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

Thanks to our devious and grasping politicians there is not much left of the public sector for the government to sell-off or give away to powerful private interests, whether on-shore or off-shore. The formula for this has been well developed since Thatcher's time. Underfund the public sector, criticise and rubbish it, break it up into bits and pay your City friends to dress it all up and sell it off for a song. Then retire to the Lords with some ermine, nice directorships and so on, to keep your cupboard full. Before long it all goes belly-up but that's somebody else's problem.

Perhaps the saddest aspect of all this is that the vile process was picked up and carried forward with glee by the Socialists. So now across the board the public sector has mostly been rolled up and privatised. Standards have suffered and will get worse, yet another big, juicy apple is about to be plucked off the NHS tree and plopped into the basket of privatisation. But we, the poor souls who will have to pay for all this cannot be told the full facts because that would breach commercial confidentiality. Is there a 'why' in cynicism? Yes, indeed. Its all done to line the pockets of those who govern us.

Lockheed Martin, an American arms company, G4S, and several other non-medical organisations are about to bid for the contract to provide support services to local GP-led clinical commissioning groups. Apart from the usual misgivings about the danger of involving profit-orientated companies in providing public services, it seems to me that having such a close association with clinical commissioning groups would give the successful bidder a "foot in the door" for a large number of other health-related contracts.

It's been reported that private health firms are about to win a further £9 billion's worth of contracts. Dr Mark Porter, Chair of the Council at the BMA, said that these privatisations have caused a fragmentation of services and have diverted funding away from front line services to costly and complicated tendering processes. The NHS does not have the enormous financial/legal resources of the private companies, and - because of this lack of a level playing field when bidding - is increasingly losing out to the might of huge multinational organisations.

Patients of these private healthcare providers may well be impressed with the service they receive. Private companies bid for the least complicated and thus more profitable areas of health care. The NHS is left with the "messier", expensive, chronic services.

Once a few large companies have a virtual monopoly over acute health care, the scene may look very different. Now that Royal Mail is in private hands, there are already murmurs that, because other companies are allowed to "cherry pick" profitable areas of operation, Royal Mail will be unable to maintain its obligation to provide an equal service to everyone. We have seen that privatising energy companies, water companies, etc, etc., has not resulted in competition bringing down prices or improving investment and services. How much more evidence do people need that, ultimately, privatisation of essential services does not work in favour of the consumer?

I worked in the private sector most of my life (manufacturing). I retired early and got a part time job with Age Concern as a carer in a day centre, I was horrified at the out of date, wasteful practices that were in place. Many of the AC management were ex NHS people and brought their practices with them. Our local Age Concern went broke, and it was no wonder. Couldn't organise a p---up in a brewery.

Ah but the magic tsar would not bring in more managers!
Agree about the looking at waste, central purchasing stuff.

I cant decide whether I think that plastic surgery should be an add on. Probably yes, if it was for cosmetic reasons.
But some would say they are being bullied etc for their looks, so not sure where the line should or ought to be drawn there.

But yep. kittlylester for health tsar.

I think that's a good idea soon, in theory, but in my experience anything that is done to 'improve' things just brings in more managers.

If someone could actually take time to REALLY look at waste, central purchasing, layers of management, whether privatisation would really work, is outsourcing really the best way to get clean hospitals, would a 'core' service with people paying more for 'add-ons', tax relief on private payments/insurance, etc, etc, that would be brilliant. Add to that a 'leave things alone' policy while they were doing it and we might get something that was fair and worked well.

I would be happy to pay more for the NHS provide the service improves. Not that I any issue with the current service I get, but if more money means it could be better, I am for it.
However it does need to become more efficient, learn from the private sector. In our area, North Essex, most routine surgery, knees, hips, carpal tunnel etc. is contracted out to private hospitals. I suspect this is because it is cheaper than utilising main hospital beds that have all the intensive care etc. available. All my recent operations have been at a private hospital.
I know that UCH were utilising hotel rooms for patients that needed several days care, but did not need a hospital bed as it was cheaper.

My perfect NHS - First it would be preventative, bending over backwards to persuade and encourage all of us to lead more healthy lives. Diet and exercise should be a national priority, backed up my much, much stiffer regulation of the food and drink industry. Secondly, medical facilities from GP to clinic, specialist and/or hospital should continue to be available to all, possibly with some sort of an up-front payment and possibly even provided by a private or semi/private organisation reimbursed by the state. However, the use of NHS facilities for private purposes would be rigorously prohibited. Thirdly - the whole thing should be taken out of the everyday control of politicians. Fourth - money. Much better budgetary and financial controls should be implemented to achieve greater efficiency and reduce postcode variations in the quality of treatment and service. After all, it is a NATIONAL health service.

Personally I think it should have more money put into it [saw the how our money is spent form this week, and the health bill, although enormous, wasnt more than I was expecting]. But with a proviso that it has some sort of health tzar? Or health major type figure. But they have to be good, ie money efficient at what they do and achieve.
I know that all sounds like a bit of a dream, but there must be people able to do it.

I reckon that the NHS is such a multi faceted organisation that is growing and developing all the time to accommodate new discoveries and also increasing demand that coming up with one all encompassing solution to how its run would be impossible. I do agree that we, the public/potential patients, need to take more responsibility for ourselves. eg we all know the health risks of smoking, drinking to excess, overeating etc etc we could do something about this ourselves. Its also clear that some people have daft expectations of NHS eg one GP of my acquaintance told me of people making appointments for seriously trivial matters - on one occasion for a nose that was "a bit red from blowing her nose while having a cold"!!

I think it does PRINTMISS - I vaguely remember reading statistics that said just that.

I don't think it should be a political issue on this thread durhamjen, although it obviously is in the real world.

It seems to me that the NHS should be rethought totally. It was a brilliant concept and could be again but it can't be all things to all people. Things have moved on too much. Maybe, because the NHS has been such a success.

No politician is brave enough to come out and say that. Apart from that, JaneA's idea of a compulsory none intervention policy for a sustained period seems like the best idea.

Does it cost us more in administrating the system, than the system itself, do you think?

Not sure if it's possible to keep politics out of this, but this is what I do not want, arms companies running NHS services.

Yes that is because they are encouraged to do so by the accountants.

I was thinking about that the other day and wondered if it would be possible for the practitioners to run things. The problem with that is that they would be called away from their valuable work. Maybe the way forward is for the practitioners to run the hospital, unit etc and employ administrators who were told how the practitioners wanted things run.

Until the top heavy management systems are sorted out, the NHS will never be fit for purpose. I would like someone to come up with a viable way of reducing the number of highly paid, but highly stressed, managers. There seemingly have to be systems in place that treat professionals as though they are going to behave like naughty school children unless someone sits in the corner checking them.

Dh, with nearly 50 years experience has a 'line manager' who, we assume is well paid, to make sure he doesn't go over his financial limit even if that leaves vulnerable people with no provision. There used to be another practitioner carrying out the same role as DH. Between them they worked 1.6 of a week. When the full time practitioner retired, Dh asked if he could have some of his funding as he was very likely to be busier being the only one. He was told to come back and ask again when his funding allocation was nearly gone and they would see if they could find him more money. The managers talk in units of activity. DH sees vulnerable, mostly old, people - ie patients.

Getting back to the way dentistry is run in the UK with no national overall provision - is this true of GP's and hospital services? Are contracts drawn up with consultants GP's etc? or how is that done?

Why I am saying is that clearly dentistry is now (and has been for a number of years) no longer free at the point of delivery, and I am not sure that I would want that nor the way the contracts are negotiated with the dentists as it seems to me that is the reason so many people find it difficult to get on a NHS dentist list

I think more needs to be done to educate people on how to keep themselves healthy as we're on a slippery slope with obesity levels rising etc. I'm not saying that it's anyones fault if they get ill by the way; I realised a long time ago that a lot of serious illness is quite often just down to rotten bad luck. But, starting with children at school health and wellbeing should be encouraged more than it is. And something needs to be done about people not attending GP/Hospital appointments; I dread to think how much that costs the NHS. I still don't understand why GP's stopped having to do night visits but are now allowed to work at out of hours centres at night.

And don't get me started on NHS employees being given huge redundancy payments and then being re-employed

And I have no idea how I would have paid for all that; I wonder to how much my contributions over my working life amounted?

Is it that our contributions are too small, or that the number of contributors is declining as the number of end users increases?

Would one pay / have paid more for what one can get? How much more would make a significant difference?

I agree with the points alluded to about a top heavy management structure, unnecessary innovation and so on.

Meant to put this up earlier, forgot! I've copied and pasted this from a thread I started a couple of days ago; it sums up my feelings about the NHS!

"This year, so far, since April,m I have had a total knee replacement, both cataracts done, and yesterday went to the pre op assessment for a hip replacement. Today - operation booked for 17th December! (yes, I know there might be a cancellation....)

I cannot tell you how pleased I am, nor how impressed I am by the consistent efficiency, kindness and attention to detail of the local (North Devon) NHS, from GP to consultant, to receptionists, physiotherapists etc. "

I'll now update myself with the new posts, before I forget...

... that should be "the past 5 years ..."

jane a I agree with your post. It is a myth that NHS services are free at the point of delivery. It may have applied way back when, but it is no longer true.

Handing out P45s equally as valid, but it won't stop this culture though: I have a friend who is on £500 a day and all she has been doing for the five years (straight from university) is one NHS Trust structural review after another, as a project lead on a consultancy basis.

It's not really that difficult, Jane10.
Some patients have had to pay for NHS dentistry, optical services and prescription charges for decades.

I'm not saying I advocate a charge for seeing a GP. Just that the bureaucracy is already there, and it's a myth that NHS services are free at the point of delivery.

There would be a lot more money for direct patient care if a law was introduced banning all structural change within the NHS for at least ten years, preferably fifteen or twenty.

That way, the people who are employed to 'manage change', write impact assessments, new protocols, redesign websites, etc, could all be given their P45s.

janerowena the sheer cost of administrating a small charge for each contact would probably consume more than the amount collected. Its a really tough one. It would generate all sorts of forms: exemption forms, forms to reclaim etc as well as umpteen new staff throughout the country to run the system. Of course that could create jobs with all the attendant benefits associated with that eg new staff would be tax payers too. Maybe that's why medical insurance is so popular in other countries as it shifts the responsibility for collecting the money from the NHS burocracy? Don't know. This thread could run and run.

I should have posted this podcast (see thread below) on here - this is what I want from my NHS and it would include "paying it forward"

www.gransnet.com/forums/health/1211866-Its-time-that-clinical-encounters-became-human-encounters-podcast

He has a most appealing voice and it goes quite quickly! - like listening to the radio...

I don't think it was each visit, I think it was for each course of treatment.