[Closed] here it comes the end of the nhs.....

Can't say I disagree with you mate. Just look how well Stafford PCT served it's customers.. oh sorry patients (and a lot of it's staff). "A "vibrant" industry" FFS. The older I get the more I wonder why the people of my parents generation bothered to suffer and lay down their lives to give us society we have today.

Currently too many of us are wanting to use acute services and as a nation we are struggling to find the cash to pay for it, so you have 2 options.

1. Close wards, and you don't get you operation
2. Get other sources of income.

Which would you prefer, you can't have your cake and eat ie low taxes and still expect to get your operation.

What is a concern though is how you would regulate it so that FT's do not chase private patients over NHS patients.

****ing labour that started it though. As far as I can see the market in the NHS just means that private patients get to use NHS stuff quicker than NHS patients. The company does not face the capital costs of building thier own hospitals etc sio it ois cheaper for them.

Can see how those patients who pay benefit but presumabaly the less well off loose out as when the private patient is operated on in a NHS hospital then clearly they are taking the place of an NHS patient. I assume these decisons [who gets the op] are not made due to clinical need.

Fits in with a thing that a local mental health clinic is in fear of cloosure as they now need to "win a bid" and they are free to tender.

This is language that smacks of privitisation by the back door. Offload loads of ancilliary service, patient home care and anything that is high cost low VISIBLE reward to DC.

But they are doing it all over the public sector. This government is going to go one step further than maggie and actually privitise the public sector.

It will then run as well as the railways and we will look at Gordon Brown as some kind of golden age prime minister.

This will explain a few things:

The other bright ideas are for GPs to do all the commissioning of services - basically fragmenting things but would allow private companies to bid for patients from GPs.

Doesn't that happen now TJ? My good lady is a physio in the NHS, and they're "losing business" because private companies are being commissioned by the GPs, purely on the basis of cost. GPs already hold a lot of the purse strings AFAIK

1% of what is intended.

well Swindons GWH is a PCT and it still manages to be understaffed, underfunded and spend what little it has on stupid schemes and fancy gardening. what do you expect, the torys are in thus its quango time!

I have private operations in a private hospital.

I have private operations in a private hospital.

Munchausens ?

I have private operations in a private hospital.

Why, what's wrong with your business?

This was all destined to happen when DC got in. The Tories are going to ruin this country.

The NHS was forged pre Thatcher when we had a huge industrial base providing massive tax revenue to fund it. People didn't live as long as they do now, healthcare is based far more upon expensive technology and successive govt's since Thatcher have viewed the NHS as a business not as social welfare.

It's screwed. Shame.

I didn't get into this game to bump the profit-margins for McKinsey, Serco, United, General Healthcare, etc - all of whom are salivating wildly right now.... 👿

Only a matter of time until NHS goes boom. Better to have private.

edit: IMPO 😉

@Junkyard I think the internal market was brought in under the Conservative Major government, pre-dates the Labour years.

Currently too many of us are wanting to use acute services and as a nation we are struggling to find the cash to pay for it, so you have 2 options.

1. Close wards, and you don't get you operation
2. Get other sources of income.

Which would you prefer, you can't have your cake and eat ie low taxes and still expect to get your operation.

Put taxes up then, most of us could afford it.

Only a matter of time until NHS goes boom. Better to have private.

Yeah just like in the US, where the government spends more on healthcare, but millions of people have no cover.

The system works ok for me in the US, but granted depends on your personal circumstances. The poor in the community suffer but they are working to address that.

Stop fighting illegal and futile wars overseas and maybe we can fund it properly.

I am sure all you ****ing Tories are rubbing your hands with glee anyway.

The truth is that whoever is in power unless the NHS changes the way it works the cost of looking after the needs of the elderly baby boomers over the next 20 years will bankrupt it. I don't agree with giving the commissioning power to the GPs for the reasons TJ suggests, but one way or another demand for hospital care is going to have to be managed. Unfortunaltely for the offspring of the baby boomers, most of the caring is going to have to be done by them.

Slightly off topic, but there is something rather unfair (if unavoidable and unitnentioned) that the generation who had everything good and for free - grew up in the sixties, grants, free love, 80s boom, good pensions, early retirement etc etc - are the ones who simply by their existence bring it all to an end for the generations that follow.

whoever is in power unless the NHS changes the way it works the cost of looking after the needs of the elderly baby boomers over the next 20 years will bankrupt it.

Well that is certainly what neo-liberal right-wingers would like you to believe - and they are having considerable success too. Due in part no doubt, to the fact that neo-liberal right-wingers have effectively now gained control of all 3 major political parties, leaving no alternative social-democratic voice to be heard.

The "ageing population" [i]and [/i]the banker's recession/credit crunch are just simply excuses to do what right-wingers have long wanted to do - attack the NHS and exploit the huge healthcare market with it's huge potential for profit. There is a lot of money to be made out of sick people.

As far as the "ageing population" is concerned, yes it is ageing, but there is no need for alarmist nonsense about "bankruptcy". We can easily afford to look after elderly citizens.

In the last 25 years the percentage of the population which is over 65 has only increased by only 1% ......... from 15% in 1984 to 16% in 2009. So yeah, more non-productive people. But also in the last 25 years, as a result of new technology, productivity has increased massively. So more is being produced by less people. Which more than compensates for the slight increase in the non-productive population.

The median age in the UK is set to increase further over the next 25 years, but it is all manageable - there is no need to stop caring for the old and sick. Unless of course you believe that greater productivity [i]should not[/i] result in more resources and more non-productive/free time for people, and only result in more/greater profits.

Isn't the motive behind handing over power to GPs a means of deflecting the blame when it all goes t*ts up? If there are tough times ahead and difficult decisions to be made, then find a whipping boy to take the flak instead of the government? If, on the other hand it works out well because GPs know "what works and what doesn't" probably better than anyone else does, then they can share the limelight and claim that they made the right decision. Good or bad, a win/win for the government?

The truth is that whoever is in power unless the NHS changes the way it works the cost of looking after the needs of the elderly baby boomers over the next 20 years will bankrupt it

The NHS does have problems- modern medicine's incredibly expensive after all (1), and keeping people alive is more expensive than not keeping them alive (2) .But people say "You can't fix this by throwing money at it", actually, yes you can and we can. If we choose not to then things will get worst but this doesn't look like any sort of answer to me.

1) I'm a case in point, my hip surgery cost the NHS something in the order of 15 times more than a hip replacement, and wouldn't have been possible even 5 years earlier. Obviously I'm glad it's an option now though! But things like this are common, modern medicine really does work miracles and miracles aren't cheap.

2) A lot of medicine is designed to extend life in the event that a cure's impossible, and if you (for example) keep a terminally ill patient alive for 5 years not 1, that costs 5 times as much. And they still die! Terrible waste of money, we should keep the budget for people who aren't going to die.)

Um northward. Would you say that if your mum or sibling was diagnosed with motor neuron disease? Or would you want them to do everything they could? Sorry mum its a waste of money you are only going to die... 😕

we should keep the budget for people who aren't going to die

Everyone's going to die at some point.

The current Government seems to be on a course to political suicide, it probably knows this, but probably doesn't care.

An opportunity too good to miss has presented itself in the form of economic crisis.

The group of very wealthy individuals within the cabinet will still be very wealthy at the end of it safe in the knowledge that they reduced the public sector and handed the profitable parts of it to their social set of friends in the form of privatisation.

Whoever comes after will do exactly what the Labour government did in 97 after the Government it ousted privatised large chunks of the public sector: nothing.

You see the changes will not be undone because they will cost taxpayers money to do so and while middle class voters who are the majority in this country continue want the something for nothing, money will not be "wasted" to bring it back under state control.

I'm sure there will be plenty of blame leveled at politicians, but that means we haven't read the small print when it comes to who these politicians are and who's interests they serve.

The fault will ultimately lie with the voter.

Should I have followed that up with "THIS IS OBVIOUSLY A JOKE"? Jeesh.

Some of you guys need a tinfoil helmet. I really can't accept that you honestly believe the crap you're spouting.

I'm with you joolsburger. It's the fist time anyone has ever described me as neo right wing too. As someone working for a mental health trust, I can see that on our current trajectory we simply would not be able to build enough hospitals and care homes to accommodate everyone who would inhabit one in 20 years time under the current model. I use the term bankrupt figuratively, but none the less I think most people would agree that isn't sustainable.

I'm no fan of the Market in healthcare, and I believe the current changes will lead to greater waste and fragmentation, but I'm not sure that throwing an extra £100bn a year at it would necessarily solve the problem either, even if it were there to throw.

This forum seems very left wing. State employees feeling a bit anxious?

I long for the day when this partisan nonsense is behind us all.

IanW - Member

This forum seems very left wing. State employees feeling a bit anxious?

Personally, I feel the creation of the NHS is one of Britain's greatest achievements, benefits every one of us and is a wonderful example of collective social justice. It stands as a beacon of what we can and should strive for as a nation, what we should aspire to be.

To see it destroyed by petty minded, cynical ideologues, bent on filling their pockets and those of their private healthcare cronies makes me angrier than I ever thought possible and ashamed to be British.

bol - Member

It's the first time anyone has ever described me as neo right wing

I can't see that anyone has done that on this thread. Although I myself, did make a comment about "neo-liberal right-wingers" .........perhaps you are referring to that ?

If so, try reading it again, and see if you can figure out what I am saying.

After your comment I wrote : [i]"Well that is certainly what neo-liberal right-wingers would like you to believe - and they are having considerable success too."[/i]

I have no idea where on the political spectrum you stand. Which btw, is fine with me.

This forum seems very left wing. State employees feeling a bit anxious?

Well I am indisputably left-wing, but I am not a state employee. Although I can't deny that I am anxious about the effect of government policy on the construction industry. As I am about the NHS. And indeed the whole economy,
from the perspective of ordinary working people - jobs, wages, etc.

I think you'll find that taking a political position from a purely selfish perspective, is something which is far more prevalent amongst Tory voters.

This forum seems very left wing. State employees feeling a bit anxious?

I'm not a state employee.

I just don't want to see the public sector gleefully destroyed using the excuse of a recession/deficit, by staggeringly rich people who have no interest in public services or regeneration etc because it doesn't affect them.

Also, does anyone think the rash of stories in the right wing press about excessive public sector pay etc are a coincidence?

i think grum has hit the nail on the head it's people (both in government and the private sector) who are using the recession as an excuse to carry out things that would be unquestionable if the economy were in a better state. Private companies have been far too quick to turn to redundancies imho. a place i used to work for lost a third of their workforce by december 2008, it wasn't even clear what was going on by that point and the company certainly wasn't in any financial difficulty.

the problem with the way the parliamentary system works currently is it creates a very short term mentality amongst leaders, they want to do what's best in the next 4 years and not what's best over longer periods. Not sure how to fix this though!

I've seen the NHS from most sides. I've worked for it and my company now supplies tests to them.

Privatisation is creeping in at so many points. On a personal level as a NHS supplier, my customers are making inital noises about setting up joint commercial ventures and this is just going to keep happening.

Generally I'm a big fan of the NHS. However the huge management structures, internal markets (commisioning) and generally complete OTT management pay (people setting their own pay is always ridiculous) is causing many of it's issues.

This is a real pity since there are many dedicated, skilled, hardworking people at the clinical end of the spectrum that I have a lot of time for. I'm just not sure how you can improve the lot of these people whilst removing the beaurocracy with privatisation.

Guys just try to remember some real truths about the NHS

We spend less on our healthcare than most similar countries. as a % of gdp we are still under 10% ( it was under 8%in 1997)

Most European countries spend 10-13% of gdp, the Us over 16%. In cash terms as our GDP is lower we spend far less.

We can afford the nhs easily, we could afford an improved nhs easily.

Management costs are low as are management saleries in the NHS - a part of the issue

The nhs is very efficient.

Britain remains a low tax economy. These cuts are ideologically driven.

The other bright ideas are for GPs to do all the commissioning of services - basically fragmenting things but would allow private companies to bid for patients from GPs.

You can't have your cake and eat it

Her position - one key issue on costs is consultants - seemingly a law unto themselves - expensive, inefficient and more money grabbing than any banker when it comes down to it - reporting their surgeries are 'full', miraculously finding diary space when waiting list incentives (additional payments) so the trust can meet it's target, come available...

Feel i might regret posting this as I'm not able to back this up should the flames rise but hey, MrsMM is 'at the coal' face as it were, thought it might offer another perspective...

Her position - one key issue on costs is consultants - seemingly a law unto themselves - expensive, inefficient and more money grabbing than any banker when it comes down to it - reporting their surgeries are 'full', miraculously finding diary space when waiting list incentives (additional payments) so the trust can meet it's target, come available...

AT the start of the NHS the two groups most opposed to it were a) the Tory party and b) the doctors. No surprise to see a) giving control to b) in the guise of efficiency. This is an idealogical policy (just as closing the coal mines was).
I look forward to the Government telling Tesco to sack it's middle management (accountants, buyers, logistics etc) to concentrate efficiency on the customer by devolving responsibility to the shops!

IanW - Member

"This forum seems very left wing. State employees feeling a bit anxious?"

No, NHS user feeling a bit anxious. They gave me back my leg. And if I was american my diabetes medication would have pretty much bankrupted me (despite the fact that their healthcare system is actually more expensive not less). If we let it be picked apart it'll be a tragedy IMO.

As an NHS manager, my biggest worry at the moment is not the £20m cuts my trust has got to find over the next four years, or even GP commissioning (although I think that's a disaster waiting to happen in loads of ways), it's the massive cuts in social care that are quietly happening in local authorities across the country. Without it the NHS will grind to a halt as beds are blocked and people referred because no one else can cope. We, like many other trusts are thinking about how we might be able to free up cash to fund social care because without it we're stuffed.

TJ wrote

Management costs are low as are management saleries in the NHS - a part of the issue

The nhs is very efficient.

Compared to what, other than your favourite of % against GDP? I do agree with you re management salaries but peanuts and monkeys spring to mind! That is not my experience/impression (re efficiency) and I would give examples were it not for the fact that myself and colleagues have been warned that discussing matters on any forum or talk platform may lead to disciplinary action.

I_did_dab - Member
I look forward to the Government telling Tesco to sack it's middle management (accountants, buyers, logistics etc) to concentrate efficiency on the customer by devolving responsibility to the shops!

Why would the government dictate the internal hierarchical dynamics of a private company?

Woody - in comparison to other EU health services. Partly due to the simpler funding stream ( altho that advantage may be disappearing)

Management costs are a lower % of total spend than most. ( from figures I saaw a couple of years back)

It also costs less than most.

todays stupidity. The NHS in England has put 1.7 billion aside to pay for this reorganisation. Thats as much as the tories claim will be saved over 7 years. Of course the savings won't be that much anyway. Thats about 3 new district general hospitals.

http://www.bbc.co.uk/news/health-10647910

Utterly ridiculous Waste of money for ideological reasons - to create a market for private companises in the NHS

Thank fully the condems have no authority here

The NHS in England has put 1.7 billion aside to pay for this reorganisation.

Another perspective...

I have lost count of the number of times I have gone to work to find (amongst others)

1. Operating list cancelled - no beds to put patients in - thus get paid to do sod all, patients have to be done elsewhere/out of hours for payment

2. List running late - short staffed, can't send for the patient blah, blah

3. List running late - the ward got confused and the patient isn't ready

Most NHS surgeons like working hard. (most). Often the reason for poor usage of capacity is not the operating surgeon.

The comment above about social care is very valid - increasing numbers of hopsital beds are full of patients who do not need to be in hospital awaiting social care. Social services are excellent at dragging their feet - although again may be matters beyond their control...

I don't understand why the NHS dosen't charge a flat rate fee for ALL operations, be it a hip replacement or something smaller and more routine like a cortisone injection. £30 say. I don't think that's out of reach for the poorest of the poor - if grandad needs a heart transplant i'm sure the family could have a whip-round even if they are all on benefits.

That way everybody puts money in the pot which helps to pay for the most expensive procedures.

That way everybody puts money in the pot which helps to pay for the most expensive procedures.

And a whipround wouldn't work as the 'poorest of the poor' or those on benefits do not have money for such things. Fags, booze and ....-off big tv's, yes, healthcare no! What would you do, deny them treatment until the next benefit cheque arrives or they have a bit of luck on the geegees ?

Apologies for the [i]looooonnng[/i] post, but this excellent comment by 'alisdaircameron' in response to a [url= http://www.guardian.co.uk/commentisfree/2010/jul/17/tories-are-demolishing-the-nhs?showallcomments=true#comment-51 ][i]Grauniad[/i][/url] article is worth reposting - it is bang on the money.

[i]Polly, don't even buy in to the idea that GPs will be commissioning: the odd one who doesn't much like clinical work may (thus in essence ceasing to be much of a GP), but the overwhelming bulk of commissioning will be contracted out/outsourced by the consortia (n.b. as most GP practices are private partnerships, how are the 'forced marriages' into consortia not a top-down approach, Mr Lansley?).
(cf the instruction from David Nicholson: working with consortia to support the creation of commercial and NHS commissioning support capability to enable the work of consortia. Note the order, private before NHS and also note that the big private consulting firms have thoroughly infested the upper echelons of the DH, and are ready to roll with their battalions of bright, but ignorant, sharp-suited fresh-from-Uni ‘troops’. Also see: Kingsley Manning, business development director at Tribal, which also already provides commissioning support services to some parts of the NHS, cautiously welcomed moves which the firm said "could lead to the denationalisation of healthcare services in England".) We won't get an erosion of bureaucracy : the difference is that it will be a private bureaucracy.
We'll see direct outsourcing to the multinationals (mainly American) whose whole modus operandi is utterly unsuited to universal healthcare. They see this as a golden opportunity and may employ some NHS staff made redundant from PCTs etc to ease their entry to the 'market', though they've already had their placemen/women on secondment in the DH for well over a decade.It was (New) Labour’s ‘direction of travel’ too. From the purchaser/provider split to FTs, the drive was all about marketisation, and allowing entry to the private sector. Fragmentation, competition ahead of cooperation or a joined-up NHS, and cherry-picking by those private sector entryists didn’t seem to bother New Labour. They undermined the NHS’s foundations, which is what is making its so bloody easy for the Tories to demolish. Welcome more (costly) hard-nosed private sector management consultants that don’t understand how the NHS ethos, and have less respect for medical professional ethics, but are supremely confident (arrogant?) in their MBA knowledge and ability. Most probably, then, those aforementioned multinationals will establish partnership subsidiaries with ex-NHS staff. Private healthcare is mostly very simple - focusing on elective surgery, usually with a patient that already has a diagnosis. It's a matter of looking up the procedure on the code list to see if it is minor/intermediate/major, and pay the consultant and anaesthetist accordingly, then pay the hospital for use of facilities and 'hotel services'. The NHS is massively more complicated and that’s before you even bring in mental health and community services - the private sector doesn’t get involved with these much because they are largely ill-defined, high risk and unprofitable.
Every one of these 500 consortia will need to have offices, IT systems, managers, administrators and secretaries. They might primarily negotiate with their nearest hospital, but also with regional and national specialist units. On the other side, the hospitals will have to negotiate with lots of different consortia, rather then primarily with their local PCT. The outcomes of these negotiations will be all manner of complex contracts - payment of some of these will depend on outcomes, but meaningful outcomes are notoriously hard to measure outside of surgical pathways.
And this is just elective admissions, who will fund emergency admissions, and what about community and mental health services, where the care given doesn’t happen in a nicely defined episode in a hospital?
So how is this going to reduce the administrative overhead, the count of the 'dreaded' NHS managers that are necessary to try and make government policy work? Opportunities for ambitious GP Practice managers, ex NHS managers, and suppliers of health orientated IT systems and business services. We thus arrive at a point when many familiar faces will be performing commissioning functions, their old job, with a new master, more remote than local PCTs in some respects, with the influence of the profit-driven commissioning partners felt more strongly too.
As to David Nicholson's letter this week, a lot of people think it had quite sinister undertones: SHA and PCT staffs have to reduce costs whilst
managing the changes to the new system whilst 40% of them face redundancy but whilst doing all of this, they are instructed to stay on the pitch and not be commentators: in other words deliver the changes without question, and if they do question they will be seen as poor leaders…and probably jobless?[/i]

Separation of healthcare providing and commisioning has been in the planning for a fair while now, with recognition that PCTs cannot provide [i]and[/i] commission services.

Makes me wonder what the lack of "suits" within a PCT structure will mean to GP services, some practices struggle already to provide a good enough patient service, maybe these are the practices who will commission private services?