“@RuralOutBack - You know why national targets first became necessary, don't you? In the early 1990s, as part of John Major's Patient Charter initiative, because of the reforms of the 1980s and the introduction of GP Fundholders. They were necessary because healthcare was inconsistent across the NHS, there was a postcode lottery for operation waiting lists and A&E waiting times. People weren't happy with the NHS and the government of the day needed to re-gain people's confidence. But I get the impression that Lansley is 'your man' and whatever is in the bill you will take as face value, which is fair enough.”

“What is different this time is locally led Health & Wellbeing Boards with locally elected politicians on them. The local strategy will be monitored against the operating framework and locally agreed outcomes which will also drive local commissioning with local democratic accountabiity.Local integrated services delivering for the patient and not for buraecratic tick box politicians in Westminster

As opposed to a nationally led PCT structure monitored by nationally set targets, controlled by Westminster politicians which has allowed consultants to decide the number of private operations they do. The Bill puts the NHS in the hands of the local area partnerships who have more knowledge about their communities than Westminster politicians will ever have.”

“The philosphy of The Bill has been built on GP fundholding etc - and we all know how that did not work. ILets face it GPs are specialiist in what they do eg 'doctoring' and adminstration, accountancy and commissioning - why are they going to find time to do that - they only work 4 1/2 days as it is.

It also beggers belief that in Leicester they GPs have already 'done the dasterly deed' - even before the Bill has been passed and 'planned and plotted'.

It is talked about how much the PCT cost - but how much will the GPs be scimming off! Who will be overseeing what goes on, one also might ask if there is no PCT!”

“"So the Bill should allow the shift of some of this funding" - How so? Previously re-organisations of the NHS since the mid-1980s should {and I would use italics If could} have had also sorts of fantastic outcomes. They didn't. They caused a lot of disruption and focused a lot of attention onto administrative processes, rather than patients. Why would this one be any different?

The government came into office promising evolution not revolution, and this would have been a sensible approach : to take PCTs, to analyse the problems, to improve them, to get greater GP involvement. That would have been positive and achievable, instead they went for abolishing PCTs and creating a whole new layer of administration, GP Consortiums. What will this really achieve? The same decisions will still need to be made, its just that the organisation making it will be called a CCG and not a PCT.”

“I suggest that those posting need to read the Bill as I have before judging. GPs will continue to refer patients on to consultants and consultants will still be involved in commissioning. GPs will put the patients needs and wishes first and look for the best place for the treatment to be delivered with patients input. I call it the 'illness service' as only 4% of the overall NHS budget goes on public health or a 'wellness service. So 96% of the NHS budget is spent on the 'illness service' which is why I refer to it as this. So the Bill should allow the shift of some of this funding that will actually make a difference to patients and taxpayers who pay for it.”

“G.P's should be the entry system in the NHS, passing patients onto those who have expertise in specific areas, Only a few GP's are fully specialised in other areas, that is why they are general practitioners. No way should they control the NHS budget, because they will choose the cheapest option for treatment to the detriment of the patient.
G.P's are for the most part good at what they do, let them do just that.”

“graydjames One of the problems with the changes is the lack of Guidance. From a voluntary position I have some involvement in the changes and little or no advice is being given by politicians. This is one of the problems. Three different groups will run the system in Leicester so you might get different treatments in different parts of Leicester. Some of these groups in some city's have already said they will not treat smokers or people who are over weight. The government are trying to sever the legal requirement to provide a medical service so there will be no come back if you are refused treatment. Trust the nearly whole of the medical profession who are against it they know it will be a disaster. Ruraloutback I think you might need to look up the figures on NHS under Labour. Cameron and Lansley backed down last week from saying the NHS was failing under Labour when they were proved wrong in parliament. They were proved wrong about Wales also after trying to imply a labour Wales was failing.”

“From whichever end of the political spectrum you come at this issue, I find it utterly depressing and deeply troubling that there are members of our society who can seriously think of the present NHS as an "illness service".

I don't know enough about these changes to really understand what it will mean. I suspect few do, but they will adopt their own prejudices and the dogma of their own politcal viewpoint to argue for or against without any undertsanding as to why they think why they do.

I tend to the left on these issues, so my own gut reaction is to be against; but I do not pontificate on the matter because no one, including Mr Johnson, has adequately explained to me why I should be against it. Nor, I might add, has Mr Cameron or Mr Rawnsley adequately explained to me why I should be in favour. All we get is rhetoric and no substance, no real explanation of how the scheme will operate and why it is a good or a bad idea.

There are only two things I keep hearing. One is that the GP will control the budget and will become the fulcrum of the system. The other is the repeated word "competition". I know two things. One is that my GP is not well placed to know about the best way of dealing with my particular medical condition because he knows nothing about it. Only my consultnat can direct me to the best options. The second is that I can think of no one single concept more likely to destroy the fundamental concept of access to good healthcare for all than competition.

On these two bases alone, I tend to be against but if only the politicians would give some real substance to their arguments I might be able to reach a more considered view and not have to rely, like RuralOutBack plainly does, on my political prejudices.”

“@ RuralOutBack; I can see why Jon Ashworths opinion could be considered by you as typical opposition rhetoric, but you do have to wonder why almost all of the Healthcare Professional bodies publicly and openly oppose this bill - doesn't that tell us something about politicians' actual insight in the provisioning of health services?...”

“What a load of nonsense from Jon Ashworth regarding this Bill. Putting patients first as proposed in the Bill has always been denied by the Labour Party so no change there. He quotes incorrect information and by putting health in the hands of professionals along side patients and opening up competition will make the NHS a quality wellness service as opposed to the current illness service.

Jon Ashworths scaremongering is the typical socialist dogma we would expect, Ashworth learnt it well as a adviser to the previous government. It is also worth remembering that when Bevan set up the NHS is was opposed by the BMA, doctors, nurses, MPs and the Lords. Bevan did underestimate the costs as it turned out to cost more than his estimate of £110 million with an actual cost of £248 million rising to £402 million by 1951 when he resigned due to the introduction of charges. In the Bevan Bill Labour passed legislation to charge for services which continues today, in other words introduced competition the very thing Jon Ashworth opposes.”