Worried about NHS being privatised? You should be


10:30 am - November 30th 2010

by Ellie Mae    


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When Tony Benn was asked how the public would respond to the NHS being privatised, he replied “there would be a revolution.

He was right. But the government, despite some of its more absurd recent decisions, is not so stupid. Lansley, Cameron et al know that you don’t privatise the NHS: you liberate here, you outsource there, until the groundwork is laid to such an extent that one of the biggest milestones of privatisation can be reached, and it is barely reported at all.

This week, Hinchingbrooke NHS Hospital in Cambridgeshire was almost completely taken over by Circle Health, the biggest private healthcare operator in the EU, in what the CBI unnervingly called a “trailblazing deal”, and what the BMA more bluntly said was “an untested and potentially worrying experiment.

The decision represents the most significant step ever towards privatisating the NHS, and was described by the Financial Times’ Public Policy Editor as “an historic moment.”

Circle Health, in case you’re wondering, is a partnership (like John Lewis) which is managed, delightfully, by a former Goldman Sachs investment banker named Ali Parsa. The deal with Hinchingbrooke has been given a dose of PR, with press releases emphasising that Circle is ‘employee-owned.

But Circle is far from a socialist utopia: half of the company is owned by private investors, including Blackrock – an asset management firm owned by the most well-paid CEO on Wall Street and famous for its lucrative hoovering up of the casualties of the 2008 financial crisis.

Make no mistake: Circle Health is a corporation at its mercenary best, with designs on expanding the UK’s private healthcare industry, and wooing the UK’s healthcare professionals away from the NHS. Andrew Lansley’s decision to give GPs control of 80% of their funding resonates harmoniously with Circle Health’s business practices, in which doctors are awarded shares in return for sending patients to Circle hospitals.

Such an alluring carrot would surely result in doctors prioritising private healthcare, not least because once they are given shares in Circle they would have a vested interest in the company’s profit margins.

It is slowly becoming clear is what a goldmine the NHS is, as more and more corporations emerge from the woodwork to siphon a bit off for themselves.

Reactions to Lansley’s NHS reforms were mixed at best, but it was private healthcare giant, Humana, whose charmless statement shed the most light on who the real beneficiaries will be. A spokesman for the company, which was once described by a whistleblower as “inherently unethical,” said: “are we optimistic? You bet we are.

The rest of us, I suspect, should be feeling apprehensive.

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About the author
Ellie Mae is an occasional contributor. She is co-editor of New Left Project. She is on Twitter and blogs here.
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Story Filed Under: Blog ,Conservative Party ,Health ,Westminster

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Reader comments


Terrible – a company trying to make money by offering lower prices and better services and outcomes so people use it rather than its’ nationalised competitor.

2. the a&e charge nurse

Ahh, so the blogsphere is finally waking up from its enchantment – the road to NHS privatisation started long before the coalition go their feet under the table – in fact I can remember being poo-poo’d on this very board for suggesting that one of the prime aims of the NHS supa-computer system was to facilitate a more comprehensive form of billing.

Is it too late do doing anything about it now – I think the answer is YES given that all of the parties have more or less signed up to the Americanisation of our health care?

2. Completely agree. It would be extremely complacent to view this as the niche of the nasty party. I can’t believe we are all sleepwalking into this.

Tyler –

These companies are offering treatment cheaper than free to every man woman and child who needs it regardless of whether or not it’s profitable?

5. the a&e charge nurse

[1] clinical services within the NHS are ALREADY being run by private firms.

Can you name just one private provider that is either cheaper, or has better outcomes?

The data on these questions (if you prefer facts to rhetoric) make for interesting reading.
http://www.hospitaldr.co.uk/features/istc-programme-at-a-cross-roads-over-damning-evidence

Why is the NHS a goldmine? Because it pays over the odds for everything! Visit the US and this NHS argument is completely reversed. Surely “free at the point of use” is the only thing that matters here…

Unless they start charging people at A&E, I’m finding it hard to work up much outrage. It’s the free-for-everyone principle of the NHS I’m committed to, not that the state directs every aspect of how it achieves this.

Still, very much worth keeping an eye on – not because private companies are inherently evil, but because they do have a habit (PFI) of leeching more public money than they’re good for. Which would be a cause of concern.

8. the a&e charge nurse

[6] health care in the USA costs 17% of GDP – it is not universal, access depends on ability to pay, and outcomes are not great if you are poor.

Unpaid health bills are implicated in 60% of bankruptcy in the States.

Yet the coaltion, and NuLab before them remain in thrall to the ‘market’ – the obvious question is why.

9. the a&e charge nurse

[7] “Unless they start charging people at A&E, I’m finding it hard to work up much outrage’ – yes, the sort of attitude that has allowed this juggernaut to get so far without anybody considering the long term implications.

Is dental care better since it was handed over to the market?

I am extremely worried about privatisation. In addition to what you’ve given, this is from Circle’s website:

The investment needed to buy land and build hospitals, clinics and invest in infrastructure is raised by Health Properties Ltd, a separate business.

Circle does not own its hospitals. Read that again. The company is simply the people who work for Circle. Everything else is owned by Health Properties Ltd, “a separate business” and Parsa is the CEO. So Circle is NOT a mutual, it is NOT a social enterprise, the actual assets used by Circle are owned by a private company, so for all intents and purposes Circle is private healthcare.

I am making this point because Parsa keeps saying that Circle is a social enterprise. It is not, a social enterprise is not-for-profit. The reason why Parsa keeps saying this is because the NHS White Paper says that they intend ALL NHS hospitals to become “employee-led social enterprises”. So going back to what you’ve said above

press releases emphasising that Circle is ‘employee-owned.’

There’s the emphasis on “employee-led” and Parsa’s own insistence on C4 News last week (ably countered by the excellent Karen Jennings from Unison) that Circle was a “social enterprise”. Parsa clearly wants Circle to be seen as the business to run the NHS.

Incidentally, Unison and Unite are just about the only organisations who are actually doing anything to stop this privatisation plans. The Labour party (who it has to be said, started the tendering for Hinchingbrooke) also want the NHS privatised.

11. Paul McGlade

Tyler
“a company trying to make money by offering lower prices and better services and outcomes so people use it rather than its’ nationalised competitor”

– Lower prices? To whom, measured how? I have never had an itemised cost breakdown of services I have received from the NHS. I have from the private few times I have had private treatment and the costs were pretty eye-opening. Do we have genuine cost comparison stats? And what is the guarantee of long-term low costs and service coverage (apart from “The Market”, which generally lapses very quickly into a cosy and highly profitable cartel where essential services are concerned (cf trains, utilities…)

– Better services and outcomes? Measured by what metrics, particularly given that the government is conveniently dumping a whole slew of quality measures, and given this is a “groundbreaking” new enterprise? And again, what long term guarantees have been put in place for keeping services quality up in the long term?

We are all aware of the problems which privatising cleaning services have produced in some places – inappropriate service provision and guarantees in contracts, cost-cutting leading to reduced service, confused chain of command.

Private healthcare in the country at present is very much an add-on. If things go wrong in your expensive clinic, you usually get shoved in the first ambulance to the local NHS hospital. They regularly use NHS doctors, equipment and beds.

The areas in UK healthcare which have been most exposed to long-term running primarily by private enterprise are: dentistry and geriatric care. Failure to apply stringent regulation to guarantee universal coverage and quality of service have badly damaged these areas of healthcare.

And once outcomes come into the equation, private companies will find very clever ways to cherrypick cases for good outcomes and exclude difficult cases. it will be like School League tables all over again, but with long-term ill and dying being bounced about the system, unless contractual conditions are in place to ensure they provide the sort of universal coverage the NHS currently does.

Apart from the threat of eventual breakup, the biggest concern people have is the frankly lax guarantees and conditions the govt is putting in place when farming out these services. The previous government basically ended up with a poor “gentleman’s agreement” with GPs when they got their last cash injection. If we want to bring in businesses, then the government should be appropriately businesslike in their dealings with them. We should ensure that they are under the strictest contractual obligations to actually deliver what the nation wants from its national health service. We don’t want the sort of utilities garage sale we had in the 1980s.

5. the a&e charge nurse

Indeed, and on this very website earlier this year I gave a case study of cataract surgery.

The NHS national tariff for cataracts is £741 per eye (this is the average cost, so some NHS hospitals do the work for less). I searched the websites of various private hospitals and found that in the private sector the cost was £1300 – £2900 per eye with the median cost around £1800. The ISTC contracted to perform cataracts was paid £939 per eye, but the cost is likely to be higher since ISTCs had a habit of “cherry picking” patients and the BMA reckon that they only performed 85% of their contracted work. The stupid ISTC contract guaranteed full payment whether the work is done or not, so assuming they only did 85% of the work that means that the average cost was actually £1100 per eye. So for the hard of thinking here are the average prices:

NHS £741
Private £1800
ISTC £1100

Can anyone see which one is the most cost-effective?

Hmm given the weirdly high number of people who seem to have interpreted this post as a tacit declaration of love for Ed Miliband, I must re-emphasise that YES I AM AWARE NEW LABOUR SET THE BALL ROLLING FOR PRIVATISATION.

Why didn’t I blog about it then? Because I only started blogging in September!

My interest is in preserving the NHS, not Tory-bashing. I am particularly worried about this development as I believe it is a milestone which has made further privatisation that much more acceptable. The CBI and the FT agree with me there.

People seem to think that the NHS will be privatised overnight. Well it won’t. It will happen surreptitiously and incrementally. Scrap that – it IS happening surreptitiously and incrementally.

I personally am opposed to that, but even if the majority of the public disagree eith me, they at least have the right to understand the situation clearly.

By the way, I am throwing this strop as a result of Twitter responses, not this thread. a&e charge nurse is giving me a very easy ride! Thanks for that.

And Richard Blogger. mais oui merci! Nice when the commenters BTL do your job for you. I may have a martini…

15. the a&e charge nurse

[11] “And what is the guarantee of long-term low costs and service coverage (apart from “The Market”, which generally lapses very quickly into a cosy and highly profitable cartel where essential services are concerned (cf trains, utilities…)” – indeed, Paul, perhaps we could even throw in ‘high street banks’ as a further comparitor, just to emphasise both the lack of meaningful choice, not to mention potential for volatility when certain market conditions arise?

Don’t forget when the shit really hits the fan Lansley & Co will be long gone.

By the way – what is former health secretary Patsy Hewitt up to nowadays?
http://news.bbc.co.uk/1/hi/uk_politics/7196420.stm

16. Paul McGlade

@Stuart (6)
“Because it pays over the odds for everything!”

Drugs companies in particular hate the NHS system because of its (massively underused) ability to negociate down on price on its bulk purchases. They would much prefer to deal with dozens of GP consortia.

The rigorous NICE-style evaluation systems (whose results are used worldwide by private and public services as a gold standard) mean that they are loath to launch some drugs in case they gets slated on grounds of effectiveness, quality of clinical trials or costs.

#11. Paul McGlade

– Lower prices? To whom, measured how? I have never had an itemised cost breakdown of services I have received from the NHS.

If you are interested you can download the full NHS reference costs spreadsheet. This lists two things.

1. MMF (Market Forces Factor) which is essentially a regional variation. You find your local hospital, and then use the MFF as a multiplier of the national tariff to get the final payment
2. The national tariff. This is the payment for each procedure.

The national tariff was introduced in 2006 and was calculated as the average cost of the procedure across England. The current government does not like hospitals. It has decided that rather than paying the average they will only pay the minimum.

So under Labour, your average NHS hospital would perform some procedures at above tariff (and generate a deficit) and some at below (and generate a surplus) and assuming that they have good financial control the surpluses should cover the deficits. (My local hospital, for example, always generates a deficit on paediatrics, but they recognise that the cuts needed to make it break even are not acceptable, so other departments effectively subsidise that ward.)

Under Lansley, with the minimum tariff, only a handful of hospitals will have their costs covered, which means that the majority will go into debt. Now Lansley intends to squeeze hospitals further. He intends to cut the tariff to below the minimum. The reason for this is that GPs are squawking that they do not want to inherit the debts of PCTs. These debts partly come from over prescribing and unnecessary referrals by GPs so understandably Lansley does not want GPs to be let completely off the hook. However, since the majority of PCT payments is for hospital referrals Lansley has decided to cut the tariff that hospitals gets paid so that PCTs can spend less money and pay off their debt. (Lansley ignores the fact that the proper solution would be to adequately fund PCTs.)

The result is that hospitals are going to have a terrible time in the next few years, they will have their income cut drastically. However, Lansley has given them one lifeline: he has removed the private income cap, so hospitals can take on private patients. Yup, more privatisation.

18. Luis Enrique

(gotta love: “an untested experiment”. er… yes).

@14. Ellie Mae

The problem is that there is a lot of frustration that Labour are simply rolling over and allowing Lansley to do what he wants. Perish the thought that anyone would suggest that you have a “tacit declaration of love for Ed Miliband”. 🙂

Over the last couple of months I have spoken to several CLPs in my area about the White Paper and I get gasps from people when they realised what New Labour did. Frankly, until relatively recently I want not aware of how they were building the foundations to privatise the NHS. I am kicking myself that I did not pay attention at the time and did not object then. All Lansley is doing is what New Labour would have done, but far far faster.

During the leadership campaign Ed Miliband talked at a local CLP and at that meeting I asked him directly:

Me: “would the next Labour government take back into public ownership those hospitals that will be taken out of public ownership by this government?”

EM: “are you talking about GP commissioning?”.

Me: WHAT??? Where did I mention GPs! I said hospitals! Hospitals being privatised! Pay attention will you?

No actually, I politely pointed out that Lansley wanted hospitals to become employee-led social enterprises, and that these are private businesses, not publicly owned.

EM: “I know nothing about this”

Well, as a former Minister for the Third Sector he knows exactly what social enterprises are, and why he created the law. And since hospitals take about half the NHS budget and the NHS budget is the second largest liability of the government, he bloody well should know about what Lansley intends to do about them.

I may have a martini…

Pour one for me too.

You mean we might eventually end up with a health service similar to, say, France?

Oh the horror!

OMG!

You mean health care will remain free at the point of use but that there will be a mixture of providers? State owned and run, for profit corporations, not for profit charitable bodies perhaps, mutuals and so on?

You know, like the systems in Denmark (ambulances and fire engines are a private supplier in much of the country!), France, Germany, Switzerland…..in fact, in much of the world other than the UK?

Disaster, run for the hills!

Richard B

Nurses are accustomed to seeing US health consultants wandering up and down the wards, giving advice on how to Americanise the NHS. They were invited here to do that in the New Labour years.

I have contempt for Cameron et al, but nothing quite matches the seething disgust I have for Tony Blair and New Labour. At least with the Tories you know you’re getting the nasty party, but Blair used the complacency at the left who thought they’d won to smile nicely while waving through neoconservative devastating policies. God, I loathe him – and his awful wife. If you want to understand the core of New Labour, read Private Eye’s expose of the CDC, which I think shows them at their very worst.

As far as Ed Miliband goes, I’m pretty sure I’d have to fight Sunny for him 😉

23. Paul McGlade

20) “You mean we might eventually end up with a health service similar to, say, France?”

What, very high quality, but costing 3-4% more of GDP and billions of Euros in the red?

Hope not.

Tim W etc

You need to consider this development in light of the values of our government.

Which does it value more: access to good quality healthcare for everyone regardless of cost, or building a state based upon deregulated private enterprise?

Given that this is the same party that is currently saving more money by cutting disability benefit than it is by taxing bankers, you’d have to be sorely naïve to think the upshot of this is going to be a healthcare system like the one in France.

Ps. To reiterate – NEW LABOUR WOULD HAVE DONE THE SAME ETC ETC

Well, let’s stop talking about governments and let’s talk basic economics instead then.

Because of Baumol’s Cost Disease services will generally become more expensive compared to manufactures over time. Medicine is largely services based and we see this in the NHS: 4%/5% inflation rate, well above the general inflation rate of the rest of the economy.

Now, this cannot go on forever. If it did we’d have nothing left in the economy but the NHS.

So, what can we do?

The only thing we know of with which we can combat Baumol’s Cost Disease is the use of markets. For we do know that markets are better at innovation than planned systems. Increased innovation is of course the same thing as increased productivity.

So, we do want to have markets in the NHS: for we do need to increase productivity over the decades.

Please note that markets are not the same as capitalism: it’s not necessary to have private for profit companies in the mix (although it may or may not be a good idea)….but we do need to have different suppliers competing to provide the services.

There just isn’t any way to bring down the NHS inflation rate (or to raise productivity fast enough, both being the same statement) other than that.

“billions of Euros in the red?”

Is the NHS somehow “in the black”?

I don’t follow.

The global elites will not tolerate public services of any kind. Once Communism had fallen the need for capitalism to be controlled went out of the window. Capitalist no longer feared the idea of a revolution form the left. Ever since 1989 social democracy has been under attack form the corporations. They will not be happy until we return to the dark days of pre Enlightenment.

The national health service will be gone within 25 years, so too will the welfare state. Good luck trying to get it back when the corporations run the world. Slavery for the masses is coming.

28. the a&e charge nurse

[20] “You mean we might eventually end up with a health service similar to, say, France” – unusually, cjcjc you seem to have missed the central concern?

We can talk about insurance based health care systems if you want, but the crucial point you are overlook is that profound structural changes are being implemented in the NHS without asking those who will be most affected (i.e. those unable to afford the best insurance options) if this is what they actually want – that stinks, surely?

Good luck when you are making £25000 a year or less |(which is what 70% of the country makes) and you get seriously ill. Lets say it requires major surgery, with follow up surgery and drugs for many years. Good luck getting your insurance company to cough up. They won’t, and if you can’t make up the difference you will die a slow death. Happens in America every day.

Morons like Tyler can prattle on about cost benefits of the private sector, but it becomes very simple. If you can’t pay you die.

@26. cjcjc

“billions of Euros in the red?”

Is the NHS somehow “in the black”?

I don’t follow.

Actually it is. Last year the NHS under spent by about £1bn. The Treasury retains the underspend. In total the Treasury has £5.5bn of unspent NHS cash. (See here.)

Hmmm, so at a time when the NHS is approaching a financial crisis why doesn’t the Treasury allow it to spend the money that it has already saved. (Note the quoted £5.5bn underspend does not included Foundation Trust surpluses, half of hospital trusts are FTs.)

Just a hint. You have missed the best time to be ill. From September PCTs have been cutting healthcare spending: now is not the time to be ill. However, it is going to get worse. The crunch point will be November 2011 when most health economists expect the NHS to be in severe financial crisis. So whatever you do, do not get ill next year. What will happen then is anyone’s guess, but it may well mean Lansley will be replaced with someone with a bit more competence and experience (Stephen Dorrell is the front runner).

[26] Is the NHS somehow “in the black” – I don’t follow.

This is pure semantics, cjcjc, and well you know it?
Sometimes a picture can say more than a thousand words – have a look at this;
http://2.bp.blogspot.com/_b5GSryT89p0/TOjQ-L4z99I/AAAAAAAABz0/rtizjUrmnJQ/s1600/Screen%2Bshot%2B2010-11-21%2Bat%2B07.56.33.png

Now total up the CUMULATIVE difference on health spending (comparing the NHS to France, or especially the USA) then ask yourself – how on earth do we (the British public) get so much for so little?

Excellent article.

@RichardBlogger – have you contacted John Healey? He was an excellent housing minister because he was on top of his brief and actually got things done – worth raising these points with him and his team.

“Because of Baumol’s Cost Disease services will generally become more expensive compared to manufactures over time. Medicine is largely services based and we see this in the NHS: 4%/5% inflation rate, well above the general inflation rate of the rest of the economy.

Now, this cannot go on forever. If it did we’d have nothing left in the economy but the NHS.”

Assuming current NHS inflation rate stays the same relative to rest of economy, in which year would our health spending as %age of GDP reach 12%?

The argument “omg, unless we have markets, then we will spend all our money on the NHS by the year 3000” is not an awfully compelling one.

@donpaskini

As you know, I’ve been ranting about this for quite a while on my blog. What worries me is this quote from Ed Miliband’s NPR speech:

What are the solutions for the future that I am interested in? I am interested in mutual solutions to some of the issues we face in our public services. To community ownership of our public services. To public services where people don’t feel, both users and those working in them, like cogs in the machine which to often they do. And also we have to be the people who stand up for local democracy and local control over public services as well.

So Ed is saying that he supports Francis Maude’s white paper next year that will start the “mutualisation” of public services.

It is the moral bankruptcy of those statements from Ed Miliband that upsets me. There is no reason why public ownership is the issue. Changing the ownership of public services will not improve them. In fact, I think it will make them worse. The reason why is in the name Public Service. The service is provided for the service user. When a private company or social enterprise or mutual runs a public service their goal is to run it for the benefit of the shareholder or the stakeholders, and not for the benefit of the service user. Take ownership out of the equation and the provider can concentrate on providing the service.

I have read good things about John Healey, but if he starts with the same premise as Ed Miliband (that public services should not be publicly owned) then I fail to see what good he can do. You’ve got my email, do you have any suggestions how to approach him over my concerns?

Hi Richard – will have a think and drop you a line – remind me if I don’t – donpaskini AT liberalconspiracy DOT org

Tyler: “Terrible – a company trying to make money by offering lower prices and better services and outcomes so people use it rather than its’ nationalised competitor.”

No, the profit incentive in this situation is to provide a terrible service to patients (because it’s cheaper) while spending huge amounts on sending battalions of lawyers to wring more subsidy out of the government.

If you privatise a large hospital, it generally has no competition locally. Few localities have two large hospitals, because they are expensive to build and maintain. The article claims Circle try to stifle that competition even further by effectively bribing doctors in order to reduce the competition created by attempts to implement ‘patient choice’. (Another unwanted profit incentive in action.)

On top of that, because there is only one large hospital, the owner of that hospital can go to the government and demand ever more subsidy with impunity, no matter how poor the service. The government cannot refuse, because if the hospital is allowed to fail like a business in any other market, lots of people die for lack of an accessible hospital.

So we would have a situation where customers couldn’t realistically make an informed choice of provider (or indeed any choice of provider, in most places), and the provider would be guaranteed government funding irrespective of performance. Any profit-oriented CEO that responded to that environment by concentrating on improving quality would be fired.

In several independent assessments, the health services in several other west European countries are rated better than the NHS and comparative patient outcome statistics seem to support that.

How do all those other countries manage it without creating monoliths like the NHS, the largest employer in all western Europe?

For information:

“The Netherlands was ranked first in a study comparing the health care systems of the US, Australia, Canada, Great Britain, Germany and New Zealand.”
http://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

[38] fine – but why are politicos of all stripes so afraid to ask the British public if they would prefer an insurance based model, especially since, in your opinion, this model is vastly superior to the NHS?

I suspect the question has never been posed because politicos have already anticipated that the public would not agree with your analysis – British health consumers certainly have good grounds to be concerned about the higher cost of health care in EU countries with comparable populations (France + Germany) – especially if we consider how significant this difference is when we total up the cumulative spend for these countries over the last 50 years.

Don

Thanks a lot 🙂

I agree with re the economics too. I’m very cynical about economic arguments. I tend to think that if we can nationalise some of the biggest financial institutions in the world, whilst still seeing ourselves as capitalist, there is little room for the ‘the markets won’t allow it’ argument.

Besides, Tim W didn’t answer my point, which is that – even if you accept his economic argument – the nature of the privatisation is crucial. All this talk of ‘but France’s healthcare system is great’ feels pretty meaningless as that doesn’t seem to be what our government wants.

“Is dental care better since it was handed over to the market?”

Well it is in my experience. My NHS hygienist only used to spend about 10 minutes cleaning my teeth. My private dentist does a much more thorough job.

I – on the other hand – get paid only slightly above the amount required for basic standard of living and have therefore not been to the dentist for 5 years, despite a recurring and painful tooth infection (I do have a friend who used to be a dentist who says I have nice teeth though).

The Tories are the masters of stealth. They want a 100% free market economy. So the NHS is anathema to Tory ideology. Why don’t they start with the BBC because that’s a tax on the poor and they don’t do enough to justify the revenue they get from license fees.

[41] well you can use your sessions with the hygienist as a basis to evaluate the rest of British dentistry if you want to – but since this service was left to the tender mercies of the market it has hardly been plain sailing, has it?
http://www.telegraph.co.uk/health/6232341/NHS-dental-crisis-Can-the-rot-be-stopped.html

@4

“cheaper than free”

How many times? IT’S NOT FREE

@36

A perfect description of how NHS hospitals behave, mainly caused by PCTs.

Where I live (a relatively well off town in the Midlands of c200,000 people) the PCT has tried to move the maternity unit to the big city hospital 8 miles away. A public outcry got it reversed as there are lots of towns of the same size or less which have a full service.

People like R Blogger (PCT member?) just don’t get it – much better that BUPA or other providers run the hospital than the PCT, IMHO.

@39: “but why are politicos of all stripes so afraid to ask the British public if they would prefer an insurance based model, especially since, in your opinion, this model is vastly superior to the NHS?”

I look at the repeating media reports of systemic failings in the NHS and I talk with patients about their experience of NHS healthcare – and especially about what they have witnessed in the treatment of the elderly. And I have my own recent personal experience of shambolic NHS administration to go on.

Against that, I can compare the findings of independent assessments of healthcare systems in other west European countries with social insurance systems and I can speak with friends who have had experience of healthcare in other countries or who have relatives in other countries.

The acute danger from turning the NHS from a health service into a fanatical cult is that the many systemic failings of the NHS will go uncorrected.

but why are politicos of all stripes so afraid to ask the British public if they would prefer an insurance based model, especially since, in your opinion, this model is vastly superior to the NHS?

Are conspirators aware of any polls / studies of the experience of emigrants / ex-pats? Such people would have the benefit of making use of at least two different systems – the NHS and that of the country where they reside.

49. the a&e charge nurse

[46] “much better that BUPA or other providers run the hospital than the PCT” – why – do you have one shred of evidence to why patients would be better off?

You mention maternity services – have you even the vaguest idea how much this might cost – look at this;
http://www.privatehealth.co.uk/private-healthcare-services/private-maternity-services/private-maternity-costs/

[47] your ability to avoid the question being asked remains second to none – so to repeat what was actually asked – if the NHS is so crap why are political movers & shakers afraid to OPENLY ask, or inform, the public that the 1948 model is being scrapped?

Where I live (a relatively well off town in the Midlands of c200,000 people) the PCT has tried to move the maternity unit to the big city hospital 8 miles away. A public outcry got it reversed as there are lots of towns of the same size or less which have a full service.

Your example doesn’t show what you think it does. Moving the maternity unit would have saved money while not harming clinical outcomes – it would have been a Good Thing. That’ll be why the PCT proposed it.

Rather, it shows that an unfortunate hazard of having a state-funded healthcare system is that economic rationality can be sacrificed to the whims of an idiot mob with no idea what they’re talking about. And that’s true under both the NHS model and the government-funded private hospitals model. Not to mention pretty much every other aspect of government spending…

I don’t have private healthcare insurance but I’ve learned that many of my friends do and I can now understand why.

Looking through some old correspondence files, I was reminded of that letter I received in August 2007 from the Pathology Department at my local hospital. Would I please return so they could take another blood sample as they had not taken enough for my recent blood test. The recent blood test was in April – it had taken the Pathology Department from April to August to appreciate that they didn’t have sufficient blood to conduct all the tests my GP had requested. Fortunately, the test wasn’t for anything critical.

@49

“if the NHS is so crap why are political movers & shakers afraid to OPENLY ask, or inform, the public that the 1948 model is being scrapped?”

I can’t speak for 47 but I think the reason is rather obvious. Any time anyone makes any suggestions to change the NHS into something a bit more sensible, the left goes up in flames and dashes around shouting that we’ll be moving to the American system and people will be left dying on the streets.

That this complaint is untrue doesn’t stop it being a political problem, hence the lack of openness and shifting things more slowly.

Centrally negotiated pay agreements in the monolithic NHS means that hospitals and other healthcare units can’t respond to local labour market conditions.

LSE researchers predicted that the ensuing difficulty of recruiting and retaining nursing staff in regions with strong labour markets would have worse medical outcomes than regions with weak labour markets where it is easier to recruit and retain nurses. And that is just what they found:

“Hospitals in the north gain from a more stable pool of nurses. Southern ones have to lean on temporary agency nurses, who can be paid more but tend to be less experienced, less familiar with the hospital and less productive. Do southern patients suffer as a result?

“The economists look at the proportion of patients aged 55 or more, admitted to hospital after a heart attack, who die within 30 days. They find a strong link between this ratio and local private-sector wages. The higher the private wage, making it harder to get good nurses in the NHS, the higher the death rate: to be precise, if the private wage is 10% higher in one area than another, the death rate is 4-5% higher.”
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_TDVGGRSS

The original LSE research is posted here:
http://www2.lse.ac.uk/ERD/pressAndInformationOffice/PDF/CanPayRegulationKilll.pdf

Friends tell me that the quality problems with night agency nurses in London and south-east region hospitals is widely appreciated.

[52] “Any time anyone makes any suggestions to change the NHS into something a bit more sensible, the left goes up in flames and dashes around shouting that we’ll be moving to the American system and people will be left dying on the streets” – eh, the NHS is now on the cusp of wholesale privatisation and there has been barely a murmer from the left [see 2] – this has been one of the scandals of NuLab’s tenure in my opinion, since it was their infatuation with market solutions that put Lansley & Co in pole position?

[53] “Friends tell me that the quality problems with night agency nurses in London and south-east region hospitals is widely appreciated” – as is the problem of getting Bob B to engage with questions that are being asked, or refraining from overuse of contextless factoids.

For example, his last two posts cover;
*friends with private health insurance, before moving on to,
*Correspondence from 2007, then,
*Problems with pathology services,
*Centrally negotiated pay agreements,
*Nurse recruitment,
*Patients having heart attacks,
*LSE research, and finally,
*Agency nurses in London.

Honestly, it’s just like listening to a stream of consciousness – but with little chance of direct questions ever being answered?

@55: Well a&e charge nurse I’ve long since observed your complete inability to respond to the many documented issues with NHS systemic failings or my recent personal experiences of NHS shambolic administration – which naturally raises concerns about your diagnostic skills.

Here is another recent news report, in this case from my local press, which provides insights into NHS productivity issues:

The chief executive of St Helier Hospital has called for a crackdown on nurses accessing Facebook at work after a complaint they have been ignoring patients because of it.

Sam Jones told the hospital’s IT team to stop staff logging on to the social networking site a fter an allegation nurses were checking their profiles rather than helping vulnerable patients at meal times.

The complaint was made to MP Tom Brake by one of his constituents.

A spokesman for Epsom and St Helier University Hospitals NHS Trust confirmed Facebook had been blocked from trust computers for at least two years, but conceded staff may have found ways to get round the ban.

http://www.yourlocalguardian.co.uk/news/local/suttonnews/8381082.Nurses_told_not_to_Facebook_at_work/

If we are going to sort out the NHS we at the very least need to be intellectually honest about its failings. Evidently, one of the greatest barriers to progressive reform is the fanatical denials of NHS propagandists in the face of documented evidence.

57. the a&e charge nurse

[56] that’s simply not true – the NHS has many failings, but none that cannot be found in every other health systems (and this is the point you continually fail to grasp).
I honestly believe you do not properly understand this vital point because there is almost always a complete absence of any analysis to the endless factoids you present (so many factoids, in fact, that we can never do any of them justice).

Clearly you would like a complete reconfiguration of our health system, based on something like the French model if your previous posts are anything to go on?
I am sure there many other critics of the NHS (Daniel Hannan, et al) who also share your view that it is time for root and branch change.

Fine, wanting change (for me) is not the problem, but, for at least the third time now, WHY will our political masters not put this issue to the electorate in everyday language so that we can properly understand each option – perhaps something along the lines of;
*is it time to abolish the NHS?
*would you prefer a system based on insurance?
*would you prefer a system managed entirely by private firms.
(obviously more careful thought would have to be given to the wording so as to capture its TRUE intent).

It is the covert nature of long lasting structural changes to our health system, not to mention a steadfast refusal to describe these changes in terms that we can all understand that has contributed to a climate of suspicion and mistrust amongst many health bloggers.

So please, Bob, no more factoids about diabetes in South Wales unless they are germane to the important sentiments outlined in the OP?

@45:

I’m well aware that it’s not free and I pay for it through taxation. It is, however, free at the point of treatment – if I visit my GP I don’t have to pull out the credit card to pay for it straight afterwards. I’m also very sure that, should the NHS be privatised, I won’t receive an appropriate reduction in taxation to cover the cost of insurance I’ll have to buy.

The latest reports in the news media about the multiple failings of our monolithic National Health Service, which is famously the largest employer in the whole of western Europe – further comment from me in the face of the compounding evidence is obviously superfluous:

Patients Association warns hospitals ‘lack basic care’
http://www.bbc.co.uk/news/health-11889342

Improve out-of-hours care – Royal College of Physicians
http://www.bbc.co.uk/news/health-11889892

Acutely ill patients more likely to die at weekends due to lack of consultants
http://www.guardian.co.uk/society/2010/dec/02/hospitals-lack-consultants

Aide-memoire:

“The full-time occupations with the highest earnings in 2009 were ‘Health professionals’, (median pay of full-time employees of £1,031 a week), followed by ‘Corporate managers’ (£745) and ‘Science and technology professionals’ (£698). The lowest paid of all full-time employees were those in ‘Sales occupations’, at £278 a week.”
http://www.statistics.gov.uk/cci/nugget.asp?id=285

Bob B #59 – funnily enough talking about highly paid health professionals doesn’t get you anywhere. For starters, the vastly inflated salaries many of them get have come about during the moves towards privatisation, as a result of the gvt’s trying to keep them happy and employ more managers. I note you havn’t covered nurses pay…
Secondly, I seem to recall lots of problems in Staffordshire, where the management were so desperate to deal with money and act as if they were a business, they forgot about patient care…


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  107. Could the NHS become the Conservative Achilles heel? | Liberal Conspiracy

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  109. Hannah Cornell

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