[Closed] Have we done this? 'Planned 49% limit' for NHS private patients in England

fantastic !

if that doesn't get the ****ers out next time we'll all deserve a shit NHS anyway

S****horpe

just checking, like 😉

Hello sir, I just need to check your [s]blood pressure[/s] credit card.

The Tories really are scum, aren't they?

Scum rises to the top though.

Will that mean the op my wife is waiting for (and is planned to wait another 6 months for) will take longer 😈

But hey, I suppose pumping your body full of drugs, going through A+E a few times each month, and spending about 1/4 of your life on a ward, just to be discharged as 'your unlikely to die before your the op is due to be done' is the way forward...

Bloody NHS, if only she had insurance before she got ill 😈

Though the idea seems outright wrong, I have to admit I'm finding it hard to argue with this:

"If these hospitals earn additional income from private work that means there will be more money available to invest in NHS services".

Of course this takes resources- ie beds, staff- away from NHS patients but if it recoups enough money to pay for more resources- more beds and staff- then that should more than balance out?

Course, I imagine what'd actually happen is their funding would be cut because "Look, you made loads of money off private patients, you don't need taxpayer's money"

In itself it will make little difference, there isn't enough private patients, which means they plan to move to a private healthcare system.

They haven't the balls to anounce the endgame, they will just keep chipping away at the current system hoping to get little changes through.

Northwind - Member
Though the idea seems outright wrong, I have to admit I'm finding it hard to argue with this:

"If these hospitals earn additional income from private work that means there will be more money available to invest in NHS services".

Of course this takes resources- ie beds, staff- away from NHS patients but if it recoups enough money to pay for more resources- more beds and staff- then that should more than balance out?

Course, I imagine what'd actually happen is their funding would be cut because "Look, you made loads of money off private patients, you don't need taxpayer's money"

You think the private patients will have the same facilities as NHS? Any money will be invested to make the private experience better.

You think the private patients will have the same facilities as NHS? Any money will be invested to make the private experience better.

But of course, how could it be any other way under the current system? That is the whole point of the system (sadly and unintentionally!)

I take my hat off to the Royal Colleges, the BMA and the whole medical profession for their ability to pull off one of the greatest scams in modern history - at a greater cost than those evil bankers perhaps? The real villains here are not the Tories (although like all parties they are protecting their own vested interests but that's another story), it is the medical profession itself. Yes, the same body that opposes sensible reform and competition at most opportunities. The same body that for years has been run as a state sponsored cartel for the benefit of patients, no sorry, the doctors themselves. It is hard to imagine a better system for its members, even though this was not the original design.

[b]The NHS was flawed from the start when Aneurin Bevan allowed doctors to continue to undertake private work as well as to work for the NHS. [/b]With the benefit of hindsight, this was a mistake of appalling magnitude. [b]How many public goods and services are designed in such a way that the suppliers are well rewarded for providing a service that is a poor substitute for the private service they also supply? [/b]

I was talking with my neighbour yesterday. He needs a new hip. Doctors treats him under NHS and then gives him the choice - wait until June and have the op on the NHS or come in next week and have it done privately and you will be playing golf in June instead. Not a hard choice. But what sort of a system is this?

How is it possible to run an effective and successful organisation if the key members of staff are allowed to compete with you by providing an alternative and better service than the one you provide. Imagine you are a "normal" company and you allowed your top staff to freelance while enjoying all the benefits of salaries, pensions, infrastructure etc. How long would you remain in operation?

Neither the Tories nor Labour will ever introduce effective change while negotiating with a monopoly supplier of labour whose interests are optimised by the status quo at the expense of the patients they are meant to serve.

So step aside from the anti-Tory slagging here - that's too easy - and look at the fundamental flaws in the system which date back to its original foundations. And then wonder why a body whose core values include - a comprehensive service, available to all, free at the point of use, based on need not ability to pay - arguably fulfills none of them!

Lifer - Member

You think the private patients will have the same facilities as NHS?

Well, yes. Since the hospitals don't have anything else to offer.

teamhurtmore - Member

And then wonder why a body whose core values include - a comprehensive service, available to all, free at the point of use, based on need not ability to pay - arguably fulfills none of them!

Some different NHS?

Nortwind - surely the hospitals will offer better conditions for paying patients (ie, extra paying on top of tax) as they do now?

Do not understand - "some different NHS?" - if you mean a radically different one, well yes. The current one is the classic "camel" ie, a horse designed by committe, with neither politicians and medical staff willing/able to address the core problems. But I have sympathy with them (to a small extent) as this political hot potato is so wrapped up in mystique/dogma rather than fact that reform is almost impossible.

teamhurtmore - Member

Do not understand - "some different NHS?"

I mean the NHS you describe is not the NHS I know, so you must be using some different NHS. Or some imaginary one possibly.

teamhurtmore - Member

Nortwind - surely the hospitals will offer better conditions for paying patients (ie, extra paying on top of tax) as they do now?

That's not what Lifer is suggesting though. "You think the private patients will have the same facilities as NHS?" Of course they will, the NHS doesn't have any other facilities.

a monopoly supplier of labour

The same body that for years has been run as a state sponsored cartel for the benefit of patients, no sorry, the doctors themselves

Care to expaynd on this theory of yours?

Ok Northwind - there is basic fact and a (deliberately) subjective element (this is STW after all!).

Fact - doctors allowed to undertake private work as well as work for NHS

(Very) subjective element - suppliers are well rewarded for providing a service that is a [b]poor substitute[/b] for the private service they also supply?

Real question - even if there is not a deliberate policy of providing a poor substitute, this is what is in effect happening. The law of unintended consequences. Take my real life example, both neighbour mentioned and surgeon are close neighbours. Under the current system there is little incentive for the surgeon to change the status quo or for him to ensure that quality of experience (not actual surgery) is the same...by his own admission. And as a rational human being, why would he want to change this?

So does the current system really incentivise a comprehensive system....etc....of course not. Hence the current news link is merely an extension of something that results from the original flaw in Bevan's design.

Elfin sure...

...pre 1948, Uk was recognised as having the best hospitals in the world. More recently, ranked by WHO below many nations who sixty years ago had far more rudimentary health systems. The recent white paper acknowledges that patient care differs very widely across the system - hence neither comprehensive nor based on need. Allocation of resources not determined by users and little choice for end consumer.

So "theory" (not really, but your words) is that patient interests have lagged significantly behind those of practioners. (Some) practioners protected by structure that in most industries/services would not be allowed to continue (either by market forces or legislation).

So in the end, system fails most of its own criteria for success as laid out by core values. I DO NOT APPLAUD OR SUPPORT the outcome. Rather point out that blaming the politicians alone is not really getting at the core issue.

At its simplest - this argument goes back (not to the Lansley, or the Tories etc) but to the flaw in Bevan's plan. What we have now is the unintended consequence of that original decision.

THM, not all services will be amenable to the kind of market competition that is being touted by the ConDem reforms. It's also somewhat reductive to claim that the NHS is providing a poor substitute for private services - given that private healthcare is hugely dependant upon NHS workforce training and acute capacity (among other things).

I won't argue that access (i.e. delay in treatment) isn't an issue - but the ConDems should be mighty careful of how they sell these reforms to the public. If the endgame is a privatised NHS, they should just come out and say it.

Edit: and if you think "producer capture/interest" is bad now, just wait until we get going with the marketing of over-investigation to the worried-well. Ker-ching!

No teeth - I am not supporting Tory policies here. Merely pointing out the same issues that you refer to:

given that private healthcare is hugely dependant upon NHS workforce training and acute capacity (among other things).

Hence my example of my two neighbors. All original stages funded by NHS, then choices given NHS or private involving same surgeon but different times, service quality and remuneration for surgeon. If something goes wrong, who will foot the bill....the NHS!! So I am agreeing with you here.

Anyone has to be careful about selling reforms because of (1) dogma/mystique and (2) the vested interests of the the profession!

Commenting on the move, Health Secretary Andrew Lansley said lifting the private income cap for foundation hospitals would directly benefit NHS patients.
"If these hospitals earn additional income from private work that means there will be more money available to invest in NHS services," he said in a statement.

If the endgame is a privatised NHS, they should just come out and say it

IIRC the BMA opposed the setting up of the NHS and I bet we pay less than [GDP] than those we rank below...you get what you pay for

THM are you not just slagging of capitalism here? If I offered a plumber x 3 his normal rate I am sure they would ditch their normal jobs and see me sooner...Have you had an epiphany over Xmas and waht everyone to contribute according to their ability and receive resources based on their need 😉
Its an interesting point you raise though what would you suggest as a solution?

I am not supporting Tory policies here

I realise that - and I am equally frustrated by how the system operates as it does. But what is true of elective procedures (where private cover will enable speedier access) is not necessarily true of other areas of healthcare. And the political rhetoric of choice & competition, putting healthcare professionals in the driving seat etc is just disingenous cover for what amounts to a reduction in services. We are living in interesting times...

Surely the other option would be all the besy surgeons just doing private?

"If these hospitals earn additional income from private work that means there will be more money available to invest in [s]NHS services[/s] the executives' pay, bonuses, pensions, business trips etc."

I wonder what will happen at the end of November when a hospital hasn't reached its quota of private patients? I hope none of my family were booked in for a consultation or operation around that time.

It time for the House of Lords, doctors and nurses, and the public to stand up and tell the Tories we don't want anymore privatisation of healthcare.

The next step towards full privatization of the NHS. I'll happen in our lifetimes - no doubt.

JY 😉 No. no epiphany I'm afraid.

As you may have picked up by now, my starting point is rarely politics but the quality/consistency of an argument and the logic of any conclusion. So in this case, while it may be perceived that I am coming from a Tory/capitalist perspective (although this is not the case), I am actually more intrigued about the original flaw in design, the behaviour of the players, and the lack of consistency between the rhetoric of the BMA and the politicians and the reality of the service we receive.

Oh and not slagging off capitalism either - of course the plummer would come to you, in the same way that my surgeon neighbor will prefer my injured neighbor to take his private service. Why would he want the NHS to provide the same quality or service? Illogical?

Of course the emotive point is the extent to which the practioners deliberately encourage the status quo because it serves their interests. I was having a bit if fun here and deliberately being provocative. But behind that lies the fact that there is an element of truth here (in fact more than an element) as there is in the politicians case.

The BMA is not against competition. Far from it - they love to compete against....yes, the NHS. So they provide private treatment for anyone who is able to pay. The cycnic in me wonders if they object to the fact that the substantial extra income that they derive from the current system would be reduced if the NHS service was improved and available without payment. It is this inherent conflict of interest that interests/exercises me!!

teamhurtmore - Member

Take my real life example, both neighbour mentioned and surgeon are close neighbours. Under the current system there is little incentive for the surgeon to change the status quo or for him to ensure that quality of experience (not actual surgery) is the same...by his own admission. And as a rational human being, why would he want to change this?

Hang on... You think it's the surgeon's fault there's a waiting list? You think he's intentionally delaying surgeries to encourage people to pay him to do them fast?

What's your neighbour's situation? Is it a wear-and-tear replacement, or a failing of an old replacement? My own experience of NHS hip ops is that the system, by and large, works as it should- emergency replacements happen fast, scheduled replacements happen slow.

Unless there's trauma involved, you don't wake up one morning and need a hip op- it comes up slowly so the timescales can be managed.

pre 1948, Uk was recognised as having the best hospitals in the world.

Recognised by who? Is this actual fact, y'know, based on reality, or just opinion? The UK thought it was great back pre-1948, fact was it probbly was not as great as it thought it was.

The standards of hospitals may indeed have bin high (I'd imagine many wealthy nations such as Switzerland, Japan and the USA probbly had stuff what was just as good), but access to healthcare was restricted to those who could pay.

Granted, doctors would undoubtedly have had their economic interests at heart, (who woodunt?), but to suggest that the NHS is a 'state sponsored cartel' run primarily for the benefit of it's staff is nothing more than your own onion. The NHS was the catalyst for a dramatic improvement of the health of the nation. That would suggest it was an institution whose primary benefit was to it's [i]patients[/i], and society as a whole.

So "theory" is that patient interests have lagged significantly behind those of practioners.

Can you actually [i]prove[/i] this?

his point { I assume] is if you pay you will get treatment quicker and the surgeon gets more if you pay privately. There is little incentive for the Dr to improve the NHS service or have the NHS service as anything other than lower than the private service...it is an interesting point that I have never given much thought to if I am honest

elfin the BMA must be the only union in the country that is not their to look after the interest if its members then but is their for the good of the country

If something goes wrong, who will foot the bill....the NHS!

If there hasn't been negligence, then the NHS would have had to provide that corrective care even if it had done that operation itself, so the system is still "ahead" because it didn't pay for the operation.

There is little incentive for the Dr to improve the NHS service or have the NHS service as anything other than lower than the private service

All this is supposition, so far.

N'wind - JY has answered the question and I think he understands my point. He has picked up my issue of incentives.

Imagine you had a clean slate and were designing a system from scratch. How would you tackle the issue that it is not in the interests of doctors to ensure that the NHS matches the quality of their private system?

Teamhurtmore - are you from the USA?

There are two fundamental problems. Firstly allowing doctors both public and private work.

Secondly, the NHS is a victim of its own success. It has succeeded in raising the standard of health to the vast majority of the people in the UK. However we (the public) have got ever more demanding is wanting treatments NOW and wanting the best treatment regardless of cost. This has never been the case with the NHS, they have always delayed treatments to be cost effective and have always gone with the most cost effective treatment.

Combine this with the huge increases in medical costs (ignore profit, executive pay) and the current NHS model is almost broken. Compared to the USA we pay less of our GDP but the outcomes of the treatments are almost at the same level.

We all like the French system, but they (like the Germans) put far more in terms of GDP, than we do. Until we are prepared to pay more we won't get a system like them.

The trouble with the Tories (and Labour) before them is that the medical corporations have got to them and told them that the best way of solving the problem is to have private companies involved. For easy stuff, it CAN be cheaper for private compared to public. However no private company would ever be prepared to run an A&E department on a fixed budget, do all the training of new doctors/nurses, etc. This model means that the state has all the difficult costs, while the private sector skims off all the low risk work.

Surrounded - no!!! And the line of thinking behind the question is probably going in the wrong direction!!!!

teamhurtmore - Member

Imagine you had a clean slate and were designing a system from scratch. How would you tackle the issue that it is not in the interests of doctors to ensure that the NHS matches the quality of their private system?

The incentive- which you identified yourself- for people to turn to private cover is generally speed of care, not quality of care. And individual surgeons and doctors don't control the speed of care (they do influence it, but not to the extent that would make this difference)

One of the other folks on my ward when I was in for my hip was getting a private hip replacement done. He had the same food, beds, doctors, physio, and even the same nutter in the ward stealing his slippers. The only difference was he'd skipped the waiting list.

This model means that the state has all the difficult costs, while the private sector skims off all the low risk work.

THM - I was just asking because of the way you spelt neighbour up there.

It should be noted that the NHS in Scotland is vastly different to the one in England and from where I'm looking at it from is far superior in Scotland.

Ahhh - yes, that was the spell check. Phew, i thought i was being tarnished as a proponent of the US system!!

northwind... could I have the benefit of your experience here please:

http://singletrackworld.com/forum/topic/hip-resurfacing

Hi, I'm afraid I've no relevant experience there- mine was rebuilt with original parts and some meccano 😉 I'll be straight onto a replacement if that repair fails though so haven't learned much about resurfacing.

[img] [/img]