NHS and politicians

[Jacob]

That's not exactly a ringing endorsement of publicly owned services, is it, Jacob?

Oh yes it is. Far better to have a powerful and responsible ministry at the top rather than fragmenting things the way things are done now - which has a not very well hidden agenda of piecemeal privatisation.

It is, sadly, a fairly accurate portrayal of how the vested interests entrenched in some of the public services protect their interest - their continuing pay and pensions, and those of their mates - without bothering too much about the pesky taxpayers or users of the service. It happened with education until Gove shook the system up and allowed many more schools to manage themselves, thus cutting out the entrenched cohorts of the 'education establishment' in both Whitehall and LEAs (which has the added advantage of cutting the overall cost of education - you still have the schools and teachers, but not the paperpushers and meetings wallahs). The schools now have every incentive to high standards, because people won't send their children there if standards are low. No longer do people have to send their children to a bog-standard comprehensive (to use Alistair Campbell's phrase) just because the LEA tells them to, and won't provide a better alternative.

Perhaps we might be better off with more of the NHS left to private enterprise. At least if a private company messes up, they either go bust and leave their competitors to pick up the business, or lose their contract to one of their competitors. Quite a good incentive to do things to a decent standard - provided, that is, those commissioning and monitoring the service on behalf of the public actually discharge their responsibilities honourably, and don't cover things up as the CQC apparently did. Private companies are usually better at dealing with complaints, too. If they just ignore complaints, as some NHS Trusts have tended to do, they get a bad reputation, and people will use alternative services.

All in all, choice is a good thing for people using services (and buying goods). The good providers thrive and grow, the bad shrivel and go bust.

I see you have been caught hook line and sinker! It's all very plausible the way you put it - but extremely dubious at the same time. Basically there is no incentive for the private sector to supply services which people can't pay for (health and education). This means the state (us) must pay, whether or not the supplier is private or state run. So privatisation is fundamentally nonsense in many cases. Take "free" schools for a simple example. :shock:

 

[Cheshirechappie]

The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.

If more privitisation, by either the front door or back door, or even by the windows, brings improved service to patients, then let's try it. GP services have always been privately owned and contracted to the NHS, and until their contracts were changed so that they didn't have to bother with after hours care, it worked OK. Change that back again, and maybe increase the number of GPs where they are under pressure, and it would probably be even more OK. Applying the same principle to some hospitals would almost certainly drive up their standards, which is all that most people want - decent healthcare when they need it. Most people don't really care who provides the service, as long as it works to a decent standard.

"There is no incentive for the private sector to supply services that people can't pay for..." - Well, not true, since as stated, GP practices are, and always have been, small businesses contracting to the NHS.

By the way, a 'free' school is to which you are free to send your children if you choose (and if they have enough places - most seem to have filled all available places very quickly, which ought to tell you something). Where existing schools are doing a good job, there's no point setting them up. None at all round our way, since almost all the schools are good anyway.

 

[Jacob]

The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.

Exactly. They are less powerful and are delegating responsibility. The current trend is to disperse power, "roll back the state", "de-regulate" etc and we are seeing the results.

If more privitisation, by either the front door or back door, or even by the windows, brings improved service to patients, then let's try it.

Big "if". Ask yourself what condition state provision for health and education was like before 1947 or the various education acts. Did the private sector fill the gap?

 

[RogerS]

The "powerful and responsible ministry at the top" didn't do a very good job, did it? Mid Staffs, Maidstone, Redditch, 13000 avoidable deaths, CQC burying reports about West Cumbria, etc. etc.

Exactly. They are less powerful and are delegating responsibility. The current trend is to disperse power, "roll back the state", "de-regulate" etc and we are seeing the results.

Tosh. Read Jarman's report and you will see that it was just as bad under Labour.

 

[Cheshirechappie]

"Did the private sector fill the gap?" - in healthcare before 1947.

Yes, it did, actually. Healthcare provision was better in 1947 than it was in 1907, which was better than it was in 1847, which was better than it was in 1807......

 

[Jacob]

"Did the private sector fill the gap?" - in healthcare before 1947.

Yes, it did, actually. Healthcare provision was better in 1947 than it was in 1907, which was better than it was in 1847, which was better than it was in 1807......

Oh right. So the NHS was completely pointless? That's a new one.

 

[Modernist]

As one of the largest organisations the NHS is too large to micro manage from above. It is obvious authority must be delegated and only overall policy should come from above together with the results of monitoring. Monitoring should go up one level above authority and (I say again) it needs teeth, where poor practice is observed.

The consultants of course have the whole system by the balls so they need to be sorted out by someone with the necessary courage.

 

[Cheshirechappie]

"Did the private sector fill the gap?" - in healthcare before 1947.

Yes, it did, actually. Healthcare provision was better in 1947 than it was in 1907, which was better than it was in 1847, which was better than it was in 1807......

Oh right. So the NHS was completely pointless? That's a new one.

Total state control is not the ONLY way of ensuring that everybody gets good healthcare. Three countries (out of several others) rated better at healthcare provision than the UK are France, Australia and Singapore, none of which uses a state-only system.

If you want a personal opinion as to whether the NHS is pointless, the answer is that it is only worthwhile if it works better than an equivalent private or public/private blend costing the same amount of money. It currently costs £120bn (this year's budget), or about £2000 for each person in the UK. if you were paying £2000 a year in health insurance, would you regard Mid Staffs, Redditch, 13,000 avaoidable deaths etc. etc. as just one of those things you have to accept? Of course you wouldn't.

The whole point of the debate is what the politicians should be doing to improve the NHS (the OP wanted us to get away from the tick-box culture, specifically). Getting more competition into the provision of healthcare services might well improve them - that approach seems to be well received by the users of education, though it's a bit soon to be sure whether educational attainment has improved (though I'm fairly sure it will).

Give people choice. Works very well with - for example - food production and distribution. Can you imagine a National Food Service? Ration books, and queues for your weekly cabbage? What you eat decided for you by a faceless bureaucrat in Whitehall?

 

[Cheshirechappie]

As one of the largest organisations the NHS is too large to micro manage from above. It is obvious authority must be delegated and only overall policy should come from above together with the results of monitoring. Monitoring should go up one level above authority and (I say again) it needs teeth, where poor practice is observed.

The consultants of course have the whole system by the balls so they need to be sorted out by someone with the necessary courage.

Competition would help here, too. If there's not enough supply in a market, others can come in to mop up the excess demand.

Why successive governments have caved in to the BMA since 1947 is a source of mystery to me. After all, they hold the purse-strings.

 

[Jacob]

.......
Total state control is not the ONLY way of ensuring that everybody gets good healthcare. .....

Well you would have to provide an example of state with zero state control and full health care for all. There isn't one.
There is no alternative to state provision for those who can't afford private healthcare or insurance (except charity of course). The good news of course is that state provision is extremely cost effective.
But the issue here isn't about state control - it's more the very strange ideological notion that private business is more efficient and can do these things better. Sometimes it can, sometimes not. Markets don't always work for everybody. If they did there would be no discussion needed - the demand for healthcare has been there from the beginning. Why have markets not satisfied this in the past. and why would they now?

 

[Jacob]

...
Competition would help here, too. If there's not enough supply in a market, others can come in to mop up the excess demand.....

Why would they if there is no profit in it?

 

[Phil Pascoe]

A screwdriver bit is 99p in the local hardware shop. An acquaintance of mine works in purchasing for a health authority, and he was saying one day that these would be perfectly good for use in a theatre as they were easily sterilised before use, and then were single use anyway. But no, because a deal has been done somewhere along the line, they have to go to one particular supplier of medical paraphernalia who charge £16 for one.
Imagine this thousands of times across a broad spectum, and see where the money goes.

 

[Cheshirechappie]

.......
Total state control is not the ONLY way of ensuring that everybody gets good healthcare. .....

Well you would have to provide an example of state with zero state control and full health care for all. There isn't one.
There is no alternative to state provision for those who can't afford private healthcare or insurance (except charity of course). The good news of course is that state provision is extremely cost effective.
But the issue here isn't about state control - it's more the very strange ideological notion that private business is more efficient and can do these things better. Sometimes it can, sometimes not. Markets don't always work for everybody. If they did there would be no discussion needed - the demand for healthcare has been there from the beginning. Why have markets not satisfied this in the past. and why would they now?

Jacob, I think you are being deliberately disingenuous.

There are options that combine state funding with private insurance. The three I quoted above (France, Australia and Singapore) do that. It's not a question of all or nothing - as you very well know.

OK - how about the 'strange ideological notion' that only the state could provide healthcare (note - in the UK it doesn't; GP services have never been under state control, even if they are predominantly paid by the state). Like I said, imagine a National Food Service.


I've had enough of this strange, circular discussion into which I've allowed myself to be sucked, wasting far more time than it warrants. As far as I'm concerned, I want what I believe most people in the UK want, healthcare that gives people what they need when they need it, without avoidably killing (or injuring) them, and without excessive cost to the taxpayer. What we have at the moment has clearly, in parts (not universally), failed to do that.

Whether the answer is state controlled or partly privatised matters not a jot to me, as long as it works. It's down to the politicians to serve the public, and if they decide to try part privatisation, that's fine by me as long as it delivers. If that means that, on our behalf, they have to take on the entrenched vested interests of the health establishment, the BMA and the Unions, then they should. It would make a pleasant change - politicians of all stripe have caved in to this unholy trinity for far too long. I am not wedded to a strange, outdated and failed ideological notion that only the state can do anything. The state does some things quite well; it has been utterly abysmal at other things - controlling the means of production did not work, for example.

As to your other comment, "Why would they if there's no profit in it?" - have you seen how much Consultants get paid? Do you not think some would take the view that earning 5% less would still be OK?

Right, Jacob, you can now have your dearest wish - the last word. I'm off to get some work done.