Junior doctors

[unixman]

... where every hospital and GP practice operates as a stand alone business spending it's own money as it see fit..

Spending whose money? Whose money is it? Whose money?

I'm just being facetious. Good post.

[unixman]

it is not a question of being for against the NHS Defining how we deal with NHS as a question of being for or against it is in effect acting as a lazy way to kill debate and protect the vested interests of the status quo. This renders the NHS as unchangeable leaving the only solution to maintaining the service to be just to pour more money into it. Those who pay the taxes to suppport this terrible behemoth of Stalinist bureaucracy will tire of this and take their money elsewhere. This of course will leave all the wailers with no other choice but to either reform it themselves or dip into their own pockets rather than everyone else's to support it. They will soon change their tune if that happened.

That's too extreme dodgyagent.

[DaveB]

As a classic wailing leftie what do you suggest is done?

I don't know, I was just pointing out that the previous poster was wrong in his assumptions about how the NHS operates.

Delivery of a health service, available to all and free at the point of use is something pretty much everyone can agree is a good idea. There are a few free market extremists who think the whole thing should be privately run and paid for through medical insurance but they are the minority. Jeremy Hunt happens to be one of them.

How this is delivered in a way that we can actually afford is a different question. Health Care is expensive and demand is continually increasing. The decentralisation of spending was supposed to reduce costs, allow competition to drive down prices and save money. The free market would deliver the best solution. Clearly this hasn't worked.

There are huge inefficiencies in the NHS and huge amounts of spending that don't deliver value for money. Because Hospitals and GP's all buy services individually they all end up negotiating their own deals. Some are better than this than others and not everyone gets the best deal available. Even on basics like surgical gloves and dressings the variation in spending is huge with some trusts paying 3 or 4 time as much as another for the same things.

Because the doctrine of competition is still so deeply ingrained in the management structure introduced as part of the "health marketplace", these organisations don't co-operate in this kind of spending. If they did then a huge amount of cash could be saved simply by picking out the best deals and using them across the board. If hospital A is spending £X on surgical gloves and Hospital B is spending £3X on the same things then Hospital A sharing it's procurement information with hospital B would create an immediate saving. This doesn't happen.

This is just one aspect of it all. Costs of medicines is an issue, with pharmaceutical companies having far too much influence on what the NHS buys and for how much. There is no independent testing of new drugs. Clinical studies are paid for and run by the companies making the drugs. There is an inherent conflict of interest that means we get things like the Tamiflu vaccine, that the producers knew from early on didn't actually work but which they suppressed until well after the Swine Flu crisis had passed, and for which they charged a vast amount of money.

The NHS is huge, complicated and difficult to change because of the way it's structured. Change does need to happen, but it needs to happen in cooperation, not through imposition of a political ideal.

[DodgyAgent]

I don't know, I was just pointing out that the previous poster was wrong in his assumptions about how the NHS operates.

Delivery of a health service, available to all and free at the point of use is something pretty much everyone can agree is a good idea. There are a few free market extremists who think the whole thing should be privately run and paid for through medical insurance but they are the minority. Jeremy Hunt happens to be one of them.

How this is delivered in a way that we can actually afford is a different question. Health Care is expensive and demand is continually increasing. The decentralisation of spending was supposed to reduce costs, allow competition to drive down prices and save money. The free market would deliver the best solution. Clearly this hasn't worked.

There are huge inefficiencies in the NHS and huge amounts of spending that don't deliver value for money. Because Hospitals and GP's all buy services individually they all end up negotiating their own deals. Some are better than this than others and not everyone gets the best deal available. Even on basics like surgical gloves and dressings the variation in spending is huge with some trusts paying 3 or 4 time as much as another for the same things.

Because the doctrine of competition is still so deeply ingrained in the management structure introduced as part of the "health marketplace", these organisations don't co-operate in this kind of spending. If they did then a huge amount of cash could be saved simply by picking out the best deals and using them across the board. If hospital A is spending £X on surgical gloves and Hospital B is spending £3X on the same things then Hospital A sharing it's procurement information with hospital B would create an immediate saving. This doesn't happen.

This is just one aspect of it all. Costs of medicines is an issue, with pharmaceutical companies having far too much influence on what the NHS buys and for how much. There is no independent testing of new drugs. Clinical studies are paid for and run by the companies making the drugs. There is an inherent conflict of interest that means we get things like the Tamiflu vaccine, that the producers knew from early on didn't actually work but which they suppressed until well after the Swine Flu crisis had passed, and for which they charged a vast amount of money.

The NHS is huge, complicated and difficult to change because of the way it's structured. Change does need to happen, but it needs to happen in cooperation, not through imposition of a political ideal.

In other words you have no idea but at least you are debating it rather than politicising it - I just wish everyone else would do the same!

[DodgyAgent]

That's too extreme dodgyagent.

explain

[DaveB]

In other words you have no idea but at least you are debating it rather than politicising it - I just wish everyone else would do the same!

Never claimed otherwise.

Although I do reserve the right to call Jeremy Hunt a rude word that rhymes with his name.

[MicrosoftBob]

Yes it does go into the pot and it isn't ring fenced but people link it to the benefits, so to sell a privatisation of the NHS to the electorate you would offer a reduction in NI, otherwise people would complain that they're getting less for their NI contributions.

That's like linking border controls to membership of the EU and stating we won't be able to control our borders if we Brexit, there is no correlation exempt in a fictional reality created by lying politicians

[unixman]

There are a few free market extremists who think the whole thing should be privately run and paid for through medical insurance but they are the minority. Jeremy Hunt happens to be one of them.

I don't agree that an insurance model of health care is extreme. Many "civilized" countries operate such a system quite successfully. Not saying I agree with Hunt though.

The decentralisation of spending was supposed to reduce costs, allow competition to drive down prices and save money. The free market would deliver the best solution. Clearly this hasn't worked.

This might be stating the obvious but the NHS is not in a free market. Nor should it be. Internal "market" yes, like when the departments in a big company "compete" with each other for budget.

There are huge inefficiencies in the NHS and huge amounts of spending that don't deliver value for money. Because Hospitals and GP's all buy services individually they all end up negotiating their own deals. Some are better than this than others and not everyone gets the best deal available. Even on basics like surgical gloves and dressings the variation in spending is huge with some trusts paying 3 or 4 time as much as another for the same things.

Again, this is the functioning or malfunctioning of an an internal "market", not a free market. In a free market, those who negotiate poor deals would quickly die off.

The NHS is huge, complicated and difficult to change because of the way it's structured. Change does need to happen, but it needs to happen in cooperation, not through imposition of a political ideal.

I agree. But how long will we have to wait for cooperation? The BMA and other vested interests have effectively blocked every attempt at reform and will continue to do so. How do you get parties to agree to something which (they think) will result in the reduction of their own power and wealth, other than by force ? Would contractors agree to IR35 if it wasn't forced on them ?

[SueEllen]

In other words you have no idea but at least you are debating it rather than politicising it - I just wish everyone else would do the same!

We could do what some of the Nordic countries do with their free health services and charge people for specific things e.g. ambulance call outs when you don't have a life threatening condition, dentistry if you are over 18. (None of them charge people extra for being drunk or having sports injuries.)

However that would involve hiring new administrative staff who are taught to chase up debts properly even when the person lives abroad. It also doesn't help that ambulances come under a separate trust to the hospital they are located at.

Or we could go the Australian model. Where everyone pays for universal healthcare but higher earners either pay slightly more or opt to have private healthcare. This means that more preventative care can be put in the system. So in theory it would get people to manage their type 2 diabetes properly, which 10% of NHS funding goes on, so it would cost us less overall.

There are other systems all of which rely on people paying up front and claiming money back unless in some cases people can prove they are exempt.

[BoredBloke]

Delivery of a health service, available to all and free at the point of use is something pretty much everyone can agree is a good idea.

Actually I don't agree with that being a good idea. That's part of the reason why the NHS gets abused so through health tourism much and why appointments are constantly missed.

There are a few free market extremists who think the whole thing should be privately run and paid for through medical insurance but they are the minority. Jeremy Hunt happens to be one of them.

It already is paid for through insurance and taxes and in part such as dentistry, through extra payments also

How this is delivered in a way that we can actually afford is a different question. Health Care is expensive and demand is continually increasing. The decentralisation of spending was supposed to reduce costs, allow competition to drive down prices and save money. The free market would deliver the best solution. Clearly this hasn't worked.

I worked on a procurement role in the NHS. The place thing is a nightmare. It should be able to influence the prices it pays given it's buying power but rarely does. The now defunct Purchase and Supply Agency in the NHS had buyers who really were not up to the job! The suppliers ran rings around them, not helped by the consultants in the trusts

There are huge inefficiencies in the NHS and huge amounts of spending that don't deliver value for money. Because Hospitals and GP's all buy services individually they all end up negotiating their own deals. Some are better than this than others and not everyone gets the best deal available. Even on basics like surgical gloves and dressings the variation in spending is huge with some trusts paying 3 or 4 time as much as another for the same things.

All the NHS should be forced to spend through the national framework and not go it alone. This buying outside the framework fragments the situation. If the framework price is too high then adjust it but don't allow trusts to buy from outside it. Make the framework price the best it can be. Part of the issue relates to suppliers knowing that they will be on the framework regardless of price. Consultants will often only use products from a certain supplier. This practice means that the suppliers know the consultants will veto any attempt to threaten to remove a supplier from the framework if they don't reduce their prices.

Because the doctrine of competition is still so deeply ingrained in the management structure introduced as part of the "health marketplace", these organisations don't co-operate in this kind of spending. If they did then a huge amount of cash could be saved simply by picking out the best deals and using them across the board. If hospital A is spending £X on surgical gloves and Hospital B is spending £3X on the same things then Hospital A sharing it's procurement information with hospital B would create an immediate saving. This doesn't happen.

It does happen - trusts can and do band together to pool their resources.

This is just one aspect of it all. Costs of medicines is an issue, with pharmaceutical companies having far too much influence on what the NHS buys and for how much. There is no independent testing of new drugs. Clinical studies are paid for and run by the companies making the drugs. There is an inherent conflict of interest that means we get things like the Tamiflu vaccine, that the producers knew from early on didn't actually work but which they suppressed until well after the Swine Flu crisis had passed, and for which they charged a vast amount of money.

The drugs companies may pay for their own clinical trials but the evidence has to be submitted and passed by the ministry of health in each and every country that drug is sold in. Anybody with half a brain knew that Tamiflu would have limited success. Flu is a virus and as such it mutates. Each version is different and any antiviral drug will only have a degree of success against it. They could have bought millions of pounds of asprin - it wouldn't have worked but a company would still have sold it to them.

The NHS is huge, complicated and difficult to change because of the way it's structured. Change does need to happen, but it needs to happen in cooperation, not through imposition of a political ideal.

Agree with you on that though!