That’s all now folks unfortunately. We’re out of time.
Last word to Poulter. Professions respond to evidence based practice and the more that the government can do to support that has to be a step forward, he adds.
“We have also learnded that one size does not fit all. We need to incentivise the right local solutions.”
A man at the audience identifies himself as the “patient from hell” (laughs) and says he is worried that clinicians too conservative and reluctant to embrace change.
Lamb says he used to be a lawyer and “that is a very conservative profession” although he has seen in his time as a minster some very inspiring clinicians.
We need to move away from directing change, he says, adding that the truth is that all governments have been guilty of this.
“If you empower people they will do great things. If you push them then they will do it grudgingly.”
Kendall says that the main driver of change has to be what the patient wants.
“You can make change by having strong rights with things like the NHS constitution,” she adds.
A patient (Jonathan Lee) asks what the policy is in terms of improving patient choice when it comes to their GP practice outside of practice boundaries?
It’s a blanket nod of approval from the panel to trying to do that, although Kendall stresses that it is difficult.
“What political party is committed to restoring the NHS to public ownership and abolishing the Health and Social Care Act 2012?” asks a woman in the audience.
Kendall chimes in that the Labour Party are committed to repealing it.
Norman Lamb: Market was established by previous govt - not true that everything changed in 2010 #gdnhealthhustings #GuardianLive
— Guardian Healthcare (@GdnHealthcare) March 11, 2015
Poulter tells Savage that more needs to be done to reduce the amount of money spent on administration.
Kendall says the Labour Party has talked about the cost of competition. Another huge cost, which she has seen is the millions which Trusts spend on tendering and legal affairs.
“We need the right people to be making decisions and it is a great irony to me that a Conservative government claimed to be against red tape have instead put much into the hands of competition lawyers and that is not the way to run the NHS,” she adds.
Fight between Liz Kendall and @danpoulter over private spending in #NHS #gdnhealthhustings #GuardianLive
— Louise Banks (@louiseb1975) March 11, 2015
Updated
Wendy Savage has a question from the front row: “Why doesn’t anyone talk about the cost of the market?”
Too much money is spent on “nonsense” like tendering and marketing she says, challenging Liz Kendall and the Labour Party to take up this. Some laughter around the audience.
Question from the floor: “How do we make sure that in the shift to Primary Care there is sufficient recognition of community pharmacy.”
Excellent question says Poulter, who says that pharmacists are often peoples’ first point of contact for healthcare and advice.
We need to work more collaboratively to deliver services through pharmacists, combatting diabetes for example, he says.
Kendall says that this ties in with greater education and “self care.” Some pharmacists are great, she adds, though others are “conservative with a small ‘c’ ”.
Measures as simple as providing side rooms so that people can have greater privacy when they go to see their local pharmacist could even make a difference, she says.
Lamb says there is a major role for pharmacists in terms of the preventative agenda, and for employers too as it happens.
“There needs to be much more open thinking about solutions which often lie beyond the NHS.”
Turning to local pharmacy before seeing your GP? Walking past toilet rolls & groceries is the elephant in the room. #GuardianLive
— Darren Fergus (@darrenfergus) March 11, 2015
Updated
A midwife makes a plea for restructuring so that there is a greater link between the work of those in her profession and the community.
“If we talk to CCGs, the commissioners are in thrall to the big providers. We would like to work collaboratively with the Trust and be based in the community.”
“But nobody wants to do it because it would destabilise the current situation. But it is already destabilised. Midwives are leaving in their droves.”
Kendall responds by saying it’s a problem across the board and that the NHS needs to be changed so that across the services more money flows into a way so that the community is front and centre.
Updated
Tax avoidance comes up. It’s a real source of anger for many in the audience here.
Lamb tells them that we need to fundamentally change the culture of HMRC so that corporate tax avoidances becomes completely unacceptable.
PFIs rear their head momentarily.
“We would not be going down the route of those PFI contracts which embed a model of care for 30 years,” says Norman Lamb, in answer to a question from the floor.
Poulter says on the same issue: “What we are doing is working with those hospitals to see how we can mitigate the costs of some of those arrangements.”
“In future our new model is to have public ownership stake.”
Updated
In response to some of that earlier criticism from the floor about the government’s handling of the NHS, Dan Poulter says that he is very proud of the health service, which he worked in.
Even in difficult times, we have managed a £6bn real terms increase in funding, he says
“As a doctor, what matters for me is that works for patients.. and that includes if that can be provided for example by Age UK or by a different provider... What matters is what does the best thing for patients by looking after them.”
Another question: What are the chances of a bigger share of the NHS cake for NHS practise?
Poulter responds by saying that we need more money into general practise, by training new GPs and by using new technology.
Kendall says it’s not just what is happening in the NHS, adding: “Just look at what is happening with local council care budgets?”
“What I want to see is a long term deal. It doesn’t make sense to make those huge cuts in spending,” she says, adding that what is needed are long term budgets.
“I am not saying that we have a total solution for the NHS and social care. But we need to get extra funding in [she mentions the mansion tax as one option].”
Liz Kendall says long-term funding deal needed across health and social care #gdnhealthhustings #GuardianLive
— Guardian Healthcare (@GdnHealthcare) March 11, 2015
Updated
We’re hearing now from an NHS consultant, who says that Lamb and Poulter are talking about an NHS that does not exist.
“There is not efficiency... no savings. Just cuts,” he says, to applause.
“People are dying in mental health already because of the cuts.”
More applause.
There are no efficiencies just cuts. Respond to that! It's getting heated @ #GuardianLive
— Bridget (@bridgetmkiely) March 11, 2015
Lamb says he has described a system which is under enormous pressure and he believes fundamentally in the NHS.
“I don’t think it’s the same bleak picture which you describe across the NHS,” says Lamb.
“I spoke to staff working in mental health care this morning. One of them told me: ‘the care we are providing to people in our community has changed beyond recognition in the last five years’.”
Updated
Short sharp questions from the audience now.
“In the next parliament, will the cancer drugs fund still exist?” asks one man.
We are very proud of it, says Poulter. He adds that 60,000 people have been treated as a result of it and he can see a fund like that continuing to exist.
Updated
“Q. Will each party guarantee a pledge to review and revise NICE?”
That’s a pre-submitted one, which Denis reads out.
Norman Lamb says that it needs to be reviewed constantly. For Poulter it’s not a priority but all organisations need to be kept under review.
If there was concerns that NICE was not acting in a timely and expedient manner then of course that would have to be looked at.
“Yes” say Kendall, winning some applause for brevity, it appears.
Updated
We’re hearing now from a GP in the audience:
“We need a fundamental shift to think about moving training from a hospital setting into the community.” (It’s already happening in South London)
“In the future people do want their care closer to their community by people they know, and not in the traditional hospital settings. We need to rethink how primary care is delivered in the future.”
On that suggestion by Norman Lamb about using secure email to facilitate consultations of patients by GPs, here’s the view of the audience:
'Would you be happy to have a consultation with your GP by secure email?" Show of hands at #guardianlive pic.twitter.com/tXgxjjVli1
— Ben Quinn (@BenQuinn75) March 11, 2015
Dan Poulter says it is a well remunerated career but that is not everything. Like Lamb, he’s also a fan of using technology to reduce the work load of GPs.
Part of the challenge is also working with medical schools to ensure that GP placements are a part of what they do.
Updated
Liz Kendall recounts the view of a GP who asked her “Why would anyone choose to be a GP when everywhere you go you are criticised?”
Kenall compares the situation of GPs with MPs facing pressures from constituents in surgeries.
“GPs need to know that they have support,” she says, adding that long term there may be a need to revise caps on the number of people going into education and training.
Lamb sounds the bell again for the need to use technology more, citing the experience of Seattle in the US, where consultations are being carried out using secure email.
“They are working under ridiculous pressure,” he adds.
Updated
The first question from the Guardian’s Denis Campbell to the panel is “ How will you solve the retention crisis in general practise?”
Norman Lamb says that we need to encourage more people to train for general practise.
“It also requires investment. That’s the bottom line,” he says
“The system as a whole will crash in the next parliament if we refuse to confront this problem [that’s the general issue of funding rather than just the retention crisis].”
“We all need to get together and critically engage with the public.”
Dan Poulter is next. There’s a broad amount of consensus about what is needed in terms of health care for the UK, he says.
We live in country which by 2018 will have three million people with three long term conditions, he tells the audience.
Poulter says that the Tories as a party are committed to ensuring that the NHS will have the resources to do its work, but also ensure efficiency savings.
We need to deliver more care in the community and in people’s homes. This could be done by utilising technology. Ninety percent of the population have smart phones for example.
There’s also a need for more “joined-up” policies in terms of breaking down the obstacles for different health care providers working together.
Six billion pounds worth of administration costs have been saved in this parliament, he says: “That’s a big saving which is now going into front line care.”
He goes on to stress the need to make sure that we more effectively use the NHS estate.
Daniel Poulter train and support workforce to work across a range of settings #gdnhealthhustings #GuardianLive
— Brian Rock (@brianmr51) March 11, 2015
Updated
Some initial reaction and commentary on Twitter to both of those speakers
Great to hear @normanlamb single out loneliness in the elderly as key lib dem priority #GuardianLive
— Mary Hinks-Edwards (@mary_hinks) March 11, 2015
Liz Kendall - responsibility and accountability is too fragmented with plethora of bodies and groups #gdnhealthhustings #GuardianLive
— Brian Rock (@brianmr51) March 11, 2015
"Reset health and care services for the 21st century" says Liz Kendall, Q: where to start? Especially to a change fatigued NHS #GuardianLive
— Sandi (@sandish_benning) March 11, 2015
Liz Kendall is the next of the three speakers to set out their stalls. The values of the NHS are values which the British people hold very dear, she begins.
It should be available on the basis of need, not what you can afford. The values associated with it are not just the country’s needs, but Labour’s as well.
“What the NHS needs is strong leadership and I don’t think we are gettign that at the moment,” she says.
Our healthcare system is still based on the model of needs that were around in 1945 when it was created --
“Now it is old age and those long term chronic conditions. So the NHS needs to make major changes when technological advances are coming... and money is tight,” she says.
“We need to reset our health and health care services so they are fit for the 21st century.”
Over the last four or five years, she argues that the government has squandered the opportunity to do just that.
Updated
Norman Lamb is first up and starts by reminding the audience that costs are rising.
There’s a “massive challenge” for whoever is in government, he says, adding that the Liberal Democrats have committed to meeting the gap in funding (£80bn by 2020) in funding by taxes on the rich and other changes.
“There are some really really tough choices to be made,” he says, adding that it’s crucial together this year to make sure that the necessary savings are made.
He goes on to emphasis the need to incentivise prevention as well as work to change a health system which is too paternalistic.
He also singles out two challenges in particular:
- old people living along with their mental and health faculties deteriorating.
- Mental health. Investment is needed, which will generate savings.
And after a little delay, we’re ready to go...
Ready to go ... #guardianlive health hustings ..the big3 parties set out their NHS visions https://t.co/NvrJnxD4tg
— Ben Quinn (@BenQuinn75) March 11, 2015
Aside from the party policies, here’s some other light reading: NHS England’s Five Year Forward View – which is driving much new thinking in the NHS.
If you work in the health service, there’s a good chance that you’ll know it back to front already though.
Other people to follow tonight:
-
Denis Campbell, the Guardian and Observer health correspondent
-
Clare Horton, Guardian journalist specialising in social affairs, although she’ll be tweeting tonight from @gdnhealthcare
Updated
Ahead of the debate proper, here’s one primer from the point of view of Richard Vize on what the three main (for now) Westminster parties are saying about the NHS,
It’s not just what the political parties are saying on health that marks them out, but how they’re saying it, according to Richard:
Labour’s policy is laced with anti-private sector rhetoric and makes ambitious promises on everything from cancer tests to staff recruitment. The Liberal Democrats, meanwhile, have allied themselves to NHS England’s Five Year Forward View by promising to meet the £8bn funding gap it identifies, while placing its health policies in the context of wider public sector reforms and increased local control.
The Conservatives don’t want to fight on this territory at all; their interest is in closing down debate on the NHS and focusing on the economy. Health does not feature in their top six election priorities.
Updated
Folks are just arriving now to take their seats here at Central Hall, Westminster, although don’t forget that you can join in the debate on Twitter using the hashtag #guardianlive, like these people:
For #NHS future #GuardianLive debate please DON'T ignore the ELEPHANT IN THE ROOM= too much medicine harming patients http://t.co/A95UhLLFvZ
— Dr Aseem Malhotra (@DrAseemMalhotra) March 11, 2015
Tonight I'm attending #GuardianLive The Big Health Debate and live tweeting at @nha_cambpeckham - follow! #NHS #GE2015
— Sioned (@welshcake_) March 11, 2015
Updated
Hello and welcome to the Guardian’s Big Health Debate, a special hustings for one of the defining issues of this year’s UK general election campaign - the future of the NHS.
We’re around half an hour from kick-off, so to speak.
Speakers from the three largest parties will be sharing their visions for the future of the UK’s health service before voters go to the polls.
We’re live from Westminster Hall in London for a Guardian Live Members’ debate, which is supported by the Association of the British Pharmaceutical Industry (ABPI).
The event will be chaired by the Guardian’s health correspondent Denis Campbell. Guest speakers include:
- Norman Lamb MP (Liberal Democrats), Minister of state for care and support
- Liz Kendall MP (Labour), Shadow minister for care and older people
- Dr Daniel Poulter MP (Conservatives), parliamentary under secretary of state for health.
Venue: Central Hall Westminster
Timings:
7.15pm Welcome from Guardian
7.20pm Short speech from each party representative followed by structured Q&A
7.35pm Crowd sourced questions
8.15pm Q&A session with the audience
9pm Close of event for Guardian Live audience
Tonight’s event is part of the Guardian’s series of live events and debates for Guardian Members. Find out what else is coming up and how to sign up by going here.
Key themes for debate will include:
- What will the health service of the future look like? Representatives from the three main political parties share their party’s vision of the NHS in 2020.
- How should the NHS be funded? If the NHS has finite resources, how should they be spent? Is it more cost effective to outsource services?
- How can we put patients at the heart of the NHS? Does giving patients responsibility for their own health encourage them to live healthier lifestyles?
- How can different parts of the health and social care services integrate to meet patient needs?
- How can we improve access to innovative, new drugs to improve patient care?
- Patient data: who should have access, and why?
