Pondering, and while slightly more optimistic than we once were, still really quite unhappy Lefty thread

[Hassled]

Where had we got to? We'd agreed that we all love Cameron, right?

But why is it that way? I know in my laast job we all ended up doing stuff because no-one could face arguing with the university secretary - one of the reasons I took severance, in the end, as it drove me mad. The culture would have to change from above, I guess.

But there's no saying private would be any better...

Oooh er Ewe, really? What's being said?

I wonder whether the NHS is that way because of entrenched positions: the NHS itself and the unions have been under rightist attack for so long that they feel they can't afford to give any ground at all. Maybe a government with good leftist credentials could get everyone around a table and say - look, the NHS is fucking marvellous and it's staying right where it is. But now let's have a Royal Commission or something to work out ways forward.

Oh, come here, please.

But then the NHS is superb value for money however you look at it.

The French system yes, is partly private, but its costs are astronomical. And in any privately outsourced system some of that money (public money, as well as individual's money) is going to produce profit as well as a service, profit that you can't control and that doesn't necessarily stay in the country.

It seems weirdly counter-logical to me to say that it's preferable to have a health service that is more expensive at point of sale and which somehow has to find extra cash to generate profits for the wealthiest.

What about Obama's suggestion of a nationally-owned insurance system? Agree that it makes no sense to have to include profits in the calculation - although of course the NHS does already incorporate some profit-making elements (eg ex-P now works for a private pathology company that supplies services to the NHS).

And also (whisper it) isn't the French health service better than ours? MmeL/Beachcomber et al probably better placed to comment on this than I am.

As I said, in my heart I want universal benefits and services. But I'm also rather taken with Quatt's argument about not over-spending. If we want to eject international money markets from our political considerations, then we have to be less in hock to them, don't we?

from my experience pw it's the position of the consultants in local PCTs and the BMA nationally who 'drive' the management of NHS, and yet it also suffers from a very bad bout of managerialism. A close friend, who I see most days, works in a training dept. and is consitently embarrased by the budget she holds and the freedom she has to spend thousands though she is in a very modest salary position.
We have had Audit Commission reports on the NHS, but the scale of the thing is massive, and is all inter-related, and so it is v. difficult to get a comprehensive grasp of it.

Mmm. Consultants are still not technically employees of the NHS - is that right? The exemption they negotiated back in '45?

We need edam on here, she knows about this stuff.

French service - 'fraid so. Expartner French and she dispairs at times at our version. Staggers at waiting time to see a GP and ahving to constantly 'go back' for test results.
Not to mention the service to mentally ill in France. For them it is c'est la vie. For us it's a matter of stigma much more, and NHS bends toward allying it withte criminal justice system. If you are ill over here it's best to commit a serious offence in order to get treatment.

But policywonk, it's the universal nature of NHS that keeps costs down. Start tinkering with that and you undermine NICE, which is one of the big reasons for low cost. The French system is waaay more expensive than ours.

I think there are a lot of pros to the French health care system but I used to live in France for a while and it definitely isn't flawless.

It's also very expensive. They spend 11% of their GDP on health care vs our 8.4% and per capita spending is over 20% more in France.

Consultants? Didn't know that, but they still hold a major influence over the organisation.

my typing and spelling is deteriorating. Off for a biscuit!

pw GPs are not (mostly) employees of the NHS but self-employed contractors (although there are some salaried GPs around directly employed by the PCTs, e.g. where practice provision is low, and more often than that, GP partners will employ salaried GPs who for whatever reason don't want the responsibility of a partnership).

Consultants tend to have contracts with the NHS, but are also free to have private contracts/practices as well (this is what Bevan was referring to). Friends I have who are consultants tend to work approx 120-hour weeks, although they are in high-pressure specialities like anaesthetics.

I suppose my (possibly entirely muddled) thinking is: keep the NHS as a universal service - stop all privatisation elements, bring services back in-house. But require the users, on a sliding scale according to income/need, to hold health insurance and make some payments accordingly. Proper exemptions/considerations for the chronically ill, terminally ill, those on low incomes etc. But for those on, say, incomes of more than £20k, you start to make nominal payments for NHS services. And the more you earn, the more you pay.

Ah thanks tactical, it sounds as though you know what you're talking about - what do you think? Does it work?

TF - no-one works 120 hours per week. That's 24 hours per day in a 5 day week,reducing to 17 hours per day in 7 day week.

Are you sure?.

Also, consultants have a nasty habit of using NHS resources ( equipment, nurses etc) when doing their 'private' work. Stopping that would represent a massive saving.

120 hour weeks?!! How does that work? Even allowing for working every day that's only 7 hours for sleeping and eating!

Or does that count being on call as working hours?

Policywonk - we're already paying towards the health service on a sliding scale - through taxes. I'll be fascinated to see a government that proposes paying for the NHS twice.

And are you talking about the NHS competing for health care you have to pay for, alongside other private providers? With the NHS being different in that it is cheaper, partly because it is subsidised by those same taxpayers who are now paying income-related fees?

Is that even legal? Isn't it a monopoly issue, or something?

And compulsory insurance is just delivering a gift to insurance companies. And we've just been through an economic crisis which has reminded everyone how you can pay lots of money to an insurance company who may, at the moment you need it, have lost all your money, because they've invested it somewhere that went down.

pol, you answered my call in style!

Ham. Arguing against FPTP is taking candy from babies, really - there are no good arguments in its favour any more (the 'decisive government' one used to be the only shot in its locker, and now that's gone too)

animula - sorry, I'm just thinking aloud. I'm not talking about the NHS being in competition with any other providers - if rich people want to use BUPA fair enough, but they'll still need to use the NHS for acute conditions (as no private providers have A+E provision AFAIK), and to do so they'd have to pay.

Re. insurance - as I said below, I'm thinking vaguely about the nationalised insurance option, rather than private insurance providers.

But quite happy to admit this might all be complete nonsense. It's just that everyone is saying (even people of good will) that the revenue streams for the NHS are going to dry up in the next five years, so I guess I'm trying to think of ways around that.

My money's on an NHS providing a basic service, with NICE regulating that. "Supplemented" by the option of going private for "add ons", or just wholesale private treatment.

I don't like "add ons". I think they undermine NICE and the NHS. But there you go.

I think that's been floated all over the place, though it did meet with a largely hostile reception. I'd hate to see that happen.

The difficulty is that things get very tribal when we talk about alternative ways of even thinking about the NHS. The UK is very wed to the NHS as it is currently formed - for both good and ill.

From my perspective, a mixed public/private system is likely to be a very inefficient way of "doing" the NHS. One of the things that can keep costs down within the NHS is that we don't need to account for every single resource that's used. Compare this to the states, where you need to come up with an itemised bill at the end of it ....

Overall, the NHS is very bureacratic but this isn't all bad. Clinicians are good at doing the clinical stuff, but not always at the managerial duties. NHS management is poor by a lot of accounts - one ex-manager I know has a theory that the NHS promotes people to their natural level of incompetence. That is, people get promoted whilst they're doing things they can manage and stop when they get to the point when they can't. This leaves a lot of people in post that aren't quite up to it.

I agree animula.

I mean - it's a scenario I'd hate to see.

I don't get why there's so much angst about NHS provision drying up. they don't seem to be fretting so much in France on this issue, where it is more expensive ....