NHS reforms- anyone else as disbelieving as I am?

[nowwearefour]

What on earth is going on here? Privatisation by stealth? I know what- let's take the focus off the patients and the healthcare and put it on re-organising ourselves.AGAIN. how brilliant. anyone care to help me see what the benefits are of this?

My dd (2.7) has a serious medicsl condition which has seen her hospitalised about 15 times this year (I have genuinely lost count :) and had surgery 4 times this year.

She will need consultant-led care & surgery for the rest of her life, as well as expensive ongoing treatment.

I have been both impressed and at times concerned with the standard of care at different times over the last few years, having spent much of it on the paediatric ward of a large hospital. I am EXTREMELY thankful for the NHS, but this thread is very concerning, since I know that my dd will be requiring the services of the NHS over her whole lifetime.

I wonder in what way I can make a difference to ensure that the care is there at a high standard for her, for our friends (other children with children with serious conditons) and for all other users of the NHS.

Apart from voting (obv done that) is there any way we can affect the way politicians view this and what changes they make. I think I'll probably feel angry at some point in the future, but now I feel scared for the future.

Have just written a long post about how shit this is and lost it!!

DC and NC LIED to us (what's new) but under the guise of honesty! This is backdoor privatisation, lining the pockets of their mates.

It can only drive down standards for those who have care that is too difficult, costly or risky for the private sector to bother with. As all the profit rich stuff gets contracted out to the private sector, the nhs is left with a double whammy not getting the profit rich work and saddled with the debt of the difficult stuff. It is rationing without actually mentioning the words. If the postcode lottery was bad before I can only imagine that it is going to get a whole lot worse!!!

My dd2 has a complex medical condition, I am terrified about what this will mean for her, to the point that dh discussed last night a move north of the border (all our family is there all ready).

I would love for a minister to come on and spout crap persuade me that this is not just a ideological axe to the nhs.

I am a hospital consultant. I have trained and worked in the NHS for 20 years. I am gutted at what is happening to it in the name of 'efficiency' - of course we can always look to improve the way we do things, but compared to 20 years ago it really is a better place both to work and to be treated and most patients (as opposed to 'the public' - although most of them too) are very satisfied with the care they receive. One of the main things that pains me is the thought of the private sector making profit from people's misfortune - I'm thinking for example of a patient with suspected cancer who currently will get referred, diagnosed and treated usually by the same hospital within 60 days. What will happen once 'any willing provider' kicks in? People shopping around for the cheapest scan? Bargain chemotherapy?

I am lucky, as my job is relatively protected compared to those who work for PCT's - and even at the Department of Health, which is in meltdown, with redundancies galore. I like GP's, I work closely with GP's - a lot of my friend are GP's. But I resent the fact that they could be in charge of deciding how I should treat my specialist and complex patients - most GP's have no training in commissioning or health service management and no desire to do it.

The only thing in these plans that I agree with is that doctors should be more involved in designing services and pathways (bloody pathways) for patients - no-one would disagree that clinical involvement is a good thing. But that can be achieved without all this crap. I am so cross - with Lansley (or LaLa as I like to call him) who I think has no clue about what really matters, but also with Cameron - all that guff during the election about the NHS and the references to his own family and real spending increases - now he is using the defecit as an excuse to break up one of the things that makes us literally the envy of the world in terms of health care delivery. These plans are dangerous and have the best interests of big business, not patients, at heart.

Sorry, not a very coherent post, but I'm so upset by it all. There is a lot more I could say but I don't want to wind myself up further after a particularly busy day at work!

This represents a complete change of ideology imo. Post-1945 it was agreed that every citizen of a democratic state was entitled to free (at the point of entry)healthcare and education. That it was the government's duty and responsibility to provide for the weakest in society - hence the Welfare State.

Cameron and his cronies clearly don't believe in this any more. How could we not have seen it coming? With Mrs Thatcher's 'no such thing as society' it was always going to end up like this, wasn't it? Grab what you can and run.

I find it really disingenuous/ignorant to bemoan the private sector making money from healthcare. Private business and healthcare are firmly entwined and always have been. Drugs companies are for profit, as are tens of thousands of practitioners.

Should the public sector manage every aspect of healthcare, down to selecting and designing office space? Isn't it better to put those sorts of contracts into the hands of private sector specialists, who fund themselves and compete on quality and price?

There are opportunities here for surgeries to become bigger and better and meet the needs of their constituents. That investment has to come from somewhere.

It's fine and well to say you like the way things are but an ageing population with longer-term health issues mean the system can't continue as it is.

Finally, these plans did not happen overnight. There was a white paper in July outlining the foreseen changes, with a consultation that closed in October.

The trouble is that there is just so many unknown factors with these new proposals and when we are dealing with people's lives (and deaths) the uncertainity seems almost distasteful.

Increasingly over recent years the `patient' has been at the forefront of the NHS but this looks questionable with increased competition within a specialist market place. It seems that money rather than patients may be becoming more important.

And where will it stop? Will we see GP's declining new patients with existing health problems as potentially they will cost them more money? Last year I would have never imagined it but who knows? Yesterdays promises and reassurances from the politcal world seem very empty today.

I really do worry for those families with long term health concerns and conditions - these are the people who need the support and the appriopriate, specilaist services which might not be perfect now but may dwindle beyond all recognition.

The optimist in me hopes beyond hope that the services we have come to expect and access will still be there in the future.

Chandelina: Drugs companies - those would be the organisations that refuse to allow cheaper non-branded anti-Aids medicines to go on sale in developing countries, wouldn't they? Now that is going to happen here - or is it already? (I appear to have been asleep for the last 10 years).

trice,

Do you have evidence that everyone would be able to pay the cost of the health insurance that they would need in order to be able to provide a health service for their families if the NHS were privatised? I think that most people in England, never mind the UK,have enough imagination or memory to be able to see themselves as poor and in need of a free-at-the-point-of-delivery health service and they would not vote to abolish it.

Which is why Mr Cameron gave all those lovely re-assurances before the election.

Havent finsihed the thread yet, but getting Lansley in to do a chat? Not likely. I heard it grapevined that he accused Dr Claire Gerada of being a hysterical woman!!!!!!!!!!!!!

Lala truly is an absolute tosser

Just a quick aside on the theme of pharma companies.

One bit of privatisation I would love to see is drugs procurement. I'd staff it with Tescos most hardheaded Rottweiler procurement staff and get then to use the size of the total spend to really drive down the prices.

Hammer if you see a physio, speech therapist, dietitian, OT, podiatrist, radiographers who work in NHS they will need to be registered with the Health professions council HPC (docs and nurses have similiar professional registers) and you can check them out on
www.hpc-uk.org/aboutregistration/theregister/ The HPC also checks out the qualifications,skills and experiences of those coming from other countries to ensure they meet UK standards before registering them which allows them to work in NHS.
Unfortunately those working outside the NHS don't need to be registered so their qualifications could be anything, and thats what worries me about letting private contractors provide services.

Personally if a patient asked me about my qualifications and experience I'm only too happy to tell them if it reassures them that I have the knowledge and skills to advise and treat them appropriately so please don't feel you can't ask.
Its very disheartening working in NHS now as I feel standards are being downgraded to save money and the quality of our health service is in grave threat. Whilst treatment might still be free at the point of delivery I am doubtful whether the quality will still be there once the coalition have finished with it.

I find my GPO hugely more competant and helpful than the PCT, and I welcome a shift from them to her. No idea how she feels about it. But getting rid of two tiers of wasteful management sounds like a good idea to me. Perhaps they could spend that money on the patients.

Oh, and more like the American system? Bring it on! NHs care is very much inferior to that available in the the states. Granted you have to pay for it. But the quality of the service is definitely superior.

Good point, oni.

Interesting to see that Mark Bricknell, who was the head of commissioning at the Department of Health, has now leaped into a private sector job. Conveniently with KPMG who just happened to win the contract for running the NHS in London. And golly gosh, is that his old Department of Health deputy who is working there with him? So much for probity... the people who drew up these ideas are lining their own pockets already and screw the rest of us.

Would welcome an MN campaign to protect the NHS against being carved up and sold off to the cheapest bidder. And to ensure that any reforms involve the strongest possible public accountability.

No-one voted for this. It wasn't in the Tory Manifesto. Even the coalition agreement merely talked about making the NHS more democratic by working closely with local authorities. There is NO mandate for this at all.

Strix - afraid you are being a little generous about the US health system. Try having a brain tumour over there - you will be bankrupted by the medical bills. In fact a startlingly large proportion of all bankruptcies in the US are to do with medical bills. Insurers don't like people who cost them a lot of money. Develop a serious or chronic disease and you are in a whole load of trouble. Lose your job and you lose your health cover. G

Look up any international comparison of the cost and quality of healthcare and health outcomes and you will see the US does very badly indeed. Shockingly so for the richest, most powerful nation on earth.

The best-performing, highest quality services in the US on any measure are run by the Veterans' Health Service. Which is basically a mini-NHS for servicemen and women and former servicemen and women.

Thanks Mumzy.

I know everyone in the NHS is really busy, but is there anything you can do from within? For example, every time you feel standards are being downgraded, could you file a complaint? Even an anonymous suggestions box might work, if individuals are worried about being identified. Or an online forum, a bit like MN where your identity is protected? Be open about it, get IT to set it up so it's all above board, and everyone can see what's going on.

Managers usually have to account to someone too, don't they?

Then there's also the press?

There's not much worse at work than feeling that things are getting bad and there's nothing you can do.

Re US: If you are admitted to A&E they will save your life. However, before they go any further at all, they will search your pockets for your insurance details. No insurance, no treatment, and off you go to die of internal bleeding or whatever. No, the US system is hideously unfair in that way.

I am an NHS employee, I moved across from Private Healthcare.

It's horrendously badly thought out but those people out there (in RL land) who don't know how these systems work are going to potentially be sucked in by this.

'Reform is needed'? - really? By whom and for what purpose? Private healthcare operates for one reason only - profit. Standards CAN be higher, they can also be lower.

If there is no profit in something, will they provide it? No, because they are not benevolent charities.

What happens if you, or your famly, suffer from something uncommon, but expensive? How many local options do you think you will have? The NHS provides ALL services in ALL areas because it has a duty of care. Private companies have no such remit, nor will GPs.

It happens already to some extent where expensive services such as neonatal inpatients for twins have too few beds, so some parents have one twin in one hospital and one twin 100 miles away in another. This potentially could be worse with private healthcare as there wil be no demand to provide all services in all areas.

What if your private carers in your area specialise in heart care and you need lung care? Prepared to travel? With DLA and other cuts you might not be able to afford to.

It's being markets as 'choice': the reality is, there wil be no choice except for those who pay.

Services are already being cut. There is no 'top heavy management' and unnecessary paperwork - the NHS is as streamlined as a racing whippet. Waiting times fell massively and most care is well within targets (now scraped of course - no time targets to hit anymore thanks to Cameron).

It's a disaster. Truly, a fucking disaster. These boys are fools, like kids let loose with the toybox unchecked by adults.

Some people have asked how doctors are going to be trained. I work in medical education & training. There is a consultation paper which opened last month following on from the original White Paper. Make of it what you will but remember the NHS is currently the country's biggest employer so we are talking about the education & training of over a million strong workforce.

We currently have a system that is pretty eficient - in my view a well-managed regional administration employing and training junior doctors and dentists. Why this needs fiddling with is anyone's guess.

The proposals will lead to deregulation and inequalities in the provision of education and training - ultimately putting patient safety at risk.

We've been stuck in with the SHA in recent years so the only thing that needs to change in my view is that we need a new home if thye are going to press on with abolishing the NHS management structures. I didn't sign up to the ethos of working in the NHS only to be farmed out to some piddling private company. I have an ethical problem with executives capitalising on people's helthcare needs.

Typos!

Those people who think a capitalist structure will improve healthcare services - why, exactly? Because the NHS, Europe's biggest employer, is managed by bungling idiots who can't manage to get 'proper' jobs elsewhere?

The fact of the mater is, it is a crime that pharmacological companies have held the economic power for so long. It has in fact results in massive bills for the taxpayer by drugs companies holding the NHS to ransom for some expensive drugs. Similarly it has lead to loopholes where pharmacists could buy within a free market and charge the NHS (DoH) what they liked - there is no obligation to provide best value.

Private interests will clash - people may be on boards of directors, agree to buy X amounts of drugs at inflated cost, pass the cost on to the taxayer. Happens already but the policies within the NHS prevent this from happening where possible.

Private healthcare will have no such compunctions.

And what happens when the money drops out of certain markets? They will withdraw, that's what. Postcode lottery, anyone?

My Trust works in partnership with my old employer, this the thing that Labour started. It works well because the NHS can tighten the reigns. Remove the overarching NHS and you have free reign, overseen them by whom? GPs? Don;t make me laugh, some of them couldn't organise a piss up in a brewery.

AND furthermore (can you tell I am angry??!) people have paid their taxes to support the NHS for all their lives. They have paid, upfront, for free healthcare at point of need. Removing that is tantamount to theft. It is a rather large white lie that the NHS cannot be sustained. It can if they want to, the fact is they have been dying to dismantle and privatise it for years, so their greasy little fatcat mates can get their hands on it. Now the voters have let them in to do just that.

Tigerseye and Ange - For some reason (I'm just not very bright, I suppose) I just accepted that the NHS must need reforming in some way. I think it's because if you hear it said often enough on the News, you end up believing it. It's like if the government say they have to cut everything in sight often enough, you do end up assuming it's true. Mistake.

I worked in the NHS for three years as a student psychiatric nurse.
Perhaps it's pertly to do with the type of work I chose, but I do feel there was plenty of room for improvement.

I re-trained as a teacher, and feel the education system is getting more things more nearly right than the health service.
Others, of course, may disagree.

But as an employee I have felt more enabled to do a good job within education than in health.

However I don't think the NHS really needs re-organising, again. Trouble is governments like to look as though they are doing something, and re-organising the management is the easiest way to give that impression.

( Watch out DC, we're a wiley, cynical old lot you know, and who can blame us ? )

I think it more needs a new ethos of care.
Nurses in particular to be more enabled to care for patients.
A greater emphasis on a personal approach, time to get to know and talk with patients.
A decent priority given to the crucial maternity services, involved with young families at such an important time.

This sort of thing - the stuff that really matters and makes a difference.

@ mumzy and hammer

occupational therapists, physios etc. working outside the NHS still have to be registered with the health professions council.

those titles are protected and only a person who has proved they have the necessary qualifications and can evidence their ongoing learning can register their name.

it is illegal to call yourself any one of the protected titles if you are not on the register, no matter who employs you

All the ideas come from Andrew Lansley's wife - she is a GP apparently. They discuss what she wants in bed at night and then he does whatever she says, it seems..

GPs can't employ people as NHS employees as they themselves are not NHS employees. They will employ private companies and management consultants. It will be privatisation of a large element of the NHS.

I'm a AHP and went out last week with friends who all work for different trusts in London. Most of the conversation was about redundancies, people waiting to find out if they were keeping their jobs, two people now having to do the job of ten etc. All of us felt pretty safe at the moment as we just couldn't imagine them making running the services that we all work in on any less staff!

The NHS needs an excellent skill mix of clinicians and those with management and commisioning skills, and each staff group needs to have influence over every aspect of health care being provided. How can GP's, already swamped with the clinical responsibilities to their patients, also take on all commissioning duties too? It makes no sense to me at all.