Go private, go see a witch doctor, pop into your local "health'/woo store and see what they recommend...or stay home and pray. What "choice" do you want? I'm happy with the NHS. They have Doctors and Surgeons there. For free. Pretty good that.Originally Posted by spanner
Apart from that, I really don't want to be rude, but it seems like a lot of words to say very little.
Perhaps I'm missing something Spanner....? Anyone..?
But what on earth is your point? Yes, it is an institution like the armed forces etc, and, like the armed forces etc, it does its job - generally extremely well. What else do you want?
If the UK's interests are physically threatened, our armed forces swing into action - if our personal health needs attention, the NHS does the same. I don't know about you, but that's exactly what I want them to do.
Whenever I've needed the NHS, and I've needed it many times for everything from life-threatening emergencies to the relief of long term chronic ailments, it has come up trumps. I have nothing but praise for our local Primary Care Trust, our local Hospital Trusts and our local Mental Health Trust - all have served me well when I've needed them.
Could the NHS be improved? Yes - and bringing all the NHS Trusts up to the standard we have here on Tyneside would be a good start. Is the concept of the NHS fundamentally flawed - decidedly not! The idea of a universal health service free at the point of delivery is hard to beat.
Last edited by brianp; 24th June 2010 at 10:43 PM.
Smudge. What's 'free' about the NHS?
BrianP. Where's your scepticism now?
I suppose that you are both uncomfortable with the hermeneutic of suspicion. You have made my point for me. You seem to regard the NHS with a mixture of awe and gratitude. Are these alert and critical qualities? There's a whiff of reification about your positions, a loss of rational objectivity, in which the NHS for you is a form of fetishism, of commodity worship.
Free at point of delivery.
Yes you can pick holes in the NHS. Yes it is flawed. But pretty good for what we pay.
It does what it says on the tin.
I still fail to see your point.
And no. No "fetishism". I hate hospitals.
I think we fail to see your point for the simple reason that you don't have one.
I don't overlook the many apparent faults in the NHS nor do I confuse principle and practice, but I do greatly admire both the concept of the NHS - a universal service free at the point of delivery - and the way it now works in this region, which is the only one I have personal experience of. My skepticism is alive and well - I follow the evidence, and, as a member of the Gateshead Health NHS Foundation Trust, I know what services are available and exactly how they are delivered in practice. Between us, my immediate family and I have used many of those services, so I know that what I was told in presentations at Trust HQ is completely accurate. We have also used most of the parts of the NHS covered by the local Primary Care and Mental Health Trusts, and we know that they work 'as advertised' too. The evidence tells me that the NHS is doing its job well here in Gateshead, so why on earth would I think otherwise?
Yes Brian, why would you think otherwise? Maybe you are confusing the beneficial effects of NHS medicine and care as a personal experience with the bigger picture, which to my mind is about hegemony, about the way folk think and feel without being aware of the ideological import. Your PFPI engagement with the NHS in Gateshead is an illustration of this defensive attitudinizing, as if you had something to lose by not going in to pitch for them. Looking back over my posts I find that I have not complained about poor treatment or a bad experience for myself. My approach is as a generalist and the big tent view. I too have been closely involve as a volunteer activist with the NHS, as a lay inspector. In all that time I always tried to see the experience from the outside because I valued my objectivity. I have also been a long term patient over the span of my life, as well as frequent but brief in-patient. Which of us hasn't? Nor have I gone in to bat for the private sector, although I hope to keep an open mind about the quality of the product.
As to what would help the NHS...I have chosen not to post about this piece of tinkering or that adjustment. Rather I had hoped that by theorizing about the broader position of the entity, about its larger identity as an instrument of the state, I might encourage some realization that the title of the thread has a limited application, and that sceptically speaking any tinkering is meaningless. Health care is something we consume when all's said and done. Product improvement is a research and development issue. Unless what you really want to debate is product replacement.
PS. Wish I had cornered your Napoleon tag. Brilliant.
spanner - May I draw your attention to this useful site
http://www.plainenglish.co.uk/
To presume that I'm being defensive, dishonest or naive when I "pitch for" the NHS is unmitigated arrogance. For the record, I pitch for the local NHS because I know that they do an excellent job, it's as simple as that. Now please stick that in your "big tent view" and "theorize about the broader position of the entity" to your hearts content.
Herein lies the tension between cost-benefit and the self perpetuating nature of all organisations. As long as you buy into the concept of universal healthcare, free at the point of care and delivery of care according to need rather than other factors, then the NHS as a single organisation tends to become the only likely successful model.
It could in theory be delivered by smaller independent business units adhering to agreed standards. However this is expensive, and the oversight functions required to ensure delivery is fair to all are enormous. Further such models by definition have units that advance at different rates, thus implementation of national strategies (e.g. national primary angioplasty service) cannot be done in a fragmented service - this is why the UK although 10 years behind many Europena countries in starting this project, overtook all other countries in terms of delivery within 3 years and now is the world leader here. Other examples include the national pulmonary hypertension service, herre again the ability to implement a co-ordinated country wide model is the envy of the world.
So agreed there are massive problems, it does not deliver at anywhere near the ideal. But, given the principles outlined what model would you suggest (accepting that no where in the world has achieved what the NHS has over the last few years. The Canadian, Australian and Swedish services will be your best comparators.
The discussion about the NHS always seems to assume that it is supposed to be treated as a commercial business entity, with private capital providing what some see as initiative. In fact, surely the privatisation of the health service was motivated by two factors: reducing the spending of the state but crucially also to open up state assets to capital so they could make money out of it?
The whole business of the Washington Consensus, globalisation, and the so-called liberalisation was all about giving the owners of capital access to profitable investment as state assets were sold off cheaply. Once you accept that rationale, the health service is just seen as another potential source of profit. And businesses try to cut costs and increase margins.
The given ideological justification for that is quite irrational. There's no reason why competition should produce socially better services since it's rationale assumes a free fully-competitive market which tends to equilibrium. The economics are flawed because sick people don't have effective choice since they need treatment, and they can't reject essential service whatever its quality. Patients are not customers.
The demand-supply curves don't intersect at one point but many, and they don't slope the way it is assumed. The more business involvement in the delivery of health care, the more likely it is that collectively the owners of capital will drive down costs, cut corners and try to smooth over customer dissatisfaction. Health isn't the aim, profit is and in a contest between the two the latter will always win because it is a captive market.
Just as the politicians assume that somehow economic growth is socially essential and will somehow drive down unemployment (when there's no necessary connection at all - you can often have growth with high unemployment), they also assume that entrepreneurial activity somehow results in higher standards.
In the current context of austerity, far too many people passively accept that cuts are necessary. They should be resisted. Instead, we should stop paying private company profit and take the health service back into state ownership. That saving alone would obviate the need for cuts in services.
Hi Bob,
I wish it were as simple as private - bad, public - good, but as experience showed n the USSR, you can have too much of a good thing. What the private sector are good at is cutting out unnecessary caution. The drive for profit and reducing cost base, results in people taking chances that would otherwise seem indefensible. Not infrequently, the cautious approach proves unfounded and unecessary expenditure is avoided. Yes, there will be occasional disasters along the way, but there are occassional disasters now. The only difference is that now we blame it on incompetence, under a private system we would blame it on greed.
Is there a better way forward? I think if we approached cost reduction as an advance in medical care, then we could study the effects of reducing investigations and treatment in a co-ordinated fashion, presently it is done is a rather adhoc fashion.
Of course it isn't that simple. I didn't read Bob's post as suggesting it was.
The USSR is a bad example to use. It had no democracy, no checks and balances. And there's always the old International Socialist/SWP argument that the USSR wasn't communist it was "state capitalist"; which is also an oversimplification but does have some truth to it. There wasn't workers control, soviets deciding the best way forward for everyone, etc, blah; the whole country behaved like a gigantic company with rich bosses living in their mansions while the workers struggled at the bottom of the pile working to make the rich richer.
But getting back on topic: I broadly agree with Bob, contracting out has involved cutting corners without financial benefits, just an extra layer of bosses to pay. The more capitalist the system becomes, the more it will cost and the less it will deliver. That is the lesson of the 80s and 90s (Railways is the best example) and of the part-privatisations of the NHS carried out by "New Labour".
Are you sure this is not a description of the NHS? Democracy only has tangential influence of the Dept of Health, the workers are only rarely invovled in strategic decisions, the manderins issue edicts which the low life must implement etc.
As you will see 4 posts above, I think the NHS is probably the best currently available health service model, but that does not mean it could not be improved upon. One aspect that drives innovation is competition. Fortunately most clinicians are highly compeditive, so given the freedom to compete that is what they will do. The question is rather how to channel that energy toward cost-benefit?
I do not think one can assert that a part private model would be worse than the current model, this is not to suggest that a private system has any ideological benefits. But the drive for profit, forces changes that would not otherwise be considered - this will blow up in peoples faces now and again - so one has moved the down side from complacency to organisational (and patient) survival. But it is well to remember (as previously noted on another thread) that the gazelle runs faster than the lion, since it is running for its life, the lion just for lunch.
There is a problem with the current system of separating private work that consultants do within NHS hospitals from NHS work.
I can understand the sense in using NHS equipment. Problem is, it becomes impossible to separate the work done by NHS staff from that which should be ring fenced as private. Secretaries and clerical staff do private work while on NHS time. This means the NHS is in effect subsidising the Private sector work of many consultants.
In general private and public medicine do not mix well. Either for the reasons you have outlined, but often for the opposite reason - hospital management set up a private ward, use income from that to subsidise NHS services - by increasing the number of staff in say radiology, pathology services, junior medics, buying new equipment, charging a premium of 40% on top to go toward general costs etc and expect the staff to then provide the private service, which they do grudgingly. The fee paying customers are unhappy since the service is poor, the staff are unhappy since they feel abused, the managers are unhappy since they don't make the profits they expected, the doctors and insurers are unhappy since everything is inefficient and takes too long.
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