The true horror of NHS privatisation is slowly coming out


4:34 pm - December 14th 2010

by Ellie Mae    


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It seems the BBC has started to cotton on to what those of us on the left have known for a while: that there will be no dancing in the streets when the NHS is finally liberated from something-or-other.

Au contraire: the NHS reforms are likely to be shambolic at best; damaging at worst.

A news story focuses on the Commons Health Select Committee’s response to the obligation of the NHS to make 4% savings year on year for four years, as outlined in Lansley’s white paper.

The article is worth a read in its entirety, but a particularly salient element is Steven Dorrell’s statement that there is:

no precedent for efficiency gains on this scale in the history of the NHS, nor has any precedent yet been found of any healthcare system anywhere in the world doing anything similar.

Yikes. The BBC has characteristically chosen not to stray too far from the party line, however; omitting to report one of the most decisive consequences of these efficiency savings: yep, you guessed it – privatisation.

One of the BFFs of the British government has long been private consulting company McKinsey, who last week warned that GP consortia will be unable to cope with the “drastically reduced management costs set by the Department of Health.”

Naturally, their suggested remedy was the employment of private management consultants who could ease the pain of consortia too broke to cope with demand.

One GP consortia taking McKinsey’s advice is Great West Commissioning Consortium, covering 57 GP practices in Houndslow, which recently enlisted the services of UnitedHealthcare UK to provide a ‘Referral Facilitation Service’ to vet the Consortium’s patients before they are seen by a doctor.

Who is UnitedHealthcare UK? It’s the British subsidiary of US health insurance giant, UnitedHealthcare. In July, the Mirror reported numerous offences committed by the company over the last decade, including overcharging patients, fixing charges, defrauding the US public healthcare system MedicAid, and ‘cheating patients out of money.’ For this, the company was fined “tens of millions of pounds,” a paltry amount in comparison to its £7bn profit for last year alone.

That this is the direction in which the NHS is heading should not be a surprise: Lansley has explicitly said he wants the private or ‘independent’ sector to become more involved in healthcare provision. And of course, that intention is totally unrelated to the fact that Lansley receives donations from private healthcare companies – a fact which Lib Dem Norman Lamb said in January “completely undermines the Tories’ claim that the NHS would be safe in their hands.”

These twists and turns in the future of the NHS, as well as the apparent inability of the media to report the situation transparently, fundamentally alienate us from our own health service.

Regardless of which end of the political spectrum you position yourself, we all have a right to decide who will be treating our ailments and delivering our children – a right which will be denied to us so long as the government continues to push through these reforms with such opacity.

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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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Reader comments


About time we had a riot about this.

There won’t be one because it’s happening incrementally.

I would like to point out I did not write this headline!

The sheeple think Call me Dave is a nice man who loves the NHS. After all , he looks Prime Ministerial or something.

They have no mandate to privatise the NHS, but then they have no mandate to do anything. Nice one Clegg, add this to your charge sheet.

Elllie,

Headlines round here are sometimes unconnected to articles and/or reality.

Incidentally, how is hiring a contractor to perform a service that is currently performed by the NHS privitisation, which requires transferring something from public to private ownership. In this case UnitedHealthcare UK (what is wrong with spaces between words?) are simply being contracted to do something, and the contract is not permanent. Not sure they are the ideal people to do this, but then again I am not convinced the present setup is either. I think we need a more nuanced argument about two things:

1. is direct provision by the state going to be more efficient than a system using state and privately-owned provision (since no-one serious has suggested that the ownership of the whole system should not be by the state);

2. should contracting systems be run in such a way that it gives an unfair advantage to a number of companies which make their money from government rather than from the market, as this does not seem to be using non-government expertise and solutions in any meaningful sense.

@2 Yes I wondered why zombies hordes hadn’t appeared. Is there any chance writers could do their own headlines to avoid this sort of thing.

I think the NHS model is very poor. However, corporatism is likely to be just as bad. Good article.

Since all continental European healthcare systems operate on a state (mostly) pays, others (mostly) provide basis, it is not obvious that “horror” will be the outcome.

“Regardless of which end of the political spectrum you position yourself, we all have a right to decide who will be treating our ailments and delivering our children – a right which will be denied to us so long as the government continues to push through these reforms with such opacity.”

And, unless we can afford private care, a right which will be denied us so long as the state remains the monopoly producer.

Glad you are in favour of choice.

What nobody seems to understand is that the deal has already been done. American private health corporations want to take ove the NHS and the Canadian state system.

And as we have seen what America wants it gets. The politicians are just whores who do what they are told. They just pretend that they are not doing what their corporate masters have demanded.

“And, unless we can afford private care, a right which will be denied us so long as the state remains the monopoly producer.”

What rubbish.

Ever heard of Bupa? I am not stopping you from going private, but you want to destroy my right to have a public system. As usual fake tory choice,

I gather from your article that private companies supplying services IS A BAD THING, but nowhere did you explain why.

About half the NHS costs (the figures vary wildly) is for staffing and half for the services – the bulk of which are already provided by private companies.

Medications, bandages, floor polish, paint on the walls, etc etc etc – all provided by private companies.

Now, you might argue that the NHS is in trouble simply because the floor polish is supplied by private companies – which would support your argument that nationalisation is the way to go.

Yet, we hear constantly that it was 13 years of Labour government spending taxpayers money – on private services – that improved the NHS.

So, is the private supply of services a bad thing – should we be nationalising Johnson and Johnson? Or is the 50% of the NHS which is staffing a bad thing – should we be cutting wages so that staff cannot earn a surplus from their labours, and “profit” from working for the NHS?

I usually have no issue with LibCon headlines. Generally I think they’re much better than anything I could come up with. It’s just that my inherent sense of reserve causes me to bawk at words such as ‘slam,’ ‘terror’ ‘rage’ ‘fury.’ No thanks, I’m British.

Here come the NHS destroyers, right on cue.

sally,

Because the state (normally – Labour did change this) restricts treatment on the NHS to NHS hospitals, systems like BUPA are restricted in the services they can offer (for example, they could not realistically consider offering much in the way of critical care) because there is minimal demand outside the NHS. If they were allowed to bid for NHS patients also (as is proposed) they could lower their prices and/or offer more services. I think that is what cjcj means.

Ironically, I actually think that allowing a greater choice of providers would reduce the demand for private healthcare however much greater the choice and cheaper the price, because the NHS is likely to be quicker (not that tricky…) and hopefully if commissioning is done on any basis other than cost and convenience, have a higher standard of service.

One dimension of the Tory innovations in “the NHS” is worth strongly emphasising. Health policy is devolved to the Scottish Parliament and the proposed structural reforms certainly will not extend to Scotland. On my understanding, equally, the Welsh Assembly has control over its health policy and structures. I’m not saying this to quibble over the competence of devolved governments. What it emphasises, for me, is how talking about “the NHS” tends to obscure the politics which are actually involved here. It fails to identify that these are ~English~ reforms for England, which are being resisted in different parts of the United Kingdom.

Or to put it in more positive terms, a decidedly different version of the welfare state and the involvement of private provision continues to be articulated in these islands. Speaking about policies as if they are universally encompassing precisely concedes the logic of Tory rhetoric – that the changes are technocratic, necessary – and so on. Differences obtaining across the devolved nations precisely demonstrates that they are not. The metropolitan fixations of the English left, it seems to me, precisely robs them of a potentially useful way of reimagining and reframing any case against these reforms.

That may well be one outcome.

But I was simply making the general point that the social democracies of Europe have not chosen to go with a centralised, monopoly producer approach.

“Horror” is not a word frequently used when describing their outcomes.

“If they were allowed to bid for NHS patients also (as is proposed) they could lower their prices and/or offer more services. I think that is what cjcj means.”

Oh you mean cherry picking the nice bits but leaving the difficut stuff to the state, that will be in decline.

But the bottom line is that it is more welfare for corporations. Hand out our money to private corprations who buy the politicians. YEA, noting could go wrong. Just like we hand over money to bankers to screw up.

17. Margin4error

The real concern over privatisation comes with the “freeing” of GPs from the system.

GP surgeries are already in effect private bodies – but with a mandated role that they undertake.

The freeing of their budgets combined with a number of other changes is not likely to lead for long to a situation whereby they hire managing consultants to run the money side (and let the doctors do the doctoring for which they are trained)

Instead over time it will lead to surgeries being taken over by private companies who provide GPs with their wages and make decisions about how their budgets are spent.

That is where we will then have private companies making decisions over how public money is spent on public health – with the ever-wondrous use of “commercial sensitivity) to keep us, the public, from scrutinising any of it.

14. Actually I’m Welsh 🙂

But I care about what happens to the NHS in England cos of human beings n that.

17. Yes that’s already happening. I believe Humana already runs 3 GP practices in the UK. Also here’s one I made earlier: http://lurehumano.wordpress.com/2010/11/30/353/

20. Margin4error

Oh – and on the managing consultancy issue being different to buying bandages from a private firm…

Bandages are not decision makers. Bandages do not have much by way of significant influence over what treatment is and isn’t to be granted. Bandages do not apply pressure to practices to sack GPs or nurses who don’t abide by often private guidance not subject to public scrutiny.

Bandages are bought, from a range of suppliers, by people who have some reasonable comprehesion of the prive and inter-changeability of different brands of bandage.

Are we so confident that GPs are as able to procure decision making and financial management in the same way?

For many reasons, it is thoroughly misleading to speak of the NHS as providing a coherent, national service. It doesn’t, as recent news reports demonstrate, such as the abuses which continued for years at the Mid Stafforshire Hospital Trust and the differentially high rates of amputations among diabetes patients in the south west region.

The “privatisation” issue is just so much bombast and political froth. The practical, fundamental issues are the breaking of the documented election pledge made by Cameron to protect frontline healthcare services, the potential downstream consequences of abolishing the Primary Care Trusts and the challenge in today’s news of targets to achieve hitherto unprecedented “efficiency savings” thoughout the NHS.

I think present and future patients of healthcare services will be more concerned with the future substantive realities of healthcare provision than with debating the hypothetical merits or otherwise of grand abstractions like “privatisation”.

The NHS was created when the notion of state-owned monopoly suppliers of services was highly fashionable in Britain but much less so in most of western Europe. The extensive documented evidence of systemic failings in Britain’s NHS is hardly a persuasive advertisement for the superior benefits of the British model. Other west European countries have well-functioning healthcare services without a state-owned and controlled edifice which amounts to a near-monopoly supplier of healthcare services. With a total of 1.3 million employees, the NHS is on record as being the largest single employer in western Europe and among the largest employers in the world.

22. Luis Enrique

Ellie,

I think it’s a mistake to assume that the NHS sub-contracting services to private providers is always a bad thing. As others point out, we have routinely done it in many areas since the inception of the NHS.

But I think I side with you when it comes to suspicion of the sorts of deals you describe. The long answer has to do with contracting difficulties, but in short I think private sector companies often know how to fleece the public sector when they’re put in charge of running things. Anyway, I can certainly agree that these things ought to publicized and scrutinized.

I think you’re last to paras are a bit over cooked. I don’t really understand why NHS reforms of any sort “fundamentally alienate” us from it – I don’t really know what that means. And whey you talk about how “we all have a right to decide who will be treating our ailments and delivering our children” it’s not obvious how that right is better exercised under a state-run-and-delivered NHS than a state-run-privately-delivered NHS. Of course the way our democracy works is that whoever is in government has the right to make changes to the NHS, notionally on our behalf. Our rights are not obviously being infringed when the government makes changes some of us don’t like. I’m not sure exactly what you mean by your last paragraph.

Margin4error,

Your concerns only have validity if those running the practices start dictating to GPs about what treatments and costs they can and cannot use. Any attempts to dictate treatment by anyone who is not doctors is surely wrong?

This can presumably be avoided by making it an end of contract occurence for GPs to be overruled by their management.

Anyway, most established GP surgeries are partnerships, like lawyers etc, which tend to be quite stable, and the partners are likely to do better as such than as employees, so unlikely to sell out.

Furthermore, if we have competition between GPs and freedom of information, it should be pretty clear which GP practices care for people and which don’t. At the moment too much bad service is available because people do not feel they have a choice (they do, but they do not see this).

In total, I think your objection is a bit of an irrelevance, considering it can be overcome quite easily and depends on assuming that their is a monopoly on patient care.

22. I should rewrite that really. I meant it doesn’t matter which side of the fence you sit on – the fact is the public should be involved in the decision-making process. If you’re going to privatise it because that’s really the best option, why not do it openly? That’s how it’s alienating.

Should read like this:

These twists and turns in the future of the NHS, as well as the apparent inability of the media to report the situation transparently, fundamentally alienate us from decision-making process surrounding our own health service.

Sunny, can you change that pls?

It is all about breaking it up. That is the first step. And if you run it down at the same time which is what most tories want you create the ideal situatation to flog it off.

I

@22: ” I don’t really understand why NHS reforms of any sort ‘fundamentally alienate’ us from it – I don’t really know what that means.”

Exactly. Some are absolutely fixated with the notion of the NHS as a socialist monument regardless of how well it functions.

The very real political problem ahead is that the public debate will get hung up on defending the monument idea and overlook the real practical issues arising from what is being proposed by the government

@1. sally

About time we had a riot about this.

Actually I think it will be closer to defenestration. The middle classes will not like it when their local hospital gets part or fully privatised, and they will go to their Tory MPs and tell them to do something or else they’ll be out at the next election. This is why much of Lansley’s plans are being obfuscated and under reported. The Department of Health has 40 spin doctors, more than any other department, who are busy now spinning stories against the NHS to try and get the public against it and compliant for the privatisations. The best thing that the Left can do is to counter these stories as soon as they come out. The Left should also lobby the Labour party hard and shame them for bringing in much of the privatisation laws. It’s about time that Dead-Ed told us whether he’s in favour of public provision of healthcare – I asked him this face to face a couple of months ago and he ducked the question.

@2. Ellie Mae

I should point you toward the LibDem policy on the NHS. It is clear that they are just as much in favour of privatisation as the Tories. In 2005 Clegg gave an interview with the Indy where he said he wanted the NHS broken up and the introduction of health insurance.

@4. Watchman

While you are right about contractors (after all, the carrot you eat in a dinner given to you as a patient was not grown on a state-owned farm) the fact is that at the moment commissioning is (mostly) done by PCTs as public bodies with public accountability and subject to FoI requests etc. Handing this work over to UnitedHealth is privatisation because the work that was done by a public body is now done by a private body. Of course, there is no accountability and you cannot get information about UnitedHealth’s decisions through FoI requests.

@10. IanVisits

I suggest you look at the post I did for LibCon before the election. The NHS is very cost effective (well, d’oh, they have no shareholders to pay!). Privatisation will cost more. Further, we will have no public control over what they do, no accountability. For example, my local hospital makes a surplus on all its departments except Paediatrics (it treats too few patients, so it makes a loss). Paediatrics is subsidised by the other departments and the hospital provides the department because it is a public service and they do it for the benefit of the public. If they were a business then they would not run a department that makes a loss. Patients would have to go to another hospital.

@13. Watchman

Because the state (normally – Labour did change this) restricts treatment on the NHS to NHS hospitals

OFT states that 23% of the income of private hospitals come from NHS patients – mostly so that trusts can meet the 18 week target. Of course, since Lansley has now reneged on this guarantee with the public, trusts won’t give the private sector the work.

The problem is that “any willing provider” will only work in some areas, and the private sector will cherry pick. They will do cataracts and hip ops that will make them pot loads of cash, but leave the difficult cases to the NHS. If Lansley was serious about a market (he isn’t, he just wants to offload the entire NHS, so that the government has no responsibility for provision) then he would mandate that private hospitals take the same case-mix as NHS hospitals. Lots of obese, poor, smokers rather than the healthy middle classes which they know they can fleece.

@14. Lallands Peat Worrier

Yes health policy is devolved, but the GPs’ contract is UK-wide, and Lansley will make sure that it is re-written to include a responsibility for commissioning. That will push a lot of his re-org policies onto the other nations in the Union.

I do have to laugh at these poor , deluded people who think we will get the European model.
,
Under this bunch of tory Euro sceptics who hate everything European you must be joking. No, we will get the US model with our politicians so in awe to the American way.

Ellie Mae,

It’s still a horror.

What has been polite and sweeping things under the carpet done for good ol blightly eh?

The problem with this is two things-

1) These conversation are ALWAYS been done by the same people who all look the same with their own agenda’s and their own way of doing things. We know the majority of ethnic minorities, working class and women use the NHS. Where are they on this table on how to blimming change it? But of course those arsewipes in govt only really react to who ‘lobbies’ the most.

2) This utter rubbish about this fair, just and equal system we have here! How can anyone look themselves in the face and say this?

Case in point-I (stupidly!) wanted a slice of the pie in public sector procurement. Did the research, even was able to start some focus groups in my local area to see what people wanted and from their service providers. By numerous people in the nicest possible way-inc someone who worked in govt-I was told don’t bother. They want touch you unless you come with 20-30 odd experience OR they have worked with you many a times.All this opening up the market is all ‘media talk’ to seem fair.’

And of course they were right. Especially if you have a penchant for reading Private Eye, how many times do we need to be told what an insider job this is?

@19. Ellie Mae

Humana offloaded 30 of their GP practices to Virgin Healthcare (I wonder if they do maternity services too 😉 ) But the Big Daddy is The Practice plc who took over Chilvers McCrea a few weeks ago, so that now they run 50 practices.

I would like to know how this will interact with the consortia. Lansley has given no guidelines whatsoever about consortia (he cannot be arsed) so potentially a consortium could contain practices from all over the country with no geographical connection.

This may mean that you could get (say) Virgin opening up a practice in each major city and make each a part of the Virgin consortium. They may even say that you could visit any of the Virgin practices. This will change healthcare as we know it – you will no longer have a “family doctor” and more importantly, the sort of people who would best benefit from such a set up would be the young, mobile and healthy people who rarely use healthcare. (Indeed, in a market, this is the sort of patient that the private companies would actively seek) So they will be paid to treat people who do not use the service (lovely profits there!) whereas other areas with elderly patients (heavy users of healthcare) and paid the same per patient will struggle to balance the books.

31. the a&e charge nurse

[22] “I think it’s a mistake to assume that the NHS sub-contracting services to private providers is always a bad thing” – the NHS ALREADY subcontracts a great deal of work to non-state providers (and have done so for a long time, especially when it comes to non-clinical services).

If you believe that sub-contracting is a good idea can you highlight just one service that provides better CLINICAL standards compared to the traditional delivery of the same services, or put another which sub-contracting development epitomises your argument – PFI’s, ISTCs?
http://www.uk-sh.co.uk/about-us/media-fact-sheets-and-faqs/faqs-about-istcs

[13] “I actually think that allowing a greater choice of providers would reduce the demand for private healthcare” – yes, that’s right, because the next logical step will be to start introducing charges at the point of delivery.

Remember when Uni fees were introduced for the first time in 1997 – it didn’t take too long for these charges to be tripled did it?

I would have more respect for the politicos if they didn’t wrap their bullshit in specious rhetoric – in time ability to pay will be an important variable in the sort of health care you receive, in just the same way as it will prove (in time) with education.

The notion of abolishing the Primary Care Trusts (PCTs) so GP-managed consortia can directly do treatment commissioning sounds great but the PCTs did more than commissioning. They provide a patients’ liaison service, for example, to mediate disputes, and the PCTs monitored the outcomes from commissioned treatments – which is how the data emerged about the differentially high rate of amputations among diabetes patients in the south west region.

Who or what will provide those functions when the PCTs are abolished? We need to know.

Traditionally, GPs have been the advocates for patients when PCTs have refused to authorise treatments on cost grounds or in disputes with hospitals over the quality of care. Who will do that when treatments are commissioned by GP-managed consortia?

These are substantive issues which will really affect patient welfare.

27 great post as usual.

I agree that Labour should start to fight on this, but many New Labour morons think everying American is shinny and bright.

The 40 spin doctors is rich coming from the party that compalined about spin doctors.

Once again the Lie Dems are to blame for going along with this.

34. Luis Enrique

a&e 31

why yes, I have detailed data on the CLINICAL standards and the COSTS of providing them (don’t forget about COSTS) for a range of direct provision and sub-contracted services right here in my back pocket.

no … I regret to reveal that my belief that it’s not impossible for private providers to sometimes do a better job that state run providers is based on no more than a reading of the general literature on public versus private provision, which shows evidence that private sector can perform better when it comes to the provision of some services, combined with the belief that there’s nothing about medical services that make them inherently impossible for private providers to provide efficiently and to a high quality.

here’s the sort of thing I’m talking about

http://www.bris.ac.uk/cmpo/publications/ppfinal.pdf

Privatisation eh? That must mean tax cuts are a-coming. I’ll keep my eyes open (but I won’t hold my breath, as they won’t be actually privatising anything any time soon)…

Richard @27,

I don’t think we can do a FoI on patient care, since that is personal data? But I do believe all government contractors should provide the same level of information as government departments (about how they spend the money), since it is public money. Not much to ask, but would deal with the problem.

And it is not privitisation since the government can take the contract away, award it elsewhere or run it themselves. Privitisation requires ownership of the contract to be sold, not a contract awarded.

As to the issue of cherry-picking, if the private sector can offer better or faster cataract treatment for patients, but not better or faster heart transplants, how is that actually a problem? It still means people get better or faster treatment. Now, if it can’t offer either (which in reality we know is not the case – a relative recently got seen within a week on private, when they would have waited months on the NHS), they won’t get the customers. If trusts and the PCTs control access, then they will channel the patients through the NHS unless they have targets to meet, regardless of benefits to patients or otherwise. If GPs can chose, they will generally get the best service to patients, be it NHS or private.

Also, if the private sector knows it can increase capacity, it can start to offer procedures and treatments it does not offer already, because it knows there will be a market, so I would expect a liberalisation of the current procurement system to result in a greater range of services offered by private providers, with more competition, which has to be the patients’ benefit.

In short, I worry that this is an ideological war, concerned with profit and the like, which ignores the fact that more providers means quicker treatment and also the likelihood that competition will improve service. Of course, if you want to make the case that the NHS as constituted is fine, feel free, but to just assume it (as assumed here) is lazy and probably a sign the argument is lost.

37. Margin4error

Watchman

The concern about management consultants making medical decisons is as you say the most significant concern.

We should not be complacent about it. In an ideal world one could envisage a rule or document or something equivelent that would prevent that ever happening. Indeed your final two paragraphs are amazingly optimistic in that regard – but in reality it isn’t. We know about collusion, cartels, corporate sensitivity resulting in lack of scrutiny, and of course good olf fashioned cover ups and imperfect information.

Cash does weigh heavilly on medical provision, and mangement consultants are decision makers with finance as their primary concern.

So it would be foolish to imagine that significant direction for decision-making would not be set by managers, and that their influence, though informal, would not be significant.

Then you get into those lovely grey areas that are utterly impossible to publicly scrutinise, legislate for, or be caught doing something unambiguously illegal in.

In regards to GP surgeries being like legal partnerships – I see little problem with that. The problem is that partnerships is not what they are legally obliged to be. Under new rules the can become more conventional private companies, or more likely, can be merged into more conventional private companies.

At that point GPs are effectively employees who do what they are told.

Now if told by a publicly accountable government that the public votes on and that is obliged to make public its decision making process, consultation, and considerations – and that exists, fundementally, to serve the nation (which is what government is for whether we agree with a specific one or not) – that is probably OK.

If told by a private company protected from scrutiny by claims of corporate sensitivity, and which is accountable to shareholders, and which exists, fundementally, to make money (which is what private companies exist to do, all be it many do not harm and a great deal of good in order to get money) – that is probably not OK.

I would love to share your optimism. But having studied economics, having a fairly well informed understanding of the corporate world I live in, and having seen personally the kind of inadequacies that legislation often carries – I just can’t share that optimism.

Sally,

There isn’t one European model of healthcare – there are multiple models. The Netherlands is currently rated as having the best according to several independent assessments:

“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

The LibDems are not just “going along with this” but are in the driving seat for many aspects – hence this interview with Paul Burstow, minister of state in the Department of Health and a LibDem MP, this morning on the BBC:

Paul Burstow expects NHS to cope under spending plans
http://www.bbc.co.uk/news/uk-11988858

Let’s be clear, the efficiency gains of between £15 and £20 billions sought amount to over 15 pc of the NHS budget.

Like most, I’m highly suspicious of this proposed change to the NHS. I would add however it’s time for us to pay real attention to detail by scrutinising every emerging issue – in particular criteria for awarding contracts and terms and conditions of those employed. Standards of care first and budgets second. I’ve no interest in peripheral issues beyond the first two.

@ 30 “This will change healthcare as we know it – you will no longer have a “family doctor” and more importantly, the sort of people who would best benefit from such a set up would be the young, mobile and healthy people who rarely use healthcare”

And these are the very people who have got the NHS into a position where it will soon have no choice but to charge. The “worried well”, the young, middle class health obsessed hypocandriacts, the type of people who thetrically cough if someone lights a cigarette half a mile away, have overwhelmed the service with their demands for instant access to a specilists for every cough, cold, ache or pain whenever they feel like it (remember polyclinics, which were designed for just this sort of prat to have a scan whenever they though they needed one, preferably in their lunch break).

Nu labour, of course, hugely encouraged this neurotic mass obsession with “health”, massively stimulating demand for NHS services by endlessly battering the population with health “information” and indulging every health pressure group no matter how obscure or ridicuolous – remember those ridiculous anti-salt adverts with the slug ??

Margin4error,

Hence my determination that we have transparancy. I would also suggest ensuring that no local monopolies could be created and limiting company involvement to a very small number of GP practices. GP practices are not the problem in the NHS, and so do not need much change (and I have not noticed much movement for such change anywhere).

I am optimistic, but mainly because I believe that like vampires, corporate corruption tends to die in sunlight, so openness and transparancy are good solutions. Also, if I was not optimistic, why would I bother with politics – to drag others down with me?

Matt @40.

I’d be more likely to consider your point seriously if you’d stop using the Nu Labour thing. It’s as pointless and irritating as the ConDem or Lie Dems things that other people use, apparently to be funny (or perhaps just to disguise the weakness of their argument).

40. Matt Munro

Good posting. Lord Beveridge (Liberal) did not intend to include those you mention.

NHS hospitals now routinely hire in agency nurses from private-sector agencies to fill staffing gaps and if you speak with patients who have stayed in hospitals, you’ll soon appreciate that there often issues over the quality and commitment of agency night nurses.

Centrally negotiated pay agreements in the monolithic NHS means that hospitals and other supply 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.”

Uniform pay in the NHS costs lives
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_TDVGGRSS

@ 42 I’m not gonna miss an opportunity am I – and let’s face it nu labours bedrock support was 30 something middle class health obsessed dinkys.

@7. I wondered about that too. It’s a strange conclusion to find within this article.

By its very nature the NHS is the antithesis of choice – it gives us no “right to decide who will be treating our ailments and delivering our children”. We are constantly told that this is a good thing, leading to the lowest costs and highest quality of service of any healthcare system anywhere. If we had the right to decide – if we could choose not to pay for the NHS in our taxes, and pay for BUPA etc. instead – then that would be a bad thing. Or so it is said.

“The right to decide” is the last thing an NHS advocate should mention, because that’s the argument of the NHS reformer and the NHS abolitionist. The advocate’s argument has to be that people MUST NOT be allowed to decide, because they will surely make decisions that are good for them personally, but bad for the poor, the elderly and disadvantaged, etc. “The right to decide” is the very last thing that the advocate stands for.

It’s the lies and deceit that get me.

Cameron parading his dying child , and telling us he loves the NHS. While all the time tipping the wink to the hungry corporations who salivate on the sidelines at the huge corporate welfare that awaits their greedy shareholders.

And as for the Lie Dems words fail me. Are the Lie Dems now Clegg alone? Time for some of them to start fighting their leadership , or they can kiss goodbye to their party for another 100 years.

@ 46. Vladimir You need to go private. The NHS was never designed for your bespoke needs and hopefully never will be.

“kiss goodbye to their party for another 100 years”

Now you’re making real sense Sally – even to me !.

50. the a&e charge nurse

[40] you are right – I think we do have a major issue when it comes to expectation, although I would necessarily agree that we should blame the doctors for this sort of mindset.

I heard it said the other day that the two most important symptoms to generate unnecessary health costs are stupidity and neurosis – I will not lose any sleep if the worried well are expected to be a bit more self sufficient but there are other’s with significant problems, especially many of our oldies, who I suspect will find things even tougher (if that is possible) once health services are put in the hands of Beardy Branson & Co?

sally,

Have some decency – the death of children is an issue which should not be a matter of politics, whatever your beliefs.

52. Chaise Guevara

@ 40 Matt Munro

“And these are the very people who have got the NHS into a position where it will soon have no choice but to charge. The “worried well”, the young, middle class health obsessed hypocandriacts, the type of people who thetrically cough if someone lights a cigarette half a mile away, have overwhelmed the service with their demands for instant access to a specilists for every cough, cold, ache or pain whenever they feel like it (remember polyclinics, which were designed for just this sort of prat to have a scan whenever they though they needed one, preferably in their lunch break).”

What’s your basis for claiming this? The impression I’ve always gotten is that most pointless visitors to the doctor are pensioners and parents with young children, which makes sense as both groups have more reason to worry and (often, at least) more time in which to book appointments.

This wouldn’t be another one of your evidence-free attacks on everyone younger than you, would it?

46. I’m not in favour of choice in the sense cjcj describes. I’m not saying we should be able to choose Bupa or Humana or whoever else – I don’t think that. I think everyone should have access to the same level of good quality, local healthcare, free of charge.

I’m saying *if* the NHS is reformed, we have a right to decide how, given that it belongs to us.

For the record I don’t want the NHS to be reformed in the way Lansley is advocating and I certainly don’t want it to be privatised.

54. Chaise Guevara

@ 7 cjcjc

“And, unless we can afford private care, a right which will be denied us so long as the state remains the monopoly producer.”

Hang on. If we can’t afford to go private and there is no state provider, surely all that leaves us with is home surgery. You’re acting as if the state are cruelly pushing a particular doctor on a particular patient, whereas in fact all they’re doing is giving that patient the chance to see a doctor at all.

It all sounds a bit like Palin’s “Death Panels”, better renamed “At Least Some Of You Will Live Panels”.

55. the a&e charge nurse

[52] “What’s your basis for claiming this” – well one measure might be the a relentless increase in ambulance call outs?
http://news.bbc.co.uk/1/hi/health/6418241.stm
?
Or a 33% increase in patients with minor ailments pitching up at A&E
http://www.pulsetoday.co.uk/story.asp?storycode=4124714

There are about 250 million consultations between patients and GPs in the UK every year. 15% of the entire population sees a GP in a two week period.
http://www.gpcurriculum.co.uk/rcgp/12_facts.htm

It seems everybody is sick nowadays – if haven’t realised it then maybe you are just not looking hard enough?

@ 46 – So you get run over by a truck and want to have “a choice” of who saves your life ? How are you going to exercise that choice ?
You can’t have “choice” in the public sector, because choice requires an excess of supply over demand, something that by definition can’t exist efficiently in a public service. One of the things that wound me up about Blair so much was his obsession with “choice” in public services, as though acessing a GP should be like choosing a mobile phone plan.

51 Watchman

I agree with you but in this situation, a lot of disability groups have been upset with what Cameron did with his child. Google it.

I felt the whole thing was so rehearsed it upset me and people I know who are disabled. Camera’s, light….do you have no shame? I guess not. Of course not.

58. Chaise Guevara

@ 55 the a&e charge nurse

“well one measure might be the a relentless increase in ambulance call outs?”

“Or a 33% increase in patients with minor ailments pitching up at A&E”

“There are about 250 million consultations between patients and GPs in the UK every year. 15% of the entire population sees a GP in a two week period.”

Um, what do any of those statements do to prove that most of this problem is down to young people?

59. Chaise Guevara

@ 57

I thoroughly dislike Cameron, but I baulk at accusing him of exploiting the death of his own child. And you can always find plenty of people from demographic-based groups to voice noisy offence, especially if they dislike the person in question (and if I were disabled I certainly wouldn’t trust Cameron).

@ 52 My evidence was from a blog I used to read “NHS Blog Doctor” written by a GP whose surgery was regularly full of yuppies who came in for “a chat” about this or that minor health issue they’d read about in the news (“allergies”, “intolerances”, that sort of bollocks) on the way back from the gym. However, for empirical evidence see @ 55.
Life expectancy and virtually all other health outcomes are improving almost by the day, and yet demand for NHS services keeps going up – it can only mean that a lot of people who aren’t sick are using the service.

61. Dick the Prick

I did a bit of briefing paper for this about a year ago and whilst it does appear that its been sprung on you (which is more to do with CCHQ being run by teenagers and the DoH being a piece of shit) I can assure you there’s loads of logic in it.

It’s all about patient journeys & outcomes which should be improved. The NHS is relatively unsustainable at the mo. By dovetailing it in toward social care budgets and less on clinical stuff it will save money. It’s gonna be hard and sure, fight when you need to but don’t just knee jerk into oppribrium – check out the proposals first.

I completely concede the information streams on this have been utter shite but, well, that’s another thing.

@ Matt

If I have a toothache, I have to pay (a relatively small sum) for a consultation to have the problem investigated.

If I have an earache or a sprained ankle, the consultation is free of charge.

Why is that?

And which of those conditions would I be more likely to put up with for a day or two to see if it went away on its own?

I’d be willing to bet that a small charge for a GP consultation would halve the overall bill for that sector of the health service.

Worth a few trials surely?

63. Chaise Guevara

@ 60

You and a&e both misread me, so I suspect that means I was unclear. I wasn’t challenging the assertation that the number of “worried well” are rising, I was challenging the assertation that these new time-wasters (if that’s a fair term) are primarily young people. None of a&e’s links seem to say anything to that effect, and unless I’m confusing you with someone else you do tend to go on diatribes about the Unworthiness of Youth Today.

@ Chaise

Do you know Cameron?

Think about it and I know you do with your comments, how many times have we-public-accused someone of a lower class when they did something dodgy? I’m not talking about but opportunism. I know/see so many people who do this all the time but I guess they are working class, so it’s not such a big deal?

I’ve worked with people with disabled or even normal kids they wanted to get rid of and the stuff they span? Or put across was wrong.

Cameron, yes you are unique in your fold that not everyone you know has struggles so the issue with your child gave you empathy BUT we did not need anymore details about the poor lad or his situation because how much hVe you shafted the disabled?

Just ‘read about it’ Chaise.

65. Chaise Guevara

@ 60

Oh, and allergies are not “bollocks”. I have a couple of minor allergies, one of which is fixed very nicely with medication and the other of which is no problem as long as I check the ingredients list of certain products, but the nastier ones can be incapacitating or fatal: see nut, bee, wasp allergies etc.

66. Chaise Guevara

@ 64

Rantersparadise

“Do you know Cameron?”

Surprisingly enough, no. Just like (presumably) everyone else on this thread.

“Think about it and I know you do with your comments, how many times have we-public-accused someone of a lower class when they did something dodgy? I’m not talking about but opportunism. I know/see so many people who do this all the time but I guess they are working class, so it’s not such a big deal?”

I really don’t think it’s fair to call me out on class here. I’m not saying, or thinking, that we should give Cameron special treatment because he’s posh. As a politician, he probably gets the opposite of special treatment, which is fine up to a point, but having a go over his dead son seems harsh even to me.

“I’ve worked with people with disabled or even normal kids they wanted to get rid of and the stuff they span? Or put across was wrong.”

I (genuinely) think you’ve fumbled that sentence a bit, could you rephrase it?

“Cameron, yes you are unique in your fold that not everyone you know has struggles so the issue with your child gave you empathy BUT we did not need anymore details about the poor lad or his situation because how much hVe you shafted the disabled?”

I don’t know, I think this is a lose/lose situation. If he’d kept a stiff upper lip about it, his detractors would have accused him of callousness. And if he’d suddenly started prioritising care for the disabled after his son died (much as I would have approved), he’d have been accused of being blinded by personal issues.

“Just ‘read about it’ Chaise.”

So far you seem likeable, so I’ll let that one pass.

Matt or Chaise,

You will never be able to stop hypochondriacs because they will always finned away.

Yes I agree, I have seen a lot of time wasting but also as a patient, the doctors ENCOURAGED the time wasting, when all I wanted was some advice.

Before my dad died, he obv through his job internationally use to pay for all our health issues inc dental. So it was obv private because that is what international people bring into this countries economy, although with my mother I wasn’t international but still.

Went to Harley Street and oh my god if I wasn’t been told this and that would do the job and then later etc etc. At the time, I was young, I thought this made…..too much money sense…but when nothing was resolved apart from them making k’s and me STILL having tooth issues as well seeing through later research they did more then they had to, how can one trust private service providers?

My sister is in banking and keeps on going to the docs, yes, I think she’s a bit of a hypo BUT the doctors encourage her to make a bottom live profit.

When you start dealing with peoples health and education with pound signs, the end result is…..a horror.

@ 62 “I’d be willing to bet that a small charge for a GP consultation would halve the overall bill for that sector of the health service.”

Worth a few trials surely?”

I would agree, say a fiver a visit would weed out a lot of time wasters. I think this has been looked at by govts of both hues and filed under “too controversial”

@ 65 – Ok some allergies can be serious, but intolerances are bollocks, and I have to say when I was young (not quite as long ago as you seem to beleive) people didn’t get allergies in anything like the numbers they claim to now.
I think I went into a long diatribe about Gen Y once, but I don’t think I make a habit of it

69. Chaise Guevara

@ 67

“Yes I agree, I have seen a lot of time wasting but also as a patient, the doctors ENCOURAGED the time wasting, when all I wanted was some advice.”

I’ve experienced that, although it was the clinic rather than the doctor to blame. I needed to fill a regular seasonal prescription (one involving drugs that don’t get you high or anything like that, so I don’t see why anyone would cheat). Despite the fact that I need these drugs every year, they demanded that I come in for a check-up, which is not required practice.

So I got thrown into their system of impossible appointment booking (you call on Tuesday, they say they only make appointments available on Friday; you call on Friday, they say “they were all booked by Wednesday, you should have called sooner”), and waited weeks for the appointment, which in my case damages the effectiveness of the meds.

Of course, when I finally did get to see the doctor he pronounced the whole thing as bloody stupid and fixed things so I wouldn’t need to get an appointment again. Another case of well-meaning incompetence!

70. Chaise Guevara

@ 68 Matt Munro

“Ok some allergies can be serious, but intolerances are bollocks, and I have to say when I was young (not quite as long ago as you seem to beleive) people didn’t get allergies in anything like the numbers they claim to now.”

I think that intolerances are a bit like whiplash: many cases are genuine, but the general impression given is that a lot of people bullshit about it and therefore everyone claiming the condition is treated suspiciously. I’m pretty sure lactose intolerance is real.

The other issue is that they tend to be diagnosed/defined symptomatically, so it’s difficult to draw the line between genuine IBS, for example, and people who just have a slightly senstive tummy or eat things they probably shouldn’t.

As for the higher amount of allergies around: multiple factors. Improved medical knowledge means more diagnoses, while cleaner living conditions, taken too far, put people at higher risk of things like hay fever and asthma. Also, some things are routinely called allergies that are in fact intolerances, which means they can suffer from the same problems I mentioned above.

“I think I went into a long diatribe about Gen Y once, but I don’t think I make a habit of it”

Cool, but then please don’t start another one here! I repeat that my (equally anecdotal) experiences suggest that young people are not considered a major problem group in terms of wasting GPs’ time.

Chaise @69

Of course-this has also happened to me. All the time.

In fact, I STILL had tooth problems and had to use NHS, it was like your experience, although not that incompetent.

What is the solution? We have to meet half way between private and state. But what the Tories want to do….

Or what Labour did??! (since 97)

72. the a&e charge nurse

[58] “what do any of those statements do to prove that most of this problem is down to young people” – yes, we are cross purposes here Chaise, I was not accusing younger patients as a discrete group just a huge surge in demand which I think is related to expectation?

Mind you I think a fair few ARE young adults but I do not have any stats at hand to back this hunch up.

[67] medicine has increasingly become risk adverse – if a patient presents with non-specific symptoms (sore throat, headache, aches & pains) in 99.999% cases it will be a benign self limiting illness but a minority will prove to be prodromal meningitis – then we get headlines like this;
http://www.pronurse.co.uk/news/articles/2060-huge-payout-to-boy-left-brain-damaged-when-hospital-missed-meningitis-signs

Sadly there is no sure way of knowing (although it all seems so straight forward in retrospect) but a prescription for antibiotics will usually exonerate the doctor from subsequent blame?

As I feared, the important issues are getting brushed aside.

Cameron has broken what was a highly attractive election pledge:

“David Cameron has denied that ‘tough’ decisions on spending will mean cuts to frontline health services while campaigning in marginal seats he needs to win to secure overall victory.” Nursing Times, 4 May 2010
http://www.nursingtimes.net/whats-new-in-nursing/news-topics/conservative-party/cuts-wont-hit-frontline-nhs-insists-cameron/5014238.article

This was a Telegraph news report on 4 December 2010:

“Across swathes of the country, patients waiting for the most common types of surgery, including hip and knee replacements, and cataract operations, will now be forced to wait months longer for treatment.

“Patients’ groups described the decisions as ‘desperate’, warning that thousands of people, especially the elderly, will be left to suffer in pain this winter as their conditions deteriorate.”
http://www.telegraph.co.uk/health/healthnews/8181390/Patients-denied-hip-surgery-and-fertility-treatment-amid-NHS-cash-crisis.html

I know of patients who have already been pushed into going private as a result – and that can cost them or their insurance companies dearly I’ve learned.

The problem with getting hyped up on privatisation is that substantive issues get overlooked. No one here has mentioned this in today’s other news:

“An investigation into how well the £5.5bn private healthcare market is working is being planned by the Office of Fair Trading (OFT). It will examine the nature of competition in the market, as well as whether it is fully competitive.

“The OFT said its preliminary research had raised questions about whether the market was working well for private patients.

“It aims to formally launch its investigation in spring next year.”
http://www.bbc.co.uk/news/business-11988768

I would have thought it important to know how competitively the private healthcare was functioning before launching into NHS reform, but there you go.

Btw note how the £5.5bn private healthcare market compares with over £100bn spent by the Exchequer on the NHS in England. We spend relatively little on private healthcare in Britain.

@16 sally: “Oh you mean cherry picking the nice bits but leaving the difficut stuff to the state, that will be in decline.”

Let us assume a starting point where the NHS provides all direct health care. 100% of it, rather than the muddle that we are in at the moment. And then we allow companies to bid to provide parts of the care provided by the NHS. Contracts would be awarded to the lowest bidders who could provide service at NHS standard.

Naturally, companies would bid to offer services that they could do more cheaply than the NHS. Some might call this cherry picking, but it means that the NHS cost for those particular services is less. More money to spend somewhere else.

Of course, that does mean that the NHS performs most of the expensive stuff — transplant surgery, A&E, long term illnesses, mental health care etc. But the NHS is already doing that. They are providing those services for which we pay as NHS funders.

The fact that private companies have cherry picked the easy stuff has no effect on the expensive stuff. Zero additional cost. The same people will be doing it with the same budget. Or possibly a bit more if savings elsewhere are shared out.

Naturally, there are a couple of provisos. Private care providers must provide it to the same standard as the NHS, in order that the NHS is not burdened with the costs associated with bad procedure.

A more complicated proviso is economy of scale. If a small NHS hospital loses too many bids for basic care, overheads are spread more thinly. Economics would argue that this is an opportunity for small NHS hospital to sell its services to a private provider.

@ 74 But where is the evidence that private healthcare providers actually *are* cheaper ?

@56, Matt Munro.

That would be emergency care. This is separate from routine, non-emergency care, and the NHS already makes that distinction internally (c.f. waiting lists).

I’d imagine that emergency care would have to be provided by a single tax-funded organisation for each city or town. Maybe this would be run as a public service, or maybe it would be privately run but publicly funded. Either way is good, and if it’s private but publicly funded, then the taxpayers have an opportunity to demand better results for their money. (Which we can’t do with the NHS.)

But I agree with you about Blair’s ludicrous obsession with “choice”. In fact it ties neatly in with my original comment, where I said that choice and the NHS are incompatible. “Choice” is meaningless within the context of the NHS, where patient choice just means added inefficiency. To have genuine patient choice you have to allow taxpayers to opt out of paying for the NHS (apart from emergency care). Somebody else here told me to get private healthcare. Good idea, but I can’t afford it. Only the rich can afford to pay for the NHS and private healthcare, everyone else has no choice.

@75 Matt Munro: “But where is the evidence that private healthcare providers actually *are* cheaper ?”

Given the cost of services, I believe that they would be covered by EU contract law for open tendering. Probably an “open book” exercise where the bidder provides an explanation of the costs to provide a service to the organisation that raises the tender (other bidders are still in the dark).

Even with companies that provide the most open books, there are surprises; a tertiary supplier might provide a bonus if a sales target is achieved, which might be very beneficial to the bidder.

In the case of NHS versus private company bidders for an NHS contract, the NHS bid will be under most scrutiny. The NHS bidder might try to hide direct costs under the umbrella of overheads but that would be very foolish; auditors are supposed to report that sort of thing.

Most bids contain dodgy statements, a fact acknowledged by bidders and tenderers. And private companies who lose a bid act aggressively. So if you cook your books a lot, you’ll be in court without a reputation.

@53, Ellie Mae.

Thanks for clarifying.. we are using words like “choice” and “rights” in different contexts. You are using them in a wider democratic context – “we have a right to decide” – whereas I am using them in a local, personal context – “*I* have a right to decide”.

I wonder what you mean by this, though. How can such a complex sort of choice be made by the whole population? The only way is surely by representative democracy. But we already have that! If our representative MPs are mostly in favour of the Lansley plans, then don’t you have to accept their decision?

I suppose you could argue that the current democracy isn’t good enough to accurately represent the people’s wishes. (You would be right.) But the people’s wishes aren’t necessarily in line with the best idea, given how easily influenced most of them are, and how little most of them know about the NHS. So again, we are back to the need for representatives, and if the representatives go to Lansley for advice, don’t you have to accept that?

@56 Matt Munro: “You can’t have “choice” in the public sector, because choice requires an excess of supply over demand, something that by definition can’t exist efficiently in a public service.”

I almost missed this point, but it is a misconception.

Choice does not require an excess of supply. Supply on demand is how all good providers delivers services. If private companies can provide goods or services on demand, then public bodies can provide the same.

Ownership, per se, is irrelevant. Management is what matters if you are bothered about service.

80. the a&e charge nurse

[77] the insurance based models of France, Germany and Switzerland all cost far more than the NHS and if we total up the culumative-difference since the inception of the NHS the only mystery is how well the NHS has done given the disparity in funding.

[76] do you think there is meaningful choice amongst high street banks especially amongst the little people who only have 3p in their current account – how long would it take before American corporations, or perhaps beardy Branson would get a stranglehold on the health market?

The health pound in the NHS is ALREADY pretty good value for money – the market once applied to all of health care will inevitably result in;
*higher costs (USA spend 17% of GDP on health – we spend 9%).
*an end to the principle of universality.
*the introduction of payment at the point of delivery.
*clinical services geared toward procedures that attract the most dosh.

@ 77 “Given the cost of services, I believe that they would be covered by EU contract law for open tendering. Probably an “open book” exercise where the bidder provides an explanation of the costs to provide a service to the organisation that raises the tender (other bidders are still in the dark).”

Neither guarantee that the private sector will provide the service cheaper than the existing service. An obvious tactic might be to bid low (as in below cost) to get the contract and then impose punitive charges for even minor variations to the contract, say £80 to hang a picture on the wall or wire a plug. Massive margins on even the smallest change over the long term (PFI is normally 20 + years) massively increases overall cost. This is already happening on hospital PFIs set up by the last government. And as we don’t own the hospitals and as the bidder needs a long time to recover the cost, we are locked into paying them, whether we need them of not, for decades. For an example of how wholly private healthacre (doesn’t) work, look at the US, the largest private healthcare market in the world, it is simulatnaously more expensive, and less effective, than some 3rd world health services.

“Ownership, per se, is irrelevant”

See my PFI example above, what you don’t own, you can’t control.

“Management is what matters if you are bothered about service.”

I would argue that professionalism is more important, “management” is, all things considered, largely bullshit.

@81 Matt Munro:

“An obvious tactic might be to bid low (as in below cost) to get the contract and then impose punitive charges for even minor variations to the contract, say £80 to hang a picture on the wall or wire a plug.”

I am familiar with that tactic. However, in the case of patient care, contracts are delivered on the basis of a defined treatment. There is (or should not be) not much room for wiggle.

“Massive margins on even the smallest change over the long term (PFI is normally 20 + years) massively increases overall cost. This is already happening on hospital PFIs set up by the last government.”

PFI is indefensible. PFI was about constructing buildings (capital) and paying for some running costs on the never, never. I deeply pray that all politicians and managers understand how stupid it is.

“I would argue that professionalism is more important, “management” is, all things considered, largely bullshit.”

As a professional, I have equal contempt for “do-nothing, never-done-anything”
managers but I occasionally get my way. Good companies are run by professionals. Manager is not the antonym of professional.

@82: “However, in the case of patient care, contracts are delivered on the basis of a defined treatment. There is (or should not be) not much room for wiggle.”

Sadly, there is often too much scope for lots of wiggle over what constitutes good patient care – which is how we get cases like the patient abuses at the Mid Staffordshire Hospital Trust, which continued for years:
http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11711097

I had an instructive experience from talking with other patients while in convalescence from surgery recently. They had tales from time spent in hospitals of what they considered inconsiderate or neglectful treatment of patients, usually elderly patients. One lady, in convalescence for orthopaedic surgery had been in intensive care with pneumonia just a little further back. Her summary was that the medicine in hospital is usually good but the patient care may not be.

FWIW my impression is that the NHS has very challenging and fundamental problems in some regions with recruiting and retaining committed, quality nursing staff, which hospitals compensate for in a variety of ways, like hiring agency nurses and hiving off what were once nursing tasks to cleaners, low-level admin staff, physiotherapists and to nursing assistants.

Abolishing the Primary Care Trusts isn’t going to resolve those fundamentals. As for the unprecedented efficiency gains now required by government, the chief executive of my local hospital trust has just mailed all hospital trust staff asking that they give up holiday entitlements to help meet the savings targets set – link to press reports available.

Every single country in the developed world has a mix of public and private healthcare. All of Europe’s top 5 healthcare systems are ran with a very large element of private money and private investment. They deliver better outcomes, have better facilities and provide better value for money.

Only two countries in the world have 100% public provision of healthcare, North Korea and Cuba.

Incidentally, the “privatisation” of the NHS started under Labour’s stewardship, you didn’t protest then and this is naked agitation because Labour is not in power now.

Vladimir

That’s an interesting question. When I referred to choice, I was referring more towards democracy and transparency, rather than the population coming together and making a collective decision.

In other words, we are being denied the opportunity to support or oppose the reforms because the government is not making clear what the implications of them are. So we are being shut out from the democratic process.

No I certainly don’t think we have to accept that Lansley knows best simply because we elected him. By that logic a politician could pass any bill, no matter how obviously damaging it was.

84

I know this is a difficult concept to grasp, but sometimes – just sometimes – there are people who criticse the Tories AND Labour. I’ll give you a moment to assimilate that.

In today’s news: Boom in NHS work for private hospitals
http://www.ft.com/cms/s/0/675afcb4-07b7-11e0-a568-00144feabdc0,s01=1.html?ftcamp=crm/email/20101215/nbe/DrugsHealthcare/product#axzz18BBIdTZ0

As reported, patients are opting in greater numbers for treatment in private hospitals when these can meet NHS prices.

87. Chaise Guevara

@ 84 Mike Thomas

“Incidentally, the “privatisation” of the NHS started under Labour’s stewardship, you didn’t protest then and this is naked agitation because Labour is not in power now.”

Who didn’t protest, exactly? Because I remember a lot of criticism of Labour’s behaviour from left-wing sources.

88. Chaise Guevara

@ 85

“I know this is a difficult concept to grasp, but sometimes – just sometimes – there are people who criticse the Tories AND Labour. I’ll give you a moment to assimilate that.”

LOL. Well put!

89. Margin4error

watchman

Experience of private contracting in the public sector suggests transparency is a forlorne hope. It is too easy for firms to hide behind corporate sensitivity, and all the more easy for them to hide behind medical confidentiality.

Competition and transparency would be fine – and by all means be optimistic – but when talking policy a degree of real-world thinking is needed too.

So how would you ensure such transparency? For example, if it seemed that a GP surgery or surgeries were not refering normal numbers of people for expensive diagnostic tests – how would you see that investigated?

You could not look at medical records as that breaches patient confidentiality.
You could not look at the accounts as that would be commercially sensitive information.
You could not prove that there was a normal level of the relevant condition if diagnosis had been prevented.
You could not show without a whistleblower that GPs had been guided informally to alternative decisions.

At present we have a degree of optimism that a system built on doing public good results in, by and large, the public good. A system built on making money might inspire less faith, and experience suggests would deserve less.

90. pete stanway

its the sheer deceit that upsets me
Cameron said “no top down changes to the NHS”
and this is a huge td change

91. pete stanway

How can we trust Cameron when he said no Top Down changes
today he said they are not changes but reforms

“you didn’t protest then ”

I must have been imagining the election of Dr Richard Taylor as an independant when he unseated a labour MP.

i seem to remember Nurses For Reform (an adam smith institute ‘think tank’) meeting up with ‘call me Dave’ prior the the election ,promoting private health care…
as in their words the NHS is a stalinist plot..or some such nonsense..that and health minister rubbing shoulders with a big private health care company does not IMHO fill me with confidence about NHS future…now you could say ‘whats wrong with that? well to me quite a lot because why would you want to? its got bugger all to do with NHS…which as far as I know a public service NOT run for profit…so why ‘consult’ with them in first place? what is it with this idea that ‘business knows best’ theory..ive yet to see what benefits it provides..apart from lining their own pockets..

why does the NHS need a ‘business model’ (management speak) when its not a business..ie it does not produce x amount of tins of beans per week..


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  31. Deborah Segalini

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    This will be …





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