The End of the NHS?

[L.A.]

But hang on contracting out of services requires careful management of those who will then have to carefully. How can two tiers of careful management be more efficient than one?

I don't quite see your point Hugh. Obviously if you are giving contracts to companies you need the legal people to see that the contracts are fair and you need a monitoring process to see that the contractors are meeting their commitments, but if you employ your own workforce you need a HR team and an extra layer of management to do much the same for your own labour force.

[L.A.]

Let's look at education...the model for everything these days.
Overriding everything at the moment is the fact that there is a teacher shortage in a sector which has little or no incentive for people to come into it. A quarter of those trained do not stay in the profession for more than a few years. It is a sector where experience does not count due to government regularly ripping up the rule book and making it very easy to get rid of Old dogs who can't or refuse to learn new tricks.

Worse is internal competition between LEA and academy chains and between academy chains, a post code lottery in education and after 25 years of a sacred inspection system failure is still or more rife than in 1990.

Academy chains are becoming more like local authorities but without the ability for joined up planning with other services making a mockery of local management.

The big problem is that it has the worst of all worlds.

The unneccesity of contracting out.

Public servants giving out money to private contractors.

Your dilemma is this. If public servants cannot doctrinally be trusted to manage services why can they be trusted to contract them out?

It seems to me that private health had it's shout last century up to 1945 and never made a very good fist of it. Why should it work now?

Most of the problems you describe are in the state education sector, which as far as I'm aware does not contracts services to any large extent.

I'd agree that in the past public servants have shown that they cannot be trusted to manage services properly. Maybe this is the area that we really ought to be focusing on!

[Hope]

Efficiency,  my sister works for the NHS and some parts of it are grossly inefficient due to it being run by the government.

Here in South Wales, the local Health Board recently moved its main offices from one block of offices to another (neither being within the context of a health provision centre - hospital,clinic, etc.)Whilst they were only moving 2 and a bit miles, all the office equipment was discarded and new brought into the new offices.  There were office chairs, office desks, packs of paper and other equipment - still in their original wrappings simply being skipped.

Are we suggesting that this was a result of government - be that Westminster or Cardiff Bay?

[Walt Zingmatilder]

I don't quite see your point Hugh. Obviously if you are giving contracts to companies you need the legal people to see that the contracts are fair and you need a monitoring process to see that the contractors are meeting their commitments, but if you employ your own workforce you need a HR team and an extra layer of management to do much the same for your own labour force.

Hang on

privatisation involves costs in.
Selection of contract,
selection of legal team,
monitoring of contract,
monitoring of legal team,
profits for legal team,
profits for contractor.

Nationalised industry involves
monitoring of workforce,
workforce.

In terms of nationalised service there are 2 problems as far as I can see. Loss through
careless procurement and productivity. But these are also issues for big private organisations.

[Walt Zingmatilder]

Here in South Wales, the local Health Board recently moved its main offices from one block of offices to another (neither being within the context of a health provision centre - hospital,clinic, etc.)Whilst they were only moving 2 and a bit miles, all the office equipment was discarded and new brought into the new offices.  There were office chairs, office desks, packs of paper and other equipment - still in their original wrappings simply being skipped.

Are we suggesting that this was a result of government - be that Westminster or Cardiff Bay?

Heads should roll.

[Walt Zingmatilder]

Here in South Wales, the local Health Board recently moved its main offices from one block of offices to another (neither being within the context of a health provision centre - hospital,clinic, etc.)Whilst they were only moving 2 and a bit miles, all the office equipment was discarded and new brought into the new offices.  There were office chairs, office desks, packs of paper and other equipment - still in their original wrappings simply being skipped.

Are we suggesting that this was a result of government - be that Westminster or Cardiff Bay?

Would this have happened if property management operated across the public sector so that a desk can be put in a hospital or school or fire station.
After all surely that is the meaning of austerity isn't it.

[L.A.]

Hang on

privatisation involves costs in.
Selection of contract,
selection of legal team,
monitoring of contract,
monitoring of legal team,
profits for legal team,
profits for contractor.

Nationalised industry involves
monitoring of workforce,
workforce.

In terms of nationalised service there are 2 problems as far as I can see. Loss through
careless procurement and productivity. But these are also issues for big private organisations.

I'm sorry I don't buy that at all Hugh. You seem to be arguing that  public servants can't be trusted to organise contractors but they can be trusted to run the entire show themselves 

There are a whole lot of problems inherent to nationalised industries, not least the tendency for politicians (of all shades) to stick their oar in.

[jeremyp]

Efficiency,  my sister works for the NHS and some parts of it are grossly inefficient due to it being run by the government.

The problem is that a private company could make the NHS very efficient simply by giving everybody a box of ibuprofen and sending them home. A service that is run by a for profit company is always under financial pressure. In many areas, I would argue that is a good thing, but when one's family and friends' health is on the line, I'm not so sure.

[jakswan]

I think in times of austerity standardisation and nationalisation as you refer to it make more sense.

As far as I'm aware no major political party advocates for this position so until you get more mainstream support for your ideas we don't need to seriously consider this.

[jakswan]

The problem is that a private company could make the NHS very efficient simply by giving everybody a box of ibuprofen and sending them home. A service that is run by a for profit company is always under financial pressure. In many areas, I would argue that is a good thing, but when one's family and friends' health is on the line, I'm not so sure.

Any service that you offer is limited by the resources at its disposable and the demand the service is faced with.

I'm not suggesting that all NHS services should be privatised just that they should be considered.

In fact last figure I heard was that 40% of current NHS services are provided by the private sector anyway.

[jeremyp]

Any service that you offer is limited by the resources at its disposable and the demand the service is faced with.

With a private company, there is a third limiting factor: profit. A private company's first duty is to its shareholders. One would like to think that the NHS's first priority is to its patients.

I'm not suggesting that all NHS services should be privatised just that they should be considered.

I agree. I would not advocate a blanket ideological policy for the NHS.  There are plenty of areas where private enterprise can help e.g. in many of the ancillary services.

[wigginhall]

I think one problem with selling various services to Virgin Care, and so on, is that the Cinderella services, such as geriatrics, mental health, long-term illness, are probably too complex to make a profit from.   So the private companies will want quick and easy treatments, from which they can make money.

This would be OK, if the other difficult stuff got equal amounts of money.   Well, it might, but there is the suspicion that they will be neglected more and more.   

So you end up with a 3-tier system - private health; private, within the NHS; and pure NHS, the latter being the equivalent of slum houses.

[L.A.]

I think one problem with selling various services to Virgin Care, and so on, is that the Cinderella services, such as geriatrics, mental health, long-term illness, are probably too complex to make a profit from.   So the private companies will want quick and easy treatments, from which they can make money.

This would be OK, if the other difficult stuff got equal amounts of money.   Well, it might, but there is the suspicion that they will be neglected more and more.   

So you end up with a 3-tier system - private health; private, within the NHS; and pure NHS, the latter being the equivalent of slum houses.

Well you could turn that argument round. Why not let private companies clear the straightforward cases. That takes an enormous burden off the NHS allowing the in-house teams to concentrate on the more difficult cases.

[jakswan]

With a private company, there is a third limiting factor: profit. A private company's first duty is to its shareholders. One would like to think that the NHS's first priority is to its patients.

The politicians sign the cheques and the NHS is used a political football.

I agree. I would not advocate a blanket ideological policy for the NHS.  There are plenty of areas where private enterprise can help e.g. in many of the ancillary services.

As I said last time I heard that 40% of front line services are provided by the private sector. GPs, Chemists, Dentists, Opticians are all largely in the private sector.

[jakswan]

So you end up with a 3-tier system - private health; private, within the NHS; and pure NHS, the latter being the equivalent of slum houses.

That is what we have now and the pure NHS isn't 'the equivalent of slum houses', you are refuted.

I do wish people would not try to score political points at the expense of effective healthcare. 

[wigginhall]

That is what we have now and the pure NHS isn't 'the equivalent of slum houses', you are refuted.

I do wish people would not try to score political points at the expense of effective healthcare.

Well, geriatrics, mental health and long-term illnesses are becoming the Cinderellas of the NHS.  For example, the report today shows that most people with mental health problems receive very little treatment.   Of course, Cameron will use plenty of rhetoric about changing this, but I doubt it.  And Virgin Care are probably not interested, no profit.

[Rhiannon]

The Priory Group do very nicely out of MH care, including out of the NHS - they provide beds for patients who need admitting and for whom no NHS bed can be found.

[wigginhall]

The Priory Group do very nicely out of MH care, including out of the NHS - they provide beds for patients who need admitting and for whom no NHS bed can be found.

There was a guy on TV whose son was very depressed, and he was given a strip of tablets and a couple of web-sites, at a surgery.   He went off and killed himself.   But I think all governments have neglected mental health, plus other areas of health.   Blair actually began the process of selling services to private firms.

[L.A.]

The Priory Group do very nicely out of MH care, including out of the NHS - they provide beds for patients who need admitting and for whom no NHS bed can be found.

They can do that only because the NHS has failed to provide those beds but it does give an indication of the problem. The NHS is an unmanageable monster. There are some areas that give world-class treatment and others that give third-world treatment. It's not surprising that successive governments have attempted major reorganisations because the overall structure is a mess and simply throwing money at the problem will not make things better.

Private companies are one way of taking some of the burden off the system and IF managed properly, could potentially shorten waiting times and reduce costs

[jakswan]

Well, geriatrics, mental health and long-term illnesses are becoming the Cinderellas of the NHS.  For example, the report today shows that most people with mental health problems receive very little treatment.   Of course, Cameron will use plenty of rhetoric about changing this, but I doubt it.  And Virgin Care are probably not interested, no profit.

I agree mental health has been neglected, don't see how that supports your claim.

The vast majority of NHS care I have consumed over the last ten years has been provided by the private sector, Boots the Chemist, Specsavers, my local GP & Dentist.

You think these would be more effective nationalised?

[Rhiannon]

There was a guy on TV whose son was very depressed, and he was given a strip of tablets and a couple of web-sites, at a surgery.   He went off and killed himself.   But I think all governments have neglected mental health, plus other areas of health.   Blair actually began the process of selling services to private firms.

This doesn't surprise me in the least. Not enough GPs are experienced or qualified enough in MH generally to be left to decide who needs acute care and who doesn't.

[L.A.]

I agree mental health has been neglected, don't see how that supports your claim.

The vast majority of NHS care I have consumed over the last ten years has been provided by the private sector, Boots the Chemist, Specsavers, my local GP & Dentist.

You think these would be more effective nationalised?

My wife used to work in mental health and she does not believe that the problem is purely money. While patient support groups were being cut, management was increasing and doing very nicely for themselves. (these were caring NHS staff not the evil private sector)

[wigginhall]

I agree mental health has been neglected, don't see how that supports your claim.

The vast majority of NHS care I have consumed over the last ten years has been provided by the private sector, Boots the Chemist, Specsavers, my local GP & Dentist.

You think these would be more effective nationalised?

Well, I'm saying that health is divided into easy stuff, done by private firms, and difficult stuff, e.g. geriatrics, mental health, which private firms will usually not touch (no profit).  This would be fine if money was allocated to each area equally, but in practice, the Cinderella areas are neglected, and you end up with crummy places, with low-paid staff,  for old people, and mad people, and long term care.   Or in fact, no places at all.

[jakswan]

Well, I'm saying that health is divided into easy stuff, done by private firms, and difficult stuff, e.g. geriatrics, mental health, which private firms will usually not touch (no profit).  This would be fine if money was allocated to each area equally, but in practice, the Cinderella areas are neglected, and you end up with crummy places, with low-paid staff,  for old people, and mad people, and long term care.   Or in fact, no places at all.

Im sure all Chemist, GPS, etc think they do easy stuff.