NHS reforms

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.

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?

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.

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

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.

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 do hope we can at some point have a proper discussion and debate in this country about the NHS without people shutting down any discussion about alternative methods of funding to the one we have now. France has a superb system, but it does involve insurance schemes, but not in the way the US does it which is the model most people quote. Wait until you know and understand the full facts before dismissing other schemes out of hand.

I don't know what the answer is but we do have to ask the question at least and not react with just our hearts and speak of the NHS as some sort of free gift which someone wants to take away from us. I understand this terrible fear that only the rich will get good treatment, but I at least want to hear about the other options. Perhaps all those people who are so totally opposed to any other form of financing have studied all the alternatives and come to an informed decision, but there's an awful lot of jumping on the bandwagon because of a sentimental attachment to "free" care and scare-mongering about the poor being left untreated.

As someone who watched her mother suffer horribly within the NHS and only last summer watched my daughter receive excellent care in one area of a hospital but dreadful care in another, I do know that the system has to change. Many other people have sent in their stories on this site under the forum, "Am I being unreasonable?" where there is a discussion running on the care of the elderly.

If you are someone who thinks the NHS should be left as it is, please read these stories and listen to what is being said. Or if someone can explain all the facts behind other successful methods of funding as used in othe countries, then let us all know. Then we can debate and discuss.

I agree that there was a lot of waste in the NHS years ago, as there was in many public bodies. However, over the years I think that waste has been pared back to a minimum. Each year, every department in a hospital is required to make large cost-efficiency savings. It is in the manager's interest to make these savings by reducing waste, otherwise they will lose essential staff or equipment instead.
Hospitals don't receive endless funding from the Government. The funding goes to the Strategic Health Authority for the area and they commission services from each hospital & pay for them. If the SHA only commissions, say,100 hip replacements, that's all the hospital can do whether they have spare capacity or not. The SHA also give each hospital a lump sum to allow them to provide general medical/surgical services. Cleaning & other hotel services have to be provided from that budget and so costs are kept as low as possible so as to spend more on actual health care. As usual, you get what you pay for. If a contracted firm don't perform, they probably won't have their contract renewed, but you have to suffer them on a day-to-day basis first.
In a body as big as the NHS, there will always be examples of bad practice. If anyone is not happy with the service, they can make a written complaint or they can contact the PALS service for the hospital or the hospital governor for their area.
Like others, I could go on & on. I am not defending a sacred cow, just saying that the NHS is a tremendously complex organisation and there are probably more things to consider than is realised.

I know all about choice in the NHS - and I have no problem with it. Last May the problems which I had been having with my knee accelerated. I had frequently told my gp that my knee was very painful and that I was having difficulty walking. The only response was to keep on taking painkillers. I was told that I could take eight paracetamol a day for the rest of my life and that it wouldn't hurt me - in fact I didn't take any because they just didn't touch the pain. The day we were due to go away on holiday I woke up to find that I could hardly walk. Grandad's walking stick was brought out of the wardrobe and off we went on our first ever cruise. After three days I was hardly any better and went to see the on-board doctor. Fortunately she decided to take an x-ray and told me that on my return home I should see my doctor straight away and arrange to have a knee replacement. She gave me a copy of the x-ray. My daughter tried to make an appointment for me to see the gp on my return - but the only time they could offer was two weeks after we were due back, so I just turned up at the Can't wait" clinic. I saw a young doctor, gave him the x-ray and he said, "yes, of course you need a replacement". He then gave me a choice. I could see a consultant in Newcastle and have the operation done there, or alteratively the Hexham consultant comes to the health centre for consultations, I could see him and have the surgery in Hexham. My first reaction was to ask which was the best consultant (I was told that they were both good). Quick weighing up of the pros and cons. Newcastle is farther away, but Hexham was easier to get to (and cheaper to park!). They are both fairly new hospitals. Anyway in the end I opted for Hexham and the operation was carried out last October.

A friend's husband has cancer - again he was offered a choice of hospitals. After being assured that the treatment was the same in either hospital, he opted for the smaller one which was farther away but which had fewer parking problems.

I used to work in the NHS when I was first married. It was my only experience of working in the public sector and I was appalled at the waste of money - and I am not talking about small sums. I particularly remember working in one hospital when time and motion people were being employed to work out the best way for the porters to do their work. For days nothing was done properly as the porters were deliberately taking longer to do things. Now I appreciate this was all a long time ago, but that was the culture.

And, I am sorry, but what are the managers in hospitals doing if cleaning contracts are not being carried out properly? It is the manager's job to make sure that things are done correctly.

I could go on and on about the NHS - in this country it is a sacred cow and in some people's eyes nobody is allowed to criticise it. Something has to be done!

I don't think the majority of us are in the know as to actually how everything has been organised in the NHS. We have to admit that alot of cash was pumped into it by the last government but little of this was used to reorganise and make efficiencies which for me are now the most important things to be done. There must be good models in other countries which we can take ideas from - France has been mentioned.

Something which really bugs me is the 'choice' idea. Most of us have no clue as to what is best and the majority will want to go to their nearest hospital. This one option is costing unnecessary monies with added correspondence and staff resources. Theoretically you can't call the NHS free to all and to give us these options. We should trust in our doctor to send us where he thinks best.

Farming out services such as cleaning and catering were another unforgivable. Services should all be inhouse so that they can be efficiently controlled.

The one major downer of privatising services is the fact that these companies need to make a profit. The in house option for this reason has surely got to be cheaper.

Could go on but things to do!

I worked in NHS hospitals for 30 years and Katydid's post sums up my position well. For years various governments have suggested that the NHS purchase services from the private sector. This happened particularly in cleaning and in my experience it has been disastrous. I'm sure it is cheaper but it is certainly not more efficient. The workers are poorly paid so the firms struggle to recruit. Many of the people who are recruited have no idea about cleaning and receive no training. They often walk out after a few weeks so the work force is constantly changing. Maybe this is why people complain of dirty hospitals?
This is my experience of private sector contribution and I think it is nearer to the truth than a vision of BUPA-like facilities.

This was obviously a very distressing and disgusting state of affairs and we all recognize that the NHS is patchy and this shouldn't be, however, my own experience of our local, excellent is almost all ways hospital, is that when they had to outsource the cleaning, for example, it was not done efficiently or to the standard that previously existed. Private firms want to make a profit and after living in the USA for a while and witnessing, first hand, their system, I would hate to see that happen here. If you are poor, or lose your job and hence your health insurance you are on your own. Of course there is room for improvement but please not by involving the private sector.

The NHS is one of if not the biggest employer in the country. This means that certainly improvements and cost savings could be made but not in the way in which this current coalition government are suggesting.

To reply to NanaAnna, I am so pleased that you had good, speedy treatment at a private clinic; however, one has to remember that a private clinic only sees the patients it wants and may be using spare capacity as a loss leader.

Although there is no excuse for dirt, unclean wards and hospitals can be due to outsourcing of cleaning contracts where the cheapest price is taken up and there are not enough hours allocated to staff to do their job adequately.

The NHS nationally needs to recognise the thousands of people - not front line medical staff - who keep things going, often on very low wages. Constant change demoralises and demotivates.

The NHS saves lives and everyone has shares regardless of income and status.

Something has to be done about the NHS! I agree that there are lots of wonderful doctors and nurses in it, but too many layers of management. There are no incentives to improve and no room for innovation or to be pro-active. We have one of the worst records in the world for cancer survival; screening is way behind other countries and the mortality rate for infants at birth is way down the list for developed countries. The treatment of the elderly is, by and large, very poor.

Perhaps we need to look at the health service in Stokholm in the 1980's and see how they improved their health care. It was known as the "Stockholm Transition". Well worth a read!

I agree with you, this "choice" is a con. Look were the "choice" in education has got us. People don't want to choose the best treatment miles from home, they want it close to home, in a clean and well run hospital. These proposed reforms are change for change's sake, with no rational behind them, other than letting in the private sector.

I'm watching the NHS reform process from overseas. I find the erosion of services quite worrying.
In particular I'm worried about restricting services for older people who often face ageist assumptions about their needs at the best of times. I don't think Cameron's talk about choice is very realistic: Most people want good quality care close to their homes.They want to know that if they're sick or injured they will be cared for in a clean, safe environment by people who show them compassion as well as skill. They don't want cold dirty wards understaffed by demoralised and overworked nurses and doctors. How can patient care not be compromised by reductions in services?

Thank you for this. I absolutly agree with you.
The problem is not lackof resources but poor management and jobsworth attitudes.
Having worked in the private sector for many years I agree that it is entirely possible to correct many of the issues frequently complained about by patients and their families.
Unfortunatly the culture which produces these issues can be found on a national basis in many ( not all) hospitals.
Perhaps what is needed is for a hospital to be taken into special needs as schools are and a management team put in place which can turn it round?
There is enough money avaliable -if it is managed properly.
Put in Gerry Robinson!

It works here in Australia, so it should work in the UK. Our hospitals are clean and hygenic because they are checked regularly. There are probably exceptions but I haven't seen them myself.

I did once have cause to complain about a very rude and inefficient nurse who had deeply upset my very ill husband. I wrote a letter to the nursing superintendant outlining the matter and suggesting a course of action (a bit of re-training for that nurse)

I got a lovely reply saying mine was not the only complaint, and the woman had been sent on a course.

GranCentral, this is really dispiriting. My experience is that once you get to the doctors and nurses, the NHS is often inspiring and brilliant and you forget all about the rest of it. It's all the surrounding stuff that is off-putting: you can feel as though you are being processed, rather than being attended to - there's something quite old-fashioned about it.

Making people feel as though they don't matter, are just there to be dealt with, can't be good for health and recovery. Every time I have to go to hospital (or even my GP surgery) I wonder the same thing: is it possible to have a great customer service ethos inside a state bureaucracy? I don't see why not.

In a world where treatment was not free at the point of need - I would be dead.

In a world where the bottom line was the most important thing - I would be dead.

There are things about the hospital I was in that I could criticise if I wanted to, but the thing is, I am, unexpectedly, alive. Without the care and commitment of NHS staff four years ago and the NHS's willingness to invest resources to save my life, I would never have graduated from university or more importantly, seen my beautiful grandson and grandaughter.

Long may we have a universal health service available to all whether they can afford to pay for their care or not. Of course there can be improvements, but the fundemental ethos of a National Health Service must remain.

I recently spent four months in a large central London teaching hospital with my 10 year old daughter who was seriously ill (I'm also a step-grandmother). While much of the medical care was good, and the clinical staff were very kind, the hospital itself was depressing and badly run. Lots of things were broken (eg lifts, TVs, plumbing, drains), there was a lack of privacy and basic facilities like children's wheelchairs, cleanliness was iffy, tests went missing, dead pigeons lurked in the netting overhead, and there were dead flowers and uncut grass and overflowing bins in the gardens. Oh, and derelicts regularly congregated to drink Special Brew and smoke dope on the front steps.

NONE of these hugely depressing things was down to "lack of resources". It was mostly down to managers who weren't interested in getting things fixed and who always blamed the suppliers for anything that didn't work (be they lifts or contractors). When I asked to see the contracts for these goods or services they either couldn't, or wouldn't, show me. As someone who has always worked in an environment where you make sure you get value for money, and you cancel contracts with incompetent suppliers, I was very shocked.

The issue is not about public or private providers, it's about getting people to run hospitals and provide medical services who are not too hopeless to actually manage, rather than wasting our money. Billions of pounds must be thrown away, and we shouldn't put up with it. I managed to get many of the problems fixed simply by nagging and not giving up (and threatening to take pictures to send to the press in the case of the broken lift that meant that special care babies had to be wheeled along a rickety gantry past a dusty building site - yes, really. It was fixed the next day, having been out of order for months).

The nurses and doctors were at their wits' end but sick of complaining, and scared of being branded trouble makers. I would often be urged by them to make a fuss about things as they knew they would be ignored.

I wrote to the CEO and chairman of the hospital trust in question, (fobbed off), I applied to join the trust board as a non-exec director (rejected without interview, despite being a lawyer with 25 years' experience in the City) and to the Health Sec (also fobbed off). So frankly I despair of anything ever improving. In the meantime, I make sure we have private health insurance (my daughter couldn't be treated privately as only adult private hospitals offered treatment for her condition so we had no choice in her case). My husband wants to move out of London as he is so scared of ending up in that particular hospital in an emergency!

I suspect that there just as many (if not more) "fat cats" in the upper echelons of the NHS and Dept of Health, than in any private health company. I'm not saying that the NHS is all bad, but it's an utter scandal that it is so patchy and wasteful, and yet it's treated as some sacred cow that cannot, ever, be reformed. We've got to stop irrationally thinking that "public" provision is somehow morally superior to "private" and fight for better care for everybody. We've been sold short.

End of rant...

Do you know how much that private clinic is costing the NHS?

If the NHS can pay a private company to provide a service, why cannot that very money be made to improve a service that is obviously already in existence but drastically underfunded?

Why should our taxes be given to private companies to allow them to make profits and get rich or richer?

No private company works for nothing, why should they be allowed to make profiits at the expense of the British public. These companies employ cheap labour, paying a pittance in wages, which then means the government forks out with various benefits for these employees, which is a cost that is hidden and therefore not included in any figures. Nobody supervises the spending of these companies, apart from those who are most likely to benefit from the profits, and we the paying public have no say in what they spend their money on, and providing the initial contract price suits the Government purse, they are quite happy, to hand over millions of our money to them. Millions that would go a long way in improving the departments that these private companies are depriving of funds to make their own fat cats fatter.

On my way into hospital yesterday I signed the petition. We do not need to change things, that in my opinion, work well as they are.
The hospital was spotlessly clean, the nurses and doctors were excellent, and their standards were very high.
Do not trust the Tories with the NHS - end of!
My son has already lost his job due to the Government cuts. We need to keep our National Health Service intact so please vote against the cuts/changes.

Bring back the Matron I say!

Let's not jump on the bandwagon. There is some merit in these changes IF they are taken slowly and thought through. I recently was sent to a private clinic for a scan by my GP. Why? Because they could do it in under 6 weeks (the wait at my local hospital) and because of cost - it was much cheaper. The service was first rate, the appointment was on time, the nurses were professional and the clinic was clean.

Compare that with my maother-in-law who suffered at the hands of the NHS - a dirty ward, her pleas for a bed pan ignored and during her stay she became dangerously dehydrated.

France has one of the best health services in the world. If the government takes their system as a model we wou;d all benefit.

Yes, by all means protest the changes but please make sure you understand exactly what is being proposed.