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We have been facing proposed changes likes this for 10 years.
balderdash - this is far more fundamental - you are either naive, deluded or mendacious to say that.
Back to your usual quality of debate. 😉 Do you wonder why people take the mickey? When you argue with people who actually know something about the subject you are pontificating about and who challenge your view, you dig in and get nasty. Bit of a flaw eh?
Thing is I met Simon Stevens before he worked for Tony Blair and United Health. And read the White papers. And followed the debate and rhetoric. If this is new to you, you are a bit out of touch.
Anyway. Really will leave this thread now. No point in discussing it with you. You just never ever listen. 🙂
Nicely played, but there's still time for the Edinburgh defence. 😯
10 pages of debate, no consensus as to best system, no attempt to suggest how we het there from here.
UK healthcare debate in a nutshell, lots of shouting, absolutely no result.
DS why ?
Goading someone who cannot read your posts is both childish and moronic. It is not likely to make him read now is it?
Why bother?
My wife who has been working for the NHS for 10 + years as a nurse has just been told all the nurses within the Berkshire trust are getting a pay cut!!
I can't discuss it with her as I am so annoyed.
Junkyard - MemberDS why ?
Goading someone who cannot read your posts is both childish and moronic. It is not likely to make him read now is it?
Why bother?
Why what?
Which message do you think I have written is directed at TandemJeremy and goading?
Do you consider [s]sticking your fingers in your ears and going Lalalalal[/s] using killfile to ignore people as being adult and not moronic? The reasons behind using it a bit hypocritical?
Do I give a s**t what TJ thinks in general or about me? Ja no!
I think you're a decent chap Junky, I've never met you, but I think you're a decent chap.
I've never met TJ but I think he's a narrow minded hypocrit based on his writings here.
Scotland. Appallingly unhealthy people, unreformed healthcare subsidised by England. Your welcome.
Scotland. Appallingly unhealthy people, unreformed healthcare subsidised by England.
*Blue touchpaper is lit.....*
*Retires to a safe distance. *
Oh, and Don Simon, +1.
I think you're a decent chap Junky, I've never met you, but I think you're a decent chap.
now you are back we may meet up and I can disprove this unfounded rumour.
If I like you I will tell you who is on my list 😉
I might do that for some professional input. Where are you based? Man U fan so I guess down south, no? 😉 You're north of Manchester, correct?
I don't know what point you think you are making about Blair? I protested about his changes as well where they were stupid and damaging
I have followed the debate and the rhetoric thats why I know this is a fundamental change. You really consider this to be incremental? the government not having the responsibility for ensuring the comprehensive coverage? The right for private companies to cherrypick on favourable terms? the lack of any duty on them for continuity of care? Allowing private companies to decide on who is the provider for certainparts of the service? removing and system of accountability and checks and balances?
Its an utter nonsense. Do you really want a situation where a healthcare provider can go bust and leave a section of society to be without care? heard of southern cross have you?
Stoatsbrother. Yes you have a good knowledge of a part of the picture. I have another part. What understanding do you have of running large institutions with hundreds or thousands of staff for example?
I have repeatedly asked for any evidence that for profit healthcare provides either better outcomes or saves money - you have asserted about some small specialised services and I have been offered a fringe right wing thinktank pamphlet. No evidence has been offered especially with regard to large scale acute work.
I am sorry - I do actually respect your knowledge and I wish you could provide something for me to look at about the stuff you assert but in the absence of any evidence that these changes will mean anything other than significant damage I consider your case falls
crikey - Member10 pages of debate, no consensus as to best system, no attempt to suggest how we het there from here.
UK healthcare debate in a nutshell, lots of shouting, absolutely no result.
Ok - my view - we take the best of what we have now. Add to that a drive for high calibre professional management.
Remove the stupid bits recent reorganisations - foundation hospitals and so on.
strengthen local accountability in a broad based way, remove power from politicians.
Look to other systems and see what they do better. Look to the best bits of the NHS and learn from that to improve the failing bits.
Really good quality financial information available in a transparent way - use peer pressure, public pressure to drive forward cost efficiency as well as improving outcomes.
Look to other systems and see what they do better. Look to the best bits of the NHS and learn from that to improve the failing bits.
And, if any of those other systems used private means to do better, I believe that you would oppose any move to "learn" from them on ideological grounds regardless of the potential for improvement.
FWIW, the above notwithstanding, I agree with the rest of your post. I may disagree with how we achieve [i]"a drive for high calibre professional management"[/i] and [i]"drive forward cost efficiency as well as improving outcomes"[/i], but these are the things that are needed.
As long as it's uncharged at the point of use I don't care who runs it. I do care that it improves from the organisation as it stands, though I do understand that it will be very difficult with the sort of fixed views expressed by some of the vested interests and political positions in the last 10 pages. I supose the first thing I would ask all the stakeholders, what the NHS is for, then what is it's most important function? That would be my start point.
It's very clear that UK healthcare is adequate but not as good as it could be, but its also clear that any attempt at reform is complicated by the political football thing that the NHS has become. Uncanny parallels with the debate in the usa.
I think it needs us to swallow our pride, put aside our politics and really try to be as impartial and open minded as we can.
It's a challenge, we shall see if we, as a nation are equal to it.
CFH - I would take anything that works.
there is no doubt that one of the things that thatchers transfer of long term elderly care to the private sector brought was vastly improved choice and hotel care. Nursing care is a lot poorer and costs are high tho and its a rigged market. Its an unintended corollary mainly tho - its the independent inspection regime that drives most of the improvement.
Truely independednt regulation / inspection of the NHS with a lot more power would help greatly - the care home regulators can close units and require new managers for example
I would take anything that works.
I sincerely hope that [i]if[/i] it is proved that some element of private enterprise working [i]with[/i] the NHS [b]works[/b] that you would take that. I still feel that you would oppose it on ideological rather than practical grounds, but I would very much hope to be proved wrong.
Rather an interesting, if legalease based, read. Of course, as it's on ConHome, it will be dismissed as being from tehevaltoryscuminnit. However, worth a read.
strengthen local accountability in a broad based way, remove power from politicians.
so who will represent the local community? you know as well as I do it with be stoogies from the main parties and those from well organised single issue pressure groups
or do you propose we draw lots?
That is the aim of this reform. Don't be mislead. Its to allow American private for profit healthcare companies to take NHS contact
Why are you agitated about it being American companies that would be engaged in provision of healthcare services? You and others have mentioned it quite a few times but capital is stateless.
When I am in hospital I cannot make a choice as to who is going to provide my meals
Again - this is just as much a straw man as the "do we expect people to choose between A&E departments in the back of an ambulance" toss above. The choice to be made between competing providers would be made by the hospital/trust itself - so for example the contract to provide catering to patients would be put out to tender, it's not the patients themselves that would get to choose.
This is exactly parallel to how it operates in the private sector: if I'm an employee of a company that has outsourced estate services, it doesn't mean that I individually have to make a choice about who fixes a broken window - the company has already chosen.
Whether you think that's a good way to operate or not, you don't have to make stuff up.
Konabunny - the point is you have a captive client group as a private supplier of food to the NHS. It is not how it works in the private sector where the people eating the food have achoice of going elsewhere.
thus it can never operate as a market - so has to be regulated. this means the only incentive on the caterer to keep up quality is thru the regulatory process - so its going to be a constant battle to keep quality up and this regulation has an additional cost that is not small.
Treating the NHS as a commercial outfit can never work, the priorities are not the same, its a natural monopoly and a market can never work in healthcare if you have universal provision
Again - this is just as much a straw man as the "do we expect people to choose between A&E departments in the back of an ambulance" toss above.
If you're referring to my earlier posts about 'choice'- nice straw man argument of your own there. 😆
Whether you think that's a good way to operate or not, you don't have to make stuff up.
Konabunny - the point is you have a captive client group as a private supplier of food to the NHS. It is not how it works in the private sector where the people eating the food have achoice of going elsewhere.
But surely by opening up public sector industries to the private sector you are going to introduce a new concept of choice.
Am I forced to go to my crappy hospital in N. Shrops or can I now take my money across the border to Wales?
It's the fear of public workers that is stifling change and progress.
Clients > Patients.
What do I win?
for most this competition myth is not that easy or as plausible. I stand in a town centre hungry I have many eateries to choose from so competiiton is excellent for me in increasing choice and driving down costs
If I have a heart attack in said town centre the choice of hospitals is less relevant as what I need is the nearest one to be good enough for me to not die when i Get there.
I may be better able to decide which foosd I like the taste off than i am able to assimilate clinical studies of various hospitals mid caerdiac arrest to make an informed choice. It is not like we can hospitals side by side delivering everything and i choose where to go.
Why are you agitated about it being American companies that would be engaged in provision of healthcare services? You and others have mentioned it quite a few times but capital is stateless.
Perhpas it is because they are just foreigners over here to take our money away [ tax payers money obviosuly] in profit and perhaps this angers people? You seem to think stateless capital is something we should not be annoyed by Why?
"It's the fear of public workers that is stifling change and progress"
Very much this.
Most patients couldnt actually give a toss who provided their care as long as it was of a good quality and continued to be free at the point of need....there will always be a few passionate individuals that lean one way or another but the masses are largely disinterested.
As said in somebody else's post, certain public sector workers (who unfortunately tend to be in positions of influence and management) know they would be out of a job if a private firm took over an A&E for example and saw just how many 'suits' were taking up space (and wages) without actually contributing anything to patient care.
It is usually these parasites that whip up the outrage about privatisation of the NHS....front line staff in my trust have for many years known it is coming and the privatisation of non emergency work was observed at close quarters about a decade ago and about 2 years ago private firms started providing supplementary ambulances to help out with emergency work too....the staff are no different to us in the NHS, the service offered to the patient hasnt changed, they carry the same kit and drugs that NHS ambulances carry.....they are however massively cheaper for the Primary Care Trust to use due to a lack of overheads our NHS trust can only dream about.
I honestly believe that tendering contracts to the private sector will be a good thing....even if the private firms bidding for a contract dont get it then it will hopefully have the much needed side effect of forcing the NHS to buck its ideas up to stay competitive.
It's the fear of public workers that is stifling change and progress
Agree, and not just in the NHS. To many people in public sector work worry about their own interests and stifle progress imo.
If I have a heart attack in said town centre the choice of hospitals is less relevant as what I need is the nearest one to be good enough for me to not die when i Get there.
And this is, of course correct, and widespread privatisation would be a bad thing.... Or would it? If privatisation improves services across the board you wouldn't have to worry about the choices being made on your behalf as ALL the service providers would be of an acceptable level.
The danger being that, like the food, there is a likelyhood of saturating the market in an attempt to grab a share and the lack of imagination in an attempt to make sales has the unique result of driving down quality. As long as the customer is driving down prices, the quality will be driven down too.
Deiviant - so much is wrong with that post that its not worth bothering with really.
Its not the workers unfounded fears thats stifling change - its the justified fears that the service provided will get worse. Evidence based practice is the mantra -= whereis your evidence?
As for overheads - once again - find some facts. Eavy I have seen analysied the privte firms overheads anre higher and so are the costs when you atully look at like for like. This is a necessary corollory of the system - the profit has to come from somewhere and unless you either cut wages of cut staff levels then there is no saving to be made.
The NHS is proven to be more efficient than private healthcare with lower overheads and management costs.
Once again - has anyone any shred of credible evidence that for profit healthcare providers either reduce costs or improve outcomes?
I have been asking for this and been furnished with none
si_progressivebikes - MemberIt's the fear of public workers that is stifling change and progress
Agree, and not just in the NHS. To many people in public sector work worry about their own interests and stifle progress imo.
Evidence?
its a classic bleat from the right wing who do not understand the public service ethos
Evidence?its a classic bleat from the right wing who do not understand the public service ethos
LOL, right wing am I? My wife works for a local Auth at reasonably strategic level, the stories I hear about staff protectionism/ inefficiency is quite frankly outrageous. It may, may not be the same in the NHS.
its a classic bleat from the left wing who do not understand the private sector ethos
ftfy
public service ethos
What Ethos? What a load of rubbish, like the public sector breeds a certain type of philosphy to work and provision!
One only has to look at Staffordshire general hospital where patients where allowed to die due poor management ,chasing targets, most of the management who have now gone have gone on large payoffs, and harold shipman, who was allowed to get away with murder, because nobody questioned his failure rate, amongst patient dyeing.
and there are a lot more cases soon to be exposed of poor management,even if services are privatised these same useles managers are still in a job.
Si - getting into local authorities is another thing altogether. I've worked for 2 local authorities on a brief freelance basis and was genuinely absolutely gobsmacked by what I saw.
public sector breads a certain type of philosphy to work and provision!
Unfortunately it does precisely that.
Local Authority Public Service ethos = unemployable, bone-idle, workshy half-wits, who frankly wouldn't last until lunchtime in the private sector, sat around doing absolutely **** All, all day!!
I suspect they wouldn't get away with it in the health service
Once again - has anyone any shred of credible evidence that for profit healthcare providers either reduce costs or improve outcomes?
I think that non-profit making providers are destined for failure as inflation passes them by and pushes them into loss making.
TJ I find that most of your arguments are chopping and changing to suit you own end that
so much is wrong with that post that its not worth bothering with really.
If you really struggle to understand how introducing privatisation into some, not necessarily all, areas of healthcare, I suggest that you do some research rather than blocking out the opinions that conflict with your own and might help you learn and understand.
If privatisation improves services across the board you wouldn't have to worry about the choices being made on your behalf as ALL the service providers would be of an acceptable level.
That is a big IF and is this not what we have now but without the private bit? Currently a large hospital can do everything. Imagine I went to say a caerdiac unit that was private and then i need to transfer to somewhere else due to complications that they dont deal with - who pays and we need adminstrators to discuss whether the private company made errors and how much they pay etc. it just depnds tbh it may be better it may be more efiicient it may not. However I dont see how adding another layer to the NHS and private companies magically makes it less beurocratic or cheaper
"It's the fear of public workers that is stifling change and progress"Very much this.
Most patients couldnt actually give a toss who provided their care as long as it was of a good quality and continued to be free at the point of need
I disagree and I think you will find most people love the NHS and want it to remain free from private influence and control as well as free at the point of delivery.
As for blaming public sectors workers for this it is just a right wing BS polemic. Any worker anywhere will think about how change affects them but the resistance to change in the NHS is not just due to "fear" - WTF does that even mean in theis context?. Even the BMA and RCN were/are resistant to the current change and they are hardly left wing organisations or known for being scared of change.
It would only be progress if it improved things so at this point better to say change than progress. Very few public sector employees DONT want things to get better whatever you seem to suggest. I doubt you can evidence this anyway and generally all employees dislike change be they public or private sector workers
DS yes North of manchester if you are in the area or doing the Lakes give me a shout - obviosuly once you have acclimitised to the weather 😉
Brilliant - I thought for a moment the t'internet had thrown a wobbly and diverted to a Dickensian kindle by mistake 🙂TJ wrote
balderdash - this is far more fundamental - you are either naive, deluded or mendacious to say that.
I also can't believe you are so dismissive of Stoatsbrother as he quite evidently (to use your favourite word) knows what he is talking about. Also, Deviant has made valid points about costs in the private sector. If you want evidence, come along to my ambulance station and chat to the bank paramedics who are on double my hourly NHS rate, or the local A+E where 'bosses' frequently outnumber doctors and nurses while patients are lined up in the corridor for hours waiting for basic treatment.
To many people in public sector work worry about their own interests and stifle progress imo.
like the public sector breeds a certain type of philosphy to work and provision!
which one are you arguing now?
They think and act alike or they dont ?
Once again - has anyone any shred of credible evidence that for profit healthcare providers either reduce costs or improve outcomes?
i have two main hospitals that refer forensic patients to me... one private (priory group) and the other is pure old fashioned NHS.
the priory one is superior in every respect, staffing, risk assessments, quality of paperwork, communication, training, patient interaction, therapeutic activities and opportunities, extended outreach, aftercare... etc etc.
EDIT - phwoarhundereddddd
- TandemJeremy Member
Deiviant - so much is wrong with that post that its not worth bothering with really.
Thats you all over isnt it.
TJ
The private firm providing emergency ambulances in Surrey employ IHCD Emergency Medical Technicians (the same as the NHS) and HPC registered Paramedics (the same as the NHS)....G4S who i do some work for only employ either registered Paramedics or registered Nurses...as clinicians we are beholden to our professional body not the private firm we work for.
Whether i am working in the private sector or for the NHS i have to work to the same standards the HPC (Health Professions Council) demand from me whatever the setting.
If the working environment is substandard and the firm (private or NHS) expects me to deliver sub par care either through poor equipment or lack of drugs etc then i am fully entitled and supported by by professional body to walk away and not return until the relevant changes have been made....the days of unqualified/unregistered cowboy clinicians polluting the private sector have long gone.
The ambulances that ERS (emregency response services) use carry the same kit as our NHS ambulances, without it they werent allowed the contract in Surrey....the service delivered to the patient hasnt got worse, it has stayed the same but that doesnt fit into you political ideal about standards in the private sector having to be worse.
The reason they are cheaper is because they have a smaller HQ than our NHS one, have fewer managers and dont have an estate of ambulance stations to maintain....the part about estates is massively important, if you think i'm talking nonsense have a gander at the direction that most NHS ambulance trusts are taking....they are selling off individual properties and creating central 'super stations' as its just too expensive to maintain the 18-20 stations we have in Surrey (and we're a small county).
The figures were told to staff a few years ago when the 'privates' first started to appear and we all questioned why the service was using them when we are all quite happy to pick up the vacant shifts on overtime?
The answer was quite simple (but probably still wont be good enough for you)....to pay full time existing NHS employees to work extra hours means paying overtime at either time and a half or double time whereas the private firm can just employ its own staff (usually other NHS staff moonlighting) a flat rate....instantly they have undercut the NHS provider, add on to that the fact that ERS dont have ambulance stations, the staff are based in the vehicle for the duration of the shift and you have another instant saving....in short the cost per hour of having this private firm do our work for us was about half what it costs to do it ourselves!
Now i'm not saying that this will be the case in all areas of the NHS, i'm sure some areas are a beacon of efficiency but in other areas the private sector can (and does) show just how poorly managed some NHS services are.
i have two main hospitals that refer forensic patients to me... one private (priory group) and the other is pure old fashioned NHS.the priory one is superior in every respect, staffing, risk assessments, quality of paperwork, communication, training, patient interaction, therapeutic activities and opportunities, extended outreach, aftercare... etc etc.
There's some evidence for you. Choke on it.
Once again - has anyone any shred of credible evidence that [b]for profit[/b] healthcare providers either reduce costs or improve outcomes?
You're playing around with your goalposts
[b]private[/b] does not necessarily mean for profit - as proven by BUPA
private does not necessarily mean for profit - as proven by BUPA
Erm, you are aware that BUPA long since divested itself of its hospital assets - now known as Spire, in turn owned by the Private Equity group [url= http://www.cinven.com/ ]Cinven[/url]... who very much [i]are[/i] about profit. Needless to say, the suits there have been waiting for this moment.
Now, I have no problem with a mixed economy in healthcare if done sensibly (and with continental levels of investment)... but I have a [i]big[/i] fug-off problem with bloc-contract cherry-picking - especially when the NHS is being left to pick up the messy/tricky/expensive stuff, even as it is being slagged off!