大象传媒

"NHS competition will be on quality not cost" is a lie.
Competition always drives quality downwards because quality is difficult to measure compared to price.

Can't help feeling Lansley might as well have just been putting the same arguments forward over the schools debate when we heard all about how parental choice, etc,etc would drive up quality. The one problem with all of this, as with all tinkering with privatisation and market led forces is the great God profit! I can't think of any public service that has been tinkered with from Thatcher on down that hasn't either ended up a poorer service or a higher cost. In most cases it has been both a poorer service and a greater cost. It sounds to me like mealy mouthing where everyone is expected to make the right moral decisions but very little law or enforcement to back it up. A typical Tory trait. Cause we know how much the profiteers despise legislation that compels them to do what is right. This is because more profit can be made from being immoral most of the time.

2. funnyJoedunn
Fully agree mate.
Back to post code lotteries, back to long queues, back to tolleys in corridors.
Of course there will be choice, if you live in a good post code area or have the money to travel.

Look how the Tories sorted out the railways, remember the promises, competition will provide cheaper, better quality, and more reliable travel.
Of course maintenance was the first casualty and it cost lives.
We have very expensive rail travel as everyone is trying to take a profit.
Like the railways, how long will we have to suffer and how many lives lost before the government has to step in and rescue the Service.

Lansley stated that a bad provider would lose patients and go to a good provider. I understood him to be talking about GPs practices? Well what happens when that good provider reaches capacity and can't take anymore patients? A lottery for places just like the schools? I suspect what will happen is just the same as what has happened with schools. Namely the pushy aspiring class will get with the better providers whilst the rest (poor) will be left with whats left cause they will not understand what choices they have and will just go along with whatever the doctor recommended. I suspect for the vast majority this myth called choice over treatments will in reality be little more than the doctor telling the patient what treatment he thinks they need and where they are going to go to get it. Which is just what happens now. Cause people are not wanting choice in these matters, they are just wanting a good service.

Looter, I agree.

It will probably end up with GP practices being given enticements from private providers to send patients their way. It may not be overt enticements but you can bet they will be there if I understand this thing right. It might be free flights and accommodation to one of the providers conferences (held in a romantic exotic place of course) oh and bring the wife for free too. I imagine you will see bupa calendars, pens, mouse mats on the doctors desk. A constant reminder that they will always be ready to take his burden off him, (as long as its not too difficult a hip job). They'll call the surgeries each month (just like the drug companies do now) hawking their wares, making a good impression with the local consortia. Oh yes, I can see where this is going my friend.

I offer the following segment for the new Private eye without further comment (but with a heavy heart):


"Just as David Cameron defended the handing of healthcare commissioning to GPs as necessary because 'there is so little incentive in the NHS to improve the health of the nation', the nature of the real incentives dictating health reform became all too obvious when management consultants KPMG won a big contract to support the 'pathfinder GP consortiums'.

This delighted KPMG health partner Gary Belfield, who happens to have been the department of health's director of commissioning until just after the election last year. His predecessor at Richmond House and a driving force behind the 'external commissioning' in the NHS that Health Secretary Andrew Lansley's reforms will depend on, was one Mark Britnell. He, it also so happens, became a KPMG partner in 2009.

While NHS staff and patients might face a troubled future, for the management consultants behind the uphevals the future is assured."

So funnyJoe dunn " can't think of any public service that has been tinkered with from Thatcher on down that hasn't either ended up a poorer service or a higher cost. "
Telecommunications is one. 11 years after man landed on the moon Britain was still using a telecom infrastructure little changed from the 1930's. Privatisation, increased competition plus a positive attitude and Britain is now regarded as a world leader in this area.
What is also interesting is that 50 other countries around the world followed Britain's lead.

TSSC, Health preservation or self preservation?

Sorry, that (6) should have been *from* the new Private Eye, obv.

7. hantsguru

Sorry, but the state owned telecomms company that Thatcher privatised was not 1930s infrastructure.
In fact, in the UK, STD started on 5 December 1958. The British telephone system was the first to have nationwide STD dialing and pioneered automatic exchanges. A technology you need if you want subscribers to dial without operators.

Many people at the time of privatisation consider that the Tory government flogged off BT too cheap as the telecomms revolution was about to rally take off.

hantsguru, further more my friend, the GPO (forerunner of BT) Dollis Hill Research Station was where the worlds first electronic computer was developed for use at Bletchley Park and their wartime code breaking.
The engineer was a GPO employee Thomas Harold Flowers.
So you see BT was not a knackered 1930s telephone company.

7. hantsguru

After leaving the RAF I went straight into GPO Telecommunications, as it was then, and straight back to working on the RAF stations I had previously served on to help maintain and provide the MOD Private Networks.

All was Hunky Dory until the privatisation when BT started to charge for those services.

Prior to it all that happened was that paper money was shuffled between departments with in the government.

Suddenly the MOD realised that they had to pay a commercial going rate for the provision and maintenance of the networks with 'real' money to an 'outside' agency.

Virtually overnight this saw a dramatic reduction in the number of staff that the MOD could 'fund' and have on site to maintain their network and private exchange (PABX) infrastructure as well as provision of new services.

In the refreshing world of commercialisation, what previously used be done as an urgent request and handled by on-base staff that used to do the work via the old boy network in a matter of hours and with the 'paperwork' following on behind, became a tortuous drawn out game of facility assessment, 'circuit' design and liaison between the multitude of commercial departments.

The standard lead time for the provision of a new piece of network infrastructure suddenly became 10 'working' days. I say working because weekends are not included unless the customer wanted to bear the cost of the overtime working.

A classic example was when the first Gulf war was about to kick off and it was found that some of the necessary landlines and data feeds to support the forthcoming operations did not exist so a request was submitted for the urgent provision of these services.

Guess what, the time scales to provide those services would have meant they would have come on line seventy two hours after the start of operations!

Luckily the 鈥楪ood will鈥� of peeps like me meant the majority of the services needed were cobbled together in time for kick off.

Oh鈥nd what happened next.

A commercial decision was made by BT to 鈥榬estructure鈥� on the basis that we were not cost efficient so I and a lot of my colleagues were made redundant. This led to the partial collapse of the service and support that BT could provide.

What happened next.

The staff that were made redundant were contacted some agreed to be taken back on as 鈥榗onsultants鈥� to keep things going!

Now, whilst I believe that BT has been at the forefront of telecommunications development they only do it for commercial reasons.

Why do I say this?
I have broadband at home and it is very slow.
I get 2.5Mb at best and the reason is that the local loop infrastructure was provided in the the mid 20th century and as far BT is concerned it is not scheduled to be 鈥榰plifted鈥�, another commercial decision.

P Nutt

Privatisation in telecoms and utilities has always confused me slightly.

Take telecoms. Unless you get your telephone service from a cable provider, whoever you pay your phone bill to, you need a BT landline. All the wires between you and the exchange are still owned and operated by BT (well, BT OpenReach as they've rebranded the infrastructure part of their busienss), and the links between exchanges might even be the same (unless alternative providers shunt the calls onto their data lines, then shunt them off again at the other end). So the call route from end to end may be the same, regardless of who you pay the bill to.

Anyway, until relatively recently, BT had a virtual monopoly on telephony services, and if you wanted to use a different provider you had to type in an access code before the number you wanted to dial.

So it certainly wasn't competition between companies that resulted in any quality improvements - unless you count their belated decision to start rolling out FTTC as a possible response to cable broadband.

-oOo-

Utility companies are a strange beast. One group of private companies produce the electricity / gas, another bunch transmit it to your home, a third bunch bill you for your usage and a fourth bunch visit you to take meter readings. You cannot choose companies (a), (b) or (d), so the cost of producing and shipping it to you is the same, regardless of who you pay. And while one of the arguments of privatisation was that it would encourage prices to drop, in reality if wholesale prices increase, the companies will immediately raise their prices by a significant margin, whereas they're much more cautious about reducing their prices if the wholesale costs reduce. Oh, and add in the fact that most of the companies are PLCs whose primary business goal is profit maximisation (i.e. make more profit each year than the previous year, rather than retaining a steady level of profit), and there's bound to be pressure to raise prices and cut back on things such as maintenance.

-oOo-

There may be more trains than in the days of National Rail, but it's widely regarded that public transport privatisation has been a joke. Different companies own the track, stations, rolling stock and services. Some bus companies are notorious for continually cutting routes and services while increasing prices.

Eddie well done and thanks for repeatedly and clearly stating that these UK government "reforms" apply to only England.

Could you please ask the minister why he and the government never say the word "England" when talking about England only policy?

The PM spent an hour earlier this week talking about public services almost exclusively English public services (as in most cases the UK government can only affect English issues).

Instead of mentioning England - the territory affected by the speech we got 18 instances of the phrase 'our public services', 4 instances of 'our country' and 2 mentions of 'our schools' (not to mention 'our schools and hospitals', 'our universities', 'our teaching hospitals and universities', 'our children', 'our health outcomes', 'our society', 'public services in our country' and 'our Foundation hospitals'). He managed to disingenuously mention the word 'Britain' 4 times as well.

Isn't it time the 大象传媒 stood for the English part of the UK and made the government say England when they're talking about England?

On a related matter seeing as so much politics on the 大象传媒 News website politics page relates to England only isn't it about time the 大象传媒 introduced a politics page under the England tab? There's Scottish Politics, Welsh politics and Northern Irish politics but no English politics.

This article /news/uk-wales-politics-12216346 which is clearly an "English" MP speaking about how the Barnett Formula affects his English constituents surfaced on the Welsh politics page - where very few English people will find it.

To me it looks like a deliberate attempt to hide the truth about Barnett from the people of England.

I think PM has let Lansley get away with murder.

Poor questioning, not really asking right questions, no alternative positions put. Not really keeping Lansley on the point, not really asking the public questions. it has been a long free advert for privatisation by the Tories.

I hope you are going to ley some one who really cares about the NHS put the case for the public, cooperative NHS rather than Lansleys smashing and privatisation.

Are you going to allow a Trade Unionist who works in the NHS a spot every night next week to put the NHS Workers view?

Lansley must be laughing all the way to the Health Consultants who plotted this Coup de grace for the NHS.

Can i just say how good our health service is, now.

I had a brain tumour and had it removed and had a brilliant consultant, brilliant surgeon, and outstanding rehab unit in walker park newcastle, you literally couldnt buy better care,i now am back at work full time, fuller time as it happens.


My sister has been diagnosed with breast canccer and once again the level of care and action from south shields hospital has been brilliant.

My father in law has been fighting cancer for six years and once again the care has been outstanding.

The health service has improved beyond all recognition over the last ten years and i dont undrestand why the labour party are not making a bigger deal of this, perhaps they dont know how good it is now.
You are always going to be able to show some examples of care that falls below what is required, if you doubled the investment you would still be able to do this.

SO

As the new Conservative plans for the health service (I am giving the liberal democrats the benefit of the doubt here as I haven鈥檛 heard anything from them on this, does Simon Hughes really agree with this madness) have not been agreed with the people in an election, it was not in anybodies manifesto, then it is only right that the government has a referendum and get the electorates agreement to this radical change in the health service.
PLEASE PLEASE Somebody ask Ed Milliband to demand one on behalf of the electorate, I know that the government cant hold a referendum on every controversial subject, but anybody who thinks that this policy has been thought up SINCE the election is deluded.

The health service does not belong to the conservative party to throw a grenade into unless throwing a grenade was in their manifesto

So please Ed get us a referendum

16. David Harbison
"it was not in anybodies manifesto"

The Tory manifesto had this:

"We will strengthen the power of GPs as patients鈥� expert guides through the health system by:
鈥� giving them the power to hold patients鈥� budgets and commission care on their behalf;
鈥� linking their pay to the quality of their results; and,
鈥� putting them in charge of commissioning local health services."

Lots of people have said it wasn't in anybody's manifesto. That doesn't really help our argument.

17
Sorry Sid but it does matter. The Tory manifesto also promised no top-down structural change and the quotes you present have little to do with the revolutionary deconstruction and privatisation of the NHS which is now proposed. The Tories won votes and built a whole corporate persona around convincing the public that the NHS was safe in their hands.

If Lansley had been preparing these changes for five years then the Tories should have announced them before the election and exposed them proper democratic scrutiny and debate.

Mr Lansley, just one question: Why in this age of NHS-budget-cuts are students and their dependants (spouse and children), who enter the UK, eligible for immediate and free NHS-care? Why are we not asking them to bring medical insurance with them, when entering the UK? And if this is not the case, why can't we reclaim the costs from their country of origin?

Further to tackle the problem at root: When will the UK stop offering free medical NHS-care for people who live here but have never paid in at least 12 or 24 months into the system? The NHS was founded by paying in therefore being able to provide. The NHS simply cannot afford any more to offer free medical treatment for everybody living in this country and has never contributed to our national health which I want to protect as a national treasure, which has been given to the people of this country some 60 years ago. It is as simple as that: Whoever has never contributed into this system, should either have medical insurance or should be charged at treatment source. In Germany, where my husband originates from, everybody who attends a surgery, German or not, has to pay at least ten Euro from his own pocket before been seen by a doctor, which I actually don`t agree with.
It is more or less a symbolic contribution, but it makes patients aware that nothing is for free. I am a practice nurse who cherishes our health care system and cannot abide to see the daily abuse of our wonderful national health system.

18. lucien desgai
"Sorry Sid but it does matter"

Did I say it didn't?

GPs are now running their meical practices as businesses. As such they try to maximise the income of the practice. If GPs are incharege of commissioning services for their patients there is a danger they will drive the most profitable services towards their own practices.
GPs that provide dispensing services in rural areas already choose to write prescriptions for medicines which they supply based upon the disscount the Drug company will give rather than what is the most cost effective medicine for their patient. This is why some GPs earn over 拢300k per year. Their needs to be public scrutiny of the way they commission and spend public money.

Under the proposed NHS reforms we will each have a personal health budget. A friend recently wrote to the Department of Health to ask what would happen if a person鈥檚 budget ran out. The reply was 鈥淭he plan [within each personal health budget] should help ensure that there is enough money available, and it should be reviewed regularly to ensure that a person鈥檚 needs are being met. If the person鈥檚 needs have changed, or are not being met, the plan should be adjusted. Nobody should be denied care because their budget has run out.鈥� Note the 鈥渟hould鈥�. It would appear then that there is no guarantee that a person鈥檚 needs will be met.
We need certain questions asked of Andrew Lansley:
1. Can he guarantee that every individual鈥檚 budget will be adjusted to meet their needs?
2. If so, then why go to the expense of creating a whole new tier of administration to monitor how much an individual is costing the NHS?
3. If he cannot guarantee this, what is the upper limit of money available in an individual鈥檚 personal budget?
It looks frightenly worrying that in fact not everyone will receive the healthcare that they need - not if they are very ill and need expensive treatment. To me, this suggests the end of the NHS. I note too that Lansley will lift the cap on the amount Foundation Trust hospitals can earn from private patients.

The involvement of the Private Sector in all of this just make it stink. Still, anyone who knows the Tories knew what to expect - they were drawing up similar plans in a Green paper pre-1997, so it was only a matter of time. We're doomed. I'm trying to think of a country I'd enjoy living in to move to - but politicians are gits wherever you go really.

Michael 21.

You are dead right this has been happening all the way through PbC and there is nothing in the White Paper or the Operating Framework to stop it.

Competition will be about price at an aceptable level of quality is what will actually happen

I have taken the liberty of collating some of the questions raised here, and sending them to PM. Here's the list - please add any I've missed.

Eddie and the team: there have been many questions raised on the PM blog and elsewhere concerning the proposed NHS reforms. Here鈥檚 a list of questions I (and others) would like to hear answered:

1. 'I have cancer. I go to my GP. What difference will I see under the new proposals?' (This is the question Simon Burns couldn't/wouldn't answer on Newsnight on Wednesday.)

2. My mother was told by her consultant that her GP should prescribe a certain drug. Consultant wrote to GP with this request, but when he read this, GP confronted my mother, asking her did she know how expensive this drug was, and how the cost had to come out of his limited budget. He has prescribed the drug, but how likely is it that the GP will withdraw it, under the new proposals?

3. In a few weeks time I have to go back to hospital for further heart work. In Norwich we have an almost brand spanking new PFI funded University hospital that is equipped with the latest technology and staffed by wonderful hard working, well... qualified and conscientious staff who provide excellent care and truly top range teaching facilities. But if I have to have a procedure more complicated than having a angioplasty (a stent inserted) then I will be whisked off to Papworth in Cambridgeshire - a hospital that has been operating since 1918! Whilst I am not wishing to detract from the wonderful work they do there, why can I not have the treatment I may require at my 'local' hospital that is within easy reach for my family and friends to visit me?

4. Care for chronic conditions that need regular hospital review. How is care of patient better if, every three years or so the service provider changes?

5. What happens if there is over spend on the 20% of the budget that the GP's do not get, i.e. the budget that funds Dentistry, Optometry, Screening programs?

6. Andrew Lansley didn鈥檛 seem to understand Eddie鈥檚 questions about private companies and profits; yet the rest of the world knows that if costs can be cut and cheaper options found, that鈥檚 what will happen. At a certain level that will impact on medical choices (unless you live in a dream world). It鈥檚 slightly alarming that the minister is implementing drastic changes without grasping this essential. I suppose the question is: why does he not think money will have any influence at all?

7. The 鈥業nverse Care Law鈥� (a phrase coined in 1971 by Julian Tudor Hart) is the principle that the availability of good medical or social care tends to vary inversely with the need of the population served. This operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced. In order to provide good medical care to those who need it most, we should protect this care from market forces, shouldn鈥檛 we?

8. Lansley stated that a bad provider would lose patients and go to a good provider. I understood him to be talking about GPs practices? Well what happens when that good provider reaches capacity and can't take anymore patients? A lottery for places just like the schools?

9. Given that 90% of GP/patient transactions do not require referral to hospitals or other providers, aren鈥檛 the proposed changes a sledgehammer to crack a nut? Won鈥檛 more referrals be made 鈥� just because they will up the profits?

10. There is a lot of talk about choice and competition. But isn鈥檛 the reality that people just want good services? I want the hospital that does my hip operation to be as good as it can be 鈥� I don鈥檛 really care if it鈥檚 better than the hospital in the next town. Why does Mr Lansley feel that it is better to promise me a choice to go elsewhere for public services than to improve the local public services that I already have access to?

11. How can we stop private companies cherry-picking? Conveyor belt surgery will keep costs down for operations which can be bought in bulk 鈥� leaving a small number of complex, intractable cases using an increasing proportion of available resources. Won鈥檛 it?

12. Forgive my naivety, but have the general practitioners received training on how to manage? If not, it would seem quite bizarre to through them into the deep end like this. And if not, would it not be wise to use the present managers to 'train-up' the GPs in order to make them more proficient? Do we not want our GPs to do what they鈥檙e good at, rather than becoming managers?

13. Is there any evidence that the proposed reforms will work 鈥� or is it a case of 鈥榝ingers crossed鈥�? Is there a plan B in case it all goes horribly wrong?

14. The cost of change: the Economist article you referred to on the PM blog has this comment: "(3) In previous articles the Economist has shown (i) that reorganisation costs 30% of productivity in year one, and shows benefits only after 3 years or more and (ii) that the NHS has been re-organised more than once every three years...so all costs and little benefit. One has to ask whether another rushed reform is really sensible."

Andrew Lansley continually states in his reforms that competition is based on quality and not price. In a market higher quality services secure a higher price than lower quality. Lansley states that quality will drive GP's allocation of resources therefore rationally he is requiring services be provided at a higher price in a static market of different providers? Eddie Mair has not challenged him on this central tenet. No doubt his response will be constantly improving services will be acheived by productivity gains, innovation and new technology. The response then should be that new technology can decrease but also increase health costs and where have productivity gains been made consistently year on year in health provision. Please use the example of a competitive health system eg USA. Please look at measures of international comparisons on productivity and effiency of the American system. It is a system of huge variations but certainly not a system driven by quality except only at higher costs. Andrew Lansley has been allowed to mention the word quality without being challenged and of course this is the only word he wants to be remembered. Please exercise more rigour in this process and tackle the belief that only competition can improve health provision.

I fear that any questions put to Mr. Lansley will be flicked away with some platitudinous tosh, unless, of course, they happen to fit in with his particular world view.

This is being driven by idealogy, not by a genuine concern for the public good. If it was otherwise, there would be a preparedness to properly trial the system, look at the pitfalls, and be prepared to ditch it if it proved to be (as I fear it will) unworkable/too expensive/not inclusive/[insert any other fear you have here].

27. Big Sister
I agree, whatever questions are put to Lansley will be brushed away with his rehearsed response.

This is a dogma driven reform and yet we were promised that there would not be a major reorganisation of the NHS before the election.

One question to be put to Lansley: What about the excellent NHS walk in centres. They are not hospitals and they are not GPs. Where will they get their revenue from.

Another question: What about the GPs who work alone and are not part of a group.
Oh yes and another question: How much is it going to cost. Even changing a logo costs a fortune. Where is the change over money coming from, is it going be taken out of current allocated NHS money. There is a cost to everything and major change costs major money!

27 BigSis
These reforms will be successful on their own terms, that is to remove the state from the delivery of healthcare; Eamonn Butler of the Adam Smith Institute let the cat out of the bag on the Today programme the other day ... in ten years the government will no more 'manufacture' health care than it does food and clothing. I think that the reasons for the endless platitudes from Lansley and other Tory/LibDem spokespersons is that they are uninterested in either the questions or the answers. The only outcome that concerns them is the creation of profit generation opportunities for the private sector, and that's an aim which this legislation will achieve with great success.

Well, it looks now as thought somebody else will have to put a good spin on this, if reports on Sky are to be believed ....

*Gah* - For 'thought' read 'though' ;)

Ah yes, now confirmed here:

/news/uk-politics-12251456

A good day to bury this story, perhaps?

32. Big Sister
Oh yes, what an excellent day to bury this story.

The sad thing is that with all this news today I guess there will be less time on PM for Lansley to not answer listeners' questions.

A distant memory and a bit of googling brought me to this.



Just substitute 'Education' for 'Health' and perhaps we can see where Messrs Cameron and Lansley found their inspiration ....

:o)

Looternite

The short answer to your WIC question is that they are commissioned by PCT's at the moment. Under the new world it will be upto the GP consortia whether they continue to fund the service and if they do what the service will be. This means their could be huge variation around the country. As some one who works in the NHS I can tell you that they are good but very expensive for the amount of care that they provide. Most of what they do during the day could and should be done by the patients GP which would not cost any more.

The bit I am struggling to understand is where the efficiency is going to come from. At the moment we have the Department of Health, who tell the Strategic Health Authorities what to do, who intern tell the PCTs what they can and cant do. THere are 10 SHA's and 151 PCTs.

In the new world, we will still have the Department of Health setting the outcomes. THese outcomes will be the objectives for the National Commissioning Board, so far staffed by the people Lansley has selected. In order to do their work it is widely accepted that their will need to be an unknown number of Regional Commissioning Boards who will actually manage the GP contracts and regional commissioning needs. Below this will be about 500 GP consortia headed by a combination of senior GPs, at a cost of about 拢170k each and former PCT directors who are furiously protecting themselves through the management cost savings process.

36. CM

Thanks. The Luton Walk-in Centre is a lot nearer to me than both my GP and Hospital.

I have been there a few times and they provide an excellent service taking pressure off A & E and my GP. After all why should I bother my GP with a DIY injury and why bother A&E with something minor.

Considering the child that was going to be handed over to social services - it sounds like Johann Hari's predictions are looking too true;

Also from the Independent a very good essay on what's really going on.

39. lucien desgai

Thanks mate, what an eye opener.
How many extra lives will be lost whilst the system is wrecked.

I really enjoyed this experiment. It was very good to hear a polititian able to explain his policies without being shouted down continually. The daily theme allowed the listener to focus on each aspect and the questioning was incisive. It fulfilled the main job of an interviewer which is to elicit information. Though I agree that polititians should be held to account for policies which have outcomes against the public interest, at this time there are no outcomes to assess. What the public needs to know is exactly what policies are going to be implemented and this is just what your programme did by providing a platform for Andrew Lansley to reach the public.

Sid (25) what an excellent compilation. Please let us (and of course the PM team) know when you get responses!!

"I think PM has let Lansley get away with murder".

I totally agree. What I heard was sickening. No strong questions or interrogation; just pandering to the demands of a totalitarian government that is driving a coach and hoses through our public services. I was born within months of the establishment of the NHS and have devoted most of my working life to it. To see the privileged Cabinet that we now have (combined private wealth of so 拢60,000,000 I believe) taking from ordinary citizens and passing money to their friends and supporters in the private sector is nauseating. Unless there is a very strong public reaction to this right wing ideology - and soon - then our cherished NHS is dead in the water. The Thatcher army has already ripped the heart out our once caring and considerate society and England is the worse for it. Thatcher, Blair, and now Cameron. Will we ever see a again a Government that cares about our country and the people who work hard every day to support it?