[Sloper]

Rather than calling the charities scum, perhaps it would be better to ask whether the T&C imposed on the NHS are necessary and proportionate?

If the T&C are necessary and proportionate then why does the tender & contract process allow these to be avoided; shurley not NHS / civil service incompetence?

[tomtom]

Ha ha the old 'no such thing as bad privatisation - just bad regulation' cobblers...

[Sloper]

Of course some privatisations are 'bad', the part privatisation of prisons is offensive in a variety of ways.

The question is, why does the NHS allow for a disparity of terms?

Now it could be that the private / non profit distributing providers meet the minimum terms of service and the NHS builds in ^burderns, pays its staff more and so on in which case there is no abuse, just the market in operation. 

For example, if say Boots can deliver the pharmacy @ £2.20 per item dispensed and remain within the regulatory framework and the NHS costs are £4.40 per item shouldn't we contract out?

I suppose we'd have to go back to Hansard and see what was discussed when Labour was enacting the legislation that has led to the current position.

[Offwidth]

Rather than calling the charities scum, perhaps it would be better to ask whether the T&C imposed on the NHS are necessary and proportionate?

If the T&C are necessary and proportionate then why does the tender & contract process allow these to be avoided; shurley not NHS / civil service incompetence?

If the particular charitable organisation is scum why call them anything else? People need to think about some of the organisations under the charity unbrella, rather then thinking of them all being uniformly warm and fluffy. It would be nice if the good charities did more to defend their common brand in all this.

Maybe they don't insist on common T&C not because of incompetence but because the revolution of the market wouldnt happen otherwise. Same with Free Schools and Academies who get more money and less regs and cherry pick areas, yet perform pretty much the same. The East Coast rail tender is another good recent example the state imposed management turned out cheaper and more reliable but couldn't stay in place.  All examples of ideology over best value for meeting clear needs. It would be nice for once for evidence to take precedence in policy but I'm not holding my breath.

[Sloper]

Sit down old boy, I entirely agree with you as to the criticism of the East Coast cock up and have strong reservations about free schools and academies.

[webbo]

Of course some privatisations are 'bad', the part privatisation of prisons is offensive in a variety of ways.

The question is, why does the NHS allow for a disparity of terms?

Now it could be that the private / non profit distributing providers meet the minimum terms of service and the NHS builds in ^burderns, pays its staff more and so on in which case there is no abuse, just the market in operation. 

For example, if say Boots can deliver the pharmacy @ £2.20 per item dispensed and remain within the regulatory framework and the NHS costs are £4.40 per item shouldn't we contract out?

I suppose we'd have to go back to Hansard and see what was discussed when Labour was enacting the legislation that has led to the current position.

Pharmacy services are contracted out lloyds provide ours. You can't beat driving half way across the city to pick up some  urgent medication and waiting in line with folk waiting to pick up their methadone. Rather just being able to ring up and get it delivered.

[Sloper]

That sounds crap, but how was it under the NHS (genuine question I have no idea and no axe to grind) and was the NHS value for money?

[webbo]

Depends what you mean by value for money, it was more efficient for staff and patients but more expensive.

[Sloper]

I'm not doubting it was more convenient for staff & in many ways better for patients but let's say to maintain the service you need to have 4 staff, two cars / motorbikes plus admin and on costs, let's say they make 100 out of hour deliveries a month that's say £100 per delivery vs say 2 hours time and a few miles @ 40p per mile c. £30.

The difference over the year is I would expect, at least a nurses salary.

[webbo]

But then if you then cost in having to drive to a team base so you can get a doctor to write a script making sure it's on the right pad for that pharmacy. Then drive to the pharmacy,get the meds and finally deliver it the patient.
Or ring up/send a fax and get it delivered to patient.

[Sloper]

Your game not mine, but I can see having people sitting around to deliver scripts might be seen as OTT, out of interest how many times do/did you require this.

[webbo]

Not that often, usually happens when the consultant is on leave. Part of the problem is that in order to reduce costs, medication is paid for by the patients GP. So has a script has to be requested and medication ordered via the pharmacy.
In the bad old days the consultant would write a med card and medication would be taken from stock which was ordered on a weekly basis from in house pharmacy.
We are no longer allowed to keep stock meds. It's all the patients own now.

[slackline]

Medicalising common ailments is one of healthcare's greatest threats by Kailash Chand* writing in Health Services Journal.


* Ex-chair of NHS Trust and deputy chair of the BMA council

[johnx2]

link doesn't work, this one should...

http://www.hsj.co.uk/comment/medicalising-common-ailments-is-one-of-healthcares-greatest-threats/5074016.article#.VVHGplOW-8B

...anyway, perfectly good piece from last year, representative of an ongoing discussion in medicine. Reasons for posting now??

[slackline]

Thanks for correcting the link.

Its an important discussion to have since increasing medicalisation has the inevitable consequence of increasing the cost of the service overall and feeds into the discussion about "The end of the NHS".

Reasons for posting now??

I only came across it today, no one linked to it last year (that I can recall).

[Offwidth]

Another good Roy Lilley...

Some ways to stop digging the NHS cost hole by utilising staff exoertise rather than distrusting it.

http://myemail.constantcontact.com/It-s-a-deal.html?soid=1102665899193&aid=h66V8tkyxHs

[johnx2]

I only came across it today, no one linked to it last year (that I can recall).

guess, but these are issues which confront every healthcare system:

 

- the medicalisation/over-medicalisation of part normal human life debate (HRT for menopause say)

 

- the mental health side to that (social anxiety disorder - so prescribe drugs - or shy?)

 

- the linked issue of paying more for new drugs/treatments which are no better than cheaper existing ones (Bad Pharma looks at this).

 

- incentives - once you start paying someone to do something they'll tend to do more of it - see the role of US urological surgeons in prostate cancer screening.

 - public health/prevention as per the 'how did you vote' thread

And on and on. All big and important, and certainly not irellevant as the strength of the NHS is that it can take a consistent and rational approach to all the above more easily than a more fragmented system, in theory at least. But different to the organisational, funding and political issues.

 

[johnx2]

Sorry for the mangled phone post. Editing would make it worse. You get the gist

[webbo]

I hope this link works.
http://www.nuffieldtrust.org.uk/sites/files/nuffield/media pack final-04-16-update.pdf

As its about the increase in privatisation in the nhs.

[johnx2]

they call me the link corrector, amongst other things*... anyway crucial hyphen omitted. This works:

http://www.nuffieldtrust.org.uk/talks/slideshows/facts-figures-and-views-health-and-social-care-pack-prepared-reports-ge2015


direct link to pdf:

http://www.nuffieldtrust.org.uk/sites/files/nuffield/media_pack_final-04-16-update.pdf






*willy head, probably.

[webbo]

Thanks for that.
Anyhow it is stating contrary to what Sloper claimed there is an increase in NHS work going to private sector.

[johnx2]

Reasons for posting now??

I only came across it today, no one linked to it last year (that I can recall).

...and now suddenly topical: "doctors warned of over-treating patients" -  http://www.bbc.co.uk/news/health-32717100

[slackline]

Reasons for posting now??

I only came across it today, no one linked to it last year (that I can recall).

...and now suddenly topical: "doctors warned of over-treating patients" -  http://www.bbc.co.uk/news/health-32717100

Not just doctors though, its also patients expectations of there being a "pill" for everything.

[Offwidth]

Thanks for that.
Anyhow it is stating contrary to what Sloper claimed there is an increase in NHS work going to private sector.

To be fair to Tom (I know!) he pointed out the previous  Labour Party increased private provision more than the Con Dems even if  as ever he was necessarily relying on slightly old KF data from a subset of the areas affected  (we pointed this out and he scoffed). His main thesis that the Conservatives do not intend to privatise the NHS any time soon remains true for the new government  (but not all tories)....as it would be electoral suicide to do anything else (a small majority including quite a few MPs with a conscience).

[Offwidth]

Roy Lilley on the crisis in nursing:

http://myemail.constantcontact.com/Crash.html?soid=1102665899193&aid=tnIjhOme88Y