De-fund, Demononise, Privatise.

It’s worked every-time before

I’ve just seen the best idea for a counter-measure against (K)Hunt on Facebook:

Coordinated. Mass. Pregnancy.
It’s the only way.
It’s like a strike, but with pay.
43% of staff will still have to work though, just like yesterday.

Do Australia and the like have vacancies for tens of thousands of doctors?

And as was heard on the radio the other day – doctors are prepared to leave the NHS to work in a private health care system on the other side of the world.

If you want to work in a private health system for better pay – why not push for making the NHS private and reap the rewards that way.

It is going to be very interesting to see what the BMA and junior doctors do now.

Fact is, junior doctors who want to progress need to stay in the NHS … so I really don`t see what they can do, aside from threaten to leave the UK. But as mentioned, Australia and Canada options are not really all that great.

The smoke and mirrors on both sides is as amazing as it is frustrating for onlookers and consumers of health services – remember them?

Pretty obvious from this morning that gov was in a position where contracts were going to be imposed. That’s the problem with playing chicken – someone ultimately loses. And the industry is in effect a monopoly.

Rather large elephant in the room – at some point we are going to have to pay towards health care. so the denial, anger and bargaining phases are running concurrently, we can all feel depressed by the process, and then finally move on to acceptance.

The elephant isn’t going to budge not matter how hard anyone blows

Do Australia and the like have vacancies for tens of thousands of doctors?

And as was heard on the radio the other day – doctors are prepared to leave the NHS to work in a private health care system on the other side of the world.

They could always go and do something more rewarding

If you want to work in a private health system for better pay – why not push for making the NHS private and reap the rewards that way.

Come on this is a wind up, yeah?

Why would a consultant want that?

The current system maximises their benefit. Roll on the status quo…

Come on this is a wind up, yeah?

Yes – in a way.

But if the offer is so great abroad they’ll all go anyway no matter what Mr Hunt does. A few grand of weekend overtime pay isn’t going to be the deciding factor for those thinking of leaving.

1 Jr doc I work with is not going back to the NHS after his PhD is finished, he’s been snapped up by Australia

1 has applied for positions in NZ

the 3 other, have a few years to decide b4 they go back full time

They all agree if they do go back there no way they’ll be doing A & E!

But if the offer is so great abroad they’ll all go anyway no matter what Mr Hunt does. A few grand of weekend overtime pay isn’t going to be the deciding factor for those thinking of leaving.

That’s exactly why they are going none of then want to leave, but those with families in particular will find it very hard to keep working here in London
As their pay increases awarded during PhD no longer count (even tho they were still working at the hospital too)so the smartest, most dedicated are being punished even more.

at some point we are going to have to pay towards health care.

We do already – what you mean is that the wealthy will continue to pay for private healthcare, the poor will have limited access to healthcare and the middle (recently known as the squeezed) will have to sacrifice more of their disposable income for healthcare.
Given we are in a consumer society where disposable income drives growth it will mean continued ‘austerity’ imposed by the wealthy tax-dodgerstories.

What would a private NHS look like anyway?

We all continue to pay NI which is used to subsidise private healthcare providers? Do we then pay anything at point of delivery?

Or does health insurance become mandatory? How does that affect those with family histories of cancer and diabetes? (if not worse).

The Canadian model seemed to work well (i.e. you payed a monthly subscription and received free at point of use healthcare from a range of private medical practices) but I don’t know how they funded the hospitals, which didn’t appear to be private.

Being pragmatic (and playing Devil’s advocate to some extent..) what is the solution to a growing and aging population with increasingly high expectations of the health service? Either we pay more in tax to hire more doctors (which I’m fine with) or we let the service go private and pay more that way through increased health insurance. The only other way is to prioritise healthcare over other government expenditure i.e. make cuts elsewhere, but where would that be?

My point being, would we pay more either way?

Well if nothing else it shows you that even the brightest, well resourced, solidaritaceous*, brother and sister workers are powerless in the face of our neo-liberal overlords. Whoop.

*Have cc’d this to Susie Dent

at some point we are going to have to pay towards health care.

And here I was thinking the NHS was funded out of taxation rather than thin air. I agree that the long term funding issue is not going away, but if the tories are so interested in tackling this, how does that square with private companies making profits off the back of it? Private sector ‘efficiencies’ no doubt. 🙂

DrP – given your observations on the previous page, why is competition for med schools still so intense?

And the rush to Aus? A system that openly combined public and private health provision and with identified contributions through Medicare. Imagine if that idea was proposed in the UK!

And if everyone up sticks and moves to Aus (ok, lets ignore the commodity cycle for now) what happens to wages?

We do already – what you mean is that the wealthy will continue to pay for private healthcare, the poor will have limited access to healthcare and the middle (recently known as the squeezed) will have to sacrifice more of their disposable income for healthcare.

Quite possibly. Now we have got past that point, sensible conversations can begin. Until then its the same old merry-go-round and can-kicking.

13th floor – the public and private sector can work together perfectly well and beyond a lot of the “privitisation BS” do in many areas of our lives. Its not one versus the other. There is a favourite case study by all accounts – Aus. How “generous” is the Aussie gov versus other countries? How much is funded by the patient?

and if everyone up sticks and moves to Aus (ok, lets ignore the commodity cycle for now) what happens to wages?

much more importantly, what happens to the quality of healthcare?

Both suffer most likely. Lose/lose game.

Not very pretty.

Next?

DrP – given your observations on the previous page, why is competition for med schools still so intense?

As I understand it, application numbers have declined.
But furthermore – a medical degree is a cracking degree to have, frankly.
Many of my uni friends got the ‘Dr’ qualification (PhD lot, hush now..!) then went into industry, pharmacy, teaching (!) etc.

People often aim for the qualification then use it for other means.

Another case in point.. our local GP training programme had 12 candidates on it. Only 3 went into UK GP practice.

DrP

13th floor – the public and private sector can work together perfectly well and beyond a lot of the “privitisation BS” do in many areas of our lives. Its not one versus the other.

Granted, I wasn’t actually trying to pitch it as one vs. the other, I was genuinely trying to picture what it might look like, I have no real conception of how ‘more privatisation’ would actually work as I have no conception of how it all works now! 😳

Are there areas where private firms could actually make a profit by delivering the same service more efficiently whilst charging the government less than they currently ‘pay’ the NHS?

It’s probably a question for another topic, perhaps one posted on the 1st of August… 🙄

Thx DRP – my younger son’s contemporaries had very high levels of competition to get into med school this (current) year, hence the question. And some v.v. bright candidates (all A/A*s etc) couldn’t find places. I find that odd in the context of the current debate. Although son’s best mate was toying with the idea of abandoning med school and going to Oxford instead.

So where do all these students go? Do they all emigrate? Why were 90% of the staff looking after my Mother recently non-Uk born? What IS going on?

13th – true. Time and place… 😉

I was amused by this comment in the FT coverage – not an FT comment BTW

I am no great fan of the BMA. Between them, the BMA and the DoH are supposed to jointly run the NHS. Frankly they have never done a very good job of this historically for many reasons. But there is more to this than just a power struggle.

This is all really a proxy war between the Treasury and the Trusts. Most of the actors, Hunt, the BMA etc are just caught in the middle. The NHS/DoH is staffed by institutionalised academic health economists. They are about as worldly wise as Central Bankers. They are really not of this world, and also completely disconnected from the practical professional world of medicine. Oddly they often have rather strange views about healthcare. Keogh’s view of the NHS as “PC World” is an example.

What we really have here is a procession of many actors with partial views, and limited perspectives. There is no point in singling one lot out for criticism. The point is that governance of the NHS is dysfunctional. Actually Mr Hunt’s job – if he has one – is to sort that out. But he doesn’t seem to have grasped what’s going on either.

?

The Canadian model seemed to work well (i.e. you payed a monthly subscription and received free at point of use healthcare from a range of private medical practices) but I don’t know how they funded the hospitals, which didn’t appear to be private.

By charging $500 for the privilege of walking through the hospital doors if my experience of Canadian hospitals is anything to go by.

N.B. the doctor’s fee was on top of that.

Have you missed the bit where it was explained that the doctors’ dispute is not about the salary? (I know that it’s hard for an economist to understand that not everything is driven by money.)

No Dr – I heard people saying that and then considered the situation for myself. Especially the final impasse? Thank goodness for critical reasoning eh? But granted tough to follow where we are amongst all the noise

I’d happily pay more NI to –

A) Give doctors what they want, which doesn’t seem that unreasonable to me considering how hard they work.

B) Keep the NHS out of private hands.

I’d happily pay more NI so everyone can get healthcare free at the point of delivery no matter who they are.

^^^^
That too!

We have been doing that for years – so why all the angst?

The NHS is mainly funded from general taxation and National Insurance contributions. Small amounts each year come from patient charges for services like optical care, prescriptions and dental care. The decision about how much money parliament will give to the Department of Health to spend on the NHS in England is made as part of the Spending Round process.

While the NHS has never been entirely publicly funded, the percentage of funding from National Insurance and general taxation is at an all-time high. An increase to National Insurance rates in 2001, designed mainly to give a boost to NHS funding, led to the balance between National Insurance and general taxation changing, although general taxation still accounts for around 80 per cent of all NHS funding.

One of the reasons Australia and Canada are attractive are that the fees of medical students are not subsidized to the same extent as here so they emerge from their training with much more debt. Salaries therefore are higher as they have to recognise the need to repay this. Obviously training here and working in one of those two countries is a nice arbitrage of the systems.

Obviously training here and working in one of those two countries is a nice arbitrage of the systems.

And yet no dismay and that type of arbitrage!! 😉

By charging $500 for the privilege of walking through the hospital doors if my experience of Canadian hospitals is anything to go by.

N.B. the doctor’s fee was on top of that.

Are you Canadian / Canadian citizen?

So if jeremey hunt suddenly collapses with chest pains, from all those naughty drs, shoving needles into their action man dolls.

Who will his staff call, the Ambulance service, to be driven by those ambulance drivers (his descripotion of highly trained paramedics)to the nearest hospital, where he will be seen and treated by overpaid and underworked nursing and Doctoring staff,(his idea) who have probably been on a long shift, before he arrived, with some challenging decisions and patients to respond to.

and all for free. and not a virgin/serco/bupa, etc in sight/0r on site.

But then again he will most probably be treated privately as other patients would most probaly try and put him right about his pathetic, privatisational views.

TAXI FOR LODDICK

Ah i see plenty of folk falling for the great NI myth that it is somehow ring fenced and not simply just another tax.

And yet no dismay and that type of arbitrage!!

That is because they are only doing it for patient safety.

the-muffin-man – Member

If you want to work in a private health system for better pay – why not push for making the NHS private and reap the rewards that way

They don’t want to work in a private system for better pay. They want to work in the NHS, for what they get paid now, under the terms they signed up for. But that’s not an option on the table.

That is because they are only doing it for patient safety.

That’s ok then.

I’m not sure if I pointed this out earlier, but I actually did the figures to compare my current salary to my potential new one under the new contract and I actually stand to personally gain from this debacle (as I’m a senior trainee at pretty much the top tier of the salary scale, I worked out that I’ll be around £4k per annum better off).

However, I still think that the new contract is an utter pile of horseshit and am against it in its entirety. It’s bad for my junior colleagues, it’s bad for future recruitment, it’s bad for women, it’s bad for academics, and it’s really bad for our fellow healthcare professionals, who are just about to get royally screwed over as well.

Are you Canadian / Canadian citizen?

No but then we don’t charge non citizens for emergency care in the UK. Oh and don’t for a minute think it was free for Canadian citizens either. They all had to pay too and different amounts depending on what province they were from.

After listening to hours of news reports and reading the papers over the last few months, I still don’t understand what the dispute is all about.

To me what the government says it wants to do all makes sense, i.e. their aims. Apart from the bit that they want services 7 days a week but on the same budget. I guess spreading services over 7 days and not 5 is possible as the demand is the same but you treat patients over more days, however I am sure its si not as simple as that. In addition the doctors are only one tiny part of the NHS and actually you need all the nurses, X ray staff, lab tech, etc to be working 7 days and the costs associated with that.

What I don’t really get is the the BMA side. They say its is all about patient safety but if that is the case why is not every other person in the NHS striking as well. Would it not also effect the consultants the nurses, etc, etc. If it really is all about safety then wouldn’t it be the duty of any and every professional person in the NHS to strike as well.

To me on the outside it really does just look like doctors not wanting or liking to be told what to do and wrapping it up in the patient safety argument. If not why are all the other NHS staff not supporting them as well and as equally alarmed about patient safety.