Is the Coalition telling us to say goodbye to the NHS?

[jamtodaybrighton]

Is anyone else really worried what the Coalition are up to with the NHS White Paper, and whether there is any way of stopping them? They seem to be backing a wholesale privatisation of the NHS. All hospitals will be Foundation Trusts, and they will be able to earn as much money as they like from private patients. Doesnt this mean that we will have the really ugly sight of a two-tier health service? Why are we going backwards in our healthcare system towards inequality, when other countries are trying to make theirs fairer?

And in community services, the Coalition does not seem to mind who provides the services. Their mantra is any willing provider. We are going to end up with hundreds of private healthcare companies doing things like community physio and podiatry. They will all say they are fantastic, but how will we really know? And the Coalition is ideologically wedded to light regulation. No-one will be watching these companies when they start to try to cut costs. They will be in healthcare to make a profit. Profit before patients - is that what Cameron meant by protecting the NHS?

Protecting the NHS does not mean conserving the status quo at all costs, surely? State-run monoliths are notorious for waste and inefficiency and the NHS is no exception. Efforts to introduce internal competition have consistently failed because the reality is that there is no alternative. The avalance of edicts issued from Whitehall get binned rather than acted on - so I like the idea of foundation trusts having control of their costs and practices.

There are much better examples of public healthcare systems even within the rest of Europe - better survival rates for patients etc. - and they successfully incorporate private elements. I think the 1940's model is long overdue for a rethink and we should learn from others' experience.

jamtodaybrighton - what facts do have to back up these worries?

"They will be in healthcare to make a profit. "

That explains why there's so many state-provided European services on the Internet, you see: those rubbish US for-profit companies just can't provide the quality that, no...wait...

That explains why the state-owned airlines provide such cost-effective service, while profit-driven companies like EasyJet and BA and Virgin are so...no...wait...

I'm just off to buy my British Leyland car because they're so much...no...wait...

My friend tells me you can get mobile phones now, but I'm still waiting for the GPO to install my party line.

No I don't think that the coalition are even thinking about abolishing the NHS but they need to look at ways to reduce the costs of universal health care and if private providers of health care are a way of reducing costs then it is their duty to pursue this avenue

But for decades people have been able to buy a private room in an NHS hospital. That type of thing is not really new. It's already two tier in that sense.

Secondly the NHS is the third largest employer on the planet after the Red Army in China and the Indian Civil Service I think. That is huge and big bodies have a lot of waste. The Coalition are committed to retaining our free NHS healthcare but they have a duty to improve the system where they can and they will do so.

jamtodaybrighton I agree with you - private services are MUCH more wasteful - 'choice' means there are at least 2 providers where you only need one, 'competition' means that one will fail and their investment (and staff) wasted.

Why are conservatives so keen to change something which is the envy of the world?! One thing that Britain does well and they want to break it.

If you compare it to dentistry, where it is now so difficult to even find an NHS dentist unless you pay, then it really is worrying.

chil - "There are much better examples of public healthcare systems even within the rest of Europe - better survival rates for patients etc. - and they successfully incorporate private elements"

Can you give those examples then?

lifeinlimbo

France. The taxpayer pays but the service is provided by private hospitals.

Germany. This is a "compulsory insurance" model and it seems to work well.

The "old" NHS model of the government running hospitals is outdated and inefficient. I am glad that with Foundation Trusts etc, the system is being moved in the French direction.

"Can you give those examples then?"

Not only France and Germany but also Holland have very good healthcare provision and I understand that the Singaporean public health-care system is particularly effective as well.

The NHS just 'happened' overnight in the forties. What one day you'd had to pay for, the next day the government paid for. Fantastic ideological leap with huge social benefits but with a lot of waste and inefficiency built in because of the haphazard way it was created and how it has evolved since. Why not take the Dutch system and see what they do that we could copy? Why is changing something for the better 'breaking it?'

France - most hospitals are public not private. Like here, where there is also BUPA if you want to go private.

Tokyonambu - there is a massive difference between airlines and cars, and healthcare. Not everyone needs a car etc, but everyone deffinitely needs healthcare - for the public good!

Chil- it definitely is not changing things for the better. At the moment I can see a local doctor within a few days, with a standard of service that is consistent across the country, and be refered for any further treatment I might need. Emergency services are also easily, immediately accessible and free at point of care.
Our services are well joined up.

Lifeinlimbo - Belgium; where healthcare is a mix of state and insurance and bloody good too.

The standard of service is really not consistent across the country or we wouldn't have phrases like 'postcode lottery'. I've been referred to a specialist by my GP and the earliest appointment I can get is 2 months away. My Belgian colleagues tell me this would be unacceptably in their system. Emergency services are free and easily accessibly in Germany, France, Holland, Singapore etc..... As I keep saying, we keep what works well and we change the things that are poorly done.

Why suggesting the NHS could be improved is seen as heretical, I'll never understand.

No-one is saying that the NHS is perfect. But it is an organisation that is highly valued by many, and that most of us want to keep not wreck.

Chil1234 and Xenia: I agree that the NHS is a huge organisation, and big organisations always need to make sure that they are being as effective as possible with public money. But I worked in health for a long time, and every year we had to find significant efficiency savings ? on top of which we had to find more savings again if there were any new services that everyone agreed would benefit patients but couldn?t be afforded. We had to constantly review what we were doing, and every year try to do things better and cheaper.

Also, the NHS is often accused of not wanting to change, but there has been a massive cultural shift in terms of waiting times, more daycare surgery, development of multiprofessional teams where nurses and health professional staff take on specialist roles, organising appointments around patients availability, more access to health care nearer home, changes in junior doctors working hours etc. It is convenient to say that none of this has happened, but it has. Respected organisations including the BMA are lining up to tell Lansley that the proposals are hugely risky, will actually set back progress on health improvements for several years due to the disruption, and do not have any clear benefits.

These proposals are opportunistic, and not really about improving health care at all. They will change the nature of the NHS completely and, if we let it happen, it will be almost impossible to get it back. Let alone that they said they would not do it.

lifeinlimbo - I live in Holland and as a higher rate taxpayer, I pay 94 euros a month health insurance with an annual excess of 165 euros. I can claim partial reimbursement for glasses and dentist too (dependent upon policy taken.)

Low earners can claim a "benefit" towards insurance and of course some companies provide it as part of your compensation. As an adult it's a legal requirement to have it, my son is covered for free.

I've just had a baby (emcs & scbu) - my care has (unfortunately) been far superior to anything the NHS could provide and I was also given a home nurse for 8 hours a day when I left hospital for 5 days.

My health insurance firm still makes a profit. The NHS is indeed a monolith.

no I don't think they're telling us to say goodbye. I don't think we'll have time to say bye before it's gone.

I've worked in the Netherlands and Australia and both have superior health systems based on a health insurance that are also considerably cheaper.

The NHS needs to be killed off ASAP and something decent put in its place which provides first world healthcare without the ridiculous debt burden it creates. Other countries can do it... why not the UK?

Yes Tokyo, quality in America is fantastic if you have money.

If you don't you are truly stuffed. The tories won't care though...'I'm alright Jack' being their ethical stance.

And look at the railways.

Oh yes, other countries have fantastic, privately operated rail systems. Why can't we? Good question. We haven't though, it's totally crap.

I think the NHS will go the same way.

Its not the modernisation thats the problem per se its the speed and lack of consultation.

nd the fact that it is being done in such a way so that future govts wont be able to change it back.

Senior healthcare officials and indie organisations are in a state of complete panic.

The skills loss alone is said to be projected at 40% where normally you would expect 15% for a restructuring - coming so soon after the amalgamation of the pcts its just ill thought out.

Not to mention giving areas like public health to councils and scrapping funding for lots of other initiatives.

What happens in France, USA, Holland etc if you don't or can't pay for it? The insurance / cost of consultation.

I agree with teh OP (no surprise there).

I wonder who is going to provide the services which are difficult to make profitable.

I wonder what will happen if eg a hospital only manages to get contracts for 2/3 of its services - it won't be able to run on that - it will have to shut?

I worry about large hospitals on premium land especially in London being sold off.

I wonder how, if you are seeing 4 or 5 different companies for your treatment, how notes will be transferred between them safely (data protection).

I worry about a lot of it TBH.

I think that running a service like this for profit is just a bad idea.

I also wonder how it is cost effective to pay GPs (some of the most highly paid people in the NHS) to run everything (which they have no experience of doing) - rather than lower paid people who have experience and presumably the right skill set.

GPs have a skill set which to my mind does not point in the direction of cheerful group agreements. they are used to working alone, for themselves, they have very strong views, are decisive, and like to be "right". A generalisation, but they're appropriate qualities for GPs. I can't begin to imagine how they are going to band together by the hundred and agree on how to run the NHS . I mean, they don't want to do it themselves.

When is the White Paper due?

At its inception, the NHS also took private patients, and this wasn't abolished until the 1970s. Balancing the books is going to be tough, but if this provides extra funds I can't see why we shouldn't return to its roots on this one.

I'm much more worried about GP led funding, especially as someone has posted that the BMA is against it (they were so right in their opposition to the last administration's new GP contracts). Especially the funding of cutting edge uber-specialities which individual GPs might want to refer a patient to only once in their career. Even big polyclinics are not large enough to provide a fair picture of population needs.

this is quite an interesting overview of systems around the world. it looks like the french govt pays more than ours. health insurance premiums are taken out of pay - both employer and employee contribute. So like NI. But then most people pay out of pocket for "top up" insurance as well. That doesn't sound so great to me TBH. More expensive and people are still paying on top.