"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Saturday, 18 February 2012


At Netroots today Clifford Singer posted a graphic showing the readership of newspapers who have left-leaning and right-leaning editorials. The graphic was meant to indicate that the majority of the UK media are right-wing. This lead Harry Cole to tweet "damn that free market eh?" which is a fair point because no one is forced to buy a newspaper.

After such a sensible tweet, Cole slipped back into his usual partisan mode by retweeting a less enlightening response from Frank Manning: "Hilarious: @PSbook reckon this slide shows right-wing bias in the media. Or, it could mean more people are right-wing." Well, no, it doesn't. People buy The Sun for the sports and celebrity gossip coverage not its political content. The politics comes "free" with the rest of the content. (The same can be said of the Mirror.) The bias aspect comes from the fact that we know how people vote, so we expect their views should be reflected in the political allegiance of the newspapers.

The sales of the National newspapers can be found at the National Readership Survey website. The following shows the readership of left/right/centre aligned newspapers, and the votes cast at the last election.

74% of the newspapers bought are right leaning, yet 40% of voters voted for right wing parties.

Wednesday, 15 February 2012

Response to Minister Burns

Today Health Minister Simon Burns issued ten reasons why the government needs the Health and Social Care Bill. Remember, it is a bill not an act of parliament, it has not been enacted, so it is not correct to ascribe any current changes to the NHS to this bill.

Here are my responses:

1. If we want to reduce bureaucracy and management costs, then we need legislation. 

This is a bizarre statement. If the Bill was needed to reduce management costs, then there would be no reduction in the numbers of managers. However, the government takes pride in how many managers it has sacked since the election:

March 22, 2011, Department of Health:

a reduction of 2,770 managers and senior managers in the NHS between September 2009 and September 2010 – this equates to 2,416 full time equivalent (FTE) or a 5.7 per cent reduction.
At the Conservative party conference Andrew Lansley said:

"Unlike Labour, we will make sure that every penny of our investment goes right to the patients who matter, not the huge Labour bureaucracy which we inherited," he will say. "And all that is why, since the election, we now have 1,500 more doctors and 5,000 fewer managers in the NHS."
If the Bill was needed to "reduce bureaucracy and management costs" how have the government reduced the number of managers since the election  by 5,000? Surely this should be impossible since the Bill is not yet law?

The Bill does not mention management. It cannot affect management in Foundation Trusts because they are autonomous and the government has no control at all over their management. Likewise, GP practices are "independent contractors" and the government has no control over how GPs manage their practices. The "managers" that the government does control are those in Strategic Health Authorities and Primary Care Trusts (PCTs), and the Bill abolishes these. However, the Bill also creates the NHS Commissioning Board (NHS CB) and Clinical Commissioning Groups (CCGs), and it beefs up the responsibilities of Monitor, the Office for Fair Trading and the Competition Commission of all of which will need "managers". Indeed, the Bill mandates that the Competition Commission performs a review of the competitiveness of NHS providers before 2019 and every seven years after that, and since the NHS is such a large organisation, this will require the employment of thousands of "managers".

2. If we want to give doctors and nurses significantly more power than they have now to provide care for their patients, then we have to change the law.

This conjurers up an image of a bureaucrat accompanying every doctor and nurse periodically taking the clinician aside to tell them what to do. It does not happen. Indeed, many of the managers are former clinicians - doctors and nurses - who are making managerial decisions. Minister Burns says that it would be great if doctors and nurses made managerial decisions, but what would that make them? Yes, it would make them managers! If that happened after the Bill is passed, we would find that #1 ("reduction of bureaucracy and management") will kick-in and cull these managers. Then more doctors and nurses will have to make managerial decisions and ... and before we know it, there will be no clinicians left in the NHS! #1 and #2 are proof - if ever we need it - that the Bill should not be passed!

The Bill says that the three hundred new CCGs (an additional layer of management) will be making managerial decisions, but what evidence do we have that any of the managerial decisions is made by a doctor or nurse? The Bill does not says "the only people allowed to make a managerial decision must be a practising doctor or nurse".

Further, do we need the Bill to create these CCGs? There are now 266 CCGs and yet the Bill has not been passed. The Prime Minister said in PMQs on the 25 January this year:
"The point is this: there are thousands of GPs throughout the country who are not just supporting our reforms, but actually implementing our reforms. Let me give the right hon. Gentleman just one example of a supportive GP, who happens - [interruption] I think they want to hear from this one particular GP, who hails from Doncaster. When he was the acting chairman of the Doncaster GP commissioning group, he said: "Becoming one of the first national pathfinder areas is a real boost for Doncaster." I think that what is good for Doncaster is good for the rest of the country, too."
Can the Prime Minister explain how this GP managed to create this pathfinder CCG without the Bill? Minister Burns says that it is impossible, and he would have to wait until the Bill is passed.

It is not clear if CCGs will actually carry out any commissioning. Lansley has already said that one quarter of the commissioning that PCTs carry out (primary care: GPs, dentists, opticians, pharmacists, health visitors...) will be performed centrally by the unelected super-quango, the NHS CB. Further, a leaked document from the Department of Health last year said that "The largest of CCGs, and even the NHS CB itself, will not deliver best value by doing everything in house" suggesting that a proportion of the commissioning that CCGs need to do will be outsourced. The leaked document suggests that this work will be carried out by Commissioning Support Organisations (CSOs) hosted by the centralising, super-quango, the NHS Commissioning Board. These CSOs will be staffed by ex-PCT managers, so "doctors and nurses" will not be involved.

3. Most people agree that local authorities, because they’re also in charge of schools, town planning, transport and housing, should also be in charge of public health. 

The Bill does mention about making local authorities responsible for public health, but does it need legislation?

It is interesting that Minister Burns uses the term "most people", it is more likely that most people haven't a clue what public health is.

Minister Burns says:
"But we can’t do this without changing the law. Without the Bill, we can’t transfer powers or money from the NHS to local authorities"
But you can. The spending review in October 2010 transferred £1bn a year from NHS capital funds to local authorities to boost the funding of social care. Was that transfer illegal?

4. Most people agree the health and wellbeing boards are a great idea. 

There's that "most people" again. I wonder if Minister Burns has carried out a survey (if so, can we see it pleases)? If it is merely a bold assertion, then perhaps I will be permitted to reply with my own bold assertion: most people do not want this Bill.The Health and Wellbeing boards (HWB) are beefed up versions of existing Health Scrutiny Boards, and it seems that the same people will sit on the HWBs. This is still re-inventing the wheel, even if the new wheel is a big bigger.

5. We need this to Bill prevent discrimination in favour of private health companies over the NHS – it’s the first piece of legislation to do this.

If that were the case, then the technical document that accompanies the Operating Framework 2012/13 (PHF09) would be regarded as illegal. This document has the following indicator:
Patients should have the opportunity to choose a range of providers for their first outpatient appointment, including those in the Independent sector. This indicator shows a percentage of patients who have exercised choice, since it is likely that an alternative NHS provider was also offered to them. An increasing percentage of CAB bookings being made to the IS may be indicative of more choice being offered to patients.
This indicator says that the DH insists that PCTs must increase choice and it makes the assumption that an increase in choose and book (CAB, the mechanism to choose a provider for NHS care) bookings made with independent sector (IS, ie private hospitals) indicates that patients have been given choice. Minister Burns says that the private sector must not be favoured over the NHS, yet the DH is saying that they will performance manage PCTs based on increasing the number of patients using private hospitals. Why is the Department of Health producing illegal documents?

6. Most people agree that we should give more power to patients

I may get bored of repeating this, but there is that "most people" again. Minister Burns continues: "more power to patients - that they should have more choice and be much more involved in decisions about their care". We already have choice, it is the Choose And Book system mentioned above. Further, last year the government said that from April this year £1bn of NHS services will be available through Any Qualified Providers. This announcement was made without the Bill.If the Bill is necessary to extend choice, how could the government have made this announcement?

7. The Bill puts in law for the first time a duty on the NHS and local government to tackle health inequality.

This is nonsense. The Health Act 2006, clause 24 says that PCTs have such a responsibility.

8. The Bill places a duty on key organisations to integrate health and social care services.

No it doesn't. This is yet another bold assertion from Minister Burns.You can only truly integrate health and social care if you integrate the budgets and the provision. The Bill does not do this.

9. Currently, patients do not have a very strong voice in the system. 

Minister Burns says that HealthWatch will provide "a hotline to the Care Quality Commission and the NHS Commissioning Board". Well I can trump that. Through your MP you have a hotline to the Secretary of State for Health (Minister Burns' boss), but the Bill is abolishing this route.

10. The Bill changes the current arbitrary private patient cap that stifles the development of groundbreaking new treatments by the likes of Great Ormond Street and the Royal Marsden that NHS patients will benefit from.

This is nonsense. Great Ormond Street is not a Foundation Trust and so it is not covered by the current private patient cap. But more concerning is the naive belief from Minister Burns that the leprechaun gold of private patients will pay for "innovations". In fact, private patients, because they are paying, will insist that they have the treatments that have already been tried out on thousands of NHS patients and proven to be effective. What private patient will use their own money to pay for being a guinea pig? It does not make sense. Indeed, nothing Minister Burns makes sense. It is more likely that private patients will be paying for treatments developed using public funds (which is right: they have already paid their taxes, and are entitled to innovations funded by the NHS).

11. We need to pass the Bill because otherwise we will be seen to have wasted hours of Parliamentary time on a Bill no one wants

The "saving face" argument. OK so I added this one, but basically it is the only reason the government has to pass the bill: if they don't they will lose face. I agree with this one, it is the only reason for passing the Bill.

Tuesday, 14 February 2012

Zombie NHS Trust

Hinchingbrooke Health Care NHS Trust (note the name) is a franchise. The franchisee is Circle. It is clear that the arrangement at Hinchingbrooke is not privatisation because Circle is not purchasing the trust.

Subway is a franchised company, managers invest into, and run the branch on behalf of the corporation. To the customer, it appears they are buying from a well-known global chain, it looks like they are actually buying from Subway, with the same menu and the same global standards. The actual branch is owned and run by the local manager (who also pays an initial franchising fee of $15,000 and 12.5% of gross sales every week to the corporation). Franchising puts the financial risk on the local manager, who effectively buys a chunk of the reputation of the corporation. The customer is reassured by the global reputation and it is this that the franchisee purchases.

In the case of Hinchingbrooke the franchise arrangement is turned on its head. The franchisee is Circle, who are taking over the running of an NHS Trust. The trust is still owned by the NHS so one could say that Circle are buying part of this "brand". But it is important to note that - unlike Subway franchisees who own their shops - Circle does not have the financial risk of investing in the ownership of a hospital. Normally the franchisee buys the reputation of the organisation, and while Hinchingbrooke will still be branded as an NHS Trust, the intention of the government is for the public to think it is a Circle hospital. This is franchising back-to-front.

Clause 178 of the Health and Social Care Bill abolishes NHS Trusts. But, you say, Hinchingbrooke is an NHS Trust, so what will happen there? Clause 178 (3) covers this:

178 (3) Where arrangements ("franchise arrangements") under which a person exercises (or is to exercise) the main functions of an NHS trust on behalf of the trust are in force immediately before the commencement of this section, the trust is to continue after that commencement to be constituted as an NHS trust until--
(a) it is dissolved or becomes, merges with or is acquired by an NHS foundation trust,
(b) where none of those events occurs before the end of the period of three years beginning with the day on which the franchise arrangements come to an end, the end of that period, or
(c) where other franchise arrangements come into force before the end of that period, the end of the period of three years beginning with the day on which those other franchise arrangements or any subsequent franchise arrangements come to an end. 
This says that since Hinchingbrooke has been franchised before the Bill, it will remain an NHS Trust while the franchise arrangement is in force (or 178(3)(c), the franchise is renewed). Joe Farrington-Douglas points me to the following parliamentary question:

Andrew Gwynne (Denton and Reddish, Labour)

To ask the Secretary of State for Health whether the NHS Trust for Hinchingbrooke Hospital plans to pursue its application for Foundation Trust status; what the timetable is for any conversion to Foundation Trust status; whether there will be any differences in the process followed; and what consultation he has had with Monitor on this issue.

Simon Burns (Minister of State (Health), Health; Chelmsford, Conservative)

Hinchingbrooke Hospital NHS Trust is expected to become, or become part of, a national health service foundation trust. There is currently no agreed timetable for this, which will be determined ahead of the end of the franchise contract when it is anticipated the trust will be ready to move forward to foundation trust status.

All future applicants for foundation trust status will follow the current process to apply to Monitor. There will be no lowering of the standards required to achieve foundation trust status. Through regular meetings with Monitor, (the statutory name of which is the Independent Regulator of NHS Foundation Trusts), the Department is assured that Monitor is aware of the trust's current position.
So Hinchingbrooke is intended to become an FT at the end of the franchise. The franchise is for ten years, so Hinchingbrooke Health Care will be an NHS Trust until 2022. However, clause 178 (1) and (2) say this:

178 Abolition of NHS trusts in England
(1) The NHS trusts established under section 25 of the National Health Service Act 2006 are abolished.
(2) Chapter 3 of Part 2 of that Act (NHS trusts) is repealed. 
So Hinchingbrooke Health Care will be an NHS Trust for ten years but this says that the concept of NHS Trust will have been abolished! To accommodate this 178 (5) effectively says, "the laws abolished in sections (1) and (2) continue to apply to NHS Trusts that have been franchised". Since 178 (3)(c) says that the trust can be re-franchised, Hinchingbrooke Health Care can be an NHS Trust forever.

Hinchingbrooke Health Care will be a zombie trust living a state that does not exist.

Sunday, 12 February 2012

FTN Letter

Last week there was a letter in the times signed by managers from NHS organisations supporting the change to the Private Patient Income Cap. (Note: it is not a 49% cap, the Bill says that income from NHS patients must be more than the private income. So that is a cap of 50% minus one penny.) I have analysed the list of names and the organisations (data here).

There are 57 signatories from 53 organisations. Out of these there are four nursing directors, one Chair, 51 Medical Directors, one (nursing) director from a private patient unit and one Business Unit Director.

Looking now at the organisations. Nine are NHS Trusts (ie they are not yet FTs); eight are teaching trusts (in total, there are 26 in England); nine are specialist trusts (there are 20 in England); ten are mental health trusts (one of which is a NHS Trust); two are community services providers; one is an ambulance trust; and the rest, 19, are FT acute hospital trusts of varying sizes.

The trusts who are most likely to benefit from a raised PPI cap are the specialist and teaching hospitals, and 40% of the English teaching and specialist hospitals are in the list. These types of trusts have the largest PPI, these are all represented in the list of signatories.

Mental health provision has been widely privatised over the last couple of decades with many private and voluntary providers now being paid by the NHS, as well as the many providers carrying out solely private work. The FT Mental Health Trusts on the list all had zero private patient income in 2003, but currently have a 1.5% PPI cap (the Health Act 2009 said that for a Mental Health Trust the PPI cap would be a minimum of 1.5%). If I wanted to be cynical I would say that these trusts have looked to the opposition - the private mental health providers - and decided that they want to get part of that business.

The glaring omission from this list, considering Cameron's promise of a "bare knuckle fight", are District General Hospitals; yet these are the trusts who are most likely to suffer from the cuts to the national tariff (1.5% cut in April 2011, "at least" 1.5% in April 2012). Indeed, whenever a Coalition MP is challenged over the PPI cap they never say that they want a big teaching hospital to "benefit" from more private income, instead they always say that they want their local DGH to "benefit". However, DGHs are unlikely to "benefit" because private patients are more likely to go to a big teaching or specialist hospital than a DGH, and this explains why few DGH managers have signed the letter: it simply does not concern them.

One final point. FT Governors are reminded frequently by their trusts not to associate the name of the trust with any political action they take. After all, an FT is a community, public benefit corporation and a governor's opinions are not that of the FT, they are of the individual governor. (I am an FT governor, and whatever I write here is my own opinion, and not the opinion of the governing board, nor the FT.) Have the signatories asked their governing bodies? If not, then I think the governors should censure them. After all, if governors as supposed to keep their political campaigning and their FT duties separate, so too should board directors, and this letter was definitely intended to be a political letter.

Friday, 10 February 2012

Re-politicising the NHS

Various commentators have pointed out how the NHS has re-toxified the Tory brand, and put the blame for this squarely on Andrew Lansley. In fact Lansley has done something worse - he has re-politicised the NHS.

One of the most significant achievements of New Labour was the creation of the National Institute for Health and Clinical Excellence (NICE). The fag-end of the Major government was dogged by postcode lottery scandals, and it was so long ago that people seem to forget what a huge scandal it was. At that time it seemed that a day didn't pass without something in the Press about someone complaining that they could not get treatment in their area that was available in another area. Where you lived determined the level of care you go. This was simply unfair. The postcode lottery dragged in politicians who, frankly, hadn't a clue about how the issue rose and just wanted it to go away.

NICE solved that issue, and it did so in a way that pleased everyone. First, clinicians were pleased because NICE is evidence based and all its decisions are backed up by peer-reviewed research. Second, patients were pleased because NICE is authoritative, and its decisions carry a lot of weight. This meant that a patient in one area could demand that they received a NICE approved treatment. If there were any rationing through a NICE decision the public were happy because it would apply to everyone and this satisfied the British sense of fair play. Third, politicians were happy because they were no longer held to account for complicated decisions over which they had no control. Of course, there are still some people who complain about NICE decisions, and there are always anomalies, but in general, NICE neutralised and de-politicised the postcode lottery.

Then we had Richard Taylor. This retired physician upset the political apple cart by standing for election on an NHS issue (he was against the re-configuration at his local NHS hospital at Kidderminster) and winning against the a government MP (largely because the Liberal Democrats decided, two elections in a row, not to field a candidate). The election of Taylor made politicians realise that it wasn't just national NHS policy that could affect their party's vote, but a local NHS decision, over which they had no control, could seriously threaten their own chance of re-election. The politics of this: local issues over which an MP has no control, was very similar to the postcode lottery that New Labour had neutralised.

During the New Labour times of plenty cases like Kidderminster were few, but the threat was always there. Lansley realised that if there was a Conservative government, and they enacted his plans for the NHS, there would be lots of Kidderminsters created; he feared the effect that this would have on Conservative MPs. Lansley had to create a NICE for all of the NHS. This was the reason behind the creation of the NHS Commissioning Board and it was the reason behind the abrogation of the Secretary of State duties (clause 1) and pushing these duties onto CCGs (clause 4). Both the NHSCB and the CCGs are unelected and unaccountable. Lansley calculated that in exchange for removing the so-called political micro-managing (which actually existed for patients benefits, but clinicians disliked) and removing managers and making clinical groups responsible for configurations, he thought that he could de-politicise the entire NHS.

Just as New Labour had neutralised the postcode lottery through NICE (Taylor notwithstanding) Lansley thought he could neutralise NHS reconfigurations through GP consortia (CCGs) and the NHSCB.

The problem is, rather than de-politicing the NHS Lansley has manage to re-politicise it. The overwhelming opposition of bodies like the RCGP or FPH is not due to a handful of troublemakers, the usual suspects. This opposition is from clinicians who until recently were largely apolitical. The Bill, Lansley's heavy handed implementation and Cameron's downright lies about NHS outcomes have persuaded many numbers of clinicians - doctors, nurses and other clinical staff - into active opposition. This is bad for the Conservatives because at the next election these clinicians won't forget how a Conservative-Liberal Democrat government had duped and bullied them.

Of course, it will also mean that an incoming Labour government will have to tread carefully because there is now a phalanx of clinicians ready to scrutinise their policies. I think that this will be a good thing because it will mean that Labour will have to create a much better health policy.

In a short space of time, rather than de-politicising the NHS, Lansley has managed to re-politicise it. This will have repercussions whose effects will be felt for many years.

Thursday, 9 February 2012

Would you invest in Circle?

The pro-market "reformers" use one simple argument that using private providers will "improve" the NHS: they say that the profit motive drives innovation and innovation makes the service better. (I have no problem with the idea that innovation will make the service better, but I object to the idea that the profit motive is the only way to drive innovation.)

So let's have a look at what the market - investors, the very people who predict the profitability of a business and use this to decide whether to invest - think about Circle. The following is the graph of the share price of Circle Holdings over the last 6 months. (Graph is from Interactive Investor.) There are two things to point out. First, Circle was floated on AIM last summer; second the jump in November was when it was finally declared that Circle would take over Hinchingbrooke (before then it was the "preferred provider" and there was six months of negotiation about what would be in the contract).

The graph shows that initially the market thought that the Hinchingbrooke deal was a good idea, but since then, there has been a consistent decline so that now the share price is at the same level it was before the Hinchingbrooke contract was signed. In other words, the market say that Hinchingbrooke will not make Circle a lot of money. It will be interesting to see how the price changes over the next six months as more details come out about how difficult it will be for Circle to run the hospital. Bear this in mind. Circle has nailed its colours to the mast on Hinchingbrooke. Its other ventures are small scale compared to this. If Hinchingbrooke turns out to be vastly more difficult to run than Parsa thinks (as is inevitably the case) the Circle share price will plummet.

Monday, 6 February 2012

Comments from a "staunch conservative doctor"

The following is a comment on Conservative Home by someone whosays he is a "staunch conservative doctor", TrueBlueDoc:
"There are also specific pathways that are a complete mess - take a look at sexual health. Chlamydia testing will be done by the local authorities. Contraception provided by GPs will be commissioned by the national commissioning board through its primary care commissioning department. Long acting contraception commissioned by the clinical commissioning groups. HIV care and we are back into the National Commissioning Board again, but this time a different department, the Specialised Department. What a mess. With the PCT, the buck stopped with the Accountable Officer and Chief Financial Officer. Ok they were often insufficiently accountable, but at least you could argue that as commissioners of the whole lot their necks were the ones that should be chopped."
If this is a common point of view amongst Conservative doctors then the Bill is dead.

Saturday, 4 February 2012

Why Patients Are Not Objecting To The Health Bill

There is a some bemusement from clinicians as to why the public - patients - are not objecting to the health bill. As a patient with a long term condition, I will explain why.

NHS patients treat the NHS like mains-supplied water. When you need it, it is there. Turn the tap on, and the water flows. Go to your doctor and get treated. You don't have to think how either is provided. You don't think about how it is funded. (Even people on metered water don't think: flushing this toilet will cost me 1p.) You know it is there and you use it when you need it.

And that is exactly how it should be.

But it will change under the Health and Social Care Bill.

The problem is that when fundamental changes are suggested, like with the Bill, patients do not understand the issues, because they should not need to understand the issues, they just want to be assured that when they go to their doctor they will get treated. And this vital, and deeply held belief that the NHS is always there for them, is too ingrained for patients to ever countenance that it may be at risk. Yet it is.

If a politician issues a platitude like "no decision about me, without me" patients will take that as reassurance. The deeply held view that the NHS will always be there for them means that patients do not demand from the politician that there is a guarantee that all the care they need will be provided. And they should do, because the whole point of the Bill is to remove that guarantee.

Sir David Nicholson's announcement that CCGs will be allowed to provide only the services that they want to provide and not what their patients need, should have resulted in an outcry from patients. Yet there was none.

Lansley's weak and ineffectual attempt to get private clinics to act responsibly and remove the substandard PIP implants that they had used should have been a warning to patients that the same will happen when unaccountable private providers are introduced to the NHS. Yet there was no outcry from patients.

Patients assume that the NHS will always provide for them. They cannot believe that the politicians they have elected could possibly bring in a system that will remove their access to some treatments. Similarly, you could never believe that you'll be in the situation that when you turn on the tap there's a chance that nothing will come out. We assume the tap will always provide water and we assume the NHS will always provide care.

Patients believe that the NHS will always be there for them: and that is how it should be. This deeply held belief is the reason why patients are not objecting to a Bill that will result in an NHS that is no longer there for them.

Friday, 3 February 2012

Family Doctor Association

The latest group to give their support for the Bill are the Family Doctor Association. Their website says:
"The Family Doctor Association unites over 1000 UK GP practices that offer their patients continuity of care and the opportunity to see their own GP."
The FDA says that they represent GP practices in the UK. There are 10,112 GP practices in the UK so they suggest that they represent 9.8% of GP practices. Their website list three levels of membership, depending on practice size: £150, £200 or £250. They are a registered educational charity (299871) and their accounts for 2011 show that their income from subscriptions were £109,762.

So that means they had between 439 and 731 members. Hardly over 1000.

Thursday, 2 February 2012

Bill Amendments

Last night I read through all the government's amendments: not the most thrilling evening I've ever had. I don't think there is much that is contentious in there other than what is missing (ie there's no amendment to get rid of the autonomy clause and none to make the Secretary of State responsible). It did highlight to me that I know nothing about the NHS Information Register and so over the next few days I'll try and find out what it is.

Rather more interesting are the non-government amendments and the following three in particular.

Clause 1

Page 2, line 12, at end insert—
"(4) The provision of the health service is a service of general economic interest within the meaning of Article 106 of the Treaty of the Functioning of European Union."

Clause 78

Leave out Clause 78

Clause 98

Page 109, line 32, at end insert—
"( ) requiring the licence holder to hold indemnity, for the services provided, which will remain valid for the lifetime of patients treated,"

I am assuming that the amendment to clause 1 is to try and prevent the NHS being subject to EU competition law (or is it? my reading of the Article seems to suggest the opposite, but I'm no lawyer). Surely you cannot simply legislate to say that you are exempt? Whether the NHS is subject to EU competition law surely depends on the behaviour of the NHS? If you don't want it subject to EU competition law then you should not introduce a market.

Clause 78 is one I've not read before and it basically says that the Competition Commission must review how competitive NHS providers are. Of course, if they find that a provider is not competitive (eg it is the only hospital in an area) then presumably the Competition Commission can say that there has to be competing providers and maybe break up a hospital trust so that parts compete with each other. Be very scared of this clause because it could cause huge upheavals for years. The Lib Dem peers are right to want to get rid of this damaging clause.

The final amendment of the three (from the crossbench peer, Baroness Finlay) suggests that NHS services should exist as long as the lifetime of patients, and to ensure this, "licence holders" (ie providers) must provide an indemnity (presumably a bond) that will fund the service if the provider goes out of business. Private providers will not like this, and I am sure the government won't either, but it very clearly says that the most important thing is the patient, not the provider.

Wednesday, 1 February 2012

Frequency Analysis of Amendments

The following is the frequency of amendments plotted against clause index (ie the number of amendments tabled so far for each of the 305 clauses). It lists the amendments tabled for the Report stage in the Lords, and lists the non-government amendments.

Clearly clause 1 and 4 are important and hence several amendments have been applied. The two big peaks are clauses 22 and 25.

The interesting thing is that the amendments are clustered towards the low end. Why? Well you start reading a document from page 1 and read forward. When the document is complicated, convoluted and obfuscating you are likely to give up after a while.

Of course there are only 41 amendments in total and hence not enough to make any real conclusion. But if I were the government I would sneak in something really contentious after clause 250. The likelihood of anyone getting that far is small!


I have now plotted the frequency of the government amendments.

The red lines are the government amendments. The cluster at about 250 are changes to the information register. Hah! I bet you hadn't read those clauses when the Bill was first published, did you? Clear the government didn't either, since they've now got to fix them.