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We also have Wes Streeting ( trousers bribes from private healthcare) stating that privatisation is the only answer.
Poly - its outright corruption. clearly so. Private healthcare companies bribed UK politicians with many millions of pounds and in return have now captured around 10% of NHS care being done by private providers at a higher cost and with worse outcomes
at a higher cost and with worse outcomes
Which the NHS get the 'blame' for but have no way of influencing the situation. This then further feeds that narrative.
https://fullfact.org/election-2019/nhs-private-spending//blockquote >
I wouldn't trust FullFact as far as I can throw them. An organisation with dubious funding and motivations. Funded mostly by the Big Tech industry to further their sphere of influence. I'm not saying your figures are wrong on this occasion, as they might indeed be correct, I don't know, but stating FullFact as any sort of authority on anything is naive in the extreme, especially considering who their funders are and how much they have got badly wrong over the last few years.
Private care. Includes most GPs, Pharmacies, and opticians. And the problem there is?
From the Full Fact link above.
Added to that is the £14 billion the NHS spent on commissioning primary care from the private sector. This includes things like GP services, pharmacies, and opticians
Let us assume for the sake of argument that Wes Streeting and Steve Barclay are equally ideoligically committed to privatising the NHS.
Which one do we think will be reigned in more by the rest of their party?
Its not ideological committment from streeting. Its plain corruption.
Its not ideological committment from streeting. Its plain corruption.
That's the answer to a different question, though.
Do we think a Tory or Labour Health secretary would come under more internal fire from their own party for privatising the NHS? Ergo - which party would be better for us in NHS terms?
with Streeting as health secretary I doubt it makes much differnce
wouldn’t trust FullFact as far as I can throw them. An organisation with dubious funding and motivations.
Hmmm.
I dunno, but that sounds like extreme tinfoiledhattery to me. Mediabiasfactcheck.com provides referenced facts that suggest that Fullfact is as close to unbiased as you can get and the funding is pretty transparent, it has to be to be granted charitable status, after all.
From that site;
‘ Full Fact is a very well-sourced, thorough fact-checker. We consider them to be a top fact-checker in the genre, with the likes of Politifact and Factcheck.org. MBFC endorses Full Fact as a highly credible fact-checker. (D. Van Zandt 11/29/2016) Updated (11/18/2022)’
And;
‘ In review, Full Fact is a signatory of the International Fact-Checking Network (IFCN). They do not use loaded words in their fact checks and always source properly. A factual search reveals they have not failed a fact check and are, in fact, a certified fact-checker.’
If there’re bending the truth to influence your thinking, then they are exceedingly good at it. More likely that your thinking has already been influenced to such a point that things like ‘truth’ and ‘facts’ don’t line up with your world view.
with Streeting as health secretary I doubt it makes much differnce
I respectfully disagree.
SO as an 'insider' I'm happy to give my tuppance worth via several points:
- "Private provider" isn't always a bad thing... care is essentially commissioned. Most of the time this commisioning process works well adn seeks to provide healthcare/investigations via the most financially appropriate route. Simple example..our NHS hospital charges (made up figure) £200 for an ultrasound. A local PRIVATE provider offers it for £120. They both comply to the same regs etc etc, so the local commisioners choose the private provider. It's quicker, cheaper, and therefore better. When I had my vasectomy, it was provided by a local PRIVATE provider service commisioned to perform it. It was actually an NHS surgeon, in a GP practice locally, but it's PRIVATE. ergo, private provision isn't always bad. Mostly it's good. It's innapropriate private provision that's spunking NHS money away (see track'n'trace etc etc)
-I would honestly say one of the biggest issues the NHS is facing is the inapropriate care of the ever growing 'frail and ageing population'. This is a HUGE concern of mine, and something that neither the state nor the patients are actually open to an honest conversation about. Simply put - We as a nation can NOT afford, nor is it appropriate, to manage the frail and ageing population in thesame way we manage the general adult population. I'll say it again:
We as a nation can NOT afford, nor is it appropriate, to manage the frail and ageing population in thesame way we manage the general adult population
In reality, the 'frail and ageing population' is a fairly new cohort of patients.
We've always had:
Neonates, paediatrics, and pregnant women - it would be 'criminal' and i'd be struck off if i manages a 2kg neonate as "one 50th" of a 100kg 45 year old man!!! They are a different patient population, with different medical needs and different treatments.
In the same way, a 36 year olf women who is 4 onths pregnant received vastly different care than a non-pregnant woman.
We simply cannot treat a severely frail, severely ill 92 year old in the same way as a severely ill 61 year old. We just CAN'T! But we do. We admit them to hospital, we submit them to the same barage of tests and investigations, and expect the same outcome and level of response.
Yet no one is confident enough (at a high up level) to admit we are doing this all wrong, and provide 'back up cover' to tose of us on the ground floor trying our best.
Case in point - my granddad at present is dying, very ill in bed. He's 92. He's NOT going to get better. He's dying. He's receiving good care and mild nursing at home. The last thing that should EVER happen to him is that 999 are called (in fact, i got angry the carers rang 111 because his blood pressure was low... "just STOP effing measuring stuff on him!!!!"), and he should NEVER be admitted to hospital. I can acheive this on him because I am aware, and NOT afraid. Because he's dying.
But.... i can garuntee there's thousands of frail, elderly, dying men like him throught the land lying in hospital beds or A+E beds because someone has called 999, and no-one is strong enough to suggest that there is no fix for them, and staying at home and eating cake (or not) is better for them. So they get carted to hospital. Then they get stuck in hospital. It's jsut sooo sad and wrong.
I'm not saying healthcare shouldn't be provided to this group, but it should be appropriate healthcare.
I often use a good analogy.
Pensions are good, right. Pensions are appropriate. We've all got pensions cos we know they are good. But... would you start paying INTO a pension aged 92? Of course not - it's daft, you wouldn't ever benefit from it, and it would be a waste of your money. You'd be better off spending the same amount you'd be paying on C+H (probably) because your needs are different.....
DrP
Teej, I share your dislike of the rhetoric that comes from Streetings mouth, but I heard an interview with him the other day where he was allowed to clarify his position; he wants to lean on private providers in the short term, but then reduce the reliance on them massively as NHS provision is improved. I think it’s a simplistic idea, fraught with pitfalls and obvious issues, but it’s not the ‘private healthcare is the only answer’ position that he’s been painted as saying.
* the Tories, and * you if you vote for them.
This.
A change of government won't fix everything or fix many things any time soon but you can be 100% sure it'll continue to get worse as long as that self-serving bunch of ****s are in power.
I dunno, but that sounds like extreme tinfoiledhattery to me.
Be kind, it's only their second day on the forum.
Makes you think....
A change of government won’t fix everything or fix many things any time soon but you can be 100% sure it’ll continue to get worse as long as that self-serving bunch of ****s are in power.
That really is the bottom line.
“Private provider” isn’t always a bad thing… care is essentially commissioned. Most of the time this commisioning process works well adn seeks to provide healthcare/investigations via the most financially appropriate route.
trouble with that is the research shows these private providers are more expensive with poorer outcomes once you control for other factors. ( poerhaps less obvious with the snip but its well proven in general with these things.)
V8. I simply do not trust Streeting. also even the most generous assessment of his position its still stupid and counterproductive. Private care is not set up to do what is needed and is more expensive than using the NHS. Using private does not produce more capacity. It actually reduces overall capacity.
He is also corrupt. Not to be trusted. He is working for the private healthcare providers not the good of the country.
Very good point DRp about allowing the elderly to die in peace tho.
Very good point DRp about allowing the elderly to die in peace tho.
Agreed, sadly its a conversation no one seems to have the courage to have.
A change of government won’t fix everything or fix many things any time soon but you can be 100% sure it’ll continue to get worse as long as that self-serving bunch of ****s are in power.
Nothing to add to this.
Normally I can mentally chart a path of how policy changes might improve the situation, but here, everything is failing, all at once, from top to bottom.
Reversing the recruitment drain, the care capacity issue, the infrastructure problems, the education and training deficit, will take a decade, if we start now. If we wait two years, I am terrified about what will be left. The NHS is haemorrhaging its most skilled and experienced staff, that will accelerate exponentially. There is only so much that their sense of duty and care for their patients can paper over their desperate, mentally destroying, working conditions.
We are heading into a post-war situation where we will have to rebuild from the ground up, Nye Bevan style.
I don't envy a Labour government coming in to try to sort this out, last time it took the best part of three Parliamentary terms, and the situation is far more dire now.
Also, **** the tories and anyone who still votes for them.
@irc:
Private care. Includes most GPs, Pharmacies, and opticians. And the problem there is?
An interesting point. I'm not sure anyone would say GPs are in a great shape just now, they were left in the private sector when NHS was created to get the doctors on board, but they are frankly a bit of a shambles with poor integration / efficiency savings with the rest of the NHS etc. I suspect most of the public don't even realise they are private (which could be an argument for it) but would think it would be better if it was a standardised service. The usual arguments for privatisation like competition being healthy don't really make sense with GPs as there is a defacto monopoly in most areas and their contracts are standardised etc.
Opticians probably provides another example of why its not necessarily in the country's best interests, or maybe even the patients to privatise care. For routine stuff it works fine, but for anything complex (i.e. expensive) its sent back to the NHS specialist clinics. In reality I expect opticians are only financially viable if they are selling glasses and making profit from that to subsidise eye exams. Pharmacy the public see as a shop not a healthcare professional which could get them advice / care they need quicker - do they perceive they are being "sold" to?
DrP - thanks for writing that. A very thought provoking post.
There’s a lot of waste and poor procurement in the NHS as well.
And people who make that same argument about all parts of the public sector are also the ones who call for senior managers to be paid far lower wages than in the private sector, as if properly experienced and trained/qualified management was unimportant in tackling poor performance and waste. And are also often the champions of poorly thought through political point scoring measures such as league tables that have been demonstrated to reduce actual positive outcomes for the public.
Private sector companies can justify paying high salaries for senior positions, so why do we expect the pulbic sector to make do?
Opticians probably provides another example of why its not necessarily in the country’s best interests, or maybe even the patients to privatise care.
You only have to look at the state of NHS Dentistry - non-existent now in many parts of the country - to understand what tends to happen during creeping, self-regulated privatisation.
Yes although NHS dentistry is a clear example of what happens when you promise the moon to everyone and make no attempt to fund providing the moon to anyone while never admitting that it’s not possible to afford giving the moon to everyone.
Even in the “good old days” when “everyone” had an nhs Dentist, in reality only 50% of the population used the service so the funding was never enough to cover 100%, and also at that time, the patients were providing around 80% of the funding over the counter themselves. NHS dentistry has had patient charges since about three years after the NHS was formed.
It’s a separate thread but the “creeping privatisation” has been driven by many of the same pay, working condition and inflating cost factors that the rest of the NHS faces. It’s also blame that is equally shared by new labour who were the architects of the last new dental contract that caused a huge shift away from NHS provision (admittedly the Tories haven’t done anything to reverse or mitigate this)
@DrP makes a good point that echoes what my GP friend told me last week.
Make me health minister and I'll sort it all out in a couple of years. Whats needed is pretty obvious but it takes both money and political will neither of which either labour or the tories have on offer
And people who make that same argument about all parts of the public sector are also the ones who call for senior managers to be paid far lower wages than in the private sector, as if properly experienced and trained/qualified management was unimportant in tackling poor performance and waste. And are also often the champions of poorly thought through political point scoring measures such as league tables that have been demonstrated to reduce actual positive outcomes for the public.
The 'too many managers in the NHS' argument is utter, utter, bullshit.
It is the UK's largest employer, has a budget the same as the GDP of a small country, and delivers a vast array of complex services. The % of managers within it is significantly lower than most private corporations. If anything, it is vastly undermanaged. The quality of managers is variable, a fair few are advanced from clinical roles by default rather being trained and well-suited to management.
I'm sure there is waste/duplication in an organisation of this size and complexity, but I'm willing to bet that the scale of it has declined significantly in recent years, and aiming at that will not produce the miraculous uplift in resources that some think.
Make me health minister and I’ll sort it all out in a couple of years.
You can have infinite cash and you wouldn't be able to even make a dent in the workforce issues in that time. You'll also need to be the Secretary of State for Education, and Local Government Minister too.
I think loads of people could sort it out as you are spot on with "money and political will" being what is required.
'Money and political will' is a great starting point, but the rebuilding of the NHS is a long-term project, and should be viewed as such. A couple of electoral cycles is the bare minimum to see meaningful improvements.
Behind the facade of a functioning NHS, we are approaching the 'Dresden in 1945' stage, with the Tories piloting the bombers, and we need a similar post-war mentality to start putting it back together.
Remember those big bags of cash given to ‘king’ Charles by the incorruptible Qatari politician(Panama leaks). Handed $3m in a series of suitcases, bags and holdalls, purportedly for his charities.
Nope. But assuming that to be true - so what? $3m is pocket change in government / NHS budget terms.
I wouldn’t trust FullFact as far as I can throw them. An organisation with dubious funding and motivations.
And again, assuming this to be true (and I don't believe it is), does that make them wrong? This is the same argument just in different pyjamas that the anti-vaxers roll out against "Big Pharma."
I think loads of people could sort it out as you are spot on with “money and political will” being what is required
For me its is much more than political will. It is societies will to pay for it.
When it gets to the point that the population are prepared to be worse off to support Health & Social Care then thigs Politicians will bend over backwards as at that point it will win them votes.
It doesnt matter who your politician is, this will cost us all a lot of money to sort, and I think people are only prepared to put their hands in their pockets when friends and relatives start dying.
Surely it’s the opposite problem as don’t we rely on an awful lot of health service staff from abroad to make up the numbers we seem to be unable (or unwilling) to train in the UK?
Yep. Percentage wise, more "foreigners" work in the NHS than use it (or at least, they did pre-brexit). If we 'send them all back where they came from' or otherwise drive them away, waiting times go up not down. Immigration is a net positive for the health service.
Still, part of the reason we are in this sorry mess is the lack of awareness of preventative measures.
The vast tract of pseudoscience aside, I've thought this for a while. We're told that early diagnosis can be critical in treating severe illness yet there's no appetite to do so. Regular healthchecks every, what, five, ten years might dramatically reduce the incidence of chronic conditions. It has to be less of a drain than patching up properly broken people, no?
This ties in with:
You only have to look at the state of NHS Dentistry – non-existent now in many parts of the country – to understand what tends to happen during creeping, self-regulated privatisation.
I've written about this before but, I've been trying to get dental treatment. The only way I can get seen on the NHS is if it's an emergency. So I can't get a simple filling done, but if I'm in absolute agony and needing antibiotics and a root canal then they will fit me in. This is surely arse-backwards insanity.
Good post @DrP
My dad died of cancer. But he was 90. The options and side effect etc were explained and treatment offered. He declined. His one big concern in his last months was that he did not want to die in hospital.
He died at home with three of his children with him after being active still driving and playing golf up to 89. As good a death as any of us can hope for. Nobody lives forever.
A painkilling injection from a McMillan nurse a few minutes before he died possibly pushed him over the edge. I'm fine with that. A couple of weeks earlier he had asked his GP to put him to sleep which of course he couldn't.
There has been a couple of times I should have gone to at least the GP this year, but haven't
A mate of ours crashed in the Clywdian Hills recently. Fairly big OTB. We offered to get him to A&E, but knowing what the Hospital in question was like (same one I should have popped to) he decided not to, and get checked out at home a few days later - 4 broken ribs and a punctured lung !
Don't go smashing yourself up too much.
That said, the last time I had a proper crash, I was straight in, ambulance, bypassed A&E and straight into Resus ! Service was fabulous. I can't recommend breaking your spine though !
@cougar yes it is insanity but see my reply a few posts up.
Incidentally, almost all dental disease is preventable. This has been known for over 30 years & it really isn't hard but we still see kids of 5 having general anaesthetic to have 10 teeth out due to decay. Parents (& adults) either aren't educated or often, are told but don't listen / aren't interested
The problem facing NHS will take sometime to be sorted so unless the next govt or whoever are determined to stick their political neck out, it will just be another prolong agony for the public. i.e. politician(s) getting the NHS portfolio then pump some money in, grab some positive headlines then move on and leave it to the next person. The long term strategy for NHS is appalling considering the only way is to keep pumping money in as a solution. As I said, NHS is the largest employer in the world and should be an exception to the rules (very low tax) if govt wishes to really deal with the issue. Everyone regardless will have to go through NHS in their lifetime (birth, aged, sickness and death) and it is simply poor for a govt not to set NHS as the top priority. All parties should sit down to solve the problem rather than using it as a political football. Sort NHS out first then they can argue about other matters. Health and well-being comes first while the rest come second.
DrP has absolutely nailed it. I’ve had this countless times and trying to explain to homes that the patient is old and their time has come can be a battle. Relatives seem to grasp this now, getting emergency health care plans can be sporadic and then getting them to follow it too.
We get old, we get frail and we die.
.
@cougar yes it is insanity but see my reply a few posts up.
Incidentally, almost all dental disease is preventable. This has been known for over 30 years & it really isn’t hard but we still see kids of 5 having general anaesthetic to have 10 teeth out due to decay. Parents (& adults) either aren’t educated or often, are told but don’t listen / aren’t interested
Ah, I missed that, thanks for the nudge.
Preventable how? Less sugar, better brushing, sort of thing? (Sorry, I know that sounds stupid, it's the "almost all" I got hung up on.)
At the risk of a thread derail and in very simple terms.
For 99.9% of people there’s nothing wrong with their teeth when they arrive in the mouth.
There’s basically two disease processes that affect your teeth, tooth decay and gum disease.
Gum disease means that the ligament and bone that joins tour teeth to your head gets progressively destroyed over the years. Each tooth only has a certain amount of ligament so if it disappears it eventually leads to teeth getting wobbly, painful and eventually falling out. It happens because the bugs that naturally live in your mouth ( in simple terms) attack and destroy the ligament starting in your mid 30s onwards.
Whether you are at risk of this happening or not is a lot to do with your genetic make up (although smoking greatly increases your risk too). Some people are genetically lucky and have bomb proof ligament, some have very susceptible ligaments and there is a whole spectrum in between.
BUT, regardless of your genetic luck, if you don’t let the bugs sit on your teeth for any period of the time the they can’t cause any damage. So if you are good at brushing and you are good at using something like floss or interdental brushes to clean the areas between the teeth that your brush can’t reach, EVERY day, even if you have dodgy genes you can prevent or severely limit the occurrence of gum problems. Especially if you start doing it in your 20s and keep it up.
So preventable......
The second disease is dental decay. Contrary to popular belief, almost no-one inherits “weak teeth” ( ignoring a few genetic disorders but you would know if you had one of those and you wouldn’t have normal looking teeth) pregnancy also doesn’t have any irreversible effect on teeth or gums.
Decay works like this. The naturally occurring bugs that live in our mouth eat sugar. That can be processed sugar that’s added to foods like in chocolate / sweets or it can be naturally occurring sugar in fruit and fruit juice. ( but not true artificial sweeteners ). When you feed them sugar ( by putting it in your mouth ) they produce an acid as their waste product ( their wee if you like) This acid dissolves the crystals that make up the enamel of your teeth eventually causing holes either in a virgin tooth surface or at the edge of an existing filling or crown.
The important point is that the amount of sugar they can eat in one go is minute ( they are bacteria) so it really doesn’t matter how much sugar is in your mouth at one time, they can only produce a certain amount of acid. So stuff all 10 polos from a pack in your gob at once and the bugs are only using a bit of the sugar from one polo, the other 9 are irrelevant. BUT if you eat the packet one at a time, that’s 10 times you’ve fed them and ten times the amount of attack.
I.e it’s the number of times you eat not the amount ( or type) of sugar in each snack that’s important. If you only eat 3 meals a day and drink water you’re quite safe but if you have snacks or drink juice or “graze” you are stacking the cards against yourself and will get holes.
The aforementioned bugs that live in your mouth like to live actually on your teeth and the nasty ones need to be attached to cause damage, they start to build up on your teeth about 20 mins after they have been cleaned off each time but the nasty ones can’t attach and cause damage until the first few layers have already become established. so if you are good at cleaning them off ( as outlined above) your chance of getting decay is greatly reduced.
If you have a low number of sugar attack’s as well as good cleaning you can effectively stop decay occurring. If you have a high number of sugar attack’s daily, you are likely to get holes even with good cleaning.
Lastly, Fluoride reduces the rate at which decay progresses by making the crystals in your enamel stronger so using a fluoride toothpaste both when you are young and your teeth are forming and also when brushing as an adult helps further. It’s even better if there’s a bit in the water but there isn’t much in most of our water supplies.
So TL:Dr decay is preventable by good cleaning and minimising the number of sugar attack’s each day.
Obviously people get problems because dental work fails but fillings etc lasts longer if you keep them clean and if you do the right stuff from a young enough age, you won’t ever need fillings in the first place (& honestly the number of “cowboys” who do fillings that aren’t needed is tiny despite what almost everyone says about Dentists)