[Closed] NHS Privitisation is coming

Telling us all how you voted is really, really interesting

Well I'm glad that you found it so. I have to confess that when I eventually relented after being persistently harangued by mrmo about my voting, I hadn't figured that many people would be interested, so it's nice to know that at least 2 of you were.

TJ, my wife is a nurse in a LARGE Leeds hospital & am concerned about the OP. However I am also very concerned about why you aways seem to mis-spell 'the' IE, you almost always type 'teh' (or a derivative). Are you dylsexic, is your keyboard on the blink, or don't you read what youv'e typed?
I know It's trivial raelly but, you know.... 😉

esselgruntfuttock

Well - I would claim Dyslexia, my teachers labelled me lazy. "teh" is an oft typed misspelling. I do try to remember to spellcheck but sometimes forget. I probably don't see it either when I re read. There is certainly something wrong with my ability to use written language however

ernie i wasn't haranguing you about who you vote for, and i am not particularly interested, the point was merely with the current system if you want a change your vote is unlikely to cause it. I do hope your approach might have a positive outcome and that enough people will vote for a party that will cause a change.

It is merely the case that i don't believe that there are enough people willing to vote for the new, for the untested.

anyway back to the topic in hand.

I don't believe the NHS we have will survive, there are too many vested interests in ensuring it fails. Look at the railways under fund it for years then declare the only solution is privatisation. Then once privatised give the money that should have gone to it before privatisation, only now it is creamed off as profit rather than going into better services. Look at the political landscape, and tell me how you can protest and actually get a response.

I would claim Dyslexia, my teachers labelled me lazy.

Ah, so you're blaming the state education system for your misdiagnosis are you ?

That's nice.......why didn't you have private education, if the teachers provided by the state were so crap, eh ?

😐

ernie i wasn't haranguing you about who you vote for, and i am not particularly interested

So now after all that, you're telling me that you weren't even interested !

I don't know why I bother sometimes, I really don't.

Thanks for that TJ, I won't roll my eyes now every time i see it.

Can't believe I typed [i]I know It's trivial raelly but, you know[/i]

Must be the Botanist gin thats affecting me! 🙄

😆

TJ - the NHS is the most efficient provider of healthcare in the world?....

....hahahahahahahahahahaha....hang on.....ahahahahahaha.

Right, got that out the way.

I work in the NHS, i also have a contract with a private firm doing similar work....the private firm is more efficient in just about every way.
My initial training course was far more comprehensive with the private firm, the private company employs exactly who it needs to employ...not whatever nonsense position some think tank or pointless government organisation tells it to employ....and the end result for the pt is of a higher standard too, why?....because staff in the private firm dont feel they are working as an insignificant cog in the behemoth that is the NHS, staff are motivated, there is a closer working relationship with senior managers in the private firm precisely because there isnt the proliferation of middle managers that the NHS is encumbered with....clinical staff are very much frontline staff and admin is taken care of by civilian employees....all things considered i enjoy the work i do for the private firm far more than my NHS work, the only thing keeping me in the NHS is the pension at the end of it.

To give you an example of how 'efficient' the NHS is, my trust employs somebody to visit the ambulance stations and report on how energy efficient they are....yes, this person DRIVES around the stations reporting on energy consumption!....we have registered Paramedics taken off road for months at a time to carry out projects and admin while frontline ambulances are left single manned or taken off road entirely because of low staffing levels....we have a 24 hour emergency service but only employ part time mechanics to maintain the fleet, when vehicles break down the pool of resources available to the public drops because there is nobody available to repair said vehicle....but its OK, we have a full time lesbian-bisexual-gay and transgender officer!

Trust me, the NHS is about as far from efficient as can be....although i am not in favour of privatisation as a whole, something does need to change, the NHS is unsustainable in its current guise unless everybody wants to pay more tax....for the same tax as we currently pay we could have a far better NHS if all the crap was cleared out and outdated working practices were changed.

deviant - it really is. The amount of money wasted on shit like that is small compared to the money saved by being co operative in nature.

You look at its cost for coverage compared to other systems and it comes out very well. Management costs are actually low in comparison to other countries. we pay a smaller % of our GDP than other countries and we get a coverage close to the best for much less money.

I'd rather the government focused on how billions is spent with companies like BAE than the NHS.

deviant - Member

I work in the NHS,...................

To give you an example of how 'efficient' the NHS is, my trust employs somebody to visit the ambulance stations and report on how energy efficient they are....yes, this person DRIVES around the stations reporting on energy consumption!....we have registered Paramedics taken off road for months at a time to carry out projects and admin while frontline ambulances are left single manned or taken off road entirely because of low staffing levels....we have a 24 hour emergency service but only employ part time mechanics to maintain the fleet, when vehicles break down the pool of resources available to the public drops because there is nobody available to repair said vehicle....[b]but its OK, we have a full time lesbian-bisexual-gay and transgender officer![/b]

.

Posted 11 hours ago # Report-Post

Job creation schemes like the above post make me so angry, nearly all LGBT staff are fully grown aduiilts and should be able to sort problems out themselves with the aid of the personnel dept, or an outside charity,its just politically correctness gone mad.

Daily male mode,rant off.

Two questions;

1.) Which country has the best healthcare system in the world?
2.) How do we make our system match that one?

1a) what are the metrics for "best"?

yeah but deviant just think all that money spent on the innefficiency and lgbt stuff you dislike so much it still manages to be more efficient than the private sector,
because of all the extra thats creamed off the top for directors and shareholders is soooo much more expensive

do your bit - fight to save the NHS

How exactly do I go about doing this? Write to my MP? Is there a "Save the NHS" campaign around?

Edit: not having a go - genuinely interested as to how I can express my POV to the people making these decisions.

but its OK, we have a full time lesbian-bisexual-gay and transgender officer!

Obviously in project land people who are gay, bisexual or transgender do not suffer any issues [ in the workplace or health] that seperate them from other sections of society. Can i join this perfectly integrated euotopia you live in project?

Just silly frothing at the mouth here from the usual righties at the usual targets

I bet they have folk who just work with old people as well the bastards.

There has to be an acceptance (IMO) that you cannot ascribe principles of profit making business to a universal free at point of care health service.

Efficiency gains can be made in every organisation wether private or state owned but trying to work them like companies may not be the right way to do it.

Your health is probably the most important thing in your life - letting profit motivated companies answering to shareholders provide this care is wrong. It is not something that you should have to 'afford' or do without. No sane society can operate that way. A bit like subcontracting defence to 3rd parties.

It is a job for the state to look after the health of it's citizens. It may be that efficiency means something else or uses a different metric in this context to what we have come to expect.

It's not like the rail network has benefitted from privatisation. That's just transport and trains. Not peoples right to a decent level of health and care.

Err - actually a pretty rigorous recent report did show that the NHS is the second most cost-effective Health Care system of those in developed countries. But I could find plenty of people whose jobs are pretty useless, whilst the ones we needed have been "reorganised" away.

There are problems and interesting oddities.

1) The sector which is the most efficient, has the best information systems, and acts as "gatekeepers" to the expensive bits is Primary Care... and lots of other countries are trying to recreate this. And as someone mentioned above - GPs are mainly self-employed sub-contractors to the NHS who can therefore avoid a lot of the BS and slow management-decision pathways. So are they Private?
2) Governments (both this one [i]and[/i] the last) find the NHS too much of a big trainset to avoid playing with it. The rules change every few years, another bunch of managers come along, spend a year learning the ropes, a year doing something useful and then a year looking for another job when the next reorganisation comes along. They all have a hard-on for the Kaiser Permanente system in the US but ignore studies which show how different and costly it can be. They all want to import other US models, even though the admin costs are huge and the efficiency is doubtful.
3) Contrary to TJs opening post - about the only people who have a broad enough perspective on what is going on, and some idea on what needs to change, are GPs - not all of them - just some who have been doing this and service redesign work for over 20 years. But we are all getting peed off by the flip-flopping from the DoH and the way local health managers seek to preserve their power over achieving cooperation and clinical change.
4) Targets - which the Tories are against - work.

Net result is a whole generation of us who have invested time and emotion into trying to change things are giving up, checking our pensions forecasts. 🙁

[i]what are the metrics for "best"?[/i]

...Is the beginning of a sensible debate instead of political grandstanding.

Suggestions;

Universal coverage or let the poor die?
Free at the point of delivery of care or on production of credit card details?
Funded by ability to pay via taxation or state insurance?
Balanced between local availability and centralisation of specialization to achieve best outcomes?
Basic healthcare package for free, non life threatening treatments extra?

Protected by law from stupid politicians making money for their mates?

My tyre stayed up all night, rainy ride pending...

4) Targets (when set by clinicians who understand how to properly measure desirable outcomes, not set by the daily mail et al who convieniently ignore/don't understand the manifold undesirable effects that a headline target such as 4hr waiting times in A&E can have on patient care)- which the Tories are against - work.

FTFY

my trust employs somebody to visit the ambulance stations and report on how energy efficient they are....yes, this person DRIVES around the stations reporting on energy consumption!

Equally, for the LGBT officer: that's an employee of the trust or the union? is that their only job? do they work on employee questions or are they outward looking i.e. to LGBT patients?

Having recently been on the recieving end of very shoddy NHS treatment I'd be love to hear that it actually was being privatised. However much the vested interests (ie the STAFF TJ!) shout about it, it isnt, mores the pity.

I lost faith with the NHS when my mother was diagnosed with cancer and told to wait 12 weeks for an operation. After my consultant brother-in-law got on the phone and tore strips off the people concerned they somehow managed to find time to do the op in short order and she happily survived. What happens to all the poor sods who dont have a doctor and a midwife in the family and just have to take what they are given?

Singapore has the right idea. Please do take a second to read, we lived there for a while, they really are proud of their healthcare system and have reason to be.

"Singapore has a universal healthcare system where government ensures affordability, largely through compulsory savings and price controls, while the private sector provides most care. Overall spending on healthcare amounts to only 3% of annual GDP. Of that, 66% comes from private sources.[2] Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth, according to the World Health Organization.[3] Singapore has "one of the most successful healthcare systems in the world, in terms of both efficiency in financing and the results achieved in community health outcomes," according to an analysis by global consulting firm Watson Wyatt."

http://en.wikipedia.org/wiki/Healthcare_in_Singapore

5 million people live in Singapore, 12 to 14 million live in London alone, so there is a significant difference of scale to consider. They have one psychiatric hospital, for example.

Interesting all the same.

5 million people live in Singapore, 12 to 14 million live in London alone

OK. So what? Economies of scale work AGAINST small markets, yet Singapore excels even though patients should have less choice, not more.

Everyone pays into a their own fund, when you (or grandma) gets sick you use your fund to pay (means tested) for the treatment at the hospital of your choice. The only difference in actual service provided was in the extras like quality of food, size of rooms, whether you shared and so on. Its all run for the benefit of the patient with private and state run hospitals competing for your attention.

Forget it - too emotive.

Just reading through this. Have some of you actually left the house this weekend? 😯

Your health is probably the most important thing in your life - letting profit motivated companies answering to shareholders provide this care is wrong. It is not something that you should have to 'afford' or do without. No sane society can operate that way. A bit like subcontracting defence to 3rd parties.

That seems to be more based on gut feeling than any real logical reasoning - if I break my leg I want it to be fixed, and while I seriously doubt that private subcontracting will actually save any money, when I'm screaming like a little girl to get my leg fixed it would make little difference to me if the doctor who is actually providing that care is paid by the NHS, BUPA, or whatever.

Personally I think the NHS should continue to be state run, free to all (at point of care), and with legally guaranteed minimum standards of care - and that necessarily means being under political control.

[url= http://www.moh.gov.sg/mohcorp/uploadedFiles/Means-Testing/MT%20pamphlet%20(English).pdf ]singapore health system. [/url]

So reading that am i right to believe that the system is not "free" but rather based on the user taking out insurance? and the care received is determined by the insurance policy in place?

It might provide a good level of care, but i wonder how much the bureaucracy costs to run the system. How much duplication exists providing differing care to different patients based on income and insurance policy?

Ah privatisation; Delivering "the minimum acceptable standard". It's worked wonders for our rail network don't you think? (yes I know network rail is pseudo-govt).
Minimal staff receiving the lowest acceptable wages using the cheapest available equipment. Nice.

binners - Member
Just reading through this. Have some of you actually left the house this weekend?

I asked a similar question some time ago.....

So does everyone diagnosed with cancer (and other major illnesses) in Singapore see the specialist immediately irrespective of their financial status?

I think it would be wonderful if we could do this too so no-one would have to wait to be seen or rely someone who is in the system queue jumping their relatives.

[i]Minimal staff receiving the lowest acceptable wages using the cheapest available equipment. Nice[/i]

You mean like GPs? 😉

I know very little about healthcare in Singapore apart from the fact that my (Singaporean, wealthy) boss told me that it is common for people to pay their doctor a monthly retainer. When they get sick, they get seen by their doctor but no extra fee is charged. I have no further details as we didn't go into it much.

Your health is probably the most important thing in your life - letting profit motivated companies answering to shareholders provide this care is wrong. It is not something that you should have to 'afford' or do without. No sane society can operate that way.

nor has the size of the cheque has been reduced to pay dividends to shareholders

[b]CaptainFlashheart & Binners[/b]

Don't worry your pretty little heads about it. The grown-ups are talking 😉

Not sure why you bother to post say you aren't interested, and why you seem so proud of your disinterest. It is the chat forum, and this is a fairly important subject, and people discussing such issues should be the foundation of a democratic process. But I'm not a big-hitter so I wouldn't really know...

And yes - I had an awesome couple of days riding (badly) in the Quantocks since you asked.

konabunny, as you say wealthy boss, what happens to those who have less money and are unable to pay a retainer? I don't expect you to know the answer, but it is what concerns me about so many health systems, money buys a better level of care. Need is not considered.

But I'm not a big-hitter so I had an awesome couple of days riding (badly) in the Quantocks since you asked.

Better with a slight edit! 😉

I'm just concerned about peoples vitamin D intake. They might get rickets! and what, with the NHS being in the state its in.....?

Fair point. Wonder how much mud absorbs sunlight.

So reading that am i right to believe that the system is not "free" but rather based on the user taking out insurance? and the care received is determined by the insurance policy in place?

You think the NHS is free? No isnt an insurance system, you pay into your own fund and then you pay for your own treatment out of the fund, topped up by the government for those on low pay. The point isnt the method of funding per say, its the fact that the providers of healthcare are a mix of state and private hospitals and doctors who in effect compete for your attention. Its about YOU THE PATIENT.

But I'm wasting my time. In the UK you cant properly debate the existence of the NHS, you can only have one state provider because somehow the great profit motivated free market cannot play any part.

konabunny, as you say wealthy boss, what happens to those who have less money and are unable to pay a retainer?

konabunny, as you say wealthy boss, what happens to those who have less money and are unable to pay a retainer?

"Singapore currently has the lowest infant mortality rate in the world (equaled only by Iceland) and among the highest life expectancies from birth"

Hate the target culture of NHS you say? There's the only stats that matter.

mcboo, the NHS is not perfect and debating is fine. But i only have one simple question, is the treatment available to the company cleaner as good as that available to the MD?

no system is free, it will be paid for through taxes, insurance, etc. but should the poor be denied treatment if they can't afford it? If a system can guarantee access then good, if it can't then there should be no discussion it should not exist.

To be fair, mcboo, Iceland only has about 250,000 citizens so that would skew stats like this. Depends on the sample size, innit?

Stoatsbrother - I must take you to task about the role of GPs - yes they have a good perspective on some parts of the NHS - however they simply do not have the expertise or desire to undertake the role the government envisage.

this is deliberate - the GPs will have to contract out much of the role to management companies who will in turn pass juicy contracts to their friends.

Amateurish management is a bane of the NHS - and while some GPs may be good managers many are not and very few indeed have the expertise to do what the government wants - and even fewer wish to take teh role.

Teh only way it can be run is mby professional managers with the necessary expertise

OK....so lets exclude Iceland. There, Singapore you are No 1!

Look, I'm not saying that you dont get a nicer room or better food or even a shorter wait time for an operation if you are wealthy in Singapore. But just because it isnt a completely flat system (like ours) can it offend your sense of fair play so much that it isnt in its entirety an admirable system of universal health provision? As an expat on a short term contract you rely on your work to provide health cover so its slightly different for us but the Singaporeans I know like the system a lot.

As an aside, Singaporeans have a TERRIBLE lifestyle, too much MSG in their food, not enough exercise and everybody chain-smokes. Yet they still have a long life-expectancy?

But I'm wasting my time. In the UK you cant properly debate the existence of the NHS, you can only have one state provider because somehow the great profit motivated free market cannot play any part.

The shareholders can never have the same interest as the patients.

Teh only way it can be run is mby professional managers with the necessary expertise

More fatuous soundbite nonsense, that's what you need.

It's admirable that the results from the Singapore system are so good, but in terms of healthcare, the way it is financed should have little effect on the way it actually works, unless there is some special medical effect that we don't know about that changes with the source of money.

It is worth looking more closely, and trying to stay apolitical, to see how the system works in terms of primary and secondary care, how long do people wait for appointments, how does the small and therefore centralised care system work in terms of treating people?

Just changing how you fund a healthcare system shouldn't affect the quality of care delivered, should it?

Mcboo is right though; lets look at it in terms of outcome and see how we can match that rather than defending the NHS at all costs.

mcboo, if someone wants to take out private health insurance, i.e. BUPA i don't have an issue, as i said more a case that if you need treatment can you get it.

I would not want a system where the treatment you receive could result in your bankruptcy, a system where when your insurance runs out your on your own. If the singapore system is basically the same regardless of income, you just get a few bells and whistles for spending a bit more, fine.

However should a system work where money can buy you faster treatment? where through contacts and money you can gain access ahead of those less fortunate than yourself?

McBoo - the reason for that is that for profit firms provide worse healthcare at greater cost - and a part of their cost is a loss of the cooperative ethic that good healthcare requires. This is ultimately damaging - you cannot consult your colleagues because they have a different employer because sharing best practice is not in your employers interests.

You can ram your co-operative ethic. We all know what that really means. Those ethics very nearly killed my mother 2 years ago.

[i]No, no, no, you've got this politics game all wrong, TJ. You're not supposed to be say "we should pay people who are good at administering healthcare systems to administer healthcare systems and pay people who are good at treating patients to treat patients". You're supposed to say, "we're going to fire all the bureaucrats and bring back ward sisters and there are too many paperpushers and the community should play more of a role instead of LBGT quangocrats".[/i]

Lol, the bigger and more complex a system gets, the more it needs managers. Otherwise you get people like me who is good at nursing doing a crap job of managing things...

So you want to introduce private companies despite their care they give being worse and the cost higher?

Singaporeans have a TERRIBLE lifestyle, too much MSG in their food, not enough exercise and everybody chain-smokes. Yet they still have a long life-expectancy?

Oh yeh when you put it like that, I forgot you are a nurse and are therefore entirely impartial.

Thats the point you see, I WANT NHS staff to be uncomfortable with the new regime.

mcboo,

So how would you set up a system so that everybody got their operation immediately?

I would really buy into that system but can't see how it would work.

Does everyone under the Singapore system get their operation within a day or two of diagnosis? If so, then hell yes we need their methodolgy and I don't care if its private or otherwise.

Hah Kona knows it.....they do like a home cooked meal thats true, am sure thats part of it.

Mee-goreng aaaaaaaaaah........Malaysian food is the absolute berries of world cuisene. Monster hangover cure.

Is berries supposed to be good or bad? Got to say that I really dislike Indo/Malaysian food - does nothing for me.

I'm not impartial, but I'm trying to be, because I know that the healthcare system will end up treating me at some stage and I'd like it to be as good as it can be.

[i]Thats the point you see, I WANT NHS staff to be uncomfortable with the new regime.[/i]

To what end? for 'revenge'?

Like it or not, the NHS is the main healthcare provider in the UK, so lets try to make it as good as it can be, rather than making political points or profit from it.

McBoo I actually like evidence based practice - and the evidence is the way the NHS does things produces better outcomes cheaper than other systems.

Like Dangerous beans - show me a better way of doing it and I will leap at it. Show me an expensive inefficient method and try to tell me its better and I will laugh in your face.

About 1/3 of it is already privatised - just a matter of time till its 100% outsourced quango 😥

Ah, its getting a bit clearer now I've looked on the Singapore Minitry of Health site, it's tiered system where some is state funded and some via medical insurance.

From the listings they provide it seems that if you had lung cancer with complications then your pot of money would provide 7.7 days of hospital care before it ran out, or use 2/3rds of your allocated pot of money for a 6 day stay for a stroke.

Not sure what happens once this pot of money has gone though.

An interesting debate and lots of valid points. I don't have the energy to add to such a complex debate here other than to hope that no-one starts by assuming that the current (Holy Grail) that is the NHS works either as a system for allocating scarce resources or for delivering a service to the sick - other than in the generally excellent provision of emergency services.

I do have to pick up on esselgruntfuttock's comments though. I see the winking smily, but is there a serious side to this post? Seems rather harsh?!?

TJ, my wife is a nurse in a LARGE Leeds hospital & am concerned about the OP. However I am also very concerned about why you aways seem to mis-spell 'the' IE, you almost always type 'teh' (or a derivative). Are you dylsexic, is your keyboard on the blink, or don't you read what youv'e typed?
I know It's trivial raelly but, you know....

If so, can I suggest less abuse and a little more self reflection?

don't you read what youv'e typed?

...what you've typed (or better still what you have)!!

I know It's trivial raelly but, you know

...it's....really.... 😉

Teamhurtmore. Esselgruntfuttok and I have debated many times over years. I am sure no offence was intended and certainly none was taken

teamhurtmore did you join the debate just to write that, because you forgot this bit.
[url= http://www.singletrackworld.com/forum/topic/nhs-privitisation-is-coming/page/3#post-2926379 ]

esselgruntfuttock - Member

Thanks for that TJ, I won't roll my eyes now every time i see it.

Can't believe I typed I know It's trivial raelly but, you know

Must be the Botanist gin thats affecting me!

Thanks for putting me in my place!! Read first post and felt it was a bit unnecessary and harsh. Good to see that I was mistaken here and that no-one has taken offence.

After posting actually wondered if it was all a joke anyway - it seemed too ironic otherwise.

TJ - so much to add here, but hard to be concise or to avoid offending others with differing views on what is always a very emotive subject. Plus tired from hard day!! 😉

Add it then. 🙂

show me a better way of doing it and I will leap at it.

You see thats what I'd say, and I'd really mean it. Lets be honest, you think you have all the answers already and anyone that disagrees with you is either an idiot or plain evil.

Have a look at the German system. Social democratic in so many ways, their healthcare system is based around health insurance. Want to see a GP? Hand over the money first. I personally dont like the sound of that last bit but each to their own.

Now, remind me.....who are the 3 largest employers in the world?

a little more self reflection?

So you want to introduce private companies despite their care they give being worse and the cost higher?

way the NHS does things produces better outcomes cheaper than other systems.

Aravind eye hospital for example?

60% of the NHS throughput, at 1% (yes, one percent) of the cost, give away 60% of their surgery free and still makes a profit

Nope, nothing the NHS could learn from there, is there 🙄

How about the Narayana Hrudayalaya Heart Hospital?

SO DOES EVERYONE IN SINGAPORE GET THE SURGERY THEY NEED WITHIN A FEW DAYS OF DIAGNOSIS IRRESPECTIVE OF THEIR INCOME, SAVINGS, ABILITY TO PAY??

Singapore is not comparative, they have very low unemployment (between 1 and 2% iirc) which is a figure that can be counted as transitory, a large migratory work force that do not have the same entitlements as citizens.

McBoo - I know a bit about how some European systems work. Germany for example is significantly more expensive per person than the UK for outcomes a bit better. A fair bit of the extra expense goes in administration because of the complex funding. The fragmented providers can also make strategic planning more difficult.

You see thats what I'd say, and I'd really mean it. Lets be honest, you think you have all the answers already

I've never been shown anything better. If its out there I woud like to know All the examples of for profit healthcare that are in any way comparable are more expensive.

The NHS has and can learn from the private sector however. Control of costs is so much better now than it used to be with people down to quite a low level budget holding and information being widely available. Attention to "hotel services" should be and often is far better than it used to be. voluntary sector can and does provide good healthcare in some areas as well

[b]TJ[/b]

Not for the first time I wonder what an earth you base some of your misinformed [i]ex cathedra[/i] statements on. I have searched to find out the basis of your professed broad expertise in matters of health. Cannot find very much. I am new around here - do feel free to educate me...

If you read my post you would see I said that [i]not all GPs[/i] have the expertise. Actually very few. As someone who has been involved in this sort of thing (not now) for some years and been on the courses with Don Berwick's mob, sat on the committees, got the T shirt, set up the collaborative schemes in various clinical areas, lobbied for and got new services across a population of 450,000, worked on process mapping and service redesign in various areas, and education/promulgation blah blah blah, run an internet resource promoting local services/education/EBM for 10 years etc etc, I do know a bit of what I am talking about. Where does your experience in the management capacities of GPs come from?

We need decent managers (we ain't got many), decent clinical leadership (usually not from Consultants who tend to fight turf-wars) and decent financial and activity analysis. Management support will be needed - but it has been needed for many years. And this will need to come from outside, because most of the decent managers fled there over the last 10 years. But no one else (Public Health espescially poor in the UK) actually gets to see the issues that happen throughout the system.

The issue is more in the way the current government is setting the whole thing up to fail. The number of changes that there have been already are mind-boggling. 4-5 years ago the system was about right and could have developed by evolution. But we are screwed.

A couple of us were discussing you at the weekend. We felt that where we found we agreed with what you were saying it tended to make us reconsider our point of view... 😉

I struggle with long sentences. Synopsis before I wade in and put the world to rights?

Ususal STW left vs right again George, that would seem to be about the size of it. 🙁

[i]Singapore is not comparative, they have very low unemployment (between 1 and 2% iirc) which is a figure that can be counted as transitory, a large migratory work force that do not have the same entitlements as citizens. [/i]

But it was being used as a shining example of best practice compared to the NHS.

I am a Nurse but really don't care if the whole system is disbanded if what it is replaced with is better, and if that meant everyone paying a bit more then bring it on I say. I work with people with learning disabilities and if you think your access to care is poor you ain't seen nothing. I spend all day every day fighting the system on behalf of my patients, often with poor results.

I am also, at times, a patient and have seen examples of both excellent and appalling practice. My wife is also a Nurse and sometimes comes home in tears through frustration - she is also ill at the moment and, to date, has recieved good care.

There seems to be a perception that if you work in the NHS you love the system and think it should be protected whatever. On the other hand we have folk who believe that capitalism is king and will solve all ills.

Me, I just want the best cos at some point I may really need healthcare and I don't want it to be shit.

Thought as much.

There is no doubt that the NHS needs a radical shake up. Privatising parts of it and loading GPs with management responsibilities is not the way to do it though.

*applauds dangerous beans*

Stoatsbrother - I am a nurse of 30 years wideranging experience. We are slightly at cross purposes here. I completely agree that some GPs have the skills and knowledge. I also agree with

4-5 years ago the system was about right and could have developed by evolution. But we are screwed.

thats the point - the proposed changes are designed to privatise the NHS. And are simply not needed nor helpful