the building of a nationwide network of people working at all levels in the professions who want to be involved in thinking about, developing or commenting on the policy that they may well one day have to deliver.

The website enables everyone to contribute, but when people actually register on the site as Partners, this enables 2020health to contact them on in relation to their specific areas of interest and experience.

"Already we are looking at major issues of Public Health, Dentistry, NICE and the interface of science and health" says Director, Julia Manning. "It is really exciting to be able involve professionals at all levels. We have pledged too that as we develop policy ideas we will get responses from the Policy makers so there is ongoing communication with all those working with us."

Please do visit the site and register your details. If you have any queries you can contact Julia through

Friday, 9 March 2007

The Chairman’s Voice

Dr Tony Clarke, Chairman, CMS

There are many problems with being in opposition. The most frustrating is watching an incompetent Government destroying things which they of all people should have protected and nurtured.

New Labour came to power on a promise to the British people that theirs would be a new type of politics, sleaze-free, devoted to investing in and improving public services and helping everyone to reach their full potential. A decade later we see more ministers than you can shake a stick at having to resign for every indiscretion imaginable, huge sums wasted on ridiculous projects like the NHS IT programme, record debt within the NHS and appalling low morale of many of the staff in the NHS, schools, police forces, the prisons and the Job Centres, to name but a few.

We have a Government that seems to know nothing of rural Britain and is prepared to raid year on year pension funds, while selling honours for cash. Add to this, little items like Iraq, the Millennium Dome, ID cards and a disaster area called the Home Office and that frustration becomes understandable. Another frustration is knowing how many of the problems could be solved. This is made worse by knowing that if the solutions are made public, then the government will steal them and then distort them. Having principals is not New Labour’s strong suit.

Oppositions however tend to frustrate their supporters if they do not come up with policies. David Cameron has already put his mark on the Party, widening its appeal to the electorate. He has established a number of groups to examine important areas of policy, including health and social security. We are now beginning to see the results of these consultations: David Cameron, Andrew Lansley and Stephen Dorrell held a briefing meeting in Bristol in late January to discuss the mid-term health plans. The CMS had put in a major discussion document in response to the preceding consultation and we were delighted to see just how much of our ideas have been adopted within those plans.

Simply put the Conservative Party rejects the present destructive target culture, the micromanagement and the endless reorganisations and gimmicks which have done so much to waste the so-called investment of so much public money. Instead:
  • We will have only high level targets related to outcome, not process.
  • We will seek to reduce mortality and morbidity of the major causes of ill health, such as cardiac disease and cancer, but will not describe or proscribe the exact methods that will be used to achieve those high level targets.
  • Rather, we will give the professionals, both clinical and managerial, within healthcare the freedom to develop the systems to deliver those outcomes.
  • We will restore public health to its proper place to protect our citizens against health risks of all types.
  • We will encourage the spread of best practice.
  • We will look to move significant funding into primary care, where the majority of healthcare takes place.
  • We will, of course, look to a plurality of provision, but from the perspective of a level playing field. Foundation trusts will be the norm – they will be able to show how good they can be at providing high quality, timely and cost-effective care rivalling anything in the independent sector.
New Labour, in the shape of Tony Blair, said “24 hours to save the NHS”. It was a silly, hollow promise, which ten years later highlights the overall failure of this Government. His refusal to step aside, despite the fact he is now discredited and ineffective, shows just how much he has lost touch with the electors whom he so enchanted and to whom he offered so much. Maybe he realises just how disastrous Gordon Brown will be for the country. We need a Conservative Government and we need it sooner rather than later. Who else is going to save the country’s great public services and put back the pride in Britain?

How to put patients in the driving seat

Article by John Baron MP, Shadow Health Minister, from the current issue of the CMS Bulletin

Delivering ‘patient-centred care’ is one of the great ambitions of today’s NHS, but this important goal cannot be achieved without an effective system of patient and public engagement.

Putting patients in control of their care as much as possible has become a familiar mantra of the modern NHS. However, for patient-centred care to be a reality, patients and the public need a much stronger voice in the design of services – and in holding the NHS to account. That is why Conservatives in Parliament have been putting the spotlight on patient and public engagement.
Of course, successful engagement should not be seen as confrontation between the public and medical professionals. Patients and NHS staff often have an intuitive understanding of each other’s needs and concerns. Where patient and public engagement is most successful, doctors and nurses see patients’ groups as a partner against the regional health service management charged with implementing Patricia Hewitt’s agenda of targets, initiatives and reconfiguration – or cuts.

It is therefore little surprise that Labour has repeatedly failed to give patients the powerful mechanisms for engagement they deserve. Ministers abolished successful community health councils (or ‘CHCs’) only four years ago, replacing them with a myriad of fragmentary new bodies. The cornerstone of the new system was patients’ forums, but these were inadequately supported, which is why they did not have the best of starts – despite the hard work and dedication of members.

The Government is now pushing through legislation to abolish patients’ forums and replace them with new local involvement networks (or ‘LINks’) but these plans have spectacularly failed to engage the respect or enthusiasm of existing volunteers – a situation not helped by the legislation not having the word ‘patient’ in the title, while being tagged onto the end of the local government Bill, almost as an afterthought. Many volunteers intend to walk away from the NHS, disgusted that forums are being replaced after all the hard work committed to them. I am therefore concerned that another tier of expertise in the health service is about to be lost.
Our objections to the new proposals are numerous, ranging from the loss of expertise to the lack of independence and statutory powers. For one thing, the specialist knowledge and skills of patients’ forums attached to mental health and ambulance services risk being lost.

Secondly, for any system of engagement to be credible, it must be independent. However, I am concerned that local authorities will have an undue influence over the new arrangements. LINks will be financially accountable to the council, and yet will be expected to hold to account some of the services provided or commissioned by it. Money for these LINks will not be ring-fenced, and so is liable to be top-sliced by cash-strapped local councils – hence the conflict of interest.

Thirdly, where patients’ forums have been successful, the power to enter and inspect NHS premises has often been key. However, the Government’s Bill contains only a watered-down version of that power. The words ‘inspect’ and ‘inspection’ do not appear. I fear that, without strong powers, there will be little incentive for volunteers to serve.

The Government’s proposals also fail to create a national voice for patients, or even the capability for regional networking of LINks. Nor does the Bill give patients a direct role in the regulation of health and social care.

That is why we have already consulted on proposals for ‘HealthWatch’ – an independent, national voice for patients, which would combine the traditional investigative and representative functions of patient engagement with those of a modern, consumer-style public services watchdog.

HealthWatch would be a voice for patients on all NHS issues and would provide a mechanism through which informed public opinion can influence the regulation of healthcare. It would have the power to make visits and acquire information, and would pursue and refer individual or collective patient complaints.

HealthWatch would be a national body – a strong, independent brand – but with a local presence and significant bottom-up elements. Until the Government joins us in embracing this concept, patient and public engagement in the NHS will continue to suffer from a poverty of ambition, and patient-centred care will remain an elusive dream.

Sunday, 4 March 2007

Doctors Chaos "is worst crisis to hit NHS"

From the the Daily Telegraph

Doctors chaos 'is worst crisis to hit NHS'
By Celia Hall, Medical Editor Daily Telegraph

The chaos created by a new training system for young doctors is the "biggest crisis to hit British medicine", a leading surgeon said yesterday.Prof Gus McGrowther: 'This is the biggest crisis to hit British medicine since the start of the NHS'The new system, being investigated by the Royal College of Surgeons, has left thousands of junior doctors without jobs as trainee consultants.Their current posts will end in August and fears are growing about how hospitals will cope.The despairing and increasingly angry doctors have set the date for a London protest march and are taking legal advice about the equity of the new system. A fighting fund has been set up.On Monday all the medical royal colleges will meet to discuss the crisis.Hundreds of junior doctors, who have spent many years and thousands of pounds on training, have inundated The Daily Telegraph website to tell of their despair.
Rob Henderson, a senior house officer, said: "Hospitals run because of the goodwill of the doctors, evidently this has now been shattered and with it patient care."Sarah Cregan, wrote: "I have spent 10 years training to be a doctor and have invested not just my own time and money but that of my family's including grandparents. I feel very let down."The fury of scores of young doctors came as Prof Gus McGrowther, professor of plastic and reconstructive surgery at Manchester University, said he was profoundly concerned about the effect of the new system on patients as well as on medicine."This is the biggest crisis to hit British medicine since the start of the NHS," he said. "We are sacrificing thousands of young doctors who are partially trained and committed to a career in the NHS."We have 200 doctors who would like to be plastic surgeons and 50 jobs. Of these 150 are already very well qualified and already members of the Royal College of Surgeons."They have spent an enormous amount of money creating this new system and the whole thing is spiralling into chaos. It is quite immoral to inflict this on motivated young doctors. I cannot find a single doctor who is happy with this flawed process and ultimately it is the patients who will suffer."Bernard Ribeiro, the president of the Royal College of Surgeons, wrote to all members on Thursday listing five "fundamental difficulties" in the system.There have been 30,000 applications for 22,000 consultant training jobs under the Modernising Medical Careers scheme, accessed by the website called the Medical Training Application Service."For 18 months I have tried to get this system modified and the number of surgery places expanded," Mr Ribeiro said. "I have not succeeded. This system must be reviewed urgently."One problem is the website, which is open to the whole world. Anyone can apply. But the application forms are designed to be so unbiased that you could quite easily get an EU candidate offered an interview when a better qualified, British trained doctor is ignored."In the new structure doctors do two years of "foundation" training and then apply for consultant training to become specialist registrars. The first foundation trainees are now ready to move to the registrar stage but they are clashing with the senior house officers from the old system.There is also an unknown number of EU and overseas doctors in the mix. Mr Ribeiro said the heavily criticised application forms might be suitable for the foundation trainees but took no account of the experience and qualifications of the older SHOs."We need a different system for the SHOs as the new system is phased," he said.Problems listed by the royal college are: "woolly" questions on the application forms; concern that qualifications have not been taken into account; concern about the adequacy of training for assessors; inconsistent rating and errors in reporting the results.The fury of scores of young doctors came as Prof Gus McGrowther, professor of plastic and reconstructive surgery at Manchester University, said he was profoundly concerned about the effect of the new system on patients as well as on medicine. "This is the biggest crisis to hit medicine since the start of the NHS," he said. "They have spent an enormous amount of money creating this system and it is spiralling into chaos."A spokesman for the Department of Health said: "It would be irresponsible to halt the interview process at this late stage. We cannot know whether the wrong people were invited for interview until they are interviewed."Tony Blair's official spokesman sought to play down the crisis, saying: "The main thing is the overall number of doctors, as with nurses, has gone up."

Thursday, 25 January 2007

75% of GPs condemn Government as poor

Nearly 75% of British GPs say the Government is doing a poor or very poor job according to GP Magazines European Barometer.

Asked which Party GPs felt closest to

44% Conservative
22% Lib-Dem
17% Labour

Conservatives Take Initiative on Health

Tories to scrap NHS targets and give more freedom to doctors
Most newspapers cover the Conservative plans to scrap the complex system of targets with which Gordon Brown has attempted to micromanage the NHS. In place of centralised targets, doctors would be given their own budgets and would be rewarded for the individual health outcomes of their individual patients. The Times gives the example of breast cancer. Conservatives believe that better care would be delivered "if the NHS abandoned its target of a two-month waiting time to first treatment and concentrated on improving the five-year survival rate."
The Telegraph notes Shadow Health Secretary Andrew Lansley's view that waiting time targets are distorting clinical judgments:
"We've reached the absurd situation where waiting time targets are being turned into a minimum wait so you've got local NHS bodies telling the hospitals that they can't treat patients before, say, 20 weeks because they can't afford to pay for it and because the waiting time target says they should be seen at 20 weeks."
Recent opinion polls have suggested that the Tories are now most trusted to run the NHS - Labour's traditional number one area of policy. David Cameron put the NHS at the heart of the Tory agenda in his party conference speech - pledging to put it at the front of the queue when it comes to public spending priorities.