How you can say private healthcare won’t deliver better results when there are estimates of 30,000 unneccessary deaths per year in the NHS is either fatuous, ignorant or just plain idiological dogma. You also say ‘howls of protest’ yet these organisations and groups have a sectional interest in maintaining the status quo and little consideration as to improving patient care. Also, there is anecdotal info from United Health Group that only 11% of health interventions are any good. What’s needed here is a full scale evidence based review and simply knee jerking ‘ooh, les horreux of the private sector’ is disingenuous and reactionary.

In no way am I saying that privatisation is a panacea but with all the evidence that has been made available being just the tip of the iceberg as to what has been surpressed then this op-ed reads more like a ‘na na na – i’m not listening’ piece.

I wouldn’t praise Burnham too highly. He is the man likely to introduce means testing for health services in the not too distant future when New Labour are back in power.

But this piece is wishful thinking all round. The NHS is now nothing more than a Quango, a committee for the funnelling of public money to the private health service providers who are carving up our hospitals and clinics between them. This is why the Tories ring-fenced the health budget to ensure private interests wouldn’t be put off when they invited them in and of course when they have taken their 20% of our NI contributions for shareholders and their own fat cat salaries front line services will be worthless.

DtP

I took the OP to be saying that nhs privatisation is (1) bad and (2) a failure of democracy.

Do you have any good reasons why either of those claims are false (e.g. for (1) data on unnecessary deaths and allocation of interventions in comparable similarly-funded privatised systems)?

Don’t your think your own claim about knee-jerk changes with no basis in evidence kind of supports (1)?

Alternatively if you think (1) and (2) are true why do you think they aren’t good topics for an article?

Like many on the left, the OP disingenuously uses ‘privatisation’ as a synonym for ‘outsourcing’. It is hardly conducive to rational discussion of this issue to call outsourcing to private contractors ‘privatisation’ when the ownership, overall management and funding of the NHS will remain in the public sector, and the NHS will remain free at the point of use.

Furthermore, the finest health services in the world – France, Germany, the Nordic countries – all use private contractors extensively to deliver state-funded healthcare. So to present outsourcing as the dismantling – and the alleged quote from Letwin is 9 years old – of the NHS is not plausible.

As for:

“…it won’t save money, it won’t provide better results…”

that is highly arguable. Properly managed, outsourcing usually saves money and provides better service in all sectors. And the results from Hinchingbrooke NHS Trust, which is managed by Circle, are very encouraging.

@4 Tone – Well said. For many years the NHS has outsourced many of its day-to-day operations with no detriment to patient care.

Frankly I couldn’t care less who launders hospital bedlinen, and if it’s done better and cheaper by the private sector then hooray for that.

@Teddy. I’m not so sure democracy is alive and well and living in the NHS. Apparently £6 billion is getting chucked into Local Government but can’t rush these things. PCT minutes were never published by the way, that’s why Private Eye is so cool!

As per point (1) if they’re qualified – cool. If GPs are getting more than consultants it’s kinda inevitable that they’re whinging.

Why were the amendments deemed necessary – is it because D-Cam is deeply committed to the founding principles of the NHS, or is it because his privatisation by stealth strategy (presently overseen by the truly odious, NHS-bashing, Jezza Hunt) is moving a tad too fast?

Put another way, lets suppose Dave & Jezza could introduce changes to our health system free of all constraints – how would such a service look, I mean what do these guys actually believe?

The way these changes have been managed proves beyond all reasonable doubt that our most senior politicos lack even a modicum of integrity, or honesty.
Perhaps such a cynical posture has become de rigueur, and is now so commonplace at Westminster that even they no longer recognise the difference between rhetoric and reality, the difference between truth and lies?

Of course such threads generate the usual tedious anecdotes about the pros/cons between a state run health service as opposed to one run by mega-corporations – the salient point, though is that such a choice was never put to the electorate – was it?

Why was such a choice never put on the table?
Probably because those lobbying on behalf of the fatcats are wise enough to understand that despite great influence and power they could still not persuade the man on the street most ordinary people would be better off under the likes of CareUK, or SERCO, than they are under the NHS.

In reply to DtP: Evidenced based argument is of course essential. All the evidence is that private medicine is much more expensive. In fact private *anything* tends to be more expensive. Most of the privatisations so far, have resulted in higher prices.

As far as I am aware, there is no evidence that private is cheaper. America is the prime private arena and it’s the most expensive in the world by far, with poor outcomes (its child mortality rates are higher than Cuba’s for instance).

62% of bankruptcies in the USA are medically related, because unlike the NHS which gives all eventualities indemnity, private systems are limited, so even if you can afford the insurance, it doesn’t do what you want.

The European model, often cited by Conservatives as the direction of travel is a fantasy. First the European examples given spend more money on healthcare than we do, (http://en.wikipedia.org/wiki/File:Health_care_cost_rise.svg) but the government is planning to CUT healthcare spending by somewhere between £40 to £50 billion.

But anyway the European markets are controlled markets and the section 75 regulations have shown the government’s hand. What is shows is a wild west market, pretty much like the USA.

You should take out shares in undertakers. The government ‘reforms’ should see them doing very well.

DtP: “How you can say private healthcare won’t deliver better results ”

What grounds have you got for believing it will?

Generally the private sector is efficient because of the market and competition.

That is simply not possible inside the NHS. Trying to create fake markets where the buyer isn’t really the consumer – as the government is trying to do with GP commissioning – has been seen on numerous occasions to be incredibly difficult and costly. Unless we want to duplicate all services in every local area to set up competition (with all the costs that entails of building two hospitals where one would do) then we are never going to have true competition.

Without the economic logic of efficiency driven by competition, for what possible reason should the private sector be more efficient?

To me it’s obvious that all the profit incentives will instead point to squabbling over the interpretation of contracts (something giant corporations are likely to be quite good at compared to a small group of GPs with practices to run and patients to see) to maximise government subsidy while minimising the service provided. It will set up a staggering level of bureaucracy and will make services vastly more expensive – but it will deliver guaranteed taxpayer-backed income to the wealthy, so I bet the ‘free market think tanks’ will love it.

a&ecn @ 7:

“privatisation by stealth strategy…a…health service…run by mega-corporations”

You are being hysterical here. Outsourcing – contracting out – of certain functions is not privatisation. The ownership, overall management and funding of the NHS will remain in the public sector, and the NHS will remain free at the point of use. Any government that tried to change that by privatising the NHS as BT (rightly, in my view) was would be committing political suicide. And a wholly private US-style system would probably be a disaster here. So, relax, it ain’t gonna happen.

What will or should happen is that private providers of medical and ancillary services will play an increasingly important role in a publicly funded, publicly regulated, publicly coordinated and largely publicly owned NHS – free at the point of use. And, to some extent, this has been happening for a long time, so what is now proposed is a change of degree, not of kind.

[10] ‘You are being hysterical here’ – yet, ‘more than 1,000 NHS doctors wrote to the Daily Telegraph demanding the withdrawal of the regulations, saying they would be “another nail in the coffin of a publicly provided NHS free from the motive of corporate profit”.
http://www.guardian.co.uk/society/2013/mar/02/doctors-bemoan-nhs-privatisation-by-stealth

If it is hysteria there seems to be a lot of it about – and how can we trust any leader who promises no more ‘top down’ reorganisations of the NHS pre-election then once comfortably ensconced at No:10 introduces a £3 billion top down reorganisation of the NHS.

By the way – what makes you so sure that once the corporations have got a foot hold they won’t lobby just as aggressively for charges at the point of delivery – many seem to be of the opinion of that the new legislative framework is little more than a trojan horse for this inevitable development?

Hmmm… We’re the pigs in the sausage factory. Don’t worry about those horrible knives, they’re just there for decoration.

So you’re saying that the government has removed it’s ‘duty to provide’ a health service and left the CCGs with the option not to be comprehensive just for fun.

I don’t think so. The government removed the duty, because it’s not going to be providing a health service.

Just do the maths. Chris Ham from the Kings fund stated on R4’s Today Programme that ‘most people’ (meaning informed obvservers) think the cuts will be £30 billion.

Sir Richard Douglas (financial Boss of the NHS) said the cuts would be £40 billion. So we’re going to have a more expensive system with somewhere between 30-40% cuts.

We can’t possibly have a tax funded system on these terms. The government keeps saying that it will be free at the point of delivery, but as they’ve consistantly lied about the health service (amongst other things), their word isn’t worth the breath expelled.

Don’t relax, if we don’t get out there and fight, it most definitely *is* going to happen.

9

That’s just the point, supporters of private companies carrying-out publically funded services, quote the market model and the implication that it is more efficient. Of course, when national insurance is forcibly taken from prospective customers and there really is no choice but to access those services, the argument becomes totally obsolete. If we are to have private health providers we should have the choice of where our money goes, after all BUPA does not get a share of the tax pot.

I think that a lot of people who consume NHS services would prefer to go private if they could afford it, if only to avoid the NHS practice of calling 200 people to an appointment with a specialist at exactly the same time. Rationing by queuing is a Stalinist way of meeting needs…it ill-behoves the 21st century, unless you work in the NHS, whereupon it becomes your ideal way of handling the problem.

[14] ‘if they could afford it’ – it didn’t take you very long to highlight the fatal flaw in your own argument

aecn @ 11:

“If it is hysteria there seems to be a lot of it about…”.

Indeed, there is: hysteria is infectious. And The Guardian article you helpfully link to is hardly convincing. It is just the hysterical bleats of vested interests which are heard in any large organisation (public or private!) when outsourcing is proposed.

Outsourcing requires the preparation of a detailed service specification and of staff having to account for how they spend their time. The Academy of Medical Royal Colleges is essentially saying that doctors are afraid of outsourcing. They want to do the job they want to do and to do it in the way they have done until now. They see outsourcing as a potential threat to their professional independence – ie they don’t want to be managed. The rhetoric that outsourcing “potentially [could have] adverse effects on patient services” is baloney. Why should it? Managers will be responsible for preparing the specifications and schedules: doctors’ input will probably involve no more than commenting on drafts and completing timesheets for a few weeks. Then it will be largely business as usual.

The claim that outsourcing is “another nail in the coffin of a publicly provided NHS free from the motive of corporate profit” is particularly silly. Since when has the NHS been “free from the motive of corporate profit”? The drugs, buildings and equipment it uses were all provided by “the motive of corporate profit”, and for a long time corporates have provided some services to the NHS. And what is wrong with “corporate profit” anyway? Many local government services – leisure centre management, street cleaning, recycling, refuse collection, school meals, highway maintenance are all examples – are often delivered by corporate contractors. They are no less public services for being delivered by the private sector, because they are accountable to Councils and service users and because they are monitored, regulated and funded publicly.

“what makes you so sure that once the corporations have got a foot hold they won’t lobby just as aggressively for charges at the point of delivery”

They may do so, but would any politician with a desire to be re-elected listen to them?

“many seem to be of the opinion of that the new legislative framework is little more than a trojan horse for this inevitable development?”

But where is the evidence? Sure, we already have some charges (prescriptions and eye-tests), and dentistry has largely gone ex-NHS (through the greed of dentists, I might add); but there is little appetite to extend those. Charges for missed (ie uncancelled) appointments could be quite lucrative, though…

thoughtful @ 11:

So waiting lists are ‘Stalinist’. Well the method preferred by the privatisers is money. We don’t all wait in a queue according to need. The rich jump the queue and the poor die.

I think most people prefer the fair, ‘Stalinist’ method to the patently unfair alternative.

tone @ 16:

Ho Hum, we’re going round in circles here. You can only present your mug of coco, cosy view, that it’s the same old NHS with a few private companies, because you’ve ignored my previous post (qv 12).

Please explain:

1) why did the government insist on removing the ‘duty to provide’ a comprehensive healthcare system, if it’s going to be the same old NHS?

2)How is this ‘same old NHS’ going to be funded, given that the government is planning to cut the budget by 40% (especially given that all the evidence shows that private medicine is MORE expensive. Qv USA and other privatisations)?

3)Why did the government just try (using section 75 regulations) to force CCGs to tender ALL services and not just those they feel would best serve their communities?

Lastly, if the H&SCA privatisation is such a good thing, why doesn’t the government have a referendum and see what people think?

I’m sure you won’t reply to these points, because you have no answer. The fact is we are going to end up with an US style system if we don’t fight like dogs to stop this.

Make sure you look out for the March on 18th May and bring everyone you know, (yes including your granny and your pet gerbil) on the march.

[16] ‘Managers will be responsible for preparing the specifications and schedules’ – yes, pro-marketeers do love wigit analogies, healthcare, supermarket – supermarket, healthcare ……. what’s the difference?

I must admit ‘specifications & schedules’ does have a certain sort of ring to it? If D-Cam was a man of his convictions perhaps he could have asked the public if they want a ‘stalinst’ based system of health care, or the NHS if you prefer: a system that is universal, comprehensive, and free at the point of delivery, or one devised by ‘managers’ who would forever be fretting about corporate driven “specifications & schedules’?

Of course those unlucky to fall outside said specifications & schedules may find themselves with their collective noses pressed against the shop window – otherwise what is the point in devising this sort of complex bureaucracy?

Apparently “Many working families worry about getting sick or injured because they cannot afford health insurance or basic health care. Many individuals are turned away from insurance companies because of a pre-existing medical condition or illness. Others lose their health insurance when they are laid off from work or change jobs. The dire health care situation can be seen in the numbers. More than 47 million people in the US do not have health insurance and about 9 million of them are children. Over 40 million people a year do not get medical care when they need it, even if insured, because they can’t afford it. More than 8 out of 10 uninsured people are from working families. Thousands of deaths every year are attributed to lack of health insurance’.
http://www.healthpaconline.net/health-care-issues.htm

In other words ‘specifications & schedules’ come at a price.

Dodgydosser @ 18:

“1) why did the government insist on removing the ‘duty to provide’ a comprehensive healthcare system, if it’s going to be the same old NHS?”

Source? The NHS is not comprehensive even now.

“2)How is this ‘same old NHS’ going to be funded, given that the government is planning to cut the budget by 40% (especially given that all the evidence shows that private medicine is MORE expensive. Qv USA and other privatisations)?”

Source? The figure of 40% is not plausible – and what you ‘heard’ on the Today programme is probably not what was said. Also, you are setting up a straw man here: no-one is seriously arguing for a US-style, wholly private, system – except, perhaps, for a few eccentrics in thinktanks. Mixed economies work better than the fantasies of either socialism or anarcho-capitalism. So what is wrong with having a more decentralised ‘mixed-economy’ NHS that uses corporate and charitable providers alongside public – as in Germany and France? Why should the UK stick with a failing (Mid-Staffs etc) model of a centralised healthcare system when only Cuba, North Korea and (I believe) Canada have adopted? Yes, a wholly private system is likely to more expensive than the NHS, but that is not what the government wants to introduce – it wants more private sector providers in the NHS. And here the evidence is that(for example) private management can turn around failing NHS hospitals:

http://www.telegraph.co.uk/health/healthnews/9889500/Hinchingbrooke-Hospital-private-firm-transforms-failing-NHS-trust.html

“3)Why did the government just try (using section 75 regulations) to force CCGs to tender ALL services and not just those they feel would best serve their communities?”

Because, as with competitive tendering in local government in the 80s and 90s, some won’t seek competitive tenders at all unless they are compelled to initially. Now, many authorities of all political colours use competitive tendering for everything from housing maintenance to leisure centre management – and these services have not disappeared or been wholly transferred to the private sector.

Also @ 17:

“So waiting lists are ‘Stalinist’. Well the method preferred by the privatisers is money. We don’t all wait in a queue according to need. The rich jump the queue and the poor die. I think most people prefer the fair, ‘Stalinist’ method to the patently unfair alternative.”

Can’t you see that scelerotic public sector inefficiency (as in the worst parts of the NHS*) and a US-style wholly privately owned and run healthcare system are not the only two options? The state-funded healthcare systems in France, Germany and Scandinavia use large numbers of private sector and not-for-profit providers, and their healthcare systems are far better than the NHS. Indeed, I believe that in Germany the majority of hospitals are private or voluntary sector bodies. What not to like?

*to be fair parts of the NHS are also world class.

[20] ‘What not to like?’ – the cost ……. obviously.

Do you have any idea of the cumulative difference in health expenditure over the last 60 year comparing the NHS to the countries you mention?

How can you square this huge difference especially given that health costs have to be substantially reduced?

Your arguments seems to fail at the most elementary level once we start talking numbers.

‘Ali Parsa, a former Goldman Sachs banker who founded Circle, received his £400,000 pay-off only six months into the project after the National Audit Office disclosed Circle had failed to deliver promised savings’ – now thats a fair few cataract operations or hip replacements.
http://www.independent.co.uk/life-style/health-and-families/health-news/debts-put-nhs-reforms-at-risk-8537552.html

Shape of things to come?

Essential viewing
http://www.youtube.com/watch?gl=CO&hl=es-419&v=OkTnCtg_Omk

aecn @ 21:

“[20] ‘What not to like?’ – the cost ……. obviously.
Do you have any idea of the cumulative difference in health expenditure over the last 60 year comparing the NHS to the countries you mention?
How can you square this huge difference especially given that health costs have to be substantially reduced?
Your arguments seems to fail at the most elementary level once we start talking numbers.”

But these countries don’t spend more on health because they contract out some of the services to non-state providers. France and Germany spend more as a percentage of GDP on health than the UK does (a) because they provide a higher and better level of service and (b) they are not free at the point of use (which is where the NHS scores highly).

So, for example, my friends in Lyon can see a GP and then a consultant on the same day (a service level the NHS comes nowhere near meeting), but, as they aren’t on benefits, they have to pay up front and then claim the fees back on two different forms. That level of bureaucracy is very, very costly.

[24] now I’m confused!
On the one hand you say ‘France and Germany spend MORE as a % of GDP on health than the UK does’, yet you claim ‘these countries don’t spend more on health because they contract out some of the services to non-state providers’.

The simple fact is health costs in France, Germany and Switzerland have ALWAYS been higher compared to the NHS (lets leave the loopy high rolling yanks out of it for a minute).
The general pattern of this wiki graph has not changed in decades if we limit it to the countries under discussion.
http://commons.wikimedia.org/wiki/File:International_Comparison_-_Healthcare_spending_as_%25_GDP.png

French and German citizens must have coughed up billions more (compared to NHS tax payers) – and more importantly this difference must be fairly astronomical when applied to the last 60 years.

Anyway you don’t seem to have grasped the fact that the NHS for all its well documented problems is still infinitely preferable to what’s coming under Dave & Jezza’s new bill – the link @23 spells out exactly why.
To paraphrase Kinnock – if you are poor, if you are old, if you have a chronic health condition, or live in a poor urban area, or rural area, don’t become sick.

aecn @ 25:

“On the one hand you say ‘France and Germany spend MORE as a % of GDP on health than the UK does’, yet you claim ‘these countries don’t spend more on health because they contract out some of the services to non-state providers’.”

No, I didn’t say that. I’m sorry if I did not make myself clear. My point is that contracting out is not the reason that France and Germany spend more than the UK on health. Rather,the reasons are (a) that their service is better (and so more expensive) and (b) that the administration and bureaucracy associated with systems that are not free at the point of use is very, very costly. The use of non-state providers is the most efficient part of these continental systems; the free-at-the-point-of-use feature is the most efficient part of the NHS. So why not combine the two features?

“French and German citizens must have coughed up billions more (compared to NHS tax payers) – and more importantly this difference must be fairly astronomical when applied to the last 60 years.”

Yes; but not as a result of outsourcing to non-state providers!

“Anyway you don’t seem to have grasped the fact that the NHS for all its well documented problems is still infinitely preferable to what’s coming under Dave & Jezza’s new bill – the link @23 spells out exactly why.
To paraphrase Kinnock – if you are poor, if you are old, if you have a chronic health condition, or live in a poor urban area, or rural area, don’t become sick.”

More rhetoric, more hysteria, about reforms that other parts of the public sector absorbed decades ago….Even the Tories understand that the NHS is a sacred cow to the UK electorate. They would not knowingly damage it because they would be committing electoral suicide.

[26] ‘They would not knowingly damage it because they would be committing electoral suicide’ – I’m sure when Dave is in his Notting Hill bunker trying to figure how to divert public money to the fatcats he is perfectly aware that privatisation of the NHS could be politically damaging – hence the endless obfuscation, or lying if you like, about the true intentions of his crappy bill itself and subsequent sneaky amendments.

Listen to Jill Mountford @23 – nobody can say they have not been warned.
Of course none of this matters if you think private firms can turn water into wine although some providers have not got off to an auspicious start, have they – I mean the likes of poor old SERCO have already taken to lying?
http://www.guardian.co.uk/society/2012/may/25/serco-investigated-claims-unsafe-hours-gp

A worthy companion to be read in conjunction with the OP
http://www.opendemocracy.net/ournhs/nicola-cutcher-lucy-reynolds/nhs-as-we-know-it-needs-prayer

As an aside, lets not thank Andy Burnham too much.
The entire debacle surrounding the coalition’s Health and Social Care Bill was made infinitely easier thanks to NuLab providing so much of the infra-structure that puts full blown privatisation almost within touching distance – Hewitt, Milburn, Johnson, et al, should all be hanging their sorry heads in shame.

aecn@25: You say “The simple fact is health costs in France, Germany and Switzerland have ALWAYS been higher compared to the NHS…the general pattern of this wiki graph has not changed in decades…
http://commons.wikimedia.org/wiki/File:International_Comparison_-_Healthcare_spending_as_%25_GDP.png”

But surely it doesn’t tell us anything at all about health costs? It’s a graph of expenditure, not of costs. Also, as the figures include expenditure on all healthcare, both public and private, it doesn’t really tell us much about the efficacy or otherwise of public vs private provision.

The one thing it does make clear is that throwing money at healthcare is not necessarily an effective strategy.

[29] ‘The one thing it does make clear is that throwing money at healthcare is not necessarily an effective strategy’ – yes, but it is likely to be a better one than increasing the financial gap even further between the NHS and Germany or France, or closing down places like Lewisham A&E, despite it being a well run and valued local service.

What I am certain of is the majority of the public will not fare any better once investment bankers are running hospitals, although the investment bankers themselves will no doubt be thrilled at the new income streams opened up by our slimy politicos.

Tone @ 20:
1) You asked for the Source of the government removing the ‘duty to provide’

http://www.38degrees.org.uk/page/content/NHS-legal-advice/

http://www.dutytoprovide.net/2011/08/27/the-stage-is-set-for-market-forces-to-dictate-the-nhs-despite-recent-assurances-from-the-department-of-health/

Now please explain why the government would want to do this if its intention is to have ‘the same old NHS’.

2) You say that cuts of 40% are ‘not plausible’. They do not seem plausible in your fantasy world where the government is trying to improve the NHS with the introduction of private companies. In the real world this is a distinct probability.

This is a quote verbatim from radio 4’s Today programme on 13th December 2012. I have a recording of the programme. I don’t know if the BBC would confirm this, but I expect if you wrote to the Kings Fund, they would.

Chris Ham: “the NHS has to cut at least £20 billion, in fact most people now think it will be £40 billion because…….”

The Financial Times reported Sir Richard Douglas (finance boss of the NHS) as saying that there will be cuts totalling £50 billion. If you read the report, you’ll notice although the the DoH denies the £50 billion (they would wouldn’t they), they do not deny massive cuts.
http://www.ft.com/cms/s/0/94115a5e-71f7-11e1-90b5-00144feab49a.html#axzz21utZLEwV

According to professor Colin Leys the privatisation of the NHS will add about 20% to its running costs: http://www.guardian.co.uk/commentisfree/2011/sep/08/nhs-health-bill-private-sector

The NHS budget at the time of the reports above was about £120 billion. If we believe Sir Richard Douglas (you couldn’t ask for a better source) then we are looking at 41.67% cuts. If we believe Chris Ham (also a very reliable source) then we are looking at 33.33% cuts. But neither estimate takes into account the extra costs of running a privatised system. If we add that we are looking at 53.33% and 37.50% cuts.

As a measure of the direction of travel, you might also want to take note that senior Coalition members have called for an end to the NHS ring-fence: http://www.newstatesman.com/politics/2013/03/vince-cable-and-liam-fox-unite-need-nhs-cuts

So I think my claim of 40% cut is cautious and pretty solid. In my opinion, the cuts will be higher as the economy sinks more and more into a slump, but I didn’t want to overstate my case.

You state that there is not just the USA and NHS. There is Europe as well. This is a common statement from deluded Tories who find it difficult to believe what’s happening.

There will not be a North European system in the country for two reasons:

a)As the ‘a&e charge nurse’ has pointed out these countries all spend more on healthcare than we do, and in the case of France have co-payments as well. As shown above we are cutting our already low spending.

b)As the recent attempt by the government to introduce rules under Section 75 of H&SCA show, there will not be the controlled markets of Europe. We will have (if the government gets away with it) a US style wild west with its attendant horrors.

So we have a legal clause that lets the government off the hook of having to provide a service. (Incidentally the CCGs only have to provide an ‘appropriate’ service, so they’re not obliged either.) Cuts that will decimate the public service, and a private sector (including private insurers) champing at the bit ready to take the money of the rich and let the poor die.

The only thing that will stop this is poll tax style mass demonstrations. Get your marching boots on and prepare for the big demo on MAY 18th. Look out for details on the Keep Our NHS Public website.

aecn@30: ‘The one thing it does make clear is that throwing money at healthcare is not necessarily an effective strategy’ – yes, but it is likely to be a better one than increasing the financial gap even further between the NHS and Germany or France, or closing down places like Lewisham A&E, despite it being a well run and valued local service.

You’ve lost me completely here. The one country in the world that has thrown vast amounts at healthcare is the US, and your graph provides the evidence. Are you saying this is a “better” strategy?

[31] the poor old yanks have been throwning shed loads of money at the fatcats for a long time, although nothing like enough of the outlay (17% of GDP) trickles down to many ordinary people.
Apart from anything else almost a third US health dollars is wasted on bureaucracy – the likes of Hilary Clinton have dedicated much of their political career in maintaing this wretched status quo.
http://www.nursezone.com/nursing-news-events/more-news/Study-Calls-US-Health-Care-Bureaucracy-Costs-Unwieldy_28816.aspx

I would prefer the NHS spend to be comparable to France and Germany so long as the extra money is not redirected to the boardroom at CareUK or SERCO.

Anyway, leaving aside my health fantasies what I do know is that we cannot trust proven proven liars like Cameron, nor indeed NuLab fuckwits who signed away god knows how much on idiotic PFI deals.
The interest rates associated with those transactions must have had the bankers in a state of near ecstasy yet the people responsible for such disasters (including the army of overpaid advisors) are never brought to book?

DD @ 31:

1. I see no problem with the end of the duty to provide, and the consequences as outlined in the 38d legal opinion are overstated.

2. None of your sources mention 40% cuts – or even just “cuts”. Even Chris Ham talks about “efficiency savings”. NHS productivity falls year on year (walk around any NHS hospital and you’ll soon see why): if that can be reversed, 20% efficiency savings will not be hard to find. Efficency savings are not necessarily cuts.

3. I’ve just read the FT article and nowhere does it mention £50bn

4. Colin Leys CiF article is hysterical in tone, and the 20% figure is one he’s plucked out of the air. He also includes potential legal actions in that figure. All very speculative, and highly suspect because the figures are so round.

5. Your points (a) and (b) are very weak. As for (a)…I have already answered aecn. And the UK’s expenditure on healthcare is not low – it’s at or slightly above the EU average. As for (b)…what are these “controlled” markets in Europe?

6. What is happening to the NHS is no more than what has happened in social care. Commissioning groups will determine local needs, and invite non-state suppliers to bid for the services.

If the NHS goes, we are all going to die because there is no other way to deliver health services.

Thank god they invented free healthcare and we no longer have to pay.

Tone @ 34:
Well, I have to give you credit for slogging it out with me. Most Tories would have run off by now.

1) You see no problem with the end of the ‘duty to provide’. At least you now accept that this has ended. All it means is that when the government reduces funding to a rump, there won’t be any possibility of a legal challenge.

Not a problem for you maybe, but for those of us that depend on the NHS, it’s a complete disaster. In fact even for those with private insurance, who at the moment can run to the NHS when things go wrong, it’s a disaster. Just remember that the US health corporations (coming to a hospital near you very soon) employ people whose job it is to find ways of getting out of paying out.

You say that the legal commentary is ‘overstated’. As you have asked me for sources, let me ask you for the source of this opinion. If it’s just your opinion against that of a specialist barrister, then all I can say is get real.

2) ‘Even Chris Ham talks about “efficiency saving”’ you say. I can only repeat that I quoted verbatim and he used the word ‘cuts’.

Your claim that 20% ‘efficiency savings’ should be easy to find is astonishing. Again what’s your source for this. This level of ‘savings’ is unprecedented and many people have cast doubt on its possibility. The National Audit Office produced a report that says that it does not think it is possible (http://www.gponline.com/News/article/1164150/NHS-England-will-struggle-long-term-savings-NAO-warns/ ).

Even if we take Chris Ham’s £40 billion of cuts, rather than the £50 billion quoted by the head of NHS finance, and even if we ignore the 20% extra for running a private system, it is still inconceivable that we could run ‘the same old NHS’ with the cuts Chris Ham cites (33.3%).

What’s your source for saying that productivity is falling year on year? Because according to what I’ve read the NHS is one of the most cost effective systems in the world.

What’s been happening is PCTs have been restricting procedures and we are seeing the beginning of charging (http://www.dailymail.co.uk/news/article-2294986/NHS-talks-8-50-charge-doctor-hospital-patients-forced-pay-meals.html ).

As the state withdraws funding, those who can afford it will take out private insurance and the rest of us had better not get ill.

3) You’ve just read the FT article ‘and nowhere does it mention £50bn’ I quote from the article “The message was pretty stark … if you look at the next period and make certain assumptions about growth rates, it’s a much bigger figure – around £50bn..

4)Professor Colin Leys’ article offers the most authoritative figure I can get for the extra burdon caused by privatisation. Can you give evidence that he ‘plucked the figure out of the air’ or is this just pejorative speculation?

Anyway the indisputable point is that private medicine is more expensive because 1) they pay obscene amounts to their CEOs. 2) They do the same for their shareholders 3) Their administration costs are much higher 4) They have to spend on marketing.

5)My point, that the North Europeans spend more than we do on healthcare, is an indisputable fact. What’s weak about it? Are you suggesting that the coalition is about to increase health spending?

The Section 75 regulations, will force all services to be put out to tender. Together with the withdrawal of funding we will see a completely private system within years. Seems pretty rock solid to me.

The reason you can say that UK’s health spending is at the EU average is that the average includes countries like Romania. You were making a comparison with France and Germany. They spend a lot more.

6) You state that the reforms are just outsourcing. Well outsourcing has given us MRSA and Winterbourne View, so I don’t feel very reassured, but you are ignoring the fact that the government is withdrawing funding (see above). We are heading for a US style system.

As a last comment on this I would like to point out that Tone his/her comments with ‘it aint gonna happen’. When faced with the facts he reverted to denial; “40% cuts are not plausible”. Once again the facts fly in the face of his assertion.

Now he has disappeared. The fact is that the section 75 regulations show the government’s hand. There will be a fully blown competative system and the state will start withdrawing from the health arena.

The only way I can see that we can save the NHS is mass action. Make sure you come on the demonstration on May 18th and join one of the groups like ‘Keep Our NHS Public’.