What's so special about the NHS?

[Jeremy]

Loz Wrote:

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> I'm gonna go for a nag, here..

Only one person is allowed to nag me, Loz. And it ain't you!

[Help-Ma-Boab]

Good man/woman Loz. just updated my EHIC. Cheers

Loz Wrote:

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> Jeremy Wrote:

> --------------------------------------------------

> -----

> > I stupidly didn't have an EHIC card (and

> stupidly still don't)

>

> Jeremy!! Five minute of your time and it lasts for

> five years. Do it now!!!

>

> https://www.ehic.org.uk/Internet/startApplication.

> do

[goosey-goosey]

I'm surprised no-one's used the following logical argument yet in favour of the NHS, or any large-scale public service. There was a tendency in the 70s towards inefficiency, but nowadays a single, modern health service could in theory aim to operate more cheaply through economies of scale and zero profit motive compared with a fragmented, privatized health market composed of competing, profit-driven companies. I'm not saying the NHS is an efficient, well-oiled machine running close to peak efficiency, but at least that is something the people running it can aspire to and seek to achieve, unlike those in the private healthcare market model, for whom profit is as much a consideration as patient wellbeing.

[miga]

goosey^2, there are a number of things in what you've said that I wouldn't agree with, but I'm afraid it would drag me away from the topic of NHS not being an amazing or unique example of its type.

[goosey-goosey]

Sorry. I should have been clearer, miga. I guess the essential holistic nature of the NHS - its single, unifying infrastructure and its consistent patient experience - and the opportunities for efficiencies that these things afford us are what I find special, inspirational even.

[Earl Aelfheah]

The NHS is actually pretty efficient http://www.theguardian.com/society/2011/aug/07/nhs-among-most-efficient-health-services

It's not perfect, but compared to other systems it stands up well.

I completely agree with Goosey. The idea that fragmenting the system and bringing in private companies will improve the service is nonsense. Not only, we are expected to believe, will they do the same things more cheaply and to a better standard, but all this whilst also channelling some of our taxpayer contributions to their shareholders in profit. And all this without the NHS's current economies of scale. I suspect (and call me a cynic), that all they are actually good at is 'extracting value' for their investors, through clever contract negotiation.

[????]

Sounds like dogma to me. As Ms Kendall rightly said it should be about outcomes not how it is delivered. BTW Huge public services e consistently been exposed as paying ridiculously over the odd prices for goods and services as they don't have the procurement skills, incentives or culture to utilise their economies of scale. I'd like less dogma and some more honest from both left and right but until we have an open discussion and when the reaction is 'close all debate down' we get the status quo which won't be fit for purpose for mid 21st century demographics or practice.

[indiepanda]

Yes, just this morning they've had a story on the (generally left wing) BBC about NHS procurement showing the variation in prices hospitals are paying for even basics like latex gloves.

Personally for items like that, I can't quite understand why they have local procurement. Surely it would make sense for those sorts of things to be purchased at a national level and have the scale to dictate the price they pay. Supermarkets seem pretty good at screwing good prices out of suppliers based on their scale, and even in professional services where I work the procurement departments we encounter do a pretty good job of forcing us to give discounts / hold our rates year after year / do extra stuff for free / work a 10-12 hr day and bill for 8.

I think the philosophy of free at the point of use NHS is nice and I certainly wouldn't want the American system where vulnerable people are left untreated or bankrupted by medical bills. However, no fee whatsover encourages people to not show up for appointments, wasting resources, and to expect the NHS to be there for them even if they do nothing to look after their health.

I hear heavy smokers and drinkers say they've earned the right to use the NHS whenever they need because of the high tax on cigarettes and alcohol. Ok, I agree, they are heavily taxed - but at a macro level, we are not paying enough in tax to cover all government spending, and spending on the NHS is spiraling due to the ageing population in a way other costs aren't.

If we're going to continue to fund the NHS in the way we have (all - or most - free at the point of use), something has to change somewhere. I am not convinced anyone wants to pay more tax, so either we make deep spending cuts elsewhere, or get a bit smarter about how we fund health.

[Earl Aelfheah]

???? Wrote:

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> Sounds like dogma to me. As Ms Kendall rightly

> said it should be about outcomes not how it is

> delivered. BTW Huge public services e

> consistently been exposed as paying ridiculously

> over the odd prices for goods and services as they

> don't have the procurement skills, incentives or

> culture to utilise their economies of scale. I'd

> like less dogma and some more honest from both

> left and right but until we have an open

> discussion and when the reaction is 'close all

> debate down' we get the status quo which won't be

> fit for purpose for mid 21st century demographics

> or practice.

There is no dogma, just (imo) a healthy skepticism about how outsourcing services will lead to improvements. The evidence so far has been that public private partnerships have proved bad value for the tax payer.

There are plenty of ways to drive further efficiency, ensure better management and incentivise the right kind of behaviours, without contract everything out. Besides, the point of posting that link was that actually, the current system is pretty efficient.

I have to be honest, when i see Capita, G4s et al sending their contract negotiators into the health service, my first thought isn't 'oh this will lead to good value for the tax payer', but maybe I'm just jaded.

[Earl Aelfheah]

indiepanda Wrote:

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> I am not convinced anyone wants to pay more tax, so either

> we make deep spending cuts elsewhere, or get a bit

> smarter about how we fund health.

I would happily pay more tax to ensure that the health service stays free at the point of use.

[Jeremy]

I know this is simplistic thinking, but I just don't get how outsourcing services to profit making companies can possibly be better value. The private sector doesn't possess some sort of magic which allows them to deliver a better service at a cheaper price AND also make a profit.

[????]

...so taken your thinking's logical conclusion everything should be run by the state then Jeremy?

I am sceptic too about much of it thus far Rah - but that doesn't mean it's not workable and shouldn't be up for discussion and trial. Too much ideology from both end of teh debate for my liking.

[miga]

Jeremy Wrote:

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> I know this is simplistic thinking, but I just

> don't get how outsourcing services to profit

> making companies can possibly be better value. The

> private sector doesn't possess some sort of magic

> which allows them to deliver a better service at a

> cheaper price AND also make a profit.

Examples of ways private companies can save money: employing fewer people, fewer employee benefits than state for state employees, using pre-existing supply chains, being more stringent about worker productivity (linking it to pay).

But as ???? said before, it's not the method of delivery (public or private) that people should be hung up about, but the quality of the outcomes.

This of course imagines that for any services there exist multiple private providers that can step in and compete on price. The worst outcome for PPP, AFAIK, is being stuck with one private supplier/provider and them holding you to ransom over costs.

[Jeremy]

?x4 - as I conceded, it is a simplistic argument. Not everything should be run by the state of course - I think you realise I am no socialist, in many cases the private sector is better equipped. But in the case of healthcare... it's an essential service we all depend on, demand is constant/predictable, and geography often nullifies competition in the market.

miga - not really convinced by many of your arguments, no reason on earth why the NHS shouldn't have efficient supply chains. You suggest that the private sector has a more streamlined workforce, but the government have spent vast sums of money on consultancy to try and achieve exactly this. So what is intrinsically efficient about the private sector, that the NHS cannot repliace?

Yes of course the quality of the service is important, but value for money for the taxpayer is also crucial.

[Saffron]

Not sure how you're defining "unifying infrastructure" or "consistent patient experience", because there seems to be quite a lot of regional varation, no?

[DaveR]

The choice between public and private is not the real issue here - it's between a single monolithic organisation and an essentially organic system driven by (publicly funded) demand. In essence it's the choice between the state education system we had until recently and the one that we are heading towards. There is also a fundamental misunderstanding of profit, and the profit motive. Profit just means surplus, it doesn't necessarily mean distributed profit. Most so-called 'not-for-profit' organisations are nothing of the sort - they make profits but reinvest all of them in their operations, or they save them for future investments. That's what all sensible organisations do when they are free to make their own decisions. There is no reason why a publicly funded health system needs more than an absolutely minimal bureaucracy, to administer the funding and monitor standards - everything else is wasted time and money.

FWIW, I agree that a 'non-profit' system should, all things being equal, beat a profit driven system i.e. one that is driven to make returns to shareholders. Funnily enough, in the US, where healthcare outcomes are the best in the world, 70% of hospitals are non-profit. Unfortunately its also the most expensive in the world because of the ludicrous private insurance system. A system with a simple public funding model and an essentially free market for providers, but with big incentives for not-for-profit organisations should beat any other system hands-down. With the added bonus of stopping idiot politicians endlessly pontificating about the NHS.

[miga]

Jeremy Wrote:

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> miga - not really convinced by many of your

> arguments, no reason on earth why the NHS

> shouldn't have efficient supply chains. You

> suggest that the private sector has a more

> streamlined workforce, but the government have

> spent vast sums of money on consultancy to try and

> achieve exactly this. So what is intrinsically

> efficient about the private sector, that the NHS

> cannot repliace?

I didn't argue that the private sector is inherently more efficient, merely listed examples of how a private company can save money. On the whole, in terms of work benefits for like for like jobs, government employees have a better deal, surely this is not controversial? On the whole, private companies are more likely to link pay to performance, rather than group bargaining and pay scales? Surely this isn't controversial? On the whole, in the services sector, a private company should have more flexibility to fire/hire than a government department, the NHS etc.? And re: supply chains - look further up in the thread and you'll see examples of discrepancy within NHS on what is paid for same things.

You mention vast sums government have spent (and continue to spend) on consultancy to make processes more efficient. I would say that's one of the problems - NHS is so vast and complicated that there is this inherent layer of external consultants built into the price of service delivery. The multi-billion IT debacles of the last decade spring to mind when it comes to good money after bad.

However, I followed on to say said that ultimately it's not about a simplistic public/private division but about getting best outcomes.

So, let's turn this and say what is inherently efficient about the public NHS that the private sector couldn't replace, and what causes such palpitations when it's even broached?

[Jeremy]

miga Wrote:

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> So, let's turn this and say what is inherently

> efficient about the public NHS that the private

> sector couldn't replace, and what causes such

> palpitations when it's even broached?

Oh no... nothing inherently efficient about the NHS, as far as I can tell. Just theoretically, I don't see why a public organisation can't be just as efficient as a private one. e.g. if NHS supply chains are fragmented, why can't they be consolidated... use the vast size of the organisation in it's favour.

[miga]

Ah...then we're talking about the same thing. Me neither. But then, I have no idea how these big monolithic organisations (NHS, big banks, Microsoft etc.) ever manage to get anything done....not for me.

[hpsaucey]

rahrahrah Wrote:

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> indiepanda Wrote:

> --------------------------------------------------

> -----

> > I am not convinced anyone wants to pay more tax,

> so either

> > we make deep spending cuts elsewhere, or get a

> bit

> > smarter about how we fund health.

>

> I would happily pay more tax to ensure that the

> health service stays free at the point of use.

You Gov survey a year ago and today say most willing ot pay more for NHS. Nearly half of those polled willing to pay more national insurance (not income tax) to spend on the NHS. I think there is a heightened feel for the 'specialness' of the NHS at the minute, given that most people don't trust the tories as far as they can throw them with preseving it (again check out You Gov surveys). They'll savage it and tear it to shreds faster than a fox hound on a hunt.

HP

[Earl Aelfheah]

.

[????]

hpsaucey Wrote:

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> rahrahrah Wrote:

> --------------------------------------------------

> -----

> > indiepanda Wrote:

> >

> --------------------------------------------------

>

> > -----

> > > I am not convinced anyone wants to pay more

> tax,

> > so either

> > > we make deep spending cuts elsewhere, or get

> a

> > bit

> > > smarter about how we fund health.

> >

> > I would happily pay more tax to ensure that the

> > health service stays free at the point of use.

>

> You Gov survey a year ago and today say most

> willing ot pay more for NHS. Nearly half of those

> polled willing to pay more national insurance (not

> income tax) to spend on the NHS. I think there is

> a heightened feel for the 'specialness' of the NHS

> at the minute, given that most people don't trust

> the tories as far as they can throw them with

> preseving it (again check out You Gov surveys).

> They'll savage it and tear it to shreds faster

> than a fox hound on a hunt.

>

> HP

*sighs*

I don't think it's that special. I don't thin the Tories are planning to destroy it - in reality they've pledged more spending. I think it needs reform but with propaganda type tosh spouted by Labour and the unions and widely accepted ( as your post shows) even getting an adult debate is nigh on impossible. Ps National Insurance is tax in all but name and how did I You GOv get on in pre-election polling?

[miga]

Agreeing with ?s on this. It ain't that great, the Tories aren't ogres, and the last thing they'll touch is holy NHS. It employs too many voters for a start.

P.S. written from a queue where I'm waiting for my (rescheduled) 9.15 appointment at 9.40, eavesdropping on nurse Julie's weekend plans.

[Otta]

Kids ENT at Tommy's was running a good hour late yesterday. I looked around at all the bored fidgeting kids in the waiting room, and was transported back 30+ years to when I was forever at eye clinic at Kings. Hospital waiting rooms have got to be the most boring places ever for kids.

[Earl Aelfheah]

What people seem to be saying is that the NHS is not perfect. Well sure, but it is generally pretty efficient. In terms of what it delivers for the amount of money it receives, it compares pretty well with the best.

In terms of 'the left' having a closed mind to reform, or being dogmatic and ideological, I think this is nonsense. Labour did much to reform the health service and was certainly not closed off the the potential role of the private sector.

The conservatives on the other hand have time and again pursued ideologically driven interventions across all manner of state services regardless of value for money or any sense of pragmatism. For example, selling state assets at under market value, as well as profit making services (bringing money into the exchequer), such as the east cost mainline. These are purely ideological decisions based on a belief that the state should only commission services, not run them.