Is there a future for the NHS? Live Debate

http://www.theguardian.com/society/live/2015/jan/20/is-there-a-future-for-the-nhs-live-debate

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8.57pm GMT20:57

And that’s all folks. We’re out of time unfortunately.

We’ll be putting highlights on the Guardian’s Membership site and the full event is now live on our YouTube channel.

Updated at 3.18pm GMT

8.53pm GMT20:53

In answer to a question about ‘redundant land’ Norman Lamb says that he would “sell it all off” in the morning and embark on a complete digitalisation of the NHS.

It’s a scandal surely that in this day and age we still have faxes still flying around the NHS when our lives have changed so dramatically in other sectors.

He earned some applause for that one.

8.50pm GMT20:50

In response to the student midwife, Bruce Keogh says that there will be a maternity review. He says that there have been concerns, for example, that there has been a higher still birth rate in this country than in other parts of Europe.

He adds that there are also concerns that the service is not provided close to home.

Norman Lamb says he is very keen on a “midwife-led” service and, most importantly, providing choice for the woman herself.

8.46pm GMT20:46

A student midwife is speaking from the audience. It’s the only place in healthcare where more than two lives are at risk at any one point, she adds, saying that this surely must be prioritised.

8.42pm GMT20:42

Julia Manning says that after the next election, even more power is going to be devolved to local councils and there will be even more opportunities for the electorate to get involved in decision making. She adds (to some murmurs from the audience):

It’ll be down to you to get involved in how we provide healthcare

Increasingly, she says that we have been seeing post code lotteries on changes to the NHS without any public engagement, and this must change.

Updated at 8.48pm GMT

8.39pm GMT20:39

Norman Lamb says he is not in favour of a “rush” towards privatisation at all.

However, he does find some merit in changing governance structures.

He adds that the mere fact of having a stake in the way that an organisation tends, on the basis of evidence have a role to play in improving productivity.

Lamb is asked (Yes or no?) if the NHS would be better or worse if Andrew Lansley’s NHS bill got through the House of Commons.

There are some jeers when he says that arguments on both sides were exaggerated.

The agenda that I am pursuing, I feel honestly, I’m very proud of, he tells the audience.

Here’s a cheeky little tweet from one audience member meanwhile:

Think many in the audience might think it an irony Norman Lamb sat under these words this evening #GuardianLiveNHS pic.twitter.com/KCehtbKeGm

Updated at 8.44pm GMT

8.36pm GMT20:36

We’re taking an audience vote now on the question:

To improve the NHS, does it need more or less privatisation?

We’ve got the following result using an app which members of the audience have downloaded:

87.8 No

12.2 Yes

* apologies for the delay in updates there. It’s due to some sudden wifi problems.

We also took that vote in the old fashioned way (the result was the same):

Show of hands at #guardianivenhs More or less privatisation ? (Overwhelmingly no) pic.twitter.com/mvHJScjCpX

Updated at 8.54pm GMT

8.18pm GMT20:18

A question is asked from the audience by a man who wants to know if the NHS is “dead” in England.

Bruce Keogh says he “simply disagrees”. The debate we are having tonight is about recognising that there are significant financial challenges at the same time as increased demand.

“It is not broken but we can’t ignore the pressures that we are under at the moment, but secondly I would say that it’s worth fighting for,” he adds.

Mark Porter says we need to ask “what do we want to keep and what do we want to take forward?” in the context of also remembering what was the original 1945 vision for the NHS.

Local government services have been disjointed from the NHS for example.

Updated at 9.06pm GMT

8.09pm GMT20:09

Julia Manning says that she was 22 when she was told that she was mentally ill. She went home and sobbed and sobbed in the bath, she says, adding that the impact of mental illness on physical health is something which was neglected for too long.

She says that there will be some research soon from her think tank, a report highlighting how medicines for mental health is ‘disincentived’.

Julia Manning harmful to separate physical and mental illness. #GuardianLiveNHS

Norman Lamb says there is a “fantastic opportunity” to achieve proper equality in terms of provision for mental and physical health.

“We have made a breakthrough about the public discourse for mental health but the last taboo really is about suicide,” he adds.

Stop dividing mental & physical illness says Julia Manning. Avoid stigma. @BruceKeogh lists range of plans for MH protocols #GuardianLiveNHS

Updated at 8.12pm GMT

8.04pm GMT20:04

Mark Porter says he is absolutely with Rodrigues, but what needs to actually happen is an effort to combat “centuries of neglect”.

It’s not just mental services which are being cut however. Other areas are suffering too, he adds.

Bruce Keogh says the science is now showing a much greater link between physical and mental health. He pays credit to Norman Lamb, who he says is “on our back” the whole time asking ‘what are you doing for mental health?’

He says: “we are starting to make some progress but there will be organic growth, it won’t be overnight”.

8.00pm GMT20:00

Former NHS mental health trust chief Lisa Rodrigues is speaking now about the stigma surrounding mental health and suicide.

She says:

We don’t spend enough on these services at the moment. Morale at the moment is really low at the moment because people are really up against it.

We need to spend about 25pc on mental health because it’s about 25 percent of the disease burden, she says, adding that cuts in recent years have really impacted.

Her question is: what are you going to do about it personally, each of you? [applause].

7.52pm GMT19:52

Mark Porter says that the NHS is inevitably going to remain a contested political field.

He makes an appeal for an end to ‘top down, prescriptive’ reorganisations.

Bruce Keogh says he agrees with a lot of what Carter said. He’s not in favour of paying for your GP, adding:

It’s the thin end of the wedge. If that, then what next?

7.49pm GMT19:49

The political parties are falling over themselves to make promises, says Peter Carter from the Royal College of Nursing, but what is needed is more detail and “triple locks” to make sure that they won’t row back once they are in power.

We need more money but we need more reform, he says, adding that public health, and improving care of the elderly is absolutely essential.

There’s applause when he says that the public would be prepared to pay more in taxes if they knew how it would translate into better care and improvements.

He concludes by making an appeal for ‘depoliticisation’ of the NHS

Dr Carter calls for reverse to cuts to district nurse workforce - who can keep people out of hospital #guardianliveNHS

Dr Peter Carter from @theRCN says UK funding on health falling behind other developed countries&thinks public might be prepared to pay more

Updated at 7.55pm GMT

7.43pm GMT19:43

Lamb says his vision is about a shift of resources to prevention, and a “much more joined up view”.

I think linking up social care, community support much more closely to primary care practises makes a lot more sense.

“I don’t favour the marketisation that Mark [Porter] warned off,” he adds, to applause.

Denis Campbell puts it to him that it was a major mistake to allow funding for general practise to decrease.

Lamb tells him that he’d like to see it increase. He adds:

I feel that the system is quite dysfunctional. If you look at the major pressure that we face in this century it’s people living for longer with chronic conditions

We need to change the system and it has to centre around primary care to be honest.

Updated at 10.26pm GMT

7.39pm GMT19:39

GP Dr Zara Aziz is talking from the audience about the time of pressures which doctors are now facing.

We are finding that there is more work being handed over to us from secondary care which is itself facing huge changes, she says.

We have also had amalgamations of the local trusts which means that local GPS are finding it even more difficult to refer patients to hospital.

At the same time, we have not seen adequate funding in community support, she adds.

Because of unchecked demand, GPs are increasingly working 12 hour days and it’s difficult to keep our heads above water, says Azis. It’s leading to burnout and a recruitment crisis,

Her question to Norman Lamb is about the unmet demand in the community and what the government plans to do to deal with this.

7.34pm GMT19:34

Back to the panel again, and it’s now Julia Manning’s turn. She says there is a future for the NHS but “it’s not for the faint hearted”.

Our balance of payments is actually the worst that we have had, she says, before going on to instance figures on the ageing population.

Raising taxes, that is long term not a solution. Services were designed for the 1950s and 1940s and we have not adopted a lot of the digital technology that could really transform things.

We need to be realistic about funding and the costs. We can’t do everything.

7.33pm GMT19:33

Here’s a quick vine of how things look from here

7.29pm GMT19:29

Norman Lamb comes next and says that the next five years will be crunch time for the NHS.

“We have to shift from a horribly fragmented system to one that is more joined up in terms of the needs of the patient,” he says, adding that this was something that existed even before 2008.

In terms of finances, the public has to come to terms with the fact that we need to find ways of paying for it

He makes an appeal for non-partisan party political support to achieve £30bn efficiency saving, with a mixture of tax changes and other measures

Denis asks him to clarify what he means by this.

Lamb replies:

If we just carry on as we are the NHS will “break” in the next parliament.

He adds that one of the disadvantages of the party political system that the UK has is that it’s very difficult to have an open debate and get the public to engage with some of the big decisions that we have to take.

The gap between the understanding between the experts and where the public is at is quite large.

Updated at 10.25pm GMT

7.28pm GMT19:28

Bruce Keogh comes in next and describes the NHS as something that was designed to replace fear with hope. It’s owned by the people and for the peple

“But the world has changed. We now have more older people,” he says, adding: “The needs and expectations of youngsters are also quite different.”

Our NHS has coped really well, adds Keogh.

While other health services have coped by slashing services or doing without them, in the last four years Keogh says that Britain has “really squeezed the orange”.

But he says that we need to look at other approaches or else a number of things could happen: Quality could deteriorate or waiting times could lengthen.

Any financial debate that we have around the NHS should relate to the value that society put on the NHS, and that debate should be around values and value.

Updated at 10.25pm GMT

7.23pm GMT19:23

Mark Porter kicks off the debate and reminds us that the NHS was established in the wake of the Second World War. The idea was to invest in the health of the future rather than pay off the deficit now.

That is something that we need to remember, he tells the audience. He adds that spending on the NHS is something that marks us as a civilised nation

The health service is being starved of resources, according to Porter, who adds that the government has seen its answer in reorganising the NSH from top to bottom by introducing market principles.

They’re a distraction at best, and probably dangerous at worse, he concludes.

Updated at 10.24pm GMT

7.13pm GMT19:13

Just ahead of the start of discussions here, we’ve just watched this video on how the busiest A&E department in the UK, at Queen’s hospital in Romford, east London, relies on locums, part-time doctors and on recruiting staff from abroad.

6.54pm GMT18:54

The hashtag for tonight’s debate is #guardianlivenhs

#guardianlivenhs event filling up with 15 mins to go pic.twitter.com/KgcFUWlKqS

Updated at 9.08pm GMT

6.52pm GMT18:52

To accompany tonight’s debate, we’ve been asking for your views and experiences of the NHS as part of a Guardian Witness ‘share your views’ call out to wider readers.

You can read the contributions here.

6.47pm GMT18:47

Ahead of this evening’s debate, one of its speakers (and the health service’s top doctor) warned the NHS’s future is in danger because its model of care cannot meet the relentlessly growing demand for treatment caused by the ageing population.

Professor Bruce Keogh, medical director of the NHS in England, said that without massive changes to the way the NHS treats patients, including far less reliance on hospitals, the service risked becoming unaffordable and could see its entirely taxpayer-funded status challenged.

Keogh told the Guardian’s Denis Campbell (tonight’s chair):

If the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future.

An unprecedented shift of resources and care into GP surgeries was necessary to help the NHS withstand the twin pressures of rising demand and tight budgets, Keogh added, given the increasing numbers of patients turning up at A&E who needed to be admitted to hospital.

You can read that piece (today’s Guardian front page print splash) in full here.

Keogh also had some fascinating things to say about the potential role which wearable technology could play in the future of the NHS.

Devices worn on the wrist like the ones that record your heart rate, calorie intake or distance run have a vital part to play in securing the service’s future, he told Denis Campbell.

Keogh believes that gadgets similar to fitness trackers, which are growing in popularity, and others resembling games consoles will revolutionise the monitoring of patients’ health, especially those with a serious condition.

6.36pm GMT18:36

Good evening and welcome to our live coverage of an agenda-setting discussion about the future of the health service (from 7pm GMT).

With the NHS set to be a key issue in the UK general election campaign, the Guardian called in a leader column recently for an “honest debate” on how to ensure the sustainability of the NHS.

Guardian Live is now bringing together leading experts and our readers to have this debate, chaired by Denis Campbell, Guardian health correspondent.

I’m Ben Quinn and I’ll be live blogging from here at Conway Hall in central London, where the speakers include:

We’re also going to be hearing from the NHS frontline, from patients to GPs, nurses and mental health workers, including A&E doctor and film-maker Dr Saleyha Ahsan; GP Dr Zara Aziz; Dr Peter Carter, OBE, chief executive of the Royal College of Nursing; and former NHS mental health trust chief Lisa Rodrigues OBE.

We’re expecting lively debate around questions including:

Is the NHS’s unique model of healthcare under threat? Is a publicly funded NHS sustainable? Are the political parties promising enough money? Do we need an NHS tax or should we be charged for GP visits?

The full event will also be available to watch online tomorrow. We’re putting highlights on the Guardian’s Membership site and the full event on our YouTube channel.

Updated at 6.36pm GMT