[mrjonathanr]

Well, do you?

Disturbing stuff from someone at the heart of it.

[fatdoc]

Yep, that's an accurate and fair summery of the situation.

[old cheese]

I am hating this constant attack and erosion of all the good stuff we have in the nation. I wish the government would realise what is important to voter but I fear the sad fact is that they are unafraid as there is a real apathy to voting especially amount young people who care about this stuff, so they are unlikely to lose their posts.

[GCW]

 

Read "NHS SOS". The privatisation plan has been in place prior to the 2004 contract. It's planned and inevitable.

[mrjonathanr]

GCW:  I'll look at that , thanks


For those interested the Act passed Royal Assent and became The Act on March 27th

Lords' votes are searchable here: http://www.parliament.uk/business/publications/hansard/lords/by-date/#session=60568&year=2012&month=2&day=6
click on March 6th 21012 for final vote day's business. The record of votes is: division> content/not content

Interestingly many voted despite being in a position to profit from the bill:


Commons record on final vote is here: http://www.goingtowork.org.uk/how-mps-voted-on-the-health-and-social-care-bill
The left column (ayes) vote for the passage of the bill. Those against (noes) on the right.

[slackline]

I'm sure some of this ground is also covered in this thread and this one

Its fucking retarded.  Many people, and mostly those who will be worst off after the privatisation in regards to access to health care, won't realise what they had until its gone and are perhaps the least likely to do anything.    

[mrjonathanr]

Politics eh?  I think most of this goes over most people's heads like you say.

As they say in education, if you think education's expensive, try the cost of ignorance. And as the same process accelerates in that domain, we will.

(IMO Labour have bought into the same philosophical framework and so are scarcely better, just a little less rapacious.)

ps and as you say Slackers, those who will feel this the most acutely are either disenchanted, disenfranchised or not supporters of this administration anyway.

[Fultonius]

I wonder how many people have just "disconnected" from politics until the next election because they feel powerless to affect any influence anyway. Meanwhile the tories are selling off the final few bits of public service that we desperately need to keep.

[Sloper]

Well, do you?

Disturbing stuff from someone at the heart of it.

The usual alarmist bollocks from the usual suspects.

The NHS has had critical failings since inception, I think the first major scandal with the response 'lessons will be learned, never again' was in the early 1950s.

The NHS is a marvelous institution but to say that it a. isn't in need of serious reform and modernisation is deluded.

I have no brief to defend the bunch of vacuous fuckwits in office, but the sheer hysterical lefty twattery about the NHS precludes any meaningful critique of the government plans.

[Fultonius]

How would you fix it then?

[Sloper]

step 1. Be honest, the NHS cannot deliver all things, to all people, all of the time, at once and all free at the point of service.
step 2. Start charging for non emergency attendances at A&E, say £80? The amount of money raised will be trivial but it will stop the mindless retards turning up with what are clearly non emergency symptoms.
step 3. Market forces work.  Recently I needed to see my g.p. (nothing major but I have a history of sinusitus and knew it was progressing) I couldn't book an appointment for 2 weeks or either be seen as an emergency (which it wasn't) a bit of competition handled well will improve the service to the patient.
Step 4. Stop funding placebo treatments, stopping smoking, non reconstructive cosmetic surgery, treatments for the self induced obese (i.e 99.9% of the fat cvnts) and so on, again, the savings will be minimal but the change in culture it will drive will be enormous.

[fatdoc]

You are very close to the mark to the feeling of the senior acute care consultant body there mate... Leaving any political tendancies behind...

Some others to add...

Do we all want 90 yrs plus equal access to ITU?, or 80? Or 75? Or not ever go to work for society again???

If your varicose veins hurt... Do get them done?

U have a hernia.. So what... Should we wait till its gets stuck??

U have a gall bladder stone.... Some flare up for ever... Some do OK if u stop eating fat...

And many many others....

Bottom line... Put 2p on income tax for health... Or go back to expectations of the origional and amazing initial concept of the NHS.

If we don't, we go down the half hearted measures of UK healthcare as described above....


franky... Referendum is the only way I can see a balancing of the expectations of society. The NHS will thus serve...

[fatkid2000]

Problem being if the medical profession is honest about the state of the NHS the government media machine will be mobilised.
If you want better GP access - more GPs will be needed - every practice I know needs another GP to get somewhere close to what is needed but everybody is staying in hospital medicine.
Although I agree with fatdoc - here's an interesting stat - primary care does 90% of NHS activity with about 15% of the budget . And the stuff like gallstones , hernias etc aren't blindly referred - well not by me.

[fatdoc]

Fair play... But I think 90% of the elective general surgery has a well dodgy reason for having an operation... If a GP refers a patient to a surgeon... They inevitably get an operation.. It's natural human reaction to 20 years of training. I don't have an answer though.....

[Sloper]

An interesting piece of evidence is the number of successful claims for clinical negligence; I can't recall the exact numbers or range but from partner instructed by MDU / MDS which accounts for pretty much 90% of his practice (i.e. he should know) and has been for 30 years (so he's got a fair data set) is that the incidence of clinical negligence in the NHS has been on the increase since the late 1980's / 90'.

That is against a better understanding in medical practice about recording evidence that allows claims to be defended.

The general view is that more errors are now being made and while people are less inhibited about making claims the data suggests with very few taking a contrary position that more clinicians are more negligent more often than was the case before.

The causes of the negligence are another matter, but if you've a 30 year trend it would be frankly silly to blame it on any government's period of office of <4 years.

[fatdoc]

Muiltfactorial of course... But interesting non the less... And echoes the concerns of the MPS... ( and my subs)

[Sloper]

Muiltfactorial of course... But interesting non the less... And echoes the concerns of the MPS... ( and my subs)

The MPS & NHSLA can be their own worst enemy, we have a claimant clin neg team and the partner is often frankly amazed at the cases they'll defend for three years before settling having done nothing other than prevent the injured patient getting on with their life and allowing us to slap down a bill of costs at £100k

I was looking at a case with counsel the other day and we think that overall the claim will be worth say £10k or perhaps £50k if we roll a double 13, I can't see there being an early admission and can imagine our costs being x10 the damages if not a higher multiple.

This is in our view about a culture that remains highly dysfunctional (God only thinks he's a surgeon is perhaps the easiest short hand) and something that shows no signs of changing soon.

Hence when you have the hysterical response to fairly incremental changes from clinicians against this back drop some of us think there's a bit of a credibility chasm.

[Stubbs]

step 3. Market forces work. 

 

[tomtom]

step 3. Market forces work. 

 

Indeed - I dont see anyone competing to give me a doctors appointment in the near future!

RE charging a flat rate A&E price - interesting metaphor can be found in the Freakanomics book - where a nursery with a pickup/drop off parking problem starts to charge customers a small fee to wait in their cars for their kids (to discourage the act). But all this means is that people who pay then feel they are entitled to wait... if you get people to pay - they'll then expect to see a doctor in X time, or get the result they want etc..

[GCW]

The MPS & NHSLA can be their own worst enemy, we have a claimant clin neg team and the partner is often frankly amazed at the cases they'll defend for three years before settling having done nothing other than prevent the injured patient getting on with their life and allowing us to slap down a bill of costs at £100k

This works both ways.  If the settlement is cheaper than the cost of court, they sometimes agree to settle even when there isn't really a case.

[Sloper]

step 3. Market forces work. 

 

Are you suggesting that market forces don't work?  really?

If GP practice A provides facilities to make an apppintment say in a ady or so and GP practice B says 2 weeks or emergeny (trans take a morning off work and wait) which practice will attract the patients, the doctors and the funding?

Or would you rather the omnipotent state to you where & when you could have a consultation / treatment regardless of the inconvenience to you?

It seems that all the major parties recognise than an element of 'market forces' however you describe is is a necessayr element in reforing and improving the NHS.

[Sloper]

step 3. Market forces work. 

 

Indeed - I dont see anyone competing to give me a doctors appointment in the near future!

RE charging a flat rate A&E price - interesting metaphor can be found in the Freakanomics book - where a nursery with a pickup/drop off parking problem starts to charge customers a small fee to wait in their cars for their kids (to discourage the act). But all this means is that people who pay then feel they are entitled to wait... if you get people to pay - they'll then expect to see a doctor in X time, or get the result they want etc..

Yes, you'll also regard that the experiment at the child care provider in isreal found that there was a point at which the cost acted as an incentive to be late, i.e. I'm paying so they can wait and a point at which it acted as a material detterent, my guess is that £80 is sufficient to act as a deterrent without actually increasing demand. Of course this is just speculation but I would be amazed if anyone who worked in A&E didn't think that taking steps to prevent unecessary attendances were long overdue.

[webbo]

My limited experience of working with A&E staff is they'd rather nobody attended.

[GCW]

If GP practice A provides facilities to make an apppintment say in a ady or so and GP practice B says 2 weeks or emergeny (trans take a morning off work and wait) which practice will attract the patients, the doctors and the funding?

This currently has various barriers meaning it can't happen that commonly.  When practice boundaries go, it will be a possibility.  But only for people with the infrastructure ie private health companies.

There's a recurrent theme throughout all of this.

[Sloper]

If GP practice A provides facilities to make an apppintment say in a ady or so and GP practice B says 2 weeks or emergeny (trans take a morning off work and wait) which practice will attract the patients, the doctors and the funding?

This currently has various barriers meaning it can't happen that commonly.  When practice boundaries go, it will be a possibility.  But only for people with the infrastructure ie private health companies.

There's a recurrent theme throughout all of this.

But GP's are private businesses aren't they, the only difference is that the majority of the time they invoice tax payer man.

What holds them back at the moment is the starting point for decision as to how to manage the system appears to be that the datum point is that it is the system that this important rather than the needs of the patients.

The NHS seems to be the only entity where litigation does not drive improvement in practice / radical reform.