Nhs

[thefunkygibbons]

This is very scary. There are some things in life that should not be governed by the profit motive and health is one of them.

 

Really

 

Two huge areas of the NHS are profit focused, being run by self employed contractors

 

 

Ready?

 

GPs

 

Pharmacies

[Saint George]

See, this is the advantage of the NHS. Because of its buying power, it has managed to drive down the costs of the drugs it buys.

 

Drug companies do make profit but much of that is derived from 'over the counter' remedies. And a large amount of 'profit' is re-invested into research. As the partner of one who works in the industry, I can tell you that the cost of this research is huge due to the very strict demands of testing and the multi-million pounds' worth of equipment required.

 

Of course, some of the profit is used to support pressure groups who want the NHS to buy the novel drugs the companies are developing.

 

Really?

 

1000% increase over 2 years, sounds like fantastic buying power to me

 

"One company boss said the NHS ‘doesn’t care what it costs"

[bridge too far]

Really

 

Two huge areas of the NHS are profit focused, being run by self employed contractors

 

 

Ready?

 

GPs

 

Pharmacies

 

Since they're independent 'sub-contractors' they're not part of the NHS then, are they (to be pedantic). They are sub-contracted by the NHS to provide services in the same way as some cleaners, porters and caterers are (although in fact some GPs ARE directly employed by the NHS). The NHS itself doesn't profit from them or from their patients.

 

The proposals are for services to be commissioned by groups of GPs who will, in essence, set up as privately owned buyers. Some of the provided services may well be provided by private hospitals who are answerable to shareholders.

 

See where the profit on the back of ill health starts to come into focus?

 

Oh and some pharmacies are owned and run by the NHS.

[thefunkygibbons]

I have had a lot of dealings with the NHS over the years with children and true, the people who work in it are fantastic, but the system as a whole sucks

 

It has one speed and to my mind, it is similar to the planned economies of Eastern Europe and we know how well they worked

 

Sadly, if the government does allow in private eneterprise, they will make tons of money as the efficiences to be gained are huge ans as the DOH showed when it agreed the last Doctor's contract, they are poor at negotiating

[bridge too far]

I have had a lot of dealings with the NHS over the years with children and true, the people who work in it are fantastic, but the system as a whole sucks

 

It has one speed and to my mind, it is similar to the planned economies of Eastern Europe and we know how well they worked

 

Sadly, if the government does allow in private eneterprise, they will make tons of money as the efficiences to be gained are huge ans as the DOH showed when it agreed the last Doctor's contract, they are poor at negotiating

 

I don't understand what you mean by this?

[dune]

I have private health insurance and it really isn't that expensive. I would wager that most people would be better off with a private health care system and not paying taxes to fund the wasteful NHS.

[buctootim]

I have private health insurance and it really isn't that expensive. I would wager that most people would be better off with a private health care system and not paying taxes to fund the wasteful NHS.

 

lol. who do you think employs the consultants used by private healthcare most of the time? who trained them? which hospital, NHS or private do you think they would send you if you need anything more than an ingrowing toenail or boob job sorting out?

[dune]

lol. who do you think employs the consultants used by private healthcare most of the time? who trained them? which hospital, NHS or private do you think they would send you if you need anything more than an ingrowing toenail or boob job sorting out?

 

What's that got to do with the price of fish? I'm saying that paying into a competitive private heathcare market to receive medical care would be cheaper than paying tax to the government to fund a inefficient public sector dinosaur of a health service like we have.

[Thorpe-le-Saint]

What's that got to do with the price of fish? I'm saying that paying into a competitive private heathcare market to receive medical care would be cheaper than paying tax to the government to fund a inefficient public sector dinosaur of a health service like we have.

 

Some of us are unable to get private coverage even if we wanted too through no fault of our own: The NHS is all I have and I will need it for the rest of my life. I'm sure that in some peoples' mind I simply burden the public purse, but in the experiences I have had with the so-called 'dinosaur' it has been efficient, courteous and to an exceptional standard. Maybe I have been lucky with Hants and Essex PCTs, but I adore the NHS.

 

Anyway back to my summer holiday which I'm sure is undeserved!

[dune]

Some of us are unable to get private coverage even if we wanted too through no fault of our own: The NHS is all I have and I will need it for the rest of my life. I'm sure that in some peoples' mind I simply burden the public purse, but in the experiences I have had with the so-called 'dinosaur' it has been efficient, courteous and to an exceptional standard. Maybe I have been lucky with Hants and Essex PCTs, but I adore the NHS.

 

Anyway back to my summer holiday which I'm sure is undeserved!

 

Perhaps you're currently unable to get private health care, but if health care was made like using electricity everyone would have access to it. The fact remains that if health care was privatised it'd create competition (you'd have a regulator to ensure this) and efficiency and the public would get a better deal than throwing cash at the public sector NHS with it's made up multi tiered jobs and staff who've never been taken out of their plod along comfort zone.

[thefunkygibbons]

I don't understand what you mean by this?

 

It plods at its own pace

 

Look at Tesco, the staff change up when the queues lengthened

 

They are always looking for ways to improve for the benefits of the customer, whereas so many parts of the NHS work that way because that is how they have always worked

[St_Tel49]

BTF - even the most blinkered Labour supporter would have to acknowledge that the NHS is stuffed with inefficiency and levels of bureaucracy that contribute nothing to clinical outcomes. In other words not enough of the billions are ploughed into actual healthcare and too much is squandered on administrative layers who are little more than drones. And, it has to be said, the Tories were the first to start the whole gravy train. But Labour in their turn have only made it worst - measuring their success on how much money they put in rather than how it was actually used.(published figures don't mean a damn thing since they are easily manipulated, which is why performance targets are generally meaningless). I share your scepticism about the value that private company's bring - after all hospital cleanliness got far worse after cleaning contracts were privatised but if the financial targets imposed on the private company's are sufficiently rigorous, and if the cost of inefficiency is pushed on to them then they are generally better at generating cost savings especially by unnecessary layers of management. BTW - who ever thought that making nursing an all graduate profession would improve clinal care? The majority of graduates don't want to deal with bedpans and there was nothing wrong with the quality of nurses before.

[Thorpe-le-Saint]

Perhaps you're currently unable to get private health care, but if health care was made like using electricity everyone would have access to it. The fact remains that if health care was privatised it'd create competition (you'd have a regulator to ensure this) and efficiency and the public would get a better deal than throwing cash at the public sector NHS with it's made up multi tiered jobs and staff who've never been taken out of their plod along comfort zone.

 

Perhaps I could get health care under a system like that, but would I not then be 'punished' for having an illness that required a lot of treatment etc by having to pay a higher premium than everyone else?

[St_Tel49]

Perhaps you're currently unable to get private health care, but if health care was made like using electricity everyone would have access to it. The fact remains that if health care was privatised it'd create competition (you'd have a regulator to ensure this) and efficiency and the public would get a better deal than throwing cash at the public sector NHS with it's made up multi tiered jobs and staff who've never been taken out of their plod along comfort zone.

I was saw an interview in a US TV channel by a couple who had just returned from living in the UK. They complained that they had left a place where healthcare was free but poor and come back to a place where healthcare was very expensive and was still poor. The example of the US would provide little support for your argument.

[trousers]

BTF - even the most blinkered Labour supporter would have to acknowledge that the NHS is stuffed with inefficiency and levels of bureaucracy that contribute nothing to clinical outcomes. In other words not enough of the billions are ploughed into actual healthcare and too much is squandered on administrative layers who are little more than drones. And, it has to be said, the Tories were the first to start the whole gravy train. But Labour in their turn have only made it worst - measuring their success on how much money they put in rather than how it was actually used.(published figures don't mean a damn thing since they are easily manipulated, which is why performance targets are generally meaningless). I share your scepticism about the value that private company's bring - after all hospital cleanliness got far worse after cleaning contracts were privatised but if the financial targets imposed on the private company's are sufficiently rigorous, and if the cost of inefficiency is pushed on to them then they are generally better at generating cost savings especially by unnecessary layers of management. BTW - who ever thought that making nursing an all graduate profession would improve clinal care? The majority of graduates don't want to deal with bedpans and there was nothing wrong with the quality of nurses before.

 

top post

[dune]

Perhaps I could get health care under a system like that, but would I not then be 'punished' for having an illness that required a lot of treatment etc by having to pay a higher premium than everyone else?

 

No, you'd pay into a scheme throughout life.

[St_Tel49]

No, you'd pay into a scheme throughout life.

 

Surely that is what you are doing with your NI contributions? I'm afraid that with private health systems the weak go to the wall and you cannot dress that fact up. People of considerable means in the US have been bankrupted by getting cancer - that is in spite of having Health Insurance.

[buctootim]

What's that got to do with the price of fish? I'm saying that paying into a competitive private heathcare market to receive medical care would be cheaper than paying tax to the government to fund a inefficient public sector dinosaur of a health service like we have.

 

Dune there is nowhere in the world, seriously, that provides the standard of healthcare the UK does for the same proportion of GDP. The NHS is cheap and efficient for whay you get. Could you get a better healthcare system? Yes, but it would cost us more like the 17.8% of GDP the US pays rather than the 9.4% we pay. Our costs are still below the EU average, ie alongside Portugal and Poland rather than Germany and France.

[trousers]

Some of us remember only too well what happened when non-clinical services in the NHS were market-tested / outsourced. Dirty, poorly maintained hospitals and a huge rise in MRSA

 

Doesn't it depend how one analyses the reasons why these outsourcing "failed" though?

 

In other words, did they fail inspite of strong internal NHS management and stringent procurement processes OR did they fail (in part) because of weak internal NHS management and flimsy procurement processes?

 

The amount of time I hear my NHS employee relatives decrying the poor service they are getting from some of the outsourced services I say to them: "why doesn't someone activate the penalty clauses that would (surely) have been inserted into the contracts and haul them over the coals for the poor service?" to which the reply usually is that the contracts don't allow for such punitive action and give the upper hand to the supplier/contractor all the time.

 

So, yes, the outsourcing hasn't worked in places, but the reason for that isn't always simply a result of the fact it was outsourced per se, it can often be that it wasn't outsourced properley by the people running the system from within.

 

It would be a bit like me employing a nanny to look after my children and then blaming him/her after five years if my children turn out to be badly behaved as a result. No, that's my fault for employing a duff nanny in the first place and not putting in enough checks and balances to make sure she's doing her job properly.

[buctootim]

Doesn't it depend how one analyses the reasons why these outsourcing "failed" though?

 

In other words, did they fail inspite of strong internal NHS management and stringent procurement processes OR did they fail (in part) because of weak internal NHS management and flimsy procurement processes?

 

The amount of time I hear my NHS employee relatives decrying the poor service they are getting from some of the outsourced services I say to them: "why doesn't someone activate the penalty clauses that would (surely) have been inserted into the contracts and haul them over the coals for the poor service?" to which the reply usually is that the contracts don't allow for such punitive action and give the upper hand to the supplier/contractor all the time.

 

So, yes, the outsourcing hasn't worked in places, but the reason for that isn't always simply a result of the fact it was outsourced per se, it can often be that it wasn't outsourced properley by the people running the system from within.

 

It would be a bit like me employing a nanny to look after my children and then blaming him/her after five years if my children turn out to be badly behaved as a result. No, that's my fault for employing a duff nanny in the first place and not putting in enough checks and balances to make sure she's doing her job properly.

 

I used to do contracting in both the NHS and local authorities. I may be out of date now, but my experience was that the contracting process was stipulated by central government so that price was pretty much the ONLY thing that counted. Even the introduction of 'Best Value' didnt change that in practice. In Brighton the council officers knew before signing the contracts that the successful tender for the waste management contract (binmen / roadsweepers) was undeliverable at that price but had no power to award it instead to a credible bid. It took three years of constant penalty and default notices (huge amount of staff hours) and appalling public service before the contractor finally agreed to mutually dissolve (ie buy itself out of) the contract. But who got the blame - the local authority for being crap of course.

Edited 20 July, 2010 by buctootim

[St_Tel49]

I used to do contracting in both the NHS and local authorities. I may be out of date now, but my experience was that the contracting process was stipulated by central government so that price was pretty much the ONLY thing that counted. Even the introduction of 'Best Value' didnt change that in practice. In Brighton the council officers knew before signing the contracts that the successful tender for the waste management contract (binmen / roadsweepers) was undeliverable at that price but had no power to award it instead to a credible bid. It took three years of constant penalty and default notices (huge amount of staff hours) and appalling public service before the contractor finally agreed to mutually dissolve (ie buy itself out of) the contract. But who got the blame - the local authority for being crap of course.

Yes - the problem was that the Tories specified value for money with an implicit definition of "Cheap and nasty" or maybe just plain "Cheap" - the nasty was a natural consequence. I also work for a company that does work for the Govmt. Contracts have to be fair - the company must make a sensible profit but it, in its turn, must deliver what is asked for. It can be done but has to be well managed on both sides with a sensible amount of good will on both sides.

[St_Tel49]

Doesn't it depend how one analyses the reasons why these outsourcing "failed" though?

 

In other words, did they fail inspite of strong internal NHS management and stringent procurement processes OR did they fail (in part) because of weak internal NHS management and flimsy procurement processes?

 

The amount of time I hear my NHS employee relatives decrying the poor service they are getting from some of the outsourced services I say to them: "why doesn't someone activate the penalty clauses that would (surely) have been inserted into the contracts and haul them over the coals for the poor service?" to which the reply usually is that the contracts don't allow for such punitive action and give the upper hand to the supplier/contractor all the time.

 

So, yes, the outsourcing hasn't worked in places, but the reason for that isn't always simply a result of the fact it was outsourced per se, it can often be that it wasn't outsourced properley by the people running the system from within.

 

It would be a bit like me employing a nanny to look after my children and then blaming him/her after five years if my children turn out to be badly behaved as a result. No, that's my fault for employing a duff nanny in the first place and not putting in enough checks and balances to make sure she's doing her job properly.

Precisely - just what were the NHS Managers doing to justify their exceedingly generous salaries if they were allowing Service Providers to deliver such poor service.

[EastleighSoulBoy]

No, you'd pay into a scheme throughout life.

 

Whole life, from birth?

 

If so then parents would be responsible. Fair enough.

 

What about a baby born with an illness and nobody has, so far, paid the baby's health care?

 

Would anybody with costly long term illnesses be expected to pay the same as others or more?

 

What about children who are then orphaned or their parent, through no fault of their own, loses a job or becomes ill and incapable of working again?

 

At the moment we can all choose to pay extra for health cover (many don't I can see) although they can't then choose to not pay into the NHS.

Edited 20 July, 2010 by EastleighSoulBoy

[bridge too far]

Precisely - just what were the NHS Managers doing to justify their exceedingly generous salaries if they were allowing Service Providers to deliver such poor service.

 

As someone else above has said, when market testing first came into being (in about 1991 IIRC), contracts were awarded to the company offering the lowest price. More recently a number of criteria are used to judge bids. Bidders have to complete comprehensive questionnaires (called PQQs) before they even get invited to tender. Tenders are then judged on price, time and quality.

 

Resultant contracts nowadays have penalty clauses (dependant on the type of contract) but the biggest problem that the public sector has is a lack of resources to monitor the contractor's performance. Monitoring is usually carried out by someone as an addition to their normal job. Many contracts these days are 'self-monitoring', relying on the contractor to produce data on a regular basis to demonstrate that the terms of the contract are being adhered to. But this still requires someone to check the self-monitoring report.

 

For example, with a PFI hard and soft FM element, KPIs will include, for example, response times to reported faults or need for a cleaner. So calls have to be logged, acted upon and then checked to see what the response time was. But also, in a hospital, consideration has to be given to whether, for example, having an operating theatre out of use impacts on the business of the hospital. If it does, then penalty points and fines are imposed. As you can imagine, this requires someone working for the hospital to check and monitor the whole procedure. It really is very time consuming, particularly when it's an add-on to someone's 'normal' work.

 

But penalty clauses ARE invoked and, in my view and experience, contractors are less likely and able to pull the wool over the customer's eyes.

 

One of the biggest offenders is the large scale building contractor. I had a friend who worked for one of these. He told me that his company used to make more 'profit' out of legal challenges to contracts than in the contract itself (by things such as delay events)!

[Thorpe-le-Saint]

No, you'd pay into a scheme throughout life.

 

What I mean is, a 'healthy' person would pay £x and I would end up paying £y because surely I would 'cost' more? If this is not the case then why are we even discussing the current system?

[bridge too far]

What I mean is, a 'healthy' person would pay £x and I would end up paying £y because surely I would 'cost' more? If this is not the case then why are we even discussing the current system?

 

And there's lots of stuff not covered by private health insurance.

 

Certainly when my dad had his stroke, his private insurance didn't cover any of his treatment.

 

And private insurance doesn't cover trauma, so if someone had, say, a car accident, they wouldn't be treated by a private hospital.

[dune]

And there's lots of stuff not covered by private health insurance.

 

Certainly when my dad had his stroke, his private insurance didn't cover any of his treatment.

 

And private insurance doesn't cover trauma, so if someone had, say, a car accident, they wouldn't be treated by a private hospital.

 

It's still nice to know that if i need an operation i won't need to sit on a long waiting list or share a ward with the great unwashed.

[AndyNorthernSaints]

It's still nice to know that if i need an operation i won't need to sit on a long waiting list or share a ward with the great unwashed.

 

Stanley please FOAD.

[trousers]

Stanley please FOAD.

 

Privately or on the NHS?

[Lord Duckhunter]

I think the whole NHS needs a revolution which only the Labour party will be allowed to deliver, unforutunatly they have not got the will to do so and therefore it'll just go along stumbling from crisis to crisis, from top down target to top down target. For a "free at the point of delivery" service it is fantastic , howver you pay for what you get. There's always going to be strains on the service and problems with it. I've laways beleived the more people that use private health care, the less strain and more money available for everyone else. Firms should be encouraged to offer private provision to work alongside the NHS. People have Company pensions and a work pension. Insurance should be offered to cover certain treatments and Doctors visits. In Ireland, if you're not entittled to a medical card (which is held by the elderly and the poorest 30% approx) then you have to pay for certain things, GP's visit ect. My friends wfe works in a supermarket, the company pay for her to have 6 visits a year under an insurance scheme (not sure if she has to contribute). Surely this is the most sensible way to go. As I pay into my Company pension, my emplyer makes a contribution, we could extend this (through a seris of incentives) so that a similar insurance scheme could help fund some of my NHS treatment.

 

I find it bizzare that we have ab obsession with free visits to the GP's and yet when prescribed a remedy, go next door to the Chemist and hand over £6 ish. Thta's hardly "Free at the point of delivery". Most prescriptions I've ever had could have been prescribed by the pharacist (as in many foregin countries) further freeing up GP's time and finances.

 

Sex changes, Boob jobs and other such treatments should not be funded out of general taxation. People who can afford it should be encouraged to take out private provision, emploees should be encouraged to offer it and provided Govt funding is not cut in line with the number opting out we may get a better service for the people who really need it.