Just in case any UK MAP'ers haven't done this yet, you really need to find out about what the new NHS bill means and write to your local MP urging them to vote against the bill (particularly if they are a Lib Dem or Tory). In brief and in order of significane regardless of your particular political leanings the bill will: Definitely be expensive (an absolute minimum of £3 billion) Definitely reduce the number of services that are available on the NHS (probably affecting mental health, borderline cosmetic treatments and expensive long term treatments immediately and then progressing to even more fundamental services) Definitely place the decisions around the types of care service to make available in the hands of un-elected regional groups and create a real* post-code lottery for health care Probably reduce the quality of care in the services that remain as their will be a financial incentive to spend less on care to pocket more in profit on the part of the private providers Probably result in decreased wages for doctors and nurses Definitely open up the way to a US style private health care model at some point in the future (not necessarily a bad thing) The health bill sets out no concrete plan as to how it will achieve anything positive and people need to put a stop to it. It's a terrible idea being pushed through because of the vested interests of several MP's who own private health care companies or are funded by them: http://socialinvestigations.blogspot.com/2012/02/nhs-privatisation-compilation-of.html If you want to read more: http://www.allysonpollock.co.uk/adm...-08/BMJ_2012_Pollock_HealthSocialCareBill.pdf If you want to write to your MP to urge them to drop the health care bill: http://www.theyworkforyou.com/ If you want to sign the e-petition to drop the health care bill: http://epetitions.direct.gov.uk/petitions/22670 * I can go into length on why if anyone isn't aware of why we don't really have one at the moment.
If an American style privet health care system is not a bad thing then why protest against this bill at all since that is where it will lead England? And on that point. An American style system would be a disaster for health care in this country. The vast majority of the vulnerable would go without health care or depend on charity organisations. As already happens in the USA. It's bad enough that we already depend on charities for the majority of palliative care in the UK. So if this current bill is bad because it "reduces" services and introduces a real postcode lottery. An American style system will be even worse. If you personally can't afford a $20,000 operation in the USA. Then it generally just doesn't happen. Today in the UK people are complaining they can't get on the housing ladder because they can't afford the 10% - 15% down payment. That normally amounts to anywhere between £10,000 and £30,000. Now something important to consider is that a switch to an American style system doesn't mean a tax cut. Depending on who you talk to NI contributions are supposed to be ring-fenced. However governments can and do use the money for other things that it was never supposed to be used for. George Osborne is also considering merging income tax and NI into a single tax. While this in theory makes the tax system simpler. It doesn't guarantee a tax cut. What it does do however is give the government a get-out clause. Since you're no longer explicitly paying for the NHS, why then should the government fund the NHS? Or even state pensions for that matter?
NHS I am never sure how to respond when I hear criticisms of opening the NHS to more private providers. I have always had a mix of NHS and private work in my practice. When I was contracted to the GP surgery I used to see patients in under 48 hours. When the NHS bureacracy stepped in the waiting times increased up to 4+ weeks as we waited for paper to be passed from the GP to the hospital to the PT department and then faxed to myself before we tried to locate the patient and make an appointment. People wait for the NHS clinic up to 6 weeks while I have never really had a waiting list at my office. This year the hospital has been so slow to pass on patients that I have not been able to even fill the quota I am paid to carry and I will likely need to return some of the cash I have been paid. Patients might also go to the hospital and be told they have to wait until someone can get back to them to give them an appointment. If they come to me to be seen quicker the hospital often will not give them an appointment because they do not want to share patients with a private provider. Our professional society says that there is no problem with a patient being seen in two places if there is cooperation between the people involved but the patients needs must not interfere with the way the bureaucracy wants things to run. I had on person come to me that had received surgery in one county find themselves being refused treatment in a second county because they had been to a different county hospital. The original hospital would not provide physio because the patient lived in a different county.... even within the NHS at present there is a hesitancy to place the patient's needs first. So when a comment is made about how private contractors will hurt the system perhaps one might consider that the system is presently not working to the best interest of patients. If more competition is allowed perhaps the system will improve for everybody... I come from an NHS where private medicine is not allowed at all yet private contractors routinely provide effective treatment for the NHS to complement what is present in the hospital system.. We definitely would never have gone the way of the American system (as non NHS medicine is illegal for the most part). Don't assume that private provision of services in the NHS will mean a poorer service... Just some thoughts. LFD
After a good rest (was tired last night after a long day) I should say that there is lots of room for things to be messed up by politicians in spite of the good intentions of persons in either the private or public sectors. There are advantages and disadvantages when you provide services irrespective of how the services are provided. I have met some pretty unscrupulous people in the private sector and I can understand Slinday's concerns. I don't know what the answer is but I do think we need to be more open and adaptable if we want to be able to provide a good level of care to the patient population. Some European countries use private healthcare companies to provide their NHS services (patient pays and is reimbursed by the government - France I believe) with great success. Others (e.g. Greece ) provide state provided services but kickbacks were often needed to access state provided services. I am sure that there are examples where the reverse of these 2 examples occur. WIKI - ''Implementation and comparisons Universal health care systems vary according to the extent of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, Italy and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights not on the purchase of insurance. Others have a much more pluralistic delivery system based on obligatory health with contributory insurance rates related to salaries or income, and usually funded by employers and beneficiaries jointly. Sometimes the health funds are derived from a mixture of insurance premiums, salary related mandatory contributions by employees and/or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries such as the Netherlands and Switzerland operate via privately owned but heavily regulated private insurers that are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance. Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others tax revenues are used either to fund insurance for the very poor or for those needing long term chronic care. The UK government's National Audit Office in 2003 published an international comparison of ten different health care systems in ten developed countries, nine universal systems against one non-universal system (the U.S.), and their relative costs and key health outcomes.[3] A wider international comparison of 16 countries, each with universal health care, was published by the World Health Organization in 2004[4] In some cases, government involvement also includes directly managing the health care system, but many countries use mixed public-private systems to deliver universal health care.'' Let's try to step back a moment and see whether there is anything workable in the things the government is proposing before reflexively nay saying everything on a philosophical basis. I really do believe that there is potential to find ways to improve the services available and reduce costs to the taxpayer. Rants over.. time to go get smashed up at today's rugby match (a definite reality not that I have now moved up to playing from 4's to 2's over the last 4 years) ... still I hope to once more avoid using the healthcare system at all :' P FWIW LFD
LFD - If bureaucracy is the problem, shouldn't we be working to fix the NHS, rather than finding ways to remove the NHS from the picture.
I am not advocating removing the NHS, only being sensible enough to allow people to supply services where they can do so effectively without necessarily having to be a government employee. When I worked in hospital I found that more time was being spent on non-patient activities and by the time I left I was in a position where I would have had to become an administrator to progress at all. I joined the profession to treat patients and I did not seek to become a manager. I have been providing (what I believe to be) quality care to the NHS in 2 countries for over 20 years outside the hospital system. I probably make less money than I would have working for the government but I am in control of my life and my income which in some ways is much more important to me. I can (and do ) provide free/extra care to people that I would not be allowed to if I was constrained by departmental guidelines, an administrator on my back and all the other trappings. As I mentioned before there is nothing wrong with private individuals working in conjunction with those working in the public sector if we all are after the goal of providing effective patient care. I have seen a local PCT rebrand itself at least 3 times in the past few years spending lots on advertising, new stationary, signs, etc (all money that should have gone towards patient care). A private person/company could not afford such waste. I don't think that this new system will remove the NHS, only the excess organisations that contribute little to patient care within the system. I do no advocate doing away with the NHS, full stop. holyheadjch, is there something I have said that gives you the impression that I want the NHS dismantled? Thanks LFD
The current bureaucracy problem in the NHS I'd argue is the result of successive Tory and Labour governments trying to introduce "competition" and "modernise" the NHS. When competition was introduced to the NHS, new management structures had to be introduced. There are now just as many or more non-medical staff in the NHS as there are doctors and nurses combined. Simplification of the management structure will deal with much of the bureaucracy. There must also be huge difference in the numbers of patients a privet doctor deals with compared to an NHS doctor? I mean just look at dental care. It's a news event when a new NHS dentist opens up shop in England. People queue round the block to get registered. Which I would argue means it's fair to assume those people were not receiving regular dental treatment and check ups. With all of that said however, surely there can't be anybody left who still believes the Tories are not trying to privatise the NHS. The problem with this bill isn't about out sourcing to privet contractors. It's a matter of trust. I don't trust the Tories when it comes to privatising the NHS. When I was about 16 the government introduced a scheme for people who wore glasses. The idea was you'd see a privet optician. You'd pay the privet optician upfront and then fill in a form and reclaim your money. Not once did I ever get my money back. My current pair of glasses cost me £300. And the lenses were paid for by the NHS. My lenses cost upwards of £90. I also pay for my dental check ups. They cost around £10 a pop. Fortunately I live in Scotland were to cost of actual treatment would mostly be covered by the NHS. I think health care in this country would become incredibly expensive if we moved to a privet system. A lot of people would simply do without. Especially in the current economic climate where there have been reports of mothers going without meals so they can provide for their children. When the choice becomes one of having or not having health care. The waiting times become irrelevant.
Question, this new bill will it lower our taxes in any way? What is our current contribution towards the NHS? Why not have a system where those who want a privatised health care the likes of Bupa opt out of paying towards the NHS, (or less) and those who want NHS treatments to pay that little extra?
It will have no positive effect on our tax bills. If anything it will cause them to rise in the long term when this scheme inevitably becomes more expensive than the old one.
That's a non-starter. Taxation in this country has never been done on the basis of 'paying for what you get', and the chances of it being totally overhauled in that way are zero. You pay your income and tax and NI based on your income, and that's that. Even if it were possible to change the tax system so that some people could opt out of paying towards the NHS, you wouldn't get enough revenue from those who couldn't afford to go private, so you'd have an enormous shortfall. Even if private medicine was forced to pay a fair whack for the services it currently gets on the cheap from the NHS, I don't think it would be enough to subsidise the system.
My point was that, even if politically you happen to agree with the American private model of healthcare insurance, this bill is still a terrible idea for the numerous other reasons.
The biggest problem with the bill is it doesn't fix any of the problems with the health service, indeed they'll likely make it worse. Private groups have been doing fixed cost procedures for NHS patients for some time, so that aspect isn't particularly new. Unless you live in London the idea of choice is relatively moot anyway. If you live in Swindon you aren't really going to be going to Reading for an operation. The changes only really effect planned procedures and consultant appointments, which were largely fixed by the last government. Most people don't wait for more than 4 months for a non urgent operation, and most people don't wait more than a month to see a specialist. The problems are with "unscheduled" care and mental health services, in large part because the purchasing model undervalues them, and except for emergency departments they're not subject to time related targets, so there's little incentive for trusts to invest in it. Most trusts do subsidise their unscheduled care with their planned work, and rely on their surgical capacity to see them through spikes in unscheduled activity. By siphoning that money away from acute hospital trusts without offering them realistic funding for unscheduled inpatients, the effect will be the closure of those surgical beds and even less money for inpatients.
Such a system has already been tried. Unfortunately however you still need emergency health care. Say for example when you're in a car accident. And when things go wrong in a privet hospital. Privet hospitals in the UK can pass off their patients to the NHS to sort out the mess. So one way or another you end up using the NHS.
