NHS reforms live blog

Join us for our daily live blog debating the government's controversial restructuring of the health service

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Photograph: Christopher Furlong/Getty Images
5.52pm: For those of you who were too busy to follow the blog closely throughout the day, here is a brief round-up of events to close today's coverage:

• There was a lively debate between you readers, NHS consultant radiologist Jacky Davis and Jean-Jacques de Gorter of Spire Healthcare, over the involvement of the private sector in the NHS. Jacky put forward her view that the NHS was heading towards a future – unwelcome to her – as "a funder of but not provider of healthcare". De Gorter said he felt "the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format".

• There was an exclusive interview with Mike Farrar, the chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks. Farrar told us that the reforms were "inexorable" despite the "pause" in the government's bill.

• There was also an interview with Sir Richard Thompson, the president of the Royal College of Physicians, who welcomed David Cameron's intervention this morning (see 11.51am), but said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work and live "off the back of the NHS".

We'll be back tomorrow morning headlining with new research from the King's Fund. The author of the research, respected economist John Appleby, will be live online from 1-2pm to answer your questions. Thanks for all your comments.


4.35pm: Mike Farrar (left), chief executive of NHS North West, who is set to become head of the NHS Confederation in the next few weeks, spoke to Rowenna Davis after a lunch hosted by the thinktank Reform, which believes in liberalising the public sector. Despite the "pause" in the government's health reforms, in this audio interview Farrar described some of the changes as "inexorable":

Some of the trends around health services are inexorable... I was born in Rochdale and at the top of my road there was a hospital, it doesn't exist any more, and there was another hospital now that is part of Rochdale infirmary.... Maternity services [in Rochdale] are moving to a smaller number of sites but we know we're going to save 30 babies' lives a year so as I say a lot of this is inexorable.

Do I think we have communicated enough of reasons for change to local people? Probably not, and it worries me sometimes when we hear people say we shouldn't be travelling further, but if it means you have a better chance of survival, I, for one, with my family, I would rather travel 15 miles further to make sure I had a 50% better chance of surviving a particular problem.

Farrar went on to say that some trusts should have been making plans to adapt to the cuts several years ago:

Given the economic circumstances, we should have been thinking about some of these changes two years ago - that's what I was trying to say. However, working with different industries in different sectors they all say it's difficult to do massive reform at a time when resources are tight so you don't have the money to "oil the wheels of change", if I can put it like that.

Finally, towards the end of the interview, Farrar said that we could expect more of the "Tesco Local" model of delivery – by which he meant stripped-down hospitals with a small offering of essential services provided close to the local community:

We are getting that notion of health services on the high street ... They don't say "Tesco Local" although if I remember we used to have NHS walk-in centres that had some of those characteristics. But I think we will see more of that model emerge because I think a lot of health aims that you used to get 30 years ago in hospitals are now much more readily available without having to use those services.

4.20pm: The doctors' union, the BMA, looks askance at last week's instruction from the head of the NHS Sir David Nicholson to "press ahead" with Andrew Lansley's reforms.

Nicholson wrote to all NHS chief executives last week urging them to "press on" with aspects of the bill, adding that the timeline for transition "remains unchanged". Doctors' leaders warned against "irreversible decisions" being made under NHS reforms despite legislation having been put on hold while a listening exercise takes place.

BMA council chairman Hamish Meldrum said:

We have always maintained that changes in the NHS must not anticipate the legislative process, leading to irreversible decisions or unnecessary risks if some or all of the bill is not implemented.

Nicholson did anticipate a delay — until July 2012 at the earliest — to key statutory changes, such as:

• The abolition of strategic health authorities.

• The assumption of full statutory powers by the NHS Commissioning Board.

• The assumption of full powers by Health Education England, Public Health England and the NHS Trust Development Authority.

• The first phase of Monitor's powers.

• The establishment of HealthWatch England and other changes to arm's length bodies.

This has done little to reassure doctors. Meldrum said it was "even more important not to rush into changes if the government was serious about the listening exercise because its findings could result in some elements of the bill being altered".

3.56pm: Dave Clements of the Social Policy Forum thinktank sends some comments following on from yesterday's Q&A and debate on this blog. Clements writes:

I suppose it isn't too surprising that the "Cinderella service" should find itself once more in the shadows. Nevertheless, I think it is worth pointing out the "NHS reforms" are not just about the NHS. The health and social care bill (the clue is in the name) will have much broader implications. With this in mind, we might, for all the understandable cynicism about the motives behind this "listening exercise", welcome the pause for reflection.

This live blog began by describing the "almost unprecedented opposition" to the reforms. What is remarkable, though, is how confused and, again, cynical that opposition is. As a recently redundant worker in social care this is all too familiar. Any notion of "radical" change is greeted knee-jerk fashion with resistance, whether its personalisation or GP consortia, by supposedly liberal and progressive Guardian-reading types. While it is understandable that, faced with massive public sector cuts, any reform can be construed as "cover" for some hidden agenda, this response is all too automatic and far too conspiratorial to be credible.

While I am no cheerleader for marketisation, neither do I buy the assertion that the NHS is "one of the UK's best loved and most respected public institutions" as the intro to this blog also claimed. My suspicion is that any reform, almost regardless of its content, is going to be experienced as negative. Unable to come up with an alternative of our own and already a little battered and bruised, there is a tendency to oppose anything that might bring a wrecking ball to our supposedly beloved - but in reality already crumbling - NHS. This is indeed a pause to reflect, and start questioning everything ... including the NHS.

3.47pm: Andy Cowper, who runs the healthpolicyinsight blog and was cited in our thread, makes the point that private hospitals - including Spire - might be too optimistic in thinking that there will be lots of business in the future. Cowper says there's no economic growth in sight and with NHS budgets flat the private sector will struggle to find lots of paying patients.

I wonder if there might not be a touch of optimism at work here? Or seeking to bring about climate change? It will be very interesting to look out for Spire Healthcare's next annual report.

Cowper has also pointed out a tweet he received from Alastair McLellan, the editor of Health Service Journal, explaining that his brother-in-law, who is the finance director of a "v big private HC provider", sees no pot of gold for his firm in the government's reforms.

@HPIAndyCowper @joefd - My brother-in-law FD of V big private HC provider - no sign of him rubbing his hands in glee re NHS (just opposite)
less than a minute ago via TweetDeck Favorite Retweet Reply
Alastair McLellan
HSJEditor

_

3.08pm: At last. Good news for the health secretary, who gets backing from the NHS Alliance, which represents family doctors, nurses and managers in primary care, for his plans to hand £60bn of taxpayers cash to GP consortia to commission healthcare.

Michael Dixon, chairman of the NHS Alliance goes further and dismisses the idea that there will be any real changes to the controversial health bill - a thought floated by the prime minister this morning (see 11.51am).

The alliance cannot be dismissed easily and are long time supporters of clinical commissioning. Politically they are NHS extremists - so much so they are one of the few organisations allowed to use the three letters, N H S, in their name. Dixon says:

There is no going back on clinical commissioning and GP Commissioning Consortia should not be forgotten amid political discussions which are not going to bring significant changes to this aspect of the bill. We are encouraging all GP consortia, especially pathfinders, to continue their pace of development and to not be distracted by the current hiatus in the passage of the bill.

2.38pm: I have just finished speaking to Sir Richard Thompson, president of the Royal College of Physicians. He welcomed David Cameron's intervention this morning (see 11.51am) in which the prime minister said that hospital doctors would be involved in commissioning healthcare for patients - and it would not be left just up to GPs.

He warned:

There may be errors where secondary and primary care doctors don't get on well.

Thompson, a distinguished medic and emeritus consultant gastroenterologist at Guy's and St. Thomas' Hospital, said he still had concerns over competition in the bill especially "cream skimming" where private providers take away easy work living "off the back of the NHS"

Listen to the interview below. I'm afraid my voice has come through very quietly, but Thompson can be heard perfectly:

_


2.37pm: Thanks very much for all your contributions to this debate, and thanks to our two experts, Jacky Davis and Jean-Jacques de Gorter. Feel free to keep the debate going in the comments.

2.11pm: DrJazz took issue with Spire Healthcare's "why choose Spire?" section on its website. The website gives these reasons:

• Your choice of an expert consultant.

• Fast access for appointments, diagnostic tests and treatment

• Your own private room, with friends and family able to visit you when you wish with in-room entertainment facilities.

• A full range of appetising meals prepared by one of our on-site chefs.

DrJazz wrote:


The first two are provided by the NHS, although I doubt very much that Spire Healthcare can provide a full range of diagnostic services or back up when something goes wrong.

Jean-Jacques de Gorter responds:


Not true I'm afraid. If you are lucky enough to be treated by a consultant (half of surgery in the NHS is undertaken by non-consultant grades), then you will typically be allocated to the one who will most likely be able to treat you within the 18 week referral to treatment target - there will of course be some exceptions.

Patients who opt to be treated privately are able to choose the consultant of their choice in consultation with their GP.

In answer to your point re full range of diagnostics etc - five of our hospitals have intensive care units (level three) and 30 other Spire hospitals have high dependency units (level two) - the other hospital is co-located with an NHS trust.

Last year our rate of unplanned transfer out to another hospital was only 0.07% - as it was in 2009, and we participate in the critical care network for every region where we operate a hospital. We run 22 MRI scanners and 18 CT scanners etc etc. We undertake complex surgery including neurosurgery (including brain), cardiac surgery, complex bariatric surgery etc.

It is an easy soundbite to suggest private hospitals only undertake easy cases. The truth is that they operate a fully fledged hospitals (albeit with fewer beds that a teaching hospital) with the technology, facilities and capable staffing necessary to make sure they are able to deliver high standards of care. After all, our success depends on it.

2.00pm: Jacky Davis responds directly to Jean-Jacques de Gorter's comment that "I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format". She says:


The NHS is one of the most cost-effective and equitable health services in the world. Others can't believe our politicians are trying to dismantle it. The answer is not to start involving the private sector - when that happens costs go up, quality and equity go down.

Treatments are being delayed or denied. The solution is not to look to the private sector to fill the gap via personal health insurance, which will not help the majority who can't afford to go down this route. We need to see where we can save money within the NHS. The most obvious place to start is with the expensive and unwieldy bureaucracy needed to run the market in healthcare.

Substantial sums of money could be saved by putting an end to the buying and selling of healthcare. In the US, administration accounts for 31% of healthcare costs. In the UK, the bureaucracy involved in buying and selling healthcare is estimated to cost an extra 10% of the NHS budget (2005 estimate) ie over £10bn a year. We could save that every year, which dwarfs the £20bn we'll be struggling to save over the next four years through cuts and closures which damage patients. It makes no sense to throw money away on an idealogical market in healthcare which has no evidence base anyway. Get rid of the market – there's no evidence for it, and the money saved will mean we can avoid the cuts and closures of frontline services that we are currently facing.

It's worth noting that the devolved nations have abandoned the market model, and there's no reason why we can't too.

1.56pm: Jean-Jacques de Gorter responds to the same question from TheNabster (see 1.47pm):


I do not believe this is how the current reforms are envisaged. Remember, GPs are already independent contractors to the NHS and primary care accounts for a substantial proportion of the total NHS spend. In addition, privately funded patients are already treated in public sector hospitals, and some NHS funded patients are treated in a private sector hospitals. You cannot separate the two.

In any event, I believe attempts to compartmentalise the discussion in this way misses the point. Use of the private sector is not a rejection of the NHS. Rather, private provision acts alongside the NHS and complements it.

Being treated privately reduces the overall burden on the NHS and frees up waiting lists. However, privately funded activity accounts for only 1% of total healthcare delivered - hardly market disruption.

I think the proper question that needs to be asked and tackled is whether the NHS is exhausted in its current format. If you were to stand back and take in the symptoms we are currently experiencing, it would suggest that it is. tackling the symptoms one by one will not help deliver a long term and sustainable solution. people are living longer (I read today that one in four 16-year-olds can expect to reach 100 years), people's expectations about the standard and type of healthcare they should receive will only increase, as will the costs of healthcare technologies. Either this has to be funded through tax alone, or we had better start having a rational, unemotional debate about HOW, and not IF, we achieve this.

If you want to see real innovation, then the answer is a) create a level playing field, b) pay a fair price and c) offer patients choice.

Just to make clear, we're is not a funder of healthcare ie we are not an insurer - we are a provider of care.

1.47pm: TheNabster asks:


Do they [the government] have a clear vision as to [what] this refurbished "NHS" will look like? Will it have a private arm and a public arm?

Jacky Davis replies:


As I said above I and many others think the intention is to have the NHS as a funder of but not provider of healthcare. This will come about via mixed funding, with insurance, top-ups and co-payments. Personal budgets are also a move in this direction. The private sector will increasingly provide care under the NHS logo so it will be difficult if not impossible to tell whether your care is being delivered by an NHS organisation or by a private company badged as the NHS.

The distinction between a public arm and a private arm will be lost as private firms are welcomed into the "NHS family". Patients and the public have repeatedly indicated that they do care who provides the service and that they don't want a bigger involvement of the private sector so this loss of transparency is not in their interest.

1.40pm: Jean-Jacques de Gorter replies to Linda Cullen's email. Linda asked what (if any) role will private providers have in training doctors for the future?

Jean-Jacques de Gorter replies:


Hi Linda - training and its funding is very topical right now, and there is a consultation under way looking at this right now ("Developing the Healthcare Workforce"). Around £5bn is spent every year on workforce training in the UK.

We (Spire) currently train nurses and allied health professionals - in 2010 alone: 269 under and postgraduate nurses, 46 pre-registration allied health professionals, a further 177 members of staff took National Vocational Qualifications and 133 completed university degree modules. In addition 5,574 candidates completed critical care courses and staff completed 46,000 e-learning modules using our web-enabled platform. Why does this matter? Because staff frequently move between the private and public healthcare sectors.

However, we are unable to access funding to train undergraduate medical students, since this takes places through universities who are separately funded to deliver this training. There is one private medical school located in Buckinghamshire.

Postgraduate training eg to become a consultant or GP for example, is funded by the Deaneries. Yes of course we would like to participate and contribute to training, and we have tried. However, there are costs to be met, and we have so far been unable to have a sensible conversation about fair reimbursement. Hopefully the outcome of the current consultation will propose a way through to enabling non-public sector providers to deliver medical training. In the meantime, we fund four postgraduate research fellow positions that enable doctors to work alongside recognised experts in their fields for a number of months at a time.

1.17pm: Gwledig and pipesmokingman both ask if the coalition's planned reorganisation is a move to a US-style "no pay, no treatment" system. Jacky Davis replies:


There is no doubt in the minds of those who have been following the debate that the intention is to have the NHS as a kite mark only, with care provided by competing providers. Initially this will be NHS organisations, voluntary organisations and the commercial sector. The private sector is likely to win out in this competition for reasons we can go into if you like.

If you doubt this I strongly recommend a new book, The Plot against the NHS by Colin Leys and Stewart Player. This documents how politicians and the private sector have worked together to get the NHS to the point where this can happen.

At the same time I think we will move towards a system of mixed funding with a three-tier service – those who can only afford the basic NHS service, those who can pay for extra within the NHS through top-ups and co-payments and finally those who can pay to go outside the NHS. These current cuts and closures will accelerate that process as we see in this latest report from Spire.

The private sector recognised this long ago - last August the head of Bupa was quoted as saying: "The UK government [has] started to articulate its plans for reform of its healthcare systems and we believe that this should offer new opportunities for our businesses in the future."

1.12pm: propforward suggests:


Maybe include a desire to include more clinician input (nurses, GPs hospital & community doctors, physios etc) over time within each PCT, but leave the basic structure alone.

Jean-Jacques de Gorter replies:


Anyone who runs an organisation understands the importance of engaging your workforce. And I don't mean "satisfaction" surveys, I mean having people who feel involved in their organisation, who are able to give and receive feedback, who are recognised for their performance and equally see poor performance being addressed, and essentially feel that the organisation's challenges are their own.

Every responsible and smart commercial organisation will recognise this, and pay more than simply lip service to results. They will also engage with their staff and customers when developing their strategy and business plans. For example, we undertake annual staff engagement surveys administrated independently. Every manager will have at least one objective based on the results, and these form an important part of our development plans for the coming year. In terms of developing our annual operating plans, this starts with discussions with clinical teams, managers, and consultants, and concludes when their insights are reconciled with our strategic analysis and conclusions.

Sorry about the wordy answer - the short version is: of course you have to engage your people if you want to be successful.

1.08pm: Jacky Davis writes:


A lot of people are concerned that there might be conflicts of interest when GP commissioning begins eg "Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?"

Yes, this is likely to be a real problem. First, many GPs (a recent survey suggested as many as 25%) have an interest in the private sector. So if they refer you to a private clinic rather than the NHS you are likely to wonder whether their decision is based on your best clinical interests or their best financial interests. This is likely to damage the patient-doctor relationship unless it is recognised and addressed

But a bigger problem is what will happen when GPs decide that commissioning is too big and time-consuming a job and bring in the private sector to do it for them (the government has already said it wants to see this happening). At the same time you have the policy of "any willing provider" to deliver healthcare.

So what's to stop the private sector (commissioning arm) buying care from the private sector (provider arm)? There will be some weak protection in place no doubt but nothing to stop "I'll scratch your back if you scratch mine". Plus the private sector changes names on a regular basis; it will take a lot of time and money (lost to the NHS) to keep a track of this.

1.05pm: Our experts Jean-Jacques de Gorter, the clinical director of Spire Healthcare, and Jacky Davis, an NHS consultant radiologist, have
begun answering your questions below the line.

Gwledig asks:


The debate seems deceptively complex but is very simple, it's a choice between a state managed, tax funded, at-cost system, run for the national good instead of exploited for profit, or the same system they've had in the USA

Jean-Jacques de Gorter replies:


I don't believe this is as simple a choice as you suggest. It's not a binary decision. There are many different types of healthcare systems across the world, and none that consider themselves to have "cracked it". The challenge faced in funding a satisfactory and sustainable healthcare system is common to every nation.

Australia and New Zealand - both places that I have worked as a doctor - used elements of both UK and US systems effectively (to my way of thinking). Both were fair, provided universal coverage, but also included elements of competition and choice.

I also have experience of the US system - my family resides in the US. Personally, it is not a model I favour and would not expect the UK to follow suit. That does not mean I disagree with the ability of individuals to take more responsibility for their own health, the importance of some competition, and the ability for people to exercise choice.

12.53pm: David Worskett of the NHS Confederation, the body that represents almost all senior managers in the health service, sends the following:


Yes, there is plenty of evidence of private providers doing a good job – most powerfully from patient surveys, which show 97% of patients rating their NHS care delivered by an independent sector provider as "excellent" or "very good". It's also important to note that independent providers now operate at NHS standard tariffs, so the cost to the taxpayer is no different.

And although with less than 5% of all NHS work being done by independent providers (excluding GP practices, of course), the scope to become involved in education and training is small, it is now possible and many independent providers would love to do so to a greater extent: But the "system" itself seems to get in the way.

12.03pm: At 1pm today there we will be holding a live Q&A session on Spire Healthcare's new survey, which shows waiting times creeping upwards for a number of procedures. Online debating the pros and cons of turning to private providers for the answer will be:

• Dr Jean-Jacques de Gorter, clinical director, Spire.


• Jacky Davis, NHS consultant radiologist.


We want the questions to come from you in the comments below, but here are a few suggestions:

• Can private providers help reduce waiting times?

• Do private providers save money? There's evidence they cost more.

• What are the risks of using private providers?

• Do we have any examples of private providers working well and working badly? Why?

• If we do use taxpayers' money to fund private contracts, how can we get the most out of them?

• Can GPs find themselves commissioning healthcare for patients from providers they might have an interest in? If so what can be done to prevent this conflict of interest?

• If private providers take all of the work out of hospitals, what will this mean for the training of junior doctors?


Photograph: Dan Kitwood/Getty Images
11.51am: My colleague Hélène Mulholland has filed a story on David Cameron's comments that "changes need to be made" to the NHS reforms (see 10.03am). Here are the key quotes from the prime minister (left):

Yes, I think they do need to change. We need to get this right. But I don't think it was wrong to get started rapidly on a process of change. While it's an option to stick with the status quo, I don't think it's a sensible option. So I think it was right to get moving.

But we have a moment now where the legislation is almost finished in the Commons, where I think it is right to stop and to pause, to rethink and improve because I think we can make further improvements to our policy. I think that is a different thing for the government to do.

Normally governments just plough ahead regardless, but I think it's important to see if we can further improve those policies and, at the same time, make sure we have more full-throated support from people working in the NHS, most of whom know change is necessary. I want to get them on board for the changes we are considering and see if they have ideas for further improvement.


11.33am: Sunny Hundal (left) at the left-liberal blog Liberal Conspiracy has just written this post criticising the NHS reforms. He says the government is confused and points to a recent YouGov poll for the Sunday Times showing that the public remains unconvinced.

Response? Total support 27%, Total oppose: 52%, Don't know: 21%. That's a big thumbs-up from the public then.

11.23am: Peter Ward Booth, who describes himself as a partially retired NHS consultant and who followed the blog yesterday, sent this email to Rowenna this morning saying that practitioners and patients need more information about the reasons about the government's reforms. Ward Booth tackles the important point about whether GPs are really in a position to cut the cash flowing into highly specialised hospital specialities.


Of course we all know it's about saving money - specifically targeting secondary specialist or hospital care - however you want to describe it. Yes, it is expensive, because it is super-specialised, with beds and highly trained healthcare workers.

Yes, if GPs hold the funds, they will restrict referrals to save money, just as PCTs restrict referrals by declaring certain procedures "low priority" - euphemism for not treating a condition. Either way the quality of care will go down, unless you can afford private care.

In the past governments tried to reduce the cost of secondary care by trying to have managers micromanage the running of the hospitals; the price was we have statistically a manager for every hospital bed. Managers are, however bright or motivated, driven by their political masters, not by patient or doctor needs. They are also very expensive.

So let's be honest and recognise we need secondary/specialist care, but address the costs issue separately. Let's give the power to the consultants to run their own departments and have "costs" league tables as well as "outcome" league tables. Have teams of peers to review the failing units with the power to hire and fire.

Above all the "reforms" should not be allowed to reduce specialist care to only those who can afford it. Yes, GPs are specialists, but not in surgery (or) cardiology.

10.37am: The health secretary got a boost today with a sympathetic and pithy portrait from the Independent's health editor Jeremy Laurance. Laurance gets the health secretary's deadpan humour to a tee, recalling his funniest personal anecdote about suffering a stroke while playing cricket.

"People imagine politicians are a bit brain dead," [Lansley] would say. "Well I am – and I have the MRI scan to prove it."

On a less humorous note, in the Guardian former Labour chair of the health select committee David Hinchliffe attacks the government for its pro-market tilt.

The same market philosophy which impacted upon my constituents 20 years ago is at the heart of the health and social care bill. Its proposals are driven by an ideology totally alien to a health service whose success has been rooted in co-operation and collectivism.

In the FT there's more bad news for the government as one of four NHS trusts chosen to be early adopters of the electronic patient records pulled out – plunging the health service's £12.7bn programme to create a vast patient database into "yet another crisis".

Also in an ominous sign of things to come, news that Trafford General Hospital is in a financial mess. It's an iconic place in NHS history - treating the first ever state-funded patient when the health service was inaugurated in 1948. The Manchester Evening News says "the hospital where the NHS was founded could find itself £75m in debt by 2015".

And trust the Daily Mail to come up with a holiday story in health. The tabloid claims that a hospital is considering flying foreign patients overseas rather than fund their long-term care. One way to beat the Easter traffic.


10.32am: Rowenna points out a political spat in Scotland where Labour claimed that knife injuries cost the NHS in Scotland £500m a year – almost 5% of Scotland's £11bn NHS budget.

Nigel Hawkes on Straight Statistics has an interesting take on how politicians are using stats on the health costs of knife crime to score political points.

He says the Scottish Labour party has promised a mandatory prison sentence for anyone found in possession of a knife outside their home. To justify the policy, they say knife injuries cost Scotland's NHS £500m a year, or 4.5% of the health budget.

But after some digging, Nigel says that even with the "best will in the world" it's hard to see the total cost of knife crime exceeding £10m a year – or 50 times less than the Scottish Labour party is claiming.

Scottish Labour's policy doesn't make much sense, Nigel argues, given that they are setting aside an extra £20m to provide the extra prison places that will be needed if more people are sent to jail as a result of their policy."

(Disclaimer: Rowenna is standing as a candidate in local elections next month in England for the Labour party.)


10.03am: Hello. I am Randeep Ramesh, the Guardian's social affairs editor, and my colleague Rowenna Davis and I will be liveblogging the government's radical NHS reforms all day. Today there will be a question and answer session on Spire Healthcare's new survey, which sees waiting times creeping upwards in a number of procedures. No surprise perhaps that families are not getting fertility treatments at a time of cuts, but worryingly patients are facing long waits for hip replacements and hernia repairs. Online debating the issues will be Spire's clinical director, Dr Jean-Jacques de Gorter, and NHS consultant radiologist Jacky Davis.

Also Rowenna will be at a conference on looking how to close hospitals painlessly. Earlier this month welfare secretary Iain Duncan Smith marched to save his local hospital; while his cabinet colleague Andrew Lansley has to marshal insufficient resources to meet rising demand, this is one of the most vexing political issues of the day.

For those who missed it Andrew Sparrow has already caught up with David Cameron's interview on the Today programme. The main take away is that there will be changes to the NHS reforms. Interestingly Cameron made a point of saying hospital doctors would have a say in how GPs commission services for their patients. The prime minister's brother in law, Carl Brookes, works as a cardiologist in Basingstoke for the North Hampshire NHS trust and memorably told him he was concerned that family doctors would become too powerful under Andrew Lansley's plans.

You can email me at randeep.ramesh@guardian.co.uk or tweet at tianran. Rowenna's email is rowenna.davis@guardian.co.uk and her Twitter name is rowenna_davis.