This is moving stuff.

Are the Tories really going to get rid of free-at-the-point-of-use healthcare? I thought they were just going to increase private sector involvement in the delivery of healthcare. But I could very well be out of touch.

If you want more life-saving drugs to be available, you need to expand the resources available for healthcare. Isn’t that a quite separate issue to whether private firms are used in the delivery of healthcare (as they are in the Netherlands, according to some the best healthcare system in the world)? Even state-run health services have budget constraints; this drug was not made available under the NHS, so I don’t see how keeping the NHS in its present form is going to make a difference on that front.

Luis: No, there is nothing in this bill that stops the NHS being free at the point of use.

“But it is not always like this, and we are on the cliff edge of a health business which will be run like the banks: with money as the motivator behind every decision.”

The bill simply doesn’t say that, and in fact it specifically says the opposite. The motivator behind every decision has to be quality of care.

There are issues with the bill, and the fact healthcare professionals themselves see problems with it is enough to re-consult and re-amend (those using the law need to actually buy in to it, after all), but the problems posited by the OP just aren’t in the realm of reality.

[1] “Are the Tories really going to get rid of free-at-the-point-of-use healthcare” – are university fees really going to triple …… of course they are.

This Bill signals the end of the NHS, according to Gerry Robertson, amongst others.
http://www.bbc.co.uk/programmes/b014gr72

We have had privatisation of structure.
Privatisation of clinical services.
And as sure as day follows we night it is only a matter of time before we get privatisation of finance – maybe not today, but the shadowy business figures who will end up pulling the strings of GP consortia will soon nudge the British public toward paying for health care as the memory of what we once had goes the same way as the way our university students were once educated.

Ask yourself this – who do you trust most, the likes of Andy, Dave & Nick, who remember just a few short months ago promised no more top down NHS reforms, or the Royal Colleges, Unions, and rank and file NHS workers who have all giving the Bill a massive thumbs down?

I suppose it depends on how easily you are taken by Lansley’s flannel?

My mum died earlier this year. There is a drug that would have extended her life. A drug that is widely available in Europe and America, but it was not licensed in the UK as it was deemed too expensive.

I am sorry for your loss. Someone close to me died in similar circumstances. It was not the private sector that killed your mum (or my loved one), but precisely the kind of jumped up little commissars who have been running the NHS for the convenience of fellow bureaucrats rather than the needs of patients.

I have seen glimmers of what a health service ruled by money looks like. It is sleepless nights, it is pain, it is being offered quick fix drugs not long term prevention. It is death.
I see this already in the under staffed, over worked and under resourced waiting rooms in hospital, after hospital, after hospital.

Yes, you see that in state-run hospitals. Never, in my experience, in private ones.

I see it in my GP’s eyes when she tells me she would love to help me more but that they are simply not allowed because of budget restraints.

And who set those budget restraints that the doctor doesn’t like, but which bind her?

Again, bureaucrats.

The whole point and purpose of this government’s plans is to remove power of treatment decisions from unqualified pen-pushers and hand it to doctors and patients.

You have spotted the right symptoms, but have made the wrong diagnosis.

a&e

you might be right – this is not an area in which I claim any competence. However:

1. pay-for-use does not follow privatization of delivery etc. as sure as night follows day: see the Netherlands and other systems which mix free-to-use with private provision
2. I think UK voters would not like pay-for-use healthcare at all. That may constrain Tories who would like to introduce it.

These arguments are not affected by me trusting healthcare workers more than I trust Coalition politicians.

Is there anything in this bill through which pay-for-use may sneak?

@2

The Bill opens the NHS up to the full force of competition from the private sector.

No private company would be interested in delivering healthcare without profit, and so we should greet their desire to be involved with extreme suspicion. The possible results are: an increase in government spending on the NHS to make room for private profit; or an increase in individual spending on the NHS to make room for private profit.

The former will, in turn, lead to more medicines – like the one that could have helped the author’s mother – being witheld on cost grounds. The only solution to this would be for people to buy medicine themselves. The latter will mean the NHS would no longer be free at the point of use. They essentially amount to the same thing.

5. No.

Secretary of State’s duty to promote comprehensive health service For section 1 of the National Health Service Act 2006 (Secretary of State’s duty
to promote health service) substitute—
“1 Secretary of State’s duty to promote comprehensive health service
(1)The Secretary of State must continue the promotion in England of a
comprehensive health service designed to secure improvement—
(a)in the physical and mental health of the people of England, and
Health and Social Care Bill
(b)in the prevention, diagnosis and treatment of illness.
(2)For that purpose, the Secretary of State must exercise the functions
conferred by this Act so as to secure that services are provided in
accordance with this Act.
(3)The services provided as part of the health service in England must be
free of charge except in so far as the making and recovery of charges is
expressly provided for by or under any enactment, whenever passed.”

There is the door left open for charges to be made (as, for example, dentistry is allowed to) with further changes in law to do so. This is all, it’s pretty explicit. Services must be free of charge.

If the Tories come by later and say all cancer treatment’s shouldn’t be free, that will require another bit of legislation, and that will be able to be dealt with on it’s own (lack of) merits.

“The former will, in turn, lead to more medicines – like the one that could have helped the author’s mother – being witheld on cost grounds.”

This logic does not follow. If the option is to carry on with the NHS’s currently provided drugs (maybe more, under a seemingly now larger budget to provide in your example) or to go with a private company who won’t give you the drugs because their desire is profit. As a patient which will you choose?

“The possible results are: an increase in government spending on the NHS to make room for private profit; or an increase in individual spending on the NHS to make room for private profit.”

Ooops! You missed the third one.

An increase in the productivity of delivery of health care, meaning lower costs to deliver the same health care and thus making room for profits.

Please note that I don’t say that this will happen: Crapita are entirely capable of cocking up even on that simple task.

However, something that economists really have been able to decide upon: market based systems improve productivity better than planned and non-market based systems.

Tim W

Economists have not decided market based systems improve productivity better than planned and non-market based systems when it comes to healthcare. I have pointed this out to you before, and provided references (Handbook of Health Economics, work from Daron Acemoglu) and you seem to ignore this as assiduously as Owen Tudor ignoring tax incidence

[7] if D-Cam can go from this
http://www.youtube.com/watch?v=nH2EmVGowCk
to the most radical reform since the inception of the NHS – I’m sure it won’t be too hard to get the backbenchers, oh, and our Nick, to make the necessary adjustments?

Private sector delivery of healthcare always been part of the NHS – doctors have always kept themselves out of state control (and have been able to milk it for decades now).

[5] just did a long reply, Luis, but it got lost – anyway, put simply, I think the business muscle that will be at the heart of the new system will be the most decisive voice when it comes to how we access health services in the future.

At a recent business meeting Geoffry Howe was touting business opportunities to the likes of Norwich Union and other big insurance firms – I’m sure payment is coming next.
http://www.opendemocracy.net/ourkingdom/colin-leys/nhs-will-be-privatised-it-doesnt-matter-what-british-people-want

Others can cling onto the wording of the Bill if they want to but it won’t matter a jot when the time comes?

“I’m sure it won’t be too hard to get the backbenchers, oh, and our Nick, to make the necessary adjustments?”

The only way they’d be able to, and keep their jobs, is if the public agreed and didn’t make it clear they’d be punished for the change. If they managed to really turn the NHS in to a paid for service it would ultimately be the public that are to blame.

I am sorry for your loss. I would note, however, that the profit motive does a very good job in creating the selfsame drugs and medicines that you refer to.

Neither they, nor the healthcare you mentioned, is “free”. Quite the contrary; it’s very expensive. Funding your hospital stays and my liposuction out of general taxation may or may not be the best way of paying for it, but it’s ridiculous to somehow ascribe to it a higher moral kite mark than any of the alternatives.

@1 With respect, Luis, the tories are anti-NHS and have been for decades. They tried to starve it to death previously and now they seem to be using the door opened by New Labour to fulfil their wildest dreams. This is politics driven by the grassroots of the party.

Cherub, I don’t deny that. I’m just questioning whether they’d end free-to-use. I’m quite sure they’d be happy turning the NHS into a (even greater) profit generator for businesses, either in the sincere belief that would raise productivity, or using that argument as cover.

I’m pretty sure fully private healthcare (aka USA) is less efficient than state administered centralized free-to-use (where everybody in the country is effectively bought compulsory health insurance via the tax system) not to mention far less equitable, and I’d wholeheartedly oppose its introduction here, but I don’t have much of a view about the extent to which private (or not for profit) providers can be usefully employed by a state administered free-to-use system. See, again, the Netherlands.

‘I am sorry for your loss. I would note, however, that the profit motive does a very good job in creating the selfsame drugs and medicines that you refer to.’

I suggest that if you are trying to defend the private sector in the NHS you don’t compare it to how the drug companies operate…

http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=abstract I
‘Medical decisions are based on an understanding of publicly reported clinical trials.1,2 If the evidence base is biased, then decisions based on this evidence may not be the optimal decisions. For example, selective publication of clinical trials, and the outcomes within those trials, can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.’

Guess what – the drug companies weren’t publishing the trials for anti depressants that didn’t show a positive effect of the drug. You can read a write up about it here http://www.medicalnewstoday.com/articles/94267.php

So my question is – can you really trust the private sector with our health when their goal is to make a profit?

If we were being honest, in the sense that we say what we actually believe, rather than merely say enough for the electorate to swallow, I believe most Tories would want to privatise the NHS. I think they accept that the public, including most of their supporters, are intrinsically opposed to this privatisation, but secretly (and in some cases, not so secretly) they find the concept of the NHS repellent. I believe that many of the Tories milling about Manchester are firmly of the opinion that they would rather see middle to lower income paying for private health insurance with perhaps or perhaps not some kind of Government scheme paying for those in the lowest income brackets. I bet I could find a couple of dozen or even more who would expect that those ‘too poor’ to afford health insurance would go and fuck themselves.

This is why they are willing to gamble with the NHS, it is simply not their baby. They opposed it from the outset and the still oppose it now on purely ideological reasons. They despise everything about the NHS, but if these ‘reforms’ fail and leave the NHS in tatters? No big deal because that will encourage middle incomers to switch to private health insurance. These Tory bastards are deliberately attempting to drive the NHS into the ground to ‘wean’ middle earners out of the concept of ‘free at the point of delivery’ health care, because they see that as a stumbling block to privatising the whole shooting match. Once people on good incomes are paying for their own health care directly, do we think they will have a vested interest in keeping paying for an NHS?

This is the same tactic they have used with the Welfare State. Chip away at it so that it is the low paid that benefit from it and you have a group of people who will be hostile to it. Ditto libraries, ditto employment laws. If you can afford a good lawyer, will you be supportive of industrial tribunals?

Anyone who cares a fuck about the NHS who thinks they can trust the Tories with it need their head examined.

Jim. What’s the gamble here?

Jim,

That sounds plausible to me, particularly the idea that once “middle England” has gone private, the NHS is vulnerable. But isn’t there also a possibility that wrecking the NHS simply loses you an election to another party that promises to repair it?

You could argue that the Tories are taking more of a political risk than they know – if their reforms go wrong, they either have to throw money at fixing it, or risk getting booted out. I think voters pay attention to standards within the NHS – many of us use it often enough. But I am veering into pretending I know why voters vote as they do, which I don’t.

You have to remember “point of use”. It’s useless for poor people to have a “point of use” several hundred miles away. When NHS services start shutting down because they can’t compete with the local private services undercutting their prices as a “willing provider”, the same local private services will then start charging.

We rapidly end up with a few departments (depending on the hospital’s speciality) and the A&E being the only free services in town.

[18] “Once people on good incomes are paying for their own health care directly, do we think they will have a vested interest in keeping paying for an NHS?” – a very important point.

It has been said that Thatch nearly went for it
http://www.hsj.co.uk/news/internal-market-was-only-way-to-stop-thatcher-privatising-nhs/26572.article
But because there would have been so much antipathy toward outright privatisation we have had, instead, a drip-drip approach, incremental change and opaque language like ‘any willing provider’ or a secretary of state who will “act with a view” (a term that probably induces a state of sexual arousal amongst certain lawyers).

So erosion of the NHS has come about by stealth, and as you say Jim, once certain sections of our society realise there are winners and losers as a result of these changes, it might be difficult to return to a system where decisions are based purely on ‘clinical need’ (rather than ability to pay) because in essence this requires some to pay for services they might hardly ever use, while others who contribute less (because they are poor, sick, or unemployed) might depend a great deal on medical treatment that they would never be able to pay for themselves.

Once we allow health care to become incentivised by profit we will begin to see these patterns more clearly.

21. This is dealt with by section 23 14S and (to a degree) 23 14Q, and to pretty much ignore sections 23 14Z and section 23 14U.

Please explain how this situation of health services being shut down can happen when the duty for the commissioning bodies (which are largely run by GPs and other health professionals let’s remember) have a duty to improve service, to reduce inequality of care, to allow patient choice and to involve the public on consultation of any changes to commissioning arrangements (who provides what services).

Granted, the last element of that is a weak part of the legislation and should require consultation and not just provision of information, however I’m interested as to how you believe that this situation will be able to occur given these varieties of legal duties?

21. You also ignore (as so many that are blindly railing against the plans rather than more usefully targetting where there are weaknesses) that the bill does not allow commissioning bodies to make decisions based on cost. That is a Labour way of doing things. Value is what matters in this bill, quality of care, integration. The cheapest will not automatically win under the law as set out in this bill.

Jim, a&e

it’s tricky – I see your concerns, but there is a cry wolf problem here. If Labour goes hard warning that the end of free-to-use NHS is around the corner, and it does not transpire, you lose some credibility. Then, if the Tories do get round to it at a later date, voters may not believe the warnings.

My guess is that free-to-use NHS will outlast the present government … I hope I’m right!

@23 – Because you can’t bind private companies into open ended, unterminateable contracts. A termination charge is a small price to pay for what is effectively a captive populace for your services.

[25] “My guess is that free-to-use NHS will outlast the present government … I hope I’m right!” – I accept the exact when is up for debate but let me lay a little Monbiot on you – I think it’s both funny and true?

“The difference between David Cameron and Tony Blair is that Blair was better at disguising his intentions. He would never have announced, for example, the sale of public forests. Instead he might have promised “a world-class forest estate” in which “walker-led beacon foundation woodlands” would be managed through “partnerships with a plurality of recreational providers”. Ten years later we would discover that our forests had mysteriously fallen into the hands of timber companies and were being felled in the name of customer choice.
Nor would he have done anything as stupid as this government’s attempt to transform the NHS in one bill. Cameron sought to dig himself out of his hole yesterday, but too late. His claim that “there will be no privatisation … no cherry-picking from private providers” reminds us that privatisation and cherry-picking are the likely outcomes of his bill. Blair would have allowed private interests to keep spreading through the health service as slowly and quietly as dry rot. In their book The Plot Against the NHS, Colin Leys and Stewart Player show that Cameron’s health and social care bill consolidates a plan that has been fermenting for many years”.
http://www.monbiot.com/2011/05/16/a-death-foretold/

Luis @ 20

But isn’t there also a possibility that wrecking the NHS simply loses you an election to another party that promises to repair it?

As long as the NHS does not suddenly collaspe overnight, then no. By the time you get to the election the NHS is a dead duck. Look at council housing. A generation ago, everyone from a ‘working class’ lived in council houses. No-one would rebuild council housing now because no one wants to pay tax to build other people cheap housing.

You could argue that the Tories are taking more of a political risk than they know – if their reforms go wrong, they either have to throw money at fixing it, or risk getting booted out.

It is a bit like ‘free schools’ in that respect. If every State school in Country closes two months before the election, then the Tories have a problem. If, on the other hand, schools are slowly drained of money, year on year the state education system will get progressively worse until ‘free schools’ are popping up everywhere, then people won’t even notice.

Same with the NHS. Things like IVF start to go down the tubes without too many complaints. Let’s face it, if you have kids you aren’t bothered and if you don’t have them and don’t want them, you are not too interested either. The only people who are in need of it are a minority and can be ignored. A cycle of IVF is what? Five grand? If you can afford five grand, you can afford private health insurance, so you are not a fan of the NHS when you cannot help you in your hour of need. What’s next? Cosmetic surgery? Your local NHS stop pining back children’s ears ‘for free’ and suddenly you got a few more that are looking at private medicine. Eventually the salami slicing leaves us with a crippled system. Waiting lists get longer as you start the death by a thousand cuts and slowly but surely, people move away from the NHS model into these purpose built, up and running private hospitals and health services all too willing to ‘allow’ those that pay to jump the queue. It will be the same hospital, the same ward, the same nurse and the same medical staff, but you will be getting a better standard of care because there will be more profit in it. You get a critical mass of people who use private health insurance and then you privatise the whole system and shit on the people at the bottom of the heap.

The one thing that annoys me about people who harp on about the Tories is they assume they are stupid, nothing could be further from the truth, they are cunning bastards. They know EXACTLY what they are saying, why they are saying it and who they are saying it for.

Luis @ 25

My guess is that free-to-use NHS will outlast the present government … I hope I’m right!

Christ, the vermin are nothing if not patient. It took them thirty years from putting three million on the dole, another three million on incapacity before they set about dismantling the welfare State. The shipyards and Dockers got complacent before they where torn to shreds, and the miners got what was coming to them too a generation or so as well. The unions were wiped out and even the Second War only delayed the process by a matter of decades. They have been chipping away at the BBC and clunking the World service onto it is the concrete overcoat that sees it swimming with the fishes. Health and Safety is merely ‘red tape’ and so is ‘consumer rights’. The Tories are experts at the long game and by christ, it is not a coincidence that the current prime minister is an Eton man, the first since? When?

The Post War settlement is lying in tatters around our ears in less than a Century and not so much as a backward glance from these vermin. The monied class have got pretty much all of the power they lent us to get us through the Second World War and they would like what little we still retain back now. The unemployed are still lazy, the poor are still drunkards and the disabled are still a fucking nuisance. You could have written that back in 1911.

Oh and the old can work themselves into a grave as well, eh?

@28 – Again, pfft, too slow for the sharks wanting chunks of the NHS. Undercutting and taking over functions then charging is FAR more lucrative. And you can easily even close the company and start up another one…you just, for example, have all the equipment owned by a third company, which rents…

This action on the NHS makes it absolutely clear that the Tories don’t give a shit about efficiency or anything else they claim, they care about reestablishing the class system, and about funnelling money to their funders.

” Eventually the salami slicing leaves us with a crippled system.”

Well, no it doesn’t, unless you’re simultaneously cutting the budget for the other services (and I assume the tax take?) by more than the cost of the services being culled off the side.

Also, I’d like to make it clear PCTs currently have the power to do everything that you’re concerned about (both Leon and Jim).

I think the main problem I have with this analysis is that what you’re worried about is what Labour already enshrined in law. The Tories plan doesn’t really change the situation other than to redress who is in charge of the groups that decide where the money is spent, and shift focus of who is involved in the decision making process as to how services are provided.

26. You’ve basically not answered my question, or you need to expand on it to make it clearer what you mean.

@31- To some degree. But PCT’s are also not independent from their doctors and other medical professionals to anything LIKE the degree of a private company, where the business people have 100% control.

It’s a MAJOR change to shift from bodies who listen to people who are involved in clinical practice in terms of patient welfare, to companies which absolutely do NOT, and whose goal is profit, not end results for patients!

Labour also went to far with their changes, incidentally, afaik.

And I was quite clear in 26… companies are quite free, in practice, to offer the moon, go “bust” and set up with the same people in the same place but now charging.

32. Businesses do not take control of the budgets, so I’m not sure where you’ve got this idea that things move from PCTs to businesses. Also actually read the bits I referenced above because it shows just how and why the public have to be listened to regarding their care level.

I say again, I don’t think you understand what is actually being put on the table, especially if you think price has anything to do with it.

Quick question for Lee Griffin:

Why did the Lib Dems not campaign on changing the NHS so dramatically, and why do so many of his own party members still oppose such changes?

~

There is no mandate for such radical change so quickly. It’s free-market high-Tory bullshit, I’m afraid, and the LDs are supping with the Devil by propping it up.

@33 – Sure. They can say “keep the service local”. And they can be ignored because it’s cheaper to do it otherwise. And?

I’m quite aware of the legalities of what’s actually on the table, and when control is removed from healthcare professionals (who have an interest in caring for patients) and into the hands of companies, what actually happens becomes strictly according to the legalities in terms of what the patients actually get. At best.

It is so important, I’ll repeat that. For free.

The NHS is not free. It is simply paid for by the tax payers, not by the sick. Nothing much is free. And it is entirely appropriate to ask if this is the best funding model we have.

But it is not always like this, and we are on the cliff edge of a health business which will be run like the banks: with money as the motivator behind every decision.

Sorry but we will always have a system like that. It does not matter if it is private or public, money determines what can be done and what cannot. We will always have limited resources and so someone has to decide what can be funded and what can’t. What you mean is that you want the NHS to continue to do it secretly behind your back where you cannot see it rather than in public. I am not sure of that. Notice that all GPs were and are private businesses. Do you feel that compromises the quality of their care?

There is absolutely no doubt that if private health care firms are involved in the choices medics are able to make about your health, the foundation stone is profit not well being. Businesses are designed to make money. They are not designed to care.

GPs are businesses. How is the quality of their care? But doctors and nurses don’t work for free. They are paid. They too are businesses of a sort. Do you think that qualifies the quality of their care too?

I see this already in the under staffed, over worked and under resourced waiting rooms in hospital, after hospital, after hospital.

These would be waiting rooms in hospital after hospital run by the NHS would it? So how is this an indictment of anything but the NHS?

I see it in my GP’s eyes when she tells me she would love to help me more but that they are simply not allowed because of budget restraints. With a flicker of regret that betrays she knows full well the words she is forced to utter offend the hippocratic oath.

There is nothing stopping her doing it for free if she wants. The private business she is. But again, those budget restraints are restraints in the NHS, no? It is your socialised medicine that is preventing her doing more, no?

My mum died earlier this year. There is a drug that would have extended her life. A drug that is widely available in Europe and America, but it was not licensed in the UK as it was deemed too expensive.

I am sorry for your loss, but to press the point – the private American system and the public-private systems of Europe provided this drug, but the fully socialised system of Britain did not – and you think this is a condemnation of the American and European systems? Why? It was deemed to expensive by the small minded pencil pushers of NICE – the British government body set up to determine if your Mother’s expected QUALY was worth it. And they said no. How is that anything but a problem with socialised medicine?

My mum was very poorly, but she was a fighter. The fact remains very clear, my mum is dead right now because of a decision to save money.

Made by the government. While private medical systems provide it.

If you want my mum’s story to be the exception, not the rule, you need to act, and you need to act fast. This is the very last chance we have of a National Health Service and not Health Business ltd.

Sorry but that is the rule because of the NHS. Every socialised medical system needs something like NICE. This is where Sarah Palin was right even if her language was strong – the NHS needs death panels. They have them. We keep the NHS, we will also continue to make sure that what happened to your mother will go on happening. It is not a bug, it is a feature.

@37 – Right, and you’re all for the American model. Where the money goes to companies, the cost is far higher for end-users, the poor get nothing and the rich get over-treated. Predictable, predictable and predictable!

“Notice that all GPs were and are private businesses. Do you feel that compromises the quality of their care?”

Yes.

And no, being an employee doesn’t make you a business unless you’re a shill looking to disrupt conversation (again).

The NHS doesn’t have “death panels”, that’s based on a complete, twisted misunderstanding of how the system works, and a clear call for denying medical care to the poor on the American model, which can easily charge the poor an orders of magnitude higher than costs, since insurance is “supposed” to deal with it.

You’re rich. You’ll keep your healthcare. As the poor die. And a third of the “health” budget goes on paperwork. All “features” of the healthcare system you want.

…You’re the bug.

34. Partisan nonsense aside, there are still key areas of the bill that are concerning, either through their action or lack of clarity/specificity. My point here is that it would be better to focus on changing those potentially harmful parts of the bill than act in this much more petulant manner.

35. “when control is removed from healthcare professionals (who have an interest in caring for patients) and into the hands of companies”

There is no part of this bill that allows for this. The opposite is true.

36. “And it is entirely appropriate to ask if this is the best funding model we have.”

Not in this debate, since the bill doesn’t challenge the funding model.

@38 – Better not to challenge the death of the NHS. Better to pretend that it doesn’t actually create a situation actually MORE iniquitous than America, since healthcare for the elderly isn’t protected, for one…

Fantasy upon fantasy. There’s a reason very, very few medical professionals in this country support this bill.

Look, I’m sorry to hear about your mother, but it was the *current* NHS, with no private involvement which couldn’t afford the drugs to save her.

Nor are the coalition plans going to change the ‘free at the point of use’ part of the NHS.

What they are going to do is allow private competition in suplliers of goods and medical services, which up till now has been an NHS monopoly. And lord knows – the NHS could do with some healthy competition to improve service, efficiency and drive down costs. Being realistic, something needs to be done as under the current system costs keep spiralling upwards, and at some point we simply won’t be able to afford it all.

Your article is very sad, but it is emotional rather than based in fact. The post-labour NHS failed your mother, and the tories aren’t about to disband it or even change anything for the users – only the producers of the NHS.

[39] “when control is removed from healthcare professionals (who have an interest in caring for patients) and into the hands of companies” – “There is no part of this bill that allows for this. The opposite is true” – a rather sanguine view regarding the burgeoning influence, and indeed intentions of outfits like Bupa, Humana, Capita, MCCI, United Healthcare, et al.

Perhaps you either fail to see, or simply do not understand how there might be a conflict of interest when private companies are involved in both commissioning and service delivery?

GPs have expressed concern that under the new system, a private company could be advising a consortium to place contracts with sister companies that
own hospitals, effectively putting commissioner and provider in business together.

To advocates of the NHS Lansley’s Bill is like watching a car rolling slowly, and inexorably toward the end of a very high cliff – now if you are a marketeer this is obviously rather good news but for those who prefer our health care to be comprehensive, universal, free at the point of delivery, and based on clinical need rather than ability to pay then it really is the beginning of the end (or given NuLab’s marvelous contribution, perhaps it should read the end of the beginning?)

There is, in some quarters, a fanatical belief that the private sector is in some way ‘better’. This is a very dangerous belief.

Are there things the NHS should be doing better? Yes, of course there are – but the main financial problems, and problems of care come from a LACK of consistency, a failure to exploit the monopolistic nature of the NHS through group procurement and consistency of practice. Individual Trusts have not shared best practices and have largely been left to run their own empires and set their own local budgets when the facts are that the day-to-day requirements of all hospitals are pretty similar on a per capita basis.

Bringing in a myriad of new providers who will be cherry picking, despite the new MONITOR rules (in the event of a car accident, the fire brigade bills the NHS for recovery costs, which GP consortia will be covering that cost? What GP Consortium will carry A&E provision?) is only going to exacerbate the situation.

I’ll put it another way, if it is possible to make profit by doing exactly the same thing as the private sector would be doing in order to appease their owners and shareholders, why SHOULDN’T the state do it, and use the ‘Profits’ to pay down our debt? Heck, wasn’t that what we spent all those billions on consultancy for, to bring the best of private sector experience onboard? If after subsidies it still means that running these centres isn’t profitable, then why on earth should a profit-centred business invest? There are two, maybe three options.

1) The Consortia are run as a zero-profit loss-leaders in order to drive people into financial services and other paid-for products.

2) The Consortia cut corners that would never be allowed from a public service and make unpleasant decisions which would have a government kicked from office.

3) The aim is to move people off the public payroll and thus reduce Britain’s public pension liabilities, but won’t actually save a single penny in day to day running.

4) The whole thing is a tax dodge.

5) Every public servant sits around picking their nose and running businesses on Ebay, but private sector workers are magical robots of steel with 200% better performance – plus it’s easier to sack them.

42. the a&e charge nurse

Perhaps you either fail to see, or simply do not understand how there might be a conflict of interest when private companies are involved in both commissioning and service delivery?

As there is when the government monopoly is involved in both commissioning and service delivery. Every day in fact. Avoidable.

GPs have expressed concern that under the new system, a private company could be advising a consortium to place contracts with sister companies that
own hospitals, effectively putting commissioner and provider in business together.

So what if they did? Although it is kind of hard to see how this would work GPs are private businesses. Always have been. Why would they be concerned about something they may or may not want to do?

now if you are a marketeer this is obviously rather good news but for those who prefer our health care to be comprehensive, universal, free at the point of delivery, and based on clinical need rather than ability to pay then it really is the beginning of the end (or given NuLab’s marvelous contribution, perhaps it should read the end of the beginning?)

There is nothing in this law that suggests there is a threat to the NHS being any of those things. We are simply moving a small way in the direction of the French system. Why is that so bad?

43. Donut Hinge Party

There is, in some quarters, a fanatical belief that the private sector is in some way ‘better’. This is a very dangerous belief.

I agree. But a belief in the market is not dangerous. A belief that the state can do as well without it, on the other hand,is a dangerous belief. It is a natural tendency for people to be lazy. The market won’t allow it – public or private – because the incompetent, the stupid, the lazy, they are all punished. But in a government monopoly the incompetent, the stupid and the lazy are not punished by the market. They can be punished by the State if the State wants to. But if the State is captured by the producer interest – as the NHS has been by the Unions – then it stops punishing the incompetent. And the system slowly dies. It is stupid to think it can be any other way. The incompetent need to be fired. If the State cannot do it, the private sector is the only option.

Are there things the NHS should be doing better? Yes, of course there are – but the main financial problems, and problems of care come from a LACK of consistency, a failure to exploit the monopolistic nature of the NHS through group procurement and consistency of practice.

Sorry but this is absurd. Hundreds of people are dying every year in the NHS from malnutrition and thirst. Because nurses can’t be arsed to do their job any more.

Individual Trusts have not shared best practices and have largely been left to run their own empires and set their own local budgets when the facts are that the day-to-day requirements of all hospitals are pretty similar on a per capita basis.

So basically you want more centralisation? As if our Soviet-style system is not bad enough, you want more managers, more middle men, more red tape and more bureaucracy, all controlled from London, to make the system work better? Have you considered the massive dead weight in costs and responsiveness such a system would impose?

I’ll put it another way, if it is possible to make profit by doing exactly the same thing as the private sector would be doing in order to appease their owners and shareholders, why SHOULDN’T the state do it, and use the ‘Profits’ to pay down our debt?

Actually I agree. Totally. But that requires discipline. The market can provide that discipline, but if you ban the market then you need to sack people. When was the last time anyone in the NHS was sacked for incompetence? It has been captured by its producers, and no longer works in the interests of its consumers. How do you propose to change that?

If after subsidies it still means that running these centres isn’t profitable, then why on earth should a profit-centred business invest?

You forget the obvious – private businesses are run to produce a profit. State owned enterprises are run to protect the workers who work in them. It is that attitude alone that means the private sector can make a profit and the State run sector cannot.

Oh, look!
http://www.dailymail.co.uk/news/article-2045391/Well-treat-minor-ailments-pay-say-NHS-GPs.html

“private companies are involved in both commissioning and service delivery?”

Private companies are not involved in the commissioning. I don’t really know how many more times I need to state this fact. It’s clear neither you or Leon are willing to accept this since your responses each time your misconception is rectified you go right back to generalised rhetoric.

“but for those who prefer our health care to be comprehensive, universal, free at the point of delivery, and based on clinical need rather than ability to pay then it really is the beginning of the end”

No it’s not, since none of those things that we prefer the NHS to be are being threatened, arguably they’re being strengthened by a renewed focus on quality of care, and integration of care, which currently isn’t enshrined in law but would be in the new bill.

Leon: “There’s a reason very, very few medical professionals in this country support this bill.”

Yes, there is, but it’s not the false and fantastical reasons you keep referring to.

[46] “It’s clear neither you or Leon are willing to accept this” – indeed, because all it will take is a few administrative manouvres for company A to appear to be independent from company B.

I’m sure there will be lots of other clever wheezes in Lansley exciting health market?
The NHS will remain still free at the point of entry, of course, but an easy way to side step this inconvenience is to develop a growing list of conditions, starting with minor ailments according to the Fail, which are no longer available without cash up front (because they now mysteriously fall outside the NHS remit) – see, that wasn’t too hard was it?

Remember one of the main drivers for the emergence of public services was the FAILING of the market.
Lansley’s Bill is nothing more than a love letter to those who align themselves with neoconservative views about the virtues of the market.

I’m touched – excellent, passionate article.

[46] “Private companies are not involved in the commissioning” – are you sure?

“Private companies believe the shake-up of the NHS will lead to a big expansion of their currently small role, as many GPs will need their help to carry out their new role as commissioners of healthcare.
Firms which already have small-scale involvement with family doctors are preparing to exploit the chance to gain an unprecedented foothold in the NHS once GPs start spending £80bn of NHS funds.
They said they expected the switch to GP commissioning outlined in the white paper to help them have a much wider involvement with the NHS, and especially to work closely with the 300-500 new “consortiums” of GPs which the Department of Health expects to emerge to become key purchasers of treatment for patients”.
http://www.guardian.co.uk/society/2010/jul/12/nhs-private-companies-gps-funds

The vast majority of jobbing GPs will be looking after their patients as they have always done – they will have neither the time or training to take a direct role in commissioning which will be delegated to those firms with the necessary contract skills and legal knowledge.

@46 – You have no idea about business. You’re defending the death of NHS, and indeed cheering it on without checking why medical professionals are actually opposed to the bill. It’s sadly typical.

Even if it all does perfectly, we’ll see closed hospitals, a failure to pass cost reductions on (since it can be put into profit, after all, and once the NHS department has closed only the private companies are competing…), and entire extra layer of bureaucracy to enable the private companies to compete.

There’s a reason that many of the private healthcare companies are talking about how much profit they’ll syphon off the NHS, though, it’s NOT going to stop there.

@37 So Much For Subtlety

The NHS is not free. It is simply paid for by the tax payers, not by the sick.

Thank god as a tax payer I’ll never get old or get sick so I don’t need to worry about those feckless ill people.

And so it begins?

“HBG Ltd Are Pleased To Announce A New Private Minor Operation Service!” HBG Ltd is, as it happens, “a company that is wholly owned and run by the Partners of Haxby Group Practice”.
http://www.haxbygroup.co.uk/index.php

The mail-shot goes on: “This new service offers the following procedures at a cost of:

Skin Tag(s) £56.30 Ganglion £99.00
Seborrhoeic Warts £156.40 Benign Lesion (inc moles) £243.00
Sebaceous Cysts £214.01 Simple Viral Warts £156.40
Lipomas £243.20 Ingrowing Toenail £146.95

(hat tip, Dr No)