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Are plans to change the NHS necessary?

10:47 UK time, Monday, 17 January 2011

The government has unveiled details about the biggest planned overhaul of the NHS in England since its inception in 1948. . Are the changes happening too fast?


The controversial Health and Social Care Bill includes proposals to give GPs control of most of the NHS budget by 2013.

Unions warn the plans could undermine the health service, while MPs say they have taken the NHS by "surprise".

But the government says modernising the NHS "is a necessity" and argues the changes will improve care and accountability.

Could savings be made on NHS bureaucracy? How will the changes affect patient care? Is there too much focus on cost savings rather than quality and are the changes happening too quickly? Will price competition for health care be damaging for the NHS?

This debate is now closed. Thank you for your comments.

Comments

Page 1 of 14

  • Comment number 1.

    The BMA disagree with a Tory PM.

    Now there's a surprise.

  • Comment number 2.

    The Tories aren't to be trusted with the NHS. Yes, savings absolutely need to made. Their are too many bureaucrats having too little impact, systems are outdated and highly inefficient. It's almost impossible for some people to see GPs. But the Tories will sell the NHS to private companies and we only have to look at the rail to system to know what happens with that sort of policy...

  • Comment number 3.

    Changes, reforms, or savings? This is how the debate has been presented.
    In reality it will be cuts. The c word again.

    And of course, big pay rises for the bureaucrats, who will supervise the savings made through cuts in the bureaucracy.

    But the Health Service is safe in Dave's hands we know, he said so.

  • Comment number 4.

    The changes are necessary if the objective is to privatise NHS.

    Majid

  • Comment number 5.

    Removing managers who put money before patient care is definitely required, and there do seem to be too many of them. This idea of line managers, and you can't go to talk to the relevant manager because you have to go through your line manager simply creates jobs which may otherwise not be necessary.

    How the rest of the changes will impact upon the rest of the NHS I don't because I don't work within the NHS.

  • Comment number 6.

    No, these reforms are neither necessary nor desirable. In essence, they amount to nothing more than a repeat of the Tory's previous experiment with GP fund holding which, as we all know, proved totally disastrous.
    So now we have New Super Fund Holding: a structure designed to disassemble the NHS structure as we know it and replace it with a raft of quangos composed of GP's who are totally unqualified to administer a £60 billion budget and "patients" - by which I suppose Cameron means the usual bunch of pen pushers and busy bodies with time on their hands.
    One again this dispicable coalition reveals its true colours. There was nothing about this in either the Tory manifesto or the ConDem agreement. On the contrary, Cameron specifically promised "No more top-down reorganisation of the NHS.". Still, he didn't sign a written pledge, did he?

  • Comment number 7.

    After working in NHS for 35 years, Yes, one of thne biggest downfalls of the system, is anyone is considered and allowed care, no matter even if not excatly ill. Also the ones who shout the loudest are often given preferential treatment, nothing to do with a clinical decission of life threatening.

    In simple terms a person wanting surgery for personal looks, will be seen and often placed in front of waiting lists, due to who they are, and nothing to do with severity or risk to life.

    The decission for care, needs to fall directly onto the senior clinician, and not on a bed management sytem, often managed by glorified clerks, with a sincere lack of clinical or medical skills.

  • Comment number 8.

    This health minister has only been in post since May, so the proposals will have been formulated as part of the 'New World Order' according to the Right wing of the Conservative Party. They are the start of transition to privatisation. The NHS is not perfect but I have found vast improvements over the last 10 years i.e. since there was some sound investment made. Change always costs money, so where have they found this money from? see Petrol, VAT, student fees.

    Too fast, too idealogical and what we are getting used to from Mr Heath - er I mean Mr Cameron.

  • Comment number 9.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 10.

    Yes if we wish to have a world class health service such as France, Germany and Spain. All recognised by OECD and other organisations as being the best. This would necessitate a hybrid system with both public and private funding through health care insurance. It would also be desirable to ring fence part of both central & local government tax revenue so that this money is spent exclusively on health care. And yes, the well off would pay proportionately more. This isn't a political but rather good management issue whereby through both public and private provision we seek the best possible use of scarce resources.

    It would also make sense to ensure that people who make themselves ill through heavy drinking, drug taking, an unhealthy lifestyle and similar either don't receive the whole spectrum of health care benefits or pay additional monies. It seems crazy and unfair to the rest of us taxpayers that we have to subsidise those who use a disproportionate part of health care provision through their own lifestyle decisions. We need to ensure linkage between action and responsibility.

  • Comment number 11.

    Privatisation by the back door by any means someone somewhere has already gotten the contract to run it all, its happening in every facet of life.
    My local council have stabbed the people in the back already, most people don't even know they have sold off the garden dept, street cleaning, refuse, recycling all to the same group, who i'd never even heard of a couple of years ago.

  • Comment number 12.

    If this means that GPs will work a FULL week and surgeries will be open on a Saturday then change is definitely needed. My local surgery has 3 'full' time GPs and 1 locum, several nurses and dispensing staff. Patients are rationed to approximately 1o minutes of time from the GPs, the locum however takes as much time as is needed and is generally still working well after the close of surgery times.

    The government has NO plan to sell off the NHS.

  • Comment number 13.

    Of course there needs to be reforms - especially in terms of the postcode lottery.

    Patient care (medical and cleaniness) should be the number one priority and anything else secondary.

  • Comment number 14.

    Sounds like the changes could be interesting. I wonder if all the doomsayers would accept they were wrong if it works out ok. We do spend a lot of money on our health service and if we can get more for what we pay then I dont see how that can be a bad thing. Better use of resources is the way to success for all businesses, why should such a goal not be strived for in the public sector. Ethicly it should be more important to the public sector to spend wisely.

  • Comment number 15.

    You do not dismantle the things that work while tinkering with the things that do not, which is the same as throwing the baby out with the bathwater. I am positive Cameron is not interested in reform to make the NHS better, he simply wants to make it cheaper. Fine, start by looking at the many outsourced projects costing a lot more than they did when initially investigated and start ensuring there is always a cheaper internal option. Kick bureaucratic control out and give the health care staff control over their own patch; history shows this is ALWAYS the cheaper option. Stop using agency nursing and medical provision.

    Allow good GP surgeries to prosper and grow and bad ones collapse, with adequate policing at Primary Care level. Respond to what people say about doctors and hospitals and show that to be the case when things go wrong. Do not sweep bad news uder the carpet; broadcast it, recompense if necessary and move on with measures which deal with the issues properly. Prioritise health care screening with no gender bias.

    No. The health service is not safe in Tory (oops) Coalition hands. They will destroy it.

  • Comment number 16.

    I work in private healthcare and we negotiate and have contracts with hospitals where if they go through us the charges are lower, including with NHS hospitals. If we can do that why cant the government !

  • Comment number 17.

    "However, Health Secretary Andrew Lansley has said the reforms set out a vision for an NHS led by patients and professionals, not by politicians and patients will be handed more choice over how and where they are treated."

    With slightly different phrasing didn't the last Labour government promise much the same thing? Once again we have an incoming government proposing significant and costly change for ideological rather than practical reasons. Once again it will not be politicians and upper level bureaucrats who suffer but staff and patients. After all politicians can do a Pilate and wash their hands whilst the bureaucrats using their "inside" knowledge move from the public to the private sector.

  • Comment number 18.

    Anyone who believes that there aren't serious organisational problems in the NHS should watch "Can Gerry Robinson Fix the NHS?"

    Every objection we hear to the proposed changes to the NHS are basically "we're scared of change, and because we're scared ,it could be bad for patients". It would be good if the unions, BMA, RCN, etc came up with objective evidence that the proposed changes would have a negative affect on patient health care, or better yet, proposed a sensible method for piloting the changes to assess what affect they will have.

    And I'm not a Tory voter saying this, just someone sick of having to listen to so much incoherent fear based rhetoric.

  • Comment number 19.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 20.

    Damned right the NHS needs 'fundamental changes'. It is totally unfit for purpose. Whenever I turn up for an appointment it never fails to amaze me what levels of stunning incompetence await me. Why is the NHS the third biggest employer on the planet? There are simply far too many people employed by the NHS, but when it comes down to anyone taking responsibility then there's no one in sight for miles. We need to look at how the best health services in Europe are funded and run and then proceed down that route. The sooner the NHS dinosaur becomes extinct then the better for all of us.

  • Comment number 21.

    I have lost count of how many times the NHS has been "reformed". The money would have been better spent on the service rather than reorganisation, we would have had a five star NHS by now. Don't get too misled by "better" figures from other countries, I was once told that we were better at collecting statistics than many other European countries and that could account for some of the differences.

  • Comment number 22.

    Good or bad? I don't know, I'm not a health care professional.

    I do distrust any politically-motivated micromanagement, though.

    As taxpayers we are paying for universal health care, free at the point of use, to be provided for all citizens. I'd trust health care professionals over politicians to deliver it: but deliver it the goverment is obliged to do - however they go about it, an obligation incurred (amidst others) by requiring that taxes be paid.

  • Comment number 23.

    Are the proposed changes necessary? I'm not sure. But I do know that change is necessary, in any business, to ensure competitiveness and to keep it vital.

    My main worry, and it has been for some time, is that Labour left a ticking time-bomb in the NHS that the Torys are going to use to their advantage. All of the wonderful PFI rebuilds had little hidden clauses to the effect that the rebuilds are owned by the private companies, with a guaranteed lease for a number of years. At the end of this period, though, the owner (private company) can rent the buildingd to private health-care institutions. I have to wonder whether Dave Cameron is simply continuing this scam to remove the N from our NHS.

  • Comment number 24.

    Yes, most definitely needed. Medicine changes daily. Treatments change daily. How they are processed and how patients are dealt with has hardly changed. If anything, it has got worse with the whole box-ticking exercise it has suddenly become. Reclassify a patient's status and we've met the 'seen within x weeks' criteria but the patient is no closer to actual treatment.

    Reform is needed. I trust the current government's approach rather than Labour's 'throw money at it and hope for the best' approach.

  • Comment number 25.

    2. At 11:06am on 17 Jan 2011, RedandYellowandGreennotBlue wrote:
    The Tories aren't to be trusted with the NHS. Yes, savings absolutely need to made. Their are too many bureaucrats having too little impact, systems are outdated and highly inefficient. It's almost impossible for some people to see GPs. But the Tories will sell the NHS to private companies and we only have to look at the rail to system to know what happens with that sort of policy...
    -------------------------------------------------------------------------
    And Labour's legacy - £65 billion of PFI contracts in the NHS for roughly £11 billion of infrastructure and services. And at the end of the contracts we don't even own the hospitals in most cases!

    I have a number of friends who work in the health service. One of them wanted a diary planner hung on the wall. Cost to hammer the nail into the wall - £25. Annual cost of maintaining the nail in the wall - £15.

    The problem is that most public sector workers do not have the first clue how to obtain a value for money contract with the private sector. And anyway, what's a few billion pounds here and there when it's not your money. Just a few more noughts.

  • Comment number 26.

    At long long last a kept promise from Cameron. His proclamation that he is "the heir to Blair" is indisputable now.

  • Comment number 27.

    Typical of the BBC that all but one of the questions heading this HYS are focussed on possible negatives of the coaliton proposals. Now tell us all again the BBC is not politically biased?

    Clearly with the national debt and household debt at an all time high the nation needs to stop spending. Will that affect front line services in the NHS? Of course it will but then if we had not overspent we would not now be cutting back.

    In short, there is little choice really but to lower the expectations of what the NHS can provide until they meet what we the taxpayers can sustainably finance.

  • Comment number 28.

    Reform is definitely necessary. The fact is that, if you are not a Labour ostrich, money is not limitless. Giving doctors who are closest to the patients more control over who gets what is a sensible move.

  • Comment number 29.

    Change - YES. Speed - undoubtedly too fast.

    Under New Labour my GP found himself able to build his own little empire. Instead of a nice friendly doctor willing and able to give his time totally to his patients he has now added an opticians, a chemist and additional surgery space. New Labour, in my view, made a big mistake when they upped doctor's pay so significantly. All my GP seems interested in doing now is meet his endless pay driven targets.

    Example - on every visit each patient regardless of their reason for seeking medical help is asked the same three questions. It is to rate their level of depression (or not). When I realised what was happening I began giving answers which indicated that I was low in spirit. So far not one member of staff has followed up on the information I have given them. Obviously it is just an exercise in futility.

  • Comment number 30.

    As far as I can tell, they aren't even changes. They are the implementation of trial pilots that are deemed to have worked.

    Whether they worked because they saved money or worked because they saved lives is another matter.

    This is the birth of the FHS - the Federal Health System, as John Humphries said this morning.

    Given that the NHS is in better shape now than it has been over the preceeding twelve years or so, this will either work brilliantly or fail horribly. As much as I dislike Cameron and the rest, he does have a point - sitting still will achieve nothing.

    So, I guess the problem isn't about whether or not the changes are necessary, it's about whether or not we trust that the right changes will be made. I'm not quite so sure about that.

  • Comment number 31.

    I would be much more interested if someone went round talking to the people who actually have to do the work to find out what they are supplied with which they really don't need, but what they do need but have trouble in obtaining.

    Time and again IT systems are brought in which cannot do the job because no one spoke to the people who would actually use them.

    Same with the NHS. No good just speaking to the people at the very top.

  • Comment number 32.

    here we go again,this is a return to thatcherism,you are in self denial if you cannot see the first steps to privatisation.this is the tory party at it's shamefull best this is the true face of the cameronites
    osbourne and the rest of the gang have dreamed about this day for the last thirteen years they are now living the dream,thanks a lot cleggy and co,a job well done.the only way to stop them is to protest and protest untill they can know longer peddle the lie of "we are all in this together"and except they are breaking election promises,remember
    "daves" claim the "the nhs is safe in our hands" listen nothing is safe in this mans hands,only the fact that is life and the people who share it will go on without change,unless, we the people bring an end to it.....

  • Comment number 33.

    2. At 11:06am on 17 Jan 2011, RedandYellowandGreennotBlue wrote:

    The Tories aren't to be trusted with the NHS. Yes, savings absolutely need to made. Their are too many bureaucrats having too little impact, systems are outdated and highly inefficient. It's almost impossible for some people to see GPs. But the Tories will sell the NHS to private companies and we only have to look at the rail to system to know what happens with that sort of policy...

    -----------------------
    Spot on!

    The NHS is in trouble becuase it is being abused left, right and centre. The Tories have complete contempt towards to NHS, they have been itching to get rid of it since the 80's. To introduce anyform of privatisation to the NHS is a total mistake. Private companies exist only to make money, not to deliver a service.

    The NHS is not a business, and it should not be run as one, get rid of the bureaucrats start running the NHS as it should be, a health service.

    How could no-one see this coming from the Tories when they voted, especially with their history of privatising everything that they lay their dirty hands on! People just need to learn to respect the NHS and not to see it as free service and thus open for abuse. It's the drunks, the obese (self inflicted!), and the down right selfish that have done this to the NHS. If you are in a serious accident, the NHS will send the ambulance, get you the surgery, the aftercare i.e. everything you need. To pay only NI to get this is cheap!!!!!

    Thanks a bunch to those that voted Tory, you just condemned everyone to losing NHS. But i'm sure you all think that private medical cover will save you. What ever you think the NHS costs, you will pay 10 fold for private treatment, and everytime you have an accident, your premium will go up and up and up, no different to car insurance (except without the no claims discount and getting cheaper as you get older)!

    12. At 11:17am on 17 Jan 2011, Lynn from Sussex wrote:

    "The government has NO plan to sell off the NHS"

    So how do you think that private medical firms have obtained space in an NHS then. The NHS were paid to allow them to operate, this is privatisation! That space is no longer available to NHS patients!

    What is you definition of selling off/privatisation?

  • Comment number 34.

    14. At 11:27am on 17 Jan 2011, in_the_uk wrote:
    Sounds like the changes could be interesting. I wonder if all the doomsayers would accept they were wrong if it works out ok. We do spend a lot of money on our health service and if we can get more for what we pay then I dont see how that can be a bad thing. Better use of resources is the way to success for all businesses, why should such a goal not be strived for in the public sector. Ethicly it should be more important to the public sector to spend wisely.
    ===================
    Ethically, it is more important for the NHS to put clinical health decisions before the profit motive.

    Privatisation will introduce conflicts of interest which threaten this principle.

    Of course, big efficiencies can be made - but the fundamentally there is no structural problem with the organisation of the NHS.

    This is just another philisophical move being adopted under the smokescreen of deficit reduction.

  • Comment number 35.

    easy way to change
    cut down on managers
    cut out company cars and perks for all staff
    increase front line staff
    stop wasting money there have been many instances reported over the years such as purchasing of art etc
    bBUILD A NHS FIT FOR PURPOSE AND THE 21st CENTURY

  • Comment number 36.

    When is this government going to relize that the more you put anything from housing to N.H.S,into the private sector you lose control of the cost.Putting the onus on GPs sounds in theory good till you relize that not all doctors and thier practices are up to it or are so above board.Given a soft doctor money could be over spent given a cavelier one and the patients will suffer. How much old school tie will we see in all this.We are allready seeing it in this governments actions. I'm being kind in thinking that most of the decisions are being done through niavity.BUT IS IT?

  • Comment number 37.

    When many hospitals have more maangers than nurses, where waste is the norm, doctors are better paid than the PM, patients are left in urine soaked clothes and beds for days on end (and they are!), you are more likely to die of dirt based infections in a hospital than a sewage works and your treatment is to be shuffled from one waiting list to another it is clear that some reform is required. When this disaster costs us more than any other part of our lives this is definately time for change.
    The reforms proposed - waste of time, as normal totally miss the point. This government is I am afraid just as incompetant and stupid as the last - Cameron is just as stupid as Brown. When they stop thinking that yelling insults across the floor at each other is 'debate' and start arguing properly researched points and discussing sensible courses of action then - and only then - may Britain get a government worthy of the name. Until then we have a bunch of expense fiddling pompous arses making a complete wreck of a once proud and great nation.
    My suggestion - get the politicians OUT of the NHS, Education, Defence, Social services... they should just write the cheque - nothing else. To listen to a defence minister who didn't know the difference between Trident and a Typhoon just highlighted whty these politicians should not be involved in these issues.

  • Comment number 38.

    Here is part of a letter published in The Times today Today:

    "the frontpage story in the Times (paywall) is based on a letter to the paper from six health unions, including the British Medical Association and the Royal College of Nursing, expressing "extreme concerns" over the NHS reforms. The unions are particularly concerned about the speed of the reforms and the introduction of price competition into the system. Here's an extract from the letter (paywall).


    There is clear evidence that price competition in healthcare is damaging. Research by economists at Imperial College shows that, following the introduction of competition in the NHS in the 1990s, under a system that allowed hospitals to negotiate prices, there was a fall in clinical quality. With scarce resources there is a serious danger that the focus will be on cost, not quality.

    Enforced competition will also make it harder for NHS staff to work collaboratively in multidisciplinary teams, across organisational boundaries, to create the integrated care pathways that patients want and need, and that will help to make services more efficient.

    Furthermore the sheer scale of the ambitious and costly reform programme, and the pace of change, while at the same time being expected to make £20 billion of savings, is extremely risky and potentially disastrous.
    ++++++++++++++++++++++++++++++++++++++++++++
    Did you get that Mr Cameron? "There is clear evidence that price competition in healthcare is damaging. Research by economists at Imperial College shows that, following the introduction of competition in the NHS in the 1990s, under a system that allowed hospitals to negotiate prices, there was a fall in clinical quality!



  • Comment number 39.

    14. At 11:27am on 17 Jan 2011, in_the_uk wrote:
    Sounds like the changes could be interesting. I wonder if all the doomsayers would accept they were wrong if it works out ok. We do spend a lot of money on our health service and if we can get more for what we pay then I dont see how that can be a bad thing. Better use of resources is the way to success for all businesses, why should such a goal not be strived for in the public sector. Ethicly it should be more important to the public sector to spend wisely
    *******************************************
    Perhaps it might be interesting, however act in haste repent at leisure applies to these moves.
    This New Government has already presided over Knee jerk actions with poor results, I would prefer they consulted more and made reasoned progress based on advice and long thought not a mad gallop.
    The problem as always when a service is viewed as a business, is any Private company's first goal is profit, firstly for the shareholder, then for the chairman etc. The NHS has to save money, not make it. It's primary duty should always be to the care of the patient and not his wallet.
    The NHS is safe with me said Dave, well I hope so but I doubt it.
    As for the usual Bland "There is No plan to privatise the NHS" statement, yeah, I have no plan to go to the pub and end up tipsy, but just because I didn't put it in writing and produce a manifesto doesn't mean that it won't happen.

  • Comment number 40.

    Given that GPs can't even order the right amount of flu vaccine, I'm quite nervous about letting them manage the entire NHS.

  • Comment number 41.

    Many times before he came to power Cameron was having long meetings with Helen Evans of Nurses for Reform and private health care companies. Does any one believe he did this because he had nothing else to do. The private health care companies are very generous donors to the Tory party. They expect pay back
    The right wing Tory press constantly have headline stories about some one disatisfied by something that went wrong with their treatment. The number of complaints is miniscule compared to the number treated but this is never put in balance. This repetition of stories is aimed at making us discontent and critical, it is slow subtle brainwashing softening us up for the dismantling of the NHS. Cameron is doing it slowly, he doesn't really think that most patients have any idea of what treatment they require. Giving so called choice is a step towards privatisation
    Cameron is in a hurry he knows the coalition is not a long bet.

  • Comment number 42.

    18. At 11:32am on 17 Jan 2011, DT_1975 wrote:

    Anyone who believes that there aren't serious organisational problems in the NHS should watch "Can Gerry Robinson Fix the NHS?"

    Every objection we hear to the proposed changes to the NHS are basically "we're scared of change, and because we're scared ,it could be bad for patients". It would be good if the unions, BMA, RCN, etc came up with objective evidence that the proposed changes would have a negative affect on patient health care, or better yet, proposed a sensible method for piloting the changes to assess what affect they will have.

    And I'm not a Tory voter saying this, just someone sick of having to listen to so much incoherent fear based rhetoric.
    +++++++++++++++++++++++++++++++++++++++++++++
    See post 38.

  • Comment number 43.

    I am a regular patient of the NHS and have a chronic illness. The service is great, the people are great and, in 10 years of regular treatment, I have only encountered the odd error which has always been minor. The service from GP's, hospitals and consultants has been great. Based on my own experience I cannot understand why all this change is necessary and having had a chat with my GP recently her view is simply that the existing system can be fixed and it is not necessary to re-invent it.
    Most of all, there is this recurring criticism of management, but the basic flaw in the NHS is that it is given instructions by politicians.
    Out of all the things that I want a politician to be involved in, treating my illness is not one of them.

  • Comment number 44.

    From my experience with cancer services, GPs are the last people to have in control. Over and over again I hear stories about people returning to GPs with well-known symptoms of cancer, and being sent away without further investigation. If the tests are going to cut into the GPs profits this is an even more likely scenario.

    Has the Prime Minister never heard of Gaius Petronius?

  • Comment number 45.

    These “reforms” are just a euphemism for cuts

  • Comment number 46.

    The NHS needs change, and this change needs to be revolutionary. Whether the proposed changes are correct remains to be seen - a 'brave' move in Yes Minister speak.

    Andrew Lansley has been drilling into the NHS for many years to identify those areas which need change, so the changes might be carried out in a hurry, but they have not been thought up in a hurry. I do not believe it will change from being free at the point of delivery, but the delivery mechanisms certainly need updating.

    I would like to see the changes go further and deeper.

    The NHS has become a treater of symptoms. GPs are mainly gatekeepers to steer the more serious to appropriate consultants. What is really missing from the whole system is diagnostics led treatment. There is always the temptation to provide treatment for the symptoms without drilling into what is actually causing those symptoms.

    As a technologist,if I have a problem, I have to drill down to the root cause. Applying 'elastoplasts' to the symptoms only ever provides short term relief, at some point I will have to find the problem.

    The NHS needs to operate in a similar manner. This is not just an opinion, I have personal experience of NHS failings in this area.

  • Comment number 47.

    The Government should get Sir Gerry Robinson on board. He did it with one hospital so why not get him involved? Don't know his politics but would be worth asking him to help.

  • Comment number 48.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 49.

    It needs fresh thought - it is old and cumbersome. The Country is in huge debt and it has to be addressed. The NHS has become sacrosanct - and Mr Cameron has helped this along as much as anyone.
    The hospital has been set on fire by arsonists and Labour is throwing stones at the fire fighters - it would have to be addressed if they were in Government.
    It needs cooperation of all the parties rather than being a political
    football.

  • Comment number 50.

    25. At 11:45am on 17 Jan 2011, Steve wrote:
    2. At 11:06am on 17 Jan 2011, RedandYellowandGreennotBlue wrote:
    The Tories aren't to be trusted with the NHS. Yes, savings absolutely need to made. Their are too many bureaucrats having too little impact, systems are outdated and highly inefficient. It's almost impossible for some people to see GPs. But the Tories will sell the NHS to private companies and we only have to look at the rail to system to know what happens with that sort of policy...
    -------------------------------------------------------------------------
    And Labour's legacy - £65 billion of PFI contracts in the NHS for roughly £11 billion of infrastructure and services. And at the end of the contracts we don't even own the hospitals in most cases!

    I have a number of friends who work in the health service. One of them wanted a diary planner hung on the wall. Cost to hammer the nail into the wall - £25. Annual cost of maintaining the nail in the wall - £15.

    The problem is that most public sector workers do not have the first clue how to obtain a value for money contract with the private sector. And anyway, what's a few billion pounds here and there when it's not your money. Just a few more noughts.
    ***************************************************
    The problem is that it's always our money and as with the Train Service, I'd much rather I didn't have to fill the shareholders pockets with cash before I consider the patient/traveller.
    As for Public sector workers not having a clue, I am pretty sure that the people at the top are not fresh from emptying bins, successive governments have attracted successful business men into the NHS with wads of cash, yet here we are !!
    Lets keep it as a service and not a money making device. Save cash where you can and spend wisely is all that is needed.

  • Comment number 51.

    As with all the other cuts and austerity measures of recent months, the proposed NHS *changes* ...aka cuts... are not needed. What is needed is a relentless and sweeping effort to close the gap between rich and poor in every part of society and to make it socially unacceptable for people to have far, far more money and resources than they need, whilst others go without food, heating, employment, medical treatment, etc. It's not rocket science .... it's just a more humane attitude is required. If the rich don't like it, let them go ..leaving their assets here, of course, when they do

  • Comment number 52.

    27. At 11:47am on 17 Jan 2011, Paul J Weighell wrote:
    Typical of the BBC that all but one of the questions heading this HYS are focussed on possible negatives of the coaliton proposals. Now tell us all again the BBC is not politically biased?

    Clearly with the national debt and household debt at an all time high the nation needs to stop spending. Will that affect front line services in the NHS? Of course it will but then if we had not overspent we would not now be cutting back.

    In short, there is little choice really but to lower the expectations of what the NHS can provide until they meet what we the taxpayers can sustainably finance.
    =================================
    Its the BMA (not the BBC) that is saying it is concerned over the proposals. Worthy of reporting/debate I feel.

    "there is little choice" you say - this is nonsense - this is a choice made by the ConDems alone - it has not been forced onto them. There are many other alternatives of what to cut and how to raise revenue.

  • Comment number 53.

    giving GPs greater control over the health service budget is a terrible idea. Sadly many of the new generation of GPs are more interested in the profitability of their own practices than patient care (see how many of them opted out of evening/weekend work). They are also often not efficient at running such businesses. This fragmentation of budgets will lead to less efficiency and greater possibility for corruption. It is not about patient care.

  • Comment number 54.

    I think that there is common argeement that the NHS is overly bureaucratic and needs to be slimmed down. It is presently populated by far too many people who may be good administrators but are far too removed from the sharp end of public health care. In the process it provides some comfortable and quite lucrative part time employment for semi-retired senior civil servants, local government officials and the like, as chairmen of the various trusts and public bodies.
    I would not dispute that most of this superstructure needs to be swept away, but I am concerned at the proposed pace of change and at the prospect of all this landing on GPs desks. GPs are specialists in medical care and are not noted for their administrative talents. They do however have a reputation for self-interest and an inability to co-operate with each other without squabbling. I am not sure that they should be entrusted with such power without adequate oversight of their activities.
    It would be reassuring to know that these proposals were based upon some decent analysis and comparison with other systems of health care, rather than simply upon political dogma and the whim of some idealogically motivated politicians.

  • Comment number 55.

    It is obvious after listening to DC on radio 4 this am that his sole aim is to privatise the NHS, he kept banging on about wanting a better health service with higher survival rates for Cancer patients etc, he kept quoting the EU and wanting the same pubic health service they have, I was rather surprised the interviewer just didn't ask him which Country in the EU had a part privatised public funded Health service - neither did the interview ask which parts of the Health service would be privatised.

    When England voted in a Conservative government did England think we would get this - why didn't the interviewer mention and clarify that we in England once again were to be penalised,it was after all England who voted them in, this is a step too far in my view, but a step closer in the revolution that will come just like in Tunisia, as yet the people are not poor or hungry enough, but the pact between the devil conservatives and the devil Libs will soon make us poor as Church mice's, not forgetting of course who started the ball rolling ie the Labour Party, who when the won there first election 13 years ago truly had the will of the people BUT like now we the people had NO idea just how much our politicians hated us!

  • Comment number 56.

    Tories and thier ilk will not be satisfied until the NHS is closed down. Tories hate the NHS they just loathe the idea that "the working class" can actually consult the same physician as themselves. Tories long for a return to the "old days" when the "working class just died. The Tory supporter longs for a return to a supposed halcyon time "When these dirty oiks knew their place" Well they should be happy now as Cameron,Tory supporters together with their fellow travellers Business ownwers. are just about to see their dreams come true. The rich and tories will be healthy, and the poor?Well, let the devil take the hindmost

  • Comment number 57.

    David Cameron on walk about meets little girl.
    "Hello little girl, are you here with your parents?"
    Little girl "I'm here with my mother, my father is a doctor and he is busy performing an appendectomy."
    Cameron "wow that is a big word for a little girl, do you know what 'appendectomy' means?"
    "Yes, about £2,700."

  • Comment number 58.

    the NHS is a mess and has been throughout labours rule!

    lets at least give these guys a chance? stop believing all the hysteria from the media?

  • Comment number 59.

    "The Royal College of GPs, the British Medical Association and trade unions say the upheaval is unnecessary..."

    Well, they would say that, as usual they're busy looking after their own jobs instead of looking after the organisation that we all rely on!

    The NHS has been a shambles for many years, someone has to take it in hand and do something about it. It won't be easy, but it can't go on as it is - it is no longer fit for purpose.

    I think Cameron is brave to take on the NHS and the unions because they will do anything they possibly can to scupper these reforms; not because they think the reforms are particularly bad, but on principle they will disagree with anything a Tory says.

    Perhaps if they got their heads out of their backsides and looked at the bigger picture for a change, instead of their usual blinkered view, we could all benefit.

  • Comment number 60.

    18. At 11:32am on 17 Jan 2011, DT_1975 wrote:
    Anyone who believes that there aren't serious organisational problems in the NHS should watch "Can Gerry Robinson Fix the NHS?"

    Every objection we hear to the proposed changes to the NHS are basically "we're scared of change, and because we're scared ,it could be bad for patients".

    I would say that:

    Anyone who is scared of change would not last five minutes in the NHS. Change is constant and, yes, it is extremely bad for patients and continuity of care.

    Don't believe everything the Department of Health tells you about the NHS.

  • Comment number 61.

    The NHS would save millions every year if it manufactured its own-brand generic drugs, rather than bought branded drugs from the big drug companies. This is where most of the money actually goes.

  • Comment number 62.

    37. At 11:54am on 17 Jan 2011, anotherfakename wrote:

    "When many hospitals have more maangers than nurses."
    -------------------------------------------------------------------------
    Name the hospitals please?

  • Comment number 63.

    Cameron is a trickster. Everything has to be changed according to his rightist ideology especially in public life. Of course that which caused the reccession, Bankers greed and deregulation of the financial sector is to be left alone.

    Then again NO change in the tax havens, tax avoidance and the general status quo. The Rich will get richer and the poor, poorer.

    Cameron's change is a perverted one.

  • Comment number 64.

    HERE WE GO AGAIN...............do we really need large scale re-organisation? Done under Maggie, then Blair, and now again the the Coalition. I go regularly to Hammersmith Hospital here in W London. Its well run, cleaners are everywhere doing a great job, and Nurses and Doctors are efficient and ready to help. Is CAMERON going to give up all these just to save a few pence. The consequences could be even more expensive !!

  • Comment number 65.

    'The decission for care, needs to fall directly onto the senior clinician, and not on a bed management sytem, often managed by glorified clerks, with a sincere lack of clinical or medical skills.' Leng

    Senior clinicians have more to worry about and deal with than malingerers, abandonded seniors and people who want a 'holiday' in the local ward.

    I am bed manager and if we only had sick people in our hospital, not only would my job not be needed but we could be half the size

  • Comment number 66.

    Personally I would be reluctant to receive private treatment and would much rather wait in a queue to be treated at one of the many first class NHS hospitals.

    Private companies are there to make profits, and if they are in a strongly competitive environment the only way to do so, is to make savings in ways which are likely to put patients at risk. For example, if they offer poorer terms and conditions of service than in the unionised NHS, they are unlikely to attract the best staff. No doubt they will provide better front of house facilities to attract patients, but this will have to be at the expense of the quality of treatment.

    The only way that the NHS could save money without reducing quality, would be to bring more things back in house, with a degree of centralisation sufficient to make economies of scale. A priority would be bring the supply and manufacture of drugs and other medical supplies in house. This move could by itself save 10s of billions.


  • Comment number 67.

    Ok, I'll not be smug cos I live north of hadrians wall. What part of the PM assurance that the NHS was safe in tories hands did you believe? You wanted change and the CONDEMS will surely deliver, simply don't get old, sick or become unemployed in good ole UK. I'm quite sure a great many CONDEMS would rather we have a USA health template aka those that can afford and those that cannot! They will simply ignore the majority of professional advice not to tinker with the NHS in the ways suggested.

  • Comment number 68.

    Our local hospital spends tens of thousands on a nice shiny new frontage, while quietly closing wards.

    Too right it is time for a "fundamental change".

  • Comment number 69.

    Change that is necessary is fine. Change for the sake of it isn't.

  • Comment number 70.

    59. At 12:13pm on 17 Jan 2011, Mrs Vee wrote:
    "The Royal College of GPs, the British Medical Association and trade unions say the upheaval is unnecessary..."

    I think Cameron is brave to take on the NHS and the unions because they will do anything they possibly can to scupper these reforms; not because they think the reforms are particularly bad, but on principle they will disagree with anything a Tory says.

    **************************************
    Brave, maybe he would be if he couldn't afford to go private if he needed to.
    The usual tired "Bogeyman Union" position, do you not think that the Unions are made up of average working people who also require NHS treatment.
    I am quite happy for changes but in a reasoned, well planned and carefully implemented manner after consultation with all experts.
    Not a mad dash to change for change's sake.
    And not by sacrificing yet another Public Service to the Cash Cow Private sector.

  • Comment number 71.

    A few weeks ago Ed Miliband did a press conference and the right wing bully boy press ripped in to him with really aggressive questioning and the whole tone was one of hostility towards him and trying to catch him out.

    I have just watched David Cameron being questioned at a press conference and I naively hoped he would receive some tough, probing questions on his NHS reforms so that I might see an expert neutral political journalist raise issues about his proposals.

    Instead, I found it deeply disturbing that he was treated in such a soft, sycophantic way, in the same ghastly way the queen is interviewed. It was like his sniveling rich public school chums were tiptoeing around making sure they didn't for one moment sound critical of anything this elite, aristocratic toff is doing. Like they were scared that if they asked a proper, serious question they might be ostracized from the 'club'.

    In the absence of me being an expert in the NHS field and in the absence of any of Cameron's media chums asking any challenging questions, I am left to my gut feelings which is that he and his rich friends have a deep contempt for public services and will cut and destroy as much as they can get away with. Cameron's Eton days serve him very well for pumping out endless vacuous PR statements about empowering the people, and I fear too many people are so gullible and short sighted that they will only truly find out the damage the Tories have caused when there is a service they desperately need and they discover it no longer exists.

  • Comment number 72.

    Remember lip flapper Camerons election pledge? The NHS is safe in Tory hands, get the feeling this is another pledge/promise that's being upended? The tories have probably already got their cronies lined up for the plum privatised jobs in the NHS as they probably have with the GPO. Tunisia have just ousted a corrupt regime that probably were no where near as corrupt as rip-off Britain, so why do we put up with corruption? Hospitals, Schools, Railways and utilities should never be in private hands. They're all essential services that shouldn't be exposed to the 'profit for shareholders' at the expense of quality of service, jobs and cost to the consumer and why? Because they are all services where we have no choice, particularly those at the bottom of the ladder. And before anyone butts in with we have choice with the utilities, we don't, they're operating a cartel, anyone who switches to get a better deal will tell you the hassle involved is just not worth swithing.

  • Comment number 73.

    65. At 12:22pm on 17 Jan 2011, Axel Ramone wrote:
    'The decission for care, needs to fall directly onto the senior clinician, and not on a bed management sytem, often managed by glorified clerks, with a sincere lack of clinical or medical skills.' Leng

    Senior clinicians have more to worry about and deal with than malingerers, abandonded seniors and people who want a 'holiday' in the local ward.

    I am bed manager and if we only had sick people in our hospital, not only would my job not be needed but we could be half the size
    =============================
    No idea what a "bed manager" is - but I take it that these patients are in hospital because they have been refered for a clinical reason.

    As for people queuing for a holiday on a local ward - you must be kidding.

  • Comment number 74.

    I suspect that the nurses, doctors, specialists and administration staff visible in my nearest hospital represent only a small fraction of the people on the NHS payroll.

    Having been for exploratory examinations several times, the impression I have gained is that there are legions of pen-pushers lurking in the background or wandering along corridors clutching clipboards. A couple of sigmoidoscopys involved the specialist and no less than three nurses; with my back to them, I had no idea what they were up to, but I'm sure no more than one was necessary and that the other two could have been assigned more useful jobs.

    The topic even reminds me of a time in the early 1990s when an ex-NHS doctor consulted me for advice on what to do with all the surplus earnings she received since she was swallowed up into a PCT. These had risen by more than 50% at one go, and her working environment improved vastly from average hospital surroundings to lavish decor and comforts.

    There can be no doubt that any changes along these lines will yield benefits for everyone - except those anonymous middle managers, of course.

  • Comment number 75.

    The NHS is probably the largest non-military organisation in the world. It has always been run by the state, and for this reason alone must be capable of significant improvements in care and economy.

    Nobody likes change, and we are bound to hear declarations of imminent doom from those who find change inconvenient, or are unconvinced of the need. I do not expect the sky to fall in.

  • Comment number 76.

    I don't trust the Tories on this issue, they were opposed to the creation of the NHS.
    Sir Keith Joseph admitted when the Tories returned to power in 1951, they considered scrapping but didn't because it was so popular. In the 80s after Thatcher won a 3rd term, they were elements in the party calling for the HNS to privatised then.
    This coalition of the right is composed of small state free-marketeers. They are idealogically opposed to apublic services funded from taxation. As their social model is derived from the USA not Europe, their model for the NHS is a private sector solution, not a government regulated health insurance scheme with both state and private provision as in Europe.

  • Comment number 77.

    Yes, reforms are necessary.

    There is too much bureaucracy in the current system, too many hierarchies and too many managers being paid too much money.

    In fact the whole system of pay needs reviewing starting with GPs who are paid far too much, then moving to managers clinical and administrative and incorporating Consultants minimum 'productive' hours.

  • Comment number 78.

    I've just been looking at transport safety statistics. The safest form is air travel and that industry is almost entirely in the private sector. Manufacturers (Boeing, Rolls Royce), airports (BAA), carriers (BA, Ryanair ). All private. Very safe. What's wrong with private companies? What's wrong with the private sector in health care? Who do you think has invented all the new drugs in the last 50 years? All the new implants, artificial joints, MRI scanners? It wasn't the 'British Nationalised Health Corporation'.

    The changes proposed will certainly affect patient care adversely. That's because the vested interests, unions, BMA, managers, will make sure of that, and any sad cases will be publicised to the rafters. I dont know if the changes are the right answer but the heavily bloated, unreformed, dinosaur of the NHS sure needs a big shake up. They can start by not putting dementia patients on general wards and leaving them to feed themselves.

    One final thought. If the smallest amount of possible cuts is going to 'destroy patient care' then what happened to the untold billions pumped in over the Labour Years? I don't remember a dramatic transformation in care, but I do remember lots of non-job creation and 50%+ pay rises for doctors (and their pension entitlements)
    Taxpayers are as entitled to get value for money from the NHS as from any state sector instituion. Going gooey-eyed just because someone says the magic word 'nurses' is a wholly inadequate response.

  • Comment number 79.

    All I know is that we are now spending what the continentals do on health care but I am still dramatically more likely to die of something that is routinely cured elsewhere. So we obviously haven't got it right yet and some changes must be necessary. If you want to keep things as they are and die younger than you should - be my guest and stick your heads in the sand. After all when you are dead no one is going to have to put up with your complaints.

  • Comment number 80.

    It is not just the NHS that needs reform but the whole of the Public Sector.
    Reform has been highlighted as requirement by many independent bodies who understand economics and understand what a drain, in its present state, the public sector is on the UK economy. Thatcher got removed before she could tackle it; Blair was stopped by Chancellor Brown, who against all economic reality expanded the public sector (incompetence or trying to make the UK people MORE dependent on the State and therefore more likely to vote Labour?). I have to admire the Coalition for their guts to tackle this problem which HAS to be addressed for the future health of OUR country.
    The Unions and vested interests (as well as dogmatic believers in last century’s politics) will resist and place out scare stories, but if we want to continue to have public services in the key areas a mature society expects, it MUST be reformed and brought into the 21st century in both structure and working practices.
    Sorry children, I know too many deluded on this HYS won’t like it but, there is a REAL world out there and we have to compete or decline. Up to you, no more Nanny, no more CBebbies type Magic Money Tree at bottom of garden, only REALITY

  • Comment number 81.

    66. At 12:23pm on 17 Jan 2011, stanblogger wrote:
    Personally I would be reluctant to receive private treatment and would much rather wait in a queue to be treated at one of the many first class NHS hospitals.

    Private companies are there to make profits, and if they are in a strongly competitive environment the only way to do so, is to make savings in ways which are likely to put patients at risk. For example, if they offer poorer terms and conditions of service than in the unionised NHS, they are unlikely to attract the best staff. No doubt they will provide better front of house facilities to attract patients, but this will have to be at the expense of the quality of treatment.


    Private healthcare in the UK operates to very high standards. They can do this and make profits because they limit the types of work they do and the types of patient they will cover. They do not provide GPs, A&E, geriatric, maternity, psychiatric and many other services that we get on the NHS. They essentially cover "cold surgery" which can be planned and resourced in advance. If you had a heart attack when on the operating table at a private hospital you'd be taken quickly to the nearest NHS A&E.

    For life threatening cases (eg cancer, heart disease etc) the patient experience may be better privately but the speed and quality are likely to be the same on the NHS (though doubtless some HYSers will claim their personal experience does not support this).

    However, since most private consultants are also NHS consultants, do you not think that such consultants have a vested interest to keep NHS queues long so there is an incentive to go private?

  • Comment number 82.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • Comment number 83.

    This is evidence of the real Tory agenda to privatise parts of the NHS. Yes there are changes needed. We need less overpaid managers and more frontline staff. These plans go too far!

  • Comment number 84.

    56. At 12:11pm on 17 Jan 2011, Frank Kirkton wrote:

    I'm not reposting it, but it has to be the most pathetic post I've ever seen on HYS.

  • Comment number 85.

    All the Top Kidney Surgeons should riot

  • Comment number 86.

    The NHS is crippling this country due to people who depend on it for their petty ailments. The government needs to address the issue of patients who need the NHS because of drugs, alcohol, nicotine and obesity problems - not to mention all the cancer inducing chemicals they use in convenience foods which cause alot of our health problems. Patients who need the NHS due to self abuse issues involving drugs, nicotine, alcohol and obesity should be required to wait the longest or pay a levy.
    The NHS needs our help if we are to continue to fund it. Stop smoking, get some excercise and limit alcohol to a none life threatening minimum (i like a drink too!). If half the smokers in this country kicked the habit then GP's would have less patients with minor ailments to deal with - i bet you!

  • Comment number 87.

    The drastic changes aren't necessary. The Tories objective seems to be to part or wholly privatise the NHS . The NHS generally works very well as it is. Some savings could be made within Primary Care Trusts. However, the Tory led coalition is planning drastic and dangerous changes which will completely change the NHS, and will encourage much more privatisation of services. David Cameron has claimed that there is a lot of enthusiasm amongst GPs for the GP consortia. There is not a lot of enthusiasm atall. Basically, GPs have been told that they have to sign up to the consortia as there is no other option under this government, so several GPs have reluctantly, not enthusiastically, signed up. GPs could have had more input into the commissioning process without these drastic changes. However, the Tory led coalition seems to be interested in cutting NHS spending in the medium to long term, and privatising as much of the NHS as possible. Price competition will be very dangerous for the NHS, as the cheapest option will often not be the best option for patients or staff. The Tory led coalition is proposing the biggest and most drastic changes in the NHS for a very longtime. The motivation behind it appears to be costcutting and privatisation. The Tory led coalition does not have a mandate for these drastic changes as I don't remember them mentioning them pre-election. The Tories just said that NHS spending would be maintained. However, maintenance of NHS spending would gradually mean a cut in spending in real terms

  • Comment number 88.

    Yes change is needed, but I would suggest careful considered change, not the Cameron bull in a china shop approach.

  • Comment number 89.

    It certainly needs to change and it needs to have a strategy for change. Whether this change is right and whether it is actually deliverable is very unlikely. It is hard to trust a party who are ideologically opposed to the very existence of the NHS with its future.

    It was of course their ideological nonsense about internal markets that contributes most to the problems today. Labour failed to remove that conceipt but the Tories came up with it. It is a joke which was supposed to remove cost through competition but of course has vastly increased cost through bureacracy and pointless duplication.

    This set of change is no better thought through and just as ideological. Just like education, something good in need of improvement will be subject to dismantling and reconstruction and the end product will at best be where we started from.

  • Comment number 90.

    Tory/LibDem Plan: If we slash the NHS all the poor will die. Job done. Then we can abolish that damn NHS and all that are left will be able to afford BUPA.

    When will people learn. The Tories will NEVER change, and the LibDems are simply empowering them to get on with their 'nasty' policies.

  • Comment number 91.

    One sure thing in life, the get-what-you-can at all costs brigade is rife in Great Britain. Divide and rule.
    I'm alright Jack.

  • Comment number 92.

    Let me get this straight: The Coalition Government is now saying than it knows more about the delivery of medical service than The President of of the Royal College of Surgeons, John Black.
    John Black has outright accused the Coalition Government of going down a dangerous path of by eliminating surgeries for patients who need them.
    Black believes that if such individuals are unable to receive these needed operations they will suffer from pain that is unnecessary and their chances of making a full recovery will be lessoned.
    The cutbacks in the NHS operations stems from an effort by the organization (?) to to save £20bn by 2014-15, this when medical costs, like most costs, seem always to be on the rise?
    According to Black, many of the trusts either put off or eliminate numerous surgical procedures e.g. adenoid, gallstone and tonsil problems.
    Black jumped into the fray ahead of the health and Social Care Bill recently published by the government; the bill will give GPs of the NHS the authority to commission such services.
    A warning that overall health care would suffer at the hands of the reforms was brought forth by
    - the NHS Confederation and
    - seconded by The Royal Medical Colleges as well as
    - The British Medical Association.
    "However, Health Secretary Andrew Lansley has said the reforms set out a vision for an NHS led by patients and professionals, not by politicians and patients will be handed more choice over how and where they are treated." I didn't know that "politicians" led the vision for the NHS now, except that it's politicians leading for these chances.
    I won't pretend to know much about delivery of medical services, but I also won't pretend to know as much as
    - the NHS Confederation and
    - The Royal Medical Colleges &
    - The British Medical Association.
    The changes may be necessary, or they may be tantamount to the British version of Obamacare.
    All this is happening too quick, which should not happen where medical care is the issue and where an agining population confounds the issue. There needs to be more free and informed discussion about how the public can best be served - not only by doctors in medically controlled partnerships but also by community pharmacists, nurses and other primary and community care providers.
    Are proposed changes to the NHS necessary.
    I'm not sure, probably.
    I'm more sure that we haven't got the right changes.

  • Comment number 93.

    58. At 12:13pm on 17 Jan 2011, scotty1694 wrote:
    the NHS is a mess and has been throughout labours rule

    ---------------------

    This is absolute rubbish. The NHS is the best thing we have in this country and has improved greatly over the last few years. Waiting times have dropped considerably
    The NHS is not a mess, it is wonderful, we have no concern about the cost of treatment when ill and no one knows when they will need it. Just try living in a country like the US, insurance companies do all they can to avoid payment and unless you can afford the premium suppliment you can forget comprehensive cover. Our friend has recently had an emergency Ceasarian, what a surprise the insurance didn't cover this, they will be paying for a decade. Just try having to live as in many European countries where there is a charge to see the GP, most children get better so you have the awful dilema of what to do. In some countries you can claim back the money but you have to pay up front at the time of the visit and many parents delay
    The private health companies have to make a profit, how can that possibly benefit the patient. The NHS has improved, a friend works for a private company and they have had a drop in membership so the NHS must be doing a good job. These companies constantly try getting disparaging stories out about the NHS published ,it is called advertising and our press are only too willing to oblige

  • Comment number 94.

    "25. At 11:45am on 17 Jan 2011, Steve wrote:
    The problem is that most public sector workers do not have the first clue how to obtain a value for money contract with the private sector."

    There is a lot of truth to this, I have seen far too many cases where contractors are laughing their way to the bank! This is usually because no one doing the procurement thought to check in detail what sort of margin they would be making to see if it was value for money, or check to see what sort of services were really included, or heaven forbid not accept a price and push for something lower.

  • Comment number 95.

    34. At 11:51am on 17 Jan 2011, sixpackerL wrote:

    Ethically, it is more important for the NHS to put clinical health decisions before the profit motive.

    Privatisation will introduce conflicts of interest which threaten this principle.

    Of course, big efficiencies can be made - but the fundamentally there is no structural problem with the organisation of the NHS.

    This is just another philisophical move being adopted under the smokescreen of deficit reduction.

    --------------------------

    I am not pushing for privatisation and I am fine with the NHS system. However the public sector ethicly should use their resources efficiently.

    Putting health issues before money (there is no profit in public sector) would kill more people. Managing the resources effectively can treat the many at the expense of the unnecessary/stupidly expensive. Why give a cosmetic treatment or hugely expensive and unlikely to work treatment when that money can actually look after far more.

    People suffer and die unnecessarily because of frivolous throwing away of money. Expense on management and not beds. Failing to look after the hospital and its patients for bad management of resources.

    I dont know if this is the solution but I hope so.

  • Comment number 96.

    sixpacker re 'I am a bed manager'

    I am part of the team that moves people for discharge out of their beds and try to make what arrangements we can, we move the people who should have been discharged but for a variety of reasons are still on the premises out of their beds into less 'valuble' beds, we are the people who phone you up to say, 'I'm sorry, we will have to cancel your appointment for a visit because we have no spare beds, your bed in particular being occupied by someone whose family have abandonded them'

    On any given day, at my hospital about 8% of our beds are occupied by 'non patients'

  • Comment number 97.

    Start saving now.

    Welcome to the PHS privatised Health system.

    A huge waste of our money to create a system based only on cost, remember what happened when Trusts took the lowest private bid for cleaning, closed wards and patents deaths.

  • Comment number 98.

    My wife has worked for the NHS for 40 years and like most of her colleagues is fed up to the back teeth with the turmoil that follows a new government taking power.
    It's all change every time.
    This time hundreds of dedicated people,including some excellent management staff that originally worked on the front line as nurses will lose their jobs. These are often the people who the press love to label as pen pushers,but in reality are the backbone of the NHS.
    And they wonder why moral is low.

  • Comment number 99.

    In rushed retreat there will ultimately be MANY attrocious casualtys.

    This is basically the Dunkirk of the NHS and as with Dunkirk the politicians will hold up any positives to smother out the attrocious negatives.

    LEST WE FORGET!!!!

    LEST WE FORGET that so much that UK governments undertake is enshrined in ineptitude and ill thought out detail and planning leading to many attrocious outcomes and unnecessary suffering and consequences which often leads to much greater expense putting right failures, as well as the costs to victims and familys.

    From such rushed retreat I ultimately expect COLLATERAL DAMAGE, which is of course a guaged political measurement of acceptability of price to attain policy plans, no less so than Gallipoli, The Somme, Ypres, Burhma, the failure of British Expeditionary Force leading to Dunkirk, destruction of UK Steel, shipbuilding, coal mines and manufacturing.

    Lets not forget that the NHS has taken decades of ironing out problems, of advances to technology and administration practices and even now it can STILL have failures, YET Cameron & ConDems would have us believe that such serious transfer of NHS administrative ability can be simply handed over like dealing out cards in a card game.

    I THINK NOT.

    The EVIDENCE of so much, just does NOT provide ANY SUBSTANTIVE factual evidential substance to justify such a destructive policy of that which currently exists to hand over such in such an adhock and rushed manner to multiple untried/untested immature structures.

    On one hand, we are told it is best and better practice for so many of our societys functions to amalgamate into centralised entitys, all eggs into fewer baskets whether our nations security services, including police & military, or government taking over and centralising quangos into government control at ultimately NO cost saving benefits or LITTLE cost saving benefits, or in MANY instances EXTRA costs and NO benefits, yet apparantly best practice policy is not fit for purpose for the NHS.

    I personally do not know of ANY doctors practices which have the instantaneous capability of providing office space to undertake such a VAST increase in administrative capability. Hence where are these new administrative offices going to be located, and at WHAT COST, including all the NEW fixtures & fittings as well as MOST IMPORTANTLY computer and software systems which are currently capable of important structural compatibility across the whole UK health service.

    Such is the high level of investment needed for such a high magnitude of change which means HUGE PRIVATE INVESTMENT, which means investors will have to have some guarantee of return and PROFITABLE maintenance of their investment.

    Such an investment will NOT COME CHEAP. NO-ONE will invest such monies WITHOUT SUBSTANTIAL PROFIT RETURN on investment, hence the NHS is being seriously undermined by FUTURE PROFIT TAKING and thus FACTUAL LONG TERM HIGHER COSTS.

    Then theres so many OTHER IMPORTANT aspects of this, what about SECURITY. Currently security is provided by NHS trusts via a shared basis, shared with its other buildings etc, yet now security will be on an individual basis, no shared costs.

    ALSO, what are the BACK UP SYSTEMS and PRACTICES and PROCEEDURES.

    There are so many areas of VITAL IMPORTANCE which for ANY individual business there are ALWAYS hicups & failures, whether its BAA & opening a new terminal with FAILING computers & baggage handling or many other areas.

    Thing is, people are NOT just BAGGAGE, when something goes wrong with people, ESPECIALLY MEDICAL PATIENTS, generally lives are LOST, victims created.

    It looks to me that patients are basically just being set up to experience politically acceptable COLLATERAL DAMAGE just so that Cameron and Torys can wrench VAST SUMS of NHS money into the hands of private individuals of whom large private investors will become so called PARTNERS with these new private doctors practices undertaking NHS administration and CONTROLLING the MONEY.

    It would be a MUCH simpler thing to just utilise EXISTING RESOURCES with doctors having better input and access to funding for treatment, getting rid of waste & non productive employees.

    This, is basically and relatively not much different to what KRAFT have done, and still doing , to Cadbury's.

    As far as I can see, this government policy is essentially based upon political biased idealism, tarted up with pretentious, devious and ultimately FALSE propaganda.

    I think, there will be many tears, not from all from lost jobs, but from devastated patients lives, both in the short term, and also in the long term due to investor profit taking wrencking mORE & MORE from NHS budget.

    LEST WE FORGET - applys to SO MUCH, NOT just WARS!!!

  • Comment number 100.

    The proposed changes (or privatisation to give it a more appropriate term) are wholly unnecessary. Last year the NHS was rated as the most efficient Health Service in the First World in an international study. Where there are health outcomes that are lower than in other countries this is not because of the adminstration of the NHS but because those countries pay substantially more money as part of their GDP towards their health services than we do.

    This morning in his interview with John Humphries, Cameron accidentally revealed that the Conservatives have been planning to make these changes for 5 YEARS. So why is it that they failed to mention them to the public until AFTER the election?

    What we have now is a government that did not win a mandate at the election and did not inform the public of their long planned changes the NHS. In fact they actively said they wouldn't make massive changes.

    Why did they forget to mention this plan? Was it because they knew they'd lose millions of votes?

    They lied to us both deliberately and through omission.

    Stand up for YOUR NHS now or lose it forever.

 

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