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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 ]
[/url]esselgruntfuttock - MemberThanks 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?
asking this of TJ, you are new here aren't you.
How could he do less 😉
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
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.