A privatised NHS?

 

          I find that the really popular part of the NHS that most voters wish us to protect and continue is the fact that most NHS service is free at the point of need , and all UK citizens are eligible for that treatment based on their need, not their means. All main political parties in the Commons – and I think UKIP – support this principle. The political debate is often about how a monopoly healthcare provider can deliver a good enough service without queues, without  high rates of hospital infection and  without bad treatment.

         There is always, however, another foolish debate about whether Conservatives secretly plan to privatise the NHS, with most people rushing to condemn any such move. Successive Conservative and Coalition governments have remained wedded to the free at the point of use  principle, and the next Conservative Manifesto will doubtless reaffirm it. Labour governments have also normally stayed true to this principle, though a former Labour government did break it by introducing prescription charges which have subsequently been accepted by all governments as a modification to the main principle. Many people are now exempted from these payments based on their own needs and resources.

         There is however, another way of looking at the Labour concern about “privatisation”. Whilst no recent government has and no future government after the  2015 election will seek to introduce charges or want to change free at the point of use, not all NHS care is delivered in NHS owned establishments by directly appointed staff. Again the irony is that the accusers over privatisation, Labour, have in office bought in private sector care for NHS patients themselves, sometimes preferring a private sector contractor to their own in house staff. All major parties accept that it may be sensible to outsource catering, cleaning, legal work or even some clinical and medical services.

        There is also one huge elephant in the room for those who claim to be against all private involvement in the NHS. That is the GP service.  The primary care GPs were never nationalised in the first place. To this day they remain as a collection of small businesses, running their own practises, with payments from the NHS under contracts for services they provide.

     As proof of their private sector status they can perform private sector work in their surgeries, offering holiday and  travel advice and vaccinations, private consultations, work for legal cases and the like for fees and charges. The GPs arrange their own properties, finance their own practises and hire their own staff. They may  run their own dispensing service to earn  additional revenue.

       The latest GP contract reminds us of their independent status, and of the controls and limits on their NHS work conduct imposed by government through the contract for services which the NHS buys. Few of those who claim to hate private involvement turn their attack on the GP model. No government has wanted to fully nationalise the GP service, and make all doctors state staff turning up for duty in NHS owned surgeries with no right to undertake private competitive medical business. Maybe this should give pause for thought when next the cries go up about the dangers and undesirability of  private involvement, and remind people that it is the no fee and charge that people most like, not the details of how the service they receive is organised.

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116 Comments

  1. Leslie Singleton
    Posted November 17, 2013 at 6:02 am | Permalink

    For completeness, please do not forget that Internal Audit is now usually outsourced. This is all very well and in some ways better in that if the Internal Auditor is just in effect an employee of the Finance Director he or she is far from being fully independent but at least such an employee is familiar with the systems in place whereas someone coming in from an outside firm of accountants for just a few hours literally on any particular subject would likely start with no clue. This latter problem is hard to combat because even if the same chap or chapess comes in the following year everything is likely to have been changed by a Government re-organisation so he has largely to start again anyway, and I don’t mean maybe.

    • outsider
      Posted November 17, 2013 at 8:31 pm | Permalink

      Dear Leslie Singleton, You are right there. By definition, internal audit cannot be external. This sounds like another of Labour’s programme of privatisation by a thousand cuts, most notably through PFI/PPP hospitals. These piecemeal measures do not address the underlying issues of choice, accountability and incentive.

  2. Brian Taylor
    Posted November 17, 2013 at 6:54 am | Permalink

    Another part of Healthcare that is also part payment is both the Services for glasses and teeth both have the capacity to provide some services free and to charge for others.
    So why is it so hard for Hospitals to collect money from those that should pay such as Health tourists?

    • lifelogic
      Posted November 17, 2013 at 8:25 am | Permalink

      “why is it so hard for Hospitals to collect money from those that should pay?”

      Well it is not their money, the systems and management are fairly incompetent and they simply do not really care if they collect it or not. Usually they do not even ask for it or present a bill.

      Often people have even tried to pay and have insurance cover but simply cannot find out what to pay or how to.

      • alan jutson
        Posted November 17, 2013 at 9:50 am | Permalink

        Brian – Lifelogic

        ……..Collecting money…….

        Agreed, almost every other Country in the World manages it, so why not the NHS.

        Surely its very simple, when you arrive at hospital they ask you for your NI number, then check your details with the number recorded.

        • lifelogic
          Posted November 17, 2013 at 9:43 pm | Permalink

          Also you credit card number – hotels and car hire companies manage it OK, it is not very hard.

      • Hope
        Posted November 17, 2013 at 11:23 am | Permalink

        Like a lot of people I have been in a hospital waiting room while people there cannot even speak English. No one was ever asked in my presence whether they were entitled or not. The staff find it too embarrassing and fear they might be labelled racist or a bigot if they did so. The Equal right guff and HRA guff need amending so people feel free to speak. This was introduced to suppress free speech around Blaire’s mass immigration policy- which some of his ministers now think was a mistake. It worked. Now it must be changed. A start being everyone can only receive treatment with the production of a NHS card. No more translation services/literature in public sector services. Children taught English before they start school to stop them holding back other children or wasting resources on basics that could be used to boost the education of the other children.

        • Max Dunbar
          Posted November 17, 2013 at 10:13 pm | Permalink

          At least one of the doctors’ unions has instructed its members not to enquire if foreign patients are entitled to free NHS services. This sort of interference in the NHS finances needs to be addressed urgently.

        • uanime5
          Posted November 18, 2013 at 5:32 pm | Permalink

          The Equal right guff and HRA guff need amending so people feel free to speak.

          Before the HRA free speech was a privilege, not a right; so the HRA doesn’t need amending.

          A start being everyone can only receive treatment with the production of a NHS card.

          Given how strongly ID cards were opposed don’t expect NHS cards to fare any better.

          No more translation services/literature in public sector services.

          Expect there to be a huge number of court cases after the UK is accused of denying people their rights by not informing them of these rights.

          Children taught English before they start school to stop them holding back other children or wasting resources on basics that could be used to boost the education of the other children.

          How exactly is this going to work if the children are already old enough to start school? Also unless the state is going to pay for these English lessons expect more lawsuits for trying to deny children their right to an education.

          • alan jutson
            Posted November 18, 2013 at 8:49 pm | Permalink

            Uni5

            …Identity cards….

            But we already have a National Insurance number so nothing new is required at all.

  3. lifelogic
    Posted November 17, 2013 at 7:12 am | Permalink

    Well we should indeed charge a fee for the NHS, that way alternative competition can compete as it clearly should. If people can pay for hair cuts, housing, food, and fizzy drinks,(often even sufficient to become obese) why on earth should they get health care for nothing? Of course if they were not paying circa 50% of their incomes to Osborne for him mainly to waste on nonsense it would be rather easier for them to pay.

    Not that people should be turned away from Casualty when they cannot pay, they should pay later, if and when they can do.

    The organisation of the NHS is hugely inefficient much of it is devoted to deterring people from using it or dealing with litigation due to its incompetence. With inconvenient booking systems, limited hours and huge waiting times …… just as one would expect with a free at the point of use service. The hospital want you to use Casualty and casualty the doctors. The doctors deter you from making appointments with limited hours and the can you call back tomorrow between 9.00 and 9.15 and we might see you are our convenience if you are lucky. Oh and will will be mainly engages then of course.

    Hospitals are however still able to mug users who come by car with parking fees & fines should they be held in the Casualty queue too long.

    The medical industry needs to learn from people like Nissan and Toyota proper lean & efficient systems. We need less demarcation and protected interests more specialist centres and the medical unions needs some real taming. Many operations and decisions could be done by people with perhaps a few months training and proper supervision there is no need for them to have a seven years training.

    Start by making all people sign a no compensation clause if they use the NHS and get rid of the absurd situation where 1/7 (I think) of the cost of Maternity care is for lawyers and compensation. If people want compensation let them buy their own insurance. Use the money saves to have a proper open safety reporting system and to avoid making the events.

    I see the absurd BBC is reporting that:

    The UK’s Disasters Emergency Committee (DEC) has urged countries to take urgent action on climate change, as UN talks enter their second week. The committee, comprising 14 aid agencies, said Typhoon Haiyan was a glimpse of the future for millions who will be at risk from extreme weather. It said the meeting in Warsaw should agree to rapidly cut carbon emissions.

    The British agencies argue that extreme weather events such as Typhoon Haiyan follow a growing pattern of threat that points strongly towards climate change.

    What compete and utter nonsense. The climate has not changed significantly yet anyway and all the evidence points to slightly warmer actually reducing extreme weather events. Still it is all about scaring children and adults, raising cash for charities and justifying ever higher taxes I suppose.

    • Bazman
      Posted November 17, 2013 at 9:05 am | Permalink

      When you are able to answer these points could you stop repeating your propaganda? You have been question a number of times on your fantasises and as a proponent of sensible and scientific thought shoul respect your own views.
      Your own insurance for medical incompetence? Get real and the problem is with this idea of paying for a visit to the GP is that the GP is in effect the gatekeeper to the NHS and any charges would put off people especially men who are already reluctant to visit their GP leading to a worsening of their condition and addition expense to the NHS when they are forced either by their condition or their partners to finally visit the doctor. This could also have grave implications of contagious diseases.
      The private doctors model has seen Doctors salaries and presumably cost to the NHS become one of the highest in Europe and try to get a Doctors appointment without being on deaths door out of hours no shit work for them, as the middle classes, weekends are sacred.
      You again have been tackled a number of times on production line medicine on the cheap. How would the treatment of an 80 year old frail woman be the same as the the treatment of a fit young 18 year old man. What if their were complications? Does not even work like that in industry and for sure you would have no part of it in your Harley Street Doctors surgery.
      More on the cheap right wing fantasy propaganda that will of course be repeated in the future as this is a belief not based on facts but on forcing people who use the service to pay for treatment to reduce taxes for the rich in you trickle down based fantasy that in reality you believe nothing should trickle down even healthcare. A return to the 1900’s of medicine or food.
      What you would see is the level of service now found in NHS dentistry with almost all of the large number of practices now private and requiring a fee every month regardless of the condition of ones teeth and the NHS used as a training ground for dentists noticeably a number of foreign ones.
      Finally is only the ‘absurd’ BBC reporting The UK’s Disasters Emergency Committee (DEC) has urged countries to take urgent action on climate change?
      No it is not. Do you believe the BBC should not report this and other should still be allowed too? Get back to use when you have engaged you brain and can do so without as you say spouting drivel as fact.

    • Bob
      Posted November 17, 2013 at 10:07 am | Permalink

      The Philippines is effectively typhoon alley.
      Electricity is transmitted mainly through overhead cables, and much of the housing is makeshift shacks with a corrugated iron roof held on by the weight of an old car wheel. Road drainage is practically non existent.

      A little more attention to decent infrastructure and building standards would mitigate the effects of typhoons.

      Closing down the British economy will not prevent typhoons or any other natural weather event.

      • forthurst
        Posted November 17, 2013 at 9:06 pm | Permalink

        What has changed for the Phippines is not the weather, but the effect of logging which has reduced forest cover from 70% to 20%. Forests soak up ground water and absorb the energy of the wind. They can blame the Chinese for buying up their timber but not for causing typhoons.

        • uanime5
          Posted November 18, 2013 at 5:37 pm | Permalink

          Typhoons become powerful due to the evaporation of sea water, not ground water.

          Forests don’t absorb much energy of a typhoon, which is why typhoons are able to destroy forests and anything else in their path.

          • forthurst
            Posted November 18, 2013 at 7:03 pm | Permalink

            More pseudo-scientific gobledegook from unanime5:

            Forests are made of CO2 and H2O: where do you think the H2O comes from?

            As to the rest of your comment, you need to learn the Law of Conservation of Energy, then you would realise that causing the rapid movement of a forest of trees, like a forest of windmills, transfers energy from the typhoon. Chopping down trees causes forests to disappear not typhoons.

        • peter davies
          Posted November 19, 2013 at 1:06 pm | Permalink

          Indeed – too much de forrestation and too many people living with poorly designed infrastructure.

          They need the aid now which they are getting but they also needed to be educated in conservation infrastructure and family planning. Any trees cut down need to be in moderation and new ones planted to replace them.

          If these steps don’t happen then this type of thing will happen again and again.

      • lifelogic
        Posted November 17, 2013 at 9:44 pm | Permalink

        Indeed

      • livelogic
        Posted November 18, 2013 at 6:35 am | Permalink

        Indeed all the billions being wasted on wind farms and PV might be far better spend on more solid housing. Underground electricity cabling and the likes. That way they get an immediate and certain benefit.

        • uanime5
          Posted November 18, 2013 at 5:41 pm | Permalink

          Just how solid would the housing have to be to withstand 160 mph winds. Make sure you explain why the USA doesn’t have these types of houses in states that are hit by hurricanes.

      • Bazman
        Posted November 18, 2013 at 6:45 am | Permalink

        A little more attention to decent infrastructure and building standards would mitigate the effects of typhoons?
        You think they would have thought of that one Bob? Maybe they just thought they would take a chance huh!? Save a bit of cash. I wonder how Britain would survive a 200+mph hurricane?

        • Bob
          Posted November 18, 2013 at 9:44 am | Permalink

          @Baz,
          “You think they would have thought of that one Bob? Maybe they just thought they would take a chance huh!? Save a bit of cash.”

          I am a great admirer of the Filipino people, but to answer your points about “taking a chance” etc. would lead into a PC minefield. Suffice to say you would need to understand the culture. They’re incredibly friendly and easy going people, but they themselves would be the first to admit that in terms of efficiency there remains much to be achieved.

          As for building standards, read the fable “The Three Little Pigs”.
          Have a look at the photographic reports, and count the number of masonry built structures that blew over.
          http://www.bbc.co.uk/news/world-asia-24922492

          • Bazman
            Posted November 19, 2013 at 6:35 am | Permalink

            What would be the average income in the Philippines Bob and how would this pay for the infrastructure you dream of? In America they must be truly reckless as the wolf blows means wealthy states houses away every year. Can,t blame the poor for being stupid for that one.

          • Bob
            Posted November 19, 2013 at 9:12 am | Permalink

            @Baz,

            You really ought to take a trip to the Phils to see for yourself. It’s a beautiful country, and the people are incredible, but don’t just go to Manila or the tourist resorts, spend some time in the provinces. You won’t regret it. Travel broadens the mind as they say.

            I didn’t quite understand your comment “as the wolf blows means wealthy states houses away every year”.
            Please clarify.

    • Denis Cooper
      Posted November 17, 2013 at 10:15 am | Permalink

      Well of course we should take urgent action, and immediately shut down the whole of our economy and do whatever else we can to completely eliminate the 1.4% of total global emissions of CO2 for which we are responsible, so that the Chinese can then entirely counteract that 1.4% reduction in the total rate of CO2 emissions within about eight months by my reckoning.

    • nick
      Posted November 17, 2013 at 11:17 am | Permalink

      Start by making all people sign a no compensation clause if they use the NHS and get rid of the absurd situation where 1/7 (I think) of the cost of Maternity care is for lawyers and compensation.

      ========

      What a sick idea. Make the victim pay so the people responsible can carry on maiming and killing.

      • livelogic
        Posted November 18, 2013 at 6:47 am | Permalink

        Well no, you release far more money to be spent on preventing accidents, you introduce proper open reporting and employ more doctors and fewer lawyers and bureaucrats. £500M almost 1/5 of the cost of Maternity care is paid out.

        All (save the lawyers) benefit as the patients get easier payout and without lengthy legal actions.
        We have fewer bureaucrats, lawyers, court time and distressing legal actions.
        We have more doctors and medical services and we reduce accidents with more resources and open reporting when things do actually go wrong.
        True patient pay for insurance if they wish to but it is money that is then effectively used to improve medical care and reduce the chances or errors.
        We get fewer damaged babies.

        • uanime5
          Posted November 18, 2013 at 5:46 pm | Permalink

          Why would the NHS need any lawyers if you can’t sue them if something goes wrong?

          Why would hospitals try to prevent accidents if they can’t be sued?

          If you can’t sue the NHS why would you get a payout if something went wrong?

          Why would anyone give patients insurance when the payouts will be huge if anything goes wrong?

          In conclusion your plan will lead to more damaged babies while making the NHS less accountable. Seriously you’re effectively calling for the NHS to be immune to any prosecutions for malfeasance.

    • Hope
      Posted November 17, 2013 at 11:26 am | Permalink

      So perhaps the EU will stop trading with China to reduce the CO2 emissions? Perhaps the EU will force Germany to accept its CO2 targets irrespective how it might hurt its car market?

      • Hope
        Posted November 17, 2013 at 11:28 am | Permalink

        Cameron should be embarrassed how he sanctioned the promoting of the NHS at Olympics when so many people died from basic care needs. Still no politician held to account, someone must have been in charge under Labour. All calls for other bodies to be reformed or examined, what about the NHS scandal where thousands died?

    • Edward2
      Posted November 17, 2013 at 2:21 pm | Permalink

      I agree LL
      On Radio 2 news around 11am this morning there was a lengthy unchallenged speech by someone high up in Oxfam stating he was certain global warming was responsible for the recent disaster in the Far East and calling for all nations to act by diverting more money to combat climate change.
      It was one of the most blatant pieces of propaganda I have ever heard on a BBC news programme.
      It wasn’t news, it was just a political rant by a charity pushing for more funding and powers.

      • lifelogic
        Posted November 17, 2013 at 9:51 pm | Permalink

        Indeed also even CBBC tries to indoctrinate my children on the issue. Telling them, in effect, that their father has contributed to the murder of many in the Philippines by stating his sound anti BBC thing science on the AGW religion.

      • livelogic
        Posted November 18, 2013 at 6:51 am | Permalink

        Indeed the BBC is even (on CBBC) in effect telling my children that their father is killing people in the third worlds as he does not believe in the catastrophic global warming religion and thinks they should build far stronger houses instead.

      • uanime5
        Posted November 18, 2013 at 5:48 pm | Permalink

        The scientific evidence shows that warmer seas make storms more violent and that global warming is making the seas warmer. So global warming is also making the storms more violent.

        • Edward2
          Posted November 18, 2013 at 7:54 pm | Permalink

          That will be the quite amazing effect of the less than one degree increase in global sea temperatures over the last hundred years.
          So amazing many scientists say there is no proof of any correlation including many IPCC peer reviewers.
          Check out the latest IPPC report Uni before you make yourself look more foolish.

    • uanime5
      Posted November 17, 2013 at 10:13 pm | Permalink

      If people can pay for hair cuts, housing, food, and fizzy drinks,(often even sufficient to become obese) why on earth should they get health care for nothing?

      Most hospital treatment costs a lot more than any of the things you listed (I assume by housing your mean rent). You also failed to explain why people should have to chose between eating, housing, or medical treatment.

      With inconvenient booking systems, limited hours and huge waiting times …… just as one would expect with a free at the point of use service.

      The private sector is much the same. Very few private sector companies don’t have limited hours.

      The doctors deter you from making appointments with limited hours and the can you call back tomorrow between 9.00 and 9.15 and we might see you are our convenience if you are lucky.

      Not sure what you’re talking about. Are you blaming GPs for not having unlimited amounts of time to see patients?

      Hospitals are however still able to mug users who come by car with parking fees & fines should they be held in the Casualty queue too long.

      Just like private sector car parks. Funny how you ignore that the problems in the public sector also occur in the private sector.

      Many operations and decisions could be done by people with perhaps a few months training and proper supervision there is no need for them to have a seven years training.

      Yet again you’re repeating this deluded fantasy. Hospitals need doctors who can cure a huge variety of problems, not technicians who can only do one thing. That’s why even the private sector hasn’t copied this system.

      Start by making all people sign a no compensation clause if they use the NHS and get rid of the absurd situation where 1/7 (I think) of the cost of Maternity care is for lawyers and compensation.

      No chance of that ever happening. The media would bring down any Government that tried to make it illegal for a parent to sue the NHS if their child was injured or killed while in hospital.

      You seem to have forgotten that if a child is injured they’ll need enough compensation to last the rest of their life (70+ years).

      If people want compensation let them buy their own insurance.

      Another deluded fantasy. What insurance company would even sell people insurance when the cost of an accident will be so high? Your impractical solutions reveal how little you know about this problem.

      The climate has not changed significantly yet anyway and all the evidence points to slightly warmer actually reducing extreme weather events.

      This is the third time you’ve confused your delusions with facts. The scientific evidence has shown that the increased average global temperature over the past century has changed the climate. Scientific evidence has also shown that warmer weather makes extreme weather events much worse (warmer oceans make storms more violent). Next time try looking at the facts.

      • Hope
        Posted November 18, 2013 at 9:02 am | Permalink

        Once more, socialist drivel. You do waste a lot of time on defending the indefensible.

        • uanime5
          Posted November 18, 2013 at 9:47 pm | Permalink

          Care to elaborate on how pointing the flaws in Lifelogics claims about the NHS or that climate change is real is “socialist drivel”. Your failure to rebut any of my points Hope indicates that I am right and you are wrong.

      • Edward2
        Posted November 18, 2013 at 12:02 pm | Permalink

        Uni
        Even the IPCC’s latest report does not agree with you on global warming causing violent storms typhoons and hurricanes.
        They call the correlation unproven and unlikely.

        • uanime5
          Posted November 18, 2013 at 10:07 pm | Permalink

          That’s not what the IPCC’s website states. It says that it’s likely that global warming has caused typhoons and hurricanes to become more violent since the 1970’s.

          http://www.ipcc.ch/publications_and_data/ar4/wg1/en/ch3s3-8-5.html

          Looks like I debunked your claim Edward2.

          • Edward2
            Posted November 19, 2013 at 10:31 am | Permalink

            Not so fast Uni .The IPCC summary says one thing the report says other things.
            Buried in the enormous report is this statement on cyclones just as one example:-
            “It is likely that the frequency of tropical cyclones will either decrease or remain essentially unchanged”
            “The specifics of the change are not yet well quantified”
            IPCC Report Page 7 of 165 Chapter2 ” Confidence remains low for long term changes in tropical cyclone activity”
            Page 62 ” Current datasets indicate no observed trends in global cyclone frequency over the past century”
            Talking about extreme weather events and increased heavy precipitation they say” The frequency or intensity…has likely increased in North America and Europe in other continents confidence in changes is at most medium.
            Yet Obama and Cameron both linked the recent cyclone in the Far East on global warming
            That’s what happens when you just read the headlines.

    • stred
      Posted November 18, 2013 at 12:44 pm | Permalink

      There was a discussion about climate change on Al Jaz last week. The participants were a representative of Friends of the Earth, a member of the US climate security committe (approx) and a Danish author of a book on how everyone is spending money on anti warming in a daft way. The latter was advocating generating a greater proportion using gas as an intermediate measure and pointing out that China was using more coal and wiping out EU measures. The FOE spokesman actually said that they did not need to look at the science any more. They could see the effects, such as the Phillipine hurricane and so science was not necessary. Needless to say he was given more time than the Danish author and ticked him off about his attitude, coming from such a leading country in enviromentally good generation.

      Had he been allowed to answer, he could have quoted p 335 of Sustainable Energy, adopted by DECC. This lists Denmark as bottom of the table for carbon intensity of electrical production at 881 grams CO2 per kWh. France is 83 and UK 580.

  4. Andyvan
    Posted November 17, 2013 at 8:02 am | Permalink

    If only somebody would privatise the NHS. I appreciate that private enterprise is regarded as evil and untrustworthy in our socialist paradise but in my experience a real free market business beats any government “service” every single time. If heath care was freed from political interference and had to face market forces with no subsidy we would see costs slashed, patient care improve drastically and taxation (or at least the appalling deficit) reduced massively.
    Before anybody says the US system of private health care doesn’t work I’d just point out that the American health industry has been subject to very large scale interference from government for decades.
    If you want something to work well then get rid of government control.

    • Bazman
      Posted November 17, 2013 at 11:50 am | Permalink

      Its interesting to note the amount and number of donations from the healthcare industry to the Tory party so rather makes a mockery of your political interference argument. How would the NHS be funded in your privatisation fantasy? by insurance one suspects, opening up the questions of who should pay, how much, for what, and what happens to the ones who cannot pay? Like the utility fiasco they just get cut off?
      The NHS is one of the few benefits that benefit everyone in this country. Rich or poor and industry too. Who could afford to have a serious illness without it? Regressive right wing fantasy you cannot afford.

      • Andrew
        Posted November 18, 2013 at 9:42 am | Permalink

        Yes indeed, the NHS is such a brilliant system no one else has copied it. And why do you think that is ? Because it doesn’t work and never has. It is high time people like you actually woke up to reality. What we need is far more private sector provision and involvement because what we have at present is a very badly run and organised state monopoly. And it could have all been so different had Labour and Bevan built on what existed before rather than destroy it and create this silly state solution. Oh and by the way do tell us how much health unions give to the Labour Party.

        • Bazman
          Posted November 18, 2013 at 4:47 pm | Permalink

          Yeah no money no healthcare unless from charity. Buy your own medicine and hide any possessions you were on the the dole. At least the union money is clean given by workers to improve their lot and the lives of millions in this country and not to gain contracts to fill the pockets of foreign shareholders and their executives. Silly dreamer.

  5. arschloch
    Posted November 17, 2013 at 8:17 am | Permalink

    Its only Dave & Co, that as Obamacare unravels right in front of them, could decide to take advice from one of its architects that “erring” doctors and nurses should be sent to jail. Why not go the whole hog and initiate a Stalinist campaign against “wreckers” in the public services, with a promise that any employee who feels to please be summarily shot? John your government really has some aplohogies to make this morning because it appears that Dave thinks NHS employees deliberately go out of their way to harm their patients. How is the NHS going to become more efficient, if people are going to be spending time to ensure everything is documented to protect them from vexatious patients and their lawyers? Do you suggest that they always wear a body camera? Is staffing not going to become a problem while people are suspended and waiting their show trial? How much more is the MDU going to charge to protect them? With all of this do you not think the siren call of Australia and New Zealand is not going to get louder ? Then its the Aussie taxpayer who feels the benefit of all that training.and expertise for free.

    • Bazman
      Posted November 18, 2013 at 5:28 pm | Permalink

      How many have done any chokey for the banking crash and the horse meat scandal? Err! None!

  6. Richard1
    Posted November 17, 2013 at 8:27 am | Permalink

    Whilst I don’t suggest Conservatives open up this debate before the election, at some point it is going to have to be recognized that our monopoly NHS does not provide us with comparable quality to that available in countries where people pay if they can. We are going to have to move to a principle where the NHS funds care that’s needed but its provided by whoever can do so best and most cost effectively. We need to encourage more private provision to take the strain off the NHS, and competition and choice amongst providers.

    • uanime5
      Posted November 17, 2013 at 10:17 pm | Permalink

      According to studies by the OECD the NHS does provide better care than most countries with private healthcare systems and costs much less.

      As most private companies only want to do the easy operations on patients in good health but have no intentions of doing the more complex operations or operations of people in bad health it’s clear that private companies will not take any of the strain off the NHS.

      • outsider
        Posted November 18, 2013 at 12:02 pm | Permalink

        Not sure where you get all this from Uanime5. According to the OECD on the web, UK health care spending has been marginally above the OECD average since 2009, both in absolute terms and as %GDP. And health services are predominantly publicly funded in all OECD countries other than the USA, Chile and Mexico. If we are better than 2 of these 3 it does not say a lot, especially since hardly anyone wants us to move to a system where most individuals have to pay for their own healthcare.

      • Edward2
        Posted November 18, 2013 at 12:04 pm | Permalink

        Private hospitals are very happy to do complex procedures and operations Uni
        As long as they get paid they will do anything.

        • Bazman
          Posted November 18, 2013 at 5:29 pm | Permalink

          Any complications and their cost will then be passes onto the NHS will it not?

          • Edward2
            Posted November 18, 2013 at 7:59 pm | Permalink

            If you are saying this happens from poor quality care then the NHS can charge for having to do remedial work and the patient can also bring a claim.
            Are you claiming this is a significant problem of which you have facts and figures Baz?
            Perhaps you should make your claims public.

          • Bazman
            Posted November 19, 2013 at 4:34 pm | Permalink

            If you have laser eye surgery and it goes wrong who will ultimately pick up the tab in the long term? The NHS.

          • Edward2
            Posted November 20, 2013 at 1:32 pm | Permalink

            First you are assuming the NHS does every operation perfectly which it does not.
            Secondly you are assuming if the private hospital does an operation badly it will not do the extra work itself and just push you back into the NHS, which it does not.
            If your health insurance entitles you to have the original operation then it will cover you as a right to have the procedure redone properly in a private hospital of your choice.
            Why would the NHS always have to do the remedial work if as in your one example laser eye surgery goes wrong?
            The private hospital has ophthalmic surgeons and consultants too.
            I think you may be confusing proper private hospitals with some dodgy clinics (often outside the UK) who do cosmetic procedures which are not approved or covered by health insurance companies.

          • Bazman
            Posted November 20, 2013 at 8:17 pm | Permalink

            Hmm!? You could be right! Now answer some of my other comments.

      • Edward2
        Posted November 18, 2013 at 12:34 pm | Permalink

        I don’t know how you get to those conclusions by reading the latest OECD health report Uni.
        Out of the 40 or so nations in the report the UK is right in the middle.

        And if you look at the 20 or so nations who spend less per head than us, there are many who have health services which give their citizens a better quality service.
        So we should be asking how they do more for less not just equating more money spent to having a better service.

        • uanime5
          Posted November 18, 2013 at 10:18 pm | Permalink

          Care to explain which of the countries that spend less than the UK have a better healthcare system? Make sure you explain which areas they surpass the UK in.

          • Edward2
            Posted November 19, 2013 at 9:08 am | Permalink

            You first
            It was your claim the opposite happens

      • Richard1
        Posted November 18, 2013 at 4:16 pm | Permalink

        Edward2’s answer above reveals that the OECD study says no such thing, you just made that up. Also, the OECD study does not take into account (and nor do UK Govt stats) of the huge hidden costs of a state monopoly supplier with the delays and queuing system. People taking hours and days off work because of rationing by the monopoly supplier is a cost which is not at present quantified.

        • uanime5
          Posted November 18, 2013 at 10:23 pm | Permalink

          I just checked the OECD website and couldn’t find anything to support Edward2′s claim, mainly because he didn’t mention which countries were meant to be doing better than the UK or in which areas.

          You also seem to have ignored that queues may be less in other countries because they have more doctors and nurses per 1,000 people.

          • Edward 2
            Posted November 19, 2013 at 9:19 am | Permalink

            You need to have a longer look then Uni
            Slowly for you
            40 nations
            UK spends the OECD average on health care
            Therefore there are 20 nations who spend less than us
            Some have excellent health services.
            My point was that we should find out how they manage to do this.
            Thats all.

  7. alan jutson
    Posted November 17, 2013 at 8:28 am | Permalink

    A simple example if I may.

    10 years ago had a problem with my shoulder, GP said we will try physio.
    At that time there was a 7 month wait for the NHS Physio, so I paid to go private and spent £1500 on treatment.

    This year I had a diagnosed trapped nerve in my neck, doctor diagnosed physio and arranged a course of treatment at the very same private practise that I had paid to get treatment 10 years previously, result a wait of only 10 days and funded the treatment through the NHS.

    So 10 years ago would have had to have waited 7 months and been in pain for about 10 months waiting and treatment time, whilst attempting to work.

    This time waited 10 days until treatment started, in both cases the treatment was a treatment success.

    In the first example I had paid twice once for an NHS contribution then to be treated, in the second case I paid once through an NHS contribution and less pain and suffering.

    Thus why complain about treatment being done outside of the NHS if it gets people treated faster and unblocks the log jam of waiting in pain.

  8. Old Albion
    Posted November 17, 2013 at 8:36 am | Permalink

    You don’t make it clear which NHS you are referring to !!
    But as you mention prescription charges, which apply only to England (naturally) I assume you mean NHS England.

    • lifelogic
      Posted November 17, 2013 at 11:21 am | Permalink

      Indeed. England the government’s cash cow with hardly any real democracy left and thus little power to resist the mugging by Osborne.

      • Bazman
        Posted November 18, 2013 at 6:48 am | Permalink

        Osborne’s moronic help to buy scheme will of course be supported by you though? Alice in Wongaland economics as one wag said.

        • Bazman
          Posted November 20, 2013 at 8:19 pm | Permalink

          I’ll take it that comment is agreed on though.
          Ram it.

  9. Mike Stallard
    Posted November 17, 2013 at 8:46 am | Permalink

    Just 35% or so of government expenditure is not spent on one or other kind of welfare at the moment. The rest goes on NHS (18%), education, welfare and pensions.

    The debt is rising to well over a trillion pounds. The interest alone means a red light is flashing. The deficit has been slightly reduced.

    We have an open door to anyone and everyone who wants to come here from the EU (boat to Lampedusa anyone? Perhaps a plane to Portugal?) and be paid, looked after, housed, healed…

    And every single person I know (mainly at the gym) insists that they have a right to free health at the point of delivery.

    So how does the poor old government react? Well, Labour uses the technique of disinformation freely. I am not actually sure what Mr Cameron believes. But when he goes to Sri Lanka, his weakness is now obvious.

    • Denis Cooper
      Posted November 17, 2013 at 10:08 am | Permalink

      The EU Commission has just proposed that visa-free travel into and around the EU should be extended t0 the 3.6 million citizens of Moldova:

      http://euobserver.com/tickers/122124

      That’s the Moldova which according to Wikipedia is the poorest country in Europe, with per capita GDP something like a quarter of that in Romania, which is itself about a fifth of that in the UK, and with high incidences of TB and HIV.

      100,000 plus Moldovans have already been given Romanian passports and so will be completely free to come here from January 1st, but the EU Commission thinks it would be a jolly good idea to allow all 3.6 million to (move ed) across the EU with minimum formality.

    • Nick
      Posted November 17, 2013 at 11:21 am | Permalink

      You’re falling into the trap set by people like John Redwood.

      Pensions are welfare?

      Are they? You’ve paid in. I’ve paid in. Irrespective of need we are due the money back in our retirement.

      Now John really knows that they can’t pay the pensions. Otherwise he would post the information about what the owe. However, he can’t bring himself to do this, because it blows the scam out of the water. With a 6,500 bn pension debt, everyone works out what’s going to happen.

      Then when you know that you won’t get a pension, people start asking the question they can’t answer. Why should we pay and get nothing?

      It’s worse. The state pension costs 152K. A 26K a year worker would have received a fund of 700K if they had invested their money. Even more difficult to swallow.

      So why you say the debt is a trillion, what about the pensions debt?

      Disinformation isn’t it?

      Reply I did publish future costs of the pension scheme!

      • alan jutson
        Posted November 18, 2013 at 9:02 am | Permalink

        Nick

        Whilst I take your points about the State pension scheme please do not think everything in the private sector is wonderful.

        Equitable life.
        5% annuity returns
        Annual management fees

        Very few private schemes benefit their customers either.

        The lucky ones are those in final salary scheme, or where the employer pays in a very large chunk, like the NHS, Police, Fire Service or civil service.
        Many of whome retire early (compared to the rest of us) as well.

      • APL
        Posted November 20, 2013 at 9:05 pm | Permalink

        Nick: “Why should we pay and get nothing?”

        Quite a few folk in their late 40’s and early 50’s are going to find their pension nationalised to pay the public sector bill. Then, when that’s all been spent, they will be destitute.

  10. Mark B
    Posted November 17, 2013 at 9:09 am | Permalink

    The NHS is indeed not free. However, people from other countries have been able to access our healthcare services whilst not having to pay in themselves, this has created a shortfall in the finances. And that includes EEA Member states who have the right to be treated here

    As for free prescriptions, they still apply in Scotland and Wales. Only in England do we have to pay, and since there is no one in Parliament who will speak for the English, we will remain a silent and disenfranchised majority in our own country.

    You state that the ‘Elephant in the Room’ is the GP’s, no it is not. The ‘Elephant in the Room’ is the EU and the commission. In its never ending drive for a single European State, it will seek commonality throughout the EU. This means healthcare, like the Royal Mail, will be sold off o private healthcare providers – you simply cannot stop this march whilst a member of the EU since you have given away sovereign right to determine Government Policy.

    If the NHS is to be privatized it should not go down the US route of healthcare only to those who can afford it.

  11. Iain Gill
    Posted November 17, 2013 at 9:11 am | Permalink

    “All UK Citizens” are not entitled to free NHS. One of the crazy aspects of the system is that British Citizens who have been abroad a few years, perhaps working, are not entitled to free NHS care on their return. This should be changed.

    It is not whether the providers are state or privately owned that keeps standards high. It’s the ability of end consumers to be able to take their business elsewhere, as and when they like. It’s that dynamic which keeps all consumer fronting businesses on their toes. And its one of the main reasons the “take it or leave it” NHS fails to provide decent service. What the NHS needs more than anything is real buying power in the patients hands to take to any provider of care they want at any point in the treatment cycle. And let places that fail to attract patients go out of business, and let those that attract more patients get more money to serve them.

    • ian wragg
      Posted November 17, 2013 at 10:53 am | Permalink

      Indeed all UK citizens are not entitled to free treatment. As I posted somewhere else, I worked in Africa and the Middle East for 20 or more years and I had to have a lump removed from my middle finger.
      I dutifully gave my overseas address at the local hospital and the Consultant immediately took me on as a private patient and I was charged £2500 at the Notts Park Hospital.
      When we returned a few years ago we couldn’t register with our local practice as it was “full” unless you were an immigrant.
      As I had paid NI and tax on my house rental for 20 years a solicitors letter soon made a space available.

  12. Denis Cooper
    Posted November 17, 2013 at 9:40 am | Permalink

    There is another huge elephant quietly entering the room, or maybe it would be better described as an elephant, the WTO, preceded by its well-grown calf, the EU.

    If health services are considered to be “internationally tradable services” then both the EU and the WTO start to come into potentially all policy decisions.

    From 12 years ago now:

    http://www.parliament.the-stationery-office.co.uk/pa/cm200102/cmselect/cmhealth/308/308ap26.htm

    “JOHN AUSTIN MP
    Q935-937 Has the Confederation considered that if the health care system in this country increasingly becomes a mixed economy of provision, even though public funded, there is an argument that it then comes within the remit of the WTO? (This is an issue that was raised by Alyson Pollock in her oral evidence)

    There has in fact been a mixed economy in the NHS for a long time especially in primary care, mental health and learning disabilities. Professor Pollock has suggested that this brings health service provision within the remit of the WTO … For the WTO rules to cover health care the Department of Health would need to agree that health was an internationally tradable service. Whilst opening the provider side to competition in the UK automatically means that it is open to firms in EU members it is not clear that this is the same as declaring health as an internationally tradable service … Interestingly although the government has talked about increased plurality there has not to our knowledge been any formal notification of firms in other EU countries. The view of our expert advisor is that this position is probably untenable if not actually illegal.”

    And during the debates on the Lisbon Treaty some Labour MPs expressed concern that the EU was increasingly interfering with the operation of the NHS; and if the EU can exert control over our national postal services, taking them to be just part of its EU postal services, then clearly it could regard our national health services in the same light.

  13. Javelin
    Posted November 17, 2013 at 9:49 am | Permalink

    I think you should start by charging foreigners and non citizens. I think you will find a good 10% of the budget will be saved.

    • Dan H.
      Posted November 18, 2013 at 11:24 am | Permalink

      You know, there’s another elephant waiting quietly in the wings here, and it’s name is “ID Cards”. If you switch from an NHS which works on the basis of everyone who turns up is entitled to free care, and move to one which demands that users be UK citizens, then you’re essentially saying “Every user of this system must be able to prove entitlement to treatment”.

      The best way to implement this is to set up a two-tier service; basic grade is mere life saving treatment, UK Citizen tier is only available on receipt of proof of entitlement. As the higher tier would be essentially a private healthcare system run by the government (probably at one remove), the users would be able to decide for themselves how to prove who they were, ranging from a card, to a tag, to fingerprints and DNA typing to prove entitlement.

      The best thing about such a system is that it would be effectively contribution-based and thus not illegal under EU law. An EU citizen in the UK would be entitled to exactly what any UK citizen who hadn’t paid into the system would be, i.e. basic life-saving care and not much more; no expensive anti-cancer surgeries or treatments, no cosmetic surgery and so on.

      • uanime5
        Posted November 18, 2013 at 10:25 pm | Permalink

        How exactly are anti-cancer surgeries or treatments not basic life-saving care? Are you saying we shouldn’t treat UK citizens who have cancer until it becomes life threatening and much more expensive to treat?

  14. sm
    Posted November 17, 2013 at 9:56 am | Permalink

    Thank you for pointing out the hypocrisy about NHS privatisation. Some years ago, a very elderly friend tripped and fell in the street. She broke her arm, knocked out two teeth and broke her spectacles.

    In our ‘free at the point of delivery’ NHS, her arm was indeed treated for free, but she had to make a sizeable financial contribution for her dental repair work, and pay for her replacement spectacles and lenses.

  15. backofanenvelope
    Posted November 17, 2013 at 9:59 am | Permalink

    My wife needs a cataract fixed. NHS will do it within 18 weeks – they hope. The local private hospital just said, could she make it next Tuesday!

    • livelogic
      Posted November 18, 2013 at 7:02 am | Permalink

      Indeed and it will probably cost the NHS far more to ( maybe) do it in 18 weeks too.

  16. Bob
    Posted November 17, 2013 at 11:01 am | Permalink

    Mr Redwood,
    I notice that you mention “free at the point of need” in your first paragraph, and “free at the point of use” in your second paragraph. Was this deliberate?

    I think it highlights what should be an important distinction. Anyone in need of urgent medical attention should be treated first, and the issue of payment should be a secondary one. However, in the case of IVF, and other non essential procedures, the cost should be met by the customer.

  17. Bert Young
    Posted November 17, 2013 at 11:10 am | Permalink

    The system of Private Health Care and the NHS already works in tandem . If someone has Private Health Care Insurance cover they may be able to have their operation done at an NHS hospital , have the surgeon of their choice and stay in a private bed . The planning and arrangement for the patient is made by the patient’s GP ; the timing and subsequent administration is done by the NHS hospital and the Surgeon . The charges involved are contracted for between the parties . I fully agree that “tourist” cases must be paid for and collected at the point of care ; where there are reciprocal arrangements in place between country and country such cases must be honoured . I don’t see the point of politicising the NHS at this time ; all Parties are basically agreed on keeping and maintaining the service to the public ; there is some cleaning up to be done , but , the differences are minimal .

  18. JohnOfEnfield
    Posted November 17, 2013 at 12:32 pm | Permalink

    This privatisation of the NHS a most fundamental issue. It is the root of so much evil & injustice in our health care system. Just a few points:

    1. Now that we have effectively open borders, we are taking on the task of providing an International Health Service not simply a National one. (Just stand in the foyer of any of our hospitals. Listen & come to your own conclusions). Why? Because effective billing systems don’t exist in the current NHS. This cost burden is enough to sink the country on its own let alone any other part of the benefit system.

    2. The monolithic centrally run NHS system is truly impossible to manage. The central issue is Gordon Brown’s insistence that we, as patients, would never have enough knowledge of our requirements to correctly choose what treatment we required. Nothing could be more fundamental , nothing could be a greater “human right” than for you to be able to choose what to have done to your body & mind. Nothing can be more dehumanising than this principle. You see it on virtually every notice board in the NHS where it says “Voilence against our staff is unacceptable”. What civilised society needs to say that? What civilised society would accept the “Liverpool pathway”? (Orwell would have loved to get stuck into that phrase).

    3. The public service which is the NHS has been captured by its employees. Specifically the Executive management. There are many symptoms of this: they protect their own; they give themselves fantastic (obscene) salaries, pension & payoffs; the lower orders such as Nurses are worked to the bone (12 hour shifts, some of them back to back because the next shift doesn’t turn up). And the unions impose their own agenda as well.

    4. A&E departments shutting down (Specifically here in Enfield). From a management point of view the logic is perfect. But why can’t a suburb of 400,000 people warrant its own A&E.? The people have spoken. But “they” don’t listen. No wonder they have to put up notices forbidding violence.

    I could of course go on & on, but it is manifestly obvious that Single Payer is quite a separate issue to Public Sector delivery. And we suffer greatly because of the conflation of the two issues. You do a great service in starting the discussion.

  19. behindthefrogs
    Posted November 17, 2013 at 1:11 pm | Permalink

    Why is it that the government rejects minimum alcohol pricing which would either have a significant effect on the costs of the NHS and other bodies like the police or raise significant revenue through the extra VAT paid.

  20. Edward2
    Posted November 17, 2013 at 2:12 pm | Permalink

    I’m the age that grew up with the NHS and I have much to thank it for, keeping me and members of our family alive today.
    The NHS is the nearest thing we have left to a national belief system, far more than the belief we have in either global warming or the Church of England.
    We believe it is free. But it is not free.
    We pay for dentistry, physiotherapy, opticians, chiropody services and all helicopter ambulances are provided by charitable donation.
    We pay for prescriptions in England and recently many new drugs are being restricted or completely denied us.
    It is said the average taxpayer is paying about £2000 per year each for the NHS.
    We are rated at about number 12 in the world in terms of excellence of the service we get.
    Yet we still believe it is good and should never be altered.

    Those that can take out health insurance should be encouraged to have it and there should be big tax breaks for those who do.
    Encourage private heath provision and the building of hundreds of private hospitals.
    It will take the pressure off the NHS which is a fatally flawed business model.

    • uanime5
      Posted November 17, 2013 at 10:24 pm | Permalink

      Why should anyone get a tax break for getting health insurance? Surely if there’s a demand for private healthcare the private sector will provide low cost healthcare, just like the private sector provides low cost energy and water.

      • Edward2
        Posted November 18, 2013 at 8:36 am | Permalink

        Uni
        Because it will help and actively encourage people to afford having such insurance cover and if applied to companies it will encourage employers to provide insurance schemes for their staff.
        At present employees actually pay extra tax as a benefit in kind at their highest rate if their employer provides them with private health insurance.
        The price would fall if millions more took out cover.

        • uanime5
          Posted November 18, 2013 at 10:29 pm | Permalink

          Why exactly should the taxpayer pay for the wealthy to have healthcare? Unless companies are forced by law to give all their employees healthcare your plan has no chance of working.

          • Edward2
            Posted November 19, 2013 at 11:00 am | Permalink

            Uni
            You keep asking the same question in different ways which I thought had been already answered but…
            Its about creating an incentive by first removing the benefit in kind extra tax bill that is currently added onto individuals that are part of a company scheme and re introducing the tax allowance against Corporation Tax businesses once had if they set up a company private health scheme for their staff.
            You could legislate that the company has to make the scheme open to all staff to get the allowance.
            If you also introduced a tax allowance for individuals to take out private health insurance together with the above incentives there would be a reduction in the pressure on the NHS and a net saving to the taxpayer.

      • alan jutson
        Posted November 18, 2013 at 9:12 am | Permalink

        Uni5

        “why should anyone get a tax break…..”

        Because they are in effect paying twice.

        Similar to Private education.

        I would certainly agree that it should not be a complete refund type tax break, because the NHS acts as an emergency service, few private providers do.

        But those who choose to go private for debilitating conditions actually lower/shorten the waiting times for those of us who use the NHS.

        And no Uni, I do not have private medical Insurance, although I and my Wife have on a few occassions paid for private treatment out of our own income/savings, just to get out of pain.

  21. Acorn
    Posted November 17, 2013 at 2:54 pm | Permalink

    “Free at the point of use leads to abuse”. That will be the fifth time I have used that expression on this site. The first time was Sept 10, 2008. Can I refer the Rt Hon member to my for previous replies on this matter.

    The French, some while back, realised the problem and introduced co-payment and voluntary health insurance to top up the state financed statutory health insurance.

    • Bob
      Posted November 17, 2013 at 9:10 pm | Permalink

      @Acorn

      The French, some while back, realised the problem and introduced co-payment and voluntary health insurance to top up the state financed statutory health insurance.

      We could learn a thing or two from our cousins over La Manche.

  22. margaret brandreth-j
    Posted November 17, 2013 at 3:05 pm | Permalink

    I think the Doctors are going to find coordinating the services far more difficult than
    the present system. We nurses have all been named nurses and many of us have had to coordinate the services to ensure seamless connection between physiotherapist social workers specialised teams etc and believe me it is no mean feat. It involves much paper work and gathering people together from all disciplines.
    Our present system ensure that all the right things are done at the right time and if boxes are not ticked there are reminders to ensure nothing is missed. Many doctors could simply not adapt to the use of computers and looking at latest research from the computer and applying it in a sensible way. My daily patient lists work this way .There are guidelines and prompts. It is an excellent system and god forbid if we went back to the sloppy doctor system of the past where they thought they could get away with a chat and a paracetamol.
    One GP complained that she thought she had to document whether a 93 year old rode a bicycle or not .. obviously misinformed: it is simply a prompt to ensure that the 93 year old is mobile. The software we have in the north ensures that the patient is asked whether they do no exercise: gentle , moderate or vigorous and amongst the thousands of patients it certainly is a good reminder.

    • Antisthenes
      Posted November 17, 2013 at 9:59 pm | Permalink

      Once again I quote from my experience in France. I am not 100% certain(because coming late into the system I did not receive a medical book/file that every French citizen appears to receive from birth) but I was of the impression that although doctors and nurses used computers the onus for keeping health records was mostly down to the patient. They received most of them directly and it was then up to them to take them along to their doctor or consultant perhaps thereby relieving medical staff of the constant need for administrative duties and also therefore avoiding needless amounts of duplication.

  23. Antisthenes
    Posted November 17, 2013 at 5:02 pm | Permalink

    I did not know that GPs did not work directly for the government. That maybe because in my experience there actions and attitudes have always suggested that they do. The impression I have in every surgery I have visited and that is many is that only the most unpleasant of receptionists are employed to deter patience from making appointments in the first place and hours of opening are designed purely for the convenience of doctors and staff. If they are in fact private then that fact is not having the desired effect. I suspect that has something to do with allowing doctors to monopolies locations and have contracts with government that excludes the competitive aspect of being private. France a country I rarely have anything good to say about does have an excellent health service where doctors and even nurses compete for patients(which is rather odd when you consider how that country is regardless of what government is in power heavily socialist leaning). Although it is not totally free as patients have to pay up to 30% towards the costs of healthcare, most take out insurance to cover that and the low paid are exempt partially or fully from paying any top up fees. The UK should look carefully at the French system it could if adopted in part of wholly save it because as it currently stands it is dysfunctional and not fit for service and it will continue to decline unless more radical policies and practices are introduced.

  24. Antisthenes
    Posted November 17, 2013 at 5:07 pm | Permalink

    Perhaps I should have added French GPs have surgery hours more in tune with patients needs not their own.

  25. stred
    Posted November 17, 2013 at 5:21 pm | Permalink

    Are statistics kept in relation to the number of administrators, managers, chief officers, in local,regional and national offices, for Continental health services, as compared to the NHS? Also, how do the Continental systems avoid spending a large proportion on lawyers and claims? And how does the pay of GPs, consultants and managers compare to state sponsored insurance in comparison to the NHS? Until we have a reliable comparison, who can make sensible decisions?

  26. forthurst
    Posted November 17, 2013 at 5:46 pm | Permalink

    “There is also one huge elephant in the room for those who claim to be against all private involvement in the NHS. That is the GP service.”

    Hospital consultants, also are under contract to provide a minimum service for the NHS after which they are free to perform private consultancy work as long as they do not use NHS premises for them.

    It is possible to define ‘private’ as what is done for profit; however, this overlooks the fact that our best schools are both private and not generally run for profit, as probably would be our medical services, if they had not been nationalised. All the buildings, drugs, equipment and consumables used by the NHS are from private provision; if there is a weakness there, it is in contract negotiation and puchasing by civil servants. A better definition of ‘private’ would be ‘not run by ex-communist civil servants jumping to the various off-key tunes played by politicians who seem perennially to wish to change things without finding out what at present works or doesn’t or why, before they start on yet another re-organisation.’ This is why the best way to improve our health and educational ystems is to abolish the departments of/from/by/with/for health and education, rather than to keep them and at the same time attract spivs into the process of provision. Ethical doctors and teachers do not want to make as much money as banksters; their motivations are not purely pecuniary.

    Undoubtedly, the NHS is poor in comparison with the services provided in comparable European countries. One odd fact is that our medical schools only produce half the intake of doctors to the NHS; one odder fact was that under the last labour government, British trained medical students were being forced to compete for training places leading to consultancy posts with medical students who had qualified abroad. Before anything else, the UK must train 100% of its doctors even if it means allowing for wastage due to emigration and consultancy training posts must go to them automatically; when it comes to how the hospitals should be run, possibly the best approach would be to examine why apart from superior staffing quality, continental medical services are better and their private provision cheaper.

  27. Antisthenes
    Posted November 17, 2013 at 5:48 pm | Permalink

    Another after thought under the health care system in France health tourism is not possible as it is in the UK.

  28. Kenneth
    Posted November 17, 2013 at 6:30 pm | Permalink

    I agree that the Conservative Party never (in my living memory) considered charging for healthcare beyond what is already charged for.

    However, I think it is reasonable for patients to be charged a nominal sum of £1.00 per consultation as I believe this would reduce frivolous appointments and save a great deal of public money way beyond the £1 charge.

    I also think immigrants should pay a bond on arrival with healthcare charges (and other services such as police etc) being deducted from their refund on their departure.

    We should also not forget that the NHS is a professional service staffed by people who are making a profit from treating the sick. I’ve nothing against people making money this way but we must not be taken in by left wing propaganda that tells us this service is free. It is not.

  29. outsider
    Posted November 17, 2013 at 9:27 pm | Permalink

    Dear Mr Redwood, I fear that for most of us privatisation means one’s local hospital being listed on the stock exchange with its policies governed by fund managers and hedge funds. That would not be a good idea. Unfortunately, only privatisation programmes that relieve the PSBR in year one and make money for investment banks seem to arouse much enthusiasm. PFI/PPP hospitals were therefore a big hit, if not for taxpayers. We need a gradual, stabilising reform that gives patients and GPs more choice and gives providers incentives to raise service and productivity.

    At the top, the NHS often acts like the worst kind of monopolist, disguised in the public mind by the great care we more often than not receive from its skilled and dedicated professionals. Much of its political effort is dedicated to reducing choice and strengthening its monopoly control: eg closure of local hospitals to form single regional super-hospitals, press-ganging GPs into group practices which were then grouped together in PCTs that set uniform policies for all; resistance to and propaganda against OTC medicines and remedies.
    Last week we were reminded of the private sector initiative to open walk-in centres with low consultation fees. The NHS soon responded by opening a 238 strong chain of its own walk-in centres, free of charge, duly snuffing out most of the private sector ones. Monitor now reports that almost a quarter of the NHS centres have been closed in the past three years, partly because they are seen as duplicating costs. And some now require appointments unless you are actually bleeding.

    I also read elsewhere that Mr Hunt , having been quickly captured by the lobby, is now campaigning for “e-cigarettes” (ie nicotine inhalers without the risky burning tobacco) to be regulated as medicines. Only the NHS, it seems, is allowed to stop you smoking.

    This drive to ever-tighter monopoly power could only be reversed by strong ministers at the top. I suggest, for instance, that state hospitals be put in to two competing national chains, with the rest being local independents. That should happen regardless of ownership structures, which now seem to be pretty mixed anyway.

    The best model for a large-scale service such as secondary healthcare is that of the John Lewis Partnership. Quite unlike any co-operative by the way. If you look at the balanced John Lewis governance structure and then look at the Francis Report, you will see that what happened at North Staffs and has been happening to some extent elsewhere would be virtually impossible under a governance model that, inter alia, allows employee partners to have anonymous critical letters published in a weekly company newspaper.

    Sadly, gradual reforms that reduce monopoly and give employees many of the incentives, benefits and responsibilities of stable ownership do not make money for investment banks and do nothing to help next year’s PSBR.

  30. uanime5
    Posted November 17, 2013 at 10:28 pm | Permalink

    Successive Conservative and Coalition governments have remained wedded to the free at the point of use principle, and the next Conservative Manifesto will doubtless reaffirm it.

    Given that the Conservatives have been closing walk-in clinics and A&E wards, which has resulted in the remaining A&E wards being stretched to crisis point it’s no surprise that people feel that the Conservatives are trying to weaken the NHS before trying to privatise it. Then there’s things like the massive NHS reorg which gives the entire NHS budget to GPs, rather than foundation trusts; allowing private healthcare companies to bid for NHS contracts; and changing the law to allow the NHS hospitals to use 50% of their beds for private patients which make it obvious that the Conservatives are trying to privatise the NHS.

    • alan jutson
      Posted November 18, 2013 at 9:23 am | Permalink

      Uni5

      You speak as if the past and present set up and running of the NHS is/was some sort of paradise.

      Did you agree with PFI agreements so loved by Gordon Brown and deemed an investment ?

      Face facts, no Political Party has grasped the problems, or got anywhere near to solving the inefficient and expensive NHS conundrum.

      All of our State run Services now seem to be virtually broken and unfit for the real purpose they were originally intended to meet.

    • Lindsay McDougall
      Posted November 21, 2013 at 7:34 pm | Permalink

      Haven’t you noticed one thing about services that free at the point of use: demand tends to be very high. Whoever is in power, we see a government that is desperately trying to cope, using funds limited by taxation, and an opportunistic opposition pretending that they could do better. “Will you, won’t you, will you, won’t you, won’t you join the dance?” Thanks but no thanks. It’s totally stupid.

  31. Andrew
    Posted November 18, 2013 at 10:04 am | Permalink

    It amazing that so many people do not realise that their GP is actually a private business and not a direct employee of the State, even if their business is very heavily regulated. It is also amazing that so many people seem to believe there was no health provision before 1948. Our local hospital, which has now been closed down, was built by ‘public subscription’ and as I recall six local families gave more than half the cost. It was built on our land. It was run by a charitable trust, but in 1948 it was simply nationalised. All the great hospitals you can all name were built by private charity and maintained like that. Bevan should have built on this not destroyed it.

  32. Terry
    Posted November 18, 2013 at 11:37 am | Permalink

    But we all know that the NHS isn’t actually “free”. It costs, on average, every household in the country, around £5000 per year, every year but not every household pays. Only those that pay our taxes actually contribute to the funding of the NHS.

    Now what miracles would those Private Healthcare Companies manage to do with just half of that sum, I wonder. The NHS employs far too many and it is too heavyweight in the Administration areas. Why is the NHS the largest employer in Europe when other countries with larger populations manage with far fewer employees? If we are to pay down our debt that “Ring Fence” will have to come off the NHS for it has become a heavy burden over the past years.

  33. Lindsay McDougall
    Posted November 18, 2013 at 1:32 pm | Permalink

    The combination of making health care free at the point of consumption and funding it wholly through taxation has resulted in the resources devoted to health care being less than most people want. This country spends about 9.5% of GDP on health care as opposed to Germany’s 11%. Some people want taxes raised to close the gap; the trouble is that the people who would pay the extra tax are not in general the people who would receive the extra health care.

    Why don’t we move to a system where the amount of State financed health care is fixed at 9.5% of GDP and there is a ring fenced top up fund, financed by voluntary private donations, to provide extra resources? It is not unreasonable to ask the wealthier pensioners to make such donations.

  34. David in Kent
    Posted November 18, 2013 at 1:53 pm | Permalink

    Labour and many of the commenters on this site are dead-set against ‘privatisation’ but it is not the ‘free at the point of use’ principle that they are referring to.
    They are frightened by any challenge to the principle that 80% of NHS money goes direct to the monopolistic, unionised and grossly inefficient hospital service.

    • REPay
      Posted November 18, 2013 at 4:34 pm | Permalink

      Spot on!! A friend of mine set up a cataract service that was massively more effective that and cheaper the local health authority hospitals …under pressure from the local hospitals their contract was suspended until the service closed. End of competition…

  35. margaret brandreth-j
    Posted November 19, 2013 at 11:07 am | Permalink

    A problem with even part privatisation may be put down to attitudes.:-
    ” I am a doctor , I have trained 7 years for this , have a high salary and am in a different class”
    response “I am a Nurse and Nurses trained in medicine for many years and passed medical exams, I have been giving medication all my life , need to know the conditions they are given for , understand the pharmacology and side effects and can be struck off the register if I administer a drug a doctor prescribes which is incorrect and don’t think about class”

    “It is my business and it is important that my name certificates and qualifications are brightly shown to all passers by to demonstrate how important I am”
    Response ” I am a Nurse and my qualifications and hard work is for the sake of the patients and the public and to show how important they are, I don’t want my certificates to be displayed “

  36. peter davies
    Posted November 19, 2013 at 1:27 pm | Permalink

    I recently sat in an NHS eye clinic with my partner who had already had a thorough examination by the local optician with a proper well researched and informative report and evidence to hand the NHS which appeared to be disregarded.

    A rough summary of what then happened follows:

    1st 60 mile round trip to the hospital – camera was broken so sent away after sitting in the queue for a couple of hours

    2nd trip photo was taken after waiting in the queue all morning

    3rd trip after a fair amount of chasing – a different doctor barely looks at the notes even though he does not know the history and dismisses the concerns telling her to “come back next year”.

    I have no doubt that there are very good parts to the NHS but I’m afraid this snapshot means we will be taking out private medical insurance and by passing the NHS – it is too big, unionised and cumbersome and was designed for a different age when there wasn’t any proper health provision.

    I honestly believe that given the complexities of medical care that NHS hospitals should be broken into smaller entities based on speciality or competence and allowed to compete freely with private providers – ie eye clinics which have a direct link to opticians, heart and lung clinics with direct links to GPs and so on – the GP (1st line) deals with the patient and sends to the appropriate place – not too far off what England is trying to do I guess (I wish Wales and Scotland would do something similar).

    How this is paid for at the point of delivery is obviously another point which I don’t have the answer to but having seen how the likes of Germany organises its health care means all options should be on the table – I can’t see anything other than paid at the point of entry through compulsory insurance being feasible.

    It works in other advanced countries so why not here?

    • Bazman
      Posted November 20, 2013 at 8:27 pm | Permalink

      Maybe Dave (17) could be put in charge of laser eye surgery? You would have this but should Dave ever make an arse of changing the tyres on the daughters BM. ie the wrong ones, would want a full extensive and exhaustive investigation of what happened, why, and who is responsible and of course everyone who has ever known related and ever met Dave (disciplined ed) and the political party in charge sent to the (dog house ed) for a start.
      Ram it.

      • Edward2
        Posted November 23, 2013 at 2:52 pm | Permalink

        Gets my vote for the strangest and least understandable post of the year.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, and graduated from Magdalen College Oxford. He is a Distinguished fellow of All Souls, Oxford. A businessman by background, he has set up an investment management business, was both executive and non executive chairman of a quoted industrial PLC, and chaired a manufacturing company with factories in Birmingham, Chicago, India and China. He is the MP for Wokingham, first elected in 1987.

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