What do we want from our NHS and how should we pay for it.

What an excellent speech by Dr Chang, DJ. As far as I am concerned the NHS is my Alamo: perhaps the greatest achievement of the UK in my lifetime after the Battle of Britain, so I would stop at nothing to save it from the predations of our grasping, conniving, devious and frankly traitorous politicians. Since Margaret Thatcher's time I've seen virtually the entire public framework of the UK deliberately wrecked by politicians and sold off piece-meal to avaricious scrap-dealers, while witnessing the spivs who did it drape themselves in ermine and titles, and further benefit from dodgy expenses.

Now the NHS, the biggest prize of all, is secretly being lined up for the wrecking-ball and privatisation. I have only utter contempt for David Cameron, Nick Clegg and their cronies for masterminding and overseeing this disaster. History will judge and condemn them, but in the meantime we must all do our best to fight for the NHS by complaining again and again about what is happening to it. I sense that the public are beginning to realise what is going on and will take massive electoral revenge on the guilty parties for their despicable conduct. The NHS must be saved. I hope you're up for all this, David Milliband, your party is our last hope.

A really interesting discussion & I agree with Micelf, some excellent posts from people who really know the NHS. I hope you've got what you wanted Whitewave. I remember the Ch4 TV series where Gerry Robinson tried to help NHS Managers improve their effectiveness &I agree with GrannyTwice that it can't all be blamed on Managers as such a big & complex organisation cannot be run without them - & quite a few I believe are ex-medics. One of our best GPs at my surgery now spends most of his time managing the practice rather than doing medicine which seems such a waste. One of the biggest problems which GR's programme brought out was the power of some of the old school consultants which was a throw back to the promises made to bring round the medical opponents to the idea of the NHS referred to by Papaoscar. They spent a lot of time working in the private sector & wanted to maintain their supremacy by sabotaging any improvements 'lesser' staff at the coal-face suggested. The Manager had become quite scared of them. The thought of having the NHS run by the likes of G4S horrifies me after the debacles their management has caused in the Prison system & at the Olympics.

I am learning a lot from the very informative posts on this thread - always good to hear from those who really know what is going on. Thank you.

Agreed, papaoscar. The list of MPs and Lords who are gaining from their links to private healthcare companies grows longer every time I look.

Thinking about a health tzar, isn't one of the problems that there are too many people who are at the top of the NHS?

The coalition said it would get rid of quangos, but there are too many parts now all vying against each other to be considered the most important. The only one who is no onger responsible for the NHS is Hunt. That is why the Efford bill has been put before Parliament, so that there is someone at the top who can be held to account. The Health and Social Care Bill took that responsibility away from the minister and shared it out between NHS England, the CQC, and other quangos.
Who is really responsible for our NHS?

The NHS was created by far-sighted idealists who after the war and at a very difficult time, forced through against strong Tory and medical opposition the creation of our present health service, which has been the model for most of the civilised world. The problem is that the NHS has been too successful for its own good and now needs reappraisal, re-focusing and restructuring, but in principle must continue to provide cradle to grave medical facilities at the point of need, regardless of the ability to pay. I simply do not trust our present politicians, especially the Tories, to do all this. They are more concerned at lining their own pockets.

I agree, kitty.
This is a brilliant speech by Khailash Chand, a GP.
This is what I want for the NHS.

classonline.org.uk/blog/item/health-care-isnt-a-privilegeit-is-a-fundamental-human-right

I still maintain there could be fewer managers and more central buying just for a start! That would allow more front line staff to be employed!

"However, what is more common and what needs overall management is very caring professionals fighting their corner and putting their patients first. However, there's is not, and there could not be, enough money for all demands to be met."
I think you are talking about the NHA party, GrannyTwice.
There would be enough money if we made rich people pay their taxes properly. A mansion tax would be a start in getting more money into the system.

" They look great on paper and computer models, but the service runs on PEOPLE and for PEOPLE and that gets forgotten."
Mishap, that appears to be the brief for the health tzar, but as the government realises it will cost more money to have more staff, he appears to have been sidelined. Hunt was quoting him everywhere last year, but has given up now. His brief was to listen to patients and carers and see what could be improved.

1. Bringing in the private sector and outsourcing some services leads to fragmentation.

2. Fragmentation leads to poor services as teamwork (the backbone of the service) is undermined.

3. Fragmentation leads to each fragment having its own costly bureaucracy.

4. Each fragment needs its own profit.

5. The positive psychology of teamwork and job satisfaction are undermined and the patient gets a poorer service; the workers get stressed and miserable.

For me the last factor is the most important one and is also the one that is always overlooked in these grand plans. They look great on paper and computer models, but the service runs on PEOPLE and for PEOPLE and that gets forgotten.

Eloethan and Grannytwice excellent, well informed posts.

I'd just like to add a point about taking an overview and prioritising competing demands.

It seems to me that we all agree the NHS is groaning under the weight of demand. That demand is to a large extent, caused not by 'dramatic' illness, but by the consequences of national policies which favour short termism and the benefits to large corporations. For example, obesity causes a vast amount of illness and suffering, but there are few policies which effectively promote and / or subsidise heathy food. Transport policies favour ever more road building to the detriment of local communities including walkers and cyclists. A culture of blame instead of openness encourages rank closing and defensiveness. I could go on, but the point is that the health of the nation has to be seen in its widest terms and not confined to dealing with illness once it has happened as a consequence of poor policies.

The theatre example I gave resulted from some senior consultants putting their own interests before those of their patients and their other colleagues. However, what is more common and what needs overall management is very caring professionals fighting their corner and putting their patients first. However, there's is not, and there could not be, enough money for all demands to be met. Someone has to take an overview and listen to and decide between the competing priorities of the various departments within a hospital. Shouting loudest doesn't mean you have the best case. Hospital politics are very real and impact on the decisions made - and these are not always in the best interests of the patients.

Brilliant post, Eloethan. Thanks.

I would just like to point out again that the Commonwealth Fund, a Washington-based foundation which is apparently highly respected for its research methods, found the NHS to be the world's best healthcare system - scoring highest on quality, access and efficiency.

Whether their findings would be the same now that this government has deliberately cut NHS funding, who knows. It is naive to think that it is possible to discuss this matter without politics being involved. The Conservative Party has a stated wish to substantially reduce the state and this, of course, affects public service provision.

Jeremy Hunt and Douglas Carswell co-authored a book called "Direct Democracy: an agenda for a new model party" which contains the comment:

"Our ambition should be to break down the barriers between private and public provision; in effect denationalising the provision of healthcare in Britain."

Michael Gove and several other Conservative gave their support to a book called "The plan: twelve months to renew Britain". The author, Daniel Hannan, appeared on US TV (Fox News) and said that the NHS was a "60 year-old mistake."

I would far rather we had our "60 year-old mistake" than the system they have in the US where, according to the Commonwealth Fund report, "America denies care to many patients in need .... and is also the poorest at saving the lives of people who fall ill."

There is also a suspicion that the enthusiasm for privatisation is not only ideologically motivated but also arises from the number of politicians who have a financial interest in the healthcare industry.

socialinvestigations.blogspot.co.uk/2014/03/compilation-of-parliamentary-financial.html

Obviously,some managers are necessary but over management is wasteful! In my experience the practitioners are not trusted to be 'professional' and are treated as though they are stupid (at best) or swindlers! In reality most NHS staff just want to do the best for their patients.

PRINTMISS - I agree about the under- funding in general. The NHS in terms of value for money is a world leader. It is also up there in terms of equity which is a vital aspect. As for nurses nursing and doctors healing - of course but in order to do that, there has to be an infrastructure to support that. The issues are different in primary and secondary care. A GP practice, for example has to have a practice manager, receptionists and administrators, access to IT support, cleaning and maintenance staff. Without all this being properly set up and managed, patient care would suffer. In hospitals, the issues are even more complex. I'm not saying that there isn't room for improvement but it isn't as simple as front line staff = good, all others = bad. i well remember an example from my days on a Trust board. Thee was very poor utilisation of theatre time at certain times. Doctors arranged it all themselves. Expensive theatres stood empty - especially on Friday afternoons- theatre staff had nothing to do, patients languished on waiting lists. We decided to appoint a theatre manager ( yes one of those dreadful manager people) answerable directly to the Chief Exec- ie if staff refused to cooperate, s/he could go straight to him. It revolutionised the use of theatres- some staff didn't like it at first but got used to working in a more collAborative way. Patients benefitted which was the end point of the exercise. I can't quite remember the figures now but I think it was something like the cost of the salary was recouped in the first 2 or 3 months.

I just think the NHS has been so under-funded over the years, because each successive government has been loath to put up taxes -( I will cover my ears!) - We are struggling to use procedures which at the time the NHS was started were unthought of, without accepting that these things involve more cash. Having said that I also think that the cash which is available is probably not used in the best way, with too many hangers-on. If only the government would allow the doctors to heal, the nurses to nurse, and stop their meddling, then perhaps more could be achieved.

That's what Cameron introduced him as, soontobe.
Has anyone else read or watched the debate about the privatisation of the NHS in parliament today. The Tories and Libdems did not turn up, they are that interested.

www.bbc.co.uk/news/health-30137368

This is what I want for the NHS now.

Never heard of him.
I googled him.
He seems to head up some sort of patient safety panel.
Not really what I had in my mind when I suggested a health tsar.

So who else wants a health tzar?
Don Berwick has obviously not been doing a very good job, as he has been Cameron's health tzar since 2013. He came from a private health company in the US.

I think I agree with Kittylester, assuming I have understood her post.

I have no issue with privatised services running in tandum with public NHS, surely that has been happening for years under governments of 'NO ONE COLOUR' to keep with the request in the OP to be unpolitical..

Who hasn't had, know somebody who has had,, waiting to have an operation or consultation at/in a private hospital but paid for by the NHS. It's common for knee/hip replacements for example to be carried out by privatised hospitals.

I know the age old argument is private hospitals 'cherry pick' but I don't neccessarily see it that way. I see it as getting minor ops done and providing larger NHS hospitals the ability to take on A&E facilities, Emergencies, Intensive Care etc. that makes common sense in lot's of ways, to me at least I know others totally disagree.

The wastage in the NHS, procurement, PFI, you name it the NHS probably fails to keep an eye on or accept the need for good housekeeping. Some of the new hospitals spend a small fortune on visitor areas and shops, why? Bed space and patient facilities should be the priority, who cares if communal spaces resemble a 4 star hotel.

We have had threads that speak of poor quality provision of food, yet some hospitals can provide good food at a lesser cost per head, management are rubbish.

We know the incredibly stupid PFI agreements that have put many Hospitals into a straight jacket for funding, repair costs putting them into debt.

Silly little costs mount up. Why shouldn't you have to put a deposit down for equipment you leave hospital with such as crutches, walking sticks. Mind you I've been told if they are returned they were chucked out not reused because it's not cost effective to 'clean' them.

Going back to privatisation am I correct that the NHS was 5% privatised and it is now 6%?

I also think it has to be accepted A&E departments are abused by the public and the whole ethos of A&E facilities needs establishing.

I also think the NHS is not free, we pay taxes to pay for the service. I think we should do the same as other countries and expect visitors to have pre paid health insurance policies, the same as we have to do when travelling outside the EU.

Kitty - how would the free ' core' and the paid for 'add-ons' be defined?

Or whitewave, are there any who can see the merits of a mixed system but with the 'free' bit much better managed than currently.

Whitewave - just the NHS

Oh papa - the process wasn't carried forward by the socialists but by the New Labour government!!

Does the private sector also train doctors or is it just the NHS?

I like the idea of a health tzar.

I wonder if there are an GN's who would prefer a private health system?