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Thread: Privatising the NHS.

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    Privatising the NHS.

    It's obvious that GPs can't 'administer' the NHS as well as doing their basic function of being a GP.

    It therefore follows that they will have to sub-contract the administrative work, limiting themselves to being on committees to vote on preferred policies.

    Who is going to provide these administrative services? Why, private limitied companies.

    Who are they going to employ to do the actual work? Why the people who do it now, working for PCTs in the administrative departments. After all, they will be out of work and have the relevant expertise.

    So, hands up anyone who is fooled by ConDem PR and hasn't spotted that this is privatisation by the back door?

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    Re: Privatising the NHS.

    It's actually quite open. The white paper makes specific reference to the idea of outsourcing the commissioning functions (commissioning is NHS-speak for buying the various treatment and services required to look after patients). At present, commissioning is being performed by the Primary Care Trusts - they are responsible for buying all NHS services for their region. There are a couple of hundred PCTs at the moment; the best guesses I've seen are that there will be around 500 or so GP Commissioning Consortia.

    That said, there are some pretty serious issues with this. The Government claims that these GP commissioning cosortia are going to be more efficient than the current PCT commissioning model and thereby save money, while providing more effective service to the patients.

    Unfortunately, there's not a lot of evidence for this.

    The Nuffield Trust took a look at GP Commissioining in California - a similar model to what they want in the UK. They found, unsurprisingly, that most of the consortia were struggling to survive as a commercial enterprise. The ones that were performing well were the ones who had hired experienced and competent managers and had invested heavily in infrastructure, especially IT. These consortia were very good (and actually quite efficient). But that efficiency and effectiveness required significant up-front investment.

    And, in the UK, if you want to find capable staff with experience in commissioning, then you will probably have to hire them from the (now defunct) PCTs. It's quite possible that at least some of these people will recieve sizeable redundancy packages then get rehired at about the same salary to do basically the same job but for a smaller population. I'm not sure how that is more efficient. If I were forced to say why, I would say that the underlying drive behind these changes is the ideological belief that the private sector is inherently and always superior to the public sector. Unfortunately, the evidence doesn't really stack up to support that belief as a universal claim.

    On top of this, they are introducing a bunch of changes to performance targets. These changes are being rushed in. To give some context, a similar change was introduced by the last Government in the ambulance services. The changes were announced in 2005, worked on for a few years, then formally introduced in 2008. By that time, most services had undergone fairly radical change and were coming pretty close to target.

    A new set of changes were announced late last year, to be implemented by April 1st. As of today, some of the fairly important details have still not been announced, so the services are a bit unsure what exactly what targets and standards they are going to have to achieve in three months time. To meet these targets will require some fairly substantial changes in operational practices. So the commissioning of ambulance services is having to go ahead without knowing what the targets will be, what effort will be required to meet them and how much potential savings can be generated from more efficient operation.

    All in all, it's a bit of a mess and seems incredibly rushed. My guess is the Government is trying to achieve everything it wants to within one term...

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    Re: Privatising the NHS.

    Quote Originally Posted by geoff332 View Post
    All in all, it's a bit of a mess and seems incredibly rushed. My guess is the Government is trying to achieve everything it wants to within one term...
    It's trying to rush through things whilst there's no coherent opposition. Hence the swiftness of things like spending cuts.

    But frankly, with Ed Milliband, I think "no coherent opposition" looks like it'll be the default position for a few years yet.

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    Re: Privatising the NHS.

    Quote Originally Posted by geoff332 View Post
    Unfortunately, there's not a lot of evidence for this.
    I don't think politicians work like that!

    In my opinion they have their ideologies, and from those they form their policies. Once they've done that they set about finding some evidence to sell those policies to the general public.

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    I don't think politicians work like that!

    In my opinion they have their ideologies, and from those they form their policies. Once they've done that they set about finding some evidence to sell those policies to the general public.
    a perfect description of a snake oil salesman

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    Re: Privatising the NHS.

    OK, so I read all that, but according to the Dailymail the current system doesn't seem very good either. In this article it says "Doctors are semi-private operators who are given a lump sum every year by the Government to pay for their practices, including rent of buildings, equipment and wages for staff. What is left over goes into doctors’ pockets as profit."

    Quote Originally Posted by Dreadful Scathe View Post
    a perfect description of a snake oil salesman
    There's no need for the words 'oil' or 'salesman'.

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    OK, so I read all that, but according to the Dailymail the current system doesn't seem very good either. In this article it says "Doctors are semi-private operators who are given a lump sum every year by the Government to pay for their practices, including rent of buildings, equipment and wages for staff. What is left over goes into doctors’ pockets as profit."
    There is no problem with this providing a) the lump sum is monitored as required in order to ensure it doesn't produce egregious income for the GPs and b) the health outcomes are satisfactory. (The Daily Mail seems to operate on the principle 'everyone who earns more than Daily Mail reporters are overpaid, and everyone who earns less is a mug or a scrounger').

    The problem with the proposed changes is that the evidence shows that the current system is beginning to produce the better outcomes that it was designed to produce, and while things could be improved, it stands to reason that imposing a wholly untried, wholesale change to the system (somebody said 'the changes are so huge they can be seen from space') whilst simultaneously restricting the funding is bound to lead to worse outcomes in the short term. (In turn, this almost certainly means that there will be pressure to impose more changes, possibly even within the term of this parliament, certainly when the next one starts, and then we're back on the merry-go-round.) In the meantime, there will be private companies getting an even bigger toe-hold and if anyone thinks they won't do every last bit of cherry-picking they can possibly wangle in order to maximise their profits, that person is almost fatally naive.

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    Re: Privatising the NHS.

    The proposed changes to the NHS is a subject quite close to my heart as I have worked in the NHS for 18 years and been through many changes to the way it is funded and run. The borough that I work in has a very good PCT and have done an excellent job in providing services for a very deprived area of London.

    From what feedback we get, the GPs do not want this change and were not unhappy with the services provided via the PCT. Obviously our PCT colleagues are concerned for their future as many are going to be made redundant at a great cost to the taxpayer. If they then get reemployed under the new GP funding, how will that be cost effective?

    Prior to PCTs there was GP fundholding that was not successful and it seems that we are heading back in that direction.

    I believe the use of private care is not a problem if sufficient services are not available in the public sector and to keep waiting times down but I can foresee some problems with NHS having to compete against Private companies for contracts as in the past when things have not gone well with patients in the private sector the NHS has had to pick up the pieces but if those facilities are no longer there because sufficient funding has not been secured it could leave people vulnerable. Also there will be certain areas that are just too costly for the private sector to deal with and these will be left to the NHS to run but if it is not properly funded will probably be unable to cope.

    As I have said I have worked in the NHS and used the NHS for a number of years and can really see a great improvement to services over the last 10 years or so. Therefore I am very unhappy with this upcoming change (not just because of my own job vulnerability).

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    Re: Privatising the NHS.

    Quote Originally Posted by Barry Shnikov View Post
    There is no problem with this providing a) the lump sum is monitored as required in order to ensure it doesn't produce egregious income for the GPs and b) the health outcomes are satisfactory.
    But it probably won't be monitored in the way you suggest, because as long as GPs are 'within the rules' everything will be fine (just like MPs and their expenses). So the only option is to change the system or the rules.

    Quote Originally Posted by Barry Shnikov View Post
    The Daily Mail seems to operate on the principle 'everyone who earns more than Daily Mail reporters are overpaid, and everyone who earns less is a mug or a scrounger'.
    At the Dailymail outrage is frequently directed at those people on the public payroll who earn more than the Prime Minister, that includes a lot of Town Hall Chief Executives. I don't find it hard to understand the Dailymails viewpoint on this, why should someone running a Council receive a higher salary than the Prime Minister? Which is the most challenging and responsible position out of the two?

    Quote Originally Posted by Barry Shnikov View Post
    The problem with the proposed changes is that the evidence shows that the current system is beginning to produce the better outcomes that it was designed to produce, and while things could be improved, it stands to reason that imposing a wholly untried, wholesale change to the system (somebody said 'the changes are so huge they can be seen from space') whilst simultaneously restricting the funding is bound to lead to worse outcomes in the short term. (In turn, this almost certainly means that there will be pressure to impose more changes, possibly even within the term of this parliament, certainly when the next one starts, and then we're back on the merry-go-round.)
    Most of the management schemes that have ever been tried for the NHS were probably not run for long enough to produce maximum benefit. I think that's the natural outcome of changing the system too frequently, you get huge disruption, huge costs, but the system is never allowed to settle down for long enough to reap any benefits.

    This link previously posted by geoff332 is really rather useful as it reveals that in the last 30 years there have been 15 major changes in the structure of the NHS. In the original article here, the author helpfully points out that "Reorganisation has often been cyclical, with new governments or ministers reinventing structural arrangements that their predecessors abolished, seemingly unaware of or uninterested in past reorganisations".

    Now, if you go here then you can see that starting in 1981 with Patrick Jenkin, we have had 14 different people as Secretary of State for Health. What that suggests to me is that every Minister that ever did the job in the last 30 years couldn't resist the urge to meddle with the NHS management system. Therefore, I suggest the biggest problem in the NHS management has been, and continues to be the frequency and scale of meddling carried out by the Secretary of State for Health (rather than the actual management system in place at any one time).

    Quote Originally Posted by Barry Shnikov View Post
    In the meantime, there will be private companies getting an even bigger toe-hold and if anyone thinks they won't do every last bit of cherry-picking they can possibly wangle in order to maximise their profits, that person is almost fatally naive.
    But lets not forget that New-Labour racked up huge future liabilities with their PFI schemes for the NHS.

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    Re: Privatising the NHS.

    Quote Originally Posted by David Bailey View Post
    It's trying to rush through things whilst there's no coherent opposition. Hence the swiftness of things like spending cuts.
    Also, I suspect, getting the bad news out of the way early on in their term, when there isn't an election looming (they hope, anyway).
    Love dance, will travel

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    I don't find it hard to understand the Dailymails viewpoint on this, why should someone running a Council receive a higher salary than the Prime Minister? Which is the most challenging and responsible position out of the two?
    At face value this seems a reasonable position but fails to take into account:

    a - the perks of the PM job (housing, etc)
    b - the golden ticket the PM gets when he retires in terms of taking up consultancy/advisory work, TV appearances, writing memoirs, etc

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    But it probably won't be monitored in the way you suggest, because as long as GPs are 'within the rules' everything will be fine (just like MPs and their expenses). So the only option is to change the system or the rules.
    I don't know what you thought I suggested. An annual consideration as to whether the lump sum should go up, down, or stay the same, is all that's required.
    At the Dailymail outrage is frequently directed at those people on the public payroll who earn more than the Prime Minister, that includes a lot of Town Hall Chief Executives. I don't find it hard to understand the Dailymails viewpoint on this, why should someone running a Council receive a higher salary than the Prime Minister? Which is the most challenging and responsible position out of the two?
    I'm baffled by this fixation on the Prime Minister's salary as some sort of benchmark. I've yet to see anyone explain why it has any bearing on what other people earn. Why shouldn't someone running a council receive a higher salary than the Prime Minister? Such persons (i.e. leaders of political parties) are committed politicians, and the nation isn't competing with banks, auditors, multi-national companies and so forth when having to attract the right calibre of applicant - but high-spending councils are.
    Most of the management schemes that have ever been tried for the NHS were probably not run for long enough to produce maximum benefit. I think that's the natural outcome of changing the system too frequently, you get huge disruption, huge costs, but the system is never allowed to settle down for long enough to reap any benefits.
    So you agree that now is not a good time to introduce yet another?
    Therefore, I suggest the biggest problem in the NHS management has been, and continues to be the frequency and scale of meddling carried out by the Secretary of State for Health (rather than the actual management system in place at any one time).
    ...and therefore one should not accede to yet another.
    But lets not forget that New-Labour racked up huge future liabilities with their PFI schemes for the NHS.
    Who gives a zhit what Labour did? The situation we're dealing with is the one we have now - proposed changes of preternatural enormity, together with a funding squeeze. You can't be serious that one argument in favour of this is 'Oo! Oo! but look what they did!'

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    Re: Privatising the NHS.

    Quote Originally Posted by robd View Post
    At face value this seems a reasonable position but fails to take into account:

    a - the perks of the PM job (housing, etc)
    Perks can't be equated meaningfully with money in the bank.

    Quote Originally Posted by robd View Post
    b - the golden ticket the PM gets when he retires in terms of taking up consultancy/advisory work, TV appearances, writing memoirs, etc
    Yes, but it's not contractual and so the benefit derived varies considerably. For example, since leaving No. 10 Tony Blair has probably already earned far more from his Premiership than Gordon Brown ever will.

    Quote Originally Posted by Barry Shnikov View Post
    I don't know what you thought I suggested. An annual consideration as to whether the lump sum should go up, down, or stay the same, is all that's required.
    I'm just saying that a small number of GPs will probably find a way of working the current system for their own gain in a way that doesn't contravene any rules and can't be controlled satisfactorily.

    Quote Originally Posted by Barry Shnikov View Post
    I'm baffled by this fixation on the Prime Minister's salary as some sort of benchmark. I've yet to see anyone explain why it has any bearing on what other people earn. Why shouldn't someone running a council receive a higher salary than the Prime Minister?
    Because the PM is the most senior person on the public sector payroll. I think that ought to be reflected in the pay packets received elsewhere in the public sector.

    Quote Originally Posted by Barry Shnikov View Post
    Such persons (i.e. leaders of political parties) are committed politicians, and the nation isn't competing with banks, auditors, multi-national companies and so forth when having to attract the right calibre of applicant - but high-spending councils are.
    The requirement for large salaries to attract top calibre applicants is an argument that I've heard many times before, but unfortunately I don't think it holds any water. The bankers had huge salaries with bonuses to match but remember how that ended, they had to be bailed out. Now consider the nurses who work at your local hospital. Using the high pay = high calibre argument you should refuse treatment from any nurse that is not on a six figure salary.

    Quote Originally Posted by Barry Shnikov View Post
    So you agree that now is not a good time to introduce yet another?

    ...and therefore one should not accede to yet another.
    On the basis that politicians have meddled far too much in the past, I think it would probably be best to just let the current system run for a while and try and get some use out of it. However, we've just had a GE and so the government has both a mandate to and is expected to change things. If they're still meddling in two years time then the obvious conclusion is that they failed to get it right the first time, we then vote them out for mucking it up and repeat the entire cycle. It's very counter-productive, but unfortunately that's what happens in politics. Maybe we should limit changes to one NHS management structure per election.

    Quote Originally Posted by Barry Shnikov View Post
    Who gives a zhit what Labour did? The situation we're dealing with is the one we have now - proposed changes of preternatural enormity, together with a funding squeeze. You can't be serious that one argument in favour of this is 'Oo! Oo! but look what they did!'
    I give a zhit. In your opening post you appeared to be directing your ire at the Condems. I thought it was appropriate to highlight the failings of the previous government as New Labour have left a lot of problems. I realise that the Condems are probably using the enormous deficit left by New Labour to justify larger cuts and bigger changes than they might otherwise have been able to. However, the fact remains that New Labour left a terrible mess for the incoming government to clear up.

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    I thought it was appropriate to highlight the failings of the previous government as New Labour have left a lot of problems. I realise that the Condems are probably using the enormous deficit left by New Labour to justify larger cuts and bigger changes than they might otherwise have been able to. However, the fact remains that New Labour left a terrible mess for the incoming government to clear up.
    Every government leaves a "terrible mess" for the next one. But Barrys point stands, if they could please stop harping on about how much of a mess they were left and simply attempt to fix it - dodgy elected blame-passing reprobates the lot of 'em.

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    Re: Privatising the NHS.

    Quote Originally Posted by Bubble View Post
    I'm just saying that a small number of GPs will probably find a way of working the current system for their own gain in a way that doesn't contravene any rules and can't be controlled satisfactorily.
    A system which can be subverted is one that needs to be tweaked, not one that needs to be dumped.
    Because the PM is the most senior person on the public sector payroll. I think that ought to be reflected in the pay packets received elsewhere in the public sector.
    Why?
    The requirement for large salaries to attract top calibre applicants is an argument that I've heard many times before, but unfortunately I don't think it holds any water. The bankers had huge salaries with bonuses to match but remember how that ended, they had to be bailed out. Now consider the nurses who work at your local hospital. Using the high pay = high calibre argument you should refuse treatment from any nurse that is not on a six figure salary.
    You've missed the point. I'm not suggesting that ability equates to remuneration. What I'm saying is that if you want a competent chief administrator for a substantial local authority, you are going to have to pay a lot of money to attract someone who could otherwise be earning almost certainly a lot more doing the same work for a substantial commercial organisation. On the other hand, there is no need to pay a Prime Minister such a large sum of money because he is not comparing his situation with the CEO of M&S. The PM"s job is sui generis, whereas competent large-scale administrators are required everywhere.
    On the basis that politicians have meddled far too much in the past, I think it would probably be best to just let the current system run for a while and try and get some use out of it. However, we've just had a GE and so the government has both a mandate to and is expected to change things. If they're still meddling in two years time then the obvious conclusion is that they failed to get it right the first time, we then vote them out for mucking it up and repeat the entire cycle. It's very counter-productive, but unfortunately that's what happens in politics. Maybe we should limit changes to one NHS management structure per election.
    Well, let's just hope that nobody known to you and me dies or suffers irreversible health outcomes during the experimental period, ey?
    I give a zhit. In your opening post you appeared to be directing your ire at the Condems. I thought it was appropriate to highlight the failings of the previous government as New Labour have left a lot of problems. I realise that the Condems are probably using the enormous deficit left by New Labour to justify larger cuts and bigger changes than they might otherwise have been able to. However, the fact remains that New Labour left a terrible mess for the incoming government to clear up.
    I was getting at the ConDems, largely because much of this appears, on the face of it, to be designed to subject the NHS to the predations of the large commercial organisations which are just itching to get their shoulders through the door and scarf at the trough. But I'm not getting at them just because they are ConDems, whereas the significance of what Labour might or might not have done is zero in the context of whether the current proposals are a good idea.

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    Re: Privatising the NHS.

    Quote Originally Posted by DavidY View Post
    Also, I suspect, getting the bad news out of the way early on in their term, when there isn't an election looming (they hope, anyway).
    Probably, yes.

    And on the "if it 'twere be done, 'tis best done quickly" theory, there's a certain amount of sense behind that approach. If you have to do something painful, delaying it never helps.

    But on this one, there's no need to radically reorganise the NHS (again). It's not perfect, but neither is it horribly broken either. In fact, I think it's pretty good as it is. Improvements, yes; efficiencies, definitely. But total restructure? No.

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    Re: Privatising the NHS.

    Quote Originally Posted by Dreadful Scathe View Post
    Every government leaves a "terrible mess" for the next one.
    Mostly, although the last Tory government (till 1997) actually left the economy in good shape. Largely due to MyHero Ken Clarke, apparently. Who, of course, will never get any credit for doing so.

    Quote Originally Posted by Dreadful Scathe View Post
    But Barrys point stands, if they could please stop harping on about how much of a mess they were left and simply attempt to fix it - dodgy elected blame-passing reprobates the lot of 'em.
    That's inevitable, at least for the next few months.

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    Re: Privatising the NHS.

    Quote Originally Posted by David Bailey View Post
    Mostly, although the last Tory government (till 1997) actually left the economy in good shape. Largely due to MyHero Ken Clarke, apparently. Who, of course, will never get any credit for doing so.
    I did use "quotes". They may say it is a mess when it isn't, or not mention it at all depending on what is expedient. The economy is not the only thing - can we not blame the last Tory government for some awful Privytisation [sic] fiascos. meh.

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    Re: Privatising the NHS.

    Quote Originally Posted by Dreadful Scathe View Post
    I did use "quotes".


    Quote Originally Posted by Dreadful Scathe View Post
    They may say it is a mess when it isn't, or not mention it at all depending on what is expedient. The economy is not the only thing - can we not blame the last Tory government for some awful Privytisation [sic] fiascos. meh.
    Oh God yes - there are all manner of things we can happily blame the Major administration for, and Tories in general.

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