Can we stop the privitisation of the NHS?

[nametakenagain]

The proposed changes to the NHS prepare the ground for heathcare in this country to follow the American model where you can have what you want if you can afford it, but there's not much for people that can't.

The NHS isn't perfect but it is the envy of the world for good reason - no other country gets the same high standards without putting in a lot more money.

Neither rich nor poor benefit where organisations make a profit out of sickness (the rich get encouraged to have unnecessary tests and surgery, the poor can't afford what they need).

Not many people in this cuontry would want this to happen, but it seems to be going ahead. I can't believe most of the MPs voting in favour realise the implications, or maybe they're too scared for their jobs. There have been a few campaigns to stop the bill but it carries on.

Any ideas?

Why on earth can people not see a plethora of solutions existing between NHS and US-style?

childrensdocmum AND Mostlymum no surprise that I agree with you both, I have seen on mumsnet a high number of socially aware and one might say socialy responsible. However and I do not make light of the problems that DO exist in the nhs, you will see from the posts in this thread a strong current of at best Laissez-faire liberalism. The type that has markets know best at it's roots. The kind that thinks everyone is self centred, self serving, and only in it for themselves.

This country is obsessed with how we are a much more frightening, violent, "diffrent" society than we used to be. "Community and society are dead" we have been told, the problem is that "we do not know our neighbours" we hear. We want to be kinder and more neighbourly to each other to bring back what we percieve we have lost.

Fine but when people like me point to the nhs as being just about the only area where each and every one of us has a stake, a say, a chance to know our neighbours because we share the same service. As a society we know about the inequality in health, we should be horrified that poor people, children, the elderly, and disabled children and adults are going to be hidden away behind corporate lawyers and ranks of PR suits. Private industry, all private industry does not openly or gladly tell people about it failings, nor does it share openly the way it allocates resources. Tragedy's like the rail disasters show us that even when things go very badly wrong, huge amounts of extra public spending, years of grief and anxiety for those involved, and lastly no accountability is what we should expect from profit driven public services. No it does not have to be this way, we could have a system like France I do not know if private companies are any better in France or any other country at being open and accountable, what I know is that this is not the type of capitalism we have here. It will not be the type of capitalism behind any of the private companies that provide health care. So why bring in failed systems when we could fix the one we have, maybe never to be perfect but then only the stupid by in to this shit that huge public services are "patient led" or are able to offer "choice".

"I can't understand why labour aren't fighting this more"

Because they were the one's who introduced the principle in the first place, thus laying the way open for these moves which are in essence a straightforward expansion of their policies.

There is no credible party which does not have private suppliers as part of their NHS policy. With the principle having been conceded a decade ago, all that is up for grabs now is method.

blogs.channel4.com/factcheck/factcheck-qa-the-boom-and-bust-of-cosmetic-surgery-in-the-uk/8956
Go on all you pro private posters explain why we should trust or give money to people like these!

Childrensdocmum & Mostlymum. I'm genuinely interested in what your concerns are. No doubt you are concerned but you haven't explained why.

The information I've read has mainly been on news websites. At a high level, the principle of competition isn't a bad thing in my mind. As long as certain safeguards are in place.

I'm open minded on the changes. I see some advantages in GP's being able to shop around for the best treatment for their patients but can see the inherent disadvantage that this could be abused or mismanaged by some. But this is again something which we should put safeguards in place for.

Shilling, we're not (well I'm not) pro-private to replace the NHS. But just that competition isn't necessarily a bad thing.

The thing is to those who think the NHS is the envy of the world. If that's the case, why isn't any other country rushing to emulate us?

Notthefullshilling: the procedures in you link weren't NHS operations contracted out to the private sector, nor were they covered by NHS clinical or corporate governance standards.

I am very concerned, particularly about clinical governance, in the new NHS model. But these examples are not related to it.

Should the bill be passed in its current form there will be an increase in private providers.

Why is this bad?

Here are 10 of the reasons why I am worried

1. Competition occurs in markets - the idea being it will drive prices down- think ASDA. TESCO etc, what happened to the small shops and the big ones that could not compete? (Think KWIKSAVE, SAFEWAY) they were bought out or folded up, what happened to the staff? Unemployed, working elsewhere).

1. Private companies pick and choose the easy, safe bits of work.

I read a BMA report that said that research indicates some independent treatment centres run at less than full capacity yet get money for running at 100%

1. Private companies are not obliged to share information in the same way as NHS bodies.

Private healthcare providers cannot be compelled in the same way to release information - so what happens when things go wrong? Thinking about all the inquiries into failures in healthcare recently.

1. Major changes are taking place on the ground before the Bill has completed its passage through Parliament.

Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) are to be abolished, it's not clear what shape the new bodies are to take, guidance keeps coming out but it?s incomplete. As no one is clear about the final shape there are concerns about how to plan the hand over to an organisation in an unknown form that is due to exist by April 2013...

1. There are real worries about the doctor-patient relationship being eroded if the PCT no longer buys your care.

For e.g. If your GP is buying your care- he will need it to be cheap, close and good, but how then can you be sure when you see him for a problem and he decides to refer -( or not refer you) if he is being unbiased in his choice? Remember he has between 1500- 5000 patients overall, of that number he sees maybe 20% regularly. His budget allowance will probably be accounted for that number. A PCT on the other had has people who have been buying in care on a regional basis for ages, have an eye to which providers do what and how good they are. Large cover - better buying power and less bias. (I am oversimplifying a major concern here about ethics and a doctor?s duty of care to his patient first rather than to a commercial provider and indeed his ability to choose)

1. Keeping people with less, getting less, and the rich getting the rich pickings, widening health inequalities, call it what you will.

'Choice' is all well and good but those who can afford private care will always go to the top of the queue; will be better informed and so always get the best available. The problem is that those who cant suffer indirectly as a result. A surgeon who is contracted to spend 37.5 hours in the NHS may choose to spend his 'sparetime' doing private ops- so he is tired the next day seeing NHS patients or if the person had a complication- it's back to the NHS which means someone waiting for a routine op gets bumped. Less perceptible is the little things that add up, the secretary does private referral letters in NHS time cos it's only one or two, the GP prescribes medicine to a private patient as it's extra cost to get that private too, so they delay doing a home visit for a few minutes, but it all adds up such that those who don't pay get a slightly worse deal, but on a population level it's massive. When a hospital is doing private and non private work how do they draw the line between the two?

1. There are a whole range of worries about who will train the next generation of doctors- it's sort of been fudged over in the Bill, who will deal with outbreaks and other public health emergencies. Think- if SARS came or a teacher had TB in school or a child came to school that later had meningitis or went to a farm and then got poorly with E.coli. Who steps in to sort it and has an overview of who needs what?

1. Before any new policy is released it is reviewed and its pros and cons looked at, something called a risk register is produced which basically tells the Government what the downsides are of a new policy being put into force. Despite repeated FOI request the Risk register on the Bill is yet to be released!

1. Concerns about missing words or the wording of the Bill that fundamentally change it from being about the NHS providing care for ALL to having discretion over whom to provide care for....Doctors leaders are fighting for that to be amended

10. NHS hospitals will be able to devote half their beds to private patients, (well 49%). What?s that going to do to waiting times? Even if everyone on the waiting list could afford to ?go private? the waiting times won?t improve!

At the moment the NHS gets along and its pretty clear who should do what. Under the new Bill the distinctions become far less clear.

Maybe we will end up with a totally pay-for health services with only those on very low / no incomes being allowed a free service. How easy is it to get dental care, or glasses, this is what will happen to healthcare. As for the 'less sexy' bits where no profits can be made {{shudder}}

These are just off the top of my head; there is far more definitive stuff here:
bevansrun.blogspot.com/p/welcome-to-bevans-run.html

www.38degrees.org.uk/page/content/NHS-legal-advice/ explains the bit about removing the Secretary Of State?s Duty to Provide

www.gponline.com/News/article/1106584/DoH-will-not-release-documents-NHS-reform-risks/ WHY?????

I have a friend with a severely disabled daughter in the US and she regularly goes hungry to buy nappies. They have zero home care. They have never had a GP visit their house, even when she was so ill she was crawling around doing the caring. They have to drive 250 miles to hospital and she sleeps in the car while DD gets treatment. Just to pay for the petrol (even their cheap petrol!) is a struggle. Her DD is 12 now and gets some help from the state. When she turns 18 I don't know what they will do.

Wherever America goes we follow, lemmings off a cliff.

But why do you believe the UK is following America, or rather "must" follow America?

Pulled from my own European health insurance (no pre-existing condition nonsense - everyone gets coverage) stats:

Year;Premium;Claimed;Paid at source (excess/billed after)
2008;1176;6886;150 (expensive year with regular therapy/tummy tuck)
2009;1176;970;155 (cheap year, included dietician + fertility clinic)
2010;1212;8606;165 (expensive year, pregnancy, pre-eclampsia, emcs, doula, baby in SCBU etc.)
2011;1248;957;610 (cheap year for insurance, expensive for me because my dentist + physio weren't covered - doh!)
2012;1488;?;220 (I've got a more comprehensive policy this year which covers dental/physio and new glasses. I'm having an elcs next month too.)

My policy also covers my children at no extra charge.

It doesn't have to be like the US insurance schemes.

Well, just trivially, google "UK follows" and see what google suggests. :P

Hi Mostly.

Thanks for your post. Competition and making people jobless is normal in a free market and a necessary feature of keeping things competitive. Your example using supermarkets, you haven't taken into account people who have gotten jobs in other stores and by & large people who stayed on. For example, my old company was brought out 10 years ago. I'm still with the new company.

I can understand the concern about NHS doing more private work but it's worth bearing in mind that it's not 49% of beds but 49% of income. So a foundation hospital can earn 49% of their income. This doesn't necessarily equate to handing over half the beds. It could be by employing doctors to focus on private care and they have to use the profits and plough it back into the NHS patients. That isn't a bad thing if the hospitals can prove NHS patients are not affected. One of the principles of the changes as I understand it is that NHS patients must come first. And rightly so.

Your example of the GP is also one of my areas of concern. But the other side of the coin is that another GP could use their new 'powers' to shop around and get the best deal for his/her patient. And as you rightly say, there is also the conflict between duty of care and profits which isn't a good thing if weak GP's are around. I'm sure some are but then I'm sure we also have some rubbish police/firemen. Hopefully they are in the minority though.

And there we have it Niceguy2, "And as you rightly say, there is also the conflict between duty of care and profits which isn't a good thing if weak GP's are around. I'm sure some are but then I'm sure we also have some rubbish police/firemen. Hopefully they are in the minority though."

You have a job, you could make choices in terms of what you use your income to do, you are obviously social able, have the ability to communicate and be an advocate for yourself and your family. In other words if you are find yourself stuck with a "rubbish" gp, hospital, mental health worker, health visitor, district nurse, or whatever. You can choose to do something about it. Good for you the changes are gonna work out out just fine for you, the poor, chronicly sick, those with learning disabilities, the elderly. meh they will get by HOPEFULLY!

But if a GP is rubbish then he/she is likely to be already rubbish. Luckily we can all change GP's but we're stuck with the hospital care we are given.

Under the new proposals though, GP's can choose on our behalf to get us the best care they can. The downside of course is that they could lie/cheat and give us worse treatment. But then that's always the risk with choice isn't it? In the same way a policeman can choose to pursue a criminal or eat a doughnut. But we shouldn't remove choice just because we fear a few bad apples may abuse their power but instead put the correct sanctions in place to ensure they are dissuaded from doing so. It's the latter I'm more interested in. The principle of competition i have no truck with.

Nice: The problem with competition is that there will be competition for the 'good' GPs and the 'rubbish' ones will be left for those who cannot afford them or don't have the ability to clearly articulate their concerns and so change to get a 'good' one. living in a deprived community could also limit access to a GP who has the power to buy you the care you need too.

PLUS it's not that easy to get a GP, it takes ages where I live even now and when I wanted to change - for convenience rather than because I had no faith in my old one it was a far from easy business with a 20-question like hoop to jump through before new GP would take me on. As for getting a new dentist...had to go on a waiting list and then appeal to my PCT to be allocated to one - basically PCT forces a practise to take you on, there I had to pay for every extra thing the dentist did including care during pregnancy which should be free. Of course market forces are in operation in dental care already.

How long and how much does it take to train a doctor or a nurse and how easy is it to flip them from one place of work to another? What are the risks to patients when you do this to health staff compared to the supermarket example I used?

I understand your concerns Mostly. But I just don't think it's as black and white as you make out. Surely 'rubbish' GP's (which are the ones we're all worried about) would come under a lot of pressure to improve when their income goes down and ultimately maybe even be forced out of 'business' whereas at the moment, they have no such worries.

Plus you are using an example of difficulties in getting treatment on the NHS to justify not changing. To me, I'd rather try competition accepting that there are risks involved rather than deny everyone a choice because a few people may be left behind. Surely it would be better that way since you now have more time/resources to ensure the very people you are worried about are looked after rather than giving trying to give everyone the same mediocre/poor service?

@niceguy2. Full on competition will lead to increased prices (many reasons for this, not just because companies will want to make profit), difficulties in accessing information on services' quality and safety (because commercially sensitive information), and no service where services are not profitable (remote areas, uncommon diseases, specialised childrens's services etc.)

Increased cost to taxpayer will lead to increased rationing and more people wanting to top up their publically funded service with either private insurance or direct payments (as happens now, of course).

Lots of organisations involved in a person's care (complicated enough, should be simplified and integrated, not complicated further) increases risk of mistakes, problems with communication, lack of responsibilty (see breast implant saga) etc.

Free-for-all also leads to companies driving up profit through making us feel inadequate as we are so that things we can buy (like breast enhancement surgery or anti-shyness drugs) are promoted (to increase market share. seen this? blogs.channel4.com/factcheck/factcheck-qa-the-boom-and-bust-of-cosmetic-surgery-in-the-uk/8956).

This is not a criticism of market forces, just that they don't work in this case - if you want a good-value universal health service, anyway.

Again Nicegy2 you talk of risks, what would be an acceptable level of risk in your view, conducting a huge top down reorganisation of an entire health service that no one ever voted for, in order to achieve what? Rooting out some "rubbish" health professionals? Or taking the risk that by listening to the people who run the service, those who use it, and lastly those who NEED it, that you could actually do as you say, improve the rubbish gp's or force them to leave?

A also feel slightly insulted that you use a business model openly to argue for how to remove rubbish staff, surely that argument is the same one that people used to talk about teachers and head teachers. So far as far as I know, no big changes of staff or exodus of rubbish teachers and heads. So no witches found in that particular hunt. Plus since your taxes went to pay for the training of these rubbish professionals I am surprised on your buisness model that you would be happy to write of such a significant outlay by just letting the rubbish people walk, more economic surely to invest in upskilling and then get them to work for the benefit of society till they retire?

'Full on' competition is far less likely to have increased prices than a monopoly. That's economics one-o-one. Right now the NHS is one giant monopoly whom private companies such as pharmaceuticals can rip off. There's little incentive to innovate.

For me all I'm saying is that I can see some risks but I can also see the potential benefits. And one rarely comes without the other. And that in my opinion, the status quo is not an option. And neither is pumping in more money we don't have.

And as for sacking staff whom prove they do not meet the standard expected? Nope, I have absolutely no problems at all with showing them the door. In fact it's disgusting how hard it is to sack a failing teacher. Our kids deserve better.

This isn't covered in economics one-o-one, for reasons given above (and because of the power of being a bulk purchaser, economics of scale, low transaction costs, info sharing etc.). All empirical evidence shows the NHS is comparatively cheap.

You can already choose to pay more for your healthcare (that's fine, it's your choice) but if the bill goes ahead, everyone will pay more for the same.

Check out which MPs and members of the house of lords will gain financially from privatising the NHS.

You can sign me in for any campaign.

I don't have anything to add that hasn't been said by others - in my view it's going to extend the changes (introduced by bloody Labour) to produce a two-tier system and a whole host of other problems - but just want to add myself as a number to show support.

Just seen a thread in another forum where there is a link to some study done by Unite that exposes a host of Tories who have links to private healthcare ie investments, board positions etc.

see it here www.leftfootforward.org/2011/11/tory-peers-private-healthcare-links-threat-to-nhs/

Worrying or what, hardly unbiased.

At the end of the day I worry about the people who won't be able to gain from a system of private health care. I think people assume the 2 tier system we have now will continue, for the very rich it will. Most of the rest of us will pay out for health care on a regular basis - exercising not choice but acting under sheer necessity. And the many, many, many people who will be left behind will suffer, thanks to market forces, for the many reasons already outlined above.

@Mostly

Thanks, that was interesting.

To continue your point:

Most bankruptcies in the US are because of medical bills.
Most of these bankruptcies are among the middle class (educated people, people with houses, people who before getting ill had health insurance etc.)

A quarter of health insurance firms cancel the insurance immediately if an employee suffers 'a disabling illness', and half cancel it within the year.

www.washingtonpost.com/wp-srv/politics/documents/american_journal_of_medicine_09.pdf

That isn't what I would expect from health insurance - but in Britain at the moment, the NHS covers people who are let down by their health insurance.

I'm not under any illusion that the NHS is free. The point is that we're in it together so that if anyone of us (and it will be one of us, we just don't know who) is really unlucky, we're covered.

All sorts of services we have taken for granted will disappear unless we are able to pay - just as in the US. Families throughout England will undoubtedly suffer. We are seeing Sure Start services and Childrens' Centres closing down when they have been proved to be so successful for the long term well-being of families and also the assault on young families through other measures too. Now our NHS is at huge risk.

It would be fantastic if Mumsnet would mount a campaign. We have 4 months left (max) in which to change the course of events in Parliament and save our NHS from destruction.

The Health & Social Care Bill, has been specifically designed as a hugely complex document to dismantle ( I heard Lansley say it!) the NHS into fragmented, localised services which will be increasingly divided into two strands - one for those who can pay and one for those who cannot. Obviously this will drastically affect waiting times for those who cannot - the so called CAP ( or the % of the NHS which can incorporate private service ) is proposed at 49%, which is a compromise proposed by Baroness Shirley Williams because Lansley wanted to remove the CAP altogether meaning that in effect some current NHS hospitals could have become 100% private!

This does not mean that the only people to use private providers will be paying patients, they will also be used for procedures as they are now ( currently at about 3%) , but much more widely. The dangers of increasing private providers is because they often do not have the same range of expertise as the NHS and also because they are not accountable in the same way - examples we now know about include the PiP implant issue and Southern Cross - so when things go horribly wrong there is no come-back. Medical training is also likely to be fragmented and localised - how will we know whether staff meet the standard until it's too late?

Nor is the idea that GPs are going to be at the heart of the new Commissioning Group to be a reality. GPs cannot spend all their time in complex management tasks - they want to treat patients. Many of these CCGs will be run by organisations such as McKinsey, KPMG, PWC and all will be able to have shareholders who will influence the way funds are spent to increase profit rather than patient care. Along with the vast majority of the medical profession, Clare Gerada, the Chair of the Royal College of GPs has voiced great alarm at these proposals

The government are also going to reward practices who make savings and penalise those who they decide are not taking what they see as the right priorities. The whole reorganisation will cost roughly £3.5 billion at a time when the NHS is also asked to make £20bill in savings. Hospitals are going to have to survive by their own finances and become completely independent Foundation Trusts. Lansley wants the Secretary of State to let go of the responsibility to ensure that all communities have NHS services through a hands off approach to duty of care

All this is currently being hotly contested in the House of Lords where many amendments have been proposed. These will be presented again in the so-called Report Stage from 6th February before going back to the Commons. Voting is incredibly tight because the Coalition takes in 2 parties.

The well-being of the NHS in England should transcend party politics.
Andy Burnham, Baroness Thornton, Lord David Owen and many Cross Bencher Lords, the Socialist Health Assoc, Keep Our NHS Public plus numerous local SOS NHS campaign groups are all stressing the urgency of the situation. Even some members of the government in the Commons and the Lords have spoken out against the proposals however all but one or two LDs have failed to vote in the right way - even voting against their own proposals! If they don't actually care about patients they need to know that the majority of the country does

In 2010 our NHS was deemed to be the most efficient in the world and had highest ever levels of approval - not perfect, but ripe for further improvements to help elderly patients, those with mental health problems and increased community provision. This would not have cost £3.5 billion and de-stabilised the whole profession!

It would really help if as many of you as possible sign the Drop the Bill petition and also get the word out amongst your local groups. Please helps us to Save our NHS! www.dropthebill.com/

i think the bill is awful - i don't think people understand it and i would welcome any campaign - southern cross and the implants should be warnings to us all - the private sector will take profits but when the pieces need picking up the NHS is the safety net.

I'm an NHS doctor and mum and I have studied the current NHS reforms closely. There is no doubt the Tory/Lib dems are planning to privatise the NHS at a time when public satisfaction ratings have never been higher and the wealth of international evidence says this is completely the wrong thing to do. What will happen is that those with less money will have a second rate health system in the UK with a better service only if you can afford this. We already have staggering figures of UK children living in absolute poverty and this is set to increase over the next few years. Every child should have the best start in life and free high quality healthcare should be an essential right for every person in the UK.

The government are undoubtedly pulling apart the NHS by stealth, and they are lying by pretending this is not what they are doing.

The money which the private sector will gain from this will be used not to improve our services but to pay the government in donations to the political party which lets them do this. Come in MumsNet, we can't allow this to happen to our precious healthcare system. Once it's lost it will not be possible to derivative it, given the legal contracts involved with the private sector. We must speak out and take a stand to stop it.