NHS reforms

[MrMetro]

What are people's thoughts on the controversial NHS reforms? I'm expecting this thread to go on for a long time!

[Mark]

I think that Cameron got elected based on his promises not to touch the NHS. And as soon as he gets in he does exactly that.

[Rollo]

As I understand it, GPs will have to form themselves into consortia to buy and sell health services between levels.
I suppose that this would then make GPs into private practices, as is the case in Australia, with hospitals and other units like pathology, x-ray, etc all separate entities.
GPs are happy because it gives them more immediate control over their own private practices.

In theory it could work, but then there's implications about corporatising and privatising the system later, which is precisely what the Tories want to do.

I don't think that Cameron's reforms are about making anything better, but rather improving the lot of the friends who fund the Conservative Party through some sort of as yet unseen nepotism and graft.

[Malbec]

As I understand it, GPs will have to form themselves into consortia to buy and sell health services between levels.
I suppose that this would then make GPs into private practices, as is the case in Australia, with hospitals and other units like pathology, x-ray, etc all separate entities.
GPs are happy because it gives them more immediate control over their own private practices.

In theory it could work, but then there's implications about corporatising and privatising the system later, which is precisely what the Tories want to do.

GP practices have always been privately owned entities which are funded by the NHS. They are owned by some or all of the GPs who work in them (partners) or more recently by private companies that have started to buy entire practices up.

Previously under the Labour government GPs were given a list of hospitals they could refer to for each service they required by their local PCT. The PCT negotiated directly with the hospitals what they would be paid for what service and also assessed which services and hospitals offered the best value for money (amongst other things). Under the new Tory reforms the PCTs will be abolished and the GPs will negotiate directly with hospitals and basically do what the PCTs used to do.

Previously funding would reach the PCTs then flow to the hospitals. Because the GPs had some choice in which hospitals they referred to they would have a virtual budget to play with but no money would actually go through their hands. Now funding will go to GPs which will then flow to the hospitals.

The advantages of the system are that by abolishing PCTs a whole layer of management will be wiped out on paper, however it does not take a genius to realise that since the GPs are already working flat out they will not be taking over the management work the new system requires but will be hiring managers from the PCTs to do the job for them, ie we're talking about moving around the management structure not reducing it.

Some GPs I know (the business minded ones especially) are looking forward to the reforms. Others don't really see why they should be getting involved in the management aspect especially since its something they've never trained for.

While people are concentrating on the privatisation aspect the fact of the matter is that the better run NHS hospitals and those with a bigger brand (ie big city hospitals) will be able to compete with local DGHs for services and win, starving some of the less well run hospitals of business and therefore funding. Its the intra-NHS competition that will cause problems in the long run not NHS/private competition because the inevitable result is that poorly run NHS hospitals will eventually go bankrupt and that is not something either the electorate or politicians are willing to accept.

Its the scale of the reforms that is most worrying however. What I've written above is a simplified version that only touches on subjects you raised. The reforms affect just about every aspect of the NHS and will be implemented quickly, the speed and scale will likely have serious implications that the government and NHS will not be aware of until after the event. That is at a time when NHS funding has been frozen and demand is skyrocketing. Most organisations are looking at making 5-10% savings per year for at least a half decade merely to break even.

I don't think that Cameron's reforms are about making anything better, but rather improving the lot of the friends who fund the Conservative Party through some sort of as yet unseen nepotism and graft.

Which would make them no different to Labour's reforms whereby the inquiry into whether and how private healthcare companies could 'assist' the NHS was lead by people from the private healthcare industry. Many of the first contracts given out to private healthcare providers under the Blair government were generous beyond belief including guaranteed payment regardless of the quantity or quality of service actually delivered. In many cases NHS organisations were simply banned from bidding for contracts including services they already delivered. The Tory reforms set out how private healthcare can compete for NHS services but unlike previous Labour reforms will not subsidise them nor shift the goalposts to help them.

In terms of 'privatising' the NHS this set of reforms doesn't go anywhere near as far as Tony Blair's did. The only recent PM to not be interested in increasing the amount of work given to private companies was Gordon Brown, though he was one of the main architects while he was chancellor.

[Dave B]

Want to know what one of Cameron's own advisors thinks of the changes?


According to a glossy brochure summarising the conference held last October, Britnell told his audience: "GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer." He added: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."


http://www.guardian.co.uk/politics/2...redirect=false

[Malbec]

Want to know what one of Cameron's own advisors thinks of the changes?


According to a glossy brochure summarising the conference held last October, Britnell told his audience: "GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process … In future, the NHS will be a state insurance provider, not a state deliverer." He added: "The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years."


http://www.guardian.co.uk/politics/2...redirect=false

While I like the Guardian a lot when it comes to the NHS they are guilty of the utmost hypocrisy. When Blair opened up the NHS to private contractors and gave them subsidies, favourable contracts and conditions etc they were silent. Now the Tories want to change the system without the same favourable conditions for the private sector they cry foul. Seems privatisation is fine for the Labour party but unacceptable for the Tories.

As for the sage words of advice from this junior advisor, I would not want to be a private healthcare provider entering the British market over the next few years. The days of easy profits and subsidies to cover startup costs are long gone. Britain is a mature market now. The GPs will not be wanting to refer much business to anyone other than themselves, they are already learning to provide more healthcare services themselves so they can avoid money leaving their consortia. The NHS hospitals are pretty lean after years of budgetary restraint and have a wealth of expertise that the private sector cannot easily poach, and there are many well-entrenched private healthcare companies already in the UK that have spent their golden years under the Blair government investing heavily in services and recouping their startup costs. All of them will be seriously tough competition for a new entrant that has to pass on startup costs and with no proven track record in the UK market.

Not only that but quality control has been tightened and the standards raised both by the last years of the Labour government and further by the Tories. Private sector companies can't do the old shortcuts they were allowed to under Blair where they were exempt from the same quality control as the NHS, the same standards apply to everyone.

Its going to be tough out there but at least its going to be fair.

[driveace]

I totally agree with your post Dylan.
Lets have some fairness,and maybe prices for ops will be reduced.A fiend of mine needed a hip replacement,they made a mess of it first time,and he was never free of pain.So went to see his Doctor who told him he could not have another one so early after the first one.So he decided to go private,went for exrays,where they told him that the surgeon who had done his first hip replacement had cut the bone nearly 1 inch short,and that was why he was walking with a slant.The price due to this damage was going to be £14000.He then went on the net and found a hospital in Boulougne.After all the checks the price was £6500,so they picked him and his wife up in Yorkshire by Minibus,took them both out there,carried out the hip replacement,she had a room next to his,and they brought them both back here.He said the hospital was spotless ,food was good and he is now sorted.

[BDunnell]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

[Sonic]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

I'm all choiced out after deciding on Jam or Marmite on my toast.

[Mark]

Am I alone in not wanting to make a choice in every single aspect of my life — where I get my electricity, who provides my gas, where I go to hospital? I have enough choices to make on a daily basis as it is.

Many of those choices are an illusion. As for electricity and gas, of course you don't have a choice where you get them from, the only choice you have is who handles the billing process.

Someone in the government suggested that in the future the NHS wouldn't exist, except as a state health insurance scheme, a prospect which fills me with dread!