[Closed] NHS Privitisation is coming

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]

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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?