NHS reforms

[future.architect]

Originally Posted by Core Rising

...
what I think I’m reading says that GP's will be accountable for budgets, allowing middle managers to be laid off to save costs.

Yes and no. The Tories plan to get rid of middle managers but they have been very clever in making people belive that these people do absolutley nothing. Obviously GP's don't have the time or skills to control multi million pound budgets and plan services so they will be forced to contract out this work to private healthcare firms.

Some of the american healthcare firms are queing up to take on this work. No doubt they will take on lots of the ex NHS managers whist their p45's are still hot off the press.

Originally Posted by Core Rising

Also GP's will have to take the cost of each treatment into account when treating a patient, and opt for the lower cost option if there is one to save money.

I've not heard about this but I wouldnt be surprised. Everytime something is privatised in this country they make a total mess of it.

It wouldnt surprise me if they where allowed to refuse to treat people with chronic conditions in order to save money.

Originally Posted by Core Rising

Is that even close? I'm finding all this rather baffling..

I think thats the point

The thing is, i don't dissagree with reform or even privatisation in principle, what I take issue with is the dishonest and haphazzard way they have gone about it. Im not convinced that the new system will be better for patients at all.

[wjfox]

http://www.guardian.co.uk/politics/2...-return-doctor

NHS shakeup risks return to 1930s, warns leading doctor

Reforms means service will be 'tattered safety net' for patients with complex illnesses, says Dr Mark Porter

Denis Campbell, health correspondent
guardian.co.uk, Sunday 6 March 2011 21.32 GMT

The government's deliberate dismantling of parts of the NHS risks returning healthcare provision back to the grim and unfair days of the 1930s and 40s, one of Britain's leading doctors has warned.

The sweeping reforms are in danger of turning the service into "an increasingly tattered safety net" for those with complex illnesses such as diabetes and obesity because private healthcare firms will "cherry-pick" patients who are easy to treat, said Dr Mark Porter, the chairman of the British Medical Association's hospital consultants committee.

Its ability to provide a comprehensive and universal service could be lost because of health secretary Andrew Lansley's plan to force hospitals to compete with independent, profit-driven providers for patients, Porter told the Guardian.

Opening up NHS care in England to "any willing provider" could also lead to local hospitals closing down and patients being denied care by private providers because they cost too much to treat, said Porter.

"Very deliberately the government wishes to turn back the clock to the 1930s and 1940s, when there were private, charitable and co-operative providers of healthcare.

"But that system failed to provide comprehensive and universal service for the citizens of this country. That's why health was nationalised. But they're proposing to go back to the days before the NHS," Porter told the Guardian.

Allowing private companies to compete for NHS contracts carries huge risks, Porter added, in remarks that increase pressure on ministers over the health and social care bill going through the Commons.

"It's not that passing the bill will instantly destroy what we have," he added. "But it brings the risk that in some parts of the country, and for some patients, we go back to what we thought we had left behind when we founded the NHS in 1948." He added: "We fear that one unintended but inevitable effect of the bill will be to reintroduce the patchwork provision that marked services in this country before the NHS, where many people did not get the care they needed because while many hospitals gave good service, you didn't get the good service we have today [across the NHS]."

NHS services in some parts of England could be "destabilised" by private firms taking advantage of the controversial introduction of "any willing provider" to win contracts for patients with easy-to-treat conditions. This could lead to some hospitals no longer offering a full range of services and ultimately having to close.

The worst-hit patients would include those with chronic diseases such as obesity, diabetes and heart failure, Porter added. They would have to travel longer distances for treatment.

The government is taking unnecessary risks by imposing market measures on the NHS, as competitive healthcare cannot deliver high quality treatment to everyone.

The NHS could become "a provider of last resort" for patients whose illnesses are of no interest to private firms, added Porterhe said. Once independent providers have signed contracts with the consortiums of GPs they could deny care to patients who would be costly to treat, Porter warned.

The return of unequal healthcare could even see provision starting to resemble that of the US, "where there are quite big geographical disparities in care and tens of millions of people can't get access to high-quality treatment".

Lansley performed his first big U-turn on his plans last week when he agreed to scrap plans to let hospitals undercut the prices they charged for treating patients, which has caused huge alarm in the medical establishment.

The BMA, many other medical organisations and Labour are fiercely opposed to "any willing provider" and hospitals having to compete for NHS work, but Lansley is unlikely to give ground on what he sees as central tenets of the reforms.

The Department of Health responded to Porter's attack by criticising the BMA and insisting that healthcare standards would not suffer. "We are modernising the NHS so we can offer patients high-quality care and improved health outcomes. Doing nothing is not an option", said the health minister Simon Burns.

"We expected some opposition to our modernisation plans from the unions. The BMA have historically opposed giving patients a choice of voluntary, independent and public sector services. But it is not in the interests of patients to bow to their demands.

"We want patients to choose the best care to suit them, but that does not mean a compromise in quality. Only those who meet rigorous quality standards will be able to provide services," he added.

[wjfox]

Sign the petition!

http://www.38degrees.org.uk/page/s/P...r_NHS_Petition

And please forward this link to everyone you know!

[pirlo_21]

has a petition ever worked?

[wjfox]

Originally Posted by pirlo_21

has a petition ever worked?

Yes.

http://blog.38degrees.org.uk/2011/02...l-our-forests/

http://blog.38degrees.org.uk/2011/02...dairy-stopped/

http://blog.38degrees.org.uk/2011/02...pped-up-trump/

[gothicform]

that mega dairy was proposed near where i live. the petition had nothing to do with it... 11,000 planning objections filed with the local council, which represented over a quarter of all householders in the area did. set a new british record in the process

[mic of Orion]

Originally Posted by wjfox

God I fucking hate these Tory scum with a passion. Right wing politics in general - I despise it utterly, with every fiber of my being. The NHS should be 100% nationalised, so should all of our transport and energy. It is patently obvious by now that privatisation is a recipe for disaster.

x 1 trillion

[mic of Orion]

Originally Posted by wjfox

Sign the petition!

http://www.38degrees.org.uk/page/s/P...r_NHS_Petition

And please forward this link to everyone you know!

done,

[PresidentBjork]

yeah, why not. I mean it can't do any harm even if it might to do much good.

But anyway, I think the pressure should be kept up on this one in anyway possible since more and more people are asking: a) why should we do this? (you know, a real reason, not just a empty statement about the need for chnage) b)what benefits will it create c)why waste the money?

[pricemazda]

Originally Posted by Octoman

If they totally screwed up the NHS then yes, they would get battered at the ballot box. The fact is, the NHS will still be funded from taxpayer contribution and still free at the point of use. Unless that changes then it has not been privatised. They will let the private sector compete to provide services. Just like the companies that provide the drugs, equipment, cleaning services, car parking etc already do. Currently the NHS operates an internal market where different parts 'sell' their services. If a private provider can offer the same services more cheaply then they will get a contract. We already spent a lot of money contracting out to BUPA to solve the beds crises. Musgrove hospital in Taunton buys bed space in the Private Nuffield hospital for over a thousand patients per year for instance.

The bit I am unsure on is whether scrapping PCTs and letting the doctors make the decisions will deliver the savings they expect. Doctors seem reluctant to take all this on and will probably contract out to to a management company anyway. We could just end up back where we started but with the private sector filling the role of the PCTs. I dont rally have a problem with that either but its not going to deliver the £20bln in savings they are tarteting.

This is about sustained lobbying by US firms like United Health and Aetna (the US Health Insurance Industry). They will become the default 'managers' of NHS budgets as GPs realistically won't have the capacity to do the paperwork. And to be honest i'd prefer a trained doctor to be treating patients rather than deciding on which services should go where. So GPs will buy in the management and the US companies will be managing the NHS budget.

Now those same companies will also be able to offer services to the NHS for treatment.

Mt Lansley was previously on the board of BUPA and suddenly produces a reform that BUPA will be one of the biggest beneficiaries of the reforms.

The NHS issue will become an absolute shit storm for the government. I can't work out why they want to even try this.

[Octoman]

Lots of guesswork and assumptions there.

You must know that GP's are already private businesses that purchase services off the NHS via PCTs? We have a situation where our doctors are forced to buy everything off of a state monopoly. And yet other parts of the health service have worked with private firms for years allowing them to seek competitive prices for surgical equipment, drugs and so on. I can see no reason why a doctor shouldnt also be able to shop around and if a private company thinks it can undercut the NHS then great.

Large doctors surgeries are already mini businesses and many employ professional managers. And yet their hands are tied by being forced to procure all their service from a single state provider with the PCT taking its cut along the way. The set up is bonkers. Even Blair who brought in the PCTs admits it was a fudge and they only went ahead because it wrestled control away from the centre. The ultimate aim was always to devolve power to localised services and create a true market rather than a state controlled pseudo internal one.

[wjfox]

http://www.bbc.co.uk/news/health-12805586




NHS satisfaction 'at record high'

Public satisfaction with the NHS has reached record levels, according to a leading health economist.

Writing on the BMJ website, Professor John Appleby said 64% of people were either very or quite satisfied with the NHS.

Critics have questioned why the government is reorganising the NHS when the public is happy with it.

The Department of Health said reform was necessary to sustain the future of the NHS.

Professor John Appleby was quoting data from the latest annual British Social Attitudes Survey.

It shows satisfaction is at the highest level since the survey began in 1983 and much higher than their levels of 39% in 2001.

Professor Appleby, of the King's Fund think tank, said: "The NHS must have been doing something right to earn this extra satisfaction, something even Conservative supporters have noticed, and something probably not unadjacent to the large rise in funding since 2000."

Reform

Much of the NHS budget is to be handed to GPs as part of healthcare reforms in England.

In the survey, satisfaction with GPs was at 80%, just short of its peak in the 1990s.

A Department of Health spokesperson said: "We welcome the findings which show public satisfaction levels are good, particularly with GPs. Our reforms will empower GPs, not bureaucrats, to commission services.

"If we want to sustain the NHS in the future, we need to modernise it now."

Last week the British Medical Association called on the government to halt to its overhaul of the NHS.

"With survey results like this you have to question why the government feels it is necessary to embark on such a radical and costly re-organisation of the NHS right now, particularly when you take into account the financial pressure the service is already under", a spokesperson said.

Shadow Health Secretary John Healey said: "The evidence is there for all to see that Labour left the NHS with the highest ever levels of public satisfaction, even among Conservative voters.

"It is also clear that the NHS is re-emerging as a worry for the public, and taken alongside recent criticism from the BMA, LibDem conference and a GP among his backbenchers, it is difficult to see how David Cameron can claim support for his overhaul of the NHS."

Professor Appleby concluded: "Future British Social Attitudes surveys will reveal how satisfied the public remain as funding for the NHS is squeezed and the government's proposed reforms take shape on the ground."

[wjfox]

Tories = evil scum

[Soul_13]

Of Bismarck and Beveridge

Written by Tom Clougherty


Given the backdrop of controversy about the coalition government’s plans for the NHS, the Euro-Canada Health Consumer Index 2010 – which assesses health systems from the consumer’s perspective, looking at patient rights, waiting times, outcomes, range of services, and availability of medicines – makes interesting reading. As in previous years, one of their key findings is as follows:

Our analysis of the performance of the 34 countries in this index shows that performance tends to be higher in countries that are organized around the “Bismarck” model than in those that are organized around the “Beveridge” model. This means that healthcare systems that allow competition between insurance providers, and in which insurers are organizationally independent of healthcare providers, tend to be the top performers. The Beveridge model, of which Canada is an example, uses a single organizational system that includes financing bodies and providers and does not offer choice between insurers. This model generally tends to create inefficiency, unwieldy bureaucracy and a general unresponsiveness to consumer needs.

Indeed, if you look at how they rank the various health systems in Western Europe, the supremacy of competing insurance over single-payer systems is pretty clear: (1) Netherlands; (2) Germany; (3) Iceland; (4) France; (5) Switzerland; (6) Austria; (7) Denmark; (8) Luxembourg; (9) Sweden; (10) Belgium; (11) Norway; (12) Finland; (13) Ireland; (14) Italy; (15) United Kingdom; (16) Greece; (17) Spain; (18) Portugal. In case you were wondering, the ‘Bismarck’ countries are in bold.

For me, that list has a handful of implications. Firstly, competing insurance ‘Bismarck’ systems are generally better for patients than single-payer ‘Beveridge’ systems. Secondly, Beveridge systems work better in small countries than in large ones (indeed, the health system in Sweden is significantly decentralized as well). Thirdly, if Britain is going to reform its health system, it should stop tinkering with the NHS (i.e. trying to make socialism work) and ditch ‘Beveridge’ altogether.

The top-ranked Dutch system provides a good model. To simplify somewhat, everyone is required to purchase a minimum package of health insurance from a number of licensed, private insurers. These insurers compete with one another on price and service, but are prohibited from discriminating between patients – they have to offer everyone the same benefits at the same price, and cannot turn applicants away. Individuals pay insurers directly, but receive subsidies if they cannot afford the premium. The government regulates and helps with funding, but beyond that, it does not get involved. To quote from the report:

The Health Consumer Powerhouse states that politicians and bureaucrats seem to be further removed from operative healthcare decisions in the Netherlands than any other country in the index, and argues that this is an important reason for the Netherlands’ outstanding performance.

In other words, the Dutch system combines private competition, consumer choice and minimal bureaucracy with universality and ‘equity’. No system is perfect (I’d like to see more direct patient-doctor payment), but it does seem like a good place to start.

[snotor]

Originally Posted by Soul_13

Written by Tom Clougherty

Forgive me if I don't regard to executive director of the Adam Smith Institute as somebody particularly worth listening to. Especially as his qualifications amount to a law degree from the University of Cambridge.

Edit: I wanted to post a picture of his smarmy 20-something face, but the foto was far too large to be healthy.

[Soul_13]

Do you have to comment anything on the following???

Indeed, if you look at how they rank the various health systems in Western Europe, the supremacy of competing insurance over single-payer systems is pretty clear: (1) Netherlands; (2) Germany; (3) Iceland; (4) France; (5) Switzerland; (6) Austria; (7) Denmark; (8) Luxembourg; (9) Sweden; (10) Belgium; (11) Norway; (12) Finland; (13) Ireland; (14) Italy; (15) United Kingdom; (16) Greece; (17) Spain; 18) Portugal. In case you were wondering, the ‘Bismarck’ countries are in bold.

http://www.fcpp.org/files/1/10-05-10...2010_FINAL.pdf

[pricemazda]

He doesn't mention to the reader how much money France and Germany pour into their systems.

Nor does he explain in terms of efficiency per £ spent related to outcomes the NHS does pretty well.

If you want to find out what private sector admin costs are with lots of small organisations all competing and duplicating services is like - compare the state run single payer US medicare system to the private insurance management system in the US.

And the Adam Smith Institute ranking health care systems is like the Pope ranking gay bars

[Soul_13]

Why do I have to compare the NHS with the American system and not Netherlands, Germany or France? I don't thing is anyone disputing that these countries have a higher quality healthcare than Britain so why we've been so slow to adapt their system into the UK?

[pricemazda]

If you'd read my post properly he is selective with what he is comparing.

[mexico86]

I find it odd that the government are still claiming the NHS definitely needs change, but they can't seem to tell us why or how.

I have a funny feeling the 'change' that the NHS 'needs' will involve needlessly funneling huge sums of taxpayers' money into the pockets of private businesses.