Emigration

[al_yrpal]

Can you please explain this myth that the NHS is being privatised or is going to be privatised. My wife worked in it all her working life and several of my family work in it too, I have asked them about these assertions and they say it just isnt true. You live in Norway, what do you know about it that we dont?

Al

[Psamathe]

Can you please explain this myth that the NHS is being privatised or is going to be privatised. My wife worked in it all her working life and several of my family work in it too, I have asked them about these assertions and they say it just isnt true. You live in Norway, what do you know about it that we dont?

Al

I understood that the last government made radical changes such that pretty well all NHS services have to be put out for open tender from any companies that want to bid. Foundation NHS hospitals just become another bidder, along with loads of other contenders (many overseas companies). It is already happening. I remember a situation recently in Nottingham, dermatology services were put out to tender and the bid was won by a private company (who had no dermatologists). The winning company assumed they could take over employing the current NHS dermatologists (and make a good profit from the service). What this company did not appreciate is that there is high demand for dermatologists and those NHS ones all refused contracts with the winning company (good on them) - so the NHS had to stop offering such services in the area (no consultants and bid winner could not provide them either and the services included acute skin cancer treatments). http://www.independent.co.uk/news/uk/politics/nhs-services-cut-in-nottingham-after-doctors-quit-rather-than-work-for-private-firm-9931763.html

Then there was the case of the corporation that took over running an NHS hospital (in it's entirety - name of the place has slipped my mind), convinced they could make loads of money. But they didn't even wait until the end of the contract before walking out as they could not see the profits they wanted.

As different bits of services are put out to tender, so more and more services will move from public sector to private "for profit" corporations. The public sector we think of the NHS will be providing fewer services and will not have the same benefits of scale. So running e.g. MRI scanners if great when you use those tools for all sorts of different departments needing diagnoses. But when half those departments are treating patients outside the NHS, so the scanners see less use and the running costs per patient increase.

As more services move to private corporations, we we get to to know less and less about what is going on - as the last governments rules about openness of data only apply to public sector providers NOT to the "for profit" corporations. Just look at what happened with the cateract scandal and Vanguard Healthcare. We had to rely on a whistleblower to find out here was a a major issue !! http://www.theguardian.com/society/2014/oct/16/leaked-report-cataract-surgery-revealed (and of course it is the NHS facing the legal bill whilst the private corporation takes their profits).

Services provided by "for profit" corporations need to make a profit which means providing as little as possible whilst charging as much as possible. How much they charge will be determined by competition and will be limited to allow them to win the business. So their main profits will be through making savings of treatment provision (e.g. paying staff less, providing cheaper and less treatment).

It is a gradual process. Not everything is being put out to tender at the same time. So there is no big bang or big sell-off - hence it is not so blindingly obvious.

I read an interesting report recently about how many NHS paitents were declining free private care preferring NHS treatment - so those needing treatment don't want the changes that Landsley forced on us. http://www.independent.co.uk/life-style/health-and-families/health-news/most-patients-turning-down-the-chance-of-free-private-treatment-on-the-nhs-says-research-10221590.html.

The issues go on and on (and I doubt anybody has read this far through my ramblings anyway.

Ian

[al_yrpal]

But… people are peddling these myths as though health decisions are being made by private insurance companies like in the US where if things get expensive your insurance gets cancelled - they are not! The NHS is free at the point of delivery and will remain so. I couldnt care less if I am treated promptly by a public or private employee (consultants often are both and GPs have always been quasi private contractors) as long as its free and not determined by whether I paid or not. I have been treated in an NHS hospital and a private hospital locally in this last year, free on the NHS. I must say that the private hospital was much better at keeping appointments on time and the reception staff were much more friendly and welcoming. If this is how things will develop with healthcare delivered more efficiently perhaps thats the way we should go? And of course… .there havent been any treatment scandals in NHS hospitals have there?

Al

[mjr]

The corporation was Circle Health, majority owned by venture capital firms but tried to pass itself off as a cooperative until true cooperatives objected noisily, and the hospital was Hinchingbrooke in Huntingdon. I think it's now being run by Cambridge University Hospitals but I'm mobile and can't check easily.

[Psamathe]

But… people are peddling these myths as though health decisions are being made by private insurance companies like in the US where if things get expensive your insurance gets cancelled - they are not! The NHS is free at the point of delivery and will remain so. I couldnt care less if I am treated promptly by a public or private employee (consultants often are both and GPs have always been quasi private contractors) as long as its free and not determined by whether I paid or not. I have been treated in an NHS hospital and a private hospital locally in this last year, free on the NHS. I must say that the private hospital was much better at keeping appointments on time and the reception staff were much more friendly and welcoming. If this is how things will develop with healthcare delivered more efficiently perhaps thats the way we should go? And of course… .there havent been any treatment scandals in NHS hospitals have there? :?

Al

I (based on my understanding of the changes and recent experiences) don't agree. I can see major issues should the NHS start to lose "business" to the "for profit" sector. They will continue to have to pay for their existing infrastructure (including the completely mad PFI deals the politicians have lumbered them with). They will lose economy of scale as the service will decline.

Those who are awarding these private contracts are now outside government control (they are largely "for profit" companies themselves). GPs really have no more control over services under the new scheme than they had previously.

We have far less information about the performance of private companies. How would you feel had you been one of those with a botched cataract operation, with the knowledge that the situation was not addressed because of the lack of disclosure regulations on services provided by the "for profit" corporations. So there may easily be far more issues left unaddressed. We may find out about some through the moral behaviour of whistleblowers. But with NHS services the regulations about disclosure mean such issues will be addressed far quicker.

We have already seen services in some areas withdrawn due to the privatisation (see my previous post regarding acute dermatology in Nottingham).

NHS is obliged to provide a complete range of services. So when the really challenging services are put out to tender, those where t is difficult to make a profit will not be bid for by the private sector. Thus the situation will gradually change to the NHS being obliged to take all the difficult non-profitable parts of the service whilst the private "for profit" sector cherry pick those parts where it is easier to make profits. And of course, the NHS with disproportionally more non-profitable treatments together with it's legacy costs mean it will become what politicians call "failed service", etc. etc.

We are still in the very early stages of the process so "things can only get worse". I personally feel there is more to the NHS and it's treatment than the "free at the point of care".

Personally I don't see any advantage of the changes. It was supposedly done to give GPs more control over treatments for their patients. This has not happened. Instead, management and admin costs of the health service have increased (so even less money available for treatments) whilst ever increasing amounts are take for shareholder profits.

If it were up to me (and probably a good job it isn't 'cos I really think my understanding of the health service is so limited my solutions would be bound to fail), I would start from the premise that if a private company can offer NHS paid for treatments and make a profit there is no reason a public sector operation cannot (and effectively plough the "profit" back into the system). But it sounds like the NHS has many legacy "issues". So, rather than have private companies tender for treatment businesses, start setting up new organisations under public ownership to undertake those treatments that would have been bid for/won by the private sector. Effectively "arms length" operations that are part of the NHS but outside it's direct control (and thus outside it's legacy problems). I suspect there are vast numbers of failings in my thoughts, but with all this "privatisation" stuff I keep coming back to the idea that if a private cmpany can do it and make a profit for shareholders, why can't a public owned company as well. and with the East Coast Mainline seems to have shown that this can work - with profits being passed back into the public finances rather than to shareholders pockets. Particularly these days where public operations can borrow money at such a low rate.

Ian

[Psamathe]

The corporation was Circle Health, majority owned by venture capital firms but tried to pass itself off as a cooperative until true cooperatives objected noisily, and the hospital was Hinchingbrooke in Huntingdon. I think it's now being run by Cambridge University Hospitals but I'm mobile and can't check easily.

In which case I think it must be the same company whose bids resulted in the withdrawal of dermatological services in Nottingham after the consultants refused to transfer from NHS to Circle and left and went elsewhere (easy as there is a nationwide shortage of such consultants) http://www.independent.co.uk/news/uk/politics/nhs-services-cut-in-nottingham-after-doctors-quit-rather-than-work-for-private-firm-9931763.html.

Its Hinchingbrooke case if an excellent example of the current situation where the private sector take the profits and whilst the taxpayers bear the losses. "privatise the profits and nationalise the losses" which is great for the wealthy but not so good for the taxpayer and seems to be happening more and more.

Ian

[al_yrpal]

It has always been the case that private insurance funded healthcare in the UK has not been able to deal with some really serious medical conditions and in the end these conditions are dealt with by the NHS free. For the more routine stuff I cannot see why some things cant be handled by a private company? If you arent satisfied with your treatment you have the option to go back to your GP and get him or her to sort it. Long in the past I had occasion to do this and it was sorted. The failing service back then was the NHS. They are not infalible. Profits in private hospitals provide equipment and are an incentive to run private businesses. There is nothing wrong with profit its what our whole economy and relative wealth is based on. As long as the UK health service remains free at the point of delivery, thats what all parties promised. I am comfortable with that.

Al

[reohn2]

There is nothing wrong with profit its what our whole economy and relative wealth is based on.

I fundamentally and completely disagree with that where public services such as healthcare and other some other essential public services are involved and I agree with Psamathe's post above.If profit can be made from such service's the same or a better system can be provided where no profit is made.

As long as the UK health service remains free at the point of delivery, that's what all parties promised. I am comfortable with that.

Al

Politrickians will promise the earth in exchange for power,you're a gullible man if you believe a politrickian.

It's my belief the NHS is whilst being available free,due to profit being made by private companies supplying services to and within it will cost more than if state owned,of course it would need to be properly managed though.

[bovlomov]

I am comfortable with that.

Are you comfortable with it in principle, or with how it is being implemented at present? Some of the posts above have explained in some detail how money is being sucked out of the system, with bad value PFI contracts, and the private sector raking off profits while bearing none of the risk.

If you think it isn't happening, you need to explain why those posts are wrong. Or are you comfortable with contracts that unreasonably favour the private sector?

I respect many of the arguments made for privatisation, but not excuses for greed and exploitation.

[Vorpal]

There are some fundamental ethical issues with health care for profit:
-because of reasons outlined above, public health institutions cannot always compete with for profit organaisations
-private companies treat health care as a commodity rather than a right
-incentives and targets can create a conflict of interest and/or erode the patient - GP relationship
-for profit companies can lobby together and exert undue influence on public policy
-because they make money from curing the sick it is not to their benefit to prevent illness

The current combination of private insurance and public care already undermines the idea of the public health care system by giving some people an opportunity to obtain services or care before others. While there will always be people who can obtain private health care, if they can afford it, it should be harder and more expensive to do so. It undermines the public health care system when 30% of patients can get their knee replacement surgery within 6 weeks, using private health care, and NHS patients can't get it within 6 months, even if the surgeon performing the knee replacement is the same person in both cases.

By drawing human resources out of the public system, private health insurance and private health service delivery pose a threat to the quality of care for those who depend on the public system. A decline in quality of care may lead to poorer health among public service users which would lead to greater costs and demands on the public system. Consider, for instance, the current situation in Germany, where people are allowed to opt out of the public health insurance program and purchase private health insurance. The expansion of private health insurance has undermined the financial stability of the public system because many people with higher incomes have withdrawn from the public system. This has resulted in declining average premium revenues in the public system and increasing average public health expenditures, as those in the public system tend to have higher health needs than those who have left the system for private care.

from http://www.nnewh.org/images/upload/atta ... urance.pdf

There is a lot of sense in this article about lessons from the British health care system http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447686/

[Psamathe]

(Further comments on the public/private debate with regards healthcare)
As I understand it private companies have to work for the benefit and in the interests of their shareholders. Public organisations have their aims set by the organiser/government/whoever. Thus a pubic healthcare operation can work in the interests of the public whilst the private "for profit" corporation has to operate to maximise returns for their shareholders. Thus when you are being treated by your private "for profit" company under the guise of NHS, remember that everything they do must be in the interests of their shareholders rather than in your interest. Sometimes those goals might be the same (e.g. it is in the interests of the shareholders that the treatment given does not kill you because compensation payouts would badly impact the profit margin - but it is the profit that is the consideration not what is best for you).

To me that is an important distinction, particularly in the longer term. e.g. a private "for profit" corporation might decide it is in the long term interests of their shareholders to work on a loss making basis undercutting a public provision for long enough for that public provision to cease/fold/discontinue. At that point they can raise their prices as it is unlikely that anybody would put much effort into paying for a public provision to be restarted from scratch. I understand it is a method often used by companies where they will undercut competitors often operating at a loss in order to put their competitors out of business at which point they hold a virtual monopoly.

Ian

[Vorpal]

Can you please explain this myth that the NHS is being privatised or is going to be privatised. My wife worked in it all her working life and several of my family work in it too, I have asked them about these assertions and they say it just isnt true. You live in Norway, what do you know about it that we dont?

Al

I"ve paid plenty of taxes in the UK, I've used the NHS, including having two babies in NHS hospitals. I've seen the effect that reforms had on my local NHS trust when I lived in the UK, and I have experienced health care in 3 different systems.

The NHS *is* being privatised bit by bit, and sometimes by stealth, by having private companies run facilities and bid on services. It may seem like a cost reduction to outsource something 'easy' like cleaning. But if the company that gets the contract doesn't do the job well, the nursing staff ends up cleaning because otherwise their patients will not have an adequately clean environment. Now, nurses wages are being paid for cleaning, the nurses are short staffed, and the cleaing company is being paid to do something that they aren't doing well. Even if the nurses complain, that's the way things are, and the best outcome of complaints, is that the next time the contract is up for renewal, another company will get the cleaning contract.

Even if a inspector finds unclean conditions, and the hospital has a notice to improve, they won't or can't return the cleaning to their own staff, becuase it looks expensive on their books. They'll either get the company that does the cleaning to make some corrective actions, or they'll change companies.

I've seen this kind of thing going on, and have a friend who works as a nurse and has been in this kind of situation. If your family members who work int he NHS haven't had their jobs impacted because of things like this, I'm sure that they should be glad. Because it does happen. And there are many other expamples of private companies providing services to the NHS who make things less efficient or more expensive in the name of competition.

[al_yrpal]

My wife was a ward sister for years and finally was senior nurse in charge of a huge medical unit. Cleaning was done by private contractors. If cleaning wasnt done properly she made sure the contractor was taken to task and the problem sorted. Poor performance was not tolerated it could result in the loss of a contract. Locally we are getting a brand new Orthopeadic unit this year and a brand new rebuilt hospital in our local market town. You are offered several choices of hospital for any treatment and two of them are private. All the hospitals are excellent in my experience. I take many old folk to and from our local hospitals public and private as a volunteer they are invariably full of praise. Our health service is under stress because of extra demand from those living longer and immigration. Many of the staff are immigrants from all over the world as they have always been and love their jobs and the NHS which simetimes creaks but invariably delivers

Al

[Tangled Metal]

Years ago I needed to see an EN&T consultant and had three options. One was an NHS hospital over an hour away with a 3 month wait. The second was an NHS hospital half away with. 2.5 month wait. The third was a private hospital half hour away with a 1 month wait. I told my gp I didn't want to wait nearly 3 months but I was not prepared to contribute to the profits of a private hospital. My gp told me something about the contract the NHS had with the private hospital. Basically they paid a flat fee per year based on a certain number of referrals. Any referral above that is effectively free. Apparently they weren't anywhere near the end of the year but had exceeded the set number of referrals. That meant it was saving the NHS money to send them to that private hospital.
So I went in 1 month to the private hospital, had the best service I've ever had.from a hospital. I got there 10 minutes early. Got handed a coffee while I'm waiting. Dead on time the consultant brought me into the room, I got checked out then sent to the technician who does hearing tests. Waited 5 minutes , offered a second cup of coffee too, then had the test. A long 10 minute wait while the test results were produced. Then the consultant and out on my way home. All with free parking.

Now I am not saying private is better than NHS in all cases but I can say it is possible to make it work. BTW I had Tony Blair and co to thank for my only known experience of private healthcare. Seems it is not just Cameron supporting the profits of private healthcare providers, New Labour did a lot of it too. I seriously doubt if Miliband would have stopped it neither. Reckon he'd have taken it up too. There's nothing like political ideology to hide behind when.you're cosying up to big business and New Labour were good at that. At least conservatives make no bones about being a for private sector. They're up front about that. Labour claim to be for public sector, NHS and against private sector doing public sector roles, but they're just hypocrites.

[bovlomov]

New Labour did a lot of it too. I seriously doubt if Miliband would have stopped it neither. Reckon he'd have taken it up too. There's nothing like political ideology to hide behind when.you're cosying up to big business and New Labour were good at that. At least conservatives make no bones about being a for private sector. They're up front about that. Labour claim to be for public sector, NHS and against private sector doing public sector roles, but they're just hypocrites.

Alan Milburn was a Secretary of State for Health who promoted private involvement in the NHS. He later joined the boards of companies profiting from those policies. It's not illegal but it's immoral.