Safe in whose hands?

I agree with you ayse. I feel the "market" and some degree of privatisation has a place, but it's all gone too far and has become a cash cow for many who couldn't give a toss about the quality of healthcare or education.

I sympathise with your friend and, of course, his late father and agree. I've seen for myself that the quality of nursing staff is variable to say the least.

Nevertheless, I don't see that a change of government would change that. Maybe the target-driven culture of the NHS could be changed, but then people would probably complain about the lack of "efficiency". I'm not altogether sure how a whole health system should be judged.

When I was in a world-famous hospital after a heart attack, the treatment and care I received were excellent. I doubt if it would have been better anywhere in the world. The speed with which I was transported to hospital was phenomenal too, with emergency paramedics already diagnosing a heart attack and preparing me for surgery.

However, after the first 24 hours, the care definitely left something to be desired. Staff weren't available and were often off-hand, I couldn't be provided with low carb food and medications were sometimes late or even missed. There was no transport available to take me home and I wasn't allowed to use a taxi on my own and there was no public transport. I was told to make a GP appointment as soon as possible to continue with necessary prescriptions, but I couldn't get a GP appointment for five weeks and there were no community nursing or home visits. I had also been told not to drive or walk too far, but the GP surgery is beyond the distance I was supposed to walk.

It seemed to me that the root cause of most of the problems was lack of staffing, which is caused by underfunding. That's why I've recently joined a patient panel organised by the CCG. It might not result in anything, but at least I feel I'm doing something other than whinging.

There is also huge inequality and growing in the UK.

Just been watching Dominic about the ambulance service in Austen, Texas. He is travelling with an ambulance service run by a not for profit organisation sponsored and supported by the local authority. All the income is reinvested in the service but he pointed out all care has to be paid for with many facing out of pocket expenses, even if they have insurance.

I’ve never understood why nursing banks are outsourced. It’s the same with teaching. In the 1960s the LCC employed both permanent and bank staff. The supply teachers were paid at a slightly higher rate to compensate for lack of pension provision. It worked very well.

The NHS is certainly a knotty problem but with creative thinking and adequate funding solutions could be found that excluded “for profit” organisations.

I agree with you Nonnie. In some cases, outsourcing is better for a big organisation such as the NHS. There's a fixed price for a fixed contract and the NHS doesn't have to take the risk of employing people, who might not always be needed. However, it only works for some kinds of contracts and the NHS gets left to deal with emergencies and seasonal surges and the more complicated and ongoing cases.

My personal view is that some degree of flexibility is fine. However, there are disadvantages, such as employment contracts for workers, changes in procedures which need to be embedded, the temptation to cut quality to undercut prices and many more. I do not accept for one moment that private is necessarily best. My biggest concern at the moment is the privatisation and "distancing" of GP services.

We should all be very wary of further involvement of US healthcare and insurance services because American providers just do not have the same ethos about universal healthcare. It's possible that we'll see privatisation on a totally different scale.

Not all nurses are kind, caring people. Yesterday I heard from a friend that he had gone to visit his very sick father in hospital. He was handed a drink which he wasn't able to hold. His son rang the bell to ask for a straw, no one came. Eventually he asked a nurse on the other side of the ward for a straw and she told him she didn't work on that side. She then berated him for not getting it himself and said his father was nasty. When he eventually spoke to a nurse on the 'right' side of the ward he was told how lovely his father was. Today I heard that his father died yesterday.

Sorry, I know it isn't relevant but I feel like sounding off on his behalf. How was he even supposed to know where the straws were. He had travelled from Belgium to support his father and said the health service in Belgium is far superior.

MaizieD Mon 11-Nov-19 17:27:57 if that is the case surely it is the fault of the NHS? When I outsourced contracts I did so because it was better for the company. I included KPIs and monitored the contract. I don't think we can blame private providers.

growstuff Mon 11-Nov-19 23:43:29 I didn't notice who mine was from but if the NHS paid for it then it was still a waste.

The trouble with QE money was that it found its way to financial institutions, who were "too big to be allowed to fail", who then did make money out of it by lending at high interest rates and paying themselves huge bonuses.

Exactly Maizie. Government bonds are a safe, reliable form of borrowing for people with surplus cash. If people/organisations/governments didn't need to borrow, people wouldn't be able to earn interest.

There are, of course, limits because the money does have to be paid back.

Only if it has been 'borrowed' by issuing government bonds which offer interest and can be redeemed after a certain period. (And which are used by many people as a savings vehicle- nice reliable income from the interest and guaranteed return of principle). A great deal of the QE money was created by 'numbers on a computer' and is 'owed' by the Government to the Bank of England, so, in effect, the govt 'owes' it to itself. That isn't going to get 'paid back', is it?

Oh yes, that is a huge outlay and in fact we knew of some permanent staff who are also registered with agencies and work back in their own departments during time off.

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And of course the communist countries with the ruling elite having the best that money can buy and t’others not so much!

PS. It's not just developing countries with huge inequality - look at the US!

Yes, it is and it's a political choice.

The choice is between having people looking after "number one", which some can afford to do, or having shared responsibility for everybody in society.

I've always seen that as the main ideological difference between conservatism and socialism. My personal choice is for a balance of the two.

Ask yourself whether you'd rather live in Norway or a developing country, where there are pockets of very wealthy people and huge numbers of people in dire poverty.

We do hear a lot of praise for the Scandinavian countries and their public services; however, I do know that their rate of taxation is much higher than ours.

There's a 30 minute podcast on the Guardian about the NHS. Maybe worth listening to, if you have a chance while having a mid-morning cuppa.

www.theguardian.com/society/audio/2019/nov/12/is-the-nhs-up-for-sale-at-the-election-podcast

BTW Maizie is right. The UK, as a country with a sovereign currency, can pay for whatever it wants. There are, of course, limits because the money does have to be paid back. That's going to be in terms of paying interest to lenders (and there's no shortage of people who want to lend to the government), but also in terms of higher customer satisfaction. With health, there are likely to be some savings if people are treated more quickly because they won't need to take time off work, they'll need fewer appointments, less GP and social care, etc. Delays in treatment can sometimes result in people ending up on benefits or taking early retirement. It's not a simple balance book exercise.

We DON'T need an increase in taxation. The government, via the Bank of England, is able to issue as much money as it likes. Where do you think that £240+ billion of Quantitative Easing has come from? QE that saved the banks from ruin in the 2007 world financial crisis. QE that's been paying for bribes to the DUP and the millions that is being spent on Brexit?
It didn't come out of taxation and most of it wasn't 'borrowed'. It's just numbers on a computer.

We can finance the NHS with no problem.

Worth reading

www.progressivepulse.org/uncategorized/the-household-fallacy

There just won't be a decent NHS without proper funding. We need to accept that an increase in taxation is needed. The main problem is that it's a victim of it's own success - as so many of us now live very long lives!

MaizieD I think it is cheaper. Hospitals have targets for waiting lists. Once they reach a certain length, hospitals are under pressure to do something about it. The choice would be to recruit new staff (not just surgeons) and open new operating theatres, etc. They'd then have those people on their staff and would have to pay all on-costs. IT's almost certainly cheaper to pay a package to do a defined number of ops. Things like cataracts and hip replacements are common ops and relatively quick and cheap, if you have people who only carry out those procedures - it's like a production line.

The downside is that if there are problems, the hospitals then get left to pick up the pieces because private hospitals don't usually have the facilities for emergency and high dependency care.

I'm not sure the consultant is able to choose. My understanding is that certain ops are outsourced once the waiting lists get too long. I don't think it's the consultant's choice.

I too had my second knee replacement ‘outsourced’ in a private hospital. The nursing staff said my consultant preferred it that way as the nurse/patient ratio was three times better (an average of one to ten patients as opposed to one to thirty). Better nursing meant better healing, less infections, quicker recovery, etc. It’s difficult to assess the cost to the NHS to outsourcing when so much needs to be taken into account.

Government spending is not paid for out of taxation. This is a myth, it is untrue. It has, however, been a most convenient lie to justify cutting public investment to the bone.

Government could spend whatever it wanted to on the NHS.

As Growstuff pointed out on another thread so many don’t pay tax or NI and that could bring in more for the service. It still needs to be spent wisely of course but that’s another story!

With regard to lagging behind Europe you will find that in many European countries those who can afford it pay for health care and their taxes and National Insurance contributions are higher. Maybe that is the answer.

It can be cheaper for the NHS to pay outside providers rather than having to employ staff itself.

Now, that's what I was looking for yesterday. Is it cheaper?