NHS reforms

Quote:

---

Originally Posted by 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.

---

The quality of gas and electricity you receive in your home is the same regardless of who you pay for it.

The same is not true of medical care, whether it be the logistics of going to a clinic close to home or a specialist centre far away or the levels of expertise and equipment available at comparable hospitals.

That said none of the reforms have really been about patient choice, in fact there was far more choice under the old system that ended at the first round of New Labour reforms whereby you could opt to be treated anywhere for anything. New Labour managed to perform the quite awesome feat of taking away patient choice altogether then reintroducing it bit by bit and taking credit for it.

Patient choice is only important in that it is a tool to 'reward' better performing hospitals and organisations with more custom and therefore funding just as in a free market. However because patient decisions are often made on factors other than how well that hospital works and how cheap its service is many other factors are taken into consideration.

As Mark said, patient choice in the modern NHS is an illusion. Its like a computer game where you think you can walk anywhere you want till you come up against an invisible wall and you have no choice but to turn back.

Quote:

---

Originally Posted by Dylan H

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

---

Is it really going to be fair, and if so fair for who and in what way?

My experience of the NHS has never included the thought that it was "unfair" and my first thoughts about features of the Tory reforms certainly do not include "fairness".

Fortunately we have had a "pause" in the implementation of a fundamental (in practical and philosophical terms) NHS restructure, which was being railroaded through. "Quick, get this done and no-one will notice until they can do nothing about it" seemed to be the plan. It worked when the likes of gas, eletricity & communications were privatised all those years ago.

Who benefitted from that?

Quote:

---

Originally Posted by ArrowsFA1

Is it really going to be fair, and if so fair for who and in what way?

---

Its going to be fair in the sense that both NHS and private companies will be able to bid for the same contracts on a level playing field. That didn't happen before.

Let me give you an example. To cut down NHS waiting lists for hips Blair introduced an idea called independent sector treatment centres (ISTCs). These would be built in each region entirely through private funding with operations performed by NHS doctors from throughout the region. The private company running the ISTCs were allowed to pick and choose which hip replacements they did and chose (obviously) the simple easy ones. The NHS hospitals were left to work on the complicated and potentially expensive ones.

The problem was that the amount the ISTCs wanted to charge per hip was in excess of what it cost those NHS hospitals to do the op themselves. Some hospitals (I know of one on the south coast where this definitely happened) refused to send patients to these centres as it cost them more money but were overruled directly from Whitehall as the ISTCs had been guaranteed custom.

In other cases involving radiology or GP contracts, existing NHS providers were simply banned from bidding as it was classified that their local specialist knowledge would confer an unfair advantage over private bidders with no experience in the sectors they were bidding for. I can tell you of another case on the south coast where the in-house NHS radiology department was not allowed to bid for a contract to increase capacity to cut waiting lists at its own hospital. Several years later an audit of the private contractors work there showed a horrendous number of errors so the hospital had to pay its own radiology department millions of pounds to re-report the scans that had been contracted out to the private supplier.

In others private bidders were allowed to import non-British registered doctors and other staff to cut costs, something an NHS organisation would never be allowed to do.

Under the new reforms both NHS and private providers will be able to bid and will be treated equally and have to meet the same quality standards. The NHS providers will not be shackled like they were before.

As I said before, the winners will mainly be NHS organisations that are well run and have a 'brand' to sell. Would you prefer to have your cancer treated at St Elsewhere's or at the Royal Marsden? If your child is unwell would you prefer Great Ormond Street or Noname DGH? Well run private organisations too will win, but many of them have the obstacle of having to invest heavily to expand before bidding and their startup costs will inevitably be passed onto the consumer (ie the NHS) so their bids will be less competitive.

Other NHS organisations that become more efficient and adapt to changing circumstances will also do well, those that don't won't. As I said, some hospitals will inevitably close as there is overcapacity in many parts of the UK, will politicians and the public have the guts to face up to that?

Needless to say, poorly run private companies won't do well either.

Quote:

---

Originally Posted by ArrowsFA1

My experience of the NHS has never included the thought that it was "unfair" and my first thoughts about features of the Tory reforms certainly do not include "fairness".

Fortunately we have had a "pause" in the implementation of a fundamental (in practical and philosophical terms) NHS restructure, which was being railroaded through. "Quick, get this done and no-one will notice until they can do nothing about it" seemed to be the plan. It worked when the likes of gas, eletricity & communications were privatised all those years ago.

Who benefitted from that?

---

I don't see any difference in the way the NHS has been treated by Labour and the Conservatives. Had you not been aware who had been in power over the past two decades, you would have assumed that the reforms in the early 2000s were put in place by an extreme right wing party with a pathological dislike of state-owned and run organisations. The current Tory plans represent a refinement or development of Labour reforms, again had you been unaware of who was in power you wouldn't be able to tell on philosophical grounds who was behind them. If anything the current NHS reforms are carefully thought through as if someone has spent years studying the NHS and thought carefully about how to reform it. I still have major reservations however as I don't believe such major reforms can take place without major negative impacts, and I certainly don't think it will save money.

The difference as far as I can see is that the media wasn't interested in NHS privatisation before, it is now. Excuse me if I'm cynical about cries and protests about Tory privatisation plans...

Quote:

---

Originally Posted by Dylan H

The difference as far as I can see is that the media wasn't interested in NHS privatisation before, it is now. Excuse me if I'm cynical about cries and protests about Tory privatisation plans...

---

Fair enough, and thanks for your clear reply :up:

It may not be explicit but IMHO the ultimate aim is to relieve the government/state/us of what some see as the "burden" of a National Health Service. The process of privatisation may have begun in some way with a Labour government but regardless it is a process which I fundamentally disagree with.

The National Health Service (the use of "NHS" does help distance us from what it actually is) was created as, for lack of a better term, a safety net. Are we now saying we can't afford that safety net, and if so doesn't that make us a poorer society?

Quote:

---

Originally Posted by ArrowsFA1

The National Health Service (the use of "NHS" does help distance us from what it actually is) was created as, for lack of a better term, a safety net. Are we now saying we can't afford that safety net, and if so doesn't that make us a poorer society?

---

The blunt answer is that we will reach a point in the future where we won't be able to afford that safety net.

Healthcare costs are rising way above inflation as is demand. Thats not just the case for the UK, that applies to pretty much the entire world. I remember an American study that claimed that if US healthcare costs and demand kept rising at its current rate then healthcare spending would reach over 100% of projected GDP by 2050 or so.

Like final salary pensions the NHS in its original state is a system that worked well when people were expected to die at the age of 60-65. Now people live 20 years beyond that and the system has to adapt to meet the rise in demand. We also live in a reality where the electorate firmly believe more can be delivered for less tax burden and any political party that tells them otherwise pays the price. Politicians are also too frightened to confront the public with the truth, if they want affordable healthcare then in future there needs to be a public debate about what we can expect the NHS to cover and what it shouldn't. Meanwhile making the system more effective and efficient by introducing and refining a competitive system involving private healthcare will keep things going for a few more years.

I too am strongly attached to the concept of a healthcare system free at the point of use and where treatment choices are not decided by affordability but by clinical need regardless of wealth. I just wish there was a real debate about healthcare and not just the usual lowest common denominator mudslinging as usually happens.

Quote:

---

Originally Posted by Dylan H

Politicians are also too frightened to confront the public with the truth, if they want affordable healthcare then in future there needs to be a public debate about what we can expect the NHS to cover and what it shouldn't.

---

The phrase 'public debate' is often thrown around, not least by politicians, when such contentious issues arise, yet I am yet to understand how said debate would take place, how it would reach a conclusion, and so on.

Quote:

---

Originally Posted by BDunnell

The phrase 'public debate' is often thrown around, not least by politicians, when such contentious issues arise, yet I am yet to understand how said debate would take place, how it would reach a conclusion, and so on.

---

Raising the level of debate beyond "MRSA" and "do you trust the Tories with the NHS?" would certainly help.

Sadly as the AV debate showed there isn't much drive from either politicians and the press to look at complex issues and how to solve them anymore.

Quote:

---

Originally Posted by Dylan H

Raising the level of debate beyond "MRSA" and "do you trust the Tories with the NHS?" would certainly help.

---

I agree, but still the question remains: what form does said debate take? People chatting in the street? Comments on internet message board and news 'Have Your Say' sites? Public meetings? A referendum?

Quote:

---

Originally Posted by Dylan H

Sadly as the AV debate showed there isn't much drive from either politicians and the press to look at complex issues and how to solve them anymore.

---

Because they are all too fond of simple sloganising, for one main reason — let's face it, large sections of the population show few signs of being able to cope with anything much more.

Quote:

---

Originally Posted by BDunnell

I agree, but still the question remains: what form does said debate take? People chatting in the street? Comments on internet message board and news 'Have Your Say' sites? Public meetings? A referendum?

---

All or any of the above.

The level of debate for example in threads on this forum concerning the US healthcare system demonstrates that even posters that are barely able to string a sentence together on other topics can articulate principles and arguments that are way above what I've come to expect from similar debates on the NHS here and elsewhere. Since the US electorate on both sides of the political spectrum are more knowledgeable their media and politicians can't get away with spewing the simplistic and often plain untruthful platitudes they get away with here.

Quote:

---

Originally Posted by BDunnell

Because they are all too fond of simple sloganising, for one main reason — let's face it, large sections of the population show few signs of being able to cope with anything much more.

---

Also because the complexity of the issues involved are often too difficult even for those drawing up the plans to comprehend, let alone those who merely read a few paragraphs from a newspaper on the subject.

Quote:

---

Originally Posted by Dylan H

All or any of the above.

---

Fine, but to what end? I'm afraid I am always suspicious of the notion of having a 'public debate', because it strikes me as a very nebulous concept.