NHS 'reforms'

[Peckhamnearbe]

This may be of interest and concern for those worried about what is happening to the NHS. A request for letters to MPs etc on SE23 Forum (template provided if needed)

http://nationalcan.ning.com/forum/topics/competition-regulations-forced-on-the-nhs

[WorkingMummy]

You can quite literally feel industry closing in around the NHS.

The independence of NICE is also under threat.

I agree with you that once made, the changes will be permanent.

The government will need to be brought down to stop it, though.

[DaveR]

I find it interesting that at the same time as people are campaigning for the Chief Exec of the NHS to resign, against a background of numerous stories of needless deaths and poor levels of care, the attitude persists that there exists a mythical institution called 'the NHS' which is an inherently better way of delivering publicly funded healthcare than any alternative system, and needs to be protected at all costs. It is always worth remembering that the NHS is pretty much unique in the world i.e. no other developed country chooses to organise public healthcare provision in this way. For that reason, if for no other, I'm sceptical of any argument or campaign that starts from the premise that 'the NHS is under threat!'.

[uncleglen]

The NHS is a victim of its own success. It has become all things to all men and I have heard very intelligent people prefer to take statins etc. instead of altering their lifestyles.

Also, worryingly, there are superbugs about and given that in Spain and other countries you can buy antibiotics over the counter without any medical advice, this is not suprising. I know for a fact that elderly people 'stock up' on these when they travel abroad- 'just in case'. Hospitals do not stand a chance.

[Marmora Man]

I don't have time to respond in detail. Those that know me will recognise my position - the NHS is not unconditionally good /beyond reproach and private provision is not unconditionally bad.

Had the N. Staffs debacle occurred in any other sector or industry under private management there would have been wholesale sackings, a media hue and cry and probably (and appropriately) charges of corporate manslaughter. Because it happened in the NHS little of this has occurred, tho there are the beginnings of an attack on senior NHS management. I know, and so do almost all professionals in the healthcare sector, that "there but the grace of god" go a significant minority (and, appallingly, possibly even a majority) of NHS /public sector healthcare organisations.

I work in the independent (but charitable) healthcare sector. Our immediate response to the Francis report has been to review out whole way of working, to conduct staff forums at every workplace, to ensure that the current, and very live, whistleblowing policy is re publicised to every member of staff, to reinforce our 18 month old Modern Matron and company "Way of Caring" philosophy and values are stressed at every level. All this has happened despite the fact that our patient satisfaction surveys indicate a 98% satisfaction (good or excellent) with only two (2) hospital acquired infections occurring in the last 12 months and no (zero) unexplained or unexpected deaths in a national private hospital business that treats 200,000 + patients a year, 25% of which are NHS funded.

Given the choice would you prefer to be treated in one of my hospitals, at no charge and funded by the NHS, or in N. Staff? My group is the true face of the alleged "privatisation" of the NHS. We can do it better, faster, in cleaner surroundings, with better outcomes and at lower cost. The NHS is one of the last bastions of a 1940's ideal of state provision that has failed us all. A comprehensive mixed economy of healthcare incorporating public, charity and private sector (roughly speaking the European model) is the way forward. Ignore left wing rhetoric that the state knows best - support quality and caring wherever it is provided and ignore / avoid bad practice.

[WorkingMummy]

Comparing "your hospitals" with N Staff is not an argument. And N Staff, however awful, is not an argument for the privatisation of the NHS. You do not have to look far into the private sector, in any industry, to find incompetence and corruption. The ultimate private system of all time (barring its recent immunity agsinst failure) is the modern banking sector and its not exactly a paradigm of efficiency and virtue is it.

You privatise a system, you introduce the interests of corporate business and you remove money from the system in the form of profit. How many industries do we need to privatise in this country in order to learn that lesson? Only this week, when gas prices are at an all time high for consumers, what does British Gas announce: a huge fat corporate profit.

And the extraction of profit is not the only reason why, although the theory of competition leading to increased efficiency is dandy on paper, its bollocks in practice. Competition for consumer choice works ok when you are dealing with sales of hamburgers or cola or toothpaste. It does not work well when the goods and services in question are essential to human health (water, gas, etc) and/or when - objectively speaking, whatever it feels like when you are the consumer- consumer choice should NOT be the determinate of what is on offer or when. Healthcare is an unsuitable candidate for privatisation on both grounds.

My big area of concern (and knowledge) is women and children's health. And my comparators are the UK and the US. In the UK, we have NICE - until recently, wholly independent commissioner of evidenced based research for the development of national standards for effective, affordable treatment. We have a National coordination centre which facilitates collaboration between different stakeholders (RCOG, the midwifery council, mumsnet, etc etc) for the provision of guidelines. Result: gold standard, world respected standards for the treatment of pregnant women and new mothers, in which doctors, surgeons, midwives and most mothers are fully invested, with procedure and protocol based on what has proven to be best for mother and child. In the States, what d'ya got? You've got obstetricians and midwives COMPETING for pregnant customers, using tactics of advertising, negative campaigning and outright scare propaganda to convince individual pregnant women that they are better off in xyz unit/with midwife led care, whatever. It's crazy. It makes no sense. Would I feel different I was a pregnant mother who wanted to demand right to a non-indicated elective caesarean? Maybe. But I am glad that it is not up to me as an individual to decide what the evidence and economics indicate should be my options.

Yes the NHS is complex and yes it could be improved. But turning it into a competitive, for profit business is not the answer. Restoring NICE independence and letting it continue to get on with standardisation is part of the answer.

The NHS is the last good reason to pay taxes in the country.

[Huguenot]

Lots of good points in there!

In particular a 'perfect' market can only operate effectively when the customer is informed and the purchase isn't made 'in distress' (I don't mean customers are distressed, although they might be, I mean that they are compelled to purchase).

Mumsnet is a 'stakeholder' (????) - I sincerely hope that lobby groups are not considered 'stakeholders'!

[Cyberia]

WorkingMummy Wrote:

-------------------------------------------------------

> Comparing "your hospitals" with N Staff is not an

> argument. And N Staff, however awful, is not an

> argument for the privatisation of the NHS. You do

> not have to look far into the private sector, in

> any industry, to find incompetence and corruption.

> The ultimate private system of all time (barring

> its recent immunity agsinst failure) is the modern

> banking sector and its not exactly a paradigm of

> efficiency and virtue is it.

>

> You privatise a system, you introduce the

> interests of corporate business and you remove

> money from the system in the form of profit. How

> many industries do we need to privatise in this

> country in order to learn that lesson? Only this

> week, when gas prices are at an all time high for

> consumers, what does British Gas announce: a huge

> fat corporate profit.

Not sure how relevant this is. Didn't MM say he works for a charity?

> My big area of concern (and knowledge) is women

> and children's health. And my comparators are the

> UK and the US. In the UK, we have NICE - until

> recently, wholly independent commissioner of

> evidenced based research for the development of

> national standards for effective, affordable

> treatment. We have a National coordination centre

> which facilitates collaboration between different

> stakeholders (RCOG, the midwifery council,

> mumsnet, etc etc) for the provision of guidelines.

> Result: gold standard, world respected standards

> for the treatment of pregnant women and new

> mothers, in which doctors, surgeons, midwives and

> most mothers are fully invested, with procedure

> and protocol based on what has proven to be best

> for mother and child. In the States, what d'ya

> got? You've got obstetricians and midwives

> COMPETING for pregnant customers, using tactics of

> advertising, negative campaigning and outright

> scare propaganda to convince individual pregnant

> women that they are better off in xyz unit/with

> midwife led care, whatever. It's crazy. It makes

> no sense. Would I feel different I was a pregnant

> mother who wanted to demand right to a

> non-indicated elective caesarean? Maybe. But I am

> glad that it is not up to me as an individual to

> decide what the evidence and economics indicate

> should be my options.

Well I have no experience of the US system, but I have used maternity services (in Lewisham) and they were pretty appalling. The inefficiency is extraordinary - and I can't believe no one warned me quite how many mixed messages I would receive - doctors contradicting each other, nurses, midwives, paediatricians all giving conflicting advice and opinions - it was a bewildering mess and as a mother I can only say I would never willingly go there again.

> Yes the NHS is complex and yes it could be

> improved. But turning it into a competitive, for

> profit business is not the answer. Restoring NICE

> independence and letting it continue to get on

> with standardisation is part of the answer.

>

> The NHS is the last good reason to pay taxes in

> the country.

In that case I think I'd better start investigating some good avoidance schemes. So I can donate the proceeds to an organisation that's actually getting things right. Other hospitals may be better - but some are surely much worse. After all, in Lewisham - people are actually campaigning for the hospital, so however horrendous it is, it can't be as bad as some others (that I haven't experienced yet though presumably these people have) - the campaigners must be comparing it favourably with something!

[DaveR]

"You privatise a system, you introduce the interests of corporate business and you remove money from the system in the form of profit."

"the theory of competition leading to increased efficiency is dandy on paper, its bollocks in practice"

"It does not work well when the goods and services in question are essential to human health (water, gas, etc) and/or when - objectively speaking, whatever it feels like when you are the consumer- consumer choice should NOT be the determinate of what is on offer or when. Healthcare is an unsuitable candidate for privatisation on both grounds."

All very plausible, but is there any evidence to support any of this? Comparing the NHS with utility companies is attractive, but there's no obvious reaosn why it's a good comparison other than utilities used to be wholly publicly owned. Actually, i would argue that utilities are a particularly poor comparison, because the 'single infrastructure' issue just doesn't apply to healthcare. Even then, it's convenient to look at energy and ignore, for example, telecoms, where it is indisputable that private ownership and competition has delivered better services at cheaper prices for consumers.

"And my comparators are the UK and the US."

Why? This is always the comparator that people choose when in fact they don't want to engage in a rational debate. Why not compare with Belgium, Germany, France, the Netherlands, or Sweden, all of whom adopt a fairly radically different approach to the UK, but similar to each other in the sense that it is not assumed that direct state provsions of healthcare is the best system. It is widely accepted that the US system, based on private insurance funding, is massively inefficient - the barriers to change there are every bit as ideological (and hence ridiculous) as in the UK. Many Americans equate public healthcare with socialism, just as, unhappily, many Brits equate any real change to the NHS with privatisation and the triumph of corporate greed.

[Marmora Man]

WorkingMummy said "You privatise a system, you introduce the interests of corporate business and you remove money from the system in the form of profit".

As opposed to the NHS where money is wasted within the system through inefficiency, over staffing, poor contracts, high salaries and the like.

[Loz]

Privatisation and outsourcing are a bit like government IT projects - you only hear about the ones that fail. There are lots and lots of success stories out there.

There are many situations where privatisation/outsourcing works very well indeed. And there are many situations where it is not suitable, but tried anyway (and unsurprisingly fails).

Intelligent use of private sector efficiencies would do the NHS a world of good and enable the money to be used more wisely. But it no universal panacea to the NHS's ills.

[Marmora Man]

Today's NHS headlines - across the NHS, on average, less than 67% of NHS staff would recommend their own hospital to family & friends. In some cases less than 40% would recommend their own hospital. My wife, a nurse, says she would not recommend certain wards at her hospital - a major and historic London teaching hospital.

While the NHS is capable of delivering a fantastic service there are clearly parts of it that are broken. Soft hearted rhetoric about it being "the envy of the world " (I have travelled widely and never, never has anyone said to me - I wish our country would set up a nationalised state run health service) or "the jewel in Britain's crown" don't help.

As Loz said above - and I implied in my initial post, judicious use of competition, private and charity services to improve healthcare for all is the way ahead and not dogmatic ideology.

[????]

Huge swathes of the State/Public Sector and many on the left are the most small 'c' Conservative forces in the country. Let's just leave things as they are...suits us.

Demographics, technology, economics are changing things all the time, we need to adapt and change and shreaking Privatisation/Dismantling the state at any hint of reform is actually no longer washing among many in the population

[LondonMix]

WorkingMummy do you really think this is true:

Result: gold standard, world respected standards for the treatment of pregnant women and new mothers, in which doctors, surgeons, midwives and most mothers are fully invested, with procedure and protocol based on what has proven to be best for mother and child.

The comparison with the US really isn't a good one. Like many others have already said, comparisons with Europe would make more sense and all of my EU colleagues think maternity services on the NHS are a disgrace and have (after initial engagement) chosen to go back to their own countries for the birth. Is this really just prejudice on their parts?

[civilservant]

Agree with LondonMix that continental Europe is a better comparator than the US.

Having experience of both continental European and British maternity services, I would also agree that NHS maternity services are not in any way exceptional.

The views of her non-British EU colleagues would also be affected by the apparent UK preference for midwife-led care - this is not gold standard in most other countries, where women would opt for obstetrician-led care if they can afford it.

[Marmora Man]

WorkingMummy - you state that NICE was once "wholly independent" - that was not the view of clinicians when it was introduced, nor of PCTs responsible for commissioning services. NICE was, and still is, seen as part of the "cost control" arm of centralised NHS command and control management systems.

You describe the "theory of competition" as bollocks - I return your compliment, your ideas and description of the NHS is not just bollocks, it's rosy minded, idealistic, ignorant bollocks. You describe an NHS that I, for one, just simply do not recognise. As for the NHS being the only good reason to pay tax - why should we all, pay yet more tax from our increasingly hard pressed incomes, to see it wasted through inefficiencies, downright poor management and complacency? NHS spending has tripled in real terms in 15 years - outcomes have, overall, remained the same and in some very well publicised cases been diabolical.

As a general point for every ? raised in taxes the government manages to purchase roughly 70p worth if goods, due to the costs of collecting the taxes, general bureaucracy and Victorian processes and a compete inability to procure goods at a competitive price due to the Civil Service's lack f skill and knowledge in this area.

Tescos, Sainsburys, Waitrose et al use their volume buying power to press down on costs. The NHS has yet to organise a truly effective central buying process for drugs, prosthesis, laundry, food or other simple goods. The profit motive drives efficiencies - state monopolies don't seem to bother - they just ask for more tax money - apparently believing it to be a free good.

[DaveR]

It's worth being clear that competition and the profit motive can bring benefits even without conventional private sector involvement. The only essential requirement is a minimum number of different providers who are independent of each other, and who each gain from their own efficiencies i.e. if they save money they keep it. Some or all of the providers can be not-for-profit organisations - they still compete.

[Marmora Man]

DaveR Wrote:

-------------------------------------------------------

> It's worth being clear that competition and the

> profit motive can bring benefits even without

> conventional private sector involvement. The only

> essential requirement is a minimum number of

> different providers who are independent of each

> other, and who each gain from their own

> efficiencies i.e. if they save money they keep it.

> Some or all of the providers can be

> not-for-profit organisations - they still compete.

As indeed is the organisation I work for - it's a "not for profit", a "Social Enterprise" or a Charity depending upon your point of view. However, it competes for NHS work but re-invests any surplus back into the business of providing top quality healthcare.

[david_carnell]

I would think that seems a pragmatic and seemingly sensible approach and wouldn't have an ideological objection to it.

[StraferJack]

and to think people were worried

http://www.telegraph.co.uk/health/healthnews/10094041/Record-number-of-operations-cancelled.html

[DaveR]

and your point is, SJ?

[StraferJack]

Lots of people (both on here an nationwide) protesting about nhs cuts and a and closures

Lots of other people saying "you're worrying over nothing. The changes are not only necessary but will bring a better service".

I just wonder how bad a service would have to deteriorate for the end user before anyone else admitted things hadn't improved

[Marmora Man]

SJ - we've engaged on this topic many times before.

A large monopoly such as the NHS should be able to bear down on its suppliers such as pharmacy & prothesis - where it buys upwards of 85% of all such sales in UK, yet it doesn't. Similarly, smaller more fleet of foot units such as the Foundation Trusts are supposed to be free of bureaucracy and thus able to compete effectively at lower cost - but this doesn't happen either.

The NHS, along with the military and the police force are about the only organisations in UK that do not, usually, recruit from outside their own circle. This can lead to a frightening lack of challenge and a high degree of complacency. I speak as one with experience of two, of those three, institutions.

The primary care system has slowly becomes more ossified - working restricted hours and throwing what would, in the past, have been routine minor enquiries, illnesses and injuries into the A?&E departments. The problem is compounded in crowded urban cities with a high influx of newcomers (students, visitors, immigrants) that haven't, yet, registered with a GP and who have no recourse but their local hospital.

Allied to this is a more modern tendency to expect "the state" to sort out an individual's problem. Back in the day a sprain, cold, bout of flu or other minor ailment was probably managed with the help of grandma's remedies, a bit of stoicism and maybe an aspirin or, in extremis, a call to the local GP who might pop in on completion of district rounds. Nowadays it seems to require a plethora of specialists to assure the individual that there is no deep underlying disease causing the small inconvenience.

[StraferJack]

So to summarise, the lengthening a and e queues are not a result of cutbacks or reorganisation, but complacency and culture?

I know we aren't going to agree in this. Not now not ever. But with the usual caveat that I in no way suggest things were ever perfect but your sweeping statements reflects neither my own experiences as a patient or the various doctors, nurses or staff I know within the nhs

But as I say, many people are telling me I have nothing to worry about and things are going to be better and cheaper. So what's to worry about

[DaveR]

SJ, how much experience do you have of an alternative method of public health care provision?

I don't think anybody is saying there's nothing to worry about. Many people are saying that the combination of tough economic times and particular challenges to funding health and social care provision with an ageing population, greater expectations etc. means there is a serious question to be asked about whether the NHS will ever be an efficient model for delivering these services. That's worrying, particularly when so many otherwise sensible people come over all theological as soon as the NHS is mentioned.

BTW, if we want to throw Telegraph headlines in by way of advancing the debate, how about this one:

http://www.telegraph.co.uk/health/healthnews/10029625/Ringfenced-NHS-budget-creates-illusion-nothing-needs-to-change.html