So the NHS that has to be saved is a bureaucratic contstruct which owns property and employs people?

And I thought the point of the NHS was that is was a scheme by which the government ensured free-at-the-point-of-delivery healthcare. Which I would sign up to support. This however seems to be confuse the service which government provides with a single mode of delivery which is undoubtedly inefficient (n.b. the consistently best bit of the NHS is the primary care (GP) service, which are already independent organisations doing their own hiring and firing).

Also, unions are there to represent their workers. Why should we assume that their workers’ interests will coincide with patients? After all, is there not an automatic tension between paying people more or investing in new dialysis machines in any healthcare system?

If the proposition were to change the fundamental principle of universally available health care based on need and free at the point of use, I would sign up immediately. However, I’ve not seen anything to suggest that is the case. Clearly, I’m missing something and would be very grateful if someone could explain it to me.

The presently structured NHS employs c. 1.3 million, the largest single employer in all western Europe. How do you suppose the hospitals, clinics, and physicians function in the rest of western Europe?

In an assessment by WHO and now in regular annual assessments by an independent Swedish think-tank – Health Powerhouse – the NHS emerges with mostly mediocre ratings:
http://www.healthpowerhouse.com/files/Index%20matrix%20EHCI%202009%20091001%20final%20A3%20sheet.pdf

“GPs want to spend more time with sicker patients while those with minor ailments see a nurse, ring a helpline or go online for a video consultation.

“The Royal College of GPs (RCGP) is calling for appointments for standard patients to be increased from 10 to 15 minutes so doctors can spend more time with the growing number of people with long-term conditions such as diabetes, cancer and obesity.”
http://www.guardian.co.uk/society/2010/mar/23/gps-consultations-ill-patients

The predictable outcome of the 10 minute appointment regime is that GPs mostly just hand out pills: “Britons are increasingly turning to prescription drugs to cure every ailment, a new study found. The average number of prescriptions dispensed per person rose from eight a year to more than 16 over the past two decades, according to the paper, titled A Pill for Every Ill.”
http://www.independent.co.uk/life-style/health-and-families/health-news/britain-turning-to-prescription-drugs-1930212.html

To be honest, I’ve not really understood the fuss about the NHS changes. What’s valuable about the system we have is that it provides free healthcare to everyone – not the specific way it’s organised. And having lived in Sweden for many years I’m pretty sure their decentralised system is at least as good as what we have here.

Don’t get me wrong, I don’t think these changes are automatically improvements. But it seems that Liberal Conspiracy has decided that anything the coalition does to the NHS is automatically bad. Wouldn’t it be better to work out which bits they are getting wrong and oppose them specifically?

The Labour Party swept to power in 1997 with the pledge “…to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition”

They didn’t do it. In fact they turned through 180 degrees and accelerated and amplified the commercialisation and privatisation of the NHS –without public assent.

Now the Tories are back and preparing legislation which will complete the privatisation process. How? To complete the market transformation, they propose to hand over £80 billion of public money to our 40,000 or so GPs to ‘buy’ care for their patients.

If the local NHS hospital charges ‘too much’ – it has all those costly chronic cases, labs and so on to cover – GPs will buy from a cheaper private unit set up by some entrepreneurial investors to profit from this succulent new market. Even worse, most GPs have little inclination and even less training to handle these vast sums of public money. Disgrace, even gaol, await if they get it wrong. There are already many private, profit-making companies, prepared (for a price) to handle the business side of things and do all the commissioning for them.

With their own ‘little businesses’ now ruined, many GPs will be offered remunerative employment by the commissioning companies. They will need to keep to the new rules – not to send too many patients to pricey hospitals or to order too many pricey tests. To cap it all, the private commissioning companies may choose to buy services from provider-companies which they own themselves.

Paranoid nightmare? Don’t you believe it. Just look across the Atlantic.

It is unlikely that the NHS will completely disappear. Much more likely that, using the economy as an excuse, it will be reduced by our present government to a safety net service so that even the poorest will get a minimum level of GP and hospital care. Those that want more will need to pay more. Cash will buy priority.

With ‘Foundation Trust’ Hospitals able to offer private care as well as safety net care, people who can afford it will be able to choose their doctor, be seen sooner and have the whole of their sequence of diagnosis and treatment completed in hours or days instead of the weeks and months of appointment queues. Inevitably, the cash customers will get first attention and, as there is finite skill in the system, this can only be at the expense of those less able to pay.

The underlying principle of social solidarity which gave birth to the NHS, treatment according to clinical need rather than ability to pay, will have been defiled. It will be a ‘retroNHS‘ with the feel of the 1930s rather than the 2010s. Liberals with their proud history of Beveridge should hang their heads in shame. As for Labour, I am speechless.

Harry,

You are confusing the NHS with its delivery. It is a service – the S stands for service quite clearly – so it is not threatened by changes.

However, your paranoia about the future ignores a few things, such as if labs are expensive to run but are needed for information, they will continue to be run. If however the same results can be obtained with the same or better accuracy for less cost, why should the government pay for a worse service just because it is provided by part of their own bureaucracy? You need to justify your default position on things like this.

You say to look at the US healthcare system as an example of commissioning gone wrong. Some examples of your concerns would be good – at the moment this is like a Fox Journalist referencing the NHS as a bad thing without any context or evidence. Also, remember that unlike in the US, the state-run NHS (the system) will still exist and can therefore exclude those who abuse a market position.

The bownshirts will not be happy until they have destroyed every institution in this country that the public loves. They are ideologically insane, and don’t give a shit about the views of the little people. The constant praising of the American care health system is vomit inducing. Get it straight trolls. The American system sucks, unless you have money.

Also, the term ‘something for nothing society’ is more true of the right than the left. The right loves taking state assets at a fraction of their value, and giving them away to their lazy corporate friends.

But this is all about the Lie Dems. The troies have no mandate to privatise the NHS. It was not in their manifest (Although we know that they lie like drains “ we will not raise VAT) But they can’t get anything through without the Lie Dems help.

I prefer to look at the evidence. Something is seriously wrong with the way the NHS is run:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

And this:

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication. The number of alerts relating to errors or ‘near-misses’ in the supply or prescription of medicines has more than doubled in two years, the National Patient Safety Agency said.

“More than 86,000 incidents regarding medication were reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005. The figures, for England and Wales, show that in 96 per cent of cases the incidents caused ‘no or low harm’, but at least 100 were known to have resulted in serious harm or death.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

“Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable.

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

Maybe there is a connection between the NHS being pushed to increase productivity and the number of recorded errors.
The constant introduction of new technology also requires that staff need constant retraining, I doubt if any company in the private sector is subject to so much continuous change on such a massive scale.
I would also be interested to know how it is calculated that ‘productivity’ has decreased. Also changes in reporting procedures and what counts as an incident which requires reporting, strikes me as rendering it impossible to make a realistic comparison of previous data.

Sally,

The bownshirts will not be happy until they have destroyed every institution in this country that the public loves.

Hardly good electoral politics I’d have thought. Mind you, you have to show that people love (rather than appreciate or take for granted) the NHS, which is an assumption I see a lot on here but not in general (especially in waiting rooms for some reason…).

The constant praising of the American care health system is vomit inducing. Get it straight trolls. The American system sucks, unless you have money.

Constant praising? Where – I mentioned it as a counter-point in an argument, as the opposite of what was being suggested, and no-one else seems to mention it at all. But no-one I have read thinks the American system is any good, although a lot believe President Obama’s attempts to fix it will not help either, by basically adding our problems to their own. As it happens, a system where the market can be so distorted by the suppliers is clearly broken and inadequate.

But then again, as with the hypothetical Fox journalist earlier, why let evidence get in the way of a good narrative eh?

Oh Watchman. Just how well you clearly know the US and its health care. The best, mainly provided by great academic centres, resistant, though not immune to financial (philanthropoid) pressures, practice superb medicine, as good as our very best. But then just cast your eyes around. 40 m uninsured, probably as many with ‘swiss cheese policies’, medical bills the leading cause of bankruptcy, multitudes going with poorest standards of care, some even with none. And at the other end of the scale, a great number of oh so lucky individuals who get more medicine than they need – twice as many operations per American, twice the proportion of hysterectomised women – and medicine and its practitioners regarded with doubt and suspicion – “is it me or just my money” as the old song went – and sued at the drop of a hat. And all of this at twice or more per head the UK cost. While you may cherish the prospect of increasing private sector involvement in determining the care you get – private sector treats all that old fashioned professionalism very indulgently – just until it gets in the way of dividends, the British people take a different view. They do NOT like the PFI philosophy – Profiting From Illness. Our job as doctors is not to make money, it is to spend m oney, but to spend it as wisely and well as we can and in full view of an informed public.

Watchman, I don’t know who you are but rather suspect you are among those fortunate enough to ensure care for yourself and your family whatever the system. I think the quite extraordinary public affection for the NHS (Nigel Lawson’s “NHS religion”) is founded in their belief that its prime purpose is for their welfare and that of their families. You may find that too “collectivist” for your taste and you must explore how much of your own attitude is based on a neoiliberal view of a free market in health. Of course the NHS needs the private sector for many purposes and in its own universe of pots and pans, cars and Mars Bars, it may be just fine but not as a driver of health care systems.

Harry,

Not sure if your saw my previous comment, but I would not like to see the US model here. I prefer my health systems to be sensible thanks. As to any model other than NHS-funding, I see no reason to adopt them. But thanks for providing a useful succinct summary of why the US system is a bad idea (it produces even more of a lottery than our own).

As to my personal circumstances, I don’t have and can’t afford medical insurance, so depend on the NHS, which has generally done a good job for me, but has rather failed other members of my family (an eight-week wait for treatment for a back injury does rather compound the damage we found). But the treatment was there, and if there are ways to make access to treatment quicker and more effective, I support them. I support the NHS, but do not equate this with supporting the current setup (and I include PFI in that).

And incidentally, the job as doctors is neither to make nor to spend money, but to make people better to the best of your ability. Or have I misunderstood your role and that nice oath that all doctors swear on graduation?

Forgive my cynicism:

“All their hard-earned national pay deals”

That’s what the opposition is really about.

“working with NHS staff unions on ways to campaign against it. As a first step, supported by UNISON and UNITE,”

Yup….and of course national pay deals should be abolished. For national pay deals, as several recent pieces of research have pointed out, kill people.

Tim,

For national pay deals, as several recent pieces of research have pointed out, kill people.

Come on, the negotiations can’t be that tough

Tee hee….:-)

The argument is that a national pay scale will be set as an average nationally (well, d’oh!). Which means that in low income or low cost areas getting such a national pay deal is just great. However, in high cost areas it’s very much not a good deal.

And yes, we do have large regional variations in private sector pay as well as general living costs. So what we would expect from such a set up is that public services in those high pay/high cost areas will have a shortage of people willing to work for those lower than locally available public sector salaries from the national pay deal.

And when we go and investigate we find this is so. One paper I recall showed that heart attack victims in a wealthy area (Surrey I think it was) had worse survival rates than those in poorer areas, worse than the national average even. The cause was tracked down to a shortage of nurses locally and the greater use of agency staff to make up for said shortage.

National pay deals do kill people.

here’s a summary of one such paper (wage controls kill people)

http://www.voxeu.org/index.php?q=node/899

And what did New Labour do about that published research showing the consequences for NHS hospital patients of centrally determined pay?

@Tim Worstall

Surely for a bold free-marketeer, like yourself, this is only the market in action. Excess heart attack deaths are God’s way of showing Surrey house prices are too high (let’s face it – how much would you have to increase nurses salaries for that).

Presumably when enough stockbrokers have been carted off to the morgue, house prices will fall and all will be well. You’re not suggesting, surely, that only the poor should bear the cost of capitalism?

My local hospitals are in the news again:

An elderly woman who had complex foot surgery had to wait seven weeks and make several trips to two hospitals to be given a pair of crutches.

Julie Fox, 69, from Epsom, had surgery on her left foot at the Elective Orthopaedic Centre in Epsom Hospital seven weeks ago with a surgeon from St George’s Hospital, who was brought in by Epsom Hospital to operate on her.

But two weeks after the surgery, instead of a pair of crutches, Mrs Fox was given a walking frame when she was discharged.

She went back to Epsom Hospital after two weeks, but was told by the physiotherapy department she would have to get crutches from St George’s Hospital because that was where her surgeon was from. . .
http://www.thisislocallondon.co.uk/news/8325290.Woman_left_without_crutches_for_seven_weeks_after_surgery/

After abusing him roundly last night, I suppose I ought thank Sunny for putting up an NHS thread that doesn’t concern watered-down water.

But this is a depressingly old-school campaign isn’t it? – and not in a good way. The only thing that’s missing is asking your local Trades Council to pass a motion of support.

This is not about the discomfiture of some NHS employees by the possible alteration of some terms and conditions. This is about the tearing apart of the structure of the NHS in the hope it can’t be put back together again.

The restructuring of the NHS should be widely attacked as a Conservative broken promise, with the implication that other promises to keep the NHS will be next. The dropping of commissioning onto GPs heads should be pointed out as producing more bureaucracy. And if Bob B thinks the extra workload will somehow enable GPs to give patients more time, he’s going to be more than disappointed. More likely the very large cohort of GPs retiring in the next few years will head for the door even faster.

People and MPs (especially Lib Dem and Tory ones) need to be shown that Lansley’s manic and arbitrary changes won’t cut back on unnecessary management – they will increase it and the cost will come from patient care. Back-door privatisation will produce the worst of all worlds – stories like the one Bob B gives above will be universal. The already poor record of the NHS on openness and ability to adapt to criticism will be submerged under the blanket of “commercial confidentiality”.

Even the hardest rightists on this site don’t want to see a US-style system. But that is what Lansley and the Tory ideologues are aiming for and where many of the companies eyeing the spoils are coming from. The public has to be convinced that this is what will happen if the changes aren’t stopped now and gradual bottom-up reform isn’t carried out instead to improve the NHS.

To fight Lansley’s changes needs organisation; knowledge that is widely dispersed; a desire to reach out for support beyond the usual suspects; a targeting of local media with local information; and most of all an admission of the mistakes in running the NHS in the past and an intention to fix them in a constructive way.

Maybe the Trade Unions are paralysed with guilt about how, when New Labour implemented the ancestors of these changes, they just whinged a little and kept handing over the money. After all as Lord Mandelson’s grandad said “Socialism is what the Labour Party does” ; so that was alright then. In that case, now is time for them to start campaigning effectively for once.

One among several recent personal experiences of the NHS:

I had a hospital appointment to see a consultant on 19 May so I ring up the hospital clinic on 17 May to confirm the appointment and to seek directions as to where exactly I should go. All is fine. On the morning of 19 May, two days later, I receive a letter by first class post cancelling the appointment and setting a new date: 23 June.

At the beginning of June, about a fortnight after 19 May, I receive a letter from NHS Choose & Book offering me an appointment. I phone them to tell them that I have an appointment for 23 June. They say they have no record of that. I’m worried in case the appointment has been cancelled again so I try – with difficulty – to quickly make contact the hospital clinic to inquire whether I still have an appointment for 23 June. They confirm that I do. I request that they inform NHS Choose & Book.

In due course, I make the appointment on 23 June. The day after, I receive a letter from NHS Choose & Book offering me an appointment so I phone them to tell them that I had an appointment the previous day. This is evidently news to Choose & Book. They asked whether I had kept the appointment so I confirmed that I had so they said they would make arrangements to stop sending me letters offering me appointments. That worries me in case I need another appointment.

Keep in mind that it is impossible to speak with Choose & Book at all without a reference number and a pass word – even to convey information that the system is screwed. I could go on and recount what followed but the details get increasingly complex, personal and deeply boring to onlookers. The saga continues because nothing is securely arranged.

Fortunately, I’m advised by a friend who has been through this experience with the same medical problem – except that they had and have personal healthcare insurance whereas I’m dependent on the NHS and I’m too old with too many pre-conditions to make it worthwhile to take out insurance. My advice to youthful professionals is to take out healthcare insurance or find an employer who offers cover.

[3] I see you are much less vocal about the NHS and standards of cancer care? Because of this perhaps?
http://www.guardian.co.uk/world/2010/aug/12/uk-lowest-cancer-death-rate

Your continual citing of Health Powerhouse (which has been debunked on previous threads) demonstrates to me that you are mostly fishing for evidence to demonstrate your preconceptions about the NHS.

I know bit’s of it are crap and I’m sorry you were messed about, but compared to the American system, for example, substantial parts of the NHS works reasonably sensibly, and free from bureaucratic pressure to ensure you have the means to pay for any treatment required.

I mean do you really want this sort of thing?
http://www.nytimes.com/2010/08/07/health/07patients.html

21
And here lies the rub, the NHS does not discriminate on grounds of age or take into account any existing medical conditions. Private insurers can, at any stage, refuse to cover existing clients if they develop certain conditions. So even if you are young and healthy, and can afford the premiums, it doesn’t mean that you can rely on private insurers.
However, whether this remains the case under this tory government (due to the aging society and it’s increased demand on the NHS ) is another matter.

@22: “Your continual citing of Health Powerhouse (which has been debunked on previous threads) demonstrates to me that you are mostly fishing for evidence to demonstrate your preconceptions about the NHS.”

Nonsense.

This is the reality of the NHS in action based on personal experience: in August 2007 I received a letter from the Pathology Department at my local hospital. It requested that I return so they could take another blood sample since they had not taken enough at my “recent blood test”. That “recent” blood test was, in fact, in April. It took the Pathology Department from April to August to realise that it hadn’t taken sufficient blood to perform the tests requested by my GP. Fortunately for me, the test wasn’t about anything critical.

My worry about scrapping the Audit Commission is that we surely need regular audits of healthcare performance in hospital trusts to maintain standards. This was in the news in 2001:

“A dozen hospital trusts in England are so bad they have failed to gather any stars in the government’s performance tables.”
http://news.bbc.co.uk/1/hi/in_depth/health/2001/nhs_performance_2001/1562247.stm

My local hospital was at the bottom of that list of failing hospital trusts – it was officially nominated the worst hospital trust in Britain:
http://www.guardian.co.uk/society/2001/sep/25/hospitals.nhs1

Standards have greatly improved since then but some old habits are hard to break.

I’m not a healthcare economist but I follow what goes on. For more than 50 years – led by the gurus of the NHS at the LSE – the claim was that the NHS is absolutely wonderful because average healthcare in America is so terrible.
It is terrible, I agree, and hugely costly relative to spending on healthcare in west European countries. The intelligent conclusion is that we should compare the NHS with patient outcomes in the healthcare systems in other west European countries, not with patient outcomes in America, and that is what the Health Powerhouse aims to do.

Civitas briefs on other national healthcare systems are accessible via this link:
http://www.civitas.org.uk/nhs/health_systems.php

Btw I notice that you have avoided responding on issues raised @3, @8, @16, @19 and @21.

A perennial problem with the NHS for patinets is the repeat doses of propaganda administered to create and maintain the illusion that the NHS provides a national service in which patients can receive the same standard of healthcare across all hospitals and clinics. This is nonsense, of course:

“Eight women who had been given the all-clear in Cumbria are having to be treated for breast cancer. Others who thought they had nothing to worry about, will have to wait for the results of new tests.”
http://news.bbc.co.uk/local/cumbria/hi/people_and_places/newsid_8914000/8914086.stm

Bob B Your presentation of evidence is just a little selective I would say. All your reports of NHS activities tend to highlight its faults and I cannot argue with those, much as I regret and would wish to correct them. You do not actually mention the many millions of successful diagnoses, episodes of care, operations, support for the [hysically and mentally disabled (whether they can pay or not) that have gone on anbd continue to do so. It is very important to have the Bob B’s around to keep our eye on the ball and to stop us getting complacent and satisfied, not that there’s much chance of that. But let me say with total sincerity that if I, or those near and dear to me, were really seriously sick it would be to the NHS that I would turn for help. It has vast resources in respect of the people who work for it, the store of knowledge and experience and, since the Thatcher throat throttle was rerlaxed, even some brilliant new gear and building. I’m not denying for one moment that the whole operation could rubn smoother and slicker. We ought to give some thought to having Regional or even locality ombudsmen (and women, particularly), readily available to the public and empowered to look in detail into the sort of problems, snarl-ups and downright errors that inevitably occur in any large organisation, and to recommend preventive action with the right and responsibility for follow up. More bureaucracy? Maybe, but better bureaucracy than the hordes of people now responsible for setting charges for every referral, for every item of clinical activity. The market now says that if I see a patient and I’m concerned about his eyes, I can’t just take him to my eye colleague next door and ask hum to take a look. I have to send him back to his GP to make another referral so the hospital gets the fee. An immense amount of unnecessary could be stripped out if, like the always sensible Scots and soon to be the Welsh, we dumped all the costly and wasteful market paraphernalia and got on with the business of providing high quality medical care.

It can also be claimed by the healthcare systems of, say, France and the Netherlands that these also achieved “many millions of successful diagnoses, episodes of care, operations, support for the physically and mentally disabled” and so on.

For patients, one of the challenging issues for them is whether they would be likely to receive better treatment in the healthcare systems of other west European countries than from the NHS in Britain – and at what cost to them and to national taxpayers in those countries.

The aged comparison between the NHS and healthcare in America is deeply flawed and I can’t understand why it is still being cited to vindicate the NHS.

Credit for starting a national welfare state must surely go to Count von Bismarck, first Chancellor of the German empire (1871-90), who launched not only state pensions for the aged but, in 1883, a social insurance scheme to cover personal healthcare costs:
http://en.wikipedia.org/wiki/Otto_von_Bismarck#Chancellor_of_the_German_Empire

Bismarck was not renown for his socialist inclinations.

The academics and medics who keep rolling out the comparison between the NHS and healthcare in America know – or really ought to know – that their argument is bogus. The American healthcare system is deeply flawed – average life expectancy in America is marginally lower than in Britain, where it is marginally lower than in a spread of other west European countries. The average infant mortality rate in America is up with the rates found in Mexico and Turkey, not with the infant mortality rates typically found in west European countries.

From what I hear from friends, there’s no doubt that those who do have the benefit of private healthcare insurance do receive better treatment – and that saves the NHS money.

As we get older, one becomes more dependent on medical treatments and support from healthcare professionals and some are inclined to think any aged person is bound to be a bit soft in the head. One specialist nurse I see every so often is apt to repeat sentences twice, presumably because she thinks I’m a bit daft – the interesting take is that the doctors and consultants don’t do this.

The sad fact is that – from personal experience – there are many, far too many, unnecessary glitches in NHS administration.

@22. the a&e charge nurse

Surely if the NHS as it presently stands was so great it would come at or near the top of at least some of these international comparisons – I’ve yet to see a ‘system as a whole’ league table that places us anywhere near the top. Even the article you link to is an exercise in dodgy statistics. “Death rates from breast cancer have fallen more dramatically in the UK than any other European county”. Right, but that doesn’t tell me anything about what the rates actually are. A quick look at the graphs in the article shows that the UK, while having good improvements, is still towards the bottom (or should that be top) in terms of actual death rates.

From what I’ve seen and heard, despite what some people might want there’s absolutely no intention from the Government to end ‘free at the point of use, taxpayer funded, based on need not ability to pay’ healthcare. So all the Government is proposing is to run the NHS to the benefit of the patients, as oppose to admin managers etc. It’s telling that the quote Sunny uses says absolutely nothing of health outcomes. There’s stuff about national pay deals, managers losing jobs, but absolutely nothing about patients.

You’re a nurse – what would you rather have? Another manager in an office, or another nurse on the floor? What would benefit the patients the most?