I looked this up: http://www.sochealth.co.uk/resources/national-health-service/reform-of-the-national-health-service/ I guess the goventment of the day will keep changing things one way or the other. And the left will claim it is being privatised which you are meant to think means being sold off like BT was. Which it hasn't been, has it?
You can be sure the superior work conditions, pensions and the generous salaries of public sector employees have a lot to do with it. People are still clinging on to the idea that the private sector should raise its standards of employment to that of the public sector and not the public sector lowering its standards to that of the private sector. If you suddenly start to expect them to work 50+ hours a week, cut all possibility of promotion for low level employees, remove all pensions except for the legally required minimum and start them all out on min wage as is certain to happen after privatisation then the country will be plunged into an economic abyss. Why? It's simple really, without consumer spending companies can't make money and all those highly paid public sector employees are currently very good consumers due to having plenty of money to spend.
Um well some jobs are better paid in the private sector and some worse. I don't see how a private healthcare company would be able to recruit any medical staff if the advertised the jobs with the minimum wage so I'm not sure what you're taking about. Anyway not one political party is proposing to privitise the NHS, or even cut spending. But at least one will claim that they will "Save it from privitisation and cuts. Perhaps a sensible conclusion is that the NHS is neither the best or worst system in the world, that some things work well in it and some things are hopeless. That there are great professionals there but a few here and there that aren't. That there is too much management process in general, but some things need to be better managed. That we need to give medical professionals to say in the management, but not employ qualified doctors to do management jobs and that some things need to be imposed from the top because left to their own devices the medical professionals won't always do the right thing either (not a great lobby of hospital consultants wanting to increase weekend working, is there?)
They don't have to propose anything, remember these "no top-down re-organisation of the NHS", "No frontline cuts", "no VAT rise" ? They maybe a little harder to find nowadays since the party that run their election campaign on those claims decided to wipe them from their own website. The cutting spending claim really depends on how you define what "cut spending" means, are we defining it in a strict £1 billion is still going to be £1 billion 5-10 years from now, not taking into account inflation, the rising cost of providing a service ? Or are we taking into account inflation and other rising costs ? As i said before all the major parties are claiming only they can save the NHS, they are all just as bad as one another IMHO.
Some figures (awesome website if you like getting raw data rather than opinion pieces): Click on the graphs to take you to the source. Whover is in health spending goes up. The real question is how you can get more out of that spending.
This is about duty of care. In order for the NHS to meet its obligation to provide free health care for ALL at the point of NEED, it must offer appropriate health care to all people who need it. Private companies do not have that obligation; they can turn away patients who they deem "unsuitable", including if they are basically too expensive to treat and don't generate a profit. Yes, this is enshrined in current agreements between the NHS purchasing authorities and private health providers. Private companies also do not have the same level of accountability that the NHS does. If you have a problem with them, you'll have to initiate a civil law suit. Legal aid has been scrapped so you'd have to do that on a no-win no-fee basis. Good luck with that (after all, you may be ill, or in pain, or dying, or dead). Private companies can also conveniently disband and reform under a different company name to avoid accountability and prosecution. Again yes, this has been done: I refer you to the PIP breast implant scandal. Being profit driven, the primary objective of these companies is to generate profit, not to deliver health care. That is just how they generate profit. Patient health and wellbeing become subjugated to making a buck. I'll leave you to think for a moment how a free market capitalist system is incompatible with patient interest. I'll give you a hint: Consumer choice. Now you can carry on implying that health care professionals' concerns are based purely in self-interest and I wont deny that it may play a small part; most NHS professionals work well beyond their paid hours motivated by a certain sense of idealism. It feels not unreasonable that part of that covenant of care is to be reasonably provided for in our old age. However let me remind you: We all have essential, highly marketable skills. If health care does go private, chances are our pay will go up and our working environment will be nicer. But patient care will become subject to market forces, and that rankles us on principle. If we have to sell our soul to private health care to make a living we will do it. But you, the patient, will be treated by soulless professionals.
While i do love a good chart neither of those take into account the extra 2.5 million people since 2010, that the amount of over 65's grew by 10% in the last decade and that it costs nearly twice as much to treat someone over 65, that paying doctors’ wages and purchasing drugs – have consistently risen faster than the overall measure of inflation. Charts, facts, and figures can be interpreted in many different ways, people can distort them to suite. fullfact.org published what i would consider an unbiased view on NHS spending.
Private companies will have whatevery duties are agreed in the contract. If the NHS asks for bids to provide a service then the NHS can specify what they are bidding for. What you are doing is creating a straw man by assuming the alternative to complete state owned provision is to leave it to privately ownwed companys to cover what they want. This isn't proposed by anyone in goverment of mainstream politics. What it is about is deciding that you want a service (such as out of hours cover), specififying waht the provided needs to provide, how much and for whom, and seeing how much they want to do it. Then you decided if they want to do that or you want to do it within the NHS. GPs have always been privately run practices. Does the profit motive ruin their care? Would you want to nationalise them? Oh and don't assume all the private providers have to be run by rapaciuos capitalists, diversifying from gaming and loan sharking or whatever cliche you like. For example BUPA has no shareholders, profits are reinvested. It was actually formed from the old provident societies that existed to provide healthcare to the public before the NHS was created.
No, you don't get it. I'm talking about contracting regulations that are already in place; that specify the conditions of all contracts that private companies can bid for. Private companies can turn away any patient they like, for any reason they like. They have no legal duty of care. Lack of accountability also has already been demonstrated with the PIP breat implant scandal. I'm not talking about what I fear will happen; I'm talking about what is already happening. But this has to happen within private purchasing regulations, which currently specify that a company can refuse to treat patients, for reasons of their own choosing. Geddit? And again: no mechanism of accountability to the patient except through expensive legal recourse. Yes. The main problem we have had with GP practices over the last decade is the ludicrous contract that the government made with them in 2004; allowing them to demand high pay but avoid out-of-hours cover --which then had to be backfilled at added expense by the NHS. Another problem is that GPs often are shareholders in primary care health services. This means that GP commissioning groups cannot comission primary care services (conflict of interest, natch) which means that there has to be a separate NHS primary care service commissioning group. Just to complicate matters. If health care provision becomes largely private, you can bet that there will be all sorts of financial incentives aimed at GPs to favour referral to these services. With GPs being private practices there it will be difficult to control that. BUPA is a lovely organisation, but for instance the imaging equipment of the local BUPA hospital is not as good as that used in our local NHS hospitals. The customer wouldn't know, however, which brings me back to the point of consumer choice. How does a layperson know who will offer the best health care for their needs? And how do they complain if they are unsatisfied? Who is accountable? My point is: there is currently no consumer protection against private providers who are rapacious capitalists.
No I have no idea what is in place at the moment. It might be completely dumb. That doesn't mean it is the only way to do it. If the NHS wants to get a service they can determine the terms and if they don't like what a private provider has offered then they don't have to go with it. If they have existing regulations that are dumb then change them. That sounds a a mess. So how would you go about nationalising the GP practices. After all they own porperty and so on.... So GPs are particualrly unethical compared to hospital consultants? How do they know if they are badly treated within the NHS given the history of coverups? The provision is for the NHS to contract services carefully and where necessary and chose those providers wisely. Anyway you are essentially providing arguaments agaisnt what you claim if the future shutting down the NHS and letting everyone go private. I am sayign that this isn't happening, isn't goign to happen and that private companies can provided useful value to the NHS without compromising the objective of providing free health care.
The government is not inclined to do that. First, it is more interested in creating an attractive market for private companies. Capitalism likes free markets, as in: unencumbered by rules and regulations*. Second: nobody reads this small print (I have). They don't know it exists. So nobody pressures the government to change it. Simples. We already have NHS primary care health centres. All we have to do is create the post of NHS GP within it. The incentive is that it's a paid job with none of the hassle of running your own business, and a service that is supported by an entire NHS infrastructure. They are just as ethical/unethical. But it is harder (although not impossible) to take advantage of clinician incentive schemes within the NHS than outside of it, because clinical decisions have to follow NHS treatment protocols, NICE guideance and MDT recommendations. They don't, but if they think they are, there are multiple pathways to make complaints and a process of accountability within the NHS. It is by no means perfect, but at least there is one. Moreover if you sue the NHS, it cannot simply dissolve and reform under a different name. No, the provision is for the NHS to contract services from "any suitable provider" according to commissioning rules and guidelines which a.o. state that such providers can turn away patients at their own discretion, and which offer no clear pathway for accountability beyond loss of contract and the usual, rather inaccessible avenues of legal prosecution. I am saying that it is happening. People very high up the food chain in the NHS are saying that it is happening. Directors in NHS, Charity and Private Health services are saying that it is happening. It is happening. The cornerstone of the private health provision argument is that, being subject to market forces, it will be more efficient and therefore cheaper to the NHS (purchasing authorities). This is untrue. The Competition Commision has found that private health care patients are overpaying for medical treatment. The reason for this is monopolisation of the market by large private health care providers (usually US companies). Monopolisation is a market force too... Moreover private companies who take over poorly performing NHS facilities have a poor record in breaking even, let alone making a profit. Circle ran Hinchingbrooke Hospital and while it all started with great promise, they too are now in a financial mess. * The idea is that consumer choice creates regulation; if you screw your customers over, or in any other way provide them with a less than adequate service, they will take their custom somewhere else. This however assumes that the customer can make valid and informed choices, and when they are sick, or worried that they are sick, or mentally unwell, they are less able to do that. Moreover health care decision making is highly complex. It's a lot harder than, say, buying a car or a computer. And the consequences of getting it wrong are more serious. It also assumes that patients want to make choices. Psychological research shows that they don't nearly want to as much as we think they do. They want to be informed and involved, but in the end they want to be able to trust a competent professional to advise and decide what is in their best interest. When commercial considerations come into the picture, that trust is undermined. Already we have patients accusing the NHS of not giving them the care they need because of financial cost considerations. Imagine what it will be like when they know their health care provider works for profit.
That's not how contracts work, two parties agree on the terms and for how long the contact will run, if one party fails to meeting it's contractual obligations you can't just go about making changes. You have to go through a long drawn out legal dispute mechanism that can be very costly, and even then you can only terminate a contact early if there has been fundamental breach, again involving a possibly long drawn out and expensive trip to the courts funded by us taxpayers of course. Any private contractor would tie up the courts time in a hope that the contact would be at an end by the time legal proceeding have come to an end of course, leading to the likelihood of suing for breach of contract to be very unlikely.
Hell you could have fooled me. Sure they are a bit less anti business than the last lot but I'm yet to see and bonfire of the regulations. OK basically you have said that somewhere in the small print there is a provision that all NHS outsourcing or buying in of services in perpituity has to be done on the basis that the private provider can pick and choose individual patients on the basis of their profitability. Provide a link because this is a big, big deal. Will you be purchasing all the physical premesis from them or setting up new ones? If they have built up a sucessful practice would they get any compensation because you will be shutting them down? Is this nationalisation a useful use of health spending? Or would you do it without compensation which would be a pretty draconian step?
Well so the problem is the past contracts then. Not with the principal of paying for services from external providers.
You make the incorrect assumption here that free trade (I think you mean the free market though) actually exists whereas it does not. Free trade doesn't exist because of taxes and tariffs, easy to dismiss but as I said I think you mean the free market. The free market does not exist (and will not as it is not profitable for the established players) due to things such as no bid contracts, state subsidies and bailouts, corruption, exclusive dealing, regulations, quotas, I could go on and on.
I meant Free Trade. And no we don't have it, but the TTIP is a move towards freer trade which is good for the reasons I stated.
Boris Johnson: Britain should go it alone on trade deal with US if EU fails to sign. Not sure if that's going on about what you guys are discussing, but thought it might be relevant and if so you'd want to know. It doesn't really give any details on the website, I'm pretty sure the paper had far more information about it.
It's a problem with all contracts, you can't just change the terms of a contract half-way through, or decide you no longer need their services. Take the example of the contract to provide security during the Olympics by G4S, they said everything was in good order right up to, what was it a week or two before the opening ceremony, we ended up having to draft in the armed forces. When talking about large scale projects and contacting them out you often find you are very limited in who can provide the scale you're looking for, then you can have problems with backhanders and/or vested interests. Don't get me wrong i have nothing against paying for services from external providers, it's a very good way to ensure quality, low prices, etc, etc. But it doesn't work well when it scales upwards, you end up in a monopolies situation, with perhaps a single company able to provide what you need.
