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Thursday, 27 July, 2000, 17:45 GMT 18:45 UK
NHS shake-up: Barry Hassell answers your questions

BBC Online's John Walton asks your questions

Tony Blair's ten-year health plan for England is being described as the biggest revolution in health care since the NHS was founded half a century ago.

Patients have been promised quicker and better treatment, and senior doctors will be asked to sign new contracts encouraging them to do more work for the NHS. Hospitals judged to be performing well will receive more funds, while those doing less well will face tighter supervision.

But the Conservatives say it's an admission of failure. Shadow Health Secretary Dr Liam Fox has dismissed the plan as more spin than substance.

What did you make of the government's proposed reforms? Barry Hassell, Chief Executive of the Independent Healthcare Association, the UK's leading representative of the independent health and social care sector came in to answer your questions about Tony Blair's announcement.

 Click here to watch


Michael, UK: Do you agree, or can you see that the major problem with the NHS is the inequalities in funding? The solution is obvious, all funding should be paid out centrally, i.e. not having specific amounts allocated to local health authorities, and to do this by paying a set rate for each procedure performed.

Barry Hassell: In many respects hospitals already receive funding from central sources through their health authorities. And increasingly, and this is what will be interesting for the future, is the growth of primary care facilities - primary care groups and the soon to be on-stream primary care trusts, where of course locally GPs will have a lot more control over their budgets. Already many independent sector hospitals offer fixed price surgery, so yes that is possible.


Cathy, Ireland: Would a closer alignment of the NHS and independent healthcare groups help cure the NHS' problems?

Barry Hassell: I think the government has to be congratulated on acknowledging the contribution that the independent health and social care sector can make to the health of the UK's population. Indeed it could be said that this is a watershed in the politics and policies of the NHS.

There's long been partnerships between the private health sector and the NHS, particularly with mental health services. Over half of the medium secure mental health facilities in the UK are provided in the independent sector. What the government has done now is to throw ideology out of the window and it's now going to enable NHS trusts, primary care groups and primary care trusts to work much more closely on a local basis and access high quality services in the independent sector.


Paul, UK: The government have been in power for some time now and they have just decided to do this just before the run up to the general elections.

Barry Hassell: Within the life span of the NHS (50 years) this is the first time a government has taken a radical view of it. I think the government has been very bold in some of its announcements.

I don't think they've left it too long, but unquestionably some of the reforms they've announced today will take five, perhaps ten years to bring about. But again by working with the independent sector and by using some imagination we can work with the government to achieve some of the targets they've set themselves.


Sharon Anderson, USA: You constantly hear how shot out our health care is here in the US but, I could not help but be shocked that you consider cutting waiting lists to 3 and 6 months respectively an improvement. Here if you need surgery it is immediate money or no money. What is wrong with your health care? In my opinion it is Government control. Too much money is spent on paperwork. What do you say?

Barry Hassell: Waiting lists are unheard of in America, so I'm not surprised she's shocked by the situation. The government recognises that it is unacceptable for there to be long waiting lists and for that reason they have entered into an agreement with the independent sector to help them reduce waiting times and waiting lists.


Sanjit, Birmingham: Have private medicine and the independent healthcare sector contributed to the mess of the NHS - are consultants lured away by private medicine rather than concentrating on their NHS patients?

Barry Hassell: Ever since the NHS was formed, NHS consultants have had the right to undertake private work. I realise for most of us the sums of money that perhaps NHS consultants earn are good salaries. But one has to look at the professional and personal expectations that they have, and to look at some of their contemporaries who may be working in jobs in the City earning huge sums of money.

One of the things that consultants are doing by working in the independent sector is achieving those personal ambitions. It could be said that the independent sector is subsidising the NHS by actually paying the consultants to work in the independent sector, thus leaving them to commit the rest of their time to the NHS.


Lana, Nottingham: Are nurses better paid in the private sector and if so why would they want to work for the NHS?

Barry Hassell: There's a little bit of a myth there, the rates of pay in the independent sector generally speaking aren't very different to those in the NHS.

What is different, and certainly Christine Hancock the general secretary of the RCN in giving evidence to a general select committee a year ago when asked a similar question, said what's different is that the working conditions are better. Nurses can get on with the job they're trained to do. They can get on with nursing without bureaucracy.


Keith, Cardiff: Why is this plan only for England - do you feel the rest of the UK are getting a raw deal on health?

Barry Hassell: I think this is one of the consequences of devolution. The plan is for England only. We have certainly made approaches to Wales and Scotland seeking similar partnership arrangements, but I'm afraid they've only been very initial contacts at this stage.

I have no doubt that the independent sector could benefit the services delivered by the NHS, both health and social care services in Scotland and Wales. I'd be delighted to speak to ministers in Scotland and Wales.


Adam Weaver, Inverness: Is the government's promise for 100 extra hospitals enough?

Barry Hassell: I haven't had the benefit of seeing the details of the proposals. I think one of the questions is the definition of hospitals. I'm not sure whether the announcement has been about general hospitals, or whether we're talking about the proposal for cottage hospitals.

There's almost 300 independent acute and mental health hospitals in the country. By the announcement the government has made today there are immediately 300 extra hospitals available to the NHS, to be used today, tomorrow and in the immediate future.

Furthermore there's over 17,000 nursing residential care homes in this country already where about 40,000 places could be made available to care for extra people - elderly people who are inappropriately kept in hospital who could be looked after in much more homely environment in an independent home.


Kara, Chester, UK: The current standard of nursing care, especially for the elderly, is one nurse to eight patients. Do you know how the government is planning on re-motivating the nursing staff that still exists?

Barry Hassell: I obviously don't speak for the government, but from what I've heard this afternoon there've been some announcements about making extra crèche and other facilities available for nursing staff.

The independent sector is recognised as being good employers and having good facilities and we would certainly be very happy to talk with NHS trusts about learning from us, and following the sort of models that would perhaps help motivate nurses in the NHS.


N.M. Chandran, UK: An extra 7500 consultants and 2000 GPs means admitting more students to medical schools in the coming years?

Barry Hassell: What I hope will come out of this particular statement is a commitment by government and perhaps even the academic establishments to have a much freer approach to making places accessible to would-be medical students in the future.

We've seen too many successive governments who've actually controlled the supply of places within universities for doctors. I hope by announcing the extra number of places that we'll move away from that sort of stop-go position that we've had for many years now.


BBC News Online: Do you think the government will actually be able to deliver on its commitments?

Barry Hassell: It's very difficult in this life to guarantee anything, but I think the government has actually made some very important steps forward in recognising openly and honestly, some of the challenges facing the NHS.

Certainly in the independent sector we look to building up the relationships locally, with the primary care facilities as well as NHS trusts and health authorities to help the government achieve those targets by utilising the high quality services that are available in the independent sector.

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