Ok, I take the privatisation thing with a pinch of salt. I think there are other countries that use a combination and it works fine.
My concern is more about how things are going to work practically regardless of whether the NHS is dismantled completely as suggested here or private providers are involved in some but not all capacities.
I'm going to pick up on what was said by Viva on the first page. I believe Viva is a midwife (correct me if I'm wrong).
From working in a hospital I'm already seeing the changes. Hospitals are very much run as businesses with business managers and accountants in charge. Each dept/ward is a separate business, so if another ward want to have some drugs as they've run out we're meant to say no.
From what I see this is really problematic. Medicine doesn't stay in one department and if you are only concerned about your departments budget it has an impact on how you plan.
I'm going to use this example as I know about it, and its something that really bothers me.
The NICE guidance from November on ELCS came to the conclusion that although the cost of an ELCS was more than a planned VB, they were happy to say it was economically viable because when they calculated the cost of complications into the system of incontinence alone the difference was negligible. They came to the conclusion that they couldn't calculate all the downstream costs from the vast range of possible complications, but on balance based on the study of incontinence it was wrong to deny a woman an ELCS on the grounds of cost alone.
Fast forward to this month and the RCOG, RCM and the NCT released a joint draft guidance for Clinical Commissioning Groups to consider. And what happens? All the costs are purely on the raw cost of C-Sections, because they aren't interested in connecting the dots and are only concerned about one department. Its a very narrow minded and blinked approach to healthcare.
What happens when you separate one area from another and make a section private?
So whilst I tend to be more in the camp of CogitoErgoSometimes and don't think the guardian piece is whole accurate and I actually don't necessarily see private enterprise in the NHS as a wholey bad thing - there are definitely some areas where I see benefits of allowing private companies in, I also see there are already major management issues in running the NHS like a business with different departments even under the publicly owned umbrella. I tend to think that people are focused on the wrong problems in this debate.
My point is, I don't see that its necessarily who owns what that is the problem, but whether they actually work together and whether they actually put the right things first as priorities; patients first - not money, not targets pulled out of nowhere, not preferable outcomes according to a paper pusher, not policy and procedure over individual care, not factory production.
Health care can be run as a business, but its a very different kind of business to all others. And things need to be in place to make sure the patient always is the centre of all decisions, and not money. And thats equally true whether its publicly or privately run.