How a subtle change in the NHS will turn patients into customers


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9:15 am - December 7th 2012

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by Claudia Tomlinson

The Government is introducing a change to the NHS that seeks to turn hospital patients into customers by asking them to take a loyalty test from April next year. It is one of many new NHS schemes intended to groom patients to think of hospitals as businesses.

We are used to being asked for feedback after shopping, going to a restaurant, or using a call centre. From next April, if you attend an A&E department, or have an overnight stay in hospital this will also be your experience. Before you leave, you will find yourself shepherded to an electronic device such as a kiosk, or tablet to tap out your experience.

You might be given a questionnaire or feedback card to complete before signing out. Or shortly after leaving hospital, you will get a text message, telephone call at home, or receive a postcard or questionnaire at home asking you to register your opinion.

Everyone knows that things can go seriously wrong in hospital care of patients, and patients have to be given ways of making their experience known. It is right to keep an eye on what patients are experiencing. That can be achieved without introducing a system that will ask patients to demonstrate their loyalty to a particular hospital by recommending it to others.

This is quite different from recommending a restaurant. Hospitals will be forced to ask discharged patients whether they would recommend a particular ward or A&E department to friends or family, if they needed similar care or treatment.

Called the Friends and Family Test, it will be part of the NHS Contract which provides hospitals with their income so they could face financial penalties if they do not comply. Results of the test will be published nationally for all hospitals.

The Government has rushed to implement this under researched methodology, based on the Net Promoter Score developed by Frederick F. Reicheld (Harvard Business Review, 2003) as a technique to boost company growth by creating customer loyalty in business.

Simply, those customers who give high scores are ‘promoters’ who are likely to shop with the company again, and speak well about it to others. Those who give low scores are ‘detractors’ who will speak badly of the company to others, and are unlikely to return.

Then there are those in the middle, the ‘passives’ or ‘neutrals’ who are fairly satisfied with the service, but will probably go elsewhere if they find something better.

A pilot at NHS Midlands and East has been operating this year, and publishes the results on their website, listing providers in order of performance.

Do we really use hospital services in the same way as we choose mobile phones? Or is it as it looks, and the Government is taking another step in creating greater market awareness in patients, pushing us further along the road to treating the NHS as a business. Let us hope NHS loyalty cards are not looming.

—-
Claudia Tomlinson is a London based public sector worker, researcher and writer, specialising in politics of health, inequalities, and internationalism. Views are her own

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Reader comments


No, we don’t choose hospitals like mobile phones but we are paying customers, albeit indirectly. Surely any organisation that wants to improve its service would want to solicit feedback.

The notion that ‘patients are customers’ was a product of Thatcherism and NHS staff were then told to find other terms to address the ‘patients’ – ‘clients’ became popular, service-user is the current term used in the mental health services on the basis that a client or customer usually chooses to purchase goods/services, but with detained service-users, it wasn’t appropriate to use a term that suggests individual choice.

Not sure what teachers now call their pupils/students, but considering much of health care and education is not a choice it has always seemed strange to me that a market
analogy is being used. And, of course, the power balance created by the conditions of any interaction with health care professionals really does not foster the idea that ‘the customer is king’

Public sector worker objects to public feedback.

Who knew?!

I pay for a service. Can steveb please explain why I’m not a customer?

And healthcare is a choice. I could choose to go private, or go to Romania or the US. Foreigners choose to come here. Americans have their teeth fixed in Mexico. Have you not heard of Health Tourism?

Hospitals make a habit of treating everyone who uses them as badly as they possibly can. The chance to give feedback is a great idea.

In principle this is a good idea – we need to ensure that there is a warning system about problems in patient care for government/managers to identofy issues before they lead to patients dying. Such a system may well have identified mid staffs earlier.

However it does also need to be combined with protection for whistleblowers, greater advocacy services, and resources for staff so that instances such as hospitals running out of clean linen don’t happen.

The proposals described here are flawed. Often people who are mistreated will not speak up whist in hospital, so asking them to complete surevys in the very same building is self evidently flawed. Secondly, patient relatives should also be included. Finally, it goes without saying that such research should be conducted by people who know what they are doing. There is an awful lot of meaningless crap in market research, and these proposals could simply end up being used as PR tools for the companies involved knowing the media never question research methodology etc.

When I worked at the DWP on the DLA/AA section there was a push to call claimants ‘customers’, so it’s not an unexpected move, and likely reflects the ideology of senior civil servants nicely.

3
Strawman alert.

4

If you took more notice of what I have written, I was referring to those services where the ‘customer’ had no choice to ‘consume’ certain services, and that is much of health, education and social care. The absolute foundation of a market is ‘free entry and exit’, when we have a law which forces us to participate, it is incongruent with a market situation. What kind of feed-back would you expect from persons who have been forced to take treatment against their will?

6
Well said

Erm, we don’t have much of a choice whether to eat or not, do we?

Having Healthcare free at the point of use is tremendously civilised, however there is a dark flip-side:

a) The providers can appear rather resentful or hostile towards patients (after all, they’ve already been paid so each new patient is a nuisance).

b) The users don’t value or respect the service as they should, because it’s “free”.

Both attitudes are fairly basic aspects of human nature. Any attempt to square this circle ought to be encouraged, though it would be nice to see the providers more involved in how this should work. Otherwise, the unimpeachable ones may feel they’re being poked with a stick.

“(after all, they’ve already been paid so each new patient is a nuisance).”

Technically speaking, in England, they don’t. They get paid per procedure. So the incentive here is to treat as many patients as possible for the shortest amount of time. In Wales the payment system is different, but it is still the case that each unit needs to treat a certain number of patients in order to meet royal college guidelines, otherwise the unit will probably be merged with others in a larger hospital.

So basically your wrong. Each additional patient is good news for a hospital.

steveb @ 8:

“I was referring to those services where the ‘customer’ had no choice to ‘consume’ certain services, and that is much of health, education and social care.”

In recent decades, we have recovered some choices in education (bog-standard comp, academy, free school or private, private with bursary etc), health (private or some increasing choice of NHS hospitals) and social care (state, charity or combination + buy-in of personal care). And, surely, choice must be extended further in public services – against the whinging of the provider interests!

“The absolute foundation of a market is ‘free entry and exit’, when we have a law which forces us to participate, it is incongruent with a market situation.”

As usual, you are deeply muddled, steve. Free(er) markets admit of degree. No-one is “forced” to participate in state or private provision, despite the fantasies of authoritarian socialists who would abolish private medicine and education in favour of a ‘Trabant/Skoda’ healthcare and schooling for all….Though, that said, many are now faced with accepting poor quality public services – think of Anne Clwyd’s husband dying neglected in our “caring” NHS. The NHS and our education system are currently a national disgrace: they can be improved only by introducing more customer feedback and by judiciously involving more private but state-funded providers.

“What kind of feed-back would you expect from persons who have been forced to take treatment against their will?”

But no-one has been “forced” to take treatment against their will. Faced with a sub-standard NHS service, most accept what is available (believing, mistakenly, that it is the best), while others go private. Social ‘democrats’ and ‘democratic’ socialists seem to want less customer-responsive service in health and education: the state knows best, so take what you are given…? And, please, don’t pull the ‘libertarian socialist’ utopia jag: we’ve been there, it won’t happen and/because it is a contradiction in terms.

Jack C @ 10:

“Having Healthcare free at the point of use is tremendously civilised, however there is a dark flip-side:

a) The providers can appear rather resentful or hostile towards patients (after all, they’ve already been paid so each new patient is a nuisance).

b) The users don’t value or respect the service as they should, because it’s ‘free’”

Exactly!

Regarding (a), the solution is surely to make hospitals more customer-focussed and less provider-led by judicious privatisation and better management… Anecdote alert – (i) I recently visited (on my NHS consultant’s advice) a private hospital for a £500 cancer test that the NHS does not provide. The service was superb: everyone made eye contact,was polite and made me feel welcome (even the cleaners), and none of the nurses were uncaring, waddling lard-arses. And (ii) I have had 4 elderly relatives die in NHS hospitals in different parts of the UK, and 3 died in appalling circumstances of neglect.

Regarding (b), agreed – just as, before prescription charges, people would visit the doctor for a ‘free’ prescription for elastoplast, paracetamol etc. This, and ‘health tourism’, suggest that minimum charges should be imposed, as on the continent. These could be automatically refunded to claimants, and many other problems could be covered by private insurance schemes with state supplements (as in France – widely regarded as the best health-care system in the world).

The results of any such hospital surveys are biased. Patients who died as the result of medical and care errors aren’t able to respond.

BBC: How safe are our hospitals:
http://www.bbc.co.uk/iplayer/episode/b01p4wmx/Panorama_How_Safe_is_Your_Hospital/

This problem of treatment errors and care failings isn’t new – it goes back to when New Labour was in government:

More than 3,000 hospital patients have died because of errors by NHS staff in England over the past year, figures show.

Hospitals reported 3,645 deaths in 2007-8 from patient safety incidents, data from the Lib Dems showed. [BBC website: 5 January 2009]

@11,
Point taken, though in my defence I was generalising to make a wider point.

After all, a particular nurse, for example, on a particular day will probably not be much driven (on a personal level) by the overall target.

I’m not seeking to criticise either healthcare workers or patients, though I think it reasonable to say that some on both sides are negatively affected for the reasons I suggest.

I can speak from personal experience of NHS hospital errors. Shortly before a scheduled hip operation in October 2010, I was presented with a surgery consent form with the wrong hip on it. Similar errors are surprisingly common:

- A toddler who fractured her leg was sent home with a plaster cast – on the wrong limb. Lucy Rylatt hobbled on the broken leg for five days before her parents realised the mistake. [Metro July 2012]

- A doctor who removed the wrong fallopian tube from a patient, leaving her unable to conceive naturally, has been allowed to continue practising.
A tribunal criticised Dr Samina Tahseen for her “hasty, careless and dismissive” treatment of the woman at Royal Derby Hospital in 2010.
The Medical Practitioners Tribunal Service panel found this amounted to “serious misconduct”.
“There is now no possibility that Patient A will be able to conceive naturally”
But they decided she could continue to practise if she is supervised. [BBC 16 August 2012]

- A surgeon is waiting to learn if he will be struck off for removing a healthy kidney instead of a cancerous one from a patient in Ayrshire. Riza Murat Gurun admitted carrying out the operation at Ayr Hospital in 2006 without checking John Heron’s scans. He has also admitted charges in relation to two other patients, one of whom died shortly after surgery. [BBC website February 2010]

Do we really use hospital services in the same way as we choose mobile phones?

Quite simply, yes we do. Customer choice driven through performance will improve standards as a whole through competition.

Who in their right mind would choose a poor hospital unless they are forced to. If you have the choice between a good hospital and a poor one, you’ll choose the good one if you can – especially if it is something as important as healthcare.

“Who in their right mind would choose a poor hospital unless they are forced to. If you have the choice between a good hospital and a poor one, you’ll choose the good one if you can – especially if it is something as important as healthcare.”

C’mon. In reality, patients often have little effective choice about which hospital they go to and virtually none in A&E cases. In most cases, the choice comes down to going to the nearest hospital with the relevant facilities.

I’ve responded to several official NHS post-op surveys which amount to no more than tick-box questionnaires. In responding, I’ve sometimes included an unsolicited note with written comments but I suspect that is unusual and, probably, unwelcome.

Is anyone keeping tabs on the amounts being paid out by the NHS in compensation for treatment errors and care failings?

“Who in their right mind would choose a poor hospital unless they are forced to”

If the poor hospital also offers a cheaper service (easyhospital type of thing. Dr Nick in the Simpsons) then it will easily survive in any form of market driven system. Health commissioners will pick it over the luxury hospital as it is cheaper, a private insurance company will do the same for the same reasons (except for customers who pick more expensive premiums), and private individuals who lack the income will probably take the chance.

Lets consider the following example to illustrate this. Hospital A offers hip replacements for £5000, on average their success rate is 80% of operations last for 5 years. Hospital B offers hip replacements for £25,000 that last 8 years on average in 90% of cases.

Which hospital is going to get business from (a) a state funded body responsible for comissioning services?, (b) private insurance firms specialising in offering cheap premiums? and (c) Individuals not in the top 5% of earners?

And that’s before we get into the information asymmetry that is inherant in the majority of healthcare systems. Hospital B may only be succesful precisely because it has wealthy clients.

20. the a&e charge nurse

The concept of the ‘customer’ is a necessary development within a health system driven incrementally toward marketisation.

In time some ‘customers’ might be wealthy enough to afford deluxe health services (akin to flying business class, if we take a travel analogy) while the rest of us will just have to make do with Ryan-air.

When SERCO or VIRGIN are running hospitals they will be clean, uncrowded, and staff will always be smiling and helpful – there will even be policeman there to keep out the riff raff, just ask Wills, or Kate.
http://i4.mirror.co.uk/incoming/article1472136.ece/ALTERNATES/s615/Prince+William+arrives+at+the+King+Edward+VII+Private+Hospital+

There is a highly successful market in healthcare in France is there not?

The state pays but (crucially) is not the monopoly provider. The patient chooses.

22. the a&e charge nurse

[21] we can’t afford it (and neither can the French nowadays).

The French system has ALWAYS cost more than the NHS – the cumulative difference must be astronomical.
http://online.wsj.com/article/SB124958049241511735.html

As usual tories talk endlessly about choice (unless it is abortion) But they only really believe in choice for the rich.

This is about changing the relationship between patient and hospital to one of customer. It is ideologically driven by the international right wing and is about turning health into just another commodity. Which for most people it is not. When you need emergency service you don’t have either time to browse or travel to other areas. This data will be used to help flog off hospitals to the tory politicians corporate masters.

Anyone who has ever filled out any customer survey for gas or water or mobile phone or airline knows how pointless it is. The greatest myth in capitalism is that companies care about their customers. They don’t. Capitalism is about giving the least possible service or product for the highest possible price.

Once health has been sold off the the real choice will set in. But you won’t be choosing the hospital. The hospital will be choosing you.

@22 I’m sure they will have to make savings but I hardly think they are going to switch to the “envy of the world” state monopoly are they?!

25. the a&e charge nurse

[24] ‘I hardly think they are going to switch to the “envy of the world” state monopoly are they’ – unlikely, that would require providing comparable outcomes at significantly lower GDP.

Ignore the substantial difference in cumulative cost (over many decades) if it allows you to bang the same ideological drum

With preventative surveys before treatment, rather than after, some costly treatments are preventable:

“An atlas published by the Government that maps variations in health spending and outcomes across England has highlighted some significant regional differences including amputation rates among diabetics. . . .

“Amputation rates among diabetics showed one of the most striking variations. Data revealed that the amputation rate for patients with Type 2 diabetes in the South West (3 in 1000 patients) is almost TWICE the rate in the South East. The Charity Diabetes UK was also concerned that the data showed less than half those with the disease (Types 1 and 2) had received nine key healthcare checks.”
http://www.mddus.com/mddus/news-and-media/news/november-2010/nhs-variation-atlas.aspx

@25 there may be the sound of two drums!

28. the a&e charge nurse

[28] touche

“Public sector worker objects to public feedback.

Who knew?!”
Brilliant comment. Adds so much to the debate.
Chris you are a genius

Tone
“And (ii) I have had 4 elderly relatives die in NHS hospitals in different parts of the UK, and 3 died in appalling circumstances of neglect.”
You let them die in neglect and did nothing, why didn’t you pay for them to go private. Too busy down the pub Tony.

31. Derek Hattons Tailor

@17 “Do we really use hospital services in the same way as we choose mobile phones?

Quite simply, yes we do. Customer choice driven through performance will improve standards as a whole through competition.”

Quite simply, no we don’t. If you get knocked down by a bus are you going to google “what’s the best hospital for road accidents” and then make an informed decision before getting in a taxi ? Even if you could, what if that best hospital is at the other end of the country ?

My GP is the local GP. If I need to go to hospital I would choose the nearest one – believe it or not, people who are unwell generally don’t want long journeys/unfamiliar cultures and would like visits from family/friends. “Choice” only works for elective/vanity surgery (enhancements, plastic surgery, etc) when there is real need and which shouldn’t be provided by the state anyway.

Lastly, If choice works to drive up efficiency and standards, why hasn’t it done it yet ? Both the tories in the early 90s and Blair a decade later, tried it, and it decreased productivity, more money in for decreasing output. Something Blair never understood was that to have choice you need an excess of supply over demand (which is why your local supermarket has a thousand lines of yoghurt) and public services always have the opposite (which is why the queue in your local A&E is longer than the one in the supermarket).

32. Derek Hattons Tailor

@1 “Surely any organisation that wants to improve its service would want to solicit feedback”.

What makes you think feedback = improved service ? Feedback is all part of the “customer services ethos” which is about allowing customers to think they are listened to and then carrying on providing the same shite service you always have whilst preserving the illusion of “choice”. Virtually all private sector organisations ask for feedback and then take no notice of it – or are highly selective in how they interpret it. I’m sure lots of people gave negative feedback about being sold useless PPI, but banks did nothing until they were forced to by law. Lots of councils got negative feedback about fortnightly bin collections, and they are all still doing it, because it saves money. Who cares what the customer thinks ?

33. Churm Rincewind

I really can’t see what’s wrong with patient feedback. Yes the process may be flawed. Yes the results may be disregarded.

But any system however inadequate which allows democratic input into the NHS must surely be a good thing.

Without organised feedback systems to accommodate favourable responses from satisfied patients, unsolicited and unwelcome complaints will be the predominant form of feedback.

Btw in large urban areas, patients often do have effective choices between hospitals for many elective treatments even though choice is limited or non-existent for acute cases and especially for A&E.

In mainland Europe, hospitals and GPs manage to cope with competition although the same caveats apply as to the limited extent of competition between hospitals.

35. Derek Hattons Tailor

@ 34 But I’d be extremely surprised if the average NHS patient is using the service for elective surgery ? (Which means things like cosmetic surgery) Most people in NHS hospitals are there because a doctor has said they should be and increasingly the NHS is primarily used by an ageing population with multiple, chronic and long term health issues which are treatable but not curable. The bottom line is the NHS shouldn’t be funding elective surgery, which is why it’s absurd to argue it should offer “choice”

“I really can’t see what’s wrong with patient feedback. Yes the process may be flawed. Yes the results may be disregarded.

But any system however inadequate which allows democratic input into the NHS must surely be a good thing.”

Because conducting a flawed form of market research will cost taxpayers money and gain nothing. Never quite thought you were in favour of wasting taxpayers money.

12

‘But no-one has been “forced” to take treatment against their will’

Obviously you have never heard of The Mental Health Act, and believe me people are forced to have treatment against their will when they are detained and refuse said treatment. They have not ‘freely’ entered into the hospital and neither can they ‘freely’ exit. Likewise, The Education Act may enable you to choose schools for your children but you cannot exit from the system. When the state introduces legislation which obliges you to act in a particular way, you have not freely chosen, hence my comment about the strangeness of using a market analogy.

9

There are, as we speak, thousands of people being force-fed
for numerous reasons such as anorexia, dementia and severe depression. As a society we intervene, we even force-feed Ian Brady, despite the fact that he is on hunger strike and wishes to die. But, over and above this, making the point that you don’t choose to eat and relating it to exit and entry of a market is pretty weak.

36

You beat me to it, what we don’t need is to employ incredibly expensive companies to conduct surveys. The only real survey is clinical outcomes, most NHS staff are more concerned with this than whether the cleaner smiles at you as you walk through the door. Still, it takes all sorts.

39. the a&e charge nurse

35 Derek Hattons Tailor: “But I’d be extremely surprised if the average NHS patient is using the service for elective surgery ?”

Be surprised then. According to this source, the NHS in England and Wales was performing nearly 105 thousands of hip or knee operations a year compared with only 46,800 in the independent sector:
http://www.drfosterhealth.co.uk/features/hip-and-knee-replacement.aspx

News sources report that NHS hip and knee operations are now being rationed:

“Access to NHS care – including knee and hip operations – is being restricted, data from trusts in England suggests.

“The evidence, gathered under the Freedom of Information Act by GP magazine, showed 90% of trusts were imposing restrictions.” [BBC website June 2012]

I seem to have had my ops done just in time. Btw without those ops, I would have become housebound. As I don’t have personal healthcare insurance, there is no way I could have afforded those hip replacement operations, a restriction that must apply to many thousands of those afflicted by arthritis. Of course, all those supermarkets with home delivery services will be loving the rationing.

22: “The French system has ALWAYS cost more than the NHS – the cumulative difference must be astronomical”

Most surveys that’s I’ve come across show better patient outcomes and greater patient satisfaction in France, as compared with the NHS in Britain. And, of course, there is an administrative cost to running a national social insurance system ro cover personal healthcare. Try the Wikipedia entry on Healthcare in France
http://en.wikipedia.org/wiki/Health_care_in_France

Average life expectancy at birth is rather longer than in Britain and the French have more physicians per head of population than we do.

41

It looks like there is a good argument there for spending more on healthcare’

42: “It looks like there is a good argument there for spending more on healthcare.”

That and/or ending the situation in Britain where the NHS has a dominant position in the national healthcare market and where supply is micromanaged and rationed by the state – as is reportedly happening now with elective treatments.

In France, I can walk down the road and drop into any GP with a namepost on his front door to seek his/her medical advice. Of course, I need to pay the fee but can recover part or all of that from the state social insurance system together with any professional or corporate cover I have and any private healthcare insurance.

If it’s a matter of hospital treatment, in the larger urban areas there is likely to be a choice of independently managed hospitals and clinics. As best I can tell, clinicians in France are less well paid than in Britain, partly because there are more of them. By most reports, patient outcomes are better and average life expectancy is longer. As best I can tell, there are fewer restrictions on drug prescriptions than under the NHS.

Given the choice, why would I want to prefer the NHS over the French system of national healthcare?

44. the a&e charge nurse

[43] The public already waste £300 million on prescriptions.
http://www.hsj.co.uk/news/finance/wasted-prescriptions-cost-300m/5022360.article

Anyway most drugs have few benefits if we look at the numbers needed to treat (NNT).
For example, for those who took a statin for 5 years:
98% saw no benefit
0% were helped by being saved from death
1.6% were helped by preventing a heart attack
0.4% were helped by preventing a stroke
1.5% were harmed by developing diabetes
10% were harmed by muscle damage

In other words;
None were helped (life saved)
1 in 60 were helped (preventing heart attack)
1 in 268 were helped (preventing stroke)
1 in 67 were harmed (develop diabetes)
1 in 10 were harmed (muscle damage)

Why are the British public obsessed with futile pill popping?

I do love the naivety of your average tory troll who bangs on about the French system. If you think your tory masters are going to give you that model, you are an idiot. Most tory MPs would happily turn Britain into the 51st state of America. (Which is worth remembering when they drone on about sovereignty.)

No, their aim and model is the American one. Where private health insurance enjoys great dollops of corporate welfare, and all very inefficient. And your average American is forced to go to Canada to get the drugs they need at lower prices. (Forcing the drug companies to demand their puppet politicians to pass laws making that illegal.) Oh and stopping the govt buying huge drug quantities which would reduce costs for Medicare patients.

Tone “And (ii) I have had 4 elderly relatives die in NHS hospitals in different parts of the UK, and 3 died in appalling circumstances of neglect.”

You are either a liar or a lazy incompetent uncaring moron. I suspect you are both.

a+e – quite. Not a day goes past without a new report showing that the health benefits of a healthy diet, regular activity and/or employment outweigh the vast majority of pills.

One thing that has amused me immensely is that we are discussing this again because of the experience of Ann Clwyd’s husband. The amusing thing being that virtually nobody, including David Cameron or Clwyd herself, recognised that the experience was in Cardiff – which means welsh NHS which is devolved. Meaning responsibility lies with labour over this incident.

If these basic facts about post devolution Britain can’t even be grasped there is very little hope. It means Wales will continue having a health service run by the most useless health minister in history.

47. the a&e charge nurse

[45] hard to trust a leader who promised (sic) no more top down NHS reorganisations, then in the blink of an eye claimed ‘reform (at a cost of £3billion) was the only way to save the health service’ – what was it Dave said in 2010 – “we will cut the deficit, not the NHS”?
http://www.guardian.co.uk/society/2011/may/16/david-cameron-nhs-only-saved-reform

It seems to me the unintelligibility of the Health & Social Care bill (described as having more pages than a Harry Potter novel with a 1,000 amendments) might have been entirely deliberate – nobody except uber legal specialists are able to understand it – I mean, how long before corporate lawyers will be making the words dance on the page just as they did with hospital PFI contracts under Broon & Blair?

@46 – ha, planeshift – nicely put.

48. MonkeyBot 5000

NHS loyalty cards could be a good idea.

If you’ve got a chronic disease or a disability, you’d build up far more reward points than someone who’s always healthy. Maybe if you get enough points you might get a discount on parking costs.

49. Churm Rincewind

@ 36 Planeshift: “conducting a flawed form of market research will cost taxpayers money and gain nothing”.

Well, I don’t know enough about the proposed methodology to take a firm view about whether the planned research will be flawed or not. If it is, then obviously we should campaign to improve it.

In the meantime it seems to me that any initiative which seeks to encourage patient input into the NHS should be both encouraged and applauded. That’s what democracy is all about…

47……. Yea. Just another of Cameron’s lies. But then if you’re prepared to use your dying son as a political prop to con people into believing you love the NHS you are probably capable of doing anything.

The tories privatisation of healthcare was already written before they came to power.. Private health providers were I believe the tories second highest donors. Only Hedge fund managers gave more. One of the biggest scandals off this parliament is the number of MPs taking backhanders from private health companies.

And if there is any justice, it is the health bill will bury Clegg and the lie Dems for a hundred years. Their support of the bill is the most treacherous thing the lie dems have done in my opinion. Shirley Williams should be hung from a lamp post as a traitor to the NHS. And Clegg as either a naive moron or one of the most dishonest politician of all time. ( And considering the number of corrupt politicians) that is saying something.

51. Man on Clapham Omnibus

43 Bob

An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a new study of 37 million patient records. I doubt this figure has changed much and suggests your faith in private medicine isn’t as warranted as you might believe. I understand that private medicine has the allure of better quality but in my experience the different in surgical quality is zilch.
The problem with the NHS in my experience is that it is poorly run, the staff are in general lazy and seem to despise the people they are there to help.One of the factors in this is undoubtedly because its free at the point of service.

52. Man on Clapham Omnibus

50. Sally

”Private health providers were I believe the tories second highest donors. Only Hedge fund managers gave more.”

Have you any data on this?

Surely, if healthcare is going to go private, we should also be given the choice about whether we pay the part of the national insurance contributions which currently covers healthcare.

Asking patients for their opinions is clearly the first step to turning hospitals into branches of Tesco. There’s no way listening to patients could ever improve patient care.

55. Derek Hattons Tailor

@ 40. I think we have a different definition of elective surgery. If a doctor has advised you that you need it, it’s not elective. Elective means vanity/cultural/Unnecessary procedures that have no tangible medical benefits (e.g homoeopathy, breast implants, gastric bands). Having worn out joints replaced clearly has medical benefits (the alleviation of pain being the most obvious one).

In more general terms how do you propose that private medicine pays for the training of doctors ? Private medicine in the UK is staffed almost entirely by former or current NHS doctors, who qualified and gained the necessary experience in NHS hospitals, using NHS equipment, NHS drugs and NHS patients.
Following your argument through, surely private medicine, operating in a market should also train it’s own people, in the same way that Tescos or Vodafone train theirs ? why should the taxpayer subsidise the profits of private medical providers ?

55

Training a doctor in the NHS costs the taxpayer approx half a million and then that doctor can then move to a private practice, big savings there. Added to that, donor products such as blood currently costs nothing. An added bonus is the purchasing power of the NHS which brings the costs of medicines down as pharmaceutical companies quickly claw back the research and development costs, this assists private purchasers. Another positive is the number of volunteers it attracts because it isn’t a ‘for profit’ organization, all of this needs weighing-up against the ‘so-called’ benefits of competition.

@53 also has a good point, why should wage earners be forced to pay contributions if there is going to be a genuine choice, which has to allow free entry and exit of the market.

What most private healthcare providers want is all of the above without cost to themselves, and they would be quite happy for the state to forcefully collect the monies which would then be ploughed into creating individual profit. If we are going to have a market in healthcare, let the state get out of the equation altogether.

@55 Derek Hattons Tailor: “I think we have a different definition of elective surgery. If a doctor has advised you that you need it, it’s not elective”

That is garbage. Hip and knee replacement surgery is officially defined as “elective surgery” and is often performed in NHS centres specialising in elective surgery. Such operations are not deemed critical to prevent mortality or even deemed urgent. That is why those operations are now being rationed, hence this news report in June:

Access to NHS care – including knee and hip operations – is being restricted, data from trusts in England suggests.

The evidence, gathered under the Freedom of Information Act by GP magazine, showed 90% of trusts were imposing restrictions.

The trend was blamed on cost-cutting by some, but the government says there was no justification for that assertion.

NHS managers have defended the practice, saying there were instances when care had to be prioritised.
The magazine received responses from two-thirds of the 151 trusts about the procedures they considered to be non-urgent.
http://www.bbc.co.uk/news/health-18495981


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