I haven't read the whole thread so forgive my ignorance. Having had a lengthy chat about this over a Sunday lunch recently with someone in the ranks, I disagree. Our NHS needs to shed the bureaucracy and expensive useless departments. This is not the start of the end for the NHS and it isn't going to be sold off to businesses.
PCT's is only a start. I recommend starting your research here www.nhs.uk and look for all the trusts. Then work your way through the expense of contractors and service suppliers. Try to find out details of ex-NHS managers/directors who set up consulting firms and then charge many times what an in-house expert would be paid. Sounds quite brief actually, but while you are looking through all this it starts adding up just how much crap you could get rid of and bring back in house. If private sector workers were to do a 6 month stint in the public sector they'd be shocked. Now add to that their pension pot. Don't get me wrong, I am pro-NHS and have received excellent treatment from front-line workers. But we're talking about cutting deadwood out due to poor times. When Labour comes back then they can give you all those fluffy things back again and re-mortgage the country to pay for it all. The only negative about giving doctors more authority is that they are doctors, not businessmen. But then the positive will be the likelihood of the country receiving larger better established health centres where many doctors will be based providing a larger range of services themselves like simple operations. Or something.
The NHS does have problems, but none of them are going to be fixed by these proposals or by privatisation. I for one, would like to see an earnings cap for all public sector workers. Make it a generous cap, maybe as much as £70,000pa and revise it periodically, but the NHS, as well as other public services, should not be a place people go to get rich. There certainly should not be people earning hundreds of thousands of pounds A YEAR out of our public purse, and especially not in the NHS. If people aren't prepared to do the job without exorbitant remuneration, then they shouldn't be doing it in the first place.
What type of people would you restrict? Surgeons, consultants? Even management has a role to play and like it or not if they are not suitably remunerated they will find work else where. If you want to attract the best people eventually you have to pay top dollar.
Lovely in theory, horrific in practice. What happens to mthe people who are highly able senior managers who decide they aren't being paid fairly for their services compared to private sector workers? They'll leave of course. How about some doctors? Do you expect someone to spend six years at medical school (which will soon come with about £100k debt attached) and spend a significant proportion of their lives in training, work unsociable, long hours and then only hope for £70k maximum salary? I think I'll study eonomics instead, thanks and go into banking.
My Mrs is a nurse, she's really struggling to find a permanent contract, they just don't exist at the moment so she's forced to work 6 months, find another temp contract, work another 6 months, all the while worrying about money etc. I can understand to a point why this is, what I don't understand though is why hospitals consistently hire agency staff to 'plug the holes' as it were that cost them 2/3x as much as a regular hired nurse. It's a crazy waste of money. For example, this ward she's on at the minute has a manager and 3 full time employed nurses, along with 4 agency staff. She's been there since October now, and all the agency staff have been there full time as well. For the same money they could have paid for another 8/10 nurses and spread them across other wards. No wonder they're complaining they're short staffed really. Add to that the fact that the central heating was on full blast last summer and all the patients were moaning that they were melting, I can see money being wasted in pretty much everything that happens at that place.
I would restrict everyone - NHS, police, armed forces, education, government etc. I'm not suggesting we let our public servants live in poverty, I'm merely suggesting that public service should not be an avenue to getting rich. Pay them decent wages which allow them to get on with their jobs without worrying about money. Others will take their place. I have no sympathy for anyone who thinks that earning over three times over the national average and doing the nation a service is not enough. They are not the sort of people I want to be treating me, or deciding on my treatment. I don't care what the private sector pays. If someone cares more about getting rich than they do about what is best for our society, they should not be part of our public services. You have to consider that all the money comes out of the same pot. Decreasing a Trust Manager's salary from £200,000pa to £70,000pa would return £130,000pa to the pot, which is enough to pay for four full-time nurses (whose mean earnings are £27,245pa). We need to put a stop to self-serving public servants.
Luckily for you even Labour have a grounding in economics. You know why some restaurants have better service than others, usually two reason pride in their work place and a better salary. If your paying peanuts you get monkeys, it applies to public service also. In the real world people want to think that they are being given a fair wage for the work they are doing if the private sector is paying 3-5x as much for probably an easier job even the most public spirited individual will become disaffected. At that point you don't want them look after you, nothing worse than a demotivated employee except perhaps a demotivated Doctor/Surgeon.
I feel my boot coming down here. You do realise Civil Servants pre-dominantly already make less than private sector workers right? The major piece of our job was "less in worklife and we support you for retirement", but now our pensions have been threatened (I know how dare we...) and you want to give us less in our salary? What the hell incentive does that give anyone working for the Government to actually work efficantly and effectively? nothing, and that will be what gets done if that occurs. [/rant] sorry, total derailment is about to occur... but I despise that view "You work for the government, you shouldn't get so much of a wage so my taxes decrease" and there is no other excuse for bringing it up. There are at least two people in the thread who might get as annoyed as me with your comment bud.
There is evidence to suggest that more money does not necessarily mean better performance. http://www.youtube.com/watch?v=u6XAPnuFjJc I think you misunderstand me. I am all for paying our civil servants decent wages and my desire for a cap is not born of a desire for lower taxes. What I want is to cap wages so that nobody earns more than, say, £70,000 from the public purse. This would produce massive savings, which could then be used to hire more staff and generally improve the services, both for the employees and for the public. Again, £70,000 is a decent wage, but if you think that would not be enough for someone to support themselves, please enlighten me. I am not advocating a decrease in all public service workers' pay, just a cap on what the government will pay at the top end.
Where do you propose we find these perfect, selfless employee? And that warm fuzzy feeling from helping the country will not help pay back the debt incurred by my six years of medical school, the hours I will have to work, the sacrifices I will have to make to my personal life and other activities in order to be a doctor. I want to help people, of course I do, but I also expect to be paid in line with the amount of work I do, and how demanding the job is. Make no mistake, being a dioctor is a horrible job. There is a reason why they have the highest rates of substance abue amongst professionals. And you are suggesting they take a pay cut? I'm a medical student. Do you think I should not be a doctor for this attitude? Who gave you the authority to judge the reasons why people do what they do? If you cut wages, you will lose some very able people who might have done medicine. As for treating me, I don't care about their motivation, all I care about is having the best doctor possible treating me.
My question for those doctors who're only in it for the money, are there not better, easier, ways to make the same pay packet, without incurring huge debts, long antisocial hours, and potentially high-stress environments? I always thought that doctors, nurses, etcetera, really ought to be doing it for a reason other than "the money", if only because "the money" only encourages you to do enough not to get fired, where as actual care, well. The extra mile, and all that crap. As for how much people in the NHS are paid, I don't really give a toss. I do, however, think it's somewhat irresponsible spending to constantly hire contractors at higher rates when a permanent job is going to cost less in the long run. Cut irresponsible spending, not pay. IMO.
£70,000 is not enough for you? What is, then? How much would you like the state to pay you, bearing in mind the things I have said about all the money coming from the same limited pot?
That is all astutely observed. But I also note that your proposed solution (as would be mine) is to bring all these costly services back in-house. Now note that the government is actually proposing the opposite: to farm all health services out to the private sector. This has several drawbacks. First, it is self-defeating. Because the NHS has ultimate responsibility and duty of care, it has to make sure that externally contracted services are of the required standard. This means that providers have to be approved. This means that the NHS can only draw from that pool of approved providers, which is very limited and therefore can charge what it wants. So much for healthy competition. Second, in practice there is a fragmenting of ownership and accountability. Before, if a ward was unacceptably dirty it would come down on the matron who would come down on the nurses and hospital cleaners. They would take note because this is about their job. Problem addressed. Nowadays the ward manager has to talk to the services manager who contracts the cleaners, who has to talk to their manager who employs them, who has to talk to the cleaners, who are all just agency staff on crappy pay trying to hit impossible targets without employee rights temping their way through college anyway so they don't really give a ****. That is a nice video, but note how that only works when a person earns enough so that money is not a concern any more. I can assure you that at £70.000,-- we haven't quite reached that point yet. Try £250.000,--. Most clinical staff will never see £70.000,--. I won't. So I'm not really fussed by thus proposal. Consultant doctors and surgeons however may be. I am the first to say that some of their pay and reward structures are ludicrous, but generally their job is fiercely hard. Forget about the six years in med school; that was the easy part. The real deal comes with the long hours as house officer and registrar, the blood, the trauma, the incessant life-and-death decisions, the post-grad exams and a regular scrutiny of clinical performance that makes a cavity search at Gitmo feel a bit casual and remote. Seriously: these guys have to constantly perform under pressure, train, demonstrate development. And yes, bodies are counted. On top of those clinical obligations comes service auditing, development and management, generation of income and management of financial and other resources, maintaining and developing professional standards and being accountable for implementation of Department of Health policy and guidance and touting for money from commissioners. There is also staff training and supervision. Easy, no? Many consultants don't crack up by virtue of the fact that they are Type A achievement-driven workaholic neurovores (i.e. they feed on stress). They are not compulsive carers, like nurses. They are not compulsive problem solvers like psychologists. They are compulsive achievers, and they like their tangible rewards. You take too much of that away and they will absolutely walk.
Not really, no. Considering the 6 years of university, £50-£100k of debt, the 10-15 years required after graduating to reach consultant grade. Add into that the ridiculous and antisocial hours a doctor works, the stress of the job, the responsibilty for people's lives and the constant risk of being sued. Oh, and the lovely taxman (remember quoting comparisons of basic salaries isn't really a fair comparison). Lowering wages would increase the amount of time doctors spent doing private work, further hurting the NHS. Taking a pay cut isn't always that simple even at high levels of earning, as people tend to have large overheads to go with the pay. I think £100k is fine (and coincedentally around the average earning for many specialties last time I checked). Don't get me wrong, I do not want ridiculous wages, as I agree that no-one should ever go into medicine for the money, and wages that are too high would lead to that.
If you check the ONS figures the "civil service" (includes lgo's,quango's who aren't technically civil service) you will find that they work a shorter week are less productive at work and earn more than the private sector! and that doesn't include the pension or job security that just doesn't exist in the private sector. Keeping it just to the NHS things that should take a day take weeks still waiting on a response from the PCT from November 2010 Dentist's are unavailable, Doctors so uncontactable I brought my last set of anti biotics from the US. Then you get the delay's trying to get out of hospital (called the police on me because I hadn't signed the release form because 8 hours after asking for it the only member of staff with the key to the cupboard had gone home Then there is the policy that says I have to be fit for work been disagreeing with the Dr over that for almost a year but still can't go back to work at a cost to the state of about £1000pcm I have an even worse opinion of the LGO,DWP,IPS but thats not relevant to this thread but if they follow through on the unions threats I think you will find out just how little sympathy the rest of the public have.
People in the public sector should be paid the market rate and not have some arbitrary caps placed on them by someone who thinks all public sector workers are lazy and over paid. These dreaded 'managers' you talk about are running huge organisations with large numbers of employees. This idea that replacing them with doctors because doctors know about health care is idiotic. Have you ever seen how much people in charities get paid? They tend to get paid very well so they can attract the best people to the roll and get the most value for money.
How about whatever he's worth? That's the only way you're going to keep good public sector employees in the public sector. I know people who grew up in relative poverty and think that anyone earning over 30k a year is rich and (generally also think) overpaid. I also know people who grew up with daddies earning 300-500k a year and think that anything less than 100k isn't very much. You can not decide what people should earn. I can not either. What decides is the market value - doctors in the public sector have a market value in the private sector, and if we want to keep them in the public sector we need to pay them a salary close to that. There's no point in having another 15 nurses if there's only 1 consultant per thousand patients because the others have all left due to being paid £200,000 less than they're worth. You might not want a consultant who wants to earn £200k treating you, and so I'd say you're more than welcome to the guy who came bottom of his class and only needs £50k. Personally, I'd rather have the guy who's worth 200k a year treating me.
