NO LABOUR MPs have had any prior opportunity to discuss the implications of the government's sweeping reforms in the NHS, which are already being implemented, and will lift off from April I, even before Parliament's endorsement of the new Health Bill.
The new scheme will place GPs -the least accountable of any group of health professionals - in the driving seat of policy-making, with a token involvement of nurses working in primary and community services. But despite the fact that hospital staff at all levels are to be systematically excluded from any voice or involvement in the planning of services, while having to suffer cuts and changes imposed by the PCGs, the plan has been "welcomed" by public sector union UNISON -most of whose NHS members will be stuck on the outside, looking in.
The positive side is that under the new system, GP Fundholding and many of the trappings of the old Tory "internal market" system will be scrapped.
The negative side is that it will be replaced by a system of 48l "Primary Care Groups" (PCGs), which will cover all of the GPs in their locality of around 100,000 population, and increasingly take over the task of planning and commissioning the full range of health services.
GPs have been guaranteed that they can take a majority of the seats on the board of each PCG, as well as the chair, if they choose.
Also on the board will be two token "nurse" representatives. a social work manager, a health authority member, and an "independent lay member" as well as a chief executive on upwards of £40,000 a year. PCGs will have budgets as high as £60-£70 million a year.
Excluded from the new system are any elected representatives of the local community, any of the clerical and support staff who keep GP practices going, and other nonnursing professionals working in GP ("primary care") services. It is the consolidation of power in the hands of GPs - who have since 1948 steadfastly refused to be employed by the NHS and remain ALL NURSES PCGs open up yet another 2-tier system, with primary care nurses in, but hospital nurses left out "independent contractors" - which poses the greatest threat to hospital services.
Early reactions by the BMA to the new system focused on efforts to ensure that funding for GP services would be "ring-fenced", and that PCGs would not begin life in April with any cash deficits.
This means that each and every deficit and cutback will inevitably fall on the hospital sector, which Labour expects also to deliver a massive 3 percent per year "efficiency savings" After months of delays it now LONGER MATINE seems that the Millbank machine is set to force this legislation through Parliament with no serious political discussion, counting on ignorant MPs obediently trooping through the lobby. What a contrast with the storm of debate, protests and meetings which surrounded the Tory health reforms of 1989-90 which first split up the NHS into Trusts.
There will be plenty of time for UNISON leaders - and anyone else who thinks this half-baked plan should be welcomed - to count the cost of their mistakes.
By Mark Findlay and Pete Firmin The government has rightly been under pressure to increase the grant to communities where coalficids have closed resulting in increased poverty: However, they have done so at the expense of some of the poorest boroughs in London.
One of the biggest problems is that 80% of local authority income is from central government grants (the rest. being mainly Council Tax). The government has said it has no inten: tion of reintroducing local business rates which might begin to shitt this. Instead it is sticking by the Tory system of crude Standard Spending Assessments (SSAs), while making it clear that it does not trust local authorities with decision-making, and is taking as much as possible away from While Prescott (belore) tries to laugh off the problems his cuts have caused, the Breni cutbacks haze united the local population, including these young people who joined the lobby of councillors at the Town Hall on January 29.
Molly Cooper