To ask- what do you think is actually happening when you hear "they are privatising the NHS"

[Arelen]

I keep seeing memes and petitions posted by friends who are concerned about privatisation of the NHS, or that the NHS is being sold off.
I wonder what people imagine is happening when they see or post these messages?

Of course it's privatisation! Partial, yes, but privatisation all the same. Where the main driver is to get a service as cheap as possible, you might as well forget about quality. And if you think it's ok because it's not the actual doctors, then think about your medical records in the hands of private information management companies, and your elderly parents being cared for by undertrained, undersupported staff struggling on shitty, zero-hours, minimum wage contracts.

What I think is happening currently is that certain services are being bought by the nhs from private companies and these companies are using the nhs to make profit.

I think that any company that is profit making is primarily concerned with making profit (naturally!) and that the nhs should not be their cash cow and they should not be allowed to use the health of the nation to get rich. I think we are very fortunate to have developed this system and we would be fools to allow anyone to take it away from us.

I also think that what is happening leads to what will happen, which is more and more services privatised and more and more seeing evidence that profits come before people, which is a bad idea when it comes to healthcare.

Difficult decisions currently have to be made and that's awful. We have X money, do we treat this cancer or that cancer, weigh it up, which is the best use of money... It's far from ideal, very far, but at least we know that they are trying to decide how to use the money to best help people.

Very different to making decisions based on the profit margin.

I think that we will slide slowly into an american style system and one day we'll look back and go hang on, didn't all this used to be available to all of us, I wonder how this happened.

Oh, and how could I forget the Southern Cross special: flogging off the assets (in this case the care home buildings) and leasing them back, only to find they couldn't afford them.

Leaving everyone else to scrabble around trying to pick up the pieces while the end users (vulnerable elderly people) were left in limbo.

But that's what you do when your core business is making money. It's not quite the same as when your core business is providing care.

www.bbc.co.uk/news/uk-england-beds-bucks-herts-20727527

It makes me think, where are the petitions and hand wringing about he fact that hospital trusts are over £800 million in deficit? Huge bailouts all over the place happening, but the media are barely interested.

Contracting is a mess, procurement is a mess and both could learn a lot from the private sector. But oh no, boo hiss to the private sector providing back office functions. Boo hiss to the private sector doing anything, even though if the publically provided services were held to proper account in the way they would be in the private sector they would all have gone bust years ago.

Fenella, the points you make are valid and it's right to have those concerns, but we already have decisions about people's healthcare being made based on cost. There isn't profit involved, bout people have been failed by the NHS countless times because of reasons that ultimately come back to money.

It's not like we have a glowing 100% successful service at the moment and someone is trying to take that away from us. The current system is in many ways, spectacularly shit, and personally I'm open to any way that has a chance of improving that.

The issue is that the NHS has become so unwieldy that is is cheaper (often with the same or better clinical outcomes) for private companies to run services at a lower cost and still make a margin. Instead of accepting this and using taxpayers money to make profit for private firms, we should be trying to address why the NHS is so inefficient, or making better use of mutuals /not for profits. That's what a lot of European countries do for elective or second tier healthcare, but there are a lot of mutuals in that space rather than for-profit organisations so the emphasis is still on patients.

Private businesses exist to make profit for shareholders. They are not benevolent institutions. When money is being funnelled to shareholders instead of into care, something will have to give. Nurses and other staff will be paid less. The unprofitable parts of the service; that affecting the chronically ill and the elderly will really suffer.
I am quite prepared to give extra unpaid hours and my goodwill to help to NHS at present. If instead of this, I am working to make money for some cunt like Branson, I will work as per contract. Without staff goodwill, the NHS in this country would not work.

All NHS spending except nursing and hospital staff salaries goes to private companies making a profit

Yes cinderella, let's allow hospitals to go bust. I'm sure that will benefit us all. If trusts hadn't been burdened with shit like PFI, they wouldn't be in such financial trouble now.

I would like to see all chronic disease management run by clinical nurse specialists in the patients' own GP surgery.

People with chronic conditions find trailing to the hospital, waiting for hours and having all the hassle with transport and parking exhausting and depressing.

If the NHS actually made use of the available IT systems that can interface with hospital systems, instead of all doing their own thing with incompatible systems, that would go a long way to improve matters.

"Better to outsource bits of it that can be run far better by experts/specialists."

The problem I have seen in my area is that the organisations bidding for contracts are not experts or specialists by any means. They do not have the right qualifications, knowledge or experience to deliver to a high standard. So to me privatisation equals cheap but low quality.

The reason why private companies win contracts is because they are so cheap. The commissioner for my service has no idea what we deliver, has no understanding of the essential standards and qualifications and has asked me as the service lead to tell her the impact of her not commissioning the service any more. Surely if you are paid to commission services to help the general population (and paid almost as much as the contact is 'worth') then you make damn sure you know what you're talking about.

Commissioning in the NHS has contributed to it becoming unsustainable. They are massively overpaid and there are too many of them, making dangerous decisions because they have no idea what they are doing. NHS money is tied up in commissioning organisations which is why they have to put unrealistic contracts out which shoddy private organisations can put in the cheapest bid win the contract. Ultimately service users will suffer.

Yes, but that was exactly my point though.

There is a world of difference between making difficult decisions based on cost - because you want to make all the money you have go as far as you can to treat as many as you can... and making decisions based on what will create the largest profits for your company.

In an ideal world we'd have enough money to treat everyone but we don't. But there's a massive difference between saying we have £X for this treatment and £Y for this treatment and sadly we can't allocate funds to this treatment because we're spending £Z on that treatment - and saying £1 for you, £2 for me, £1 for you, £2 for me...

VenusStarr

Well said. This is exactly the problem. It is so frustrating trying to negotiate with people who control the money, but haven't the faintest clue what the clinical needs of the patients are.

When you go to a meeting to fight your corner and find that the other people there have no clinical knowledge at all, or are from a completely different area - (think podiatrists deciding on the commissioning of a cardiology service) - you just feel that there is no point even turning up.

It is all about ticking a box to say that they got the cheapest contract - never mind about quality of care or safety.

I think Hoorah!!

A private company would probably do it a damn site better than the top heavy structure that's there at the moment. People would be held to account and sacked if not performing and companies would need to do a good job or would lose their contract.

Commissioning in the NHS has contributed to it becoming unsustainable. They are massively overpaid and there are too many of them, making dangerous decisions because they have no idea what they are doing.

Oh God, YES!
In my experience, commissioners are pretty hopeless. They love gadgety bollocks like Assistive Technology, which is expensive and pretty useless, because its flashy and they've been promised miracles by spivvy salesmen. Commissioners, once again in my experience, act like toddlers and have the memory span of a gnat. They trial something; it doesn't work and costs a fortune. They then end the trial, wait three years, and commission the same bollocks all over again. This is what introducing the commissioner/provider split did to the NHS.

I'm not saying that they should be let to go bust, don't be so absurd. I'm saying that it's not sustainable. And rather than holding the public services up as a model of quality and wonder that the nasty private sector wants to destroy, if trusts had to think a bit more about profitability then things might start to change.

One of the biggest reasons that private sector organisations can offer a cheaper service in some cases by the way is pensions. Public sector organisations have a huge cadre of people on final salary plus lump sum pensions, expecting to retire at 55. If you're not paying those kind of overheads and contributions, you can employ either more people or the same amount of people, not impact on quality and still make a profit.

I'm not saying the NHS should scrap the pensions of those already in the system, just that there are other things in the mix which make it more complicated than just saying "they will have to run a reduced service"

A private company would probably do it a damn site better than the top heavy structure that's there at the moment. People would be held to account and sacked if not performing and companies would need to do a good job or would lose their contract.

Complete idiocy, I'm afraid. The privatised utilities and power companies receive a massive amount of complaints, dies anyone ever lose their jobs.
The home care companies are contracted out and are private. How's that working out then? Poverty wages, 15 minute calls, staff burnout and dropout, HUGE problems. You want to extend that to the NHS? That's moronic.

Public sector organisations have a huge cadre of people on final salary plus lump sum pensions, expecting to retire at 55.

Pure bollocks. I'm not going to be able to retire until 65.

The NHS has become so sanctified that to it often feels we can't criticise The service which means problems are allowed to escalate to the point where private providers seem the only option. As with immigration we need a sensible debate about the NHS what we want from it and how much we want to spend on it. The main problem for me with the privatisation of the NHS is like with schools private providers will use unqualified staff to deliver core services.

I have nursing colleagues who are looking at having to work beyond the age of 65.

I'm sorry, I've worked in the NHS for over25 years. I'm politically aware. I've seen the internal market, PFI, all the tentative attempts at privatisation. If you really, honestly think that introducing private companies into the NHS is going to help anyone but highly paid executives and shareholders, then you're an idiot. Sorry, but that's the truth. By the time it's trialled and implemented, people will be really suffering, and it'll be too late to go back. We'll be stuck with the same system that has made the trains horribly overcrowded and ridiculously overpriced, and the energy cartels that sell us hugely priced gas and electric. How has 'competition' worked for our benefit there?

Yes, Peltata I agree. Nothing should be such a sacred cow that it can't be discussed and criticised.

And at what point did "change" become "privatisation"?

Something must be done, this is Something, so let's do it?

RandomNPC

Yes - they think "ooh we will have this wonderful piece of technology that is all singing/dancing, that means we don't need any actual qualified staff at all, we can employ any random person on minimum wage and they can operate the wonderful piece of technology, what could possibly go wrong?"