NHS Privitisation is coming

Ok Grum

That was indeed the one. And I’d mentioned it too.

1) Only covered 19 countries
2) Finished in 2005
3) At the time it finished. UK NHS spend was only 7.1% of GDP, by 2009 it was 9.3% and rising. Has then NHS become 31% more efficient over that 4 years? And the cost has gone up since…
4) The metrics used were very limited – not including anything happening to people over the age of 74…
5) The discussion at the end certainly flags up the limitations.

We could look at Cancer mortality where we do pretty poorly. Or CHD where we have done rather well. Main thing is the US system sucks.

Stoatsbrother – Member

So how do we fix broken services run by complacent clinicians and obstructive managers, where patients have their appointments cancelled 7 times in a row, and get no apology, where there is no other provider within 20-30 miles…

With high quality professional management and democratic oversight 🙂 There is no excuse for poor performance like that.

If thats your diagnosis of what is wrong I can happily agree that that is an issue and a very difficult one. I can accept your experiences mean you see some use in using the private sector. The examples you give – got any links / hard data – I would really be interested. I bet its more expensive than the best practice in the NHS and / or its providing less of a service

An little anecdote about competition. Its generally thought of in financial terms – however as an example of non financial competition. years ago the hospital I worked in had no queues for hip replacements – why – cos the two consultants had a friendly competition running to see who could have the shortest list.

Their are many ways of driving down costs and improving outcomes. Simply using a private provider instead of a state one does not necessarily lead to improvements, infact the experience generally across the UK is the other way round.

Ok Grum

That was indeed the one. And I’d mentioned it too.

So there are some issues with the study – meaning that it is completely wrong and the opposite is true, the NHS is actually terrible? Where is the evidence for that – because everything I have seen on this thread about how dreadfully inefficient the NHS is has been completely anecdotal.

TJ – you almost got it:

Simply using a private provider instead of a state one does not necessarily lead to improvements,…

but…sigh….

..in fact the experience generally across the UK is the other way round.

😉

So why do huge private companies outsource certain functions – catering, for example? Why should the NHS be any different? Or is there really nothing you could more efficiently provide with private contractors?

Why should the NHS be different? Healthcare can never be a market as choice simply is not possible. When I am in hospital I cannot make a choice as to who is going to provide my meals and also that teh NHS must and should have other priorities than cost. Such as quality, responsivness, control and so on.

grum – I am saying the NHS is good, but not great, and could be better. I have spent a lot of time trying to get it to be better locally, at both a micro and a macro level. We cannot afford to be complacent.

We need to look at the message from that study – which is that in those two limits metrics of mortality – the UK isn’t doing badly – but there is so much more we can do. If you want to dig out some other cost-effectiveness stuff you will see slightly different results.

TJ wish I could give you the specifics of two very concrete examples of how we improved one local surgical speciality’s performance by shifting temporarily some activity privately and by commissioning changes we made. I suspect I’d be up before the GMC for “disparagement” if I did. The Hearing aid and optometry services I mentioned are commissioned at the same price/cheaper. Many hospitals already contract out chunks of cross-sectional imaging to private providers at the same tariff.

For all your hopeful statements that with the right management things can get fixed, often the management and the consultants just are not willing to change. They do not take a view of their service wider than the task they are doing at that second. Again I could name a service I have been trying to work with in developing clearer access pathways – but nothing happens. They have no incentive to change.

TJ – again you are asking the wrong question. It is not about choice of lunch – that is absurd.

Under the current system, choice is available BUT only if you can afford it. For routine operations, you can chose your doctor, have flexibility on timing, go to a comfy hospital with a nice (clean) room and have tasty food to eat etc….(but the latter is not the swing factor!!). And there are plenty of examples on this thread of the provision of choice to prove it.

1. Explain why the structure of the NHS failed right from its early days (please see my earlier post)

It hasn’t. It has provided us with cheap high quality healthcare

2. Explain how, against all theory and most practice, a monopoly supplier can be a more efficient supplier of scare resources that one that is subject to competition

It just does. No matter how much you wish otherwise thats the direction the evidence points. Dunno what theory or practise you refer to

3. Explain why most people who can afford to, will choose private versus public sector suppliers of health, education etc. Are they mad? Or do they recognise that they can pay for a better service(albeit probably not in the case of genuine emergencies)?

Most people? I know plenty of folk who could afford private healthcare and don’t. Anyway private healthcare is only a small topup on NHS care. Much stuff you cannot get privately.

got any evidence to back that up?

Stoatsbrother – Member

Anyway – I know my place – I’m not a big hitter so I’ll scurry back under my rock.

Dinnae dae that – its interesting

TJ have you ever considered your posting style might be slightly counterproductive? Just a thought. And you do seem to get more angry and your argument more disorganised.

I am a bit disorganised right now – too many early starts / short nights.

TJ – I am all for debate, but this dogmatic style and continuation with the “any evidence” line when plenty has been given is frankly tiresome.

I will retire gracefully as this continues to focus on the wrong question anyway…

…now where was my bike?

often the management and the consultants just are not willing to change. ……..They have no incentive to change.

They have to be given the incentive. it does not have to be financial. Why are some NHS units so much more efficient than others? Why are some areas so much better than others?

Over the last few years where I have seen large chunks of Lothians healthcare I have come to the conclusion that is poor quality management is the main issue. We need higher calibre people/ better training of the managers. Private and NHS. the best mangers make a huge difference. it matters not one jot about their background – good managers make for good services.

So in the specifics of the failing service you mention – the people involved must be held accountable. Their responsibility is to run the service – sack ’em if need be and get power as far away from consultants as possible.

Its a management failure that leads to a poor service – and I have seen this in private healthcare as well

teamhurtmore – Member

TJ – I am all for debate, but this dogmatic style and continuation with the “any evidence” line when plenty has been given is frankly tiresome.

Plenty? I have seen none at all.

Its a bit tiresome to be asked to back up your claims isn’t it.

here is some stuff about the failings of NHS contracting out services
http://www.timesonline.co.uk/tol/life_and_style/health/article6843637.ece

Teamhurtmore. – you expect me to accept a document from Reform as evidence?

And who sacks them?

If the chief exec doesn’t see a problem and improving the service might reduce the trust’s income? I could give you details of our local trust’s last 2 chief execs which would intrigue you – but lead to a lawsuit… I even did a FOI request on one’s severance package. £540,000 I think it was. And the next one banned me from speaking to her team, because I was looking at how expensive one service was.

Just remembered another example – we looked at anticoagulation services for which an extortionate rate was being changed. We saved a 7 figure sum per year just by looking closely enough. We then saved another 6 figure sum per year by shifting most of it into Primary Care where we have a cheaper service, closer to patients, with better IT allowing better audit and quality assurance. Yet another bit of evidence.

The way you show a bad shop you are unhappy is by telling them once or twice, then shopping elsewhere. Otherwise they do not change.

I think your charming statements about how you can change things are as robust and realistic as a Miss World’s aspirations for world peace.

Bottom line – things have moved on. I am anti handing the keys to everything to outside conglomerates, even though both Labour and Conservatives have flirted with it. But there are things to be learnt from private/independent providers. Your polemic stance is 10 years too late, and ignores the benefits of an open mind about these things.

Why should the NHS be different? Healthcare can never be a market as choice simply is not possible. When I am in hospital I cannot make a choice as to who is going to provide my meals and also that teh NHS must and should have other priorities than cost. Such as quality, responsivness, control and so on.

You’re confusing customer choice and an open bidding process that leads to a private service provider – I’m talking about a hospital (or trust) requesting tenders to provide a service, for a given maximum price, with a given set of characteristics – in this case a minimum number of meal options, vegetarian, low / zero salt, etc., 24×7 service, etc. Once the bidding process is over that one provider would run the hospital catering service. I’m not talking about patients deciding which caterer they fancy on a given night!

OMG! The linking to articles and overuse of quotation boxes has started, this is getting serious now…. I’m out before I get sucked in and lost forever…

Mogrim – I am confusing nothing. I am pointing out the limitations.

If a supermarket say outsources its catering I can choose to eat there or not. I do not have this choice in hospital – therefore I do not have the ability to reject the offerings. A captive market. Quality does not matter to the catering company as there is no financial penalty of dropping sales if quality is poor.

As for contracting out catering services in the way you describe – I have never seen it work and I have seen it tried many times – always the quality is appalling or the cost is high. Basically if you give them the NHS budget for providing meals a contracted out caterer cannot provide cooked from fresh on site for that cost. The result is bulk produced cook chill systems and a complete lack of flexibility along with god awful quality. Have you ever eaten a cook chill omelette? its disgusting.

perhaps it can be doen better but my experience is that cooked from fresh on the premises is the only aceptabel way and a contracted out service cannot do this withig the budgets

perhaps it can be doen better but my experience is that cooked from fresh on the premises is the only aceptabel way and a contracted out service cannot do this withig the budgets

I’ve not seen NHS subcontracted caterers, but I’ve been to lots of Spanish ministry canteens run by private companies, and they’re cheap and have perfectly acceptable quality.

edit:

Quality does not matter to the catering company as there is no financial penalty of dropping sales if quality is poor.

You need to include an objective quality measure as part of the contract.

Not going to work mogrim, if it hasn’t happened in Tandemworld, it hasn’t happened.

Quality does not matter to the catering company as there is no financial penalty of dropping sales if quality is poor.

Can someone tell me how that works?

Cooked from fresh on site? thats the key – I have had contracted out catering in a private unit – that was good as it was cooked from fresh on site – more expensive than the NHS catering it replaced tho ( which was offsite and awful).

Why would the contracted out service be cheaper? – its costs are the same – staff wages ( unless it forces wages costs down) and ingredients and the private one has to pay a profit to someone and has higher management costs. a decently run non profit making system will always be cheaper – the challenge is to run them well.

Can someone tell me how that works?

Year-on-year improvement in patient surveys would be one way.

objective quality measure

Very difficult to do and to build in meaningful penalties. You will be fighting the pressures to reduce quality constantly

Why would the contracted out service be cheaper? – its costs are the same – staff wages ( unless it forces wages costs down) and ingredients and the private one has to pay a profit to someone and has higher management costs. a decently run non profit making system will always be cheaper – the challenge is to run them well.

Definitely, which is why a private company serving 30 hospitals is likely to be cheaper than part of a single hospital serving just that one. Not sure why management costs would be any higher, though.

Again the issue here is that a private provider may be more motivated to manage the quality and delivery of a catering or other hotel service if it is on a three or five year contract with quality control than a legacy directly NHS employed catering department who feel at no risk of their jobs whatever what ever they serve up.

Some of the mankyist food I have had had been at NHS hospitals. Some of the best in Australia.

mogrim

Definitely, which is why a private company serving 30 hospitals is likely to be cheaper than part of a single hospital serving just that one

Why – where is the saving to be made? The NHS already has the benefits of economies of scale,

Not sure why management costs would be any higher, though.

Because its more complex management costs will be higher and you loose the economies of scale

Stoatsbrother – so the answer is to manage the NHS system properly.

Why would the contracted out service be cheaper? – its costs are the same – staff wages ( unless it forces wages costs down) and ingredients and the private one has to pay a profit to someone and has higher management costs. a decently run non profit making system will always be cheaper

Any answers to where the saving is supposed to come from?

Your polemic stance is 10 years too late, and ignores the benefits of an open mind about these things.

Remember Scotland does not have the stupid nuLabour bollox – we didn’t adopt any of that and merely undid the worst of the freemarket nonsense the tories put in.

Its still not too late in England – You are incredibly naive to not understand how fundamental this proposed change is.

we didn’t adopt any of that and merely undid the worst of the freemarket nonsense the tories put in.

coughcoughtramscoughcough….

😉

Just don’t CFH or I’ll mock your rugby team

Yeah, good point. Taking cheap shots is too easy! 🙂

a decently run non profit making system will always be cheaper

Theoretically you are right and you appear to be using a theoretical argument to support a very different reality.
That is perfectly logical as if all things are equal a non-profit organisation is going to be cheaper than it’s profit making counterpart.
Making the question quite redundant.

Any answers to where the saving is supposed to come from?

Would a profit making private company be cheaper and more efficient than the current publicly funded inefficient non-profit making system is the question you should really be asking.

Hmmm, 9 pages. Is it worth a read?

thegreatape – Member

Hmmm, 9 pages. Is it worth a read?

Wadday think? Lots of hot air and hard data is in very short supply.

I was thinking from an entertainment rather than educational point of view.

@ CPT

1 – It’s seen as herecy to posit the idea that there could be some benefit to change within the NHS

is it? People seem to be objecting to the change not change per se.

2 – Anyone who even considers such a change is an evil privateer (Nice use of the word, there!) and wants to rapaciously slash and burn their way to a profit by taking the state out of the NHS

no of course not they seek to profit from healthcare because they are great humanitarians and want to give something back it’s an act of philanthropy 🙄

3 – There is an incorrect assumption that somehow the this will be total NHS Privitisation (sic), when in fact it would be looking at ways of making improvement

it would be privatising some though and you have given nothing to explain why this would be an improvement.

4 – Looking at ways of making improvements is apparently evil
etc. etc. etc.

Who said that?
Stick to the pithy comments your arguments are quite weak and largely consist of misrepresenting others views rather than explaining why your view is so good or why or how competition will help.

Na- stoatsbrother and I started to exchange insults but non of it was very inventive

Ok cheers

We have been facing proposed changes likes this for 10 years. Some of the anti rhetoric is straight out of the 1970s.

Just saying the NHS should be well managed is pointless. It often isn’t. There isn’t the medical management hierarchy system there is in many countries, and getting rid of poorly performing Consultants and managers is near impossible.

In the end the only way to change somethings is to open a competing shop, and see what happens then.

In the end the only way to change somethings is to open a competing shop, and see what happens then.

You keep claiming this – however there is no evidence that this is so – infact the evidence is the other way. Private healthcare is more expensive for poorer outcomes no matter how you compare it.