Pressure building over NHS plans

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24 January 2012 Last updated at 10:23 GMT By Nick Triggle Health correspondent, BBC News The health bill is working its way through Parliament Pressure is building on ministers over the NHS reforms in England after a critical report by MPs has added to the mounting concerns.

The health select committee report said the overhaul was hindering the ability of the NHS to make the savings it needs to safeguard its future.

It comes ahead of a meeting this week of medical leaders about the plans.

Health Secretary Andrew Lansley has again defended the reforms, saying they were "essential" for improving the NHS.

The report by MPs, which was leaked over the weekend, did not specifically look at the changes.

Instead, it was focused on how the health service was doing in meeting its savings target.

While the health budget is being protected, it has still been told to save £20bn by 2015 through improving productivity to keep pace with the rising demands linked to the ageing population and lifestyle factors, such as obesity.

'Disruption and distraction'

The MPs said there were strong concerns about the ability of the NHS to make the savings - the equivalent of 4% a year.

It said there had been too much emphasis so far on short-term cuts and "salami-slicing", instead of rethinking the way care is delivered.

And it argued there needed to be more integration with social care to stop people needing hospital treatment, which tends to be more expensive.

But it warned that in some ways the opposite was happening as councils were increasingly restricting access to services.

On the reforms, it concluded they were "complicating" the savings process because they were acting as a "disruption and distraction".

The committee is chaired by Conservative former health secretary Stephen Dorrell, who said every comment about the NHS tended at the moment to be framed by the debate about the bill.

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There is a growing sense that the critics of the NHS reforms are scenting blood.

Last year's pause had taken the sting out of the attacks and the bill was well on its way through Parliament when 2011 came to a close.

But there is now a feeling among those who have been expressing concerns about the changes that the momentum is again gathering behind them.

The decision last week by the midwives and nurses to move to "outright opposition" attracted attention - as has this report by MPs.

Ministers accused the unions of being motivated by the row over pensions.

But later this week a host of health bodies are meeting to discuss the reforms.

The majority of them are professional bodies that are focused on standards. So if they come out with a strong rejection of the plans it will get even more difficult for ministers.

Attention will then turn to the Lib Dems and whether their MPs will block the bill when it returns to the Commons.

There are no signs of that happening at the moment, but serious questions will start to be asked.

He said the need to achieve efficiency savings in the NHS was paramount, and that the bill must come second.

"The priority is to deliver more efficient care, in order to meet demands placed upon the system - and the implementation of the bill has to fit in around that," he said.

The findings have prompted critics to renew their attacks.

Last week the Royal College of Midwives and Royal College of Nursing said the bill underpinning the changes should be scrapped - joining the British Medical Association in moving to outright opposition.

Rachael Maskell, of the Unite union, said the report should be the "final nail in the coffin" for the bill.

And BMA chairman Dr Hamish Meldrum said the plans will prove harmful to patients.

"The health select committee say it's distracting - we would say it's completely unnecessary and somewhat dangerous.

"As the Health Select Committee say, it's taking everybody's mind off the real issues, which is trying to run an efficient health service, trying to make changes to the health service for the benefit of patients, and, at the same time, trying to identify savings."

Peter Carter, general secretary of the Royal College of Nursing, said the plans will pose a threat to patient safety and the future of the NHS itself.

"We completely concur that money has to be saved. We've never disputed that, it's the way they're going about it."

'Uncertainty'

Concerns were also expressed outside of the union movement.

Professor John Appleby, chief economist of the King's Fund think tank, said: "The report should serve as a wake-up call for ministers and the NHS about the magnitude of the task ahead."

And Mike Farrar, of the NHS Confederation, which represents NHS managers, agreed.

He said there was a lot of "uncertainty" in the NHS at the moment that was dangerous.

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The legislation's not completed its passage, the Lords are making many significant and constructive suggestions, and we will take those on-board, but the principles of the bill are widely supported”

End Quote Andrew Lansley Health Secretary "The NHS faces a once-in-a-generation financial challenge that is still to be explained properly to the public," he added.

Attention will now turn to the meeting on Thursday when the Academy of Medical Royal Colleges, an umbrella group of 20 organisations, and unions will discuss what to do about the plans.

The bill is still working its way through Parliament and at the weekend Deputy Prime Minister Nick Clegg said the planned reforms must go ahead, despite the fresh criticism from MPs.

A number of major structural changes have already taken place within the health service and senior staff have started to be recruited to head up the new organisations.

Enough GPs have also come forward to set up the new management groups to cover 97% of the country.

Mr Lansley said the government's plans for modernisation were "essential if we are to put the NHS on a sustainable footing for the future".

He told the BBC: "We have to deliver more care in the right place at the right time. That means more care in the community.

"There's been support for the principles of what we're doing, including from many of the leading professional organisations.

"The legislation's not completed its passage, the Lords are making many significant and constructive suggestions, and we will take those on-board, but the principles of the bill are widely supported."

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Fears grow over NHS plans future

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26 January 2012 Last updated at 01:23 GMT The health bill is working its way through Parliament Talks between ministers and medical leaders have taken place over concerns about changes to the NHS in England.

The Academy of Medical Royal Colleges, which represents 20 groups, held a meeting on Tuesday night to discuss their opposition to the plans.

A draft statement was drawn up which the BBC understands said the medical establishment could not support the overhaul plans in their current form.

However, it is unclear whether it will be signed off.

The view of the royal colleges, which are the professional bodies in the NHS that set standards in areas such as training, is seen as key in the current climate.

'Serious concerns'

Unions have already come out to say the overhaul should be scrapped, but ministers said this had been motivated by the row over pay and pensions.

This week an influential group of MPs said the changes were hindering the NHS as it attempts to make the savings it needs to safeguard patient care.

If the medical royal colleges toughen their stance, it could provide a devastating blow to the government's attempts to get its changes through parliament.

The bill underpinning the changes is due back in the Lords next month.

The meeting on Tuesday night was followed by a series of discussions between ministers and the colleges on Wednesday.

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Changes are needed and we want the NHS to be able to make them in the interests of patients”

End Quote Department of Health spokesman The BBC also understands some colleges are not convinced a hardening of their position is the right move. The Royal College of Surgeons has made it clear it would not sign up to the draft statement.

The academy, which in the autumn said it had serious concerns about the plans, particularly in the areas of accountability, competition and training, is now due to meet the three key health unions on Thursday night.

The academy confirmed it had had discussions about its "continuing concerns", but would not be making a statement at the moment.

But the government has indicated it was ready to push ahead with the changes regardless of what happens.

A Department of Health spokesman said: "There will always be some people who oppose changes to the status quo in the NHS.

"We have listened and we have made changes which have been widely welcomed including by professional bodies. But this process cannot go on forever. Changes are needed and we want the NHS to be able to make them in the interests of patients."

The developments came after the prime minister and Labour leader Ed Miliband clashed during Prime Minister's questions on Wednesday.

Mr Miliband said it was time for the bill should be scrapped.

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Plans to insure cosmetic surgery

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20 January 2012 Last updated at 04:04 GMT By Simon Cox BBC Radio 4's The Report PIP implants contain industrial silicone but there is no evidence they pose a health risk An insurance scheme for cosmetic surgery patients could be introduced after the PIP breast implants scandal.

Sir Bruce Keogh, who is leading the government review into PIP implants, told the BBC the scheme would protect consumers.

Although there is no clear evidence PIP implants cause harm, the NHS will remove and replace those it fitted.

But patients who were treated privately are being told by most clinics they must pay for the procedure.

About 40,000 women in Britain have implants made by the French firm Poly Implant Prothese (PIP).

The 3,000 cancer patients who had them for breast reconstruction will have their implants replaced for free by the NHS for compassionate reasons to ease the concern of patients.

But that leaves thousands of women - fitted with implants that contain industrial silicone that is not supposed to be in human bodies - with no official recourse for help.

The three leading clinics which performed breast implant operations, and which would have used the PIP products, are Transform, the Harley Medical Group and Surgicare.

All three have declined to offer free replacements for their patients despite the government saying they have a moral obligation to their customers.

An insurance scheme for future cosmetic surgery patients would offer greater protection for consumers in these scenarios.

Sir Bruce Keogh, the NHS medical director, was appointed by Health Secretary Andrew Lansley in December to lead the review into PIP implants.

Protecting consumers

He told Radio 4's The Report the scheme being considered would work much like the insurance protection scheme in place in the travel industry.

"One of the things my review will be looking at will be... something like the Abta arrangement, which means that when a company runs into trouble for whatever reason, the consumer is covered," Sir Bruce said.

The Association of British Travel Agents (Abta) offers financial protection for its members and their customers should something go wrong.

Companies pay a subscription to become members of Abta, which then provides a fund for people to fall back on should there be a problem.

Sir Bruce said this model "captured the flavour of where we want to go," but said he did not want to pre-empt the recommendations from the review.

Jim Frame, professor of aesthetic plastic surgery at Anglia Ruskin University, supports an insurance system under which the patient would pay a premium but if a problem occurred with implants years after they were put in, there would be "an all-expenses paid replacement of a ruptured implant, absolutely no hassle and we do not have to worry the NHS."

Professor Frame also supports a breast implant registry which is likely to be reintroduced to record details of all operations.

A registry did exist between 1993 and 2006.

The inquiry team will meet in two weeks' time to review the data from private clinics about the failure or rupture rate of PIP implants.

Further tests are also being conducted on the industrial silicone which was used in the implants, to determine how toxic it was.

This edition of The Report was on BBC Radio 4 on Thursday, 19 January at 20:00 GMT.

Listen to the full programme via the Radio 4 website or download the programme podcast.

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Wal-Mart's Health Plans for 2012 to Increase Premiums for Smokers

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Penalty per pay period that Wal-Mart's health insurance plans will require of employees who smoke in 2012. The cost will amount to $260 to $2,340 extra per year for those who want health coverage. According to the benefits consulting firm Mercer, several other large employers also charge higher premiums to workers who smoke; among the largest employers, about 28% adjust their premiums based on workers' tobacco use. [via The New York Times]

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Obama and Romney health plans borrowed from Nixon

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Mitt Romney, shown at a CNN debate, contends the Massachusetts health care plan differs greatly from the Obama planRomney promises to repeal Obama health care plan, yet critics find links between twoStuart Altman says both plans had their basis in Richard Nixon's health care planAll three plans built on private, employer sponsored health insuranceRomney, Obama plans don't significantly restrain costs, he saysEditor's note: Stuart Altman, Chaiken Professor of National Health Policy at Brandeis University's Heller School for Social Policy and Management, is co-author of a new book, "Power, Politics and Universal Healthcare".

Waltham, Massachusetts (CNN) -- Mitt Romney has pledged to repeal President Obama's universal health care law if he is elected president. Critics find his position rather strange, arguing that the plan he helped develop when he was governor of Massachusetts is quite similar in design to the Obama plan. Romney disputes his critics, saying there are important and fundamental differences between the plans. Who is correct?

In actuality, both plans draw extensively from legislation offered by President Nixon in January 1974. In a book just published, "Power, Politics, and Universal Health Care," David Shactman and I explain how Romney and Obama used the same approach as Nixon to lower the number of uninsured.

All three built their system on private, employer-sponsored insurance in which all but the smallest employers had to provide insurance to their workers or pay a penalty. All utilized Medicare to insure the elderly and an expanded Medicaid-type program to insure the poor. All provided subsidies to low-income individuals and small employers. The Romney and Obama plans created state-based private insurance exchanges to make insurance more accessible and affordable to small business and individuals.

President Obama has been heavily criticized by conservatives because his plan includes a mandate for all individuals to have insurance or pay a penalty. Romney, too, has joined those criticizing the president, yet his plan in Massachusetts included just such a mandate. This idea was originally proposed by conservative groups as a measure of personal responsibility and an alternative to a single-payer system advocated by many progressive organizations. Romney believes it is alright to have a state require all to have coverage but that it cannot be mandated by the federal government.

Romney contends the Massachusetts plan required no new funding, whereas the Obama law calls for nearly a trillion dollars in increased taxes and cuts in projected Medicare spending over 10 years.

What Romney doesn't say is that the Massachusetts plan is partly funded with earmarked federal dollars and partly with state funds generated by a tax increase previously enacted to pay for a universal coverage plan that was never implemented. Unfortunately for Obama, there was no larger entity to support his plan. He had to pay for his plan with new federal monies and cuts in future federal spending. Although the federal government will assume a greater proportion of health spending, total health spending in the United States is projected to increase only 2% more by 2019 under the Obama plan than it would have otherwise.

As with the Nixon proposal, neither Romney nor Obama decided to include significant measures to reduce health care costs. Although both were criticized, I believe that was a sound political decision that allowed all the major health groups to support both plans. President Clinton's health plan drew strong opposition from many stakeholders because it included a tight spending budget. Under Obama's plan, hospitals, insurers and drug companies agreed to modest cuts in future revenues or rate increases, because all expected increased revenues from the millions of newly insured Americans. Both Obama and Romney expected that constraining health costs would be necessary in future years.

A complete review of the two plans should acknowledge that the Obama plan includes many components not in the Massachusetts legislation. The most controversial are a board appointed to control Medicare spending and a requirement that insurance companies spend a minimum percentage of their revenues on direct patient care.

The plan also includes a number of provisions to reform Medicare and Medicaid, and an extensive list of new delivery system approaches to be tested with federal pilot and demonstration programs. Important as these components may be, they are not part of the basic framework of the plan.

After comparing the Romney and Obama plans, it is clear that the similarities far outweigh the differences. Romney could argue, however, that Obama didn't use the Massachusetts plan as a model but rather drew on the proposal put forth by Richard Nixon almost 40 years earlier.

Romney's plan worked for Massachusetts, reducing its uninsured rate to the lowest in the country. Although the legislation did not put a brake on rising health care costs, there is some evidence it did reduce its rate of growth compared to other parts of the country. Health insurance premiums have traditionally been higher in Massachusetts than in the rest of the United States. The gap, however, has narrowed somewhat as premium growth between 2006 and 2010 in the United States grew by an average yearly rate of 5.1% while in Massachusetts the average growth was 4.4%.

The opinions expressed in this commentary are solely those of Stuart Altman.

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Limits on supplemental Medicare plans eyed

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An elderly man walks past The National Debt Clock, which displays the current United States gross national debt and each American family's share, on a wall in midtown Manhattan, in New York July 13, 2011.

Credit: Reuters/Brendan McDermid

By Donna Smith

WASHINGTON | Mon Oct 10, 2011 1:13am EDT

WASHINGTON (Reuters) - Medicare supplemental health plans, popular among politically powerful retirees, could come under the budget knife being wielded by the special deficit-reduction panel of Congress, according to sources keeping close watch on its work.

The so-called "Medigap" insurance plans shield the elderly -- many living on fixed incomes -- from costly deductibles and other expenses not covered by the traditional fee-for-service Medicare healthcare program.

"This one is clearly on the table," said a lobbyist who has been following "super committee" deliberations on ways to trim federal budget deficits by at least $1.2 trillion over 10 years.

But super committee Democrats are unlikely to vote to saddle retirees with new out-of-pocket expenses if Republicans refuse to embrace tax increases for the wealthy.

While the elderly buy the private plans, studies suggest they boost government Medicare costs as the extra coverage for deductibles and co-pays encourages greater use of medical services. That, in turn, pushes up costs for Medicare, which has to pay for its portion of the care.

As a result, proposals to limit the plans have been included in a number of deficit reduction packages, including one proposed by President Barack Obama.

A congressional aide, who did not want to be identified, told Reuters it was one of the ideas being reviewed by the super committee.

Medigap plans are popular among people who choose not to enroll in Medicare Advantage plans, which deliver Medicare benefits through private insurers, or have no employer-backed retirement health benefits. Some Medigap plans pay nearly all the relatively high Medicare cost-sharing requirements.

The federal government already regulates Medigap plans, which are offered by insurers such as United Healthcare Insurance, a unit of UnitedHealth Group Inc, and Bankers Life and Casualty Company, a unit of CNO Financial Group Inc..

Of some 46 million people enrolled in Medicare, about 9 million have signed up for one of 10 standardized Medigap plans. A majority are enrolled in plans with little or no deductibles or cost-sharing requirements, according to the Kaiser Family Foundation.

ON THE TABLE

Budget analysts argue that getting "more skin in the game" by requiring Medicare enrollees to pay a share of costs that otherwise would be covered by Medigap plans would discourage unnecessary visits to the doctor.

In his submission to the super committee, Obama proposed a 30 percent surcharge on premiums for new Medicare beneficiaries who buy low deductible Medigap plans starting in 2017.

The non-partisan Congressional Budget Office said Obama's proposal saved an estimated $2.5 billion over 10 years. But the budget savings would grow over time as new Medicare enrollees turn to higher deductible Medigap plans to save money.

More far-reaching proposals that would affect current holders of low deductible Medigap plans would save even more -- as much as $93 billion over 10 years, according to the CBO.

The six Democrats and six Republicans on the super committee have until November 23 to develop a deficit-reduction plan. If it fails, a similar amount of across-the-board spending cuts would be automatically triggered starting in 2013. Congress will have one month to vote on any super committee deal.

DISCOURAGING NECESSARY CARE

Obama's bipartisan fiscal commission last year suggested requiring a $550 deductible on Medigap plans and limiting coverage on the next $5,000 of costs to 50 percent. CBO said such a plan would save about $53 billion over a decade.

The health insurance industry and healthcare advocates oppose moves to restrict Medigap plans. They argue that limiting coverage would not just discourage unnecessary doctor visits, it would discourage necessary care.

"My hope is that Democrats are going to be loath to make changes in something that deals with out-of-pocket expenses for seniors and I believe they will be," said Ron Pollack, executive director of Families USA.

The National Association of Insurance Commissioners wrote the super committee last month to urge the panel to avoid changes that would affect current policy holders.

"An abrupt alteration of the Medigap cost-sharing benefits for in force policies will cause a major market disruption and cause serious confusion for seniors," the group wrote.

The insurance commissioners also noted that two new types of Medigap policies, which require higher cost sharing, were introduced into the market only last year. More time is needed to gauge their effect on the Medicare program, the letter said.

(Editing by Doina Chiacu)

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