[Sloper]

Why would the NHS having driven all GP's to be centrally contracted on say a scale of £80-100k (insert more realistic numbers I'm just guessing) and owning the estate, having centralised HR & IT systems then pay more for a profit making (if not distributing provider) provider?

Slightly different, but look at Circle.  Private provider takes on running the trust.  Once demand increases and income falls a bit, it's not a viable business.  The rest of the system is running under the same increase load and reduced income.

"Its franchise to operate the trust was not sustainable" - I think that's quite a damning statement for the whole system as is.

Exactly and that's why the system is just not suitable (as I said many posts ago) for privatisation and why there are no plans for privatisation & etc

That the Blair & Brown PFI project has been such a disaster is surely reason enough not to trust Labour with the NHS.

[lagerstarfish]

is the plan to make the NHS function at such a low level that more people will begin to take out private health insurance?

[Sloper]

is the plan to make the NHS function at such a low level that more people will begin to take out private health insurance?

BUPA & etc have been around since er when exactly, let me fire up google.

[lagerstarfish]

yes, they already existed, but I'm sure they would be happy to increase their customer base if they were to become become the only percieved safe option for people who are scared of their families suffering ill health and related death stuff

[petejh]

With zero stats to back up my claim I'm certain that private healthcare is becoming increasingly common in the uk. I've gone through 10 years of on-off treatment for lower back problems and virtually all of it has been self-funded - MRI's, various consultants, physio, chiro, and eventually an operation. All private. I had one injection on the NHS - and even for that I jumped the queue by seeing the consultant privately, who then offered me the injection on NHS (against the rules). I felt at the time that this was morally questionable. My back hurt so I did it anyway.
My clear impression of the health care system in the UK - at least for muscular-skeletal treatment - is that there exists a large well-established 'grey market' of consultants and scanning technologies, and that there are loads of people 'topping-up' and accelerating their treatment by having scans, consultations and other such treatments privately - which then gets you further along in the system - while trying to keep the really expensive stuff -operations - on the nhs.
Waiting to have all treatment on the nhs is akin to sitting in the left-hand lane, as a two-lane road 'merges-in' approaching roadworks, and watching every sharp elbowed twat move past you on the right-hand lane - thus making your journey slower. The advertising backs this up. Various companies now overtly offering 'jump the nhs queues'. Another symptom of the have/have-not society (below the super rich) in this country

[Sloper]

yes, they already existed, but I'm sure they would be happy to increase their customer base if they were to become become the only percieved safe option for people who are scared of their families suffering ill health and related death stuff

Actually I'm not sure that they would want to increase their number of members (across the board) as their own capacity is probably less flexible than the potential increase.

Peter, you're absolutely right abou the grey market, when I needed my knee surgery (waiting time 2 years in 2004/5) I paid for a private consultation c£250 and the magically foundmyself on the NHS waiting list in 3 months 

[tomtom]

Yup - I've not even bothered my GP regarding my back problems... all ££ from my own pocket. Still I can afford it at the moment, so...

[petejh]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

[GCW]

Part of the issue is the unfair two tier system of NHS and Private medicine where going down the PP route queue jumps NHS care, and any f**k ups done in private care get dumped on the NHS to sort out.

[webbo]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

[petejh]

That's why I didn't type 'nurses'.

[webbo]

That's why I didn't type 'nurses'.

As you state Doctors, consultants and other healthcare professionals who else do you mean other than Nurses. Occupational Therapists?

[tomtom]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses?

[petejh]

That's why I didn't type 'nurses'.

As you state Doctors, consultants and other healthcare professionals who else do you mean other than Nurses. Occupational Therapists?

You're the medical guy - suggest someone with a similar power to mould their environment as 'Doctor' and 'Consultant'. If there is no-one then take my 'other' to mean 'no-one'.  You might have figured that was my intent though.

[petejh]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses?

As well as for Judges, Police and Nazi Party members..

[webbo]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses?

You promised to keep that quiet.

[lagerstarfish]

Actually I'm not sure that they would want to increase their number of members (across the board) as their own capacity is probably less flexible than the potential increase.

easily solved by buying up unused industrial units and vacant city centre shops and offering enough money (and free health care) to existing NHS staff to move across to working only with people who are stable enough to earn money

[tomtom]

...
Which raises this point in my mind:
Doctors, Consultants and other health professionals are partly responsible for creating the system. The system undermines the fairness and equality of healthcare treatment in the UK. The government surely encourages this, but I find it hard to listen to healthcare professionals without having the constant niggling feeling that many of them have their noses in the trough either willfully or without fully acknowledging it. It's a commonly recurring theme of institutions/life in this country...

I'm not saying they shouldn't do this. Just that their actions don't align with 'the message'.

I think you will find that there are somewhat limited opportunities for nurses to have their noses in the trough.

For MrsTT's hen do, a fireman (well I assume he was a fireman - he was thus attired) came around and carried out some 'exotic' dancing for the gathering... I'm sure similar opportunities might exist for Nurses?

You promised to keep that quiet.

I've still got your number....

[webbo]

You think you have but as I have recently flitted back across the Rio Humber, you may struggle to track me down

[slackline]

[Offwidth]

Steve, did you read the Kings Fund debunking the myth of privatisation & etc? They're hardly Monday Club nutters are they?

There is no credible basis for saying that a Conservative government will lead to significant damage to the NHS let alone its wholesale destruction, privatisation or the like.

As for the implication in your post, viz. that Gordon Brown had nothing to do with the crash, that's simply a moronic lie.  Gordon brown instituted the failed regulatory regime overnight and ran a deficit in the boom years.  As such not only was he partially responsible for the bust he was wholly responsible for having nothing to hand to deal with the bust when it occured.

Sorry been away. The posts I linked were from Roy Lilley who is an ex trust CEO and one time advisor to Maggie: hardly a trot, to follow your theme. Lets have less of the moron stuff please. I thought you were the one who flitted in and out of cartoon character online, is this calm uncle with an occasional potty voice approach the new more acceptable persona?

Oh and on Gordon and Blair, you know me so you know I'm no fan (certainly not of the PFI blight which like student fees is another stunt to raise money they dont have without it going on the defecit), but to be fair to them Will Keenan in the Observer on Sunday reminded us that the tory boys reluctantly backed labour spending plans in the run up to the crash so all this blame either goes both ways or is especially dishonest hot air. I favour a mixture with more of the latter as there must be a chance that Keynes had something with his stimulus ideas in recession and even if he didnt Osbourne is just doing the stimulus bit more inefficiently through QE.

The present government IMHO has done more damage to the NHS than any other with its failed reorganisation burning money, destroying functioning (if inefficient) management structures and wasting so much time and energy of health workers and failing to almost entirely to work properly with their representatives. With the links of Osbourne and co  to those with pretty hard core small state beliefs its hard to beleive they are just being stupid... the small state bunch almost need the NHS on its knees whilst professing their undying love and regret that more reform is now the only way. Being public about despising the NHS is electoral suicide. Labour (and or others) would certainly fuck some things up but not on this scale and only out of well intentioned error, as they believe in the NHS and don't despise the status and organisations of most of it's employees. Hence vote anything but Tory (or further right) for the moment remains my view.

[Offwidth]

The latest from Roy:


Diogenes   News and Comment from Roy Lilley

Ok, I accept, it might be me. On the cusp of losing my first flush of youthful optimism.  I might be entering a pessimistic, sceptical phase.
 
I could be heading towards misanthropic? Noooo! I could accept sardonic; only because there is no point in denying it. If you are feeling generous, I would prefer wry. But, I am a realist. The bright polish of my boyish hopefulness has journeyed through the sanguine and been corroded by experiences that have pushed me into being a touch, a tiny bit, a soupçon, well... cynical.
 
There; I've said it. In a circle of complete strangers I have joined the group, stood up and said; 'My name is Roy Lilley and I am a cynic'. A small ripple of applause might warm the cockles of my hard heart.
 
I'm working my way towards contemptuous, derisive and scoffing. Why? Because I have had my fingers burned. I made the catastrophic error of trusting David Cameron.
 
I'm old enough to be his father and feel licensed to give him a bit of a Dutch-Uncle; David, either you are a fool or a liar and I can't figure out which. Either way, you need to sort this out before the election.
 
David is privileged and all the rest but you can't choose where you are born or who your parents are. As a young family man he suffered the agonies of a profoundly disabled child who was not to reach manhood. An experience that would leave a fingerprint on a soul made of Teflon.
 
When he said there would be no more top-down reorganisation of the NHS I believed him. I thought his personal experiences would have cemented his commitment to the men and women who create and run the health services. When Andrew Lansley's madness was unveiled as the Health and Social Care Bill, I never thought for one moment Cameron would see it through. I really did believe the 'pause' was designed to find a graceful way out of an ugly cul-de-sac.
 
I followed Lansley around the pre-election conference circuit and heard him, time after time, talk of reducing bureaucracy, putting Doc's in the driving seat and introducing a management cost cap. He never mentioned the wholesale destruction of all the instruments of management and replacing them with a cat's cradle of unworkable bureaucracy and beadledom.
 
The key question is this; just who knew what and when? Did Lansley tell bare faced lies? Did he know exactly what he wanted to do? Did he share his dark secret with Cameron or did he lie to him, as well.
 
The Prime Minister is in a difficult position. Either he too is a liar and knew exactly what Lansley's plans involved or he is a fool, naïve and his judgement in doubt. Was he duped by the man who was once his boss?
 
There is a third explanation. During the frenzied negotiations, the weekend after the election, Tory Oliver Letwin, privatiser and market maniac and LibDem David Laws, who has written of his preference for a social insurance model for the NHS, were in charge of creating a coalition health policy.  The result took everyone by surprise. Lansley included.
 
I think herein the truth is to be found. With trade-offs, deals and the Bond Markets breathing down his neck, Cameron was powerless to stop it.  He needed a cabinet, agreement and a government by Monday morning.
 
So, here we are again. An election in the offing. Cameron says there will be more money for health. Of course there will, everyone knows that. It is not a policy it is a necessity.
 
'Health' does not feature in Cameron's 2015 list of key election themes; the deficit, jobs, tax, home ownership, education and retirement.
 
How are we to interpret this silence.  Is it sinister?  Should we be worried?  The NHS is facing unprecedented pressures and the PM doesn't have the NHS on his list?  Is the answer:
 
I'm letting Simon Stevens crack on with the 5YFV, we'll fund what the economy allows and try to distance politicians from the NHS as much as possible.
 
Or, we have no policy; steady as she goes and fingers crossed.
 
Or, I've learned my lesson from last time and sacked Lansley.
 
Or, I got away with it last time and you won't believe what I have up my sleeve this time.
 
Prime Minister you have to persuade me and 1.4 million NHS workers, we have no cause to turn into a latter day Diogenes. 
------------------------
  Contact Roy - please use this e-address
roy.lilley@nhsmanagers.net

[Sloper]

Steve,

Can you just post a link?

As for your comments about the economy.  Quantitative easing ended in 2010, the current government has not applied QE, but hey what are facts between mates

http://www.bankofengland.co.uk/publications/Documents/quarterlybulletin/qb110301.pdf

My point was have you read the Kings Fund debunking the myth about privatisation?

What I am saying is that this bollox that the tories are planning to 'end the NHS' & etc is just risible and you should know better.

I'm not saying that the NHS isn't facing a period of profound change or that it is, has been and always will be substantially dysfunctional.

As for the current government 'burning money' @ etc, while the merit of their proposals or otherwise (and whether it is a top down re-organisation) can only be something to be assessed in perhaps 10-15 years time: however to compare this government with the waste of the last and describe it as 'having done more damage than any other' is risible to the point of dishonesty, again, shall we brings some evidence to the discussion? 

Here's a precis of the Labour reforms to the NHS

1999 NHS reorganisation: GP fundholding is abolished; new primary care groups (PCGs) are established
2000 NHS Executive abolished
2002 District Health Authorities are abolished and we get Primary Care trusts and Strategic Health Authorities
2002 Regional Health Authoriy Powers are transfered to Strategic health Authorities.
2003 Community Health Councils abolished; NHS Modernisation Agency;Regional Directorates of Health and Social Care abolished
2004 Foundation Trusts
2004 The Healthcare Commission takes over from the Commission for Healthcare Improvement
2005 Modernisation Agency replaced by NHS Institute for Improvement and Innovation
2006 Strategic health authorities reduced from 28 to 10, Primary Care Trusts from 303 to 152
2008 Abolition of Community Health Councils
2009 The Health Care Commission abolished and replaced by the Care Quality Commission (CQC)

Let's now focus on the burning of money, NHS IT system and projects were a byword for overspend and failure with the well known one costing £10bn before it was scrapped,

PFI, hmm well covered elsewhere we can move on,

Private Sector treatment sectors hmm a monstrous inefficiency and overspend (and badly managed at that)

Management inefficiency, at the highpoint they were employing > 3000 consultants (note not doctors but management consultants) at day rates up to £1000 and so on etc. 

Let's not forget Stafford and the other scandals.

I don't think that it would be possible to replicate their level of fuckwittery if one tried.

So I don't think we've seen anything like the degree of fuck ups (although to be fair Labour did have longer and who knows what could happen in the future) but as for intenion, you have noticed the number of former Labour Ministers (and yes Tories) who are now on the Boards of private health providers.

So in short, other than a cut and paste and a heap of factual errors beyond some froth we haven't actually got much of substance from you have we?

[Offwidth]

Wish I could link Roy Lilley's stuff but its a posted blog so unless someone can come up with an alternative its cut and paste (which loses many of the evidence links). I dont agree with everything he says but he does cut through much of the crap and I do agree with the seriousness of the situation the NHS is in and he's one of the few from the management end pushing the vital importance of the proper treatment of front line staff in any solution and real ideas on such solutions.

The Kings Fund posts are problematic for all sorts of reasons which I'll come back to this if I have time. My main gripe is their key conclusion that the tories will not 'privatise the NHS' is stupidly simplistic (but I guess its easy to slip into this when responding to some of the hyperbole out there) but overall is correct in as much as it can be (the situation is, very complex but privatisation is growing and some areas the conservative part of the government tried on would have been very damaging and  hard to reverse). However that was not my point. If something is spinning out of control what does it matter who might run it in a decade. This government is responsible for what happens now and next. They took a limping system and hobbled it and now seem stuck like rabbits in approaching headlights.

Despite that list of Labour faults (most of which I'd agree with) there was no large scale crisis, just the odd local crisis and way too much waste (mitigated by generous funding). Its possible to list equally mad and bad stuff other governemts have done and lots of good stuff too, but whats the point? Governments fuck up stuff in the NHS but so far they bumble through to avert major system crisis.

[slackline]

Wish I could link Roy Lilley's stuff but its a posted blog so unless someone can come up with an alternative its cut and paste (which loses many of the evidence links).

What is a 'posted blog'?  Blogs (a portmanteau of 'web log') are hosted on web-pages, all of which have URLs which can be copy and pasted, this would then make all links contained within available to others.

Perhaps you mean its text from an email you have received, which isn't a blog (because by definition blogs are posted on the web), but a distribution list?  If so these often have a link to "Read in browser" which might be useful?

I dont agree with everything he says but he does cut through much of the crap and I do agree with the seriousness of the situation the NHS is in and he's one of the few from the management end pushing the vital importance of the proper treatment of front line staff in any solution and real ideas on such solutions.


The Kings Fund posts are problematic for all sorts of reasons which I'll come back to this if I have time.

Kings Fund Whos Who : Roy Lilley