NHS Crisis

[Chippy_boy]

Far from it mate - me - and I expect 99% of people on here and not far off that in the UK BOUGHT that right. Its called tax and NI. Successive governments have promised us all the NHS is safe in their hands. If they can't fund it properly they should tell us - preferably in a manifesto - not appoint a fuck wit like Hunt to deny it and dance on a pin head over what is and isn't 4 hours in A&E. I'd bet the vast majority vote one way or another based on promises on the NHS ( cough..... what referendum bus ...cough ) rather than in support of defence spending or HS fuckin 2 .

Those of us old enough on here remember the run down of BR through lack of investment followed by sell off followed by huge increases to private franchises in subsides to run a poorer fragmented service and see the echoes in the NHS. Its worth noting the biggest beneficiaries are now European NATIONALISED railways so quite soon we will be seeing our NHS services free at the point of need in Germany or France as they mop up our taxpayers subsidies to the NHS. Vote leave eh? Ha ha ha .

That's a fair point about us paying for it and therefore expecting to get it. Although it was supposed to be paid for out of NI, which nowadays nothing like covers it.

But look, as I said in my post, I am not opposed to "free" health provision. The question is how do we provide it, and CLEARLY the current status quo is not working as we would all want. Do we throw more and more and more money at it until it works to our satisfaction, or do we look for other ways to achieve a better end result? Personally, I think the NHS is broken in its current form.

There is nothing wrong with privitisation, but there is plenty wrong with bad privitisation (which is what's happened with the railways, for example). When the NHS outsourced cleaning services for example, and we see dirty hospitals, does that mean privitisation is bad? No, it means we've fucked up the outsource contract, which should reward excellent performance and have penalty clauses for inadequate work. That the cleaning company is allowed do an inept job, is the fault of whoever drew up the contract, or those who are supposed to be monitoring the performance.

When I see people like my grandad in hospital for 3 months for a hip operation that should have been seen him in and out in a fortnight, I see HUGE amounts of waste. We are already starting to see work like this being farmed out to private companies, who on a tightly controlled contract would have the financial imperative to do things right, do them once, and do them properly. If they did not, they'd lose money since the amount they'd be paid would essentially be fixed. There's lots of scope for more of this. "Would you like to have your hip operation done here Mr Jones, or we can offer you an alternative service at your local Bupa hospital if you prefer".

I understand why people are against privitisation when I see how it's been cocked up in the past, but that just tells me we shouldn't cock it up. I remember when I used to fly to Paris on business and it used to cost me £400 to £500 back in the 90's. Nowadays, even after 20 years of inflation, it's a fraction of that. That's what proper competition can do in the private sector, and we could have proper competition for certain aspects of healthcare provision (not all of it of course) with enormous benefit. I do not envisage an NHS with 100% of the services provide by private-sector business, but perhaps 30% or 40% of the top of my head, as opposed to the 6% at the moment.

Why anyone would be so hell bent on the public sector unning things, when all the government ever does is fuck things up, is quite beyond me. If you want something doing well, the very last people you want anywhere near it, is the public sector..

 

[The perfect fumble]

There is nothing wrong with privitisation, but there is plenty wrong with bad privitisation (which is what's happened with the railways, for example). When the NHS outsourced cleaning services for example, and we see dirty hospitals, does that mean privitisation is bad? No, it means we've fucked up the outsource contract, which should reward excellent performance and have penalty clauses for inadequate work. That the cleaning company is allowed do an inept job, is the fault of whoever drew up the contract, or those who are supposed to be monitoring the performance.

I understand why people are against privitisation when I see how it's been cocked up in the past, but that just tells me we shouldn't cock it up. I remember when I used to fly to Paris on business and it used to cost me £400 to £500 back in the 90's. Nowadays, even after 20 years of inflation, it's a fraction of that. That's what proper competition can do in the private sector, and we could have proper competition for certain aspects of healthcare provision (not all of it of course) with enormous benefit. I do not envisage an NHS with 100% of the services provide by private-sector business, but perhaps 30% or 40% of the top of my head, as opposed to the 6% at the moment.

Oh god! I'm tired of hearing this parroted over and over again, when a private contractor fucks up, it is never the fault of the contractor, it is always the fault of those who drew up the contract and who's job it is to oversee it. Every time it is the outsourcing process and not the deliverer of the service that is at fault. Everywhere we see the private provision of public services fuck up and yet it is never due to the inherent problem that the private provision of public services, driven as it is by profit, is hardwired to fuck up.

Everywhere the answer to problems in health and education is competition, and when time and time again it fucks up the problem is always "it isn't being implemented properly", or it isn't "true" completion and the solution is more competition and more privatisation. It is a mantra, a right wing ideological rigidity so ingrained many never question it.

Then the unquestioning throw in a completely irrelevant example of a cheap flight to Paris as an example of "good" competition and jobs a good un.

It would be amusing if it wasn't so depressing.

 

[The Light Was Yellow Sir]

That's a fair point about us paying for it and therefore expecting to get it. Although it was supposed to be paid for out of NI, which nowadays nothing like covers it.

But look, as I said in my post, I am not opposed to "free" health provision. The question is how do we provide it, and CLEARLY the current status quo is not working as we would all want. Do we throw more and more and more money at it until it works to our satisfaction, or do we look for other ways to achieve a better end result? Personally, I think the NHS is broken in its current form.

There is nothing wrong with privitisation, but there is plenty wrong with bad privitisation (which is what's happened with the railways, for example). When the NHS outsourced cleaning services for example, and we see dirty hospitals, does that mean privitisation is bad? No, it means we've fucked up the outsource contract, which should reward excellent performance and have penalty clauses for inadequate work. That the cleaning company is allowed do an inept job, is the fault of whoever drew up the contract, or those who are supposed to be monitoring the performance.

When I see people like my grandad in hospital for 3 months for a hip operation that should have been seen him in and out in a fortnight, I see HUGE amounts of waste. We are already starting to see work like this being farmed out to private companies, who on a tightly controlled contract would have the financial imperative to do things right, do them once, and do them properly. If they did not, they'd lose money since the amount they'd be paid would essentially be fixed. There's lots of scope for more of this. "Would you like to have your hip operation done here Mr Jones, or we can offer you an alternative service at your local Bupa hospital if you prefer".

I understand why people are against privitisation when I see how it's been cocked up in the past, but that just tells me we shouldn't cock it up. I remember when I used to fly to Paris on business and it used to cost me £400 to £500 back in the 90's. Nowadays, even after 20 years of inflation, it's a fraction of that. That's what proper competition can do in the private sector, and we could have proper competition for certain aspects of healthcare provision (not all of it of course) with enormous benefit. I do not envisage an NHS with 100% of the services provide by private-sector business, but perhaps 30% or 40% of the top of my head, as opposed to the 6% at the moment.

Why anyone would be so hell bent on the public sector unning things, when all the government ever does is fuck things up, is quite beyond me. If you want something doing well, the very last people you want anywhere near it, is the public sector..

But people don't want to travel 50-60 miles for hospital treatment which, if you want to begin real efficiencies, is where you would need to start. Imagine the private sector took over in the north and said the most efficient and sustainable model is four very large hospitals; one in Liverpool, Manchester, Leeds and Newcastle. Everything else will be through the GP or a minor injuries unit. There is no patient transport you'll just have to get yourself there if you need a hospital appointment. Would you support that?
On to your BUPA fallacy. The NHS hospitals are funded through a mechanism called National Tariff which is, in essence, a price list for doing things. It was brought in so competion (which you seem to want) couldn't be based on price. By it's very nature it is an average price. If the price is £5000 to replace a knee, some patients will cost £3000 and others might cost £7000 based on how complex they were and whether they had other stuff wrong with them. But, the amount paid would be right overall. In come BUPA on its white horse and says "we can do some of this to help ease the pressure on the NHS". Brilliant says the NHS but we can only pay you £5000, like we do the NHS. Absolutely fine says BUPA but, we can only treat the patients who are relatively simple because we don't have an Intensive Care Unit (should the patient become really sick, we will transfer them to the local hospital). OK say the politicians because, ideologically, we are so wedded to 'competition' we must encourage this. So BUPA gets all the patients who 'cost' £3000 whilst the local hospital get all the ones that cost £7000 and they both get paid £5000. Oh, and BUPA don't have to train any medical staff, or stay open 24/7 and can employ their surgeons from......... the local hospital (who have to pay for all their on-going training and development). Efficiency is quite easy when your getting paid much more than your costs and you have no responsibilities particularly when compared with the NHS hospital that has just the opposite.

 

[Tim of the Oak]

That's a fair point about us paying for it and therefore expecting to get it. Although it was supposed to be paid for out of NI, which nowadays nothing like covers it.

But look, as I said in my post, I am not opposed to "free" health provision. The question is how do we provide it, and CLEARLY the current status quo is not working as we would all want. Do we throw more and more and more money at it until it works to our satisfaction, or do we look for other ways to achieve a better end result? Personally, I think the NHS is broken in its current form.

There is nothing wrong with privitisation, but there is plenty wrong with bad privitisation (which is what's happened with the railways, for example). When the NHS outsourced cleaning services for example, and we see dirty hospitals, does that mean privitisation is bad? No, it means we've fucked up the outsource contract, which should reward excellent performance and have penalty clauses for inadequate work. That the cleaning company is allowed do an inept job, is the fault of whoever drew up the contract, or those who are supposed to be monitoring the performance.

When I see people like my grandad in hospital for 3 months for a hip operation that should have been seen him in and out in a fortnight, I see HUGE amounts of waste. We are already starting to see work like this being farmed out to private companies, who on a tightly controlled contract would have the financial imperative to do things right, do them once, and do them properly. If they did not, they'd lose money since the amount they'd be paid would essentially be fixed. There's lots of scope for more of this. "Would you like to have your hip operation done here Mr Jones, or we can offer you an alternative service at your local Bupa hospital if you prefer".

I understand why people are against privitisation when I see how it's been cocked up in the past, but that just tells me we shouldn't cock it up. I remember when I used to fly to Paris on business and it used to cost me £400 to £500 back in the 90's. Nowadays, even after 20 years of inflation, it's a fraction of that. That's what proper competition can do in the private sector, and we could have proper competition for certain aspects of healthcare provision (not all of it of course) with enormous benefit. I do not envisage an NHS with 100% of the services provide by private-sector business, but perhaps 30% or 40% of the top of my head, as opposed to the 6% at the moment.

Why anyone would be so hell bent on the public sector unning things, when all the government ever does is fuck things up, is quite beyond me. If you want something doing well, the very last people you want anywhere near it, is the public sector..

A significant part of the current crisis is that Social Care providers (who are 90 percent private employers) are not taking people into care who are supposed to be discharged from hospital. There is not a sufficient profit (or sometimes no profit at all) in it for them because of cuts to social care budgets.

They are businesses and I am not blaming the care homes for that. I am making the point that your aren't addressing the real issues because of focussing on public versus private arguments / ideology.

 

[Chippy_boy]

But people don't want to travel 50-60 miles for hospital treatment which, if you want to begin real efficiencies, is where you would need to start. Imagine the private sector took over in the north and said the most efficient and sustainable model is four very large hospitals; one in Liverpool, Manchester, Leeds and Newcastle. Everything else will be through the GP or a minor injuries unit. There is no patient transport you'll just have to get yourself there if you need a hospital appointment. Would you support that?
On to your BUPA fallacy. The NHS hospitals are funded through a mechanism called National Tariff which is, in essence, a price list for doing things. It was brought in so competion (which you seem to want) couldn't be based on price. By it's very nature it is an average price. If the price is £5000 to replace a knee, some patients will cost £3000 and others might cost £7000 based on how complex they were and whether they had other stuff wrong with them. But, the amount paid would be right overall. In come BUPA on its white horse and says "we can do some of this to help ease the pressure on the NHS". Brilliant says the NHS but we can only pay you £5000, like we do the NHS. Absolutely fine says BUPA but, we can only treat the patients who are relatively simple because we don't have an Intensive Care Unit (should the patient become really sick, we will transfer them to the local hospital). OK say the politicians because, ideologically, we are so wedded to 'competition' we must encourage this. So BUPA gets all the patients who 'cost' £3000 whilst the local hospital get all the ones that cost £7000 and they both get paid £5000. Oh, and BUPA don't have to train any medical staff, or stay open 24/7 and can employ their surgeons from......... the local hospital (who have to pay for all their on-going training and development). Efficiency is quite easy when your getting paid much more than your costs and you have no responsibilities particularly when compared with the NHS hospital that has just the opposite.

Some fair points.

But on the other hand, outsourcing of work, works in other scenarios where similar challenges exist. For example, when a bus operator takes on a franchise, they have to pick up the unprofitable routes as well as the cash cows. Clearly the problem with analogies is that you can only take them so far. (And in your example, I don't see why the outsourced knee contract couldn't mandate that the service provider pays for ALL knee operations and pays the NHS back for ones it can't handle, at a rate that compensates the NHS adequately). So I am not suggesting it's the same, nor that there would be no challenges in further privatisation, but I believe it can be made to work to a greater extent than 6% of the services.

And what's the alternative? More and more and more money and keep everything the same? Really?

 

[Chippy_boy]

A significant part of the current crisis is that Social Care providers (who are 90 percent private employers) are not taking people into care who are supposed to be discharged from hospital. There is not a sufficient profit (or sometimes no profit at all) in it for them because of cuts to social care budgets.

They are businesses and I am not blaming the care homes for that. I am making the point that your aren't addressing the real issues because of focussing on public versus private arguments / ideology.

I agree with your main point about social care, absolutely. If we could solve that problem, it would improve things enormously I am sure. That is not to say I agree that there is no mileage in a public vs private argument though. We can and should focus on all aspects where things could be improved.

 

[Chippy_boy]

Oh god! I'm tired of hearing this parroted over and over again, when a private contractor fucks up, it is never the fault of the contractor, it is always the fault of those who drew up the contract and who's job it is to oversee it. Every time it is the outsourcing process and not the deliverer of the service that is at fault. Everywhere we see the private provision of public services fuck up and yet it is never due to the inherent problem that the private provision of public services, driven as it is by profit, is hardwired to fuck up.

Everywhere the answer to problems in health and education is competition, and when time and time again it fucks up the problem is always "it isn't being implemented properly", or it isn't "true" completion and the solution is more competition and more privatisation. It is a mantra, a right wing ideological rigidity so ingrained many never question it.

Then the unquestioning throw in a completely irrelevant example of a cheap flight to Paris as an example of "good" competition and jobs a good un.

It would be amusing if it wasn't so depressing.

Sorry to depress you. Try to just think of it as amusing.

 

[Ifwecouldjust.......]

Really? If true, then good news. PROPERLY privatising the majority of it would be an enormous improvement since it would bring some real efficiency improvements.

Or maybe they are underfunding it because every department - health, education, defence, welfare , policing etc etc are ALL desperate for more money that we haven't actually god with our huge deficit and even more gigantic debt. Just a fucking thought.

Because you're one step away from the American System where you are charged for the midwife to pass you your baby after giving birth....charged for oxygen being on standby (even if you don't use it) charged 40 times the actual cost of medicine available in the uk. kicked off the private healthcare plan once you submit a large claim and then find you can't get alternative cover thats affordable or covers pre existing medical conditions.....

The very principal of insurance is that all contribute so that those who suffer a loss will get sorted. Our government are withholding £30 billion of cash from the NHS and watching it collapse whilst they happily use their BUPA medical insurance if they or their families need care. There would be a lot more money if the government had ring fenced and protected it rather than wasting it

 

[grunge]

That's a fair point about us paying for it and therefore expecting to get it. Although it was supposed to be paid for out of NI, which nowadays nothing like covers it.

Doesn't look that far off, with a quick ( not massivly conclusive ) google, in 2014 the gov took in 110bn in NI. in 2015/2016 the NHS cost 116bn. No idea if NI increased in 2015 to cover that 6bn difference.

If we did privatise the HNS and go towards an american insurance system I very much doubt that NI would vanish or be cut. we'd end up paying the insurance ontop of NI too.

 

[Prestwich_Blue]

I agree with your main point about social care, absolutely. If we could solve that problem, it would improve things enormously I am sure. That is not to say I agree that there is no mileage in a public vs private argument though. We can and should focus on all aspects where things could be improved.

The way to improve it is to put more money into it. The budget has been hugely cut over the last few years by over £6bn meaning it takes longer to get a less adequate package, assuming you can get one at all. The private companies you champion (although I'm not against the use of private providers in the NHS per se) restrict visits to a limited time, don't pay staff for travelling time (efectively paying under minimum wage) and do everything else to keep costs down and revenue up. We've had all this with my mum, who recovered after being desperately ill in hospital but had to stay there, under pressure from bed managers, while we desperately tried to get a suitable care package together for her to support her living at home. But the best package the council could provide wasn't enough so she's had to go into residential care.

The other major improvement would be having one authority control medical and social care budgets as that would mean hospitals and local authorities wouldn't be fighting each other to avoid spending any more than necessary. I believe they're trialling this in Salford.