The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland.
PFI was all about the Labour government wanting to hide capital spending which would have needed to come from additional borrowings. So a large part of increased NHS costs is the result of moving the debt for building hospitals from general taxation to the Health Service budget that now has to repay the mortgage. Labour's objective was to avoid showing any increase in public expenditure. The fact that it is cheaper for the government to borrow money in the market than for hospitals to borrow from the City was simply ignored for political ends. Labour handed the city and leading contractors a gravy train and easy money with little risk. It's tax payers who are paying the price and the NHS which is suffering.
Sounds like an argument for nationalising all PFI hospitals. The gravy train has run long enough. I note that the Tories have recently signed a new PFI agreement for a hospital in Liverpool. They are all in it together.
In terms of what the public sector provides and what the private sector provides, the reality is that they do different things well. A&E, and state of the art facilities for surgeons to use, is bound to be best done through public services. The wide range of ancillary services are best done by whatever system works, I don't think it should be a political matter and if cherry picking means public money paying for private services they do better, so what? The fear of the profit motive in the private sector, for me, is balanced by the absence of accountability in the public sector. And I am suspicious that the most noise against the private sector is from public sector workers and unions claiming to want to protect our interests when, in reality, it is all about protecting their own interests.
The trouble here is that in order for things like A&E and the state of the art facilities to work, they need a big enough income stream. Cherrypicking means taking the easy operations and leaving the state to do the difficult (and thus more expensive) operations. Time and again contracts are let for certain kinds of operations and the private sector duck out of the difficult stuff, meaning the average cost of those operations goes up on the NHS while the contract has been priced based on the private company doing all, they just do the easy 90%, making their profit from avoiding the expensive stuff. The analogy with the railways is actually quite a good one - they're run for private profit until something goes wrong and the state steps in, bailing them out as it is really a service that is too important to be left to the market. Actually that analogy is true of almost all privatised industries (water, power) and some that never were before, like banking.
I agree it is a political football - it would be in the Tories' interests (and most patients') to depoliticise it; unfortunately like politicians everywhere they cannot stop meddling, hence their enormous reorganisation you blamed on Labour earlier. I suspect most people working in the NHS also will not trust the Tories after their promise of "no top down reorganisation" proved to be as big a fib as Clegg on tuition fees. You are right to say that unions will want to protect their own interests. So do management consultants (who always recommend a course of action that includes more management consultants, supervising privatisation). So do private companies - they ditch anything where they don't see a profit and have politicians paid off to make sure this is politically acceptable.
I see so many people complaining about the railways, and they are almost all in private hands, what makes folks think the NHS will be any better if it was taken out of the public domain? Even on this thread a part of the service that is privatised already has come in for criticism.
The problem with the railways is that they aren't really privatised in the truest sense of the word. First of all, the railways are still nationalised, it's the train franchises that are run privately, and when a train franchise goes tits-up, it is bailed out by the Government and so cannot truly fail. There is literally no incentive for train companies to be either run competitively (e.g. to lower ticket prices in order to compete for passengers) or efficiently (since any and all losses are underwritten by the Government).
With healthcare, it is slightly different if you're lucky enough to be able to go private because you're able to shop around for better care - failing private health providers will exit the market as the more successful ones take their custom, and if you are unable to afford private health cover the Government provides a comprehensive taxpayer-funded healthcare plan that is, yes, worse quality than one people pay for. Of course some private health providers are also pretty terrible but are allowed to fail and exit the market.
As far as I can see, no one is arguing for the full privatisation of the NHS or do not support health services remaining free at the point of use for everyone. What a lot of people agree with, however, is the idea that the government and politicians continuously meddling in the NHS has only led to cock-ups, tragedy and disaster.
A failing train company gets you to Euston late, so might a failing health service provider get you to the cemetery early?
I do get what you are saying about government. But you seem to be talking about a partially privatised health service, which would appear to be no different to the partially privatised railway? If Lewisham hospital goes tits up under Greedyinvestor Healthcare Ltd would the patients be wheeled into the street and tipped out of their beds, or would the government step in and save the day, like they do with the railways?
PFI was all about the Labour government wanting to hide capital spending which would have needed to come from additional borrowings. So a large part of increased NHS costs is the result of moving the debt for building hospitals from general taxation to the Health Service budget that now has to repay the mortgage. Labour's objective was to avoid showing any increase in public expenditure. The fact that it is cheaper for the government to borrow money in the market than for hospitals to borrow from the City was simply ignored for political ends. Labour handed the city and leading contractors a gravy train and easy money with little risk. It's tax payers who are paying the price and the NHS which is suffering.
The NHS has become a political football where NHS principles are second to the posturing of politicians and public sector workers. I think Jeremy Hunt is doing his best too make positive changes given the crap he has been handed.
In terms of what the public sector provides and what the private sector provides, the reality is that they do different things well. A&E, and state of the art facilities for surgeons to use, is bound to be best done through public services. The wide range of ancillary services are best done by whatever system works, I don't think it should be a political matter and if cherry picking means public money paying for private services they do better, so what? The fear of the profit motive in the private sector, for me, is balanced by the absence of accountability in the public sector. And I am suspicious that the most noise against the private sector is from public sector workers and unions claiming to want to protect our interests when, in reality, it is all about protecting their own interests.
And a private hospital would be telling us it's all about the patient when, in reality, it's all about making the investors a profit.
"Sounds like an argument for nationalising all PFI hospitals". PFI is a financial arrangement concerning the building and it's maintenance being provided through private services. It's happened, you can't nationalise it, unless you mean you stop paying the mortgage and have the financiers foreclose. And the public sector is free to take over the services if it wants to tender and gets appointed by the NHS.
PFI was a Tory idea that Labour pinched, blaming Labour for implementing it, so not intending to suggest we trust politicians of any particular persuasion.
PFI contractors can't ditch anything they don't see a profit in because the contract ties them in and there are penalty clauses. More the truth that the NHS managers weren't capable of arranging a contract that diid what was needed and rather than admit their own incompetence, blame the contractors when stuff doesn't get done that wasn't in the contract,.
For those who seem to know how the NHS is going to be privatised, I suspect there is some confusion between the State paying money to the NHS and the State paying money to a private health care organisation. The cherry picking would be by the State, not the private providers, in deciding what they could undertake on behalf of the NHS. Greatest danger is the proven inability of public sector officers to negotiate an effective contract for bulk buying tea and biscuits, let alone a computer system or services for operations.
No one would accept the scenario where the State says we are going to stop the NHS doing simple operations and we are going to ask the private sector to take over so that people have to pay up front for an operation. To suggest that is making up a fairy story for the sake of having a big bad ogre. If the private sector proves it can take over some procedures at a price that is lower than the State pays through the NHS, what is the problem? GP's as self employed private sector professionals are already paid by the NHS to do what the NHS needs, presumably, in principle, we should nationalise GPs.
If a private sector service that is of national importance, but the State can't run properly, goes bust then the State steps in. Don't see a problem there, the money to bale out a private sector business would be less than continuously baling out a nationalised industry bleeding money. That's why the stuff was privatised.
Nothing wrong in protecting your own interests, that's what companies do, and it's pretty transparent that's how they work. The public sector on the other hand only ever claims to be taking action to protect my interests when patently it is only interested in protecting what it holds, regardless of my interests.
Only the public sector use management consultants and are able to pay them the fees they think they deserve. A private sector company doesn't need them as much because it makes its own decisions. The public sector, not used to being accountable, uses committees and sub-committed to avoid any individual taking responsibility for a decision, but for big ones they get management consultants to tell them what to do. Invariably it goes pear shaped because management consultants know jack shit about the real world, let alone hospitals, so why are they employed?
Don't know the numbers but would not be surprised if the NHS spends as much on private services as on their own staff. So just very confused by the "let's get the private sector out of the NHS" rallying cry. Seems it cannot survive without private sector services simply because it's incapable of managing resources, be it staff or buildings.
PS Very happy about the ranking of the UK health care, but the report, as I recall, did make us 10th out of 11 for stopping people from dying who didn't need to.
I've worked for and been a long term patient of the NHS. I have nothing but admiration for the service, warts, scars, blemishes and all. It does a terrific job and 99.9% of the workforce are fantastic and devoted to their jobs, the patients and the service. The administration may be bloated and over-manned. However. My theory is that in a time where the universities and colleges of this country are turning out thousand upon thousand of talented young people with degrees, high expectations and a paucity of good jobs, the 'public sector' by taking up the slack, can employ, career-educate and give experience to many of these young people in bureaucratic and administrative/ management roles, in the expectation that in future, they will transfer their skills into the profit making private sector. In the future, the question is, how will the NHS be funded ? .. Longer life expectations, more available and better yet more expensive treatments and drugs, more staff costs, more pressure from an expanding population etc etc .. we all know the background. For my part, I see a degree of increased privatisation as inevitable. In my area alone North (East) Lincolnshire/East Yorkshire, for example in Hull, private enterprise has built and equipped absolutely first rate cancer, maternity and heart care facilities. In Grimsby, MacMillan provide a superb cancer care and chemotherapy wing at the local general hospital. All these facilities are staffed by NHS workers, all do a fantastic job, much better than the outdated buildings and equipment that preceded them. None would exist without the 'profit motive' inherent in the PFI structure. Ask yourself this : is money going to outside shareholders as dividends and to private companies as profit any less well spent than on NHS managers and contractors being paid to manage and continually patch up outdated and outmoded facilities where staff and patients alike are depressed and demoralised by having to use buildings and equipment that are years past their use and sell by dates ? If taxation alone is to fund the NHS in the future then we will all have to dig deep and possibly cut back on our private individual spending to find the revenue. Yes, I know the arguments about spending on nuclear weapons, foreign aid, the arts council and all the other pressures on the treasury handouts, but we are where we are. We all know that the NHS will NEVER EVER become a totally privatised organisation, it is far too big and essential as an icon of British society for that. However, for my part, organisations that are willing to support the NHS for profit, within reason, are welcome. The key words are of course 'reasonable profit'. One man's profit is another man's theft.
I don't understand why 90% of NHS services shut between 5pm Friday and 8am Monday. The only sector which has any reason to close between these times is the financial sector and that is only by mutual consent. I'm not a doctor but I'm pretty sure cancer doesn't take the weekend off.
Purely down to money. Many departments are effectively 9 - 5 mon to fri and if they were to change to the 24/7 scenario advocated by you comment it would need a huge increase in staffing and all the associated costs. Would you be prepared for a big hike in taxes to provide this ?
The NHS is far from perfect but outside of A & E and the work it generates there are very few procedures that are true emergencies that cannot wait 48 hours. If someone does need emergency treatment then it will happen.
I don't understand why 90% of NHS services shut between 5pm Friday and 8am Monday. The only sector which has any reason to close between these times is the financial sector and that is only by mutual consent. I'm not a doctor but I'm pretty sure cancer term or usual workload' doesn't take the weekend off.
Purely down to money. Many departments are effectively 9 - 5 mon to fri and if they were to change to the 24/7 scenario advocated by you comment it would need a huge increase in staffing and all the associated costs. Would you be prepared for a big hike in taxes to provide this ?
The NHS is far from perfect but outside of A & E and the work it generates there are very few procedures that are true emergencies that cannot wait 48 hours. If someone does need emergency treatment then it will happen.
Locally, i.e. Northern Lincs & Goole NHS Fndtn Trust, there are agreements in place for some non clinical staff to work shifts. 'Non emergency/routine' XRay/CAT/MRI scans are regularly carried out until 21.00 Monday to Friday and until 16.00 on Sundays .. pathology and associated services have also extended their working hours. I am told that the changes are to cover 'short term work overloads' and originally were covered by overtime. As 'short term' seemed to morph into 'long term or normal workload', shift patterns have been developed to cover this development. As staff are needed to cover A&E/Emergency Admission XRays and tests, rather like Tesco or ASDA, management have rationalised that as staff are on site and as expensive equipment should be in use as much as possible, why not use the staff/time/machinery for 'everyday' work. I am also told that the CAT and MRI scanners are hired by local private Hospitals and clinics. A case perhaps of BUPA (or whatever the name is nowadays .. Spire, Sphere?) paying the NHS rather than the other way round
By way of an example. I work in radiotherapy. It is a nine till five service Monday to Friday but staff are contracted to work between eight and eight when the patient workload requires it. That leaves the weekend unmanned apart from an on call service for radiological emergencies.
To have the weekends worked would require many more staff. Radiographers, doctors, physicists, nurses, engineers. A significant investment in staff without thinking about increased capital costs as expensive linear accelerators wear out more quickly.
By way of an example. I work in radiotherapy. It is a nine till five service Monday to Friday but staff are contracted to work between eight and eight when the patient workload requires it. That leaves the weekend unmanned apart from an on call service for radiological emergencies.
To have the weekends worked would require many more staff. Radiographers, doctors, physicists, nurses, engineers. A significant investment in staff without thinking about increased capital costs as expensive linear accelerators wear out more quickly.
It really is not an easy equation.
agreed.. this could well be the work pattern I was writing about, except for Sundays .. it could well be agency staff working the worst hours
Having worked in two NHS (PCT) establishments in the last 8 years they are without doubt the worst managers of their assets i have witnessed. Their mismanagement of funds is almost criminal---this impacts the outstanding front line services that the NHS often gives.
my own examples:
A lone PCT didnt even know how many buildings it was responsible for . they said 14 -- it was 17. They hadnt charged the doctors surgeries (who occupied these premises) for years (M+E,rent,utilities, cleaning etc). I stopped counting at £500,000 --yep half a million quid that the Drs should have paid into the PCT. i showed the Trusts CEO who in turn brought their lawyers in ---fecking disgraceful. I assembled the Property Terrier for this PCT and all the assets that they had within them documented---it was to go onto a computer system ---they were paying me alot of money and i made the point an admin assistant at a fraction of the cost could now do it ---they ignored me so i sat the for another month and did it.
A recent assignment was to undertake an M+E project for a huge hospital. They had the biggest back room project management team i have ever seen. There was Operations (projects) ---Non Capital Projects--and Capital Projects . all with at least 6 project managers. In my room 4 of them were actually employees of MACE ---feck knows what they would by charging the NHS for that. It was a total joke and i left after one month
They above are two separate PCTs (or whatever they are called today).
Then there is the huge problem of PFI--we have spoken of it on this board before--it is costing the NHS billions of pounds-----both Tory and labour supported it and used it. When the prees point out it costs £30 to change a light bulb at hospital XYZ --yes it does!!!! because the company that built the hospital , financed the build , own the maintenance contract on that building for 30 years and wrote what is in the contract and whats not !! Huge amount of what are business as usual jobs within maintenance are not in the contracts for they are charged as EXTRAS. The trusts cant buy the contracts back because they would be charged 100z of millions. In some cases the final builds do not conform to regulations, but time constraints mean they are used anyway which in turn mean the contractor has a get out as they can now say the Trust didnt allow them time to de-snag the buildings ---not their fault but they will address but charge for it !!
my betting is the NHS in Wales fell for the PFI bollox just after devolution ---"came and see what a great NHS we have in Wales now we are free from Westminster"-----------------then the bills started coming in-----the additions to the contracts and oppps we have no more money.
PFI and support services overspend / inefficiency IMO (and having seen it) huge reasons the NHS is struggling.
Anyone stupid enough to think that privatisation of the NHS will lead to an improved service are living in a fantasy world. Many of the problems that exist are due to half-arsed ideas from the private sector that don't work and the dreadful PFI funding. Politicians from all parties favour privatisation by the back door in return for backhanders and consultancies from private healthcare firms. We're hurtling towards an American model which will be more expensive, wasteful and exclude large sectors of the population. None of the main political parties have any interest in addressing the existing problems with the NHS - handing healthcare to the private sector will just lead to a more expensive and limited service. Politicians won't take responsibility for the problems they helped to create - too spineless and vindictive.
To clarify my earlier post; I am not against private involvement in health care, in fact I think as partnership this can work well ( I am not taking about PFI )
My main problem is the style which I have seen of contracts being tendered for clinical services. Often these are for three year periods which allows for very little stability as everything is geared around getting the next contract. Sometimes services can change hands every three years. One mate of mine has been in three different Services that have been taken over and it is never a positive experience for him or the patients.
Another issue is the manner in which the performance of these services are measured. Very often targets are focussed on narrow areas . So you get a service which rushes to meet and record these but does not focus as much on other areas.
I think that if this trend continues that the temptation would then be to hand over all of the NHS and we end in a situation whereby the Government simply tended out all services. The step from there to us all having Health Insurance would be logical and too tempting.
Unfortunatly this would impact on the service being national and regional variations would become even more marked. That is why you always get more GPs in richer areas and it is difficult to get them to work in Poorer areas.
I also do not have faith in our very limited private health providers to be able to provide adequate services or to do so in a cost effective way. Private does not always equal best and certainly not cheapest.
Personally I think that the changes in management and organisation I have seen need to continue. However we, as a nation should commit to the NHS and fund it properly. That is about choosing where we spend our tax money and raising more if it is need be.
If we continue on the current path our NHS will die a death of a thousand, well intentioned, tenders.
If people could explain what they actually mean by "privatisation of the NHS" before condemning it as an idea of stupid people, it would be really useful. There is a vast difference in abandoning the NHS and replacing it by US style private health insurance which is proven to not work, and allowing NHS resources to be targeted to best use. Think about what some are implying:
1. Only hospitals built by NHS staff, bricklayers and plasterers and owned and managed by the NHS would be available. 2. All contracts with doctors with private practices would be terminated and replaced by new doctors recruited from somewhere that has spare doctors. 4. All agency nurse contracts would be terminated and only NHS trained nurses would be employed 5. The NHS has to manufacture its own materials such as beds, sheets, thermometers, toilet paper etc. 6. No shops should be allowed to open up in hospitals, the NHS will move into retail distribution. 7. No cash machines, the NHS will set up its own bank. 8. NHS will build its own hospitals and recruit the steel erectors and plasterers direct. 9. Grass will only be cut by NHS employees. 10. Car parking contracts will be terminated and NHS will build and manage car parks and issue fines themselves. 11. Etc. etc etc.......
The reason many contracts don't work well is down to the contract terms agreed between a street wise corporate and an ill-informed, poorly led NHS consumer. The principle is OK but, as IAgree implies, the NHS like measuring what can be measured on a computer instead of intelligent, objective assessment of results.
The same people do the jobs whether it's a public sector service or becomes out-sourced, these companies don't have an army of staff waiting to step into the new jobs. Blaming the private sector for all its problems is passing the buck.
It all comes down to management, and public sector management is woeful. The same failed managers in one authority after being sacked for incompetence, with a massive pay out and early pension rights, just breeze into another job with another authority. Its a closed shop of mediocrity. You don't get real managers because the structure doesn't allow real management, that's why everyone keeps coming to the conclusion that a top down restructuring is required. Will not happen because there is no will to make it happen within the NHS itself, too many turkeys to vote for Xmas from the very top to the very bottom.
What I don't understand if how completely cack-handed the NHS IT systems are*. It's possibly the one system in this country you want to have all your personal information (such as address, next-of-kin, date of birth, medical history etc.) yet in my recent experience, I have had to visit 4 separate NHS facilities across 2 trusts and every time I have to give them various details that they should already have (this isn't identity verification because they are typing down what I say to them and checking for spelling). This normally takes 5-10 minutes every time. This might not sound so bad but these visits have been in relation to a broken leg so having to stand there like a mug repeating myself, aggravating the injury I'm there to have treated in the first place isn't exactly helpful, especially when the receptionists seem to be made up entirely of near-sighted old crones who can barely use a keyboard and mouse and seem completely bored by their jobs.
Yet if I bought something on finance 10 years ago, 40 different PPI legal firms seem to know my name, address, all my phone numbers, shoe size, blood type and dog's middle name. Says it all really.
* - Actually, I do understand, the Labour government paid umpteen billion pounds to a firm that was in over its head with the scale of the NHS IT system and decided to cover up how bad a fuck-up it was instead of admitting they'd made a catastrophic error.
If people could explain what they actually mean by "privatisation of the NHS" before condemning it as an idea of stupid people, it would be really useful. There is a vast difference in abandoning the NHS and replacing it by US style private health insurance which is proven to not work, and allowing NHS resources to be targeted to best use. Think about what some are implying:
1. Only hospitals built by NHS staff, bricklayers and plasterers and owned and managed by the NHS would be available. 2. All contracts with doctors with private practices would be terminated and replaced by new doctors recruited from somewhere that has spare doctors. 4. All agency nurse contracts would be terminated and only NHS trained nurses would be employed 5. The NHS has to manufacture its own materials such as beds, sheets, thermometers, toilet paper etc. 6. No shops should be allowed to open up in hospitals, the NHS will move into retail distribution. 7. No cash machines, the NHS will set up its own bank. 8. NHS will build its own hospitals and recruit the steel erectors and plasterers direct. 9. Grass will only be cut by NHS employees. 10. Car parking contracts will be terminated and NHS will build and manage car parks and issue fines themselves. 11. Etc. etc etc.......
The reason many contracts don't work well is down to the contract terms agreed between a street wise corporate and an ill-informed, poorly led NHS consumer. The principle is OK but, as IAgree implies, the NHS like measuring what can be measured on a computer instead of intelligent, objective assessment of results.
The same people do the jobs whether it's a public sector service or becomes out-sourced, these companies don't have an army of staff waiting to step into the new jobs. Blaming the private sector for all its problems is passing the buck.
It all comes down to management, and public sector management is woeful. The same failed managers in one authority after being sacked for incompetence, with a massive pay out and early pension rights, just breeze into another job with another authority. Its a closed shop of mediocrity. You don't get real managers because the structure doesn't allow real management, that's why everyone keeps coming to the conclusion that a top down restructuring is required. Will not happen because there is no will to make it happen within the NHS itself, too many turkeys to vote for Xmas from the very top to the very bottom.
I should have known the moment I first saw a man who wasn't wearing an NHS uniform mowing the grass it was privatisation by the back door!
All the Tories are allowed to do is throw money at the NHS, not try to improve outcome through changes etc, it is going to have to be Labour that make the necessary changes, and I hope they have the bottle to do it.
The issue with the NHS is people won't care if you poured £5 billion into a furnace in an NHS hospital (And in some cases you might as well), as long as that £5 billion goes to the NHS, they will be happy. Spending can only go up in the NHS, the focus is far too much on what is spent, and not enough on the quality of outcome. That is largely due to sentimentality people have in my opinion, they will proclaim that the NHS is fantastic because of how they treated their dear old mum, and then dismiss a story which states the complete opposite.
Regarding the PFI contracts, for what its worth I have read a few and it is quite plain to see how the government were getting shafted from day 1.
For example, on paper it looks like Queen Mary (I think it was) in Sidcup has the worst rodent problem in the UK when you look at the figures, purely because a pest controller visited twice a day.
There were no rodents at all in the hospital or the surrounding area, they were just contractually obliged to call someone out twice per day.
The PFI contracts effectively privatised all of the revenue raising areas of the hospitals, so, car parks, shops etc, meaning that the hospitals had no hope of raising revenue, and many started each new financial year in debt before they had even started running.
PFI was created PURELY in my opinion to hide capital expenditure, to cook the books as if it were, why pay £500 million for a hospital, when you can pay £50 million a year (for 30 years), although of course the public sector had a terrible record of delivering projects a) on budget and b) on time. The idea was supposed to be that private companies could borrow at the government rate as they would guarantee the projects, and then they would lease the hospitals back, however the servicing contracts built into PFI deals completely robbed them.
Effectively as some have said on here, it was exceptionally savvy lawyers who knew about the kind of contracts they were writing (as they had written them in private sector deals) who were going to the government who had next to no experience. The government didn't hire good enough lawyers, and as a consequence got completely screwed.
The thing is, PFI could actually be a fantastic idea, it is just that the clauses in the contract are onerous, for example, if you wanted to reduce pest control to once a week rather than twice a day, you would pay through the nose for the privilege, meaning there's not much point in doing it, but if these contracts had been written fairly, we could have done a lot better. As it is it would have been better if the government had just built the hospitals in the first place.
If people could explain what they actually mean by "privatisation of the NHS" before condemning it as an idea of stupid people, it would be really useful. There is a vast difference in abandoning the NHS and replacing it by US style private health insurance which is proven to not work, and allowing NHS resources to be targeted to best use. Think about what some are implying:
1. Only hospitals built by NHS staff, bricklayers and plasterers and owned and managed by the NHS would be available. 2. All contracts with doctors with private practices would be terminated and replaced by new doctors recruited from somewhere that has spare doctors. 4. All agency nurse contracts would be terminated and only NHS trained nurses would be employed 5. The NHS has to manufacture its own materials such as beds, sheets, thermometers, toilet paper etc. 6. No shops should be allowed to open up in hospitals, the NHS will move into retail distribution. 7. No cash machines, the NHS will set up its own bank. 8. NHS will build its own hospitals and recruit the steel erectors and plasterers direct. 9. Grass will only be cut by NHS employees. 10. Car parking contracts will be terminated and NHS will build and manage car parks and issue fines themselves. 11. Etc. etc etc.......
I see number 1 was so good you used it twice. I think a reasonable person wouldn't argue with any of those as you have phrased them, but personally I think the NHS should control what other work its employees do (no 2 -most employers expect you to just work for them if it is a well paid job) and should cut down on expensive agency nurses (4). All the ancillary services you mention don't include the most important, cleaning. Since this has been privatised, standards have plummeted and so have the real wages of the workers. Some hospitals are now taking it back in house because of the incompetence of the private sector. Cleaning is labour intensive - the only costs you can cut to make profits are peoples' wages. So what used to be a job that could pay its way now becomes one that requires tax credits - the taxpayer subsidises the company paying such low wages. Where three people would clean a ward now one cleans two. This is the private sector's innovation: fewer workers, paid less. (I don't think it is inevitably so, but in something like cleaning it is).
The same people do the jobs whether it's a public sector service or becomes out-sourced, these companies don't have an army of staff waiting to step into the new jobs. Blaming the private sector for all its problems is passing the buck.
It all comes down to management, and public sector management is woeful. The same failed managers in one authority after being sacked for incompetence, with a massive pay out and early pension rights, just breeze into another job with another authority. Its a closed shop of mediocrity. You don't get real managers because the structure doesn't allow real management, that's why everyone keeps coming to the conclusion that a top down restructuring is required. Will not happen because there is no will to make it happen within the NHS itself, too many turkeys to vote for Xmas from the very top to the very bottom.
I've worked for private and public sector management. I'd be hard pressed to put a fag-paper between them for incompetence and short-termism, though I was managed far more when i was in the public sector. Since then I've regularly had managers I've never met, watched colleagues be forced out, legally or illegally, with no idea from management as to what they even did, let alone how to cover their work. I get it, you don't like the public sector. I don't think it has a monopoly on incompetence at all. And with the arguable exception of BT, I cannot think of a private company that delivers a better service than before it was privatised. Do you want to try? Are you harking back for the days of Connex Southeastern? Does the French state electricity provider get you excited? Does Thames Water do anything apart from collect ever-increasing water bills while regularly dumping raw sewage in the Thames and begging the govt to pay its capital costs?
If it is the same people doing it, what on earth could it be? Perhaps the management are ignoring things like customer service because they want to make more profit. I don't know. I regularly watch my management do things like close a money-making section to subsidise a loss-making one. (And no, that didn't make sense to me either).
I'd tend to agree that outcomes should be the focus for any contract. Unfortunately, this has been tried elsewhere to lots of special pleading from the likes of rail franchises, who bid on outcomes they never deliver for amounts they claim they will pay the Treasury that magically turn into subsidies once the ink is dry on the contract.
On PFI, what I find totally bizarre is that the govt now owns some of these through nationalised banks. Why not just cancel them?
One added point is that you can't use FOI requests to find out what the b******s are up to unlike a public NHS. Companties become exempt from disclosure, wakey wakey folks, the jewel may be looking a tad tarnished but it's still our greatest accomplishment and is still envied the world over. I will fight to the death to save what I can but Cameron is determined to arrange my expiry date a bit earlier than I had anticipated.
Its the Trusts that OWN the PFI contracts thats the point its not the governments. It was done to raise capital and naff all consideration was done to the content of the contracts or the length buy out clauses. All the NHS wanted was they were geting new wards / hospitals. The people have long gone who signed these contracts. Buy out ? thats loss of profit etc and penalty clauses----billions at the very least 100z of millions of pounds.
As NI/Scotland and Wales now run their own NHS you cant blame the Westminster government for their collapse ------the SNP+ Labour repeated that lie a million times a month ago. They have the devolved power.
Sorry, NHS trusts are an arm of the govt. A contract isn't owned, it has 2 parties. It can be cancelled if both are agreeable. So why can't those that are owned by the govt be cancelled? Normally, I would expect that the contractor wants to keep them going (bearing in mind they get paid even if they do nothing) as it is a licence to print money. The people involved in signing these may be long gone (and I'd agree are to some extent culpable for the mess) but when the govt of the day says "it's PFI or nothing" and you have a falling-down hospital, what do you do?
Sorry, NHS trusts are an arm of the govt. A contract isn't owned, it has 2 parties. It can be cancelled if both are agreeable. So why can't those that are owned by the govt be cancelled? Normally, I would expect that the contractor wants to keep them going (bearing in mind they get paid even if they do nothing) as it is a licence to print money. The people involved in signing these may be long gone (and I'd agree are to some extent culpable for the mess) but when the govt of the day says "it's PFI or nothing" and you have a falling-down hospital, what do you do?
That's the great thing about politics - if you can stall the ceiling from collapsing on you long enough to exit the room, you can't be held accountable. No minister has been brought to court over matters that, if they had been taking place in private companies, would have been liable for prosecution for corruption, fraud or negligence.
A moving speech describing poverty in the early 20th century but with little relevance to the challenges the NHS faces today. The Labour speaker could have been followed by Michael Palin telling of his days living in a shoe box, except it was meant to be serious. And nothing wrong with bread and dripping for tea, we had it all the time.
If someone suggested that doctors were to be privatised there would be wailing and gnashing of teeth, except doctors are already privatised and always have been since 1948. They were bought-off in 1948 by being allowed to retain their self employed status and were bought-off again by the Labour government in order to implement the disastrous reforms to abolish NHS Primary Care Trusts and hand over power to GPs. People who say doctors shouldn't be allowed to do private work as well as NHS work simply lack any understanding of the relationship between doctors and the NHS, right from the birth of the NHS.
Instead of saying let's protect the NHS as it is at all costs, what most people really mean is let's protect the principle of free access to health care at all costs. As long as essential services and care is accessible to any citizen, and free at the point of delivery, and of good quality, what is the significance of whether the staff involved are employed by the State or a private employer. The NHS was not against private services, it was against private services not being available to the poor. If private services are replaced by better public services fine, but the idea that public services are uniquely able to provide care needs is claimed mainly by NHS workers, their Unions and political sympathisers.
My sister in law at 26 with two young children was admitted to the Brook with undiagnosed symptoms on a Friday. Most of the senior staff took off for the weekend leaving my sister-in-law in the care of untrained, unqualified, junior doctors. Sunday evening she was dead from a blood clot in her leg that shifted to her brain. She was diagnosed after she was dead, pity they were closed for the weekend and couldn't do it any earlier.
My daughter suffered a multiple fracture of her collar bone and went to A&E. In great pain, an East European doctor who we later learned had only appeared that day, said there was nothing to do and she could go home, it would sort itself out. On collapsing in the corridor the Sister told us to get a second opinion but because there wasn't another doctor available she was put into observation over night. Observation was a small darkened room, with beds separated by a single side screen, full of mostly men, some drunk, where a nurse occasionally appeared. We tried to get a nurse to make our daughter comfortable and ended up running around the hospital looking for a nurse to ask for some pillows. Had to interrupt two having a chat in the corridor who seemed a bit put out at our request.
First thing next day we got her transferred to the private section of the hospital, a different world. She needed an operation to insert two metal plates. We had no initial desire to go private but am not in the least guilty for having done so.
So some of us don't have the sentimental dewy eyed image of the NHS that others have, it's all based on personal experience. I don't have confidence in the management of the NHS - period. I make sure my family are covered by private health insurance so that we can get half decent care outside the NHS.
These are fair points and as someone that works in the NHS i understand how distressing it can be to be on the receiving end of poor healthcare. In my view the NHS is massively underfunded. My wife also works for the NHS having previously worked in Sweden and is of the view that in the UK we have a second rate healthcare system at best. The reason Sweden's healthcare system is so advanced is due to their paying over 30% Income Tax and having a very small military budget with no nuclear program. There if the local hospital doesn't have space for a treatment procedure, patients are free to go to any other hospital / clinic, NHS or private at home or abroad and the tax payer will pick up the bill. If we seriously want healthcare akin to a private hospital, the money needs to be spent. If we don't want to spend the money, we can't expect anything better.
As for your comment on Eastern European doctors, they are some of the best and highest trained doctors we have in the department. Remove the Indian subcontinent staff and the NHS would cease to exist.
To use an analogy, Charlton can't compete with Chelsea because they spend more money on their team every year. If Charlton spent the same money over a period of decades we may just catch up. You wouldn't expect a team with 8 players to win against a team with 11 players. Without the money the status quo will remain.
Am i proud of the NHS, absolutely. Do i think it could be improved? Give me a sheet and i could list things until Christmas.
Strange to release this news on a Sunday, on Andrew Marr this morning, but this headline from The Guardian is interesting
George Osborne announces billions in extra NHS funding UK chancellor tries to neutralise health as election issue, pledging £1.1bn for GP services and £2bn a year more for NHS Linking the two issues, Osborne said: “This is a downpayment on the NHS’s own long-term plan. It shows you can have a strong NHS if you have a strong economy.”
Osborne did not explain how he would fund the extra £2bn, but stressed that it was not a one-off payment, but would be added to the baseline in the health budget, starting from April 2015.
Government sources said that some of the £2bn would come from savings in the central health service budget, which opens Osborne up to the charge that he is recycling NHS money. It is thought the rest would come from under-spending in other departmental budgets.
Labour said it supported Osborne’s extra health spending, but that it would top it with an extra £2.5bn, which the party would pay for from its Time to Care fund.
Comments
I agree it is a political football - it would be in the Tories' interests (and most patients') to depoliticise it; unfortunately like politicians everywhere they cannot stop meddling, hence their enormous reorganisation you blamed on Labour earlier. I suspect most people working in the NHS also will not trust the Tories after their promise of "no top down reorganisation" proved to be as big a fib as Clegg on tuition fees. You are right to say that unions will want to protect their own interests. So do management consultants (who always recommend a course of action that includes more management consultants, supervising privatisation). So do private companies - they ditch anything where they don't see a profit and have politicians paid off to make sure this is politically acceptable.
I do get what you are saying about government. But you seem to be talking about a partially privatised health service, which would appear to be no different to the partially privatised railway? If Lewisham hospital goes tits up under Greedyinvestor Healthcare Ltd would the patients be wheeled into the street and tipped out of their beds, or would the government step in and save the day, like they do with the railways?
PFI is a financial arrangement concerning the building and it's maintenance being provided through private services. It's happened, you can't nationalise it, unless you mean you stop paying the mortgage and have the financiers foreclose. And the public sector is free to take over the services if it wants to tender and gets appointed by the NHS.
PFI was a Tory idea that Labour pinched, blaming Labour for implementing it, so not intending to suggest we trust politicians of any particular persuasion.
PFI contractors can't ditch anything they don't see a profit in because the contract ties them in and there are penalty clauses. More the truth that the NHS managers weren't capable of arranging a contract that diid what was needed and rather than admit their own incompetence, blame the contractors when stuff doesn't get done that wasn't in the contract,.
For those who seem to know how the NHS is going to be privatised, I suspect there is some confusion between the State paying money to the NHS and the State paying money to a private health care organisation. The cherry picking would be by the State, not the private providers, in deciding what they could undertake on behalf of the NHS. Greatest danger is the proven inability of public sector officers to negotiate an effective contract for bulk buying tea and biscuits, let alone a computer system or services for operations.
No one would accept the scenario where the State says we are going to stop the NHS doing simple operations and we are going to ask the private sector to take over so that people have to pay up front for an operation. To suggest that is making up a fairy story for the sake of having a big bad ogre. If the private sector proves it can take over some procedures at a price that is lower than the State pays through the NHS, what is the problem? GP's as self employed private sector professionals are already paid by the NHS to do what the NHS needs, presumably, in principle, we should nationalise GPs.
If a private sector service that is of national importance, but the State can't run properly, goes bust then the State steps in. Don't see a problem there, the money to bale out a private sector business would be less than continuously baling out a nationalised industry bleeding money. That's why the stuff was privatised.
Nothing wrong in protecting your own interests, that's what companies do, and it's pretty transparent that's how they work. The public sector on the other hand only ever claims to be taking action to protect my interests when patently it is only interested in protecting what it holds, regardless of my interests.
Only the public sector use management consultants and are able to pay them the fees they think they deserve. A private sector company doesn't need them as much because it makes its own decisions. The public sector, not used to being accountable, uses committees and sub-committed to avoid any individual taking responsibility for a decision, but for big ones they get management consultants to tell them what to do. Invariably it goes pear shaped because management consultants know jack shit about the real world, let alone hospitals, so why are they employed?
Don't know the numbers but would not be surprised if the NHS spends as much on private services as on their own staff. So just very confused by the "let's get the private sector out of the NHS" rallying cry. Seems it cannot survive without private sector services simply because it's incapable of managing resources, be it staff or buildings.
PS Very happy about the ranking of the UK health care, but the report, as I recall, did make us 10th out of 11 for stopping people from dying who didn't need to.
The administration may be bloated and over-manned. However. My theory is that in a time where the universities and colleges of this country are turning out thousand upon thousand of talented young people with degrees, high expectations and a paucity of good jobs, the 'public sector' by taking up the slack, can employ, career-educate and give experience to many of these young people in bureaucratic and administrative/ management roles, in the expectation that in future, they will transfer their skills into the profit making private sector.
In the future, the question is, how will the NHS be funded ? .. Longer life expectations, more available and better yet more expensive treatments and drugs, more staff costs, more pressure from an expanding population etc etc .. we all know the background.
For my part, I see a degree of increased privatisation as inevitable. In my area alone North (East) Lincolnshire/East Yorkshire, for example in Hull, private enterprise has built and equipped absolutely first rate cancer, maternity and heart care facilities. In Grimsby, MacMillan provide a superb cancer care and chemotherapy wing at the local general hospital. All these facilities are staffed by NHS workers, all do a fantastic job, much better than the outdated buildings and equipment that preceded them. None would exist without the 'profit motive' inherent in the PFI structure.
Ask yourself this : is money going to outside shareholders as dividends and to private companies as profit any less well spent than on NHS managers and contractors being paid to manage and continually patch up outdated and outmoded facilities where staff and patients alike are depressed and demoralised by having to use buildings and equipment that are years past their use and sell by dates ?
If taxation alone is to fund the NHS in the future then we will all have to dig deep and possibly cut back on our private individual spending to find the revenue. Yes, I know the arguments about spending on nuclear weapons, foreign aid, the arts council and all the other pressures on the treasury handouts, but we are where we are.
We all know that the NHS will NEVER EVER become a totally privatised organisation, it is far too big and essential as an icon of British society for that. However, for my part, organisations that are willing to support the NHS for profit, within reason, are welcome. The key words are of course 'reasonable profit'. One man's profit is another man's theft.
The NHS is far from perfect but outside of A & E and the work it generates there are very few procedures that are true emergencies that cannot wait 48 hours. If someone does need emergency treatment then it will happen.
Locally, i.e. Northern Lincs & Goole NHS Fndtn Trust, there are agreements in place for some non clinical staff to work shifts. 'Non emergency/routine' XRay/CAT/MRI scans are regularly carried out until 21.00 Monday to Friday and until 16.00 on Sundays .. pathology and associated services have also extended their working hours.
I am told that the changes are to cover 'short term work overloads' and originally were covered by overtime. As 'short term' seemed to morph into 'long term or normal workload', shift patterns have been developed to cover this development.
As staff are needed to cover A&E/Emergency Admission XRays and tests, rather like Tesco or ASDA, management have rationalised that as staff are on site and as expensive equipment should be in use as much as possible, why not use the staff/time/machinery for 'everyday' work.
I am also told that the CAT and MRI scanners are hired by local private Hospitals and clinics. A case perhaps of BUPA (or whatever the name is nowadays .. Spire, Sphere?) paying the NHS rather than the other way round
To have the weekends worked would require many more staff. Radiographers, doctors, physicists, nurses, engineers. A significant investment in staff without thinking about increased capital costs as expensive linear accelerators wear out more quickly.
It really is not an easy equation.
my own examples:
A lone PCT didnt even know how many buildings it was responsible for . they said 14 -- it was 17. They hadnt charged the doctors surgeries (who occupied these premises) for years (M+E,rent,utilities, cleaning etc). I stopped counting at £500,000 --yep half a million quid that the Drs should have paid into the PCT. i showed the Trusts CEO who in turn brought their lawyers in ---fecking disgraceful.
I assembled the Property Terrier for this PCT and all the assets that they had within them documented---it was to go onto a computer system ---they were paying me alot of money and i made the point an admin assistant at a fraction of the cost could now do it ---they ignored me so i sat the for another month and did it.
A recent assignment was to undertake an M+E project for a huge hospital. They had the biggest back room project management team i have ever seen. There was Operations (projects) ---Non Capital Projects--and Capital Projects . all with at least 6 project managers. In my room 4 of them were actually employees of MACE ---feck knows what they would by charging the NHS for that. It was a total joke and i left after one month
They above are two separate PCTs (or whatever they are called today).
Then there is the huge problem of PFI--we have spoken of it on this board before--it is costing the NHS billions of pounds-----both Tory and labour supported it and used it. When the prees point out it costs £30 to change a light bulb at hospital XYZ --yes it does!!!! because the company that built the hospital , financed the build , own the maintenance contract on that building for 30 years and wrote what is in the contract and whats not !! Huge amount of what are business as usual jobs within maintenance are not in the contracts for they are charged as EXTRAS.
The trusts cant buy the contracts back because they would be charged 100z of millions. In some cases the final builds do not conform to regulations, but time constraints mean they are used anyway which in turn mean the contractor has a get out as they can now say the Trust didnt allow them time to de-snag the buildings ---not their fault but they will address but charge for it !!
my betting is the NHS in Wales fell for the PFI bollox just after devolution ---"came and see what a great NHS we have in Wales now we are free from Westminster"-----------------then the bills started coming in-----the additions to the contracts and oppps we have no more money.
PFI and support services overspend / inefficiency IMO (and having seen it) huge reasons the NHS is struggling.
Politicians from all parties favour privatisation by the back door in return for backhanders and consultancies from private healthcare firms.
We're hurtling towards an American model which will be more expensive, wasteful and exclude large sectors of the population. None of the main political parties have any interest in addressing the existing problems with the NHS - handing healthcare to the private sector will just lead to a more expensive and limited service.
Politicians won't take responsibility for the problems they helped to create - too spineless and vindictive.
My main problem is the style which I have seen of contracts being tendered for clinical services. Often these are for three year periods which allows for very little stability as everything is geared around getting the next contract. Sometimes services can change hands every three years. One mate of mine has been in three different Services that have been taken over and it is never a positive experience for him or the patients.
Another issue is the manner in which the performance of these services are measured. Very often targets are focussed on narrow areas . So you get a service which rushes to meet and record these but does not focus as much on other areas.
I think that if this trend continues that the temptation would then be to hand over all of the NHS and we end in a situation whereby the Government simply tended out all services. The step from there to us all having Health Insurance would be logical and too tempting.
Unfortunatly this would impact on the service being national and regional variations would become even more marked. That is why you always get more GPs in richer areas and it is difficult to get them to work in Poorer areas.
I also do not have faith in our very limited private health providers to be able to provide adequate services or to do so in a cost effective way. Private does not always equal best and certainly not cheapest.
Personally I think that the changes in management and organisation I have seen need to continue. However we, as a nation should commit to the NHS and fund it properly. That is about choosing where we spend our tax money and raising more if it is need be.
If we continue on the current path our NHS will die a death of a thousand, well intentioned, tenders.
1. Only hospitals built by NHS staff, bricklayers and plasterers and owned and managed by the NHS would be available.
2. All contracts with doctors with private practices would be terminated and replaced by new doctors recruited from somewhere that has spare doctors.
4. All agency nurse contracts would be terminated and only NHS trained nurses would be employed
5. The NHS has to manufacture its own materials such as beds, sheets, thermometers, toilet paper etc.
6. No shops should be allowed to open up in hospitals, the NHS will move into retail distribution.
7. No cash machines, the NHS will set up its own bank.
8. NHS will build its own hospitals and recruit the steel erectors and plasterers direct.
9. Grass will only be cut by NHS employees.
10. Car parking contracts will be terminated and NHS will build and manage car parks and issue fines themselves.
11. Etc. etc etc.......
The reason many contracts don't work well is down to the contract terms agreed between a street wise corporate and an ill-informed, poorly led NHS consumer. The principle is OK but, as IAgree implies, the NHS like measuring what can be measured on a computer instead of intelligent, objective assessment of results.
The same people do the jobs whether it's a public sector service or becomes out-sourced, these companies don't have an army of staff waiting to step into the new jobs. Blaming the private sector for all its problems is passing the buck.
It all comes down to management, and public sector management is woeful. The same failed managers in one authority after being sacked for incompetence, with a massive pay out and early pension rights, just breeze into another job with another authority. Its a closed shop of mediocrity. You don't get real managers because the structure doesn't allow real management, that's why everyone keeps coming to the conclusion that a top down restructuring is required. Will not happen because there is no will to make it happen within the NHS itself, too many turkeys to vote for Xmas from the very top to the very bottom.
Yet if I bought something on finance 10 years ago, 40 different PPI legal firms seem to know my name, address, all my phone numbers, shoe size, blood type and dog's middle name. Says it all really.
* - Actually, I do understand, the Labour government paid umpteen billion pounds to a firm that was in over its head with the scale of the NHS IT system and decided to cover up how bad a fuck-up it was instead of admitting they'd made a catastrophic error.
All the Tories are allowed to do is throw money at the NHS, not try to improve outcome through changes etc, it is going to have to be Labour that make the necessary changes, and I hope they have the bottle to do it.
The issue with the NHS is people won't care if you poured £5 billion into a furnace in an NHS hospital (And in some cases you might as well), as long as that £5 billion goes to the NHS, they will be happy. Spending can only go up in the NHS, the focus is far too much on what is spent, and not enough on the quality of outcome. That is largely due to sentimentality people have in my opinion, they will proclaim that the NHS is fantastic because of how they treated their dear old mum, and then dismiss a story which states the complete opposite.
Regarding the PFI contracts, for what its worth I have read a few and it is quite plain to see how the government were getting shafted from day 1.
For example, on paper it looks like Queen Mary (I think it was) in Sidcup has the worst rodent problem in the UK when you look at the figures, purely because a pest controller visited twice a day.
There were no rodents at all in the hospital or the surrounding area, they were just contractually obliged to call someone out twice per day.
The PFI contracts effectively privatised all of the revenue raising areas of the hospitals, so, car parks, shops etc, meaning that the hospitals had no hope of raising revenue, and many started each new financial year in debt before they had even started running.
PFI was created PURELY in my opinion to hide capital expenditure, to cook the books as if it were, why pay £500 million for a hospital, when you can pay £50 million a year (for 30 years), although of course the public sector had a terrible record of delivering projects a) on budget and b) on time. The idea was supposed to be that private companies could borrow at the government rate as they would guarantee the projects, and then they would lease the hospitals back, however the servicing contracts built into PFI deals completely robbed them.
Effectively as some have said on here, it was exceptionally savvy lawyers who knew about the kind of contracts they were writing (as they had written them in private sector deals) who were going to the government who had next to no experience. The government didn't hire good enough lawyers, and as a consequence got completely screwed.
The thing is, PFI could actually be a fantastic idea, it is just that the clauses in the contract are onerous, for example, if you wanted to reduce pest control to once a week rather than twice a day, you would pay through the nose for the privilege, meaning there's not much point in doing it, but if these contracts had been written fairly, we could have done a lot better. As it is it would have been better if the government had just built the hospitals in the first place.
I think a reasonable person wouldn't argue with any of those as you have phrased them, but personally I think the NHS should control what other work its employees do (no 2 -most employers expect you to just work for them if it is a well paid job) and should cut down on expensive agency nurses (4).
All the ancillary services you mention don't include the most important, cleaning. Since this has been privatised, standards have plummeted and so have the real wages of the workers. Some hospitals are now taking it back in house because of the incompetence of the private sector. Cleaning is labour intensive - the only costs you can cut to make profits are peoples' wages. So what used to be a job that could pay its way now becomes one that requires tax credits - the taxpayer subsidises the company paying such low wages. Where three people would clean a ward now one cleans two. This is the private sector's innovation: fewer workers, paid less. (I don't think it is inevitably so, but in something like cleaning it is). I've worked for private and public sector management. I'd be hard pressed to put a fag-paper between them for incompetence and short-termism, though I was managed far more when i was in the public sector. Since then I've regularly had managers I've never met, watched colleagues be forced out, legally or illegally, with no idea from management as to what they even did, let alone how to cover their work. I get it, you don't like the public sector. I don't think it has a monopoly on incompetence at all. And with the arguable exception of BT, I cannot think of a private company that delivers a better service than before it was privatised. Do you want to try? Are you harking back for the days of Connex Southeastern? Does the French state electricity provider get you excited? Does Thames Water do anything apart from collect ever-increasing water bills while regularly dumping raw sewage in the Thames and begging the govt to pay its capital costs?
If it is the same people doing it, what on earth could it be? Perhaps the management are ignoring things like customer service because they want to make more profit. I don't know. I regularly watch my management do things like close a money-making section to subsidise a loss-making one. (And no, that didn't make sense to me either).
I'd tend to agree that outcomes should be the focus for any contract. Unfortunately, this has been tried elsewhere to lots of special pleading from the likes of rail franchises, who bid on outcomes they never deliver for amounts they claim they will pay the Treasury that magically turn into subsidies once the ink is dry on the contract.
On PFI, what I find totally bizarre is that the govt now owns some of these through nationalised banks. Why not just cancel them?
Buy out ? thats loss of profit etc and penalty clauses----billions at the very least 100z of millions of pounds.
As NI/Scotland and Wales now run their own NHS you cant blame the Westminster government for their collapse ------the SNP+ Labour repeated that lie a million times a month ago. They have the devolved power.
The people involved in signing these may be long gone (and I'd agree are to some extent culpable for the mess) but when the govt of the day says "it's PFI or nothing" and you have a falling-down hospital, what do you do?
As for your comment on Eastern European doctors, they are some of the best and highest trained doctors we have in the department. Remove the Indian subcontinent staff and the NHS would cease to exist.
To use an analogy, Charlton can't compete with Chelsea because they spend more money on their team every year. If Charlton spent the same money over a period of decades we may just catch up. You wouldn't expect a team with 8 players to win against a team with 11 players. Without the money the status quo will remain.
Am i proud of the NHS, absolutely. Do i think it could be improved? Give me a sheet and i could list things until Christmas.
Strange to release this news on a Sunday, on Andrew Marr this morning, but this headline from The Guardian is interesting
George Osborne announces billions in extra NHS funding
UK chancellor tries to neutralise health as election issue, pledging £1.1bn for GP services and £2bn a year more for NHS
Linking the two issues, Osborne said: “This is a downpayment on the NHS’s own long-term plan. It shows you can have a strong NHS if you have a strong economy.”
Osborne did not explain how he would fund the extra £2bn, but stressed that it was not a one-off payment, but would be added to the baseline in the health budget, starting from April 2015.
Government sources said that some of the £2bn would come from savings in the central health service budget, which opens Osborne up to the charge that he is recycling NHS money. It is thought the rest would come from under-spending in other departmental budgets.
Labour said it supported Osborne’s extra health spending, but that it would top it with an extra £2.5bn, which the party would pay for from its Time to Care fund.
http://wallstcheatsheet.com/business/3-of-the-best-and-worst-countries-for-medical-care.html/?a=viewall