Feel like I've betrayed my principles..

Mishap I agree if it does in fact cause 'fragmentation of the service' but don't think that is necessarily the case. I think it is unfortunate that it has been necessary to do so but if it is the only way we can afford the care we need then it is necessary. Selective outsourcing does not cause the issues you mention. Clearly it would not make sense to outsource things like A & E but straight forward elective operations done at a fixed cost, which is less than the NHS costs, would seem to me to be a good idea. It might even lead to efficiencies in the NHS.

Hard decisions do have to be made as it does in the end boil down to costs. We cannot all have all we want all the time.

I refer you to my earlier post where I explained the difference between what I was offered by the NHS and what I was offered privately. Clearly the NHS was being wasteful. I have another example: my 2 year old son had very loose hips and I had to take him back to the hospital every 6 weeks and hang around for hours each time. Eventually we went privately and our Consultant had actually trained the NHS doc. He said that our son would grow out of it and to bring him back in 2 years. We were left wondering if the NHS guy simply wanted to build up a long list.

I can understand anybody with a medical need going private by choice or if the NHS cannot or will not undertake the task. That is their right. What I am getting increasingly uneasy about is the insidious encroachment of private companies, domestic and foreign, good and bad, into the heart of the NHS, often with the tacit, or even manipulative, consent of government, senior medics and even NHS management. Divide and conquer is such a true saying, and I have little trust in many of those on whom rests the responsibility of protecting the NHS from the worst aspects of the business world. The solution? Put people in charge of the NHS who will protect it and make it more efficient. That would include stripping medical specialists of their right to use NHS facilities for private gain. That would all take a determined political will which is just not there.

Jane, I think msny people used to think about working for the state because they had free higher tuition. In fact they had grants. Nowadays, because they have to pay for their degrees, they do not think so much about it.
What's legal aid, by the way?
Nonnie, how do you know how much an operation really costs in the private sector? Private healthcare companies do not have to give us their financial records. It's called commercial confidentiality.

Nonnie, have you read this about NHS and private care workers?
Do you think this is acceptable?
www.theguardian.com/society/2014/aug/09/former-nhs-carers-intensify-strike-over-pay

Nonnie - the outsourcing of cleaning and food provision has caused a marked drop in standards as the workers from outside who come in have no commitment to the establishment and are not part of the team - they just swan in, do their bit and vanish over the horizon. It really does not work. Hence the patients starving in the beds.

Agreed, Mishap. Most of the outsourcing is done by the companies who built the hospitals under PFI and have now gone into other more lucrative areas, where they can undercut NHS staff who cared.
There were signs in our local hospital saying Balfour Beatty were responsible for the toilets that were never cleaned, or had broken down, etc. Same with the catering and the porters.
The problem is that it's impossible to say when this happened, so the NHS gets the blame when it isn't their fault. This in itself needs a campaign.

lifeinthenhs.wordpress.com/

Just did a search for "Why does the NHS get the blame?" and it came up with this. Very interesting, I find. I'll need to look at it in more detail.

Please do not misquote me. This seems to happen a lot, to a lot of people.

I agree that outsourcing does not always work but where should the blame for that lie? If you outsource something you should create good KPIs for the contractor to achieve and monitor them to ensure they do. If they don't, cancel the contract and bring it back in house or award it to another company. The NHS is responsible for the outsourcing and should not just sit back and blame their contractors, they should have ensured the contracts were waterproof and then dealt with any infringements. It is far too easy to just say it is the outsourced companies who are to blame.

When I was responsible for contracts I made jolly sure that I got what I paid for!

Just realised what you mean Dj. Are you telling me that the NHS outsources at greater cost than using their own services? Well that takes the biscuit! It had never occurred to me they would do that. If that really is the case then the NHS is to blame.

A similar thing happens in Social Services departments. People "retire", take their pensions early, then go back as locums because they get paid many times more then they did before and than the ex-colleagues alongside whom they are working. Bonkers!

In the NHS - I would like to know what the bill is for all creating all these outside contracts and who monitors the quality - and what all that costs.

The problem with outsourcing contracts is that penalties get built in with the statutory agencies, so after reviewing, correcting and giving yet more chances to get it right, it costs the same to end the contract as it does to stay with it. Meanwhile, executives get shifted and new ones come along to try and make it work, they don't immediately understand the problems and time is ticking away. Public services don't blend easily with private contracting.

If the aim is to break down the NHS and replace it with a private system- then it does make perfect sense of course. Too tragic for words.

Now there are many great Consultants out there, dedicated to the NHS still- but just too many who deliberately run down their NHS work to push for their private sides. The type who will suck their breath and say ou'll have to wait for months and more- than in the next breath tell you they can do it next week privately. Now- ask yourself. How and why???

"Public services don't blend easily with private contracting." Exactly - that is the crux of the matter. But if one is tied up in political dogma, one does not want to see that reality.

Of course, big businesses often take 'losses' to kill other businesses- they have money and power on their side. Look at supermarkets and the way their undercut others- selling many key products at a loss. Of course when competition has gone ...

Thinking of you Susieb- and hope all goes well. We really should be taking this discussion on another thread.

All I can say there are some unholy alliances out there- and who truly do not have the interest of the NHS and the less well off at heart. A two speed system would be disastrous- be it for health or education.

I wasn't arguing with your basic tenets, janea, only pointing out that a generation of docs (at least, possibly two generations) would not have had enormous debts at the start of their careers. Will people who had to pay fees have reached a consultancy yet? (no idea how long it takes on average).

A further thought more generally: those of us who think it's fine to go for private health care if it speeds up treatment (or whatever) presumably should also agree that it is not wrong of, say, Labour politicians to choose private schools for their kids if they think they are better than state schools? After all, their reasoning that they have to use the best of the system that is actually in place is the same as the reasoning (which I have no quarrel with) that the health of one's family members or oneself is more important than loyalty to a political 'creed'.

It's up to them, bags. Hypocrisy from ministers of any political persuasion is the issue for me. If they're saying one thing but doing the opposite in their private lives, it doesn't bode well for giving us confidence in their commitment to the job, nor does seeing the old boy private school network operating to exclude state educated MPs when prioritising who gets the top jobs.

I think it's inconsistent to say yes to private health care when one wants it and when one claims to "fully support the NHS" and then to call the choices of other people who use private schools hypocrisy.

This is a separate issue from the OP's query. It is a philosophical point that has arisen from the discussion. I fully support the OP's right to decide what is best for her in her circumstances given that it's the only way she's going to get the treatment she needs when she needs it so as not to have to suffer even more problems than she already is suffering. All the best, susieb.

I agree about the problems you mention, when, but the principle I'm talking about is no different, or so it seems to me.

The Local Authority I used to work for had to make financial cuts at the directive of the government (current one) I took voluntary redundancy as it coincided with the time I could claim my pension (work place). However I have subsequently been paid as a freelance to carry out the work I did previously. It has saved the LA money but my former colleagues cannot offer the same level of service as before and call upon people like me when it gets really impossible to do the job they are expected to do.

The fact that much of the private contracts withing public service sector (inc NHS) are not always a good idea is becauseIf you want a quality service you need a quality workforce..that is not the way to get it!

oops...a whole sentence deleted from my post! Should read:

The fact that much of the private contracts withing public service sector (inc NHS) are not always a good idea is because staff are paid minimum wage, have 0 hour contracts and no job security. If you want a quality service you need a quality workforce..that is not the way to get it!

Well - saw him and he was very nice, thankfully he says its not crohns disease, but seems to be a rare reaction to gall bladder removal, although liver apparently not too well... I am having more tests and have finally been given medication

I am glad that the outcome of the consultation was not as you feared; and that he was nice - they are always nice when you pay them!!

I am so pleased that you have some treatment happening - that must be a great relief. I hope all your tests go well.

Thank you for initiating such an interesting discussion.

That must be a relief susieb755, thanks for the thread, and for updating us.

Penstommen's experience is reflected across the NHS and social services. My husband was made redundant because of the cuts. He is now employed as a consultant. Most sw teams are staffed by newly qualified workers, and agency workers. The agency workers are paid more than the employed sw, plus a cut goes to the agency, so much more expensive. Ridiculous, but that's the effect of the cuts. Penstomen's and When's comments about outsourcing services are spot on.