Tuesday, 15 March 2011

It is 19 years since the British Medical Association last thought it necessary to call a crisis meeting of its members in response to upheaval in the NHS. On that occasion, 26 March 1992, representatives of doctors across Britain debated John Major's attempt to reform the NHS by separating the purchasers of healthcare from the providers. On Tuesday a special representative meeting will take place again – this time to consider its position in relation to Andrew Lansley's plan to take the internal market of that era several stages further and prepare the NHS for privatisation.

Lansley has a problem; few of the BMA's 140,000 members believe his plans are sensible or will deliver what he claims. The British Medical Journal has dubbed the reforms "Dr Lansley's Monster", the National Audit Office has warned that the quality of service offered by GPs could drop, and the King's Fund has pointed out the government runs the risk of replacing the bureaucracy of performance management with the red tape of economic regulation.

This mother of all reforms plans to further extend the healthcare market within the health service in England, fronted by GPs, herded en masse into commissioning consortiums. They will be given £80bn of public funds to buy healthcare from a system of competing providers under an "any willing provider" policy that will see private hospitals able to provide NHS care.

For professionals delivering care, the commercialisation of the health service will lead to a situation where clinical decision-making is increasingly influenced by financial considerations leading to the erosion of the social contract between doctors and patients. This is an affront to the public service ethos that glues the NHS together. The traditional role of doctors as the true advocates of patients will soon become history, just as it has in the US.

But the BMA has its own problem: many of its members believe its policy of "critical engagement" with the government over the NHS reform white paper that became the current health and social care bill has failed, and that it has to be more direct. Despite having more than 30,000 GPs in its ranks – the supposed winners from the shakeup – the BMA has been criticising the bill in increasingly strident tones. But the meeting will hear impassioned pleas for "critical engagement" to be replaced with outright opposition to the entire bill.

The BMA must grasp the nettle and unmask Lansley's reform agenda for what it is – the final step in the privatisation of the service. No amendments are going to turn this sow's ear into a silk purse, and the special representatives' meeting needs to vote in favour of rejecting the bill in its entirety. This would send out the strongest possible message that the grassroots of the medical profession have understood and rejected Lansley's ideologically driven plans.

The meeting should also recognise that a continuous evolution of the NHS is needed, with greater provider responsiveness and accountability. However, a high quality and efficient NHS will never be achieved using the market forces of "creative destruction". It is time to reject the market ideology that has plagued the NHS for more than 30 years and wasted billions of pounds, and move forward with a publicly funded, publicly provided, publicly accountable healthcare system based on co-operation, collaboration and the social contract between doctors and patients.

Tomorrow's meeting will be passionate and argumentative. There is a huge issue at stake: how doctors should respond to, and hopefully extinguish, plans that have little logic, support or justification. The BMA has world-class leaders. But at times such as these, when the core of the NHS is at risk, they can no longer simply wait and watch.

Tuesday, 8 March 2011

Government eyes reform of basic state pension

The basic state pension needs radical reform and cannot be immune from the Coalition Government's welfare shake-up, Iain Duncan Smith will declare today. The Work and Pensions Secretary wants to scrap the pension credit top-up scheme introduced by Labour for over-60s on low incomes and instead give people more incentive to save. The move could be signalled in the Budget on 23 March.

By simplifying the system and cutting administrative costs, Mr Duncan Smith believes the basic state pension – currently £97.65 a week for a single pensioner and £156.15 a week for a couple – could be raised to a flat-rate pension worth around £140 a week for all pensioners. This would benefit women and carers, who are disadvantaged by the current system because many do not clock up enough national insurance contributions (NICs) to qualify for the full state pension. The new "single tier" pension would be based on residency rather than NICs.

Critics may argue that people who cannot afford to save while they are of working age could be worse off and that the proposal would help better-off pensioners. Any reform potentially carries high risks because there is a high turnout among the 10.5 million pensioners at general elections. But Mr Duncan Smith is confident he can sell the proposed change as fairer and more generous than the present system.

He intends to sweep away means-tested state handouts which, he argues, penalise people who save while working. At present, the £6bn-a-year pension credit guarantees a minimum weekly income of £132.60 for a single person and £202.40 for a couple.

In a speech to the Age UK charity in London today, the Work and Pensions Secretary will say his plans mirror his proposal for a universal benefit for people of working age. "We have to send out a clear message across both the welfare and pension systems – you will be better off in work than on benefits, and you will be better off in retirement if you save," he will say.

Mr Duncan Smith's approach is backed by Steve Webb, the Liberal Democrat minister for Pensions. They are believed to have made progress in their negotiations with the Treasury, which was initially wary. However, such a fundamental reform would have to be phased in over several years.

Monday, 7 March 2011

London Mayor Refuses To Meet With Wise Owls To Discuss Shocking Age Audit Findings

The Mayor of London, Boris Johnson, has refused to meet with Wise Owls to discuss the findings of our recent Age Audit and our wider Age Equality Impact Assessment Campaign.

The Audit, which used FOI data to examine employment opportunities and redundacy rates of older people within London Borough councils, found that over 50s are 3 times more likely to be fired than their younger counterparts. In addition, over 50s made up as little as 18% of new recruits.

Despite these shocking findings, our request to meet with the Mayor has been turned down.

For more information on our Age Equality Impact Assessment Campaign and the findings of the Audit, click here

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