Monday, April 18, 2011

The shorter NHS reform debate

Now, I know that the whole NHS reform debate is pretty complicated and no one quite knows what's going on—so, your humble Devil has decided to provide a handy cut-out-and-keep guide to the whole issue...
All doctors (most especially GPs and GP bloggers): "The reason that the NHS is crap is because it is run by managers, not medical staff who know best about their patients' treatment."

All doctors (most especially GPs and GP bloggers) on the news that medical staff are to get the ultimate say on how the NHS is run: "We didn't mean us!"

Meanwhile, as 0.12% of the RCN membership passing a vote of no confidence in the Health Secretary is reported as 99% of nurses pass a no confidence vote in Lansley, your humble Devil reports that 99% of nurses starve their patients to death.

Hey! Don't thank me—I'm here to help...

58 comments:

Anonymous said...

Brilliant! :)

Just Woke Up said...

Think - thank.

Nice to see spin be unspun

Richard said...

Of course, if the restructuring and cost-cutting activities of a competitive enterprise on a relatively free market were conducted in such a manner as to harm the quality of that enterprises services to its customers, relative to the quality of services offered by a competitor, that enterprise would lose business. As a result, it would lose revenue. As a result, investors and owners would lose incomes. As a result they would have an incentive to alter the planned restructuring and cost cutting.

So the real irony is that most of the opponents of reform in the NHS are fundamentally opposed to the idea that recipients of healthcare be able to choose not to buy healthcare services or coverage from the NHS or the government, but be free to turn to a competitor. The irony of opponents of reform is that they fundamentally believe it is right for people to go on being forced to pay for an NHS whether they like its services or the way it is run or not!

Sres said...

I'd be interested in YouGov poll that asked the question, if you had a choice would you go public or private for an operation?

the a&e charge nurse said...

"Now, I know that the whole NHS reform debate is pretty complicated and no one quite knows what's going on" - rubbish, the issue is simple.

The tories, sorry coalition, and NuLAB before them are all hellbent on privatising the NHS but are frightened to say so in so many words - hence ridiculous phrases like "any willing provider".

Don't panic Libertarians the corporate health giants will soon be calling the shots in the UK so perhaps the public will finally be 'free' to indulge their most exciting health fantasies?

the a&e charge nurse said...

BTW Devil - well done for quoting the Fail - such an unimpeachable source undoubtedly lends even greater gravitas to your cheap shot, sorry, argument?

Blue Eyes said...

I am guessing that if patients don't like being treated by the "corporate health giants" they will tell their GPs to send them to the local organic co-op cataract centre. That is the "choice" bit I think. They will be presumably be prevented from forming a cartel by the existing rules under the EU Treaty and Competition Act.

Is there a bigger "corporate health giant" than the NHS? If you like smaller operations and plurality then surely these reforms are exactly what you support!

Or perhaps the dastardly "corporate health giants" that treat patients to a superlative standard in such libertarian paradises as Germany, France and The Netherlands will come over and sort out our creaking incompetent bureaucratic dirty health system.

I do wish that people would wipe the red mist away before deciding that the only solution is a Stalinist one.

the a&e charge nurse said...

"I am guessing that if patients don't like being treated by the "corporate health giants" they will tell their GPs to send them to the local organic co-op cataract centre" - er, no, the 'choice' in many cases will eventually be between a shit service or nothing at all, especially for those with unsexy chronic health conditions like dementia, MS or schizophrenia.

In other words a market based system will not be driven by clinical need (which for all it's faults is the case with the NHS) but rather those conditions which are the most profitable amongst those sectors of the population most able to front up the highest insurance premiums.

the a&e charge nurse said...

"superlative standards" in Germany, France and The Netherlands, eh?

Hardly surprising how many extra billions have been poured into their health care system over the last 60 years.

Given this VAST culmulative difference the only question, surely, is how well the NHS has performed in comparison - perhaps one reason might be all the unpaid hours of work put in by docs & nurse, many of whom happen to subscribe to the NHS's founding principles.

Would the likes of BUPA inspire the same sort of loyalty?

Devil's Kitchen said...

A&E,

I am all for the privatisation of supply for precisely the reasons that Tim Worstall amplifies in this post, i.e. that the health system that is consistently rated the best uses that system.

As for my quoting the Fail... Well, it's not as though there is any shortage of stories about nurses leaving patients to starve in their own filth, is it now?

And the NHS is driven by clinical need except of course, when it's not, e.g. waiting lists (rationing by time—particularly super for oncology outcomes), money (various drugs, so-called "post code lottery", etc.).

DK

Blue Eyes said...

A&E, is the coalition proposing private insurance? No.

the 'choice' in many cases will eventually be between a shit service or nothing at all, especially for those with unsexy chronic health conditions like dementia, MS or schizophrenia.

So not unlike now, then.

As for pouring billions in over 60 years, Blair poured billions into the unreformed NHS and what happened? GPs gave themselves a decent payrise and the number of bureaucrats increased. Productivity collapsed.

You are glorifying an idea without actually noticing that it doesn't work as well as you would like it to.

the a&e charge nurse said...

"is the coalition proposing private insurance" - is it Tuesday today? - ask me again on Wednesday - in other words is simply a matter of when, not if.

"In 2000 there were no foundation trusts; no payment by results for hospital treatments; no private health companies already providing NHS acute care and GP services; no independent regulator of a healthcare market (Monitor). Without all these changes, and many others, what Lansley’s Bill now proposes would be unthinkable - All of these changes were major. Yet most people were largely unaware of them, and certainly unaware of where they were leading – and that includes many MPs and even many clinicians. And not just because the NHS is complex, and organisational changes don’t make sexy headlines. It is above all because the changes were made covertly, using government powers that did not require primary legislation. The true purpose of a series of so-called reforms was deliberately concealed".
http://www.opendemocracy.net/ourkingdom/colin-leys/plot-against-nhs

So relax guys - the market nirvana you long for has finally arrived - no more scandals about malnourished, or incontinent patients then, eh devil?

Blue Eyes said...

"All of these changes were major."

And all of them had been enacted a few years previously before Idiot Dobson undid them leaving he successors to redo them.

Basically you are saying that any post-1948 reform is akin to introducing the US system by stealth. Even though nobody is arguing for the abolition of "free at the point of use".

You need to take the tin-foil hat off and get some perspective.

I suppose you would be upset if we ended up with the French or German system too?

the a&e charge nurse said...

"Even though nobody is arguing for the abolition of "free at the point of use" - oh do and try to keep up.

"There are new mechanisms to introduce charges and privately funded healthcare. The secretary of state’s duty to provide free services that are “part of the health service in England,” except where charges are expressly allowed (section 1, 4), is undermined because the power under the Health and Medicines Act 1988 to impose charges is transferred from the secretary of state to consortiums (section 22). Consortiums will determine which services are part of the health service and which are chargeable (section 9), and they have been given a general power to charge (section 7, 2h).
http://www.bmj.com/content/342/bmj.d1695.full

Blue Eyes said...

"oh do and try to keep up."

Nice.

A producer quoting an article from the union's web site. I think I will take that with a pinch of verboten salt.

I see you still haven't answered whether you would be as angry as you apparently are if we ended up with the French system or the Australian system or the German system or the Dutch system or the Singapore system.

the a&e charge nurse said...

If we can't afford the NHS I don't see how we can afford the more costly systems favoured by the Germans and French.

BTW - I'm not just a producer - I was an NHS customer when my children were born - same again when my parents died.

I assume "producer" is being used as a pejorative term implying an inherent bias? - even so I would still fancy my job prospects even if the likes of Richard Branson got his foot in the door.

Blue Eyes said...

So now you are saying that the NHS is great because it's cheaper? Would the same amount of money be spend more wisely with a German structure or a Stalinist structure, then?

Presumably you are contrasting yourself as a customer with me as a non-customer. If you must get personal then I can exclusively reveal that the NHS fucked up royally by not diagnosing my father's cancer until far too late for anything to be done about it. Likewise a good friend of mine (a doctor, no less) has also managed to avoid having her breast cancer diagnosed until it was the size of a golf ball.

Having said that, I went to my GP the other day and was seen on the same day and he was not late for the appointment. However he did prescribe me something for £7.40 which I can buy at Boots for a fraction of the price.

What a fucking ideal system you love.

the a&e charge nurse said...

Hang on BE - this has gone off track a bit.

First of all I was simply disagreeing with our host that the debate is complex - the NHS is being covertly privatised, and has been for some time.
None of the main parties have been honest enough to be open about it, or put such a choice to the electorate - obviously I have my own opinion as to why.

I then went on to say that marketisation will not (in my opinion) improve the nation's health overall, although there will be winners and losers.

There are certainly problems with the NHS and I am not trying to gloss over cases (such as your Dad's) when the standard was simply not good enough.

As I say the traditional NHS system is all but over and I am sure we will continue to have debates about how effective (or ineffective) the new market driven system proves to be?

Blue Eyes said...

"I am not trying to gloss over cases (such as your Dad's) when the standard was simply not good enough."

That is exactly what you have been doing. You believe that a top down system where a committee of experts in Whitehall directs the resources of the NHS to decide what is best for each patient is the only way to do things.

You state that any kind of reform that introduces choice or diversity of provision or the localisation of decision-making is the same as "privatisation" which you equate with "evil".

You state, with a kind of certainty that I would find difficult to summon when choosing something as simple as a mobile phone contract, that a GP-driven system will not work even though there are countries which run such systems very successfully.

You then go for a neat Marie Antoinette-style dismissal of all my arguments, stating that I am simply too ignorant to know what I am talking about, following it up with a "I use the NHS too and I think it's fucking great" argument.

Nurse Pangloss, you need to understand that the reason the NHS makes so many horrifying mistakes is BECAUSE of its structured and not by some freak chance each and every time.

I hope you are better at patching people up in A&E than you are at forming an argument.

the a&e charge nurse said...

"you need to understand that the reason the NHS makes so many horrifying mistakes is BECAUSE of its structure" - according to this study the NHS actually had the LOWEST rate of medical errors (USA had the highest).
http://www.commonwealthfund.org/Content/News/News-Releases/2005/Nov/International-Survey--U-S--Leads-in-Medical-Errors.aspx

Such claims make little sense unless there is a comparitor - unfortunately EVERY health system has it's share of horror stories.

You obviously believe in plurality and local decision making, etc - fine - but my problem is with the fact none of the parties have bothered to explain the long term implications that such developments entail (see Pollock's analysis).

GPs can either be clinicians (in other words seeing patients) or they can be business men or women but I don't think they can be both - the consortia role will quickly be devoured by the sort of organisations responsible for managed care in the USA.

So cheer up - the market based conditions longed for by the libertarians have finally arrived in the UK.

Blue Eyes said...

Presumably just as solicitors and accountants and financial advisers cannot be trusted to run their own businesses and have been swallowed up in huge "corporations".

Hold on a minute, aren't GPs already running their own practices. Oh yes, so they are!

You are being defeatist. You are basically saying that a British government doesn't have it in it to set up the kind of system which works brilliantly in many other countries. You are still peddling this idea that it is a black/white choice between the dysfunctional US system and the monolithic state monopoly of the NHS. You still haven't answered my question about the international comparison, perhaps because you can't bring yourself to admit that there might be better ways of doing things?

The system being proposed by Lansley is nothing like a libertarian free market and you know it, or at least you should know it.

the a&e charge nurse said...

"The system being proposed by Lansley is nothing like a libertarian free market and you know it" - my point exactly because Lansley, like Alan Milburn & Co before him, does not have the integrity to come out and state exactly what the longer term implications of these changes will lead to.

Hell the tories didn't even have the bottle to mention their £2-3 billion reform in their pre-election manifesto - maybe they simply forgot to tell us?
http://www.bbc.co.uk/news/health-10647910

lost_nurse said...

Long time no see, A+E CN. Hope all well with you.

Like you, I am baffled as to why people think that some kind of bodged alliance of Serco, Mckinsey and United is going to make everything, you know, ok. Or how hiving off elective/profitable surgery in the generally fit is going to improve conditions on understaffed elderly care wards. All that producer interest must be blinding me to the exsanguinating obvious.

Here's my shorter NHS debate: nobody on the shopfloor considers it to be perfect. Their key concern is that these reforms will fragment what the NHS can do well. This is isn't some kind of careful re-think a la the Dutch - it's a political car crash dressed up in easy platitudes about choice & competition... which, frankly, often mean fcuk-all where I'm standing (in emergency surgical admissions).

lost_nurse said...

this isn't... sorry, bleary eyed typing.

Blue Eyes said...

So because it looks nothing like a libertarian free market, the inevitable conclusion will be a libertarian free market?

You are scared of change, that is not unusual. However, sometimes change can be a good thing. It is not always part of some wider conspiracy to subjugate people into slavery and poverty.

For example in the not too distant past people like you thought that other more demanding people should get over their desire to wait less than several months to have a telephone installed. They thought that the telephone system should be run as much for the benefit of the people who ran it as for the benefit of the paying customer.

The communications unions with a straight face demanded the right to regulate anyone who had access to the telephone network, at one point suggesting that only union-approved workers should be allowed to maintain computers connected to the network.

How laughable that seems today.

lost_nurse said...

"people like you"

Yes, when dealing with a potential bowel obstruction in an elderly patient with COPD, I always think how acute care is just like a highly-regulated telephone system.

Also, how emergency surgery is just like buying a TV. How amazing that they are now available in colour - when once they only showed things in black and white!! Incredible.

Eddie Douthwaite said...

A coalition of hatred.

http://f2cscotland.blogspot.com/2011/04/work-together-says-scottish-coalition.html

magento themes said...

Really i am getting confused what is going on........

Anonymous said...

NHS staff aren’t inherently afraid of change (they’d never have survived the endless reorganisations over the past 20 years). What they are afraid of is replacing a broken system with one that is somehow even worse.

The NHS Commissioning Board will have the real power, not the GP consortia. It’s highly likely that they’ll order the consortia to commission the cheapest services. This will in turn incentivise the providers to cut costs wherever possible, especially in the money-losing areas like acute medical wards. The easiest way to save a large amount of money is to reduce staff.

It’s pretty obvious that you don’t improve quality of care by reducing the number of clinical staff or replacing them with those less-qualified. It leads to wards with thirty patients starving in their own filth while the lone registered nurse runs around trying to prevent one of them dying. The least ill patients (elective surgery) are already prioritised over the sickest because they bring the hospitals the most money. The new plans will simply accelerate this.

If Lansley really wants to improve the standard of care and give patients choice, then a French-style system would be the way forward, with everyone given the funds to choose their provider. The main issue is the cost of introducing such a system. When the reforms kick in, the choice will be made for you; it will be whoever can do it on the cheap, regardless of the quality.

the a&e charge nurse said...

lost_nurse - I see you are on the money as usual - ah, well, at least we tried to warn them.

Anonymous said...

ah, well, at least we tried to warn them.

A&E, please don't kid yourself that you give a shit about the rest of us. The laudable original intent of the NHS was perverted long ago by the unions to suit the needs of the staff, not the public. It is that perversion that you so vehemently defend.

The evil private sector may well shaft us, but let's face it, that's what NHS staff have been doing to us for years.

the a&e charge nurse said...

"A&E, please don't kid yourself that you give a shit about the rest of us" - yes, a fair question - does anybody really give a shit about anybody else if they are being honest?

People like Dawkins have discussed traits such as altruism and of course nothing is ever quite what it seems.

At least we agree the public will be shafted by the private sector but perhaps you simply prefer a more open sort of shafting culture that one invariably expects from the fatcats?

For an exercise in self delusion why don't you revisit the various reasons why bankers were so insistent that they should still be awarding themselves billions (in bonuses) despite nearly running the country into the ground.

Anonymous said...

At least we agree the public will be shafted by the private sector but perhaps you simply prefer a more open sort of shafting culture that one invariably expects from the fatcats?

A&E, firstly, I agreed no such thing - I merely remain open to the possibility. It is a shame you cannot accept that NHS staff are equally capable and indeed have been very successful in shafting the tax payer.

Secondly, would I prefer openess to the current position where the "fat cat" BMA, driven by pure self interest, greed and maximising the profit of its members continues to roger successive governments to ensure that "fat cat" GPs and "fat cat" NHS consultants continue to grow rich at our expense? Actually, yes, I would prefer more openess. Wouldn't you? Or is it only private sector "fat cats" you object to?

As for your comment regarding self delusion , consider this. The banking crisis was one of liquidity. The debt the country now has to pay off was largely the handiwork of the labour government ably abetted by its loyal public sector.

To continue to blame the banks for the debt, and to believe that public sector incompetence and greed played no part - that is self delusion.


Finally, your point about altruism is interesting. Contrary to what Dawkins thinks, there are plenty of examples of truly selfless acts, which are inspirational and restore one's faith in the better elements of human nature. Which just goes to prove that Dawkins is an utter cunt.

ex-pat said...

So again a debate on the NHS founders on the intransigence of its employees. We are all wonderful & where would you be without us? It's that tricky conflation of the 'caring professions' with the opposite of not giving a toss. Do you think your the only ones who regularly give more than expected to aid those who rely on you? There's loads of people out in the business world who do exactly the same. They do it, not only because looking after customers keeps customers, but out of a sense of professional responsibility.
And don't think the NHS is short of its own share of couldn't give a f***ers. That's the medical staff let alone the bureaucracy which all too often has the charm & helpfulness of East German border guards circa 1970.
The 'NHS is the best health service in the world' schtik only works with people who've never experienced any other.

the a&e charge nurse said...

"Do you think your the only ones who regularly give more than expected to aid those who rely on you? There's loads of people out in the business world who do exactly the same" - which other group of workers ROUTINELY put in as many unpaid hours as NHS staff?

I'm talking EN-MASSE rather than the odd individual who spends a few late nights at the office ever mindful of the bonus that will be coming his/her way?

BTW - I accept that teachers put in a lot of unpaid time as well - perhaps you can tell us which group in the private sector put in a comparable number of hours ......... gratis?

ex-pat said...

Oh boy, comparing yourselves with teachers! You trying to provoke some sort of coffee/keyboard interfacing here. Teachers? Sh*t. Why didn't you pick another bunch of politicised incompetents with their heads jammed so hard up their collective backsides all they can hear is the echoes of their own gibberings? Probably because none compare. Have you seen the state of education in your country? I have. I recently spent a day trying to straighten out a business plan for a supposed university graduate. The original submission went back with "Learn to use a fucking spell-checker" as a subject line before I'd even read it through. Perhaps if teachers worked less hours -although what with the extended holidays, sick days, days on 'courses' that might be difficult- they might be able to manage to give their charges a rudimentary education.
And which group put in a comparable number of hours? Take a bow the self-employed small trader. Easier to ask them how many hours they have off that don't involve sleeping than how long their days are. No guaranteed pension at the end either or even a guaranteed income for that matter. Not everyone apart from you works in offices you know? Want to know whose done the most for health in the last couple of centuries? Not you lot. The humble plumber keeping your shit out of your drinking water. Trouble is a TV soap with the cast up to their waists in waste doesn't work for the drama value does it?

the a&e charge nurse said...

"The humble plumber keeping your shit out of your drinking water" - yes, but NOT for free, which was the point I was actually making - it's generally the doctors, nurses and teachers who do that.

I picked this firm of plumbers at random
http://www.emergencyhomerepair.co.uk/emergency_call_out_charge.html

Hourly call out rates start at £89 per hour - but compared to how health bills will eventually look once the tory reforms pick up steam £89 per hour might not seem like such a bad deal?

Just think, you will soon be "free" to shop around for the cheapest operations ....... marvelous?

bishop brennan said...

lost_nurse - the Lansley reforms are - or at least parts of them are - based on the Dutch experience: an economic regulator for health.

You're right that retaining the Stalinist element in the NHS Commissioning Board - run by an 'ex' Communist, who behaves like Stalin on steroids, i.e. in the usual shit style of NHS management by bullying - will probably weaken the benefits of the good elements. But that's not the bit, surprise, surprise, that the unions complain about - because it doesn't threaten their vested interests, but strengthens them.

In fact, the Dutch case illustrates just how stupid the debate in this country has been - the introduction of price competition in hospital care has reduced prices, increased quality and removed waiting lists (for nothing, compared to the £billions frittered away by Brown et al). And yet, what was the argument here - oh yes, 'price competition would be a disaster'. It makes me weep.

A&E nurse - actually, when you compare the NHS to other systems, it still looks shit. The best measure is mortality amenable to health care. The latest OECD stats for 2007 show that the UK still lags behind New Zealand, despite that country taking the decision in 1997 not to increase the proportion of GDP spent by government on healthcare - compared to the doubling (trebling in nominal terms) of spend in the UK.

And I use the NHS too - more's the pity. Just like every Communist system, in order to get the best treatment, you need to know someone, know how to manipulate the system - a classic insider-outsider problem. And my family has nearly paid dearly for its incompetence on several occasions. Apologies for shouting, but you need to hear this: LARGE CHUNKS OF THE NHS ARE SHIT. And I don't see why I should be forced to pay for shit.

ex-pat said...

Sorry, I didn't realise you lot worked for free. Didn't realise teachers did either. Next time we speak I must ask that ex-girlfriend of mine where that final salary pension scheme she lives so comfortably on came from.

Plumb right, that enormous £89 p/h also covers the cost of the several thousand pounds worth of equipment carried in the van that's he's bought & has to maintain so he can drive half an hour to your place, fix your leaking pipe & drive half hour home again. Maybe someone else will need his services that night. Maybe they won't. Bills'll keep coming in though.

"..compared to how health bills will eventually look once the tory reforms pick up steam..."
Look sport, I'm a french resident. I know there's a better way of running a health service & the NHS ain't it. Have you ever seen a decent health service? You know, the clean modern hospital with efficient friendly staff sort of health service? Maybe your neighbours across the Channel could come over & show you how it's done. We can afford it, why can't you?

ex-pat said...

Come to think of it, whilst we're conversing, as an A & E nurse you can explain something that's always mystified me.
Back when I was UK side I've several times had to cart people down to the hospital after they've hurt themselves. So you sit there with some bloke whose shredded his fingers & is dripping blood all over the place for 3 hours waiting to be seen & you realise that last time you were doing this it took 3 hours & the time before that 3 hours. Doesn't seem to make any difference the time of day or night or how busy it is or even which hospital. Always a long wait. And it occurs, that actually this is impossible. Either the hospital has adequate staff for demand so there shouldn't be much of a wait. Or it's under resourced in which case the delay should extend eventually to the point where patient mortality would be a limiting factor. What it can't logically do is stabilise at a constant waiting time. Not unless you build it into the system......

Mark M said...

"The NHS Commissioning Board will have the real power, not the GP consortia. It’s highly likely that they’ll order the consortia to commission the cheapest services"

Bang on the money Anon. But it will always be the way in any Marxist system. "From each according to his ability, to each according to his need" will always require there to be someone who decides what is 'needed'.

Personally this is why I think people should be able to opt-out of the NHS, and be given £1,000, approx two-thirds of the per capita split of the NHS budget. It's up to them if they want to purchase health insurance with that money or not, but the important thing is that the money is in the hands of the customer, not the provider.

the a&e charge nurse said...

ex-pat -"in the last year 20.5 million people attended A&E Departments in England – the equivalent of 40 per cent of the population making one visit".
http://www.telegraph.co.uk/health/healthnews/7723533/Record-numbers-of-patients-in-AandE-official-figures-show.html

This represents an increase of over 30% in attendances in less than a decade - it's just like the M25 - you add another lane yet it becomes congested in the blink of an eye.

Mark M - £1,000 might get you 2 days work from a plumber, but if you are a renal patient, say, you would soon be in trouble because of the steep cost of either a kidney transplant or sometimes decades of haemodialysis.

Libertarian said...

All you nursey nursey types on here seem to be under the impression that Doctors,Nurses, clinical support staff and other healthcare professionals can't be trusted to care for their patients properly or provide a caring and respectful service unless they work for the government. What utter bollocks you speak. Your arguments are entirely political.

By the way just because services aren't provided by the government doesn't mean that health care providers are for profit companies. Nothing stopping hospitals being charitable trusts, clinics being CIC companies or health providers being provident companies.

Wake up and smell the coffee the NHS is the 18th most successful health care system in the world NONE of the 17 above it is provided by that countries government all are provided privately.

The US system which is the one NONE of us want is 35th by the way


What I want and I suspect most libertarians want is a government mandated insurance scheme that covers the population for health care that is free at the point of use.

KevinWard76 said...

With all the noise coming from the left about the health service being "destroyed" and "privatised", you'd have thought that the reforms would be a vicious and severe transformation of the NHS…

…but as I suspected, and thanks to the cut-out-and-keep guide above, it is actually quite uncomplicated.

As a regular, reluctant user of the NHS, I will put money on there being virtually no difference to the end-user after the reforms…

lost_nurse said...

Your arguments are entirely political.

What bollox this is. Historically, the NHS has provided a reasonable service for less-than-continental-levels of investment. Could it be improved? Yes (not least with a continental budget). Will these reforms do the trick? I very much doubt it. The suits at Cinven (PE owners of Spire), Circle, Care, United etc etc are positively creaming themselves at the thought of all the lovely assets. But, no, it's the clinical staff who get accused of producer interest, ad nauseum.


My stance has got nothing to do with being a sanctimonious angel (I'm a six foot bloke & pretty ugly, if you want to imagine me a dress...) - I simply object to the fookin' crass platitudes dribbled out on sites like these. IME, people who spout on about the beauty of competition rarely have anything useful to say when it comes to friday night PICU tranfers, or emergency surgery in patients with extensive comorbidities. When the "range of quality providers" steer clear of the messy stuff, you can bet that somebody will have to (try and) pick up the pieces. I imagine large teaching hospitals will have to preserve such capacity in a charitable manner. So, yes - a mixed economy involving a subtantial NFPt element. But - for fcuk's sake - enough of these dumbass supermarket analogies.

the NHS was perverted long ago by the unions to suit the needs of the staff, not the public

The NHS is being run for my benefit? I must inform payroll - I knew there had been a mistake. I suspect that a single RN caring for twelve patients (not unusual on general wards) would still be accused by some on here of being an over-unionised, work-shy layabout.

lost_nurse said...

My comment seems to have disappeared...

Your arguments are entirely political.

What bollox this is. Historically, the NHS has provided a reasonable service for less-than-continental levels of investement. Could it be improved? Yes (not least with a continental budget). Will these reforms do the trick? I very much doubt it. And I've yet to hear a convincing explanation from the SoS. Meanwhile, the suits at Cinven, Care, United, Serco etc are positively creaming themselves at the thought of all those lovely assets - but it's the clinical staff who get accused of producer interest, ad nauseum.

My stance has got nothing to do with being a left-leaning sanctimonoius angel (I'm a six foot bloke & pretty ugly, if you want to imagine me in a dress). I simply object to the crass platitudes dribbled out on threads like these. IME, people who spout on about the beauty of competition rarely have anything useful to say when it comes to friday night PICU transfers or emergency surgery in patients with extensive comorbidities. I imagine that large teaching hospitals will have to preserve such capacity in a semi-charitable manner - so, yes, a mixed economy with a substantial NfPt element. But, FFS, enough of the dumbass supermarket analogies...

the NHS was perverted long ago by the unions to suit the needs of the staff, not the public.

The NHS is being run for my benefit? I must inform payroll - I knew there had been a mistake. I suspect a single RN caring for twelve (& potentially acutely unwell) patients - not unusual on general wards - would still be accused by some on here of being an over-unionised, work-shy layabout. Much of what goes wrong in healthcare would be remedied by improved nurse:patient ratios - do I see any sign of that happening as a result of the ConDem plans? I do not.

KevinWard76 said...

"Much of what goes wrong in healthcare would be remedied by improved nurse:patient ratios"

So… lessen the number of patients then… ;)

lost_nurse said...

So… lessen the number of patients then… ;)

Don't give them ideas! :)

Now, where's my copy of Logan's Run?

Libertarian said...

@lost-nurse

There you go again projecting your political bollox. Serco aren't a medical company they're an admin outsource co.

No patient WITH A CHOICE would go to a serco or capita or compass health care provider because they are crap at health care. They can run the canteen, flower shop and maybe cleaning services.

You just wilfully don't want to understand what competition means. The full range of medical treatment would be available as well as highly specialised centres of excellence and A+E and mental health etc etc just like it is in ALL the 17 better and private systems in operation around the world.

Just pretending that the only medical services anyone would offer would only be the cheap and easy stuff is basically to live in a blinkered cocoon. Go to France and experience medical treatment in the Worlds Number 1 country, then come back to explain why we have to put up with the NHS crap

In France, Italy Singapore, Germany Australia all their vastly better and privately provided health care is provided by fully qualified very professional health care people and quite often not for profit. Even in the crap US system an awful lot of the hospitals are not for profit charities.

In the UK if anyone seriously wanted to improve health care and "privatise" the NHS it would immediately free up more money to invest in health care and ALL the same highly qualified staff would work in it as currently are employed by the government.

Your argument is still ideological politics and not effective health care

the a&e charge nurse said...

"What I want and I suspect most libertarians want is a government mandated insurance scheme" - big brother extorting money for health care, how very unlibertarian?

Still the mystical power of Norwich Union, et al, is not to be sneezed at.

Nurse Anne said...

I am so happy to be Nursing in the USA now. One degree Nurse to every 5 patients and no wards staffed with mostly care assistants. The patients get excellent care.

Catering sends up enough food to feed the patients and the staff get time to feed them. In the NHS two staff had a 15 minute window to feed 30 patients before kitchen insisted on getting those plates and left over food back. It was all about kitchen staff wanting to get their work done quickly so they could go home on time.

I am getting paid double what I made in the NHS and of course the work over here is easier because the private sector is always easier. I like having excellent health insurance coverage as well. All in all health care is cheaper for me now that I am out of the NHS.

I have always hated socialism. I don't believe it works. But I don't believe for one minute that the current government's reforms are going to improve medical and nursing care in the UK. They are trying to sell you dumbasses the same shit that you have had all these years but they are disguising it too look like there will be more competition etc etc.

Dumbasses. You lot are going to have no healthcare rather than shit healthcare once this all goes through. And the NHS Nurses and Doctors know it.

Great if you want to reform the NHS (you really fucking should) but the current reform is going to bugger things up even more.

Nurse Anne said...

I was a member of the RCN whilst in the UK. The only reason for this was the liability coverage. The working conditions of frontline NHS health care professionals is shit beyond what most private sector employees can imagine (and I am a private sector employee now. The RCN was completely powerless to do a thing about it. Still had to give them my money every month though. What a joke.

lost_nurse said...

Glad things are working out for you, Nurse Anne - at least there's a healthy global labour market for nursing staff. Perhaps we should follow the example of the bankers & threaten to leave en masse - last one out, turn off the lights/macerator/defib etc. :)

Nurse Anne said...

Seriously. Leave. The only thing that is kind of crap is that there is less annual leave compared to the NHS. But who cares? I don't bother about vacation time if I enjoy my job. I never enjoyed any time off in the UK because I was so freaked out about work all the time and also couldn't afford to go anywhere.

the a&e charge nurse said...

"One degree Nurse to every 5 patients and no wards staffed with mostly care assistants. The patients get excellent care" - at a cost though, >17% of GDP.

Neither the NHS or any other country in the world spends remotely like that figure on health - yet even though the USA spends far more than anybody else it consistently has unfavourable outcomes when it comes to infant mortality, life expectancy, or death rates amongst conditions said to be amenable to health care.

The obvious question is why?

Anonymous said...

Nurse Anne , surely you realise the RCN is a kapo union ie not really a union at all. It sold out to the management decades ago.

the a&e charge nurse said...

Predictably the Devil's article implies the usual market panacea (this time because of the various binds associated with failings in state provision).

But if health markets are so great why do situations like this arise?
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

No wonder some of the libertarians (upthread) are demanding a state enforced insurance based system?
Let's face it - you'd have to be a pretty thick bastard to entrust your health to the fatcats?

lost_nurse said...

Serco aren't a medical company they're an admin outsource co.

As the disappeared comments seem to have re-appeared, I'll just reply to this. I am well aware of what Serco is, and what they do. Fact is, like Crapita, they are seeking to run ever larger chunks of public sector infrastructure, including healthcare. And much of what is often described as "shit" about the NHS (not least the catering) is ALREADY outsourced. Noting that nobody would "choose" Crapita is entirely beside the point - like NuLav before them, the ConDems are happy to hand the assets over like candy. It's notable, too, that George is still (enthusiastically) signing off PFI projects. That's really going to help.