The 2015 Popularity Contest (aka UK General Election )

[Bruce Wayne]

I am not trying to score political points with the following comments, but the withdrawal of Circle from its contract at Hinchingbrooke is exactly what I have spoken about before. Private capital and private operators are not suitable to support and run the NHS because ultimately they are not permanent. By its very nature, investment capital seeks the best returns and when it can not find positive returns or the prospect of positive returns it usually withdraws and is re-invested elsewhere.

We saw this at the height of the credit crunch when private capital failed to support the banking sector, forcing the tax payer to become the ultimate funder. This pattern will be repeated continually in the health service whenever conditions do not make a positive return likely.

The Circle contract had break clauses based on accumulated loss levels within the contract. No private capital or service provider would enter a contract without these provisions, so it will always be the case that the private provider can walk away from their obligations leaving patients without critical services, and the taxpayer to pick up the bits.

Far better to stop this farce now and commit to state funding across the health service.

I wonder if there isn't more to it though. I mean that hospital was failing under the NHS, and Circle don't appear to have been able to make a go of it either. I wonder therefore what is really going on there that makes running a successful hospital so challenging? If we get bogged down in the private vs public debate then I feel that investigation will get overlooked.

 

[The Esk]

I wonder if there isn't more to it though. I mean that hospital was failing under the NHS, and Circle don't appear to have been able to make a go of it either. I wonder therefore what is really going on there that makes running a successful hospital so challenging? If we get bogged down in the private vs public debate then I feel that investigation will get overlooked.

I'm not saying there is not problems at that particular hospital, that is self evident. What I am saying is that if the Government of the day persist in selling parts of the NHS to private providers, this situation will be repeated and quite probably more frequently. The other situation that might develop is that you end up with the private sector "cherry picking" so called "profitable" sectors or hospitals leaving the tax payer to pick up the less desirable parts of the service.

Neither options are desirable.

 

[Bruce Wayne]

I'm not saying there is not problems at that particular hospital, that is self evident. What I am saying is that if the Government of the day persist in selling parts of the NHS to private providers, this situation will be repeated and quite probably more frequently. The other situation that might develop is that you end up with the private sector "cherry picking" so called "profitable" sectors or hospitals leaving the tax payer to pick up the less desirable parts of the service.

Neither options are desirable.

And neither is assuming that you have all of the answers in house imo. When you fall into that mindset then generally all that happens is you start manipulating the question.

Healthcare in the western world faces all manner of challenges at the moment in terms of demography, technology, finance and medicine, and I don't think it's wise at all to refuse to entertain particular insights on the basis of their location. That should be irrelevant, with the patient outcome being all that matters.

 

[The Esk]

And neither is assuming that you have all of the answers in house imo. When you fall into that mindset then generally all that happens is you start manipulating the question.

Healthcare in the western world faces all manner of challenges at the moment in terms of demography, technology, finance and medicine, and I don't think it's wise at all to refuse to entertain particular insights on the basis of their location. That should be irrelevant, with the patient outcome being all that matters.

But Bruce the first principle in offering any critical and universal product or service is ensuring adequate funding and continuity of that service provision.

Yes there's obviously the requirement for private participation in many areas particulary technical, research, development and pharmaceutical services and developments. However ultimately there has to be a provider of capital and underwriter of the costs incurred in providing these services.

Just as with the banks the only ultimate and totally omnipresent provider is the Government.

If that point alone was firmly established, how much resource would be freed up to solve the operational issues to the benefit of us all.

 

[Pienaar's gloves]

"Do we need a navy". Hello ! We are a feckin Island nation, nuff said.
On a separate point, George Osborne just made some compelling and powerful arguments on BBC to give your vote to the Conservative party and not spoil your ballot paper (the ballot paper for which hundreds of thousand gave their lives so that you could have it)

In 2015 our geographical position means little.
Which compelling and powerful arguments were these?

 

[Bruce Wayne]

But Bruce the first principle in offering any critical and universal product or service is ensuring adequate funding and continuity of that service provision.

Yes there's obviously the requirement for private participation in many areas particulary technical, research, development and pharmaceutical services and developments. However ultimately there has to be a provider of capital and underwriter of the costs incurred in providing these services.

Just as with the banks the only ultimate and totally omnipresent provider is the Government.

If that point alone was firmly established, how much resource would be freed up to solve the operational issues to the benefit of us all.

As far as I'm aware, there has never been any doubt about who pays for this, even with Circle running the hospital, it was still paid for via taxation and it was still free at the point of delivery.

I really don't think there is a future for healthcare in Britain being both paid for by the state and provided by the state. It simply isn't feasible in my opinion. Things are changing so quickly that I don't believe a single provider has a hope of keeping up, even with the best of intentions.

I've no problem with the NHS being funded by taxation, but it should be provided by whomever is best equipped to do so.

 

[The Esk]

As far as I'm aware, there has never been any doubt about who pays for this, even with Circle running the hospital, it was still paid for via taxation and it was still free at the point of delivery.

I really don't think there is a future for healthcare in Britain being both paid for by the state and provided by the state. It simply isn't feasible in my opinion. Things are changing so quickly that I don't believe a single provider has a hope of keeping up, even with the best of intentions.

I've no problem with the NHS being funded by taxation, but it should be provided by whomever is best equipped to do so.

But if private providers can withdraw, subject to contractual terms, at will, where does that leave the health service and most importantly the people who the health service serves if you make the NHS reliant upon transient private providers?

 

[Bruce Wayne]

But if private providers can withdraw, subject to contractual terms, at will, where does that leave the health service and most importantly the people who the health service serves if you make the NHS reliant upon transient private providers?

If I could gaze into my crystal ball, it wouldn't surprise me to see the very nature of healthcare changing. If you take Coarsian theory, the only reason for an organisation to form is due to high transaction costs of arranging yourself independently.

In a whole host of sectors, those transaction costs are melting away so I wonder how long healthcare will persevere how it is. For instance, you've got things like Genspace, whereby a fully functioning biotech lab is rented out to scientists (professional or amateur) just as you would a gym membership.

It wouldn't surprise me at all if hospitals don't go down a similar route but of course that's miles away at the moment, and the service continues to waste billions each year on an inefficient property portfolio. To be honest, I can't see it ever happening whilst the NHS exists in its current form. It'll bumble along from crisis to crisis as it does now as the whole political nature of the NHS gets in the way of change.

Take health data for instance. There are so many reasons why having that more sharable is a good thing, yet it's such a hot potato and the media love whipping up scare stories around it that it probably won't happen anywhere near as fast as it should, and when (if) it does happen it'll probably be a hotchpotch.

 

[The Esk]

If I could gaze into my crystal ball, it wouldn't surprise me to see the very nature of healthcare changing. If you take Coarsian theory, the only reason for an organisation to form is due to high transaction costs of arranging yourself independently.

It's nothing to do with the cost of providing the services, it is the existence of the services themselves.

As demonstrated by Circle, the only reason they provide services is to make a profit. In the absence of profit or the realistic chance of making a profit they cease to offer the service. That's what businesses do.

Contrast that with the obligation of the state run NHS to provide services and you will notice a complete non-alignment of interests.

At best you get cherry picking with profits moving from the public sector to the private sector, and the public sector having to pick up the remaining unprofitable areas.

At worst you get what nearly happened in the banking sector with a complete demolition of private capital and no organisation willing or able to provide services other than the State.

 

[peteblue]

Some institutions in life should belong to the state and never be in private hands, Police, Military, Fire Brigade etc. Health is one of those odd ones that can operate quite well in either. The problem with the hospital concerned is that they wanted it privately run as part of the NHS, which was never going to work. It can be private or it can be NHS, it can't be both, imo....................

 

[Bruce Wayne]

It's nothing to do with the cost of providing the services, it is the existence of the services themselves.

As demonstrated by Circle, the only reason they provide services is to make a profit. In the absence of profit or the realistic chance of making a profit they cease to offer the service. That's what businesses do.

Contrast that with the obligation of the state run NHS to provide services and you will notice a complete non-alignment of interests.

At best you get cherry picking with profits moving from the public sector to the private sector, and the public sector having to pick up the remaining unprofitable areas.

At worst you get what nearly happened in the banking sector with a complete demolition of private capital and no organisation willing or able to provide services other than the State.

There's no reason why it has to be for profit though. I've mentioned Buurtzorg a few times, and they're a Dutch based community health group that are private yet non-profit.

I guess all I'm advocating is that we don't rule anything out. I'm not sure being absolutist is a good approach here, as it's surely not accurate to say everything the NHS does is great (or indeed bad), just as all private organisations are great (or bad). I don't think patients should be denied the chance of better care (nor indeed the tax payer denied cheaper healthcare) just because an organisation isn't in the right box.

Probably the only thing that is guaranteed is that demand for healthcare is only going to go up if we carry on as we are due to the changing demography of the nation. I'm not sure it's at all wise to simply say "carry on as you are" and just chuck more and more money at it. I'm sure we can be smarter than that.

For instance, I spoke recently with the people at https://www.myhometouch.com/. Could they do a better (and cheaper) job than the current debacle in care homes? Quite possibly. Should they be excluded from having a go because they're not run by the government?

 

[hullefc]

The patients who can’t leave hospital – as no one will make a profit

Says it all really about the further expansion of the 'profit from health care' system in the UK. Seems like the new national health slogan is 'We can't make money out of you, so stay where you are'. Absolute disgrace that profit is put before what the patient needs.

 

[hullefc]

I wonder why NHS trusts and untimately the government don't listen to those in house people in the front line of the NHS crisis.

BBC News - Ambulance cuts will put 'lives at risk', union warns

Fall man waits four hours for ambulance (From The Bolton News)

How come the government are trying to spin the present NHS crisis as 'unprecedented demand'. What a load of rubbish. What 'unprecedented demand'. Has there been a major outbreak of an epidemic that is throwing 100 000's of people into hospitals? If so they have kept it quiet.

Cameron told the world in 2006 that the 'NHS is safe in my hands'.
NHS safe in my hands says Cameron - BBC News

NHS safe in my hands says Cameron

Mr Cameron was joined by wife Samantha after his speech

Mr Cameron's speech
David Cameron said the NHS is safe in his hands as he brought the annual Conservative conference to an end.
Mr Cameron accused Labour of mismanaging the health service and said he would be taking to the streets with a campaign to stop the cuts.

The Tory leader also hit out at those accusing him of peddling spin rather than substance.

He warned against rushing out policies and argued the Conservatives were "getting ready to serve again".

Health priority

Mr Cameron called the NHS was one of the 20th Century's greatest achievements.

"Tony Blair explained his priorities in three words: education, education, education," he told Tory activists in Bournemouth.

"I can do it in three letters: NHS."

What a con merchant.

 

[Tubey]

Problem is they cut care in the community drastically, meaning all-but healthy elderly people can't be moved on from hospitals as they were in the past, meaning the beds are clogged. Demand hasn't changed, the structure has, and you can blame that 100% on the Conservative ideology.

 

[Tubey]

There's no reason why it has to be for profit though. I've mentioned Buurtzorg a few times, and they're a Dutch based community health group that are private yet non-profit.

I guess all I'm advocating is that we don't rule anything out. I'm not sure being absolutist is a good approach here, as it's surely not accurate to say everything the NHS does is great (or indeed bad), just as all private organisations are great (or bad). I don't think patients should be denied the chance of better care (nor indeed the tax payer denied cheaper healthcare) just because an organisation isn't in the right box.

Probably the only thing that is guaranteed is that demand for healthcare is only going to go up if we carry on as we are due to the changing demography of the nation. I'm not sure it's at all wise to simply say "carry on as you are" and just chuck more and more money at it. I'm sure we can be smarter than that.

For instance, I spoke recently with the people at https://www.myhometouch.com/. Could they do a better (and cheaper) job than the current debacle in care homes? Quite possibly. Should they be excluded from having a go because they're not run by the government?

Difference is Bruce that despite your idealism private companies will for the most part live for the profit. They aren't charities.

If you put health in the hands of those chasing profit, then standards will slip if profit will result from those standards being lower. Hospitals aren't five-star hotels that receive a proportional increase in profit based on standards, unless you charge for the care, which means the less well off get poor treatment, the better off get proper treatment.

If that's the choice with privatisation, I'd prefer keeping the NHS myself.