Is our NHS already lost

I don't think doctors should pay, but I see no reason why private providers using NHS trained staff shouldn't pay something towards that training. So perhaps a sliding scale- doctors employed with 5 years NHS training, x amount paid, 10 years training 2x, and so on with a consultant costing the provider most. A similar system to apply to nurses.
After all if the NHS uses a private operating theatre they have to pay for it.
The alternative is for private companies to fund training and allow training in private hospitals.

What I meant, maddy, is that if a law firm sends a lawyer to a client on secondment, there is an agreement that if the client approaches the lawyer to employ them within a certain period, they have to pay an agreed sum to the law firm. It’s not unusual for a company to have a lawyer on secondment then offer them a job.

I didn’t know about law firms paying back for poaching trainee lawyers GSM. However it doesn’t work like that with barristers. After pupilage barristers apply to work through a set of Chambers and are accepted and commence work. They pay their Chambers for the ‘rent’ of their room and the clerks at the Chambers sort out to the work according to the level of expertise of the barrister. As the barrister gets more experience and years under his/her belt, the fees that he/she pays to the Chambers rises and becomes a very large amount. On the other hand, solicitors are employed.

With regard to doctors, they pay university fees at the same rate as every other student whilst they are based at the university. The final two years of their course, they are engaged in clinical practice. In other words they are working in the hospitals. For this reason no fees are payable. They will be engaged in the type of work that junior doctors engage in. Sometimes they will be observing, other times actively practicing medicine. Then as a qualified doctor, they work as F1 and F2. This is two years work in general medicine, and so means they do a variety of rotations in the hospital. Then they can choose to train in a specialty, or continue to broaden experience by applying for a variety of short term contracts, usually six months to a year.

My point is that doctors work in the NHS for a minimum of four years, and usually longer before they can offer their skills to a private medical provider. Indeed most who choose to do so work between the two systems. They work contracted hours in the NHS and additionally do some private work. Doctors have paid their dues to the NHS and have no need of further payments to private providers. I’m certain that solicitors who are ‘poached’ are not working across two systems or two providers, and consequently are not comparable. Additionally, when doctors work in the private sector, the patients they treat are normally taken out of the state system and therefore do not cost the state anything. A hip replacement paid for by the patient no longer needs the treatment by the NHS. How does this in any way compare to the situation that solicitors work under when they change from one office to another? The reduction in treatment to private patients by the NHS is in itself payment enough without further payment. Any other payment would simply be politics of envy in practice, rather than a celebration of shorter treatment lists, which are more than long enough already.

The NHS is owned by the state; doctors are not owned by the state and are free to offer their expertise to any provider, including providers abroad.

I did go "private" because I was in so much pain. It was a very pleasant experience, but very costly. I have a pinched nerve at the bottom of my spine, which makes me cry with pain. I have not found any painkillers that can deal with it! It cost me more than £1,000.

Yes, all students here pay for their courses, at pretty much the same rate for all subjects. Medics pay the same as other students, although their courses are longer. A typical Batchelor's degree is three years with an extra year for a placement in some cases, and a lot of people go on to a Masters after that, so many students study for 4-5 years, depending on their course and if they need a Masters for their career.

Don’t your medical students have to pay for their courses? They certainly do here, very ,very expensive. It is taken out of their wages when they start earning.

Yes, it’s intended to stop firms benefiting from a secondment to poach the secondee and is entirely reasonable. I don’t see why a private company shouldn’t be charged a levy for employing an NHS trained doctor or nurse within X years after qualification.

Actually, now I think about it, I think the deal was that if he went to work for a company to which he'd been seconded during the contract or within 6 months of it ending there would be a levy. The levy itself was more, if memory serves. It was enough to be a deterrent, and it was touch and go as to whether the new people would get the budget to cough up.

Also, I talked about a levy of 6 months' salary being paid to 'poach' staff in private industry - in the sector where my son works, at least. I'm not saying that he had to work there for six months - at the level this sort of thing kicks in people need to have several years of experience behind them.

I can't remember how long he had to stay with the sponsoring company, as it was a while ago now, and he wasn't looking to leave. It was years rather than months though.

Exactly, GSM.

And maddie, I am not proposing that medics should be singled out. It is, as GSM and I are saying, normal practice in a lot of sectors, but in any case it is the private providers who should pay, IMO, as they are the ones making a profit out of taking state-trained staff out of the system,

It’s absolutely normal, if seconding a lawyer to a client, to provide for a compensatory payment if the client poaches them within a given time, also for an employee to be required to repay sponsorship costs if they leave the sponsoring employer within a given time, Employers spend a lot of money sponsoring would-be lawyers through law school and thereafter training them.

That’s interesting Doodledog because none of the people I know who have worked in the private sector have been subject to such conditions, but as you’ve mentioned it, it does ring a bell and so I must have heard about it somewhere along the way.

However, doctors (not speaking nurses here) work in the NHS during their final two years of clinical experience (last two years at uni) and then they do F1 and F2 years in NHS hospitals. They then decide to train for a specialty (on the job training, so still working) or to take on a variety of placements to broaden their experience, all in the NHS. My own daughter did F1 and F2, a year in Mental Health, and then GP training, all in the NHS and therefore she was working in the NHS all that time. In total she worked for fourteen solid years in the NHS. You talked about six months in private industry. Do you think that she owes a lifelong commitment to the NHS? Maybe six months would be enough as it is in private industry? I don’t think she owes any of us anything. I think she’s paid her dues.

We cannot have a system whereby doctors and nurses are the only people not allowed freedom of choice in their employment. It’s discriminatory and unfair. The fact that we don’t have enough doctors is not down to doctors, it’s down to government. Anger should be directed at government, not doctors, nor nurses, nor private health care. Private healthcare provides a service. If people choose to pay it shortens the waiting list for others. Consultants are contracted by the NHS to work whatever hours the NHS requires. If consultants and others choose to work privately in addition that is their choice and nothing to do with anyone else because those consultants have worked years and years and years, not six months!!! In the NHS.

Additionally to say that training a lawyer (by that I assume you mean the three year university course of Jurisprudence, which is merely a degree and no where near the full training, which commences after university) to say that a degree at Oxford where classes are individual, or in tiny groups, is not as expensive as teaching in huge groups in lecture theatres is simply wrong. Oxbridge is our most expensive method of teaching at university level because of the numbers.
Like for like, it will absolutely cost more. But the differences between the cost of people studying say, Engineering, Biochemistry and History is that the engineers will have lab equipment to test things like centrifugal force and other concepts beyond my ken, specialist software and so on. The biochemists will need chemistry labs and animals (with associated staff), chemicals and costs of trials and so on, and the historians will need books. There may be better examples, but those come from my immediate experience. Clearly, a History course is significantly cheaper to teach, whether the classes are large or small.

I am not going to argue about the difference between jurisprudence and full legal training - it doesn't matter to what I am saying, which boils down to the fact that course costs are not equal, although fees are, and one subject subsidises another. I think that's fair, as otherwise there would be expensive courses that are only available to those who can afford them. Medical degrees are extremely expensive, and the only reason I mentioned it in my post was in response to you saying that doctors and nurses pay fees like any other students. They do, but their training is massively subsidised.

IMO that is as it should be, as the country needs them, so that subsidy is an investment in our collective health and well-being; but when companies who have not invested a penny in the training (towards which we have all contributed) cream off the fully qualified staff to treat patients who can afford high fees, and then refer them back to the front of NHS queues when they need further treatment, then IMO it is taking the proverbial. I can see no reason why those companies should not be asked to pay a levy towards training the people needed to replace the ones they have 'poached'.

My son works in the private sector, and when he moved from one role to another his employer had to pay such a levy, as the previous role involved seconding staff to clients, and the deal was that if such staff were 'poached' it was at a cost of 6 months' salary. Earlier in his career he was sponsored by an employer through postgrad professional exams, on the understanding that if he left their employment within a set period he would have to pay back the costs. That is not an unusual scenario in the private sector, and I don't see why it should be different in the public one.

Doodledog

Oh, and of course the main reason why people feel invested in the NHS is because our health and potentially our lives are on the line.

I absolutely understand this Doodledog. I am actually waiting for an appointment myself to see my hand surgeon as I have an extremely painful hand. I won’t bore you with the details but our local hospital have been the pits, on the other hand my GP fantastic. She arranged the tests that she could arrange very quickly and efficiently, but all were negative and now I need further investigation. It’s annoying that the hospital are being so useless at arranging a simple outpatient appointment, and they blame the new IT system and anything else they can. It’s annoying and infuriating, but it’s not the fault of the doctors.

Of course people feel invested in the NHS Doodledog because that’s our health service and of course we pay for it through our taxes. But we also pay for our education service through our taxes, and citizens are entitled to be educated from age five through to university if they so wish. I didn’t hint at any degrees being ‘inferior,’ that must be your interpretation about what I wrote. Nonetheless no one is able to say why it’s okay for people to go to university (and yes, they all pay fees now) and benefit both themselves and the companies they work for, but do not owe anything from themselves or from their companies, back to the country. It’s been glossed over, so I assume must be thought to be fine. So companies can make vast profits using staff with degrees, and not put anything back into society, in fact in many cases taking huge bonuses for themselves, and that’s fine apparently.

Additionally to say that training a lawyer (by that I assume you mean the three year university course of Jurisprudence, which is merely a degree and no where near the full training, which commences after university) to say that a degree at Oxford where classes are individual, or in tiny groups, is not as expensive as teaching in huge groups in lecture theatres is simply wrong. Oxbridge is our most expensive method of teaching at university level because of the numbers.

When a mother gets a degree and goes to work for a private company the company doesn’t ‘pay back’ for her education, it merely makes a profit. When that mother has a baby, we, the tax payers, pay towards her childcare so that she can return to work. The company which is making a profit from her work, isn’t even asked to contribute towards the childcare (although there are a few workplace nurseries in this country.) I simply cannot see the difference that is being drawn between the examples I have given and medics. Therefore I conclude that there is a ‘blind spot’ when it comes to medics, especially doctors. People are emotionally unable to rationalise because our health is an emotional subject, and especially when we see medical services at rock bottom as they are now. This is caused by the government, not by medics opting to work elsewhere, in either this country or other countries. Thankfully the general public can pontificate on this subject till the cows come home, but they cannot change the status quo. Medics are as free as every other person in the population to sell their labour to whosoever they wish. There is no reason to discriminate against them.

Oh, and of course the main reason why people feel invested in the NHS is because our health and potentially our lives are on the line.

University funding is a lot ore complicated than how many students are in a class, though. I can't pretend to know enough about different courses to be able to say which cost more, but I know that when students need equipment, placements, supervision and so on they cost a lot more than ones who are taught in classrooms or lecture theatres.

I would guess, therefore, that training a doctor costs a lot more than training a lawyer, whatever the staff/student ratios. As for the people hinted at as taking 'inferior' degrees - the odds are extremely high that these will not cost much at all. They wouldn't exist otherwise, and in many ways the students taking them are further subsidising those on equipment-heavy courses who are charged the same fees as those on book-based ones.

Also, the reason why people feel that they have a stake in medical staffing issues is because not only to they/we pay for the training, but also for the NHS where we assume medics will work, and we expect that our investment will be repaid by having the right to prompt and appropriate treatment, free at point of need and delivered when we need it. Nobody expects that of a vet or a lawyer, as we are not paying for veterinarian surgeries or legal chambers out of our taxes (legal aid, shamefully, having all but become a thing of the past).

When companies spring up making money by taking the staff whose training has been sponsored by our taxes out of the hospitals that have been paid for out of our taxes, and charging more than most people can afford to get treated by them, then yes, people complain. I don't see why that is difficult to grasp, really.

maddyone Just because you are a medic's mother does not mean that you are the only one who understands how medics train.

I still think it's reasonable to expect private healthcare companies to contribute to the training of the people they employ. I believe companies over a certain size have to contribute to the apprenticeship levy.

MaizieD

^But none of this has anything to do with NHS funding.^

You're right, growstuff, it doesn't. But my original point was in response to GSM saying that private companies can provide new treatments. My contention being that if the government invested in R &D of new medicines and treatments then it would be well placed to introduce them into the NHS without having to pay private companies to undertake them.

Not to mention the attraction of top talent to well funded R & D programmes and the prospect of exporting the results of successful programmes, rather than having to import from other more farseeing regimes...

I have to admit that I found it a rather bizarre idea that private investors should be the arbiter of what is worth developing and what isn't.😱

I agree. It's very bizarre. For example, most young women are now vaccinated against cervical cancer, which not only saves the NHS money in the long term but prevents deaths and unpleasant treatment. In other words, the female population gain. Why should any private company have to fund that? It's a public gain, so the public (via the government) should make the investment. It's the same story with most childhood diseases, which used to kill people. Or cancer? Or childbirth? Or heart disease? Or anything?

Medical research isn't like doing the lottery. As I explained in my previous post, scientists work for years on developing new techniques, share the information and then somebody latches on to it and develops some new treatment. It's not like investing in a new company and expecting quick returns. Only the government - and some of the huge pharma companies - have the resources to make the investment.

Unfortunately many people do not understand the way doctors train. They think that because medics are trained by the NHS that either the medics, or their employers owe something back. They don’t and they shouldn’t. We as a society do not own medics just because they work in our much valued NHS. Anyway, medics are only partially trained by the NHS. Their initial training is in university. My daughter went to a London school of medicine which usually recruits over 300 students to the Medicine degree course per year. This means that most of the teaching is done in large lecture halls with many students. On the contrary, my son went Oxford University to study Jurisprudence. He was one of 8 students in his year and the teaching was totally by 1-1 tuition or by 1 - 2/3 tutorials. So which is more expensive? Obviously the Oxford model. When he graduated and later qualified as a barrister no one at any point complained that he needed to ‘give back’ to the state in any way any of the expensive cost of his education. Nor was he expected to work as a low paid criminal lawyer in order to ‘pay back’ to the society which had paid for his education. Nor were his Chambers required to pay the state any costs for having enrolled him to work as a barrister from their organisation. Similarly my other son works for a private company as a financial director. Neither he nor any of the companies he has worked for have been expected to pay back the state for his expensive University of Wales education. On the other hand, my daughter worked for no pay at all in a variety of London hospitals for the final two years of her medical training whilst she was still officially a medical student. Of course she wasn’t doing open heart surgery as a medical student, she was engaged in routine tasks similar to many junior doctors, and she was able to observe and take part in specialty areas such as surgery. She then worked in the NHS for her two Foundation years. She continued to work in the NHS for an additional twelve years before leaving for New Zealand. She’s owes none of us a single penny, and had she decided to stay here and do a bit of private work, nor would the organisation owe any of us a single penny.

The most expensive degree course in this country is Veterinary Science. I haven’t noticed anyone thinking that vets should ‘pay back’ or their employers should ‘pay back’, and yet everyone with an animal benefits from this expensive education.
Oxbridge is well known for the expensive education it provides but I don’t see anyone claiming that Oxbridge educated students should ‘pay back’ for that education, nor that the companies they work for should ‘pay back’ for the well educated young people they employ. This suggestion is only ever made with regard to medics. Why? Because people think that somehow a doctor owes them something. But they owe you nothing. No more than any other university educated young person, or the employer of the young person, owes any of us a single penny.

Nusgranny

Germanshepherdsmum

The map is very misleading and alarmist. For instance in my area two prisons are flagged up as well as my large local hospital which has a contract with a scanning company.

That's because they are using private providers to provide their care. The whole point of the map.

So if one very small section of a large NHS hospital is put out to private contract, eg scanning, then the whole hospital is included on that map as a private enterprise.

Misleading.

Germanshepherdsmum

The map is very misleading and alarmist. For instance in my area two prisons are flagged up as well as my large local hospital which has a contract with a scanning company.

That's because they are using private providers to provide their care. The whole point of the map.

But none of this has anything to do with NHS funding.

You're right, growstuff, it doesn't. But my original point was in response to GSM saying that private companies can provide new treatments. My contention being that if the government invested in R &D of new medicines and treatments then it would be well placed to introduce them into the NHS without having to pay private companies to undertake them.

Not to mention the attraction of top talent to well funded R & D programmes and the prospect of exporting the results of successful programmes, rather than having to import from other more farseeing regimes...

I have to admit that I found it a rather bizarre idea that private investors should be the arbiter of what is worth developing and what isn't.😱

Saggi

….and ‘Growstuff’ ….I think you’ve got the most interesting idea🤔

Not sure which idea you mean . Amongst the garbage I spout, I do occasionally have interesting ideas.

My partner works with glycoproteins, which he finds absolutely fascinating. Personally, I haven't a clue what he's talking about most of the time, but he gets quite excited about them. (Sad, I know)

Anyway, they're made up of protein and carbohydrates and are found all over the place and have multiple functions. I'm sure we all know what a coronavirus spike looks like. They're covered with a glycoprotein, which helps them to latch on to cells within the human body (that's why covid is so deadly).

After spending decades researching these molecules and being funded by various official bodies (some indirectly by the government), my partner's work was suddenly relevant and some of his research was used in covid research.

The point is that he and his lab have been tootling along for years. They produce papers which are read by other researchers, who then see something relevant when developing vaccines or whatever. Glycoproteins are also involved in the structure of collagen, so are relevant to the beauty industry; others are involved with producing mucus, so it's important to understand them when producing treatments for colds, etc.

None of the above research would be possible if it relied on private investment. The technology being used now has taken decades to develop and just wouldn't provide an efficient return for investors. Whoever discovered glycoproteins would have had no idea how they would eventually be used, but they couldn't be used now, if it weren't for the years of boring research. That's partly why I wince when people claim that covid vaccines were produced in a hurry - no, they were the culmination of lots of bits of research over many years.

But none of this has anything to do with NHS funding.

Casdon

Saggi

No ….but it’s a short way off ! It’s what all parties want ….a general slip-slide into the American system…. two tier health …the ‘haves’ and the ‘have nots ‘ …. unfortunately I’ll be a ‘have not’ ….but I’m over 70 so my disappointment in the way this country is heading won’t be long-lived!

I don’t think that’s true. It certainly isn’t the way the NHS operates in Wales, which has a Labour Government with devolved responsibility for health and social care.

It's true in England.