NHS reforms

In response to an earlier post - yes, France does have a fantastic health service, but it is very expensive. Social contributions (equivalent of National Insurance) are very high and in addition we (couple in our sixties) pay a top-up insurance, which costs us 120€ a month. There is considerable disquiet here about how the country can continue to pay for the health service.

I think this discussion is mainly about variable quality of hospitals and about choice. Choice, introduced by the last government is a good thing. It allows us to elect to go further away to a better hospital or one with special expertise rather than go to a local mediocre or jack of all trades facility. Even on an emergency admission I have seen this: "Of course she can go to wolverhampton not walsall if that's what she'd want"

The NHS reforms proposed by the government don't seem to be addressed at getting better hospitals. They are all about "commissioning" by GPs and getting rid of PCTs if I understand it. It's a system that ain't broke. It is working better than it ever has. It will probably get worse at least for a few years and may never be as good again. The private provision horse has bolted - a bit of a mess up by the last government I suspect - but too much of this threatens the viability of NHS hospital. You can only maintain expertise as a surgeon if you get to do the operations. You can only recruit good staff if you have the challenges to tempt them. That "reform" word is easy to say and sounds like a good thing - but it is one of those weasel words that politicians use.

I guess the "reforms" are about cutting the costs of PCTs - but the GPs are going to have to pay someone to do all the paperwork. And the majority of GPs don't want it. It will inevitably cost a fortune in terms of whitehall salaries to make it happen. Most of the civil servants are paid to run round in circles trying to implement changes that ministers want.

"Reforms" are also a bit distraction from the important issues addressed above re management of hospitals. Busy, busy, busy "reforming" the NHS while hospitals still fail to deliver good care to elderly, frail and ill people. See the thread on this under "the am i being unreasonable " heading.

Anyone got a clue how NHS reform Mark 2, as per yesterday might work?
If so could you explain.

In my opinion the NHS is only being compared with the system in the USA. Why look over the Atlantic all the time? What about Northern Europe? Here in Germany the health service is private but everyone has to pay into it who earns less than a decent monthly salary. The rich can opt out if they want.

The big difference is that we pay far more for our service than the people in the UK. No one is turned away from a German hospital or a doctor if they are in need. I once worked in a Women's Refuge and accompanied a Polish woman into hospital to have her baby. She had no health Insurance card but I was told such cases are catered for.

I am amazed that well off pensioners in the UK pay nothing into the NHS, whereas we still pay monthly but not as much as when we were working. The working population pay 1% of their earnngs into a fund for the care of the elderly which is then payed to the people needing care or to the carers. ( it is something but often not enough)
I also think that doctors, like every educated person should be allowed to have the freedom to be self-emlpoyed and make their own decisions. My own daughter was a self employed midwife which is usual in European countries. Why not?

The attitiude here in Germany is that you have to take responsiblity for your own health. You get no written reminders of appointments, and in my local hospital there is only one little office for admissions. All the paper work is done by the health Insurance office and blood tests etc by your GP.
We don't have huge hospital waiting rooms for examinations, they are done by local doctors who have 'specialised' . The only people waiting in hospital are those undergoing operations or the after care etc.

I landed in A&E in Rotherham after a slight car accident. It was like going back to the 50s! The doctor couldn't Xray me nor take my BP. Nor could he make a copy of the form he filled in which I needed for my German health Insurance Company. I had a bruised rib and trauma and thought I might need physiotherapy later. He let me go with the advice to take two Paracetamols.
Not that the Germans don't complain. They just don't know how lucky they are and I suppose it is the same with the French and the Scandanavians. Nick Clegg is a true European, he lived in Germany and knows that other systems work better.

Well they say you get what you pay for expatmaggie. You get an Audi and we get a Ford.

There is nothing to stop self employment in health professionals in the UK. In fact GPs are all self employed - they are not employees of the NHS. There are also private midwives etc if people want to pay.

A and E is often not very life-affirming as it is a walk in service as well as a service for serious emergencies. The aim is to deal with those at death's door first as they come off the ambulances and the less urgent cases have to wait.

Doctors conference today still very unhappy about the NHS "reforms" - seems to be a smoke screen for financial cuts but Dave doesn't want to be seen to be an NHS baddie because he relied on the NHS when he had a brain damaged child in his family. And he promised to look after it.

(is anyone else fed up with the BBC showing the same clip of Dave with his tie tucked into his shirt, walking down the same hospital corridor every time they have a news item about the NHS?)

I just about understood the idea of commissioning before - but as of yesterday the smoke screen even thicker and more murky. The idea of commissioning is that someone acts on behalf of the patients to buy the services they need. The PCTs or whoever (the GPs under reform mark 1) are the purchasers and the hospitals are the providers. Now they are talking about hospital doctors being involved in commissioning - how can that work? They will be pushing their own agendas. Any thoughts or beams of light through the mists anyone?

Well I've learned something that the GPs are self employed. However the services of a self employed German midwife are free.

I had one baby in England and one in Germany. That was 1965 and 1970. The sad thing is that then the NHS was so much better than the German system. More modern, more patient friendly; rooming in, which had been introduced in England was unknown in the German clinic. It is the intervening 40 years which are the scandal. How a good service has been allowed to go into decline.
I don't understand what comissioning is either. It sounds too complicated to work.

The potentially disastrous health bill is being debated. It is going to remove all democratic accountability for the provision of healthcare, including that which rests with the government.
It will also introduce a postcode lottery, of nightmare proportions.
For legal opinion follow the link.

www.38degrees.org.uk/

I have just sent this link and brief comments to my MP via the website WriteToThem - it only takes 5 minutes. Come on gransnetters lets lobby.

The bit of the NHS I know about has, over the period the last government was in power, added layer upon layer of self serving "managers" while not having enough money left to pay for treatment for patients who are actually in need. My GP is in favour of reform and I know him to be a really "professional" person so, while not really having a fantastic grip on what the proposals mean, trust in his judgment. We, or at least the PCTs, seem to have lost sight of the fact that most people who work in health care are genuine, caring people trying to do a good job.

HI kittylester. Do you think it is right though that the NHS should be completely removed from any democratic control or accountability? Which seems to be the plan. Just cut it loose and let the devil take the hindmost - those who live in areas with less competent consortia.

Well, I might trust my own GP, but I am not sure I should trust all of the others too. Anyway the BMA is against the reforms.

expatmaggie Well-off and even fairly okay pensioners pay tax here and general taxation is the source of NHS funding. National Insurance is a spurious tax (not ring-fenced but just goes into the general coffers) that is supposed to cover pensions, unemployment pay and other so-called benefits and pensioners don't pay that.

Hi Jess - I doubt that there will ever come a time when the NHS is completely removed from any accountability - genies don't readily go back in bottles! As I said, I think we should respect and trust the GPs and if consultants etc are included in the consortia maybe they will understand the real needs of the community rather than have their working practices dictated to them by people who have absolutely no hands on experience! I have heard patients referred to, by managers, as "units". These are people not blinking units!

I dont doubt future sec of states will come under pressure re health. But maybe the job won't exist... You can see the effect with the railways and the privatised utilities - they are not supposed to be under govt control but they keep on trying to get involved and coming under pressure re railways, fuel prices etc.

You have obviously had good experience of GPs. MY MIL lives in a relatively deprived area of the midlands and she has had terrible service from hers over the years. She has been living with my SIL in a much more affluent area for the last 9 months and the GPs are so much better there, you would not believe. It is, literally, like going to a different country. (But why wouldn't the best GPs choose to live and work in the nicest areas... ) Under the new system I think the better off areas will get an even better service.
Under the new model, nobody will take those tough decisions that have to be taken if you are to have a modern cost-effective health system. I used to live somewhere that had two hospitals and two A and E departments. Against opposition, one of them was, effectively, closed. As you an I know if you are to give a 21st century service and recruit the right quality consultants, someone has to make those choices. Who will do it under the new system? No-one will have the power. Takes a long time for "market forces" to close down a third rate department or hospital however you structure the market.
And post-code lottery-ism is going to go crazy with all the consortia setting their own priorities.
I cant see how the "reforms" are going to get rid of your excess managers either - maybe it will increase the admin/management load in hospitals even. Wouldn't surprise me.

I am not sure what the reforms are supposed to achieve, but I do not think it is more equal health care.

I do not trust individuals to exercise their judgement on my behalf, even if they know better than I do. If they could be relied upon to use their powers for my good, it would be different. But one reason for having democracy is the sheer weight of evidence that shows that power is inevitably abused sooner or later, and that "experts" can abuse it as enthusiastically as the talentless.

If we must have the situation where the Secretary of State (him/herself not directly elected anyway) can shed the responsibility of providing adequate health care free at the point of use to all UK citizens, then at the least we should be allowed to elect directly the person/people who take on that responsibility.

GP consortia do not exactly meet that requirement.

The majority of us are on the outside looking in and the odd medical experience doesn't qualify us to vote on the currently proposed reforms. The NHS is such an unweildy organisation and it will take grit and determination to reform successfully.
Some way back on this thread somebody suggested France's sysyem to be a good model. There must be somewhere in the world that can show us how to do it!
This current period of dithering must be very demoralising for all involved in attempting to deliver a quality service - and I would like to add that this is the one desire of the majority working within the NHS.
All of my family, up until now, have everything to be grateful for from their experiences with the NHS. My sincere wish is that thorough reorganisation results in good clinical results with a necessary economy which is not damaging.

Sorry to hear about your MiL's experience, Jess, but maybe things would have been different if a consortium had been in existence. Lots of the best healthcare professionals choose to work in the worst areas to do the most amount of good. As gangy said, most people don't have anything but outside experience and something has got to happen to stop all the money wasted paying high wages to "managers" but making nurses redundant and then running out of money to pay for essential treatments.

Gangy - what qualifies the MPs to make these decisions?

kittylester - can you explain how the current "reforms" are going to decrease the numbers of hospital managers?

Ask your MP if he has private healthcare???

Hattie64 I don't personally know my MP but, if she does have private health care, that is surely her choice.

JessM there are more 'managers' in the NHS than just those in hospitals -PCTs are overrun with them in various guises.

I seem to recall that before the election the Conservative party said that it had no plans for major changes to the NHS. Once in government, Andrew Lansley announced his fully formed plans but has never explained truthfully why the NHS needs reforming as opposed to improving and what those reforms are supposed to achieve. Introducing a market economy into something that is fundamentally a service has failed in the past and there is no reason to believe it will succeed now. I am convinced that this is privitisation by the back door.

You are right JessM that polititians don't have the know how to make these decisions. One can only hope that they are consulting thoroughly with all those in the know in the NHS because this is where, a failure to do this results, in deep set dissatisfaction amongs the workforce - consultation is the name of the game!!
To be honest, I think that a few people like ourselves, involved in the shake up, could come up with some good ideas - simply because we are looking in from the outside and aren't hindered by politics or other inside forces!!

Being a food professional and after a stay in my local hospital I volunteered to go along and suggest what was going wrong with the catering. As with most things, guided by a little commom sense, problems were easily ironed out and at no extra expense.

I suspect that PM declared that they were going to be a reforming government and that all ministries had to come up with some form of "reform" however hair brained.
kittylester I know there are lots of wonderful, dedicated professionals in the NHS. many of them are doctors and some choose to work in deprived areas.
Equally there are some lazy, uncaring so-and-sos who are only in it for the money. If we are to believe the Daily Mail today, some are even defrauding the NHS.
Some of the dedicated professionals are even managers. I think the reforms will just re-create bureacracy (the GPs are going to have to employ managers to run the consortia, so all the PCT staff will probably end up with new jobs) - in the hospitals they will probably need more managers and administrative staff, because they will not be working in a single system any more, with all PCTs working in the same way.
I don't think that saying, basically, "doctor knows best" is a very convincing argument to reassure people that it will all come right in the end. There is going to be a huge outcry about postcode lotteries in 2-3 years time and in about five or six years time some government is going to be spending time and money on unpicking it. Or trying to.
A truly reforming government in my book would put a freeze on legislation and spend a while just concentrating on the management functions of government. The money spent on implementing new laws (in terms of civil servant salaries) is astronomical.

It is not true to say that all PCTs work in the same way. I know that the two round here duplicated systems and staff but interpreted things in entirely different ways causing great confusion among the healthcare professionals and, as I said before, then they run out of money to provide patients, particularly the elderly, with fairly basic help. That can't be a good system.

I'm sure they do run out of money, but why should we believe that PCT mark 2 run by GPs is no going to do the same. I can't see any way in which it will improve things and fear they will be a lot worse. What I meant is that NICE set nation wide standards about what NHS will pay for at the moment and that is going to be replaced by a free for all. If you are a hospital dealing with several consortia all of whom are willing to pay for different combinations of drugs, is that not going to increase bureaucracy? The poor hospital doctors are going to be tearing their hair out asking patients which consortium area they are in before they can make a clinical decision on what to prescribe.
Or have I got this all wrong...