Personal Health Budgets PHBs – a transition to a two tier US style Health Service?

“Personal Health Budgets” (PHBs) are being rolled out across the UK. Have these been publicly debated? Are the media paying attention??  Are WE paying attention??

The stated advantages of Personal Health Budgets are very persuasive but is this the whole story?  Are Personal Health Budgets just Health Vouchers which in the long run will be a subsidy to the wealthy and those with expensive private insurance who can pay to top up their voucher.   Will those less well off  (the majority ) have to make do with fixed cash limited budgets that do not keep up with inflation and personal health costs?  In short are these budgets too easy for governments (current or future) to manipulate? Will this lead to a two tier health service? Is this the unstated intention of the government? Anyone know the answer?

The article below[1] by Lucy Reynolds details how she thinks PHBs will lead to profit driven health care and a two tier system based on a US style insurance system.  Those who cannot afford or cannot get insurance will suffer a third rate cash limited service as PHBs fail to keep up with inflation in health care costs.

UPDATE: Since starting this topic I have had an interesting Twitter interaction and have been made aware of just how well PHBs are working for long term care in the pilot areas. There seems to be pretty convincing evidence of the success of PHBs . But I still worry that this is down to the commitment and sincerity of those who are implementing the pilots. What happens if the budgets are no longer sufficient to cover the costs?  I will have to leave the debate open, clearly PHBs are proving to be successfully implemented by sincere and committed people lets hope no one lets them down in the future.

For a positive view, take a look at:  People Hub Personal Health Budgets Network

This is all happening NOW. The government consultation finishes 26th April: 
Open consultation: Changes to direct payments for healthcare
., March 2013

Here’s another argument in favour (Zesty is an online Health Care Market so stands to gain from Personal Health Budgets): Personal health budgets to be rolled out in the UK.  Zesty 4th Dec 2012

[1] Here’s an argument against:
Personal health CARE budgets as a transition state to profit‐driven care  Lucy Reynolds Health Services Researcher London School of Hygiene and Tropical Medicine


GPs should not block personal budgets even if treatments have no evidence, says RCGP  Pulse 9 Jan 2013

DH consults on paying families management fee to administer personal health budgets  Pulse 4 March 2013

Lobbying: “The Next Big Scandal” (and its influence on NHS privatisation)

This is my latest letter to our local MP, John Glen, regarding a promise made by David Cameron concerning the “next big scandal”.


Dear Mr Glen,

Before the last election Mr Cameron promised there would be no top down reorganisation or privatisation of the NHS. He also pointed out that ‘Lobbying’ would be the next big scandal and promised to do something about it.

Three years after the last election, I note that a disturbing number of contracts in the privatisation of the NHS (part of a massive top down reorganisation) have gone to companies that have been generous donors to individual MPs, government ministers or the Conservative party in general. I also note that a disturbing number of MPs and Lords, not just Tory, stand to gain financially from the outsourcing of NHS services.  It would seem then that Mr Cameron’s prediction is about to come true. I am sure that you want to avoid this as much as ordinary ‘hard-working ‘ citizens, whose tax payments will fund this scandal.

I am therefore keen to ensure that the government fulfils its commitment to create a statutory lobbying register. If it is not legislated for in the next parliamentary session, I am sure that you will be concerned that the government may miss its chance to implement this pledge, which was in the coalition agreement.

Please can you ask the minister in charge, Chloe Smith, to seek an assurance that the legislation for it will be announced in the Queen’s Speech?

Also, if you have not yet done so, please sign EDM: 222 Register of Lobbyists.

This, on its own, will not be sufficient to prevent the scandal but will be a small first step and will indicate that the government is serious about this particular promise.

Many thanks,

Colin Lawson.

NB: Abundant evidence to substantiate the conflicts of interest, lobbying and political donations that are a part of the NHS ‘reforms’ is in the public domain but I can provide details if you so wish.

Some evidence from 2012: Special Report –  Selling the NHS: how parliament and the healthcare industry got cosy

NHS is threatened by ‘legalised corruption’ March 2012

 Unhealthy influence: The rise of the NHS Partners Network  Social Investigations, March 2013

The Chair of the committee that advises on business appointments to departing senior civil servants is a director of a company that has won a contract related to the Health and Social Care Act in which he voted in favour.  Social Investigations, April 2013

Latest on Conflicts of Interest:
CCG head awards “£70,000 contract to a firm where he is medical director.” 

BBC News – Conflicts of interest ‘rife’ among new GP commissioners

GPs need protection against conflicts of interest, say legal experts  Pulse, 4th April 2013

GP duty of candour undermined by ‘inappropriate’ gagging clauses in CCG constitutions  Pulse, 5th April 2013

And, in case anyone wasn’t paying attention:How the BBC betrayed the NHS: an exclusive report by ‘Open Democracy’ on two years of censorship and distortion

Healthcare trusts seek big increase in income from private patients, raising fears of two-tier service  Observer 6th April 2013

1,000 GPs gagged by CCGs from talking about local health services  D Telegraph 6 April 2013

More than 100 lobbying professionals still hold parliamentary passes: Senior managers at interest groups and businesses still have passes despite coalition promises to change perception of lobbying  10th April, Guardian


More evidence of the involvement of Virgin Health in our local NHS

The Joint Board for NHS Bath and North East Somerset (B&NES) and NHS Wiltshire Cluster PCT has two members who are Doctors in GP Practices that are in partnership with Virgin Care.

Dr Ian Orpen B&NES CCG Chair:  Member of Assura Minerva (part of Virgin Health – practice is a shareholder)  also GP Partner providing NHS services under PMS Contract

Dr Stephen Rowlands Medical Director NHW Wiltshire and Interim Wiltshire CCG Chair: Practice member of GP practice which is in an LLP with Assura Medical (part of Virgin Health)


For further background see: ‘Virgin Care’ partners in Wiltshire

Conflict of interest fears in NHS shakeup plans (Bureau of Investigative Journalism, June 2011)

Bed numbers at North Devon District NHS Hospital to be cut to allow focus on orthopaedics and private patients.

Not much information on this at the moment but the article below describes a memo from trust chief executive Jac Kelly, which says that “cuts to bed numbers in the Lundy Ward would allow focus on orthopaedics and private patients”.

Beds and theatre at risk as North Devon District Hospital outlines cuts (‘This is Devon’, Aug 16th 2012)

NHS Update

Its seems that, in order to meet government cuts, the NHS has so severely cutback on Nurses that it is now having to pay huge sums for agency nurses.  Clearly agency nurses cannot provide continuity of care and the cost of agency nurses is extortionate and of course represents yet another funneling of tax payers money into the hands of the private sector. In fact it seems that a major  beneficiary might be Tory donor  Lord Ashcroft.

Meanwhile, here in Salisbury, a freedom of information request has been submitted to Salisbury NHS Trust requesting further information on the supply of medical agency staff to the trust from 2009 to 2012 to including the following information: 1 Cost to the trust/authority; 2 Grade; 3 Supplier/Agency; 4 Speciality.

It will be interesting to see the result of the FOI request.

NHS pays £1,600 a day for nurses as agency use soars (D. Telegraph)

Lord Ashcroft’s Co. makes £7,000,000 supplying agency staff to the NHS as Lansley sacks 28,610 staff (Éoin Clarke)

Freedom of Information Request

NHS staff in the South West who don’t agree to pay cut face sack

As already reported here NHS staff in the South West including Salisbury Hospital face a pay cut and worsening conditions of service. This comes  as a result of the government’s enthusiasm for regional pay and the foundation of a “Pay Cartel” consisting of 19 NHS organisations across the South West.  This of course comes on top of a pay freeze and increased pension contributions.  Employers claim this will help them make the £20 billion in “savings” over four years required by the government, but coincidentally it could help to smooth the privatisation of the NHS where providers like Virgin and Serco will make their profits by driving down pay and conditions.

See here for more details: NHS staff who don’t agree to pay cut face sack

Salisbury NHS Watch

Hospital trusts’ joint talks on rising wage bill stokes fears of NHS pay cuts (Marlborough News Online)

Salisbury NHS Watch – Update

Not much to report, but the following updates may be of interest:

Virgin Care to take over children’s health services in Devon: As reported here previously, we already have fifteen GP surgeries in Wiltshire  partnered to Richard Branson’s “Virgin Care” and a GP from one of those surgeries appointed as Chairman of the new Wiltshire Clinical Commissioning Group.  So it may be of interest that Virgin Care have been named preferred bidder in a £130m deal that will see the privatisation of children’s health services in Devon.  See here for details.  It seems like Serco and Virgin have privatisation of the NHS in the South pretty well sown up.

It is important to point out that concern about companies like Serco, A4E, G4S, and Virgin Care taking over the running of our public services is not part of some left wing ideological agenda.  If the NHS were out sourcing parts of its work to small or medium sized, home grown businesses or organisations that are part of our community and have a track record of providing a quality service for a responsible and reasonable rate of remuneration then there would be no need for concern. But, in reality our services are being taken over by large national and international corporations that do not have a promising track record – they are essentially in the business of making large profits by employing members of our own community (Cameron’s hard working families) on lower pay with poorer employment conditions while providing the minimum service they can get away with.  Remember that these organisations will be signed up on confidential contracts, protected by commercial confidentiality and will not be open to Freedom of Information requests – they will be pretty much unaccountable and if things go wrong it will be the remnants of the NHS plus tax payers money that will be left with the problem. (Breast implant scandal: 3,500 private clinic patients referred to NHS)

Senior staff could be moved out of the ‘Agenda for Change’ pay framework under proposals devised by NHS Employers. Unfortunately this article is behind a pay wall but I suspect that the article will confirm what we already know – that regional pay for NHS staff (i.e. lower pay for everyone except for those who work in wealthy high pay areas) will not apply to the senior managers.  Sounds like a good way to encourage loyalty and enthusiasm from the staff or is it just a way to smooth the transition to the lower pay of Serco and Virgin Care?

Salisbury NHS Watch

Are Salisbury Hospital Staff to have their Pay Cut by 15%?

In light of the government’s move towards regional pay* in the NHS  – apparently a  euphemism for channeling cash from poorer to wealthier areas of the country, there has been an interesting development locally.

Following the revelation of the formation of NHS “Pay Cartels” in the South West, a freedom of Information request has been submitted to Salisbury NHS Foundation Trust by a J. Stewart.

Here is the main focus of the request:

“Please confirm or deny that the proposal being considered includes the possibility that Salisbury NHS Foundation Trust Staff will be dismissed and offered revised terms and conditions of employment.

Please confirm or deny that the proposal being considered includes the possibility that Salisbury NHS Foundation Trust Staff will have their pay reduced by upto 15%, and or that staff will have their annual leave entitlement reduced, and or sickness pay entitlements will be reduced, and or no longer offering staff membership of the NHS Pension scheme.

Please also confirm whether all Trust Senior Management and Board members would be included in any proposed change in Terms and Conditions.”

The Trust has 20 days from 12th June to respond.

(* interestingly regional pay will not apply to top tiers of management – there’s a surprise)


FOI Request:

RCN Response (pay cartels):

Health Unions response:

NL Group blog:

Blog Post by Eoin Clarke:

Regional pay:

Salisbury NHS Watch

Salisbury Journal –  Possible pay cuts at Hosptial

Salisbury Walk-In Health Centre in Avon Approach scored highest among local Salisbury Surgeries

Salisbury Walk-In Health Centre in Avon Approach scored highest among local Salisbury surgeries in a national survey and yet it is due to close. So what was the purpose of the survey??

NHS forced to close walk-in health centres because they are ‘too popular’ (The Bureau of Investigative Journalism, June 2011)

Letters to Salisbury Journal

This is a copy of  a letter that I wrote to The Salisbury Journal letters page (Postbag) and which appeared on Thursday 22nd March 2012.  Link

Having been the recipient of excellent healthcare from my Salisbury GP service and Salisbury District Hospital, I am compelled to write about my concern that we, the patients and taxpayers, seem to be doing little to prevent the destruction of our NHS.

According to independent and objective international comparisons, the NHS is one of the most cost effective and successful health care systems on the planet. This is despite political interference and chronic underfunding for most of its existence.

Yes, there are defects, as there are with all other systems, and we should be ashamed that we have not fought harder for these to be fixed.

But the government reforms, not mentioned in any manifesto, and with no democratic mandate, will result in an NHS run by companies who will make decisions which prioritise their shareholders’ interests and will channel huge sums of tax payers’ money into their profits and CEOs’ bonuses.

Some of these companies already have a dubious track record. Their contracts and finances are subject to confidentiality and they are immune to the Freedom of Information Act.

We cannot trust any of the political parties.

The Labour Party, when in power, introduced privatisation by stealth and the present Tory/Lib Dems want to turbocharge this and enshrine it in law to prevent any reversal. If we want to retain a National Health Service we will have to fight for it ourselves.

If we care about the NHS we need to pay attention and get involved – it will soon be too late and there will be no going back – our children and grandchildren will not forgive us if we do not fight the self-interest and ideology which threatens our NHS.


The Postbag editor clearly wanted to liven things up and so gave my letter the headline:  “Political parties cannot be trusted with our NHS”.  I do not think this fairly reflected the thrust of my letter but nevertheless it did prompt Steve Fear from the Labour party to write in response.  This is a link to his letter. I have not pasted it hear in case the Journal has the copyright.

In the following week there was a response from John Wigglesworth. Link here.

As I do not believe either of these responses addressed the focus of my original letter, I followed it up with another letter to the Journal – this was published on Thursday 19th April with another letter from Steve Fear. Here is the link to Steve’s message. I have posted my letter, in full, below (the Journal’s version was significantly edited).

Letter to Salisbury Journal Post Bag (published 19th April)

My recent letter to Postbag (21st March 2012) regarding the demise of the NHS has generated a couple of responses but both were of a party political nature.  They did not address the focus of my letter which was that the passing of the Health and Social Care Bill effectively means the end of the NHS as we have known it and that health care in the future will be subject to huge conflicts of interest with inadequate safeguards.

At the local level, a senior GP has resigned as chair of Sarum NHS Alliance Clinical Commissioning Group (CCG) due to the adverse impact on his professional and personal life and the care he felt he could provide his patients.

In case you didn’t know, CCGs are taking over from the old PCTs (Primary Care Trusts), does this mean that people are being made redundant from the PCTs, at great expense, only to be reemployed by the new CCGs?

I note that at least one experienced local GP is giving up one day a week in her surgery because of her membership of Sarum NHS Alliance. How many more GPs are being taken away from contact with their patients?

It now seems that our local Sarum NHS Alliance is going to amalgamate with the rest of Wiltshire to form a county wide CCG.  Will this be good or bad for Salisbury?

What happens if our local GPs decide that they didn’t enter medicine to become managers of multi million pound budgets and they decide to hand over the CCG to management consultants with service delivery run by Virgin Health Care or the health care equivalent of A4E?

I don’t know the answers to any of these questions.  It would be great if someone who does could write a letter to Postbag giving us an update.

The reform bill gives a legal basis for charging and providing fewer health services this could mean a large number of private beds in our hospital and, as seems likely, GPs telling their patients that they will have to pay for services currently provided free through the NHS.

Please don’t think I am making this up – check for your self, these changes are already happening in other parts of the country.  If we care about this we need to pay attention to what is happening locally and be prepared to fight for the retention of a comprehensive, integrated health care system that serves the whole community.

Colin Lawson