MegaSack DRAW - This year's winner is user - rgwb
We will be in touch
free schools run by comercial providers will be next too
Yay!
[b]TJ[/b]
[i]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.[/i]
1) Which bit of this did I misunderstand?
2) What is your expertise in Health Service change outside Dementia services in the last 10 years?
This subject is too important to be simplified into privatisation vs NHS. I've put together business cases where shifting activity into the private sector (of which I am not a great fan) could save 50% costs, double activity and get rid of waiting lists... and what happened? - the Chief exec of the local acute trust banned any of her team from talking to me without her present... Many Managers within the NHS tend to think of their organisations agenda and profile first, their next job next, the patients after that, and their employees last.
[i]Many Managers within the NHS tend to think of their organisations agenda and profile first, their next job next, the patients after that, and their employees last. [/i]
That sounds more than a little familiar.
To be frank i think a lot of managers, irrespective of organisation, are more interested in their position and their promotion opportunities than they are in what they are actually tasked to do.
Again, and I apologise for dragging it up, but I'm not getting any younger, and have had yet another puncture that finally jeffed me off so much that I rode to the bike shop on a FLAT TYRE AND BOUGHT ANOTHER TYRE...
Sorry, I think the debate should be what/who has the best healthcare system and how do we get there from here? Not who has the largest willy...
Stoatsbrother - I have done plenty and seen plenty. Managed in PFI, private voluntary and NHS healthcare. Million pound budgets
We really are not that far apart in thinking on this either. However pretty much everything I personally have seen where a for profit organisation is involved in healthcare its pants.
Do you really think GPs as a profession are the right group to take on the role envisaged? I don't. and the statements from various medical bodies has not been enthusiastic to say the least
Stoatsbrother - Member
TJI've put together business cases where shifting activity into the private sector (of which I am not a great fan) could save 50% costs, double activity and get rid of waiting lists... and what happened? - the Chief exec of the local acute trust banned any of her team from talking to me without her present... Many Managers within the NHS tend to think of their organisations agenda and profile first, their next job next, the patients after that, and their employees last.
Posted 15 minutes ago # Report-Post
But what would the patient experience be,what would be the extra cost for hospital based infections, due to cost cutting,also have you actually worked with real patients or just figures on a computer.
[b]TJ[/b] Projects outside Dementia and MH services?
I cannot see who else can give a perspective which is has both a clinical element and a broad scope. Consultants and Nurses as they progress up the hierarchy get to know more and more about a narrower and narrower range of issues.
The Consultants feel threatened and excluded by processes going on at the moment, but try and get them to work and talk together, or do a Friday afternoon operating list...
And once again you are viewing GPs as a whole group. The GPs who will be involved with this and who have driven a lot of the change over the last 20 years are a small group of 5% tops, who can and want to do this. I could do it, but no longer want to. Time for someone else.
[b]Project[/b] - well - shifting physio activity outside to private providers for instance - patient experience and outcomes would improve. And some investigations can be shifted very easily, and protocol guided. All this has been done all over the place with good outcomes and high customer satisfaction.
My local NHS hospital breaches waiting list targets, the charity-run private provider up the road gets the same NHS tariff and sees people within a week or two, keeps its MRI waiting list down etc etc etc and has no MRSA...
There are some very weird costings in the NHS, and some very perverse incentives.
Anyway - no point in continuing this - I'll never convince those who assume external involvement is always bad.
Stoats brother Do you want My full resume? Yes a whole load of different places and I am not MH trained 🙂 What expertise do you have of running large institutions with multimillion pound budgets and many hundreds of staff?
- yes - so the other 95% will contract out the functions to management companies - hence the stealth privatisation 🙄 these companies are alreay awaiting in the wings. Mind you hospital consultants would be worse. I prefer the current system - this idea is simply going to be disastrous. I do not want one professional group doing this - I want broad based leadership drawn form a variety of places and professional management.5% tops, who can and want to do this
The GPs who will be involved with this and who have driven a lot of the change over the last 20 years
Gps have only driven change over an part healthcare and some of that has been more successful than others.
good professionals have a role in running healthcare - their professional background is irrelevant.
Stoatsbrother - MemberProject - well - shifting physio activity outside to private providers for instance - patient experience and outcomes would improve.
evidence? How about terms and conditions for the staff?
I'll never convince those who assume external involvement is always bad.
Dunno who that is. I work for a healthcare charity now. No one would think Marie Curie had nothing to offer. there might even be places where for profit companies are good but I have never seen ofr heard of it
[i]Resume[/i]
What is this, Gossip Girl? It's a CV you pretentious bore you.
French or latin. Which is more pretentious?
Stoatsbother,so who pays for the transport of patients from the NHS hospital, to the private practice somewhere else, also Physio is non invasive so no clinical or hospital based infections.
As its a private physio,they would need to pay buisness rates and insurance,heating etc, all things the NHS DOESNT HAVE TO PAY.
So how are the private ones going to be cheaper.
How about terms and conditions for the staff?
I thought healthcare was about patient outcomes
As its a private physio,they would need to pay buisness rates and insurance,heating etc, all things the NHS DOESNT HAVE TO PAY.
Errrm you are so wrong this all comes out of the Estates & Facilities budget.
And the strange thing is they have to pay VAT but cannot claim it back unlike private companies.
[b]TJ[/b] see this is why I [i]know[/i] you don't know what you are talking about... GPs form/are formed into consortia, and the 95% have the commissioning done, with external governance and oversight arrangements, on their behalf by a board which includes the 5% who do have the skills. And similar organisational arrangements to a greater or lesser extent have obtained for the last 10-12 years, from PCGs to PCTs and PBC. So it is not 95% going direct to private management companies.
I think I'll have to join that list of people who leave a thread when you join it. There really is no point when you seem unaware of the boundaries of your ignorance.
[b]Project[/b] The issue is more why the NHS is sometimes so expensive that a physio appointment with a junior level physio locally was costing about £70 on average with a 6 to 8 month routine wait. The world of NHS budgets is totally Alice-in-Wonderland.
Project The issue is more why the NHS is sometimes so expensive that a physio appointment with a junior level physio locally was costing about £70 on average with a 6 to 8 month routine wait. The world of NHS budgets is totally Alice-in-Wonderland.Posted 2 minutes ago # Report-Post
But thats down to poor management, and poor fiancial planning.
grantway - Member
As its a private physio,they would need to pay buisness rates and insurance,heating etc, all things the NHS DOESNT HAVE TO PAY.Errrm you are so wrong this all comes out of the Estates & Facilities budget.
And the strange thing is they have to pay VAT but cannot claim it back unlike private companies.Posted 13 minutes ago # Report-Post
But the hospital is there if there are patients or not, the heating is on etc etc, its all there ,before the first patient arrives, so its just pretend figures on pages, as opposed to writing out cheques to private comapnies.
[b]Project[/b] re the physio cost issue - You'd think so - especially when another hospital they ran was a "National Exemplar Site" for physio access targets. But because GPs were not allowed to refer anywhere else, or to private providers, they had no incentive to change and develop an efficient system, and because sections of the budget were not hypothecated to the departments which had generated the income the physio dept had no money to do it...
In very many ways the way the NHS is organised rewards failure, not efficiency. The lack of clear hypothecation and budget streams means money rarely gets thrown at efficient departments, it gets thrown at the inefficient problem departments. And often that is as much to do with pig-headed Drs as it is down to managers.
The big costs in running a hospital are staff. Not premises. Using them efficiently would be a start. And private providers have fixed costs too.
Project re the physio cost issue - You'd think so - especially when another hospital they ran was a "National Exemplar Site" for physio access targets. But because GPs were not allowed to refer anywhere else, or to private providers, they had no incentive to change and develop an efficient system, and because sections of the budget were not hypothecated to the departments which had generated the income the physio dept had no money to do it...
Havent the faintest what the above means, and probably no one else who you talk to does............
Stoatsbrother. Look you continue to misconstrue and are unwilling to hear any criticism. This is not a simple continuation of previous arrangements - its a fundamental reorganisation.
This is driven my the tories links with private health companies and is designed to give them access to skim of the parts they can make profit from.
I ask again - what experience do you or any other GP have of running and organising large intitutions with hundreds or thousands of staff.
Project 😳
Ok... If you have only one LBS, don't expect cheap prices. If this staff don't get any incentive to work well, don't expect good service.
[b]TJ[/b] Tony Blair was being advised on Health Service reform by a nice bloke called Simon Stevens many many years ago. Google him and who he is now if you think things are really any different now. Or look at the Labour imposition of Capital Charges to "level the playing field" so the private sector to compete. Or the Labour impostion of DTCs? The trouble is you make it a simple political issue, foist on the UK by a political party which has no legitimacy in Scotland. Actually it is a continuation of what has been happening for years. And Labour (of whichI I was once a member) are just as bad. And some sort of competition and willingness to let some NHS organisations fail is necessary to get any change.
Look you continue to misconstrue and are unwilling to hear any criticism.
Pot/kettle...
TJ to the corner of the room. Have a hat with a big D on it.
The likes of McKinsey (already fat from the largess of PFI etc) will be all over these reforms like a rash - that alone is enough to make me highly suspicious of 'em. As with ISTCs, there will be much [i]talk[/i] of competition - as cover for a whole bunch of bloc-contract cherry-picking. I don't see how that is going to improve outcomes at the messier end of acute care.
And if we are going to consider continental-style provision (only feasible with continental-style investment, natch), how about we consider continental-style social service? Making as many people as possible work as care assistants for a year would do wonders for the debate - and it might see an end to [url= http://www.****/news/article-2031199/Nursing-tabards-tell-patients-disturb.html ]this kind of tabloid sh1te[/url] (inwhich the [i]Daily Fail[/i] completely fails to grasp what is involved in undertaking drug rounds). 😈
Project The issue is more why the NHS is sometimes so expensive that a physio appointment with a junior level physio locally was costing about £70 on average with a 6 to 8 month routine wait. The world of NHS budgets is totally Alice-in-Wonderland.
Ermm you are so wrong about the wait time you can self referral, in which you can be scene
within a few days to a week then if you need to revisit afterwards you they will book
you in for your course of Physio.
Errr... What?
No physio self referral on the NHS on our patch.... Shame. If you have it that's great but it is not universal.
We do now have a decent alternative NHS Funded route, via a private provider. Took 4 years of battles though.
But the nhs is not allowed to make a profit or to charge foir the majority of its services, the figures quoted are just figures to fill a column up on a page.
This is in the Bourough of Newham East London
But cannot see this only being offered here, think you may need to check.
Far from it. Trusts have to pay people. They actually do need money. Every outpatient appointment, every day in hospital and every A&E attendance generates a bill. Some do make "profits" which usually get nicked by the failing trust next door. So you really don't want to underspend too much 😉
[i]This is in the Bourough of Newham East London
But cannot see this only being offered here, think you may need to check.
[/i]
Grantway - trust me I know it isn't. It could have saved me making regular formal complaints on behalf of patients.
But its not a profit its surplus to allocated to other hospitals all from the general NHS budget, and just goes to someone elses budget.
As opposed to shareholders, or a private comapny.
I prefer not-for-profit or charitable providers, for the reasons you mention. But the current system allows inefficient and bad departments to continue to function with unjustified subsidies from better ones.
Like Network rail, another revamp of british rail
Stoatsbrother - Member
Errr... What?
No physio self referral on the NHS on our patch.... Shame. If you have it that's great but it is not universal.
All you need to do is go to the Physio department in your Hospital and self referral.
Thats what I did.
I live 6 miles from the Sea. I am sure you must do too. Have you checked? 😉
Stoatsbrother Grantway - trust me I know it isn't. It could have saved me making regular formal complaints on behalf of patients.
Trust me go via a Doctor and you just seem to have no chance having Physio.
My Doctor told me if he made an appointment il wait a year so I self referred
and waited 2 days ?
[url= http://www.circlepartnership.co.uk/ ]As opposed to shareholders, or a private companny[/url]
Funny how those interests which are keen to see the end of the NHS are often those which have benefited from NHS workforce training (not to mention proximity to NHS critical care facilities...).
Not that they tend to talk about that side of things in the marketing, of course.
Stoatsbrother - Member
I live 6 miles from the Sea. I am sure you must do too. Have you checked?
Sorry fella 1 mile to the Thames for me 😉
grantway - Member
Stoatsbrother Grantway - trust me I know it isn't. It could have saved me making regular formal complaints on behalf of patients.
Trust me go via a Doctor and you just seem to have no chance having Physio.
My Doctor told me if he made an appointment il wait a year so I self referred
and waited 2 days ?
The NHS, would function much better wityhout patients being ill.
lol
OK Grantway. I worked with the local physio department on designing their forms, providing web based info on their services and referral criteria, and the same for the new additional service from a private provider. I know that they refuse self referrals.
Used to live in E14 (before the Yuppies arrived) and then E3 myself.
I know that they refuse self referrals.
But they don't?
Used to live in E14 (before the Yuppies arrived) and then E3 myself.
Thanks for that. But born in Plaistow and lived in E3 Mile end and Bromley by bow for about 27 years
and now in East Ham E6 for several years.
😆
Nice for you. Down on the sarf coast we seem a bit behind the times...
As its a private physio,they would need to pay buisness rates and insurance,heating etc, all things the NHS DOESNT HAVE TO PAY.
Errrm you are so wrong this all comes out of the Estates & Facilities budget.
But the hospital is there if there are patients or not, the heating is on etc etc, its all there ,before the first patient arrives, so its just pretend figures on pages
Errrm, no - buildings aren't just fixed cost bonary things that you either have or don't. You can use space in lots of different ways depending on what's efficient.
French or latin. Which is more pretentious?
Zingggggg!
So stoatsbrother where is you private facility getting its physios from? NHS trained physios? there is a huge subsidy as it does not have to train its staff. Seniority? terms and conditions of employment? Research?
Stoatsbrother - MemberNice for you. Down on the sarf coast we seem a bit behind the times...
Clearly.
Stoatsbrother - Member
Nice for you. Down on the sarf coast we seem a bit behind the times...
Obviously This PCT got it right and without Private intervention and non Private funding.
So shouldn't you be contacting NHS Newham to find out how they done this instead of waisting
money on the Private sector ?
where is you private facility getting its physios from? NHS trained physios? there is a huge subsidy as it does not have to train its staff.
So what? GPs and dentists are private businesspeople trained at public expense. In fact, inasmuch as most British people's education is subsidised by the government, most British people are educated and trained at public expense.
Besides, trainees are paid less than a fully-qualified professional precisely because part of their remuneration comes in the form of training.
Seniority? terms and conditions of employment?
Such things exist in the private sector too. By the way, you'll notice you've now changed subjects from whether the private sector is more efficient to whether private sector employees are as well-paid as public sector ones.
[b]G[/b] I'm guessing they did it by having a cooperative management team on the Trust side - based on the way our trust has sandbagged negotiations - and continues to do so in other services. And this is because we are next to the sea it means we have less competition around, no other acute trusts for 20 miles, so they can get away with it. Which is why we have to bring in other providers to get an alternative. If there was Wiggle and no other bike shop would the prices be as cheap and the service as fast?
[b]TJ[/b] That's about your first decent point, but made better previously by someone else. I see you are still not acknowledging the way Labour had [i]totally[/i] got into bed with the private health sector. This is where your political stance seems to blind you. 😉
The bike industry comparison is a good one. Imagine there was no Merlin/CRC/Wiggle/eBay/Canyon/On-One/STW Classifieds. Just a bike shop in every town owned by the government and staffed by TJ.
Well if you wanted a helmet you'd be sh*fted 😆
mcboo - Member
The bike industry comparison is a good one. Imagine there was no Merlin/CRC/Wiggle/eBay/Canyon/On-One/STW Classifieds. Just a bike shop in every town owned by the government and staffed by TJ.
That's exactly the sort of socialist utopia TJ et al dream about. No point letting the hoi polloi have a choice or an opinionm, when those who are better than them could, and should control all of their lives...
Four legs good.....
Just a bike shop in every town owned by the government and staffed by TJ.
😯
Where the hell would anyone buy a helmet?! Or anything with a really nice logo?
Remember all those bike shops you used to walk into where you could FEEL the bottomless pit of bad attitude from the staff? My LBS used to be like that until exactly the week a nice shiny Evans opened up round the corner. All smiles and offers of deals now.
Really? The Evans near me is the surly one. Hate the place.
I try not to go to Evans either. The point is I can use the LBS and not feel like a chump because I now have a choice and they know it.....
Fair enough. I bought my Trek from Evans. They were the only ones to have it in. Leisurelakes were less than useless.
I hated every second of Evans, from being insulted at the door (mistaken identity) to shop assistants being worse than those in Dixons to wanting to just sell me the damned thing so they could sell more trailers and stuff to other shoppers.
Never again. It was like having a poo sandwich, with no marge.
That's exactly the sort of socialist utopia TJ et al dream about. No point letting the hoi polloi have a choice or an opinionm, when those who are better than them could, and should control all of their lives...
Choice is an illusion.
I'd rather have one bike shop that stocked what I want, rather than 1000 shiny suited shysters telling me what I need. 😀
"Choice is an illusion.
I'd rather have one bike shop that stocked what I want, rather than 1000 shiny suited shysters telling me what I need
"
Me too. Whats it's address? I will meet you there.
Trouble is - unless the LBSs are competing with other LBSs or providers - you will get some who are brilliant and well-stocked and helpful out of the goodness of their hearts and because they want to be excellent - but lots will be serving that poo sandwich, because they can get away with it.
Where the hell would anyone buy a helmet?! Or anything with a really nice logo?
Who buys helmets or branded clothes? .......... Oh!
[img] 
[/img]
Me too. Whats it's address? I will meet you there.
So you're happy to nationalise cycling?
Excellent!
I KNEW I'd be hailed as a genius eventually.......
Obviously, the quality of bike you will be able to buy will be directly related to your actual, not percieved cycling ability.
We don't want to be wasting precious resources on those without the need for them (mincers like myself, for example) do we? 😀
IMAGE.GUARDIAN.CO.UK Why are we making our very efficient health service more like the very unefficient American health service? So that the Tories' friends in big business can get a slice - no other reason whatsoever. All this rubbish about choice and competition - yeah it really worked for the railways didn't it? Nationalise the cost, privatise the profits - brilliant.
The history of the NHS and the wider welfare state is a record of failed attempts to curb the costs of the over-optimistic promises made by politicians.
Throughout is history (arguably from 1911 or more normally since the 1942 Beveridge Report) no-one has been able to control the costs of a service where the demand is infinite and the benefits are not linked to contributions.
We have been conditioned by the idea of a free and universal health system but in reality this never existed. Right from the outside, governments were warned about having an open-ended burden of the NHS and not surprisingly the first three years of the NHS were not the success people like Bevan had suggested. From the start there were problems with cost over-runs, lengthening waiting list (the socialist alternative to charging for the service!) and the realisation that this was a system that didn't work/couldn't be funded. So WITHIN three years, charges were re-introduced leading to Bevan's resignation.
Who should pay for health care then became a political hot potato with costs being scrapped/introduced/scraped etc over the next 20-30 years....so the debate is hardly a new one.
Turning to today, there was a study by the LSE's CEP that concluded that, "in an organisation the size of the NHS hundreds of lives appear to be being lost because of poor management." The authors concluded that, "NHS managers seem to be incompetent compared with managers in the private sector."
Tim Harford (of The Undercover Economist fame) concludes that, "A better diagnosis is not that the NHS is missing some elusive quality of private sector-iness, but that it is missing any sort of competitive pressure, the sort of competitive pressure that most businesses (outside banking) have to cope with every day...Competition raises standards – something that should be music to the new government’s ears."
I have some sympathy with the CEP conclusion. The sad fact is whatever system you chose, if you put monkeys in charge, you will end up with a mess.
Competition [i]might[/i] work in certain circumstances to improve efficiency - but in some sectors it's false competition. Take the example of the trains - you don't decide to go to Glasgow instead of Leeds because you prefer the train operator. All you want is to go to your desired location with a decent service at a reasonable cost.
Does anyone really want to be studying hospital league tables and googling stats on the record of a particular A+E department? Or do they just want to receive decent care from the nearest place (which the vast majority of people currently do)?
"Choice is an illusion" or "Choice can be an illusion"
...makes me think of how a few interested parties can manipulate areas of public life. The latest being Simon Cowell's SYCO who have been able to dominate and manipulate the ITV 'entertainment' section. I shed no tears to read that the latest drivel "Red or Black" is struggling. Perhaps the public is seeing through blatant promotion of SYCO's investments eg, Il Divo last night.
the hoi polloi
terribly tautological...
Classics teaching in public schools aint what it once was
Does anyone really want to be studying hospital league tables and googling stats on the record of a particular A+E department?
Except that's not what anyone is suggesting. The introduction of choice and competition into the provision of e.g. A&E services is not that individual A&Es would be competing against each other for customers and sending ambulance drivers out with laminated menus. (Neither is that what happens in the US - you will be taken to the ER which can best meet your medical needs). Rather, trusts or companies or organisations would compete with each other to manage A&Es over an X year period.
However you feel about the proposed reforms and the status quo, trotting out rubbish straw men is just a waste of time.
Except that's not what anyone is suggesting......However you feel about the proposed reforms and the status quo, trotting out rubbish straw men is just a waste of time.
Except that's what you are encouraged to do now, under Labour's own bullshit 'choice' initiatives. Maybe not for A+E departments but last time I had to have an operation I was given the 'choice' of different departments at different hospitals where I might like to have the operation.
The Tories are talking increasing 'choice' - and I just think the concept is bogus.
I think we can all agree the railways are not a fabulous example of competition in action. National infrastructure v local services, please stop trying to make that connection. Straw man/Aunt Sally/bullsh1t.
I think we can all agree the railways are not a fabulous example of competition in action.
But lots of people seem to be suggesting competition automatically = better efficiency, which is clearly not the case.
And if we are into criticising other people's arguments - all your emotive stuff about your family members is hardly adding anything to a sense of measured debate is it. Maybe you have some criticisms of the report I linked to above showing the NHS to be one of the most efficient health services in the world? Or does your personal experience trump proper research?
I think we can all agree the railways are not a fabulous example of competition in action.
OK, give us one example where privatisation of a previously nationalised service has resulted in a cheaper, fairer and more efficient service for the customer.
Telephony.....how'd you like The Post Office to be the ONLY provider of your home/mobile/cable?
All the introduction of 'competition' and 'choice' has done is to deliver previously public services (initially built up with taxpayers money, lest we forget) into the hands of Private Monopolies and cartels who then use their position to screw us all
If I want to et the train from Manchester to London I can use Virgin or ....erm.... nope, that's the limit of my choice, I'm afraid. As a result of this they have raised fares every year by, in their words: "as much as the market will bare"
And the supply of gas and electricity has been great for everyone since its been de-regulated, hasn't it?
As Martin Lewis pointed out, since privatisation there hasn't been a single incidence of one supplier raising prices, where the otehr suppliers didn't immediately do the same. That's not a competitive marketplace. Thats a cartel!
But in both these examples of blatant, completely anti-competitive and anti-choice profiteering, someone, somewhere is making a hell of a lot of money!. I'm sure the same people are rubbing their hands with glee at the opportunities the 'marketisation'* of the health service will provide
* I absolutely despise that word!!!!
Airlines. What would rather fly on, Aeroflot or Virgin?