The Great NHS debate

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  • The NHS should be privatised to make the savings we need for efficiency, which is a word the NHS does not understand.

    If they succeed, it will be a job well done and we will finally get a professional service that we need and deserve. If it fails to deliver, at least we can then take it back into the public service, with the savings made. We can then start anew and without any black holes.

    What exactly would privatising the NHS mean, them only saving the lives of people who can afford to pay and bugger those that can't?

  • What exactly would privatising the NHS mean, them only saving the lives of people who can afford to pay and bugger those that can't?

    I don't really care who runs the NHS so long as the service is "To each according to need and free at the point of delivery" as was the original tenet.

    It is a fact that non state run businesses are much more efficient as the amount of bureaucracy is much less. A more efficient NHS would be able to treat more patients for the same amount of expenditure. The graph below shows the eye-watering amount the NHS swallows up yet many complain of "cuts" no doubt caused by havng ever more managers and poor procurement.

    History is much like an Endless Waltz. The three beats of war, peace and revolution continue on forever.

    4312-gwban-gif

  • I don't really care who runs the NHS so long as the service is "To each according to need and free at the point of delivery" as was the original tenet.

    Well that's how it should be run, but will a private company want to run it like that or will they be more interested in making a profit. Health care is not always something you can predict as the covid pandemic has proved, everyone with hindsight can say well they should have done that differently.

  • The NHS is being bogged down with people who are NOT genuinely ill........ Too many people wasting the NHS recources having appointments and procedures done for nothing more than lifestyle choices.

    The NHS is there to treat people who are genuinely ill. That's what it was set up for.

    If anybody wants lifestyle changing surgery --- Pay for it themselves at a private clinic, dont expect the taxpayer via the NHS to fund their fancies.

    The Voice of Reason

  • It is a fact that non state run businesses are much more efficient as the amount of bureaucracy is much less. A more efficient NHS would be able to treat more patients for the same amount of expenditure.

    This isn't really true for public bodies that are put into private management. A private organisation thrives (or dies) on competition. An NHS placed into private management would not function as a private organisation, it would operate as a public body with a for profit management system and shareholders to satisfy. The costs would escalate, the diversity of services would diminish to only those that were profitable and with time the parent company would extract more and more profit whilst providing the contractually acceptable bare minimum service. The principle point being that there is no competition for customers so there is no drive to be efficient or offer a great service. The service would be what was specified by the contract and the fees for providing it would be fixed including the profit element, the management company would drive efficiency by cutting costs (staff) to the bare minimum and then paying the least they could get away with for those that remain. The service would crumble but we the tax payer would still pay for it from our taxes, probably more than we are paying now.

    The same model was applied to the railways with the letting of franchises, the companies just screwed all the profit they could out of the system and the service went to pot and was taken back into government management in a few cases and eventually they all will be now.

    Privatisation is not the answer.

    Celebrate it, Anticipate it, Yesterday's faded, Nothing can change it, Life's what you make it

  • Well that's how it should be run, but will a private company want to run it like that or will they be more interested in making a profit. Health care is not always something you can predict as the covid pandemic has proved, everyone with hindsight can say well they should have done that differently.

    The trick is to get the specification for the contract right, and then monitor it to ensure compliance.

  • The trick is to get the specification for the contract right, and then monitor it to ensure compliance.

    The trouble is that civil servants with arts and humanities degrees are far too easily bamboozled by hard nosed businessmen.

    History is much like an Endless Waltz. The three beats of war, peace and revolution continue on forever.

    4312-gwban-gif

  • This isn't really true for public bodies that are put into private management. A private organisation thrives (or dies) on competition. An NHS placed into private management would not function as a private organisation, it would operate as a public body with a for profit management system and shareholders to satisfy. The costs would escalate, the diversity of services would diminish to only those that were profitable and with time the parent company would extract more and more profit whilst providing the contractually acceptable bare minimum service. The principle point being that there is no competition for customers so there is no drive to be efficient or offer a great service. The service would be what was specified by the contract and the fees for providing it would be fixed including the profit element, the management company would drive efficiency by cutting costs (staff) to the bare minimum and then paying the least they could get away with for those that remain. The service would crumble but we the tax payer would still pay for it from our taxes, probably more than we are paying now.

    The same model was applied to the railways with the letting of franchises, the companies just screwed all the profit they could out of the system and the service went to pot and was taken back into government management in a few cases and eventually they all will be now.

    Privatisation is not the answer.

    I disagree. Privatisation is the answer, but it needs to be managed properly.

    The competition can be provided by awarding contracts in geographical areas or for individual hospitals, GP surgeries, etc and selection of companies through a tendering process.

    The NHS is not working in its present form. It is too big, unwieldy, inefficient and bureaucratic and customer satisfaction is declining.

  • I disagree. Privatisation is the answer, but it needs to be managed properly.

    The competition can be provided by awarding contracts in geographical areas or for individual hospitals, GP surgeries, etc and selection of companies through a tendering process.

    The NHS is not working in its present form. It is too big, unwieldy, inefficient and bureaucratic and customer satisfaction is declining.

    Regions, areas etc. all sounds like the franchise model. Or maybe these entities could be called NHS Trusts 😉

    This also runs the risk of the individual franchises not offering a universal service forcing postcode lottery medical care just like we have now.

    The NHS is a public service, not a business and it is adequately funded. The problem is the people that manage the NHS do not spend the money sensibly. Perhaps it is time to let the doctors run the NHS again and ditch the professional managers?

    Celebrate it, Anticipate it, Yesterday's faded, Nothing can change it, Life's what you make it

  • Ironically it's the already backdoor privatisation that is putting the NHS on it's knees so whether it should be privatised or not is not even a discussion. It already is being privatised department by department or sections of departments at a time. IMO it's the privatisation that is causing the problems we already see with the NHS. It's turned into a business rather than healthcare and there are business managers managing things who only deal with profits and cutting costs while the genuine medical staff are left fighting the management and having to either cut corners or delay treatments much to their frustration.

    As for each according to need and free at the point of delivery, if you have money or are in a position of power you can already jump the queue. There is also the option of a private ward in the same building that everyone else is in and gets treated by the same staff. It will just be a separate floor in the same building without shared wards and you probably get a TV by default instead of being ripped off by the conning hospital hire companies and better quality food.

    Mike brings up a valid point as there are far to many cosmetic treatments available on the NHS but if it's something that effects mental health then it can possibly borderline on being clinical but these cases need assessing better with valid evidence from an ongoing mental health team.

    There's another hole that needs plugging which is the NHS treatment of foreigners to make money. They treat first and then get them to fill in the paperwork and expect patients to cover the costs afterwards and there is nothing to stop these people running off back home and not paying their bills.

  • The competition can be provided by awarding contracts in geographical areas or for individual hospitals, GP surgeries, etc and selection of companies through a tendering process.

    So you end up with different hospitals offering different services and treatments which then result in if the hospital in the area you live in doesn't offer the treatment you need you either have to go without or travel to a different hospital which could be miles away, all this when you are feeling ill, and maybe not have your own transport or maybe too ill to drive anyway and have to rely on public transport, and yes that is already happening and chances are with private companies running the NHS it would get worse because they would cherry pick the most lucrative treatments and services to ensure they make a profit.

  • So you end up with different hospitals offering different services and treatments which then result in if the hospital in the area you live in doesn't offer the treatment you need you either have to go without or travel to a different hospital which could be miles away, all this when you are feeling ill, and maybe not have your own transport or maybe too ill to drive anyway and have to rely on public transport, and yes that is already happening and chances are with private companies running the NHS it would get worse because they would cherry pick the most lucrative treatments and services to ensure they make a profit.

    And you avoid that from happening by making sure you have a well designed and fully comprehensive specification drawn up, against which each company is performance tested.

    Hospitals offering certain treatments that others don’t happens now under the existing system.

  • Swap the term Patient for Customer and the term NHS to Business and Care for Profit.....it's then easy to see where the NHS has failed. Business managers running a health system does not work.

    It's the only way it can be unless there are unlimited resources. Everyone wants a better NHS, but few people are prepared to lower their standard of living and disposable income to have one. I have always upheld that the NHS is big enough and well funded enough to be better, the problem is that we have far too many people using it.

    The intelligent are being oppressed so the stupid don't get offended

  • It's the only way it can be unless there are unlimited resources. Everyone wants a better NHS, but few people are prepared to lower their standard of living and disposable income to have one. I have always upheld that the NHS is big enough and well funded enough to be better, the problem is that we have far too many people using it.

    Not to mention the fact they have too many managers all tripping over each other. A privatised service would sort that out pretty quickly, creating huge savings, part of which could go into improving services and part to be retained as profit. The apportionment of that should be agreed as part of the contract, so it would be legally enforceable.

  • Not to mention the fact they have too many managers all tripping over each other. A privatised service would sort that out pretty quickly, creating huge savings, part of which could go into improving services and part to be retained as profit. The apportionment of that should be agreed as part of the contract, so it would be legally enforceable.

    Privatisation means more management not less. Plus a government side compliance office to monitor everything plus the regulator.

    Even worse most of the cash pumped in will leave the UK and go to the home nation of whoever gets the contract which for sure won’t be a British company.

    We already subsidise the French energy market with our inflated prices for EdF or the Germans for nPower or trains with Arriva. Why would we want to do the same for the NHS? It is poor value for money and just plain stupid.

    Celebrate it, Anticipate it, Yesterday's faded, Nothing can change it, Life's what you make it

    Edited once, last by Armitage Shanks (October 20, 2021 at 8:32 PM).

  • Privatisation means more management not less. Plus a government side compliance office to monitor everything plus the regulator.

    Which is what we have now and is at the core of the problems not to mention the micro mangers that are stealing. NHS fraud by employees is massive. Bloody Nigerian managers driving around in Mercedes and sending money back home from where they have fiddled the books. There was one guy on an NHS fraud TV programme where he was caught using an NHS credit card to buy himself cigarettes at a local petrol station and putting it down on the books as stationary. He also purchased stocks at inflated costs from a company that he owned under another name or owned by a family member or something so his name was not directly on documents. Government style tactics being used there. All this could easily be cut out if the NHS had a central stores and logistics department that covered all hospital trusts. Stick it right in the Midlands like a big Amazon type warehouse.

  • Hospitals offering certain treatments that others don’t happens now under the existing system.

    Yes and that's the problem, you end up with a postcode lottery for certain treatments, don't live in the right postcode you don't get the treatment

    And you avoid that from happening by making sure you have a well designed and fully comprehensive specification drawn up, against which each company is performance tested.

    Would that require another level of management to manage that, you can bet it would, more men in suits receiving huge salaries. :/  :D

  • Privatisation means more management not less. Plus a government side compliance office to monitor everything plus the regulator.

    Even worse most of the cash pumped in will leave the UK and go to the home nation of whoever gets the contract which for sure won’t be a British company.

    We already subsidise the French energy market with our inflated prices for EdF or the Germans for nPower or trains with Arriva. Why would we want to do the same for the NHS? It is poor value for money and just plain stupid.

    That isn't true. A private company would be far more likely to reduce management. For a start, they wouldn't have a diversity manager, or a manager in charge of equal opportunities etc etc. I spent my life in management, and believe me, the directors were looking at ways to cut us back. I don't believe in a fully privatised NHS, but what we have at present doesn't work, so possibly a combination of the two may help. Going back to what I said prior, the NHS could manage better if there wasn't so many people using it

    The intelligent are being oppressed so the stupid don't get offended

  • Going back to what I said prior, the NHS could manage better if there wasn't so many people using it

    The problem is certainly that the NHS could do with having fewer patients. That is why I cannot understand why they don’t encourage those who can afford it to go private.

    I don’t care whether the NHS itself is privatised or not, as long as it is efficient. Sadly, the public sector, as a whole, is not.

    I do think privatisation is the answer, and I also believe a private organisation would carry out a cull of managers.

    But it would need to have a good contract for services specification and light touch (but effective) controls.

    It’s certainly not working as it is now.

  • That isn't true. A private company would be far more likely to reduce management. For a start, they wouldn't have a diversity manager, or a manager in charge of equal opportunities etc etc. I spent my life in management, and believe me, the directors were looking at ways to cut us back. I don't believe in a fully privatised NHS, but what we have at present doesn't work, so possibly a combination of the two may help. Going back to what I said prior, the NHS could manage better if there wasn't so many people using it

    It won’t be a private company running the NHS it will be a for profit contractor winning a management contract, the old government owned contractor operated model. This means much more management as that is what is being paid for. Lots of service level agreements, lots of monitoring and reporting, mainly into how to cut front line staff to maximise profits.

    Celebrate it, Anticipate it, Yesterday's faded, Nothing can change it, Life's what you make it

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