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The NHS - some food for thought


asperity
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With the current examples of Rail and Energy, I'm surprised there's even talk of NHS privatisation, but that's Tory dogma for you. We've had successive Governments dabbling with this political football since it was created, and from a dogma perspective rather than a user perspective. Ironically, the NHS is a victim of it's own success and advances in medical treatments, all of which tends to be expensive and which continue to grow. So the first issue to be addressed is "what should be the scope and extent of it's provision"? This is open for public debate, as to whether the NHS should provide a full panoply of services EG: Cosmetic, trans-gender, premature births, terminal delay drugs, treatment over a certain age etc? Once parameters a set and a clear mission statement established, organisational and service delivery questions can be addressed: EG: should we have hub specialisation to concentrate skills resources at centres of excellence (making the patient travel) or should we ensure equal provision and quality in ALL LOCAL Hospitals? Should there be clear lines of clinical managerial control EG: Hospital Matrons, Ward Sisters etc? rather than Departmental silos and competition for resources? Once established, should there be less political interference, and ever changing "targets" and actually allow managers to manage, subject to a national standards inspectorate? Should we value the basic caring role of the nurse with empathy for the patient or introduce career advancement opportunities with degree qualifications for desk jobs? Should we invest more in preventative medicine and health maintainance; EG. dietary interventions, life style interventions. relieving demand pressures or just treat the results of unhealthy lifestyles? Should there be closer scrutiny and enforcement of drug procurement costs and dispensing? Should there be closer scrutiny and enforcement of patient eligibility for free treatment and of reciprocal funding arrangements with other Countries? What is clear, is that the principle of an NHS "free at the point of need" has, despite all the dabbling by politicians, stood the test of time.

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So you didn't read the article Obs, just went off on your usual "free at the point of need" rant. Our NHS is such a successful model that it has been copied by, lets see - oh yes exactly nobody else. As this article shows there is need for radical change and the introduction of some form of privatisation before the whole of the country's GDP is used to prop up a failing giant.

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I was actually trying to stimulate some thought by raising various issues within the NHS to curb the cost spiral whilst improving efficiency - and "privatisation" isn't one of them.  It's a fairly simple equation - private = profit; profit either comes in with higher charges for use (see the railways and utilities) and/or dangerous cuts in standards (see Banks); and if you want cheap, you'll get cheap.

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Obs, the proof of the pudding is in the eating. Even you admit that the NHS cannot continue in the same way, so lessons must be learned from other countries which do provide good, affordable healthcare. One of the problems about your much vaunted "free at the point of need" mantra is that people have come to expect the NHS to care for their every need however minor. So we get mothers taking their offspring to A&E with a grazed knee instead of going to the household medicine cabinet for some Savlon and a plaster. If there was some (VISIBLE) element of cost involved (and the NHS is not, by any stretch of the imagination, free to the taxpayer) perhaps mum might think twice about A&E as first port of call?

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Asp, if you'd read my first post, you'd have sussed that I outlined most of the issues to be addressed - none of which will be helped by privatisation. If folk havn't  learnt from the recent examples of the Banks, Railways, & Utilities the nature of private companies, they'll never learn.

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So you didn't read the article Obs, just went off on your usual "free at the point of need" rant. Our NHS is such a successful model that it has been copied by, lets see - oh yes exactly nobody else. As this article shows there is need for radical change and the introduction of some form of privatisation before the whole of the country's GDP is used to prop up a failing giant.

 

I think you're right Asp , seems like folks haven't read the Circle article. Elsewhere on " local forum "  performance of  Warrington Hospital would seem to identify it as a candidate for privatisation !

 

If Circle can get a hospital £10M in the red into the black by cost cutting and private funding, it has to be the way to go.

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I don't think privatisation and efficient management are mutually inclusive - look at the Bank debacle. The cutting of staff and safe practises in order to create a financial surplus, that is then creamed off by shareholders, doesn't relate to service provision imo. According to a recent TV documentary, 80% of current demand for NHS surgery is due to the demands of the elderly demographic. I'm not suggesting it by any means, but if you really want to be ruthless at making savings and reducing the tax burden, euthanasia would be the ultimate answer. However, that wouldn't be acceptable in a civilised and compassionate society, and thus the burden has to be borne. Then on the same ethical basis, we have to decide availability and accessibility, rather than affordability at the point of use. We've now witnessed the results of privatisation with the Banks, Utilities, Railways etc - all being underwritten by the taxpayer at some point, yet still ripping off their customers with obscene levels of profit and top management reward.

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Part of the present situation and the past cause, was de-manning, staff costs can be as much as 70% of the total. Add to this politically imposed "targets", the inertia caused by threats of litigation and just sheer bad management and organisation, and the scale of the problem becomes apparent.

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If Circle can get a hospital £10M in the red into the black by cost cutting and private funding, it has to be the way to go

 

 

And they did this how, cutting services perhaps, or cutting medicine or cutting the wage bill?

 

Seems you still haven't bothered to read the article, as how they did it is laid bare for you to read. 

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A franchised hospital is accused of taking "work"(!!!) away from an NHS hospital "only" 24 miles away!! A joke yes? I can imagine the howls of protest from the usual suspects if it was suggested that Warrington hospital be closed because it is taking "work" away from the Royal Liverpool "only" 24 miles away :lol: :lol: :lol:

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Unless I have misread it the article fails to mention that financial losses were greater than anticipated last year and Hinchingbrooke’s CEO Ali Parsa “stepped down” with a 400K pay-off: It also injected £4m of its own money to get the first years losses down, money which it will at some time want back.

 

"

A complete lack of strategic oversight resulted in separate decisions being taken to build a new PFI hospital at Peterborough and to award a franchise to a private company to run a nearby NHS hospital. No consideration appears to have been given to the impact these two decisions would have on the local health economy and health expenditure. The hospitals are located only 24 miles apart in the East of England, an area of the country where the NHS has a long-acknowledged over-provision of acute healthcare.

The decision to approve these two deals flies in the face of past and present government policy to treat more people outside hospitals and to concentrate key services in specialist centres. This has left the Government with two hospitals whose financial viability and future is in doubt and whose value for money has not been secured."

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Would you be happy to have to travel 24 miles to the next town for A&E? Both towns want their own hospital obviously.

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The man's political party means nothing in this case, he is just being a constituency MP looking for funding for HIS local hospital, and if this means other hospitals closing then it's not HIS concern.

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True, but he was making a statement on behalf of a Public Accounts committee 

 

Stewart Jackson was speaking as the Committee published its 28th Report of this Session which, on the basis of evidence from the Department of Health, Monitor, Circle, and Peterborough and Stamford Hospitals NHS Foundation Trust, examined the franchising of Hinchingbrooke and the financial sustainability of Peterborough and Stamford.

 

 

qoute "The Committee is concerned that Circle’s bid was not properly risk assessed and that Circle was encouraged to submit overly optimistic and unachievable savings projections. While some financial and demand risk has been transferred to Circle, the NHS can never transfer the operational risk of running a hospital leaving the taxpayer exposed should the franchise fail."

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  • 4 weeks later...

Well, it appears we have in the NHS "never events"; things that are never supposed to happen, like cutting off the wrong leg or leaving surgical instruments inside patients.  Just a thought, but why don't they use a tray with the range of instruments outlined on it, thus easy to spot if one is missing - or is that toooo simple?

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