Getting cultural change into a bill

Baroness Murphy

I’m writing this in the half hour break we’ve been given for lunch on the 5th day of committee on the Health and Social Care Bill. We’ve been discussing the role of GP Clinical Commissioning groups and then Public Health. There is broad unaniminity around the House about the objectives and very little disagreement about the aims of the policy but significant differences about the degree of latitude peers would like to give to those who will have to implement the Bill. I think there is a danger in being overly prescriptive and some matters, like a change of culture in the NHS about who can best provide a service is difficult to achieve by statute.  Social care services, housing or perhaps a voluntary agency may be better placed to provide a service in partnership with health rather than health alone and would almost certainly be more cost-effective.  Lord Warner, Lady Pitkeathley and I have been struggling to find a way to ensure that GPs commission more effectively to produce an integrated service across health and social care at least but we have not really found any way to do it yet which would make sense in legal terms in a bill. We continue to work on this outside the Chamber in the hope we can produce something acceptable at Report Stage.

11 comments for “Getting cultural change into a bill

  1. MilesJSD
    16/11/2011 at 11:53 pm

    To your middle-bit, that
    Social care services…may be better placed to provide Britain with a ‘clean-bill-of-Health’ service
    (as distinct from “illnesses” services already provided by the medical-latter (NHS),
    should be added that

    the maintenance and improvement of existing and further-potential individual Health-&-longest-term-Wellbeing, needs to be created as a sector in-its-own-right.
    Why not have a few group-studies through the original United Nations WHO Primary Health Care Declaration (Alma Ata 1978),
    even put it out to the General Public to urgently-participate-in
    and see what can be salvaged
    from what was so widely agreed then but never allowed to be implemented
    instead being altered out of recognition. wording and spirit, by being swept both under the BMA’s long-prior-entrenched ‘Primary Medical Treatment and Care’, and the same august body’s Epidemiology sub-section staff
    (but at least three of the latter did genuinely comprehend and attempt to proactivate that UN Primary Health Care spirit*, but were both short and longest-term over-ridden by the main ‘Course-Unalterable juggernaut’ of the BMA’s Illnesses- monopoly and its political and financial accomplices who had already in 1948 unfortunately entrenched the new NIS (National Illnesses Sector) under the new brighter Banner of Nationa Health Service (NHS to this day, but now increasingly “juggernautly” so) ?

    I alone could quote you many passages and potentials from that under-played document
    (a copy of which I, as Mr JSD Miles, requested from WHO Manila when I was working ‘permanently-resident’ in Australia in 1995; which was sent to my address under the title “Doctor John S.D. Miles” )

    (Wow! were they that desperately short of ‘health-on-side’ real doctors as recently as 1995 ?)

    * Fred Abbatt in foreword to “Health Care Together” by Susan Rifkin (UK) & Mary Johnston (Australia); Macmillan

  2. Gareth Howell
    17/11/2011 at 7:26 am

    What are the generally agreed objectives?

    Still;getting to grips with the wisdom of the business, or lack of it?

    I was surprised to discover during my unfortunate journey thru the bowels of the nhs, that the most important decisions were made by a former colleague of my sister-i-l, a high flying accountant.

  3. Gareth Howell
    17/11/2011 at 7:33 am
  4. Gareth Howell
    17/11/2011 at 7:48 am

    Service Level Agreement Management(SLAM)

    I hope that is not too commercial.

    • maude elwes
      18/11/2011 at 4:06 pm

      Labour was no better with the NHS than this bunch. Except maybe, they are ethically for a NHS that is free at the point of delivery and this government want to be able to privatise it wholely, as the money to be made on the stock market and in business is incalculable. It is the biggest stinking heap of compost presently on the books.

      What this government is not telling us in any way at all, is what they propose in the place of the NHS. All that closet talk of we will allow the buying of services and products from the private market is a crock of it. It tells the public nothing. And the reason is, they don’t want the electorate to know what they are hiding up their sleeve. As they know they will never be in power again for their lifetime, if ever, should they reveal their true intentions.

      So, Fred, can you find a link that tells us the real story? One that will lay out the future plans for us all?

      Is government planning a health service akin to the USA? Where we will pay monthly to an insurance company and they decide what they will pay out on, similar to my pet insurance? Is the alternative a European style health insurance which is somewhat better as they cover if you have a pre-existing condition, whereas the USA policies will not? Any other style of cover for the people the government has in mind?

      I have searched the web incessantly and can find nothing straight on any of it. Just jargon and rut speak.

  5. George
    17/11/2011 at 8:13 am
  6. MilesJSD
    17/11/2011 at 3:18 pm

    I think we need a preliminary-site for our hopefully-rising participatory-democratisation: some linked Introduction site, to ‘put us in the bigger picture & clarify smaller essential-details’.

    Such as
    where do the individual’s holistic and various health-building needs
    (as distinct from illness-treatmments)
    fit into your Role of GP…and of Public ‘Health’ ?

    Likewise “…a change of culture in the NHS about who can –
    (which unfortunately implies “already can”;
    but many might prefer to see
    ‘who could, given the necessary legislation & budgetary support)-
    provide the best service…”.
    would I be the only voice asking for a classification ‘tree’ of the many and various contrasting terms and sub-terms, under such headwords as “Culture” ?

    The NHS would have to be one-whole-sickness-cum-‘health’-sector, within which at virtually countless levels there are sub-cultures and sub-sub-cultures, some set but others transient or ‘floating’.
    A descriptive-snapshot for the mind-weary might be the African country where the prevailing and traditional Culture ‘dictates’ that a mother be held in social-derision if she has less than five children, regardless of whether her support-income and personal competence-level are sufficient or not;
    America’s ‘gun-culture’;
    Cockney language ‘plates-of-meat’;
    Socially-correct English language:
    “Got to let you go (sacking you”,and
    “Ethnic-cleansing (murderous-persecution)” are further ‘cultural’ snapshots.

  7. Gareth Howell
    18/11/2011 at 11:15 am

    Nobody seems to be interested in health and social care, even with all the necessary links to the subject problems!

    Yet there was a vast fuss a few weeks ago.

    • MilesJSD
      18/11/2011 at 9:32 pm

      We’re having to DIO, do it ourselves, Gareth.
      (See my submit above, to Lord Knight’s “Scarred youth” posting).

  8. Fred/George and so on
    27/11/2011 at 5:33 pm

    The whole point about commissioning of Pascal is exactly the same as the commissioning of my Oil boiler or a soldier in the armed forces.

    PASCAL has been in the making for at least seven years, downloading X-rays instantly to patients’ GPs for example.

    Every bit has to work on command, and it has apparently now come to that point of being commissioned.. that senior managers will be able to test every single pc on the system at any given time and know that it works properly…… otherwise bad things happen to the boiler, or the Army or….

    In the example of the army each commissioned solider has to be able to take command when necessary, but that is something else altogether with reference to an NHS.

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