adrianc
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Post by adrianc on Apr 27, 2016 14:48:47 GMT
Unfortunately the drive in this country is towards private companies cherry picking the potentially profitable elements of healthcare and leaving the NHS to pay for the care of emergencies, the elderly and frail. AIUI, NHS trusts and commissioning groups are able to tender for those contracts, not just private companies - so are just as well-placed to get that "potentially profitable" work. If they are doing so from a not-for-profit, then assuming all else is equal, they should get the work as their pricing will not need to include an element of profit. If a private company still gets that work, profitably, then it would be because it is cheaper for the NHS to put the work that way than to do it in-house. Whether you think that's a good thing or a bad thing may depend on if you think value for money is somehow less important than whether the work is ultimately done in the private or public sector.
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Post by ablrateandy on Apr 27, 2016 17:20:31 GMT
The author of the Telegraph piece also doesn't work in a place where the contract is being imposed. He is choosing to move into the jurisdiction, so he at least has a choice.
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Post by davee39 on Apr 27, 2016 17:29:57 GMT
Several years ago hospital cleaning went out to the cheapest private contracts, to be followed by a massive rise in hospital acquired infections as multiple corners were cut.
When all the services are provided by separate profit oriented companies exactly what will happen to patients?
Recent personal experience relates to an elderly relative admitted in an emergency to an out of area hospital due to a lack of beds, and several weeks of buck passing between two NHS trusts, neither of which wanted to provide the care. This would be massively worse in a compartmentalized Health service, split railway style into multi contract disputes with patients being a very low priority.
Many current financial problems stem from outrageous PFI contracts, where the need to service private profit severely constrains many trusts.
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adrianc
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Post by adrianc on Apr 27, 2016 17:38:37 GMT
Several years ago hospital cleaning went out to the cheapest private contracts, to be followed by a massive rise in hospital acquired infections as multiple corners were cut. So which bit of the NHS failed there? The bit that drew up the contract, or the bit that monitored whether it was being performed properly?
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ben
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Post by ben on Apr 27, 2016 17:44:31 GMT
probably both as normally when drawing up contract the private company hires solicitors/lawyers to go through the small print and the civil service gets pete from admin to do it either though he works on a completely different project
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agent69
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Post by agent69 on Apr 27, 2016 18:02:26 GMT
I work in the private sector and if all my colleagues went on strike the business would go bust and we would loose our jobs. The doctors dispute is an example of a unionised monopoly, where that type of financial pressure doesn't exist, because there will always be a job to go back to.
I think it is fundamentally wrong for a union to try to dictate to management how the business is run. Ultimately the union will try to dress up the dispute as being about health and safety or quality of service, but I have no doubt that all the problems would go away with a big enough pay rise.
Ultimately the doctors have the same choice as me. If you don't like what your employer is offering get a job with somebody offering something better. If you can't find a better offer then be thankful for what you've got.
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Post by bracknellboy on Apr 27, 2016 18:16:51 GMT
Several years ago hospital cleaning went out to the cheapest private contracts, to be followed by a massive rise in hospital acquired infections as multiple corners were cut. As others have noted, that is just as likely/more likely to be function of the contracting party rather than the contractor. Nonetheless, a rush to private contracts managed/placed by an organisation which is steeped in non-commercial culture is particularly likely to lead to failures of governance. Who knows - but its a big leap to assume / imply that it will be worse (or indeed better) just because it involves profit making organisations. So its already badly broken in many instances....... Why should it necessarily be so ? If the funding followed the patient then the opposite would happen: they would clamber over each other and patients would be the top priority. Indeed I thought part of the earlier reforms / pilots were intended to achieve just such behaviours by having money follow patients within a public NHS. Many PFI contracts stem from the then Govts desire to keep what amounts to public spending off the govts books. In their desire to do so, many PFI contracts that were drawn up were very poor value for the taxpayer. That is what happens when politics gets in the way and becomes a consideration which overrides value for money. That is not the same as saying 'public provision good / private (with profit) provision bad'. Given that the govt can borrow at better rates than private bodies, there is an argument that large spend on public infrastructure projects are better being funded by govt, not private. But then we come back to the question of whether govts/civil servants/public bodies are generally capable of spending that money efficiently/wisely/well. All of this said. What is often lost in the debates over the NHS is that the UK is rated as having one of the best 'value/return for money spent' health provisions (as measured by outcomes vs. spend on) when measured on objective economic criteria. But for an individual it does of course depend on what yoiu are trying to get out of it. Its not all bad news, its just not all good or unimprovable either.
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Post by bracknellboy on Apr 27, 2016 19:35:29 GMT
... that they will have to pay for using the NHS. That is a red line and a no no as far as I am concerned, it should be free to everyone, no argument. : apologies in dredging up a several days old post :-) but..... I don't know whether you meant that as literally as written or whether you meant it as a 'broad brush' philosophy. As the latter I agree. As the former I no longer do. The problem with an entirely 'free at the point of use' service is there are no disincentives to over using / abusing it. And assuming we don't believe in a fairy god mother providing an infinite resource, that inevitably means that no constraints in one place leads to greater constraints somewhere else. For example, GP surgeries are rammed - and a significant part of the load are repeat 'offenders' who have no good reason to be there. The ambulance service is rammed, and a significant enough portion of that is from people who should not be calling on an ambulance. The introduction of small incentivising/discinctivsing charges for e.g. GP appointments should not IMHO be ruled out, and in fact should be both seriously considered, and seen as a way of preserving the fundamental model of 'free at the point of use', not undermining it. Of course that should be 'tuned' rather than blanket (not apply to children under age of xxx, not apply to individuals with long term conditions that need regular appointments etc). In reality, it isn't entirely 'free at point of use' anyway: prescription charges ? we live in a different world: 'me' and 'entitled to' seem to be more regularly used words than they used to be. And that places unnecessary additional burdens on the likes of the NHS.
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Post by ablrateandy on Apr 27, 2016 20:19:30 GMT
Ultimately the doctors have the same choice as me. If you don't like what your employer is offering get a job with somebody offering something better. If you can't find a better offer then be thankful for what you've got. Ultimately, unfortunately, that is what will happen. As mentioned before, my wife's specialty in a major central London teaching hospital is staffed 50pc below recommended levels. Ie people are completing training and then not going into hospital medicine. GP numbers are declining. Doctors without families can move to Oz, triple their pay, get 9-5 plus overtime and no weekends. Over the next five years, when the contract is imposed, this whole middle tier is going to collapse, with a consequent impact on care. I'm as Tory as they come, but even I can see the flaw in the plan....
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Post by captainconfident on Apr 27, 2016 20:20:33 GMT
The details that leap out at me in regards to Belgium are repeated references to private & evidence of competition, likely to be considered an anathema in the UK. Several companies offer successful healthcare systems based around some public-private co-operation. The key is the provision of comprehensive cover to all that need it. Unfortunately the drive in this country is towards private companies cherry picking the potentially profitable elements of healthcare and leaving the NHS to pay for the care of emergencies, the elderly and frail. The USA has the most inequitable, expensive healthcare system in the world but there seems to be a push to try and replicate this dysfunctional system rather than (for example) Belgium's. The word Private/Privatisation clouds understanding of the potential for potential private-public running of the system in the UK, so here is a description of it in Belgium To quote ilmoro's report, The health system in Belgium is "provisioned by a mixture of state and non-profit hospitals" The (private) health insurer picks up all bar a small fraction of the bills you incur in the hospital. There is a tiny bit extra which is not refunded, presumably to stop you living on the GPs doorstep. Everyone must have insurance and it is subsidised to a point where everyone can afford it. "Private" health insurers range from trade union run, Catholic church, socialist, large private companies you would have heard of, and best deal for me, one that gives really good deals to self employed people So that is the "mixture of public and private". The private insurers purchase the services you require from the publicly run hospitals. This is supposed to be efficient, and this is the area in which the " too many administrators in the NHS" come in, but I am no expert. Hope that helps.
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Post by bracknellboy on Apr 27, 2016 20:40:26 GMT
Ultimately the doctors have the same choice as me. If you don't like what your employer is offering get a job with somebody offering something better. If you can't find a better offer then be thankful for what you've got. Ultimately, unfortunately, that is what will happen. As mentioned before, my wife's specialty in a major central London teaching hospital is staffed 50pc below recommended levels. Ie people are completing training and then not going into hospital medicine. GP numbers are declining. Doctors without families can move to Oz, triple their pay, get 9-5 plus overtime and no weekends. Over the next five years, when the contract is imposed, this whole middle tier is going to collapse, with a consequent impact on care. I'm as Tory as they come, but even I can see the flaw in the plan.... In a properly free market economy, the ultimate arbiter of whether the balance of pay and conditions is 'right' for any particular industry, and specific role in that industry, is whether there is a queue to sign up or a hollowing out of experience and a shortfall of replacements. And that has to be in the context of a global market for the the requisite skills. Pretty much everything else is irrelevant.
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Post by earthbound on Apr 27, 2016 22:18:12 GMT
... that they will have to pay for using the NHS. That is a red line and a no no as far as I am concerned, it should be free to everyone, no argument. The introduction of small incentivising/discinctivsing charges for e.g. GP appointments should not IMHO be ruled out, and in fact should be both seriously considered, and seen as a way of preserving the fundamental model of 'free at the point of use', not undermining it. Of course that should be 'tuned' rather than blanket (not apply to children under age of xxx, not apply to individuals with long term conditions that need regular appointments etc). In reality, it isn't entirely 'free at point of use' anyway: prescription charges ? we live in a different world: 'me' and 'entitled to' seem to be more regularly used words than they used to be. And that places unnecessary additional burdens on the likes of the NHS. All good.. but who do you think the incentivising/discinctivsing charges should be applied to?
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ben
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Post by ben on Apr 28, 2016 4:32:38 GMT
The NHS has probably had its day when it was created if you had something like cancer, a) they would not know it and b) you were basically sent hone to die, nowadays they can spend millions keeping one patient alive, obviously if we were that patient we would all like it to be paid for but ethics aside the reality is someone has to pay for it so there is two choices the funding is significantly increased to cover this (ie taxes) or people would have pay private insurance to cover this.
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duck
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Post by duck on Apr 28, 2016 5:33:22 GMT
Whilst I'm very pleased with the treatment I have received over the years for many and varied injuries I'm wondering if some of the newly introduced 'preventative' measures being introduced and the routing of everything through GPs are not going to impose further strain on the NHS and GPs in particular. I received an invite for a 'general health check' from my GP surgery ... everybody will get one. I don't smoke or drink, I don't carry excess weight and walk 6-8km every day, I'm healthy ....... but why not. See a nurse who finds a minor problem which needs checking for a week. See nurse after a week - problem still there, need to see a GP. See a GP who then notices the effects of one of my old injuries - you need to see physiotherapy. See physio - you need to see a specialist. Specialist wants X rays but these need to be ordered by GP See GP who orders X rays See radiographer. Physio sees Xrays and doesn't like what she sees - need to see specialist. Specialist - physio can't help, you need fairly major surgery and soon ..... but that needs a referral from the GP. See GP who looks at Xrays and checks me out. Referred to Hospital for surgery! Now this has all happened in the last 3 weeks the equivalent of 10 appointments (yes I'm persuasive!) seeing 7 different Health professional with more on the way! 3 weeks ago I was healthy with a few longstanding 'niggles' now I'm preparing for hospital food  |
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JamesFrance
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Port Grimaud 1974
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Post by JamesFrance on Apr 28, 2016 7:00:04 GMT
Ultimately, unfortunately, that is what will happen. As mentioned before, my wife's specialty in a major central London teaching hospital is staffed 50pc below recommended levels. Ie people are completing training and then not going into hospital medicine. GP numbers are declining. Doctors without families can move to Oz, triple their pay, get 9-5 plus overtime and no weekends. Over the next five years, when the contract is imposed, this whole middle tier is going to collapse, with a consequent impact on care. I'm as Tory as they come, but even I can see the flaw in the plan.... In a properly free market economy, the ultimate arbiter of whether the balance of pay and conditions is 'right' for any particular industry, and specific role in that industry, is whether there is a queue to sign up or a hollowing out of experience and a shortfall of replacements. And that has to be in the context of a global market for the the requisite skills. Pretty much everything else is irrelevant. Which is why the public sector unions try to demonize privatization, where they would have to justify their pay and Spanish practices and give value for what Gordon Brown called investment but is really current expenditure.
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