The NHS and its future

Chippy_boy said:
I don't accept these comparisons. The waste that goes on in the NHS cannot be compared to losing 1 felt tip pen in every 50. It's widespread, endemic in fact and on a huge scale. It's institutionalised waste.

I also do not accept that the only things that can get privatised are the "profitable" bits. If the NHS does them efficiently ("profitably", if you will), then there's no need to privatise them. The bits that should be privatised are the bits that the NHS are bad at, not those they are good at!

So if the NHS - with it's inherent lack of fiscal responsibility and inherent, institutionalised waste - can do a bog standard hip operation for £3,000 and Spire say they'll do them for them with a shorter lead time for £2,500 then that's worth doing. If it only costs Spire £2,000 and they make £500 on the deal, then everyone wins. The NHS gets work done cheaper than it can do it itself, the patient gets it done quicker (and more efficiently) and the private company makes a reasonable profit (allowing for the fact they'll overrun on costs on some of the work and need some contingency.) The work is still "free" from the patient's perspective and free at the point of delivery. There's absolutely nothing wrong with this sort of arrangement and it's a great shame I think that Labour have decided that ideologically its some sort of heinous sin.
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The problem is that the cost or price of your hip operation is an average price. If your £3000 is correct that is supposed to cover someone who is fit and healthy as well as someone less so. Spire come along and can only take the fir and healthy ones, leaving the NHS to pick up the rest, the ones who stay in hospital longer and have worse outcomes. Then, as if by magic, Spire are not only a bit cheaper, their outcomes are better and the length of time people spend in hospital is shorter. Lets give it all to the private sector and we will be saved. Except, they tried that with a company called Circle, who took over Hinchingbrooke hospital, increased its debts, made it worse for patients, took plenty of government cash and then pissed off leaving the good old NHS to pick up the pieces and Virgin have done similar.
What you need to realise is, is that Spire doesnt have to have a critical care unit ready just in case (it cherry picks it's patients and uses the local hospital criticsal care unit, if necessary), it doesn't have an A&E department, it doesn't have to train doctors (as it gets them from the local NHS trusts, as well).
 
BJL_City said:
don't need to chase. Foreign national comes to hospital, provides ID, and the charges are logged on the system against their ID and shared with immigration. When they decide to leave the country without paying, they're stopped at passport control and either pay up or are banned from coming back into the country till they've paid up. No "chasing" at all. Charges logged at source.
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That is still "chasing", you would have to create and man systems to do it, Bolster passport controls, airport security areas etc etc. and those dont come cheap. our passport control doesn't even log entry / exit times at the moment let alone allow this.
 
The Light Was Yellow Sir said:
The problem is that the cost or price of your hip operation is an average price. If your £3000 is correct that is supposed to cover someone who is fit and healthy as well as someone less so. Spire come along and can only take the fir and healthy ones, leaving the NHS to pick up the rest, the ones who stay in hospital longer and have worse outcomes. Then, as if by magic, Spire are not only a bit cheaper, their outcomes are better and the length of time people spend in hospital is shorter. Lets give it all to the private sector and we will be saved. Except, they tried that with a company called Circle, who took over Hinchingbrooke hospital, increased its debts, made it worse for patients, took plenty of government cash and then pissed off leaving the good old NHS to pick up the pieces and Virgin have done similar.
What you need to realise is, is that Spire doesnt have to have a critical care unit ready just in case (it cherry picks it's patients and uses the local hospital criticsal care unit, if necessary), it doesn't have an A&E department, it doesn't have to train doctors (as it gets them from the local NHS trusts, as well).
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No no no. I've heard this excuse before.

It's down to how the contracts are structured and currently (admittedly) it seems they are often structured very badly indeed. Cleaning services are outsourced now and yet you see crap on the floor all the time. Either the contract doesn't adequately reward cleanliness and penalise dirtiness, or someone in the NHS is not doing their job calling the cleaning company to account. Private companies will always seek to minimise costs - to cut corners even - in order to maximise profits. It's what they do and it's a good thing; it's why capitalism - for all its flaws - is the only system we know of that actually works. So to work in a public service context, you have to be very specific about what you are contracting for and what you are not, and the rewards and the penalties. Then it works. Clearly this is the case because the entire private sector outsources all sorts of things. You do not see this level of push back about privatisation anywhere in the private sector! It's simply a lame excuse those ideologically hell bent on 100% state ownership put forward in order to try to muddy the water.

To answer your specific example, Spire would not get to pick and choose what sort of jobs they want. They'd be given a contract to perform say 10,000 hip operations and get paid (in stages) 30 million quid for it. Of course there would have to contractual provision for things it can't do - exceptions. And those would have impact on the level of reward it receives. The details are unimportant for this discussion. The important bit is that privatisation can be made to work and the idea that it cannot work in public services organisation is a complete smoke screen.
 
Saddleworth2 said: ↑
Tax revenues don't work like that. A couple of years ago the institute of fiscal studies stated that about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%. The situation is only going to get worse and I don't see anyone on either side of the political divide coming up with any sustainable answers.
Vic said:
Shurely shome mishtake...

Saddleworth2 said:
Mate, a bit early for the hard stuff. Don’t you know that excessive alcohol abuse puts a strain on the NHS?
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I'm With Stupid said:
If you see tax paid in as an individual thing, then technically that's correct. Just under half of the people in the country effectively take out more in services than they put in. But of course tax isn't really an individual thing. The company you work for makes profits off your hard work and pays taxes on those profits (in theory). By definition, people get paid less than the value you add to the company (on average), so taxes that a company makes are also effectively taxes that their employees have contributed.
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..about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%...

Shurely shome mishtake... (google it)
 
Chippy_boy said:
No no no. I've heard this excuse before.

It's down to how the contracts are structured and currently (admittedly) it seems they are often structured very badly indeed. Cleaning services are outsourced now and yet you see crap on the floor all the time. Either the contract doesn't adequately reward cleanliness and penalise dirtiness, or someone in the NHS is not doing their job calling the cleaning company to account. Private companies will always seek to minimise costs - to cut corners even - in order to maximise profits. It's what they do and it's a good thing; it's why capitalism - for all its flaws - is the only system we know of that actually works. So to work in a public service context, you have to be very specific about what you are contracting for and what you are not, and the rewards and the penalties. Then it works. Clearly this is the case because the entire private sector outsources all sorts of things. You do not see this level of push back about privatisation anywhere in the private sector! It's simply a lame excuse those ideologically hell bent on 100% state ownership put forward in order to try to muddy the water.

To answer your specific example, Spire would not get to pick and choose what sort of jobs they want. They'd be given a contract to perform say 10,000 hip operations and get paid (in stages) 30 million quid for it. Of course there would have to contractual provision for things it can't do - exceptions. And those would have impact on the level of reward it receives. The details are unimportant for this discussion. The important bit is that privatisation can be made to work and the idea that it cannot work in public services organisation is a complete smoke screen.
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My daughter's bunions were done on the NHS by Spire (quicker than waiting for the surgeon at her local NHS hospital) - by some Scandinavian butcher who left her feet no better off and the NHS a lot poorer.
 
Vic said:
Saddleworth2 said: ↑
Tax revenues don't work like that. A couple of years ago the institute of fiscal studies stated that about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%. The situation is only going to get worse and I don't see anyone on either side of the political divide coming up with any sustainable answers.




..about 45% of working age didn't actually pay tax. So the burden of the NHS falls on the other 65%...

Shurely shome mishtake...
Click to expand...
Even the 45% who 'don't pay tax' do pay tax, as the only way to avoid it is to nick everything you ever need!!!
 
Vic said:
My daughter's bunions were done on the NHS by Spire (quicker than waiting for the surgeon at her local NHS hospital) - by some Scandinavian butcher who left her feet no better off and the NHS a lot poorer.
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Oh right, let's not bother then. You've convinced me.
 
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