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Private health and care services essentially inefficient and need to be brought into the state sector

Really, I ought not to take the bait, but here goes anyway.

Contrary to your assertion that private medicine is less efficient than the NHS, the reverse is so.

That’s because surgery in private hospitals is ‘elective’, (‘life improving’ - not ‘life-saving), and can be better planned.

If an operating theatre in a private hospital is scheduled to perform say six knee replacement operations on a particular day, they will go ahead as planned. In an NHS hospital which also has an A&E Dept, it isn’t unusual for someone to be on the point of going into the theatre for say a coronary by-pass or orthopaedic operation, when victims of say a car crash need life-saying emergency surgery right away, which could include limb amputations. Often there will be several casualties in such instances, which will tie up the theatres and surgical teams for rest of the day, and sometimes beyond. That’s nobody’s fault – it’s just the way things are.

As to 'being brought into the State Sector' - Private Health is used extensively by the NHS – has been for decades, and it costs the NHS no more than if done in-house.

It was a Labour government that expanded that involvement when John Reid was Secretary for Health in 2003. He controversially increased capacity by introducing private companies to run treatment centres for knee, hip and eye operations. He did so to provide extra staff and extra capacity to help treat more patients in the NHS at an unprecedented rate delivering a staunch defence of Labour's reform programme to the party's annual conference. He made the case for extending to all the choices normally only available to those who could afford them.

If a GP needs to refer you for a physical or mental health condition, in most cases you have the legal right to choose the hospital or service you'd like to go to. This will include many private hospitals if they provide services to the NHS and it does not cost the NHS any more than a referral to a standard NHS hospital. You can also choose a clinical team led by a consultant or named healthcare professional, if that team provides the treatment you require. My wife and I both had a knee replacement operation in a private hospital on the NHS (she in 2017, me in 2018). We asked our GP which hospital and surgeon she would choose if she needed the operation and went with her advice, choosing the private hospital she would have done, and the surgeon who carried out our operations.

Cataracts:

Over 400,000 cataract surgeries are done by the NHS every year in England – many at private hospitals.

Some procedures on the NHS, were never envisaged in 1948 and aren't to treat people who are ill. Many such procedures are outsourced to the private sector.

Abortions:

Pregnancy is not an illness - it's consequence of unprotected ***.

Often welcome and planned - too often, not so. Contraception is widely available, including the 'morning after pill' of which there are two types, which work up to five days after unprotected ***. The pill is available at most pharmacies, Minor Injuries Units, A&E and GPs. Despite this, there were 214,256 abortions for women resident in England and Wales in 2021, the highest number since the Abortion Act was introduced in 1967.

98.5% of abortions are funded by The Department of Health. In 2021, the number of funded by the NHS performed by private abortion providers such as BPAS and Marie Stopes, was a record high of 165,400 (77.2%).

There were 624,828 live births in England and Wales in 2021, an increase of 1.8% from 613,936 in 2020. Thus, of 839,084 conceptions, 214,256 were terminated - a termination rate of 25%. Hence, the most dangerous place for a child to be is in its mother’s womb, (which nature provided as a place of safety) – not in the outside world.

It's called 'A Woman's Right to Choose'.

I'm not being judgmental - I was born illegitimate in 1939 - my mother was 36, and thought she was in a stable relationship which would lead to marriage. Not so - my father (who I never knew, and think of only as a 'sperm donor'), was a married man. She was abandoned by him, and disowned by her family. I/we spent the first 3 months of my life in an unmarried mothers' home, then she/we were turfed out to make her/our way in the world as best she/we could. She died of TB aged 41 when I was five., so I had a bleak start in life. But how lucky I was to have been conceived in 1939 - not 2019, or I may not have made it to the outside world. Everything I've had in life, including life itself, has been a bonus to me. Not a 'misery memoire' - a good luck story.

The other side of the coin is Infertility. A condition, not an illness.

Since 1978, the miracle of IVF/DI, became possible. (Once called 'test-tube babies').

Over 1.3 million IVF cycles and more than 260,000 donor insemination (DI) cycles have been performed in the UK since 1991, resulting in the birth of 390,000 babies, new figures from the HFEA (Human Fertilisation and Embryology Authority show. (March 2024). The treatment is provided by private clinics, and about 40% are funded by the NHS, if the patients meet NHS criteria. (About 20,000 cycles in 2021).

Wes Streeting is spot on when he says: 'The NHS isn't a shrine - it's a service'.

A lot needs to change in the NHS, and it's not just about throwing money at it.

He'll have his work cut out, but I think he'll do a good job.

David.
 
I have a complaint - I spat my coffee.
Apologies for the spill. I should have put "straight talkers" in inverted commas! His preferred mode rather than a statement of approval. It just makes it easier for him to sounds reasonable.
 
Really, I ought not to take the bait, but here goes anyway.

Contrary to your assertion that private medicine is less efficient than the NHS, the reverse is so.

That’s because surgery in private hospitals is ‘elective’, (‘life improving’ - not ‘life-saving), and can be better planned.

If an operating theatre in a private hospital is scheduled to perform say six knee replacement operations on a particular day, they will go ahead as planned. In an NHS hospital which also has an A&E Dept, it isn’t unusual for someone to be on the point of going into the theatre for say a coronary by-pass or orthopaedic operation, when victims of say a car crash need life-saying emergency surgery right away, which could include limb amputations. Often there will be several casualties in such instances, which will tie up the theatres and surgical teams for rest of the day, and sometimes beyond. That’s nobody’s fault – it’s just the way things are.

As to 'being brought into the State Sector' - Private Health is used extensively by the NHS – has been for decades, and it costs the NHS no more than if done in-house.

It was a Labour government that expanded that involvement when John Reid was Secretary for Health in 2003. He controversially increased capacity by introducing private companies to run treatment centres for knee, hip and eye operations. He did so to provide extra staff and extra capacity to help treat more patients in the NHS at an unprecedented rate delivering a staunch defence of Labour's reform programme to the party's annual conference. He made the case for extending to all the choices normally only available to those who could afford them.

If a GP needs to refer you for a physical or mental health condition, in most cases you have the legal right to choose the hospital or service you'd like to go to. This will include many private hospitals if they provide services to the NHS and it does not cost the NHS any more than a referral to a standard NHS hospital. You can also choose a clinical team led by a consultant or named healthcare professional, if that team provides the treatment you require. My wife and I both had a knee replacement operation in a private hospital on the NHS (she in 2017, me in 2018). We asked our GP which hospital and surgeon she would choose if she needed the operation and went with her advice, choosing the private hospital she would have done, and the surgeon who carried out our operations.

Cataracts:

Over 400,000 cataract surgeries are done by the NHS every year in England – many at private hospitals.

Some procedures on the NHS, were never envisaged in 1948 and aren't to treat people who are ill. Many such procedures are outsourced to the private sector.

Abortions:

Pregnancy is not an illness - it's consequence of unprotected ***.

Often welcome and planned - too often, not so. Contraception is widely available, including the 'morning after pill' of which there are two types, which work up to five days after unprotected ***. The pill is available at most pharmacies, Minor Injuries Units, A&E and GPs. Despite this, there were 214,256 abortions for women resident in England and Wales in 2021, the highest number since the Abortion Act was introduced in 1967.

98.5% of abortions are funded by The Department of Health. In 2021, the number of funded by the NHS performed by private abortion providers such as BPAS and Marie Stopes, was a record high of 165,400 (77.2%).

There were 624,828 live births in England and Wales in 2021, an increase of 1.8% from 613,936 in 2020. Thus, of 839,084 conceptions, 214,256 were terminated - a termination rate of 25%. Hence, the most dangerous place for a child to be is in its mother’s womb, (which nature provided as a place of safety) – not in the outside world.

It's called 'A Woman's Right to Choose'.

I'm not being judgmental - I was born illegitimate in 1939 - my mother was 36, and thought she was in a stable relationship which would lead to marriage. Not so - my father (who I never knew, and think of only as a 'sperm donor'), was a married man. She was abandoned by him, and disowned by her family. I/we spent the first 3 months of my life in an unmarried mothers' home, then she/we were turfed out to make her/our way in the world as best she/we could. She died of TB aged 41 when I was five., so I had a bleak start in life. But how lucky I was to have been conceived in 1939 - not 2019, or I may not have made it to the outside world. Everything I've had in life, including life itself, has been a bonus to me. Not a 'misery memoire' - a good luck story.

The other side of the coin is Infertility. A condition, not an illness.

Since 1978, the miracle of IVF/DI, became possible. (Once called 'test-tube babies').

Over 1.3 million IVF cycles and more than 260,000 donor insemination (DI) cycles have been performed in the UK since 1991, resulting in the birth of 390,000 babies, new figures from the HFEA (Human Fertilisation and Embryology Authority show. (March 2024). The treatment is provided by private clinics, and about 40% are funded by the NHS, if the patients meet NHS criteria. (About 20,000 cycles in 2021).

Wes Streeting is spot on when he says: 'The NHS isn't a shrine - it's a service'.

A lot needs to change in the NHS, and it's not just about throwing money at it.

He'll have his work cut out, but I think he'll do a good job.

David.
Private provision is far more problematic than you describe. Firstly, the workforce is largely the same, insufficient pool. The more you sponsor private over public, the more you shift the workforce from public to private. Secondly, the different activity being carried out in the private sector doesn't make it more efficient, it just makes it different. Its easy to be efficient when you cherry pick simple easy to streamline services because you can reduce your risks, increase your profits. More problematic for the NHS is that staff get better paid (because of the higher charges) and get simpler lives, because they get to avoid the complex more challenging work. And therein lies the third point, having that more industrially process efficient work in the NHS isn't just something that the NHS can do more cheaply, it is also crucial for overall workforce management, because it means that you can roster staff across activities of varying intensity. What the atomisation of the NHS is doing, is leaving the staff within the NHS left with workloads of constant intensity with ever decreasing volumes of "base lining" workloads. This is reducing training opportunities, deskilling the workforce, while increasing burnout and the exodus from the system. And the exodus is frightening! There is also significant attrition in medical school, but the loss between FY2 and first year of specialist training (so year 3 of being a doctor) is now in the order of 50%. We have an insane system where we are doing nothing about staffing, and working conditions, ensuring we lose our most experienced trained staff, while pouring huge amounts of money into massive medical schools school expansion. Bonkers!

There are issues with private sector provision, such as through outsourcing, and while the % involved is still relatively small, it is still an issue, especially because, and the data evidence this well, the private providers take up the contracts, the original teams involved are dissolved (and because of that can never bid for the work again, because they aren't there as a team to do so), and then when the private sector providers fail, or do not renew because of lack of profits, there is then only one option, which is wider geographical consolidation and larger travel times for patients. That is, however, still on the smaller side of the total, albeit significant in effect and the failure demand it produces (less appointments made, shifting work onto patients to travel etc), but the greater issue currently is that privatisation isn't about allowing the private sector to take over provision of a facet of NHS work, it is withdrawal of service that leaves the private sector as the only option for patients.

You are right about the fact that the extent of what the NHS can do has grown exponentially, and that there are real limits about what can be afforded. However, the issues are not around things like IVF, which is rightly rationed. The far bigger problem is that of an ageing population who now live not with one disease and then die, but with many diseases. The volume of failure demand of patients coming into hospital being discharged, and coming back, is insane, and isn't just an issue in its own right (from industrial process improvement perspectives of being a ridiculous level of failure demand), but the imperatives to discharge quickly effectively just increase the demand coming back in, and are so extensive that the inhibit the performance of all aspects of secondary care system functionality. The main problem here is that we do not, and have not, thought to plan for our own futures. We have decided to have a model where our youngest pay for our eldest, and haven't care that this drives massive generational inequities in how much people have to pay for their forbears, in the perfect knowledge that they will never receive anything like it themselves. Quite the opposite, they have to retire ever later, and their own life expectancy is already falling due to the overall reduction in living standards. The issue is fundamentally one of an ageing population that doesn't work and has not contributed what is required for their own care, despite being the recipients of economic benefits that will never be repeated (oil driven economic boom, and property market inflation). Accepting that these were not evenly distributed, those who could and should have paid more did not, and this was simply a passing of an existing liability or debt onto their children. That is where we are, and the problem still has a way to run with social care in collapse, and the NHS issues unresolvable until these are fundamentally addressed at the economic and system level.


Wes streeting is just a spiv.
 
Contrary to your assertion that private medicine is less efficient than the NHS, the reverse is so.
That's because they only do the profitable stuff in private hospitals. When the sh*t hits the fan they refer you to the NHS.

A few years ago my daughter, who was staying with me at the time, had a minor operation that involved a general anaesthetic. She has private healthcare through her company and the op was carried out at a local private hospital. Very nice.. private room, shower in the loo, choice of lunch.... all very posh.

Brought her home at 5pm. Throughout the evening she was a bit breathless and in the morning she was like a severe asthmatic, couldn't catch her breath at all. I called the private hospital and they told me to take her to Bournemouth General, the closest A&E. (I thought... WTF??? but did as I was told)

You read all these stories about 3 hour waits in A&E, well, they take problems with anaesthesia very seriously. We were there 5 minutes when the triage nurse called her. Got a summary of her symptoms and she was being wheeled to the Major unit two minutes later. The Major unit is for "serious injuries and illnesses". She was seen immediately by an intern, then a doctor, then a consultant. A pulmonary embolism (blood clot in the lungs) was initially suspected but quickly ruled out by a blood test (done and results returned within 15 minutes) and a chest X-ray indicated pulmonary oedema (fluid on the lungs) - probably caused by a bad reaction to anaesthetic administered at the private hospital. She was then transferred to the AMU (Acute Medical Unit) for observation. Happily, her breathing got back to normal over night and she was discharged the next day.

When the going gets tough private medicine bails out.
 
...

A lot needs to change in the NHS, and it's not just about throwing money at it.
Only an id iot would suggest that in the first place.
But the NHS has been systematically underfunded for some time and constructive investment of more money would certainly help.
The private sectors involvement is somewhat mythical as it is paid for by the state. Might as well nationalise the effers and cut out the profiteers, the dividend/bonus takers, gamblers, dubious finance et al.
Yes, and Wes Streeting is just a spiv.
 
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At its founding in 1948, it was guided by three core principles: That it covers the whole population (universality) That it be free at the point of delivery. And that it be based on clinical need, not ability to pay (equity)

Delivery of the core principles should not be dogma based, but founded on a reality of an inevitable compromise between quality, cost, and extent.

What is included
The original expectation was that the NHS would ensure all had access to basic healthcare. Rapidly some treatments were excluded - dental, opticians. That which can now be delivered using newer drugs, technology and medical advances has taken healthcare way beyond the original remit.

What is meant by privatisation of the NHS
The total resources needed by the NHS has always involved the private sector. The key point is that the NHS agree the contracts and hold the purse strings.

Building hospitals, manufacturing medical equipment, research and manufacture of drugs, medical gases etc are sensibly provided by the private sector under contract. It would make little sense for the NHS to try to replicate those skills and expertise,

Basic services - catering, cleaning, car parks etc - even IT systems and development may be better provided by the private sector which has the breadth of experience and skills.

Since the start of the NHS GPs have been contractors under contract to the NHS, not NHS employees. Other "close to patient" services are often contracted out - eg: imaging, chemists, etc.

That there is some fundamental issue which determines how the service is delivered is a complete nonsense. I simply want the best service for the funding available delivered effectively. If the private sector can do it better or more efficiently - use them!

How much of NHS provision should be "privatised"
The NHS at its best is rightly regarded as a centre of excellence. But it does not have a monopoly on innovative ideas which improve the patient experience.

Strategically there are real merits in ensuring that the private sector takes responsibility for (say) 20-30% of the total healthcare burden. Large enough to have economies of scale and demonstrate effectiveness (or otherwise), small enough to allow the NHS to continue as the core provider.

The NHS would take responsibility for managing contracts and performance management. Private and public sectors would benefit from a comparison of methods, quality, performance and cost.

The dogma driven "privatisation is bad" mantra is similarly nonsense.

"Privatisation" reached a peak during the Blair/Brown years when PFI contracts were awarded. That they were often expensive, poorly drafted and poorly managed may be true - but it did deliver a substantially improved infrastructure. Better management is the solution!
 
Only an id iot would suggest that in the first place.
But the NHS has been systematically underfunded for some time and constructive investment of more money would certainly help.

The NHS workforce plan - the first of its kind - is a 15-year programme which was devised by the NHS and has been backed by both Labour and the Conservatives. It will involve doubling medical school places in England from 7,500 to 15,000 and investing an extra £1 billion in training medical professionals beyond the general election.

Well worth a read - if only the summary:

https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/

However, what has been said by Labour so far as to funding doesn't inspire confidence.

Labour sources insist that actions in the workforce plan were backed by £2.4 billion in government funding up until 2028-29, saying “funds would be covered by existing baseline spending arrangements”. (It takes five years until trainees become junior doctors, meaning the costs of employing staff will gradually increase as the plan goes forward).

Angela Rayner has claimed Labour delivering the NHS workforce plan will not cost anything, despite warnings of a £50 billion annual price tag. It comes after the Institute for Fiscal Studies (IFS), an influential think tank, said the Workforce Plan will raise health Service spending by around 2 per cent of GDP – equivalent to an extra £50 billion a year.

When Labour published its manifesto last week, the IFS said it provided “no detail” about NHS funding in the next parliament “beyond some small amounts” set aside for hospital equipment.

Sir Keir Starmer said during a BBC Question Time Leaders’ Event on Monday, that he had a “fully-costed” workforce plan for the NHS. But the £1.8 billion of top-up funding included in the Labour manifesto is earmarked for commitments other than staffing, and the workforce plan would require a significant increase in the number of NHS employees.

The IFS noted that £1.8 billion is less than 1 per cent of the £192 billion that was spent on health and social care in England in the last financial year. “Delivering on all these promises would be expensive,” said the IFS. “It would almost certainly require real-terms funding growth upwards of 3 per cent per year.”

Angela Rayner seems to feel that because she was once a Unison Convenor for NHS staff, she has unique insights into the NHS, not possessed by the IFS and says: “I actually think by having that workforce plan we could save money if we can do those reforms. “If we can value the staff, if we can retain the staff so we are not paying huge agency fees, I actually think we could save money, never mind coming in cost-neutral.”

I doubt it will be too long before those words come back to haunt her.
 
the two main parties need a good kick up the backside & reform are the party to do that
Reform are just the military wing of the Conservative party. Think of them as the very worst of the cruel and incompetent elements of the Tories (as they are now), and turn it up to 11. Their spending pledges are completely ludicrous, they're about as likely to fund the NHS as the nonsense that was printed on the side of a bus, and just this evening Farage has been fellating Putin again.

Reform is just Farage's latest grift vehicle. With luck it'll die like all his previous cons... though he does usually manage to do a fair bit of damage (and make himself a fair bit of money) with each one first.
 
But the NHS has been systematically underfunded for some time
Throwing more money at it would work if you could just buy the doctors and nurses needed of which there is a shortage. Giving the nurses and junior doctors a payrise that reflects there training and responsabilities would help retention and maybe attract new trainee's. I also suspect that there buying is not as efficient as it could be, if all the NHS trust buy for there area and there is not a centralised buying department for the nhs as a whole then a lot of savings are being lost.
 
Think of them as the very worst of the cruel and incompetent elements of the Tories
I think that raising the tax threshold to £20,000 is a good idea and would help the lowest paid whilst giving incentive to the unemployed to seek work, leaving the ECHR is a good move as it frees our legal system from the EU and migration needs to be controlled because increasing the Uk population by 6 million in a decade is unsustainable and is putting enormous pressure on resources and is the highlight of conservative failure. So what is cruel about what Reform would like to do ?
 
I think that raising the tax threshold to £20,000 is a good idea and would help the lowest paid whilst giving incentive to the unemployed to seek work, leaving the ECHR is a good move as it frees our legal system from the EU and migration needs to be controlled because increasing the Uk population by 6 million in a decade is unsustainable and is putting enormous pressure on resources and is the highlight of conservative failure. So what is cruel about what Reform would like to do ?
Leaving the ECHR would be an insanity. Be very fearful of those who think the rules of human rights are a bad thing. Just because they have others in their crosshairs today doesn't mean it wouldn't be you tomorrow.

Edit: suggest having a read of https://www.amnesty.org.uk/what-is-...igned up to the,rights and freedoms of people and asking yourself why you might want to see us leaving it behind.

What's cruel? Well, take all the foul rhetoric about "small boats" from the Conservatives and dial it up further. Ben Habib (Reform, of course) has been pretty clear in his view of letting vulnerable people drown. Like many, he also repeats the untruths about "sending them back to France".

Raising the tax threshold would help a lot of low earners, but likely less than getting appropriate tax from high earners. Regardless, Reform seem to be promising everything to everyone; with no apparent way of funding it. Last time someone tried that (the "Trusterf*ck" budget) it... didn't go so well.
 
As always the politicians are telling us what they want us to hear, irrespective of reality:
  • the NHS spent £10bn in 2022/23 on temporary staff - includes cover for maternity leave, recruitment gaps, extended sickness, etc. The cost included agency staff at £3.5bn.
  • if all agency requirements were filled by permanent staff, the saving is estimated at £1.5-2.0bn as the salary costs for the additional staff would need to be paid.
  • this represents ~1% of the NHS total costs, and ~2% of staff costs - welcome but hardly game changing. Could easily be lost in a slightly generous pay settlement!
The main parties are selling a lie of substantial reform at trivial cost. There are only two possible conclusions - either nothing of any consequence will change, or they will implement changes at complete variance to the manifestos issued in only the last few days.

It's no surprise Reform are winning support - their "contract" (not manifesto) seems an honest statement of intent. That it is unaffordable, and taken as a whole repugnant or bonkers is a separate issue.
 
....

It's no surprise Reform are winning support - their "contract" (not manifesto) seems an honest statement of intent. That it is unaffordable, and taken as a whole repugnant or bonkers is a separate issue.
So an "honest statement of intent" is good even if utterly impossible and largely irrelevant?
I suppose it makes as much sense as Starmer's promise of "change", without saying quite what, why or how.
But then - are they all lying anyway?
The Farage approach: “The key to success is sincerity. If you can fake that you've got it made.” (George Burns.)
 
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