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 blood ran cold at the man on R4 this morning who said that doctors and nurses shouldn't be civil servants; people need food and clothes but the government doesn't buy them for you, so should it be for health ...

So that's it then - health according to your means to pay. Utterly sickening. Has really coloured my view of the post dh is applying for in NHS England at the moment.

Hope that the reconstruction goes smoothly wubblybubbly and that you stay well. I had a lump investigated several months ago, and the whole system, from calling GP to getting mammogram and all-clear, was faultless, brilliant, and kind.

Thank you Eleison

The whole process really hasn't been as bad as I thought. The care I've received has really helped me to get through this, allowed me to believe that there is life after cancer.

Living with the fear of it returning is made just about bearable, knowing that this amazing team of people are there for me, dealing with my worries and concerns. I feel like the safety net is stripped away.

Of course, it might not, but the unknown is such a worry for people going through this. For some reason, I'm not in the least reassured by Cameron's words.

Another despondant NHS worker here! so many cuts, staffing levels reaching dangerous levels on our ward, its going to cost someone their lives in time!

From The Independent today:

"As Nigel Edwards, acting chief executive of the NHS Confederation, noted in yesterday's Financial Times: "By 2014, the NHS will no longer be a system which still contains many of the characteristics of an organisation ... Instead it will be a regulated industry ... The Secretary of State will no longer have the power to intervene in NHS organisations which will stand or fail on their own ... there will be no power for the secretary of state to prop them up, or intervene if something goes badly wrong ... And unless a service is designated as protected, it will also be possible for a hospital or other healthcare provider simply to stop providing a service or operating a site from which it can no longer make money". Approve or disapprove, the policy marks the end of the NHS."

Since in this new 'regulated industry' the providers are paid by the state through taxation, the state is the ultimate 'customer', but that is the one customer that this govt is quite happy to crush into impotence.

Yep, our life-threatening illnesses are opportunities for private enterprise.

The problem with the NHS is that it has become a massive black hole for money. As people live longer and we find more and more cures for ailments minor, major and life saving are being discovered every day which the NHS fund and population increases it is constantly increasing the amount of government funds it takes up.

The NHS is currently horribly understaffed, and many PCTs are running out of money every year, there are several PTs that have cancelled a lot of elective surgeries such as hip replacements until April as they can't afford them until the new financial year. This is only going to get worse (under the current structure). So it's already not managing onthe money it gets.

If we carry on with the current structure and pour an ever increasing amount of money into it, this will not be sustainable over a period of time, we will never have enough money to fulfil everything people want from the NHS. Something fairly radical has to be done, or we have to accept that we finance the NHS at the exclusion of all else, taxes will need to go up, and even more than has already been cut will need to be cut.

I have no idea whether this proposal is the correct one, I see strengths and weaknesses to it and it's not my field of expertise. However I'm genuinely curious as to what people think the other options are, because I read a lot of No, it's terrible, but little about what should happen instead.

UNISON MARCH FOR PUBLIC SERVICES

action.unison.org.uk/page/content/march/

lucky, the living longer and more cures is not a problem for the NHS specifically, it's a problem for healthcare.

So even if you have entirely private healthcare, these things have to be paid for (tho I guess not paying for more cures solves the living-longer problem...). Under a private model, the payments are called insurance premiums and funnelled through private, profit-making companies which describe paying for treatment as a "medical loss" to their business. Under a public model, the payments are called taxes and are funnelled through non-profit-making organisations which put clinical need first and answer (often indirectly) to the people through elections.

The real gold for a private company is a public-private partnership where you privatise profit but socialise risk - when you do well, you get to keep the dosh; when you fuck up, the taxpayer bails you out. Or dies, depending what sort of fuck up it was.

No, I'm aware it's a general healthcare issue and how payments work - I mentioned it solely in the context of the NHS as that is what the conversation is about.

So what should be done?

I supported the "put a penny on my tax" movement back in 1997 and would do so again. A good NHS is something I'm very, very happy to pay for.

I say this as someone who's lived all across the world, under every kind of health system or lack thereof. You have no idea just what good value the NHS is. (US, for example, pays twice as much for healthcare per head for a lower life expectancy.)

I also wouldn't destroy NICE and fragment the Health Authorities into tiny weeny GP consortia. One of great advantages of being a mega-organisation, as the supermarkets well know, is purchasing power - you can demand favourable prices. No wonder big pharma wanted NICE disbanded, with its "value for money" calculation before it would permit a drug. They must be rubbing their hands at the thought of separate presentations to individual GP groups with the bargaining power of a gnat, and who are GPs, not MBAs.

I predict non-urgent lab services (genetics, histology, some haematology) will be made private in the next 10 years.

Newsnight are running a segment on this tonight and are asking for question to put to a presumably junior minister.

If anyone's interested?

It is interesting to take the arguments in turn:

It will cut bureacracy

Really? creating more mini organisations? giving more generous management allowances per head? The growth in management has been to a certain extent due to the growth of the internal market in healthcare. Costs are 8-15% here, in USA they are 30%. USA spends more per capita on healthcare than we do. The NHS is actually quite efficient.

There is no other option - grow up

There was also no appraisal of the options. No look at what has worked and what has not. And the DOH has refused a freedom of information request to look at what the DOH considers the risk to be. We can guess why. Surely there was a more cost-effective way of achieving these (rather diffuse) goals?

The NHS needs to make £20 billion savings..

These were already in the pipeline, before the election. Common sense will tell you that the kind of management needed to make unprecedented savings is not one learning the ropes.

Clinicians need to make decisions for their patients and it will improve care

No-one is arguing with that one. However I would not like to be a GP in a few years time refusing my patient IVF because my consortia has decided not to pay for it. The quality of care provided by a minority of general practice is poor and commissioning is complex. it is not all black and white.

Patients will have more of a say.

Actually it is not clear they will. There will be an organisation run by local authorities to keep an eye on services but I cannot see how they are going to have power over indedependent GP consortia

No-one, except Lansley thinks this is going to work. It will be a pleasant suprise if the NHS does not deteriorate. DC has been forced to back it otherwise he will look like a prat. Sorry this is a bit long.

we need to agree on one q for newsnight.let's not waste this opportunity!! anyone want to start the ball rolling?

Where are Newsnight asking for this question?

Ah! Here it is.

Get posting!

Why, in the face of almost unaminous professional and expert warning about the pace and circumstances of change, and without an electoral mandate are you going ahead with this?

Sorry didn't do the link as I saw it on last night's show, have done their facebook comment.

nowwearefour - anyone can ask a question the more ideas they have to run with the better I imagine...

bedhed well put!

What will you do when private companies make money from treating the 'easy' cases and monopolise the potentially lucrative specialities, leaving the NHS to try and pick up the pieces on the loss making, difficult and complex procedures, when you have already said that there will be no financial bailouts?

Thanks Doris. Will now get off my soapbox and look after my unwell baby!

In that case doris may just post direct.

Am still struggling with the utter shitness of what seems to be happening to the NHS.

Everyone - we can also post questions to Lansley for Friday's edition of PM here

great- let;s get posting. thanks for the clarification Doris- i realised once i had seen the link so the more questions the better. i think if mumsnet is referred to and the strength of feeling on here, it cant harm.

The Beeb are looking for people to interview here:
"Are you undergoing treatment? Are you concerned about the changes? Or are you a GP? If you are willing to be interviewed by the BBC please fill in the form below."