NHS Privitisation is coming

– 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 for profit healthcare providers either reduce costs or improve outcomes?

You’re playing around with your goalposts

private 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 Cinven[/url]… who very much are 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 big 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!

Your point being?

The medical care provided by BUPA is still not for profit, no point talking about the ownership of assets, thats like saying that their scanner assets are owned by the NHS… doesnt really matter to the end user, what matters to them, is that they can go to their GP, wave their BUPA card and get a consultant appointment and MRI scan for their damaged knee booked in a matter of days, rather than months through the NHS (using the same scanner, and the same consultant)

I’d be willing to bet that the actual invoiced cost for the two jobs isn’t that different, just who’s paying for it – would be interesting to hear from someone in the know who could compare prices 😉

I disagree with some of those figures above deviant. My overtime @ 1.5 times normal rate is still less than the base rate private firms pay their Paramedics. In addition to that, they get travel, meals and hotel accommodation included, so as a rough estimate, the actual cost, including a profit for the private firm, will be 4 x my hourly rate.

I have maintained that it would be much more cost effective to pay existing employees an extra shift ‘bonus’, or double time for weekend work, as an incentive to cover shortfalls. This will not be done as they appear to be happy to pay the much higher cost to contract a private firm to make up the weekend shortfall. Poor management, negligence, or is there another motive?

I have maintained that it would be much more cost effective to pay existing employees an extra shift ‘bonus’, or double time for weekend work, as an incentive to cover shortfalls

Now I wonder why you think that.

As for overheads – once again – find some facts.

Okay, I can walk into any supermarket and pick up a pack of ibuprofen for 20p. I know for a fact that my local hospital pays much more for them, and on top of that has to pay a fiver for ‘pharmacy’ costs. Even I can see an overhead there.

I don’t think the issue is NHX vs private. I think the issue is NHS managers and successive governments just being a) plain lazy and just signing any deal and b) just not having the knowledge to come up with requirements that could in anyway shape or form be watertight enough for companies.

happens time and time again (see most government IT projects). They get the soundbyte out. Some shoddy requirements, companies bid then the requirements change and it’s kerching, that’ll be £1 billion please to change it.

As you said, TJ earlier, you want better managers in the NHS – you’ll have to (in theory) pay good money for good managers so costs go up.

Wow 11 pages!!

Now there are obviously a lot of people from the medical profession here. Can you tell me, how many times can you go round a roundabout before you get too giddy? 😉 (TJ – if you answer, please provide proper, documented evidence 😉 Congrats on your stamina BTW!)

Woody, my hourly rate is roughly the same whether i work in the private sector or in the NHS, if i work overtime at time and a half in the NHS then it’s more than my hourly rate in the private sector….if you PM me the private firms paying hourly rates higher than my NHS overtime rate then i’d be eternally grateful!

The medical care provided by BUPA is still not for profit, no point talking about the ownership of assets, thats like saying that their scanner assets are owned by the NHS… doesnt really matter to the end user, what matters to them, is that they can go to their GP, wave their BUPA card and get a consultant appointment and MRI scan for their damaged knee booked in a matter of days, rather than months through the NHS (using the same scanner, and the same consultant)

Sod *that*. If BUPA want scanners etc. they can pay for the things themselves. Leeches.

There’s some evidence for you. Choke on it.

That’s not really what I would call evidence – it’s one person’s limited personal experience.

If BUPA want scanners etc. they can pay for the things themselves

thing is, that to a large extent, the NHS scanners are actually paid for by the fees they earn from BUPA patients 😀

thing is, that to a large extent, the NHS scanners are actually paid for by the fees they earn from BUPA patients

Reference? When I were a wee lad in Wrexham there was a massive push for an MRI scanner and everyone put their money in.

There was an almighty roar in all the local papers when it was discovered that BUPA people could jump the queue for the device after people had paid for it.

Again, leeches. Buy their own.

Now I wonder why you think that.

Well apart from being factually correct, it has been done in at least one other area effectively and would save money. Would you grudge someone a bonus for putting up with the shit you get on weekends? I already do it 3 weekends out of 5, so the thought of giving up my free ones for time + 1/2 less tax isn’t really that appealing.

Deviant – I’ll find out and let you know but the difference with them is that they are employed by the private firm as self employed contractors on a ‘full time’ contract by contract basis. They are working 4 days a week, Friday to Monday. Most of the private firms around my way pay the same hourly rate as you and I are on for other work eg. event cover.

That’s not really what I would call evidence – it’s one person’s limited personal experience

i’d agree to be honest!

although its my professional experience, not limited personal experience.

my personal experiences are wide ranging and exciting, often making ladies wet in the undercarriage.

my personal experiences are wide ranging and exciting, often making ladies wet in the undercarriage.

If I were you I’d buy a different car.

I think he means he’s got one of these:

😉

That’s not really what I would call evidence – it’s one person’s limited personal actual professional experience.

Fixed

That’s not really what I would call evidence – it’s one person’s limited personal actual professional experience.

Yes but you’re talking about one person’s experience – in terms of evidence of wider patterns it’s almost meaningless. A research study with such a small base would be instantly dismissed. Just because it ties in with your own prejudices doesn’t make it compelling evidence of anything.

I’m sure I could find a crap company and compare it to a well run public body and declare that therefore all public bodies are better than private ones – but it would be meaningless.

grum makes a good point, i have not worked in every setting 🙂 jsut wanted to remind the forum that i’m not just an online idiot, i’m a professional one in real life!

Your point being?

The point, Ratty, is that much of the choice & competition rhetoric is disingenuous cover for something else. Of course, this was already well established under NuLav, but a whole bunch of external interests are looking to the ConDems for the final Do Not Resuscitate order! Whatever their pompous “credo”, the board of Circle[/url], for example, have been positioning themselves for this very moment (note the issues surrounding their takeover of Hinchingbrooke).

You’ve got a point, its hardly a definative survey of UK health provision. But if someone showed you or Jeremy one you’d just say it was rubbish.

I really dont have any ideological axe to grind. I think the NHS should offer free universal care, I just think the best way for that to be delivered (like in Singapore and Germany and countless other countries) is by a mix of public and private run hospitals. Only in Britain could that even be faintly controversial.

Only in Britain could that even be faintly controversial.

Again, I don’t have a problem with the private healthcare sector – but I have a big problem with them being able to cherry-pick routine caseloads (even as they benefit from NHS infrastructure, workforce training etc). It’s easy to spout platitudes about competition driving up quality – but I’m not convinced this will be the case for outcomes in much of acute/chronic care. Put simply, outsourcing elective surgery in the otherwise fit n’ healthy is not going to put an end to the kind of thing seen at Mid-Staffs.

I have a big problem with them being able to cherry-pick routine caseloads

Agreed and noted. But otherwise you would support yes?

my personal experiences are wide ranging and exciting, often making ladies wet in the undercarriage

piss them self laughing when you drop your pants?

😆

indeed junkyard. indeed.

(was that meant in good humour or have i offended you at some point in a thread and not revisited to realise? if so, sorry dude!)

Agreed and noted. But otherwise you would support yes?

In principle, I would support a mixed-economy in healthcare, if we were sensible enough to match continental levels of investment with a bomb-proof, safety-netted (i.e. non-refusal) social-insurance framework (and found a way to get a whole lot better at prevention & had a complete sea-change in our attitude to elderly care). But let’s not forget that both the French and the Germans spend more than us (and, indeed, they do battle with many of the same problems).

But, no, I don’t support the ConDem reforms (although dedicated GPs might well see opportunities ahead, a la Stoatsbrother). At its best, the NHS can be fugging ace – but it can only function like that by virtue of multi-specialty capacity & co-operation, some of which is in serious danger of fragmentation. That said, the NHS at its best certainly does not excuse it at its worst… but I am not convinced the proposed reforms will drive up quality – everywhere – in the way that the politicos are claiming. IMO, platitudes about competition will not be matched by improvements on the ground – especially given the overstretch in acute care. And in the meantime, the usual suspects (bludy Mckinsey for one, who have long enjoyed a revolving door at DoH) seem to be making hay.

In the context of what is provided by (say) a major teaching hospital, I just want to be able to access services run by battle-hardened staff who know what the fug they are doing! Most of my family are either doctors or nurses – I might have to rely on them… 😯

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?

If your objection to NHS reforms is that it’s all about dirty foreign types that want to “take our money way”, then perhaps you should consider finding out what the health policies of the EDL are. Who knows, you might be able to get everything outsourced to John Bull Eng-er-lund Healthcare Solutions (no foreigners allowed) and then you’ll have taken care of the “just foreigners” objection.

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.

Not sure whether you’re being dense or just disingenuous there. It’s obvious that the choice or competition between catering providers wouldn’t happen at patient level between meals – it happens at trust/hospital/facility level between catering contractors.

I don’t have a problem with the private healthcare sector – but I have a big problem with them being able to cherry-pick routine caseloads

Why? Doesn’t that just clear the NHS’s decks of the mundane easy stuff and leave them to focus on the complicated/unusual/urgent stuff?

was that meant in good humour

Yes.
You have not offended me ever on here[ I am one of the sensitiev lefties as well] though I dont always share your awe of lolcatz 😉

Kona I offered an answer to your question – you seem to have confused this with me agreeing. There may be some jingoism/ or underlying racism if you prefer – in the motive of people saying they are yanks. It is a bit like people like westminster but hate Brussels[spell] – numerous other examples exist without EDL or race cards. Do the EDL have a scottish wing and can I get annoyed you assumed I was english now – racist 😯 I dont think either of us are racist, can we move on?

Why? Doesn’t that just clear the NHS’s decks of the mundane easy stuff and leave them to focus on the complicated/unusual/urgent stuff?

Nope. IME, it’s a false distinction to separate emergency & elective care. It’s better viewed as a continuum: of staff, skill sets, kit, infrastructure, everything. It’s why the loss of routine lists can have significant consequences for both emergency surgical cover and workforce training. For sure, some [surgical] stuff that presents in A+E can be scheduled for elective ops further down the line and some has to be done pronto… but hiving off the “simple” cases doesn’t necessarily better equip a major hospital to deal with the messy stuff (and even “simple” stuff can go south fast). Furthermore, it’s why much of the “competition” supposedly fostered by the introduction of ISTCs [Independent Sector Treatment Centres] was nonsense – they did the easy cases, got paid over the odds & any post-op complications were re-admitted to the NHS! It was a stupidly expensive way of using extra capacity.

I’m not saying that, er, niche clinics don’t make a good job of what you might call production-line surgery – but even so.

i can’t stand lolcats… but the mods keep emailing me telling me to keep posting them as it cheers the place up.

i tried to find one that said you confue TSY with mods but I got bored

konabunny – Member

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.

Not sure whether you’re being dense or just disingenuous there. It’s obvious that the choice or competition between catering providers wouldn’t happen at patient level between meals – it happens at trust/hospital/facility level between catering contractors.

No – I am making a point you fail to see. A captive client group means no market.

In say a cafe quality drops then people stop buying the meals – this means the owner has a reason to keep quality high. with the NHS this is absent so you have to regulate for quality – which is very subjective and difficult to do

There can be no real market – its a fundamental flaw in the privatisers ideas and this is why private provision is always more expensive when real comparisons are made.

Its a basic mistake made by people who confuse price and value

I am still awaiting any evidence of for profit healthcare reducing costs.
I know why this is – because there isn’t any that stands up to scrutiny

Dr Clare Gerada, chair of the Royal College of General Practitioners, said it supported the idea of giving more power to GPs.

“However, we continue to have a number of concerns about the government’s reforms, issues which we believe may damage the NHS or limit the care we are able to provide for our patients. These concerns have been outlined and reiterated pre- and post-pause,” she said.

“As a college we are extremely worried that these reforms, if implemented in their current format, will lead to an increase in damaging competition, an increase in health inequalities, and to massively increased costs in implementing this new system.”

Dr Peter Carter, general secretary of the Royal College of Nursing,”However, at a time when the NHS needs to find £20bn in efficiencies, tackle waste, work harder to prevent ill-health and deal with an ageing population, we are telling MPs that this bill risks creating a new and expensive bureaucracy and fragmenting care,” Dr Carter said.

You’ve got a point, its hardly a definative survey of UK health provision. But if someone showed you or Jeremy one you’d just say it was rubbish.

If someone showed me decent evidence I would have a critical look at it – but to rubbish it I would have to back it up my opinion – and I would do.

I’m still waiting for the evidence to have a look at. Everything I have ever seen shows that for profit healthcare is more expensive for worse outcomes.

Oh – and I think McBoo referred to the german model of mixed provision.

Its a significantly more expensive system a percent or two of GP higher and in cash terms significantly more per patient with admin costs far higher than the NHS

spend as much here as they do in Germany and we would have very good healthcare indeed

Two systems that would be interesting to look at would be Japan and spain – both significantly cheaper than the rest and seem to provide pretty good provision but I know no details

I am still awaiting any evidence of for profit healthcare reducing costs.
I know why this is – because there isn’t any that stands up to scrutiny

You never will !
My Mrs worked years back for a company called New Church & Company
(Nothing unto wards about the company not one bit.)
and they organised the first PFI and even though they showed the rates
to pay back She could not believe that the NHS took on such debt.

But the Government of the time was not spending the money at the time
to want the NHS to work rather watch it internally and has a whole fail.

I think there are a few Hospitals around the country now spending millions of pounds.
Money for our health care to get them out of such crippling contracts.

Just does not make sense turning to a profiteering system when the NHS is not
allowed to make a profit, so to pay out for profitable bills the NHS will eventually cease
to exist for financial debts.