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?

The evidence on choice is mixed. People generally still choose the hospital which is nearest to them. Unless you live in a large metropolitan area, your choice is a false one.

I have read some of their documentation to see how on earth they could be possibly justifying all this. They seem to be so focussed on power. Power to the patients and power to the gps. Surely all patients want is good healthcare and good treatment. Power? v odd language to choose if you ask me.

'Competition drives up standards of healthcare, if a hospital is dirty or has poor treatment quality then people won't go there.'

What's your evidence?

People will go to the nearest hospital that can fit them in, whether it's clean or dirty. They won't have a choice, as other posters have said. Choice for patients is meaningless in this context. All anyone wants is to get better.

These arguments are getting circular. Read some of the earlier posts about how the more expensive services in your area will fold because no-one will want to provide them, etc

Haha, so we ar all going to get more, free, better healthcare for less money?

Through private investment and profit-making businesses?

Really?

I think it is naive to not reckognise that we have all had the benefit of free local services to meet all our healthcare needs with some of the highest standards in the world.

You want to replace it with insurance? Those countries in the world with insurance schemes spend MORE per capita than we do to run the NHS. And actually, they don't get better care, necessarily.

So explain please, I must be thick. I have worked for private healthcare, they chase the buck. Not only the buck, it's true, they want to provide good healthcare for their patients, but believe me, they behave ruthlessly and if the buck aint there, they aren't either.

BUPA by the way buy old NHS equipment and charge private patients to use it. The NHS has more modern equipment to do a better job. Private does not necessarily mean better. I could have paid for a bone density scan at my local BUPA for £100. My NHS area has its own scanner - a new one. For fre. The sold the old one to BUPA. This happens everywhere, I hear it again and again. I find it shocking.

So why will there not be black holes in healthcare? Or poor quality care? Or less choice?

Hammer I do see where you are coming from, but I think it is simpler than that - Lansley seems to be a bit of a zealot who has a vision for the NHS and has insufficient humility to listen to anyone else. I think that they have moved a bit away from a private system but this is effectively fragmenting the whole service.

Evidence, its the classic market mechanism suppliers which provide a good/service that isn't of a satisfactory standard go bust provided the market is functioning properly.

Nowwearefour, no government ever gives up power voluntarily. The first thing that matters to them is to stay in power, because they can't do anything if they are not elected. They want to reduce the role of the state, but it's not the same thing. What that means, I think, is that they want to give more responsibility to other organisations so that they are not called to account, and don't have to fund them. So people will vote for them because they don't blame them for things that go wrong - in transport, education, health. That's how I see it anyway.

I notice the eg that hasn't been given of private companies running service and infrastructure is Railtrack, perhaps because that one all worked out so well.

It's not written in their share prospectuses that private companies must behave like this, but fragmentation and profit-seeking make them extremely prone to it.

For a private company, the primary customer is the share-holder or private owner; the person who travels on the train, buys the sausage roll or consults the doctor is merely a means to serve that shareholder. Sometimes this works out well for the train traveller, sausage roll buyer or patient; sometimes it doesn't. When there's a conflict of interest, the shareholder gets looked after first.

And I ain't payin' taxes for the shareholder to come above the patient.

Supply and demand depends solely on there being sufficient supply to offer consumer choice. It won't necessarily be the case with a privatised healthcare system.

Economics means that you provide the least service to get a reasonable outcome to make the most profit. To some extent the NHS does this to manage the small pot of money it has. Private healthcare does this to a greater extent, in my (aditedly relatively limited) experience.

And when profit margins go down, they pull out. What is there to stop them?

You may be right, Bedhed. He's definitely out for his moment in the spotlight.

huddspur read any basic health economics text book and you will realise the health care system does not work like a 'normal' market system. Why? patient's cannot make choices on complex medical care, it is not like buying a pair of knickers, it is hard to 'enter' the market - hospital cost a lot of money, it is highly regulated (for safety) and hospitals rarely go bust. You just cannot compare it. Healthcare is a social good. If it is treated as a normal market you get what you see in America, the most needy cannot get healthcare.

The problem huddspur, when you're diagnosed with cancer, you really don't have the head space to start analysing data on which facility is the cleanest or offers the best service. I'm sure the same is true of most people who are seriously ill.

Honestly, on a good day, I have difficulty comparing household insurance policies.

The people using the health service are ill or elderly or both. They really are not in a position to start scouring the market place for the best service.

I also wonder whether this choice will actually be available to patients or, more likely, to the GP consortiums? Will patients have to travel to X for CT Scan, Y for MRI scan and Z for surgery, because it will save a few quid?

I have been wondering, btw, why the govt feels able to take this monumental risk of tampering with our beloved health service, and I think it's because they have nothing to lose. Neither party got in on their own merits last time, and they know that the chances are they won't get back in next time on their own, so they want to bring in radical new policies that no one party can get blamed for if it all goes pear-shaped.

I've just realised this (I'm a bit slow).

You are right Wubbly people really are very vulnerable when they are seriously ill.

bedhed I'm not advocating the american healthcare system by any stretch of the imagination, I think you will find it difficult to find a worse system than the American one. In France the Government ensures that everyone has insurance as its mandatory and it pays either contribution or the whole lot depending on income, no-one goes without

There is a parellel though with drugs companies. Certain drugs are sexier than others and get researched and marketed - and sold at high prices. Areas that can be profitable are well-researched (some would say over researched) and others fall by the wayside. Drugs companies flog their products very hard to GPs and consultants. Some have cornered the market.

Some diseases - women's diseases in particular (take endometriosis as an example) don't attract research funding mainly because they are not sexy, they are complex, there is a male-dominated system, and for many there is no 'cure'.

Sexy gynaecology are areas like IVF, where there are positive outcomes to be had, a bit of glamour, your name in the papers. With less sexy diseases there is no such outcome.

There are fewer doctors therefore training and specialising in less sexy diseases. Fewer want to go into those areas as they can't be lauded for finding the next miracle treatment as often there isn;t one, or if there is it is a long way off.

'Cinderella Services' is another nickname for it - mental health is commonly termed this. The poor relation, that no one wants as it's expensive with no clear successful outcomes.

If you are cursed with an unsexy illnesses, you will be looking at less choice, not more. No profit+no glamour=no profit.

In France they spend a hell of a lot more than we do on healthcare! So will we be doing that? Nope, it is about cost-cutting.

I agree with Huddspur I think we should seriously consider emulating France which has the best healthcare system in the world.

The idea that people want to research and travel to get treatment is just silly. As with schools, most people want to go to their nearest but they want their nearest to be good. Some money and time rich and educated people may do their research and be able to travel to the hospital offering the best treatment but as with schools the most vulnerable people will have no choice at all.

But no-one in the govt looked at any other system.

So France and Germany offer more choice, better outcomes, no up front charges, costs less to provide and no-one goes without?

If Carlsberg did healthcare...

Tigereyesmum I think you have a very good point there. This is a worry and mental health is one area that GPs themselves have said they are not confident about taking over.

I think the only way we can compare ourselves with France etc is to spend as much as they do, look at outcomes and see if they are different then.

Elieson said: No, it certainly isn't a clear-cut party issue. As with tuition fees, Blair made this possible with his encouragement of the principle of market-based public-service provision. But I hope that the renewed Labour Party can come up with some very trenchant opposition to the reforms. I don't trust them to lead opposition, though. I don't know what the best thing to do it, but for a start I would like to see a clear public voice in support of all the health-related unions for any action they take.
Add message | Report | Message poster gettingtogrips Wed 19-Jan-11 09:16:37
Our local hospital has ALREADY built the surgical centre to be used by private companies, with NHS staff, on NHS land. Take a look at your own local hospital, I bet many have already built the private facilities.

Don't kid yourselves, this plan was initiated under Labour. These things always take years before they're announced to the public.
Add message | Report | Message poster ToxicKitten Wed 19-Jan-11 09:32:54
It all boils down to money over people every time.

No-one has the courage to stop and re-evaluate "ideology" and accept that all human life is equally valuable, regardless of gender, colour, age, creed and ability, and that money is the thing that causes the inequalities.

Even if you accept and believe that as an individual, all the time that principal is tested, because it's "not realistic". It's only not realistic if you believe it is.

We live in a world where it is apparently "ideologically" unsound and "naive" to truly want to live in peace and harmony and equality and see everybody treated well, and if you express those sentiments you are regarded as well, a bit "mad". So you go around trying to live responsibly as an individual and despairing because lots of people obviously feel the same, but trying to "do" anything co-herent about it is constantly undermined by the practicalities which are all created by..... money.

"Big Society" actually seems to mean that some people are bigger than others. Like some people are more equal than others, allegedly.

We say it's "human nature" but I sometimes think that's an excuse.

These NHS issues are such a reflection of money over people. How can caring for the sick and needy ever be quantified in monetary terms? What happened to the concept of vocation? Why does "good organisation" have to depend on systems that ultimately relate to "money" over "people"?

Think about the language that is now applied to everything - "clients" "service-users" etc. That is the language of business, not humans.

I used to think I was a bit thick because when my son went into the education system I felt bamboozled by the terminology used. It's the same now when I read anything to do with politics.

Politicians used to talk in rhetoric and with passion, and policies were clearly defined by their beliefs. Now it seems they all talk the same language - making money.

Am I being particularly negative? Am I seeing what I want to see? Am I a bit "delusional"? Because although many people tell me things aren't that bad, I wonder if it is the way we have been brainwashed over the last 40 years or so by the Powers That Be that resistance, or doing things differently, is a futile effort.

If you can't beat 'em, join 'em. Hang the cost, and if you don't want to play because it feels all wrong, it's your problem, not anyone elses.

Campaigns - great, let's get to it. But every principal will be manipulated and negotiated until you think you've got what you want, and then you discover the catch.

Labour "got it all wrong".

The Conservatives are "getting it all wrong".

Can anybody get it "right"?

More to the point, has anyone got the courage to try and do so?

They might lose money.

Can't have that.

Money and property are valued more highly than life in our justice system.

Think about it.

[END OF HER POST]

Blame JFK for how rubbish politics became, and then blame Bill Clinton and Tony Blair for the massive amounts of spin, use of "soundbites" and general corruption (cash for honours/influence)that has been present in politics for the past ten+ years.

Gordon Brown got it generally right, with two key exceptions - not cutting back public spending massively in 2008-5.2010, and not being good enough at PR to present a viable alternative to DC/NC.

We'll need time to see how the reforms work - as one minister said, they will make or break the reputation of the coalition.

The bottom line is that there is less money in the pot and services are already closing and being severely cut back.

The cynic in me suggests the NHS is being run-down to pave the way for private funding. Our waiting times have already gone up.

I cannot work any longer or harder than I already do. Maybe I should welcome private healthcare with open arms - I got paid almost a third more and did less work

Oh except - hang on, I know....private healthcare services closed, opened, closed, opened, moved, were crap, cut back, saved money, delivered care on a shoestring, courted the government, operated in a cut throat manner to eliminate competitors, were badly managed by overpaid twats and eventually wound it down as not profitable enough. Then the NHS stepped in to pick up where they left off

wubby - the NHS comes out top of the international league for access. So however good France and Germany are, it's more expensive and some people are not getting the care they need.

I'd love the government to plough the same money in as the French do. Instead they are cutting £20bn - 20% of the entire budget.