No party wants to privatise the NHS,but the NHS has always used a lot of private sector work

 

One of the most ill informed debates which Labour regularly makes us have is the debate about “privatising the NHS”. Labour, Conservative, Lib Dem and UKIP all say they will not privatise the NHS.  I think what they all mean by this is we are all fully signed up to the proposition that health care should be available  free at the point of need for UK citizens who want it from the NHS, a very popular principle.

In practice the private sector plays a large role in the NHS, and has done so since its foundation. It would be a good idea if we began the debate with a proper explanation of the current structure of the NHS. Labour, Conservative and coalition governments with the Lib Dems have all preserved the extensive use of the private sector inherited from the original NHS scheme, and have extended the role of the private sector in certain ways.

From the beginning it was decided to depend entirely on the private sector for the supply of drugs and other medical supplies. A very profitable competitive industry has grown on the back of NHS contracts and their equivalent elsewhere in the world. We still depend on large pharmaceutical and medical supplies companies for everything from pills to scanners, from bandages to beds.

From the beginning it was determined that most GPs would be private sector businesses, earning much of their living from NHS contract payments. So it has remained, with a majority of GPs today being private sector contractors working under the NHS banner. On average 95% of their income comes in NHS contract payments and 5% from private sector fees and charges. The typical  GP partnership receives gross payments based on the size and composition of their list of patients registered, and based on particular services they provide which qualify for additional remuneration. Out of the gross payments they pay their practice costs and then receive the rest as personal remuneration. According to NHS England  in 2011-12 the average GMP received £178,200 gross , which gave take home pay before  personal tax of £106,100. I think it right that we seek to reward  people with medical qualifications at good levels for their expertise and professional study.

In hospitals many years ago under the Conservatives  it was decided in some cases to introduce private sector contractors to do the cleaning, to provide the meals and some of the other hotel services. Labour continued with this approach. Labour  also added some limited use of private sector medical services, bought in to relieve shortages of capacity in particular specialities or to improve the patient outturns and reduce the waiting lists. In office Labour argued that the essence of the NHS was to offer good quality care free at the point of use. Sometimes, they said, this could be done more quickly and more cheaply and better by buying in service from the private sector and paying for it with NHS  funds for patients.

It is therefore curious that today Labour wish to maker a political issue out of the “threat” of privatisation. As far as I can see there is absolutely no threat from any political party to the idea that the NHS should be free at the point of need to those who want it. Nor do I see any likelihood that Labour, who used the private sector extensively in power to help deliver NHS services, would want to nationalise doctors and drug companies were it to get back  back into office.

This entry was posted in Uncategorized. Bookmark the permalink. Both comments and trackbacks are currently closed.

69 Comments

  1. Brian Taylor
    Posted November 23, 2014 at 5:57 am | Permalink

    Thank you for the above, now perhaps the BBC wil present the facts!!!
    Next would you have ago at PFI contracts and give us some Facts please.
    My local hospital was built with PFI money ( The Norfolk & Norwich university hospital )
    After a few years it was so obvious the deal was very expensive it was reduced and a refund? Was obtained, not sure of all the details.
    Is this another case of poor negotiation skills when it is tax payers money?

    • Hope
      Posted November 23, 2014 at 11:51 am | Permalink

      The NHS is a good concept but is inefficiently run by left wing politically correct bean counters. They appear more interested in providing translators than proper care and treatment. When are proper controls going to be applied to who receives treatment? Anyone check where some of the patients live? How many managers does the NHS need? When will there be a proper investigation for Mid Staffs atrocity including and up to the health secretary at the time.

      Cameron had it as a centre piece for the opening of the Olympics when most of us cringed. Instead of paying the £1.7 billion extra EU payment, without negotiation from Osborne, why is this money not used for nurses and doctors? Overseas aid could be used as well. Instead of arresting people under the EAW for wanting better treatment for their child than the NHS offered he could have spent our taxes more wisely.

      The NHS needs root and branch reform for the way it is run. Cameron keeps on building to help his mass immigration, when is he going to provide the infrastructure? His plans do not stand any form of scrutiny.

      • Lifelogic
        Posted November 23, 2014 at 5:47 pm | Permalink

        Mid Staffs is alas just the tip of a rather unpleasant iceberg.

    • Lifelogic
      Posted November 23, 2014 at 12:14 pm | Permalink

      The state sector is as bad at negotiating deals with the private sector as it is running things themselves. After it is not their money they are wasting nor is it the NHS that suffers if they are much up it is the patients (or deceased ex-patients and relatives).

      The NHS and government often blame the private sector and PFI deals (for some NHS problems) but it is the NHS who agreed the contracts, they should make decent fair contracts that work and enforce them properly.

  2. Lifelogic
    Posted November 23, 2014 at 7:29 am | Permalink

    Alas there is indeed no party likely to challenge the “free at the point of rationing” and often very poor treatment indeed that the NHS delivers. Clearly people should be treated if they cannot pay at the time but there is no reason for them not to pay back later. Charging £25 or something for every visit to the NHS/GP would be a very good thing. Not charging kills almost all private competition in the industry. In the case of the many drunks and drug problems at casualty charging them might prevent them getting so drunk and returning on the next Friday & Saturday night.

    Free at the point of need is indeed a popular principle, as would be free food, free heating, free movies and free housing – it does not make it sensible. It is alas this principle that is at the heart of the problems of the NHS.

    The way people are expected to wait hours at casualty departments, the way they are turned away for and/or have to wait months for basic scans, angioplasty, angiograms, biopsies and basic diagnosis. The way they find difficulty even making an appointment with a GP and then are given only say 7 minutes and can only discuss one condition at a time. The outcomes in the NHS are poor and badly deteriorating (despite the technological advances) when compared to most developed countries.

    The NHS has all sorts of silly tricks to ration & delay treatment, delay operations, do pointless minor operations when a major one is needed and all sort of way of pretending the waiting list are lower than they are. Often patients are misled about the need for an operation they could easily pay for themselves were they honestly told they needed it (but the NHS were rationing it). So positive damage can be done to patients by poor information and diagnosis.

    Another problem is the out of control litigation culture that has developed and the expensive defending the NHS has to do. Here the NHS should limit liability with a no blame minor compensation agreement with patients. If patient want more cover they can buy insurance. It is better that way as then you can have more open and honest investigation of mistakes made. Patients who have suffered then also get compensation quickly without years of legal argument and uncertainty.

    Clearly people who cover themselves privately (with comprehensive insurance cover) should get tax relief on premium as they are then not a burden on the NHS. In fact the government just tax them further with insurance premium taxes (6% or 20%) further penalising the prudent and rewarding the feckless.

    • Lifelogic
      Posted November 23, 2014 at 7:50 am | Permalink

      Essentially the government (by taxing in advance and then providing a very poor & rationed service that is free at the point of use) kills nearly all competition in the medical sector and gives the most consumers little or no choice. They get the second rate service they are offered and put up with it. They get the treatment, at the times and after the delays that suits the NHS provider and their rationing systems.

      You get what you are given and like it. It is just tough, we have your tax money already anyway. If you do not like it get another GP or hospital if you can, or just get lost. This seems to be the general attitude, caused by the way it is funded and structured. The money does not follow the patient sufficiently the best way to do this is for the patient to pay and hold the money.

      The NHS only works at all due to a number of excellent, hardworking and well meaning medical staff in the NHS who cope despite the dreadful system, the appalling administration, silly politics and very poor leadership there.

      It is largely the same in the education systems of course. Education vouchers are the simple solution and all schools should be private.

    • stred
      Posted November 24, 2014 at 5:43 am | Permalink

      Only in the NHS could a simple reversal operation, following earlier surgery, be held up for a year due to management prioritisation. A friend of ours was left to deal with a colostomy bag for a year, while waiting for the reversal.

      • Lifelogic
        Posted November 25, 2014 at 4:55 pm | Permalink

        Not at all untypical in my experience. The elderly often seem to receive little real treatment at all. This on the basis (one assumes) that the more they delay the less chance they will ever have to do any operation at all.

  3. Mike Stallard
    Posted November 23, 2014 at 7:40 am | Permalink

    “I think it right that we seek to reward people with medical qualifications at good levels for their expertise and professional study.”
    Please be careful. When nurses (like my own wife) lived off £4.00 a month, they were respected. Young girls straight from school saw nursing as a career path like being (at the time) a film star or air hostess. When the pay went up and universities became involved, nobody wanted such a dirty, smelly job.
    Doctors are expected to listen to you as “your best medical friend”. They are expected to understand you. If they are off skiing, if they live in a huge house with servants or if they only turn up a couple of days a week, then they are withdrawn from you and they begin not to understand in the same way (cp politicians). It is all the difference between a senior consultant and a friendly, open g.p. (now on £100, 000, 000 a year).

    • Margaret Brandreth-J
      Posted November 23, 2014 at 12:36 pm | Permalink

      Yes when I was 19 years old in Ancoat’s casualty as a student Nurse I was told if I did not go immediately and suture this African’s man neck up who had been knifed with a razor at a local industry I would not make a nurse. I watched one suture being done at the side of me to a thumb in 2 mins and then up to our hands and aprons in dirty smelly ,blood I stopped the bleeding and sutured his neck. The surgeons upstairs in the theatre were cleansing out bowels in colorectal surgery.

  4. Leslie Singleton
    Posted November 23, 2014 at 7:52 am | Permalink

    One reads that the NHS is looking for Polish nurses to speak to the ever increasing number of Polish patients. I do not need much convincing that the language problem (blithely ignored by the EU lovers) is potentially serious. A Polish restaurant (or perhaps better to say just a restaurant run by Poles) has just opened near me and the other day, despite my best endeavours, I was unable, no matter what I said or did (and the same applied to customers on nearby tables who tried to aid with the explanations and attempts at translation), to order a glass of orange squash. Whilst trying very hard to be helpful, they simply had no idea what it was. I do not wish to be boring but the same applied to such advanced concepts as “one slice of toast” as against the two they insisted on bringing and ” no butter”. I didn’t suffer too much but it might be different in a hospital. A pox on the EU as usual.

    • Hope
      Posted November 23, 2014 at 12:01 pm | Permalink

      It is near on impossible to find an English trained/speaking NHS dentist where I live. It is also not free at point of entry. A dentists costs a fortune and people cannot afford it. Meanwhile last week Cameron is insistent on giving away £650 million pounds of our taxes for stupid climate change agenda!

      • Lifelogic
        Posted November 23, 2014 at 5:54 pm | Permalink

        The cost of the climate change act is very many £billions on top of that – and all for nothing. Further more the high energy prices it causes cost £billions more in lost and exported jobs and industries. All because cameron thought pretending to be green would win votes.

        In fact it was one of the factors that cost him the election. That, the EU ratting and Clegg’s equal billing on the TV debates.

  5. Old Albion
    Posted November 23, 2014 at 8:38 am | Permalink

    It’s simply an example of politicians putting politics before the good of the country.
    Labour want to win the next election. So they spread mis-information about the NHS (incidentally, i presume this whole article refers to Englands NHS) in the hope it will win them votes. Doing what is best for the country comes second to winning an election.
    It works both ways of course. The Cons and Lib-Dems are just as guilty.

  6. Javelin
    Posted November 23, 2014 at 8:44 am | Permalink

    If the reports in the Telegraph are true – that there are at least 2000 UK Muslims fighting for ISIS then you are simply arranging the deck chairs on the Titanic. This will mean thousands more within a year.

    (predicts tensions here in UK ed)

    Our cosy lives will be destroyed.

    Oh what have you done.

  7. Richard1
    Posted November 23, 2014 at 8:58 am | Permalink

    Labour have had one very reliable line in all recent elections: ‘if you vote Tory they will privatize the NHS’. It might be rubbish to the point of lies but they seem to think its worth repeating. The best antidote to it is the one the Conservatives now rightly employ: to point out the desperate state of the NHS in Wales under Labour. I also think they could turn up the heat on Labour, and Mr Burnham in particular, for the dreadful tragedy of all the deaths and suffering at mid-Staffs under Labour, and many other failures. Labour’s other reliable line, especially at the 2005 election, was to accuse the Tories of ‘racism’ if they wanted to discuss immigration at all, a loine which they have of course now had to drop. Time to beat them on the NHS as well. After all on the NHS as on many other things, the facts of life are Conservative.

    • Hope
      Posted November 23, 2014 at 12:04 pm | Permalink

      A judicial enquiry should be held and those responsible held to account including politicians. Over a thousand people died for goodness sake. This is more important than the stupid squabbling between the LibLabCon who wants to present the EU law, policy, regulation and directives.

      • Richard1
        Posted November 23, 2014 at 11:11 pm | Permalink

        Indeed. There were more British casualties in the Labour mid-staffs disaster than in the Iraq war.

  8. Peter
    Posted November 23, 2014 at 9:02 am | Permalink

    Sadly it’s quite true that none of the parties wants to privatise the NHS.

    Personally I think breaking this disfunctional colossus up and privatising it would make for much better healthcare in the UK.

    Why do we have to stick with this piece of Soviet-style 1940s central planning?

    • Lifelogic
      Posted November 23, 2014 at 12:19 pm | Permalink

      Exactly.

      At least they do not want to make food production and distribution and energy production and distribution go the same state monopoly/rationing/soviet way – then again with all the green crap subsidies and mad regulations perhaps they are doing exactly that.

    • William Gruff
      Posted November 23, 2014 at 5:26 pm | Permalink

      ‘Privatising’ the NHS can only result in the same mess that privatising the formerly state owned industries and utilities created – all of which are now foreign owned, if they exist at all (coal mining, railway and vehicle manufacturing, ship building and so on all little more than a memory in now middle-aged minds). While I agree that the NHS must be dismantled and state involvement in health and medicine ended, privatisation, which merely puts public assets in private hands, is not the way.

      A more effective course is to break up the NHS empire and mutualise its components, placing them in the care of charities that are genuinely and inalienably socially rather than state owned and managed, with local people having ultimate authority and staff being genuinely accountable. Selling it off to anonymous and virtually autonomous global corporations is not in our interests.

      None of that is possible while we continue to elect time-serving careerists, party men, cynical opportunists, incompetents, liars, swindlers, perverts and criminals to parliament. We’ll get the government we deserve until we start thinking for ourselves and voting accordingly.

      • Lifelogic
        Posted November 25, 2014 at 4:58 pm | Permalink

        We need it broken up and lots competition just as we have with cars, hair dressers, shops, vets and the like.

  9. agricola
    Posted November 23, 2014 at 9:05 am | Permalink

    You put matters very fairly, free at the point of use to UK citizens, but how the care arrives at the point of use is deemed by what is practical and economical. Labour if they suggest otherwise are being dishonest for a perceived political end.

    I am sure that the NHS as it is managed can be better organised. I do not have access to the figures for spending on consumables but can imagine the figure is vast. It therefore should be a target for professional purchasing on a national scale, but not left to any form of civil servant. It is a job for people from the motor or supermarket industries where value analysis is the norm, and where the purchasing pool is fully international. I would expect professionals to be able to take 30% out of this budget without affecting quality, maybe even improving it.

    • JoeSoap
      Posted November 23, 2014 at 6:10 pm | Permalink

      Be careful what you wish for.
      It appears that Chinese companies are making me-too medical devices, CE marking them in China under Chinese-approved CE regulatory systems, and shipping them to Europe to undercut US and indigenous supplies to the NHS, which is under pressure to “reduce costs”. Rather like the breast implant stories of 2-3 years ago, things could get HORRIBLY bad and expensive later by saving pennies in the wrong place now….

  10. JoolsB
    Posted November 23, 2014 at 9:11 am | Permalink

    Labour have selective amnaesia when it comes to their record in office and their disastrous handling of most things including the NHS but that won’t stop them making this a major issue at the next election. They’ll be repeating their mantra to everyone who will listen that “the Tories intend to privatise the NHS”. It is blatant scaremongering and as usual, the truth and the worry this will cause to many who will believe them, will not deter them.

    As usual the Tories are useless at attacking them back. They should be shouting from every rooftop and reminding people of Labour’s record on the NHS in England – North Staffs, East Thurrock, denial of cancer drugs, mixed sex wards etc. etc. and of course their current dismal handling of NHS Wales.

    “The NHS is not safe in Labour’s hands” should be printed on every GE leaflet and put through every letter box in the land.

    • peter davies
      Posted November 24, 2014 at 8:39 pm | Permalink

      It should be quite simple – I have yet to hear a proper explanation in the media why the Welsh Govt has delayed the OECD inspection of the Welsh NHS – an open goal for the Tories if ever there was one

  11. stred
    Posted November 23, 2014 at 9:21 am | Permalink

    Recently, the last of our older friends died after eventually being diagnosed with the correct illness. She was prescribed painkillers of the type that can be bought without a prescription for a fraction of the price. Then, after a fall, she received good standard treatment for a hip repair and was sent home after a few days. The pain continued and my partner, who is medically qualified, eventually found a locum who prescribed stronger painkillers. Both GP partners, who are not British, were on holiday. Our friend collapsed when using the bathroom and her builder rushed around to pick her up and put her to bed. She then found a private care service and was visited twice daily, until she was too weak and, after paying for a private consultant and scan, her disease was confirmed. Her friends and neighbours found a private nursing home, mainly for patients with dementia. Our friend was fine mentally . There they cared for her very well until she died after a month. During the whole 6 months, she never had a home visit or correct diagnosis from her GP.

    However, when any politician dares to suggest that our health service should be more like the French, Swiss, Dutch, German or Swedish, which are excellent, instead of Cuban, he or she will be finished. The continental models cost slightly more in relation to GDP and the insurance cost is paid directly with the cost kept down in order to avoid the American rip off. The cost of treatment can be refunded. The patient is then in the driving seat and can chose wich diagnostic clinic, consultant and hospital to use. If these do not have a good reputation, they are not used. Only the good ones succeed. There is then no need for the huge pyramid of highly paid managers, who spend most of their time deciding who gets what and using ‘Quali’ units to assess whether the patient is worth saving. The older the patient, the fewer qualis or days left with quality of life. Our friend did not have enough to deserve a visit, early diagnosis and treatment and in the end the pain was so bad that she said wanted to die. But the NHS is our national treasure.

  12. ian wragg
    Posted November 23, 2014 at 9:42 am | Permalink

    John, on Thursday I came home after 4 days in a private hospital after having a routine operation done to improve the quality of my life. I am almost 70 years old and started off with an appointment with my GP.
    As I have not attended the surgery in anger for many years he took about 2 minutes had a sample taken and sent me merrily on my way.
    A few days later I phoned up the surgery and was told the results were negative and no further action necessary although I felt rubbish.
    After a few days I phone the local private hospital for an appointment and was seen within 3 days. It transpired I had a very serious condition which was causing my kidneys to malfunction. I had and emergency procedure to alleviate the situation and was given the option of private/nhs to do a permanent repair.
    I spoke to the surgery and was told no definitive date could be given but it would be within a year.
    I opted for the private and was done immediately and the quality of life is 100% better.
    Many people in the private hospital were having routine procedures done for the nhs. My local NHS Trust is a joke and appears to lose more than it cures despite the enormous amount of taxpayers money thrown at it. I would suggest that all the NHS be put on a co insurance basis and taken out of the governments hands as it appears to be a job creation scheme for foreigners and administrators.
    There seems a colossal amount of waste and no accountability.
    ps. I see we are now recruiting more foreign staff to cater for the influx of non native English speakers. You couldn’t make it up.
    Soon all public bodies will have to be staffed by foreigners to cope with foreigners except of course the English cash cow is vanishing rapidly.
    How’s Gideon getting on with the deficit…………

    • Mark B
      Posted November 23, 2014 at 11:02 am | Permalink

      Glad to hear you are better. Take care.

    • Hope
      Posted November 23, 2014 at 12:07 pm | Permalink

      I have waited six months and still waiting to be treated. The house building still near me continues at a fast pace. Where will these people get treated?

    • Richard1
      Posted November 24, 2014 at 4:38 pm | Permalink

      This story shows what is not officially acknowledged: that there is rationing in the NHS (obviously since its free for everybody) and the ones who are at the back of the queue are the 70+. More should be made of this when politicians are accused of pandering too much to pensioners. Pensioners need the money to pay for private healthcare given the rationing in the NHS.

    • peter davies
      Posted November 24, 2014 at 8:43 pm | Permalink

      All to many stories like this – sounds like NHS Wales. Glad your better

  13. Brian Tomkinson
    Posted November 23, 2014 at 9:49 am | Permalink

    I was surprised that under such a banner you failed to mention the exorbitantly expensive PFI schemes. To help I quote from the New Statesman 10 July, 2014 :
    “Labour is right to focus on rescuing the NHS from the harm done by this government, but must face the truth that it was the party that introduced private finance into the health service in the first place.The NHS is riddled with extortionate debt from decades of misguided PFI deals. NHS hospitals owe £80bn in PFI loan unitary charges – in other words, the ongoing costs of maintaining PFI hospitals and paying back the loans. Next year alone, trusts will make some £2bn in repayments.”

    • Lifelogic
      Posted November 23, 2014 at 2:05 pm | Permalink

      Indeed many of the PFI scheme were absurd and that is the fault entirely of the NHS and those who agreed such daft inflexible contracts.

  14. acorn
    Posted November 23, 2014 at 9:52 am | Permalink

    The Commonwealth Fund has a short piece at http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror It worked out that when it comes to a Universal Health Care (UHC) system, the UK has the best allrounder. At circa £2,000 per capita compare it to the, less than universal US system at £5,000 per capita (see the chart).

    There is a good article at http://www.forbes.com/sites/danmunro/2013/12/08/universal-coverage-is-not-single-payer-healthcare/ It concerns assumptions that UHC systems are always government or single payer funded.

    BTW, of the £123 billion public funding of UK healthcare, naturally England gets the least at £1,912 per capita; Scotland, £2,115.

    • libertarian
      Posted November 23, 2014 at 11:35 am | Permalink

      Acorn

      The World Health Organisation list the NHS as the 18 ( EIGHTEENTH ) best system on cost/benefit/outcomes.

      France is listed first. You can tell a non thinking person every time as they ONLY ever compare the free at the point of use taxpayer funded NHS with the private health system of the USA ( despite the fact that the federal US govt actually spend more on public health than we do on the NHS).

      If people really cared about health and its costs then we would be comparing all the better systems that now exist around the world.

      For the avoidance of doubt my view is that privatising the bits that aren’t already private will be no better. A massive corporate is no better at delivery than a massive public organisation. The problem as with all things is the organisation is too big and the vast amount of its financial resources are wasted on poor bureaucracy , middle management non jobs and political activities. If the money was spent on frontline healthcare we’d be far better off and if it was broken up and operated at a local level close to the patient it would be far more effective. We also need a far better way of funding it. Maybe if NI was actually ring fenced and used for health we’d have a better idea of costs and a better discussion about what we need for the future.

      • acorn
        Posted November 24, 2014 at 9:45 am | Permalink

        18th was back in 2000. UK public sector was spending 5.8% of GDP then, it’s about 7.8% now. Public sector spends about 83%, private 17%. Private share has dropped recently.

        • libertarian
          Posted November 24, 2014 at 11:25 am | Permalink

          Acorn

          Yup it was, but spending isn’t an indication of quality of healthcare. The NHS has very poor outcomes. Its not money or resources. Its structural. The system doesn’t work

    • Lifelogic
      Posted November 23, 2014 at 12:30 pm | Permalink

      Well the US system with even more litigation and defensive medicine is certainly not the way to go. Though they do have rather better outcomes despite eating too much.
      There are far better systems/routes than both the UK and the US ones.

      They may spend more per head in Scotland but it does not seem to help their life expectancy very much. Glasgow having the lowest in the UK I understand.

  15. Hefner
    Posted November 23, 2014 at 9:57 am | Permalink

    Fine words indeed. What about the further privatisation induced by the EU-US TTIP agreement now being discussed. Will this Parliament or the next one prevent this agreement from being applied to the NHS, or will we get the usual excuse: It is not us, poor MPs, it was imposed on us by the big bad EU? Last thing I heard from Cameron, he looked very supportive of TTIP. So, even if in the future the UK comes out of the EU, how can we be sure that the powers that be will not sign to a TTIP-type agreement?

    Reply The Health Secretary has assured us the NHS will be exempt.

    • Hope
      Posted November 23, 2014 at 12:11 pm | Permalink

      The same health secretary that does not charge people from around the world to use the NHS. The same one who points out a pay rise for nurses could cost 14,000 nurse jobs while forgetting the £1.7 billion extra payment to the EU could employ and cover the costs of pay and pensions for 60,000 nurses per his colleague MEP Hannan.

    • Denis Cooper
      Posted November 23, 2014 at 3:45 pm | Permalink

      And you accept that assurance?

      What would you say some years down the line, in answer to the claim that it was always clear that the provision of health services would be included?

  16. Margaret Brandreth-J
    Posted November 23, 2014 at 9:58 am | Permalink

    You miss the point John. The private sector provides an excellent service in its pharmaceutical products and study days for practitioners who use them. This has always been. The devices , equipment and machinery or course are made by private companies who very well work with the NHS . The changes can be seen with private companies who have not a clue about managing services and people who are ill and try and impose their will on professional Nurses and Doctors treating them as hourly rates and giving them zero hours contracts.This impacts upon the patients as all scurry to get enough money to live on.
    You cannot manage the NHS like a cattle market.The patients end up paying for this sort of management . The NHS management then contract out to those companies whose personnel try to get good positions in their lives without ever coming into contact with the humbling experience of trying to save lives and make human beings comfortable. Believe me as someone who has studied very hard for 40 years being a professional Nurse,I have watched the blunders and suffering right from the 60’s and I know the inefficiencies which we face and the wrong people who get the high salaries. High remembered ‘A’ levels and competitive medical degrees ( which many feel are not relevant today) do not make good Nurses and Doctors. The real world is hard physical work as we dash around hundreds of patients treating , taking tests with alacrity , coming to quick decisions, being extremely accurate, watching our backs for the private management who pick upon the insignificant ( to better their own career) rather than solid problems.
    As Nurse practitioners we have to teach new GP’s (Those with 10 or less years experience) about general practice which is entirely different from secondary care and belittled by the NHS not recognising the highly medical input which we contribute and are paid poor salaries , have our names and qualifications put under the name of a GP. This plagiaristic stance I will continue to fight.
    It s only a few years ago when over seas Dr’s who simply had paper qualifications were brought in and thousands a week was paid for them. We had many of our own Dr’s and Nurses/ Nurse Practitioners who were being paid peanuts to teach them.

  17. Mondeo Man
    Posted November 23, 2014 at 10:14 am | Permalink

    No comment on the massive Tory defeat at Rochester and Strood ?

    Instead the distraction that Ms Thornberry provided – thus turning a Tory defeat into a Labour crisis.

    Truly heirs to Blair.

    Also I’m bothered about newspaper headlines being hidden from public view

    How sinister !

    I don’t buy the ‘protecting the children baloney’. Especially seeing as only this week a leftist declared on the BBC that people are turning to Ukip because they don’t get their news from the BBC.

    (Leftists sneered at Mary Whitehouse and want kids to be taught sex aged 7)

    Reply Yes, I wrote about the Rochester result the next morning! It’s not another conspiracy! It happened 3 days ago and we talked about it then.

    • Lifelogic
      Posted November 23, 2014 at 10:43 am | Permalink

      “a leftist on the BBC” surely is a tautology. If they were not a leftist would they be on the BBC? Other perhaps than as an occasional token to be mocked by all the rest.

      Not helped of course by the fact that Labour, Libdem, the Greens & most of the Tory party are pro EU, big state, ever higher taxes, leftists.

      • Hope
        Posted November 23, 2014 at 12:17 pm | Permalink

        The Tories got thrashed deposits Cameron stating he would throw the kitchen sink at the by-election. What are we to think? Either he is useless, as we all believe and failed, again, at a task or that they are now trying to cover it up by deflecting the failure on a Labour non story? Cameron was more insulting calling UKIP voters closet racist and fruit cakes. Tories even called their own supporters turnip Taliban. Clarke repeated UKIP insults only recently, you know, the one Cameron placed in cabinet.

      • Anonymous
        Posted November 23, 2014 at 4:46 pm | Permalink

        Lifelogic – Two days ago Owen Jones and another (both from the Guardian) were interviewed on the BBC about the Ukip phenomenon.

        Why weren’t we Ukip supporters asked directly ?

        Clearly we are treated like rare goldfish in a bowl.

        The people are becoming a different species from the politicos and their chosen media outlet.

    • Mondeo Man
      Posted November 23, 2014 at 4:27 pm | Permalink

      “It’s not another conspiracy !”

      Another ?

      It’s all in my head then, John.

      Sometimes I fell blessed that I didn’t have the *education* that you did.

      It doesn’t take a ‘conspiracy’. All it takes is a meme. A zeitgeist.

      Can you honestly not see this ?

      Reply Can’t you see that I wrote about UKIP and the by election the next morning – I don’t intend to write about the same thing three days running!

      • Mondeo Man
        Posted November 23, 2014 at 4:39 pm | Permalink

        I’ve just revisited the post three days ago entitled ‘A Eurosceptic Split’

        Sorry. We were never joined – so how could it ever be a split ? You got stuffed at R&S and then moved swiftly on to the Thornberry cock up. As it happens I’m sick of the Ukip movement being defined as a White Van Man/Old Fogy movement – which the Conservatives ascribe to as much as Labour do.

        I think that Ms Thornberry made a good point. As it happens I have more affinity with my black and Asian friends than WVM.

        Yup. It’s all got rather complicated. Or simple – if you accept that our country is FULL !

        • stred
          Posted November 24, 2014 at 6:03 am | Permalink

          Most of the people I know are WVM and or sklilled/professional and of all races, including same race European, and most of them have been here for ages and agree that England is FULL. etc ed

  18. Mark B
    Posted November 23, 2014 at 10:42 am | Permalink

    Good morning.

    With many issues either being controlled in part, or in full by the EU, there is little for any of the Legacy Parties to discuss.

    Labour, quite naturally, want to discuss the NHS because they feel they would be on far safer ground compared to say, immigration or the economy.

    But is the NHS safe in the Labour’s hands ? One only has to look to Wales and Mid-Staffordshire to see that this is indeed not the case. One also only has to visit both our hospitals and GP Surgeries to see what other policies implemented by Labour have done.

    I have, in the past, had course to use the Emergency Services and have been taken to hospital in an ambulance run by a private company. On the way, we had a very interesting conversation, much of which our kind host would not be able to repeat, since a number of allegations about the NHS were made, which has raised my concerns about its future.

    Many people would indeed be surprised that many Doctors are private. And many more would be surpirsed that more and more people with skills gained in the Public Sector, are seeking to go Private as they see their skills in demand and can offer both a better services to their patients, free from administrative overheads, targets and associated burdens.

    The NHS is free ‘at the point if service’. Not free ! Someone, somewhere has to pay. Of course, if you have never paid into the system, whether you are born here or not, it is free, and in my view, that is no longer acceptable and some form of contribution, whether financial or through voluntary social work, should be considered as a way of contribution.

  19. NickW
    Posted November 23, 2014 at 10:47 am | Permalink

    “Free at the point of use” is the fundamental principle of the NHS which concerns us all as patients and potential patients. Concerns about “privatisation” come in the main from the NHS workforce who are anxious to protect their jobs, pay levels, and pensions. Because of the size of the NHS, it employs a high percentage of the electorate. The public sector unions ensure that the NHS workforce speaks with a loud and coherent voice which drowns out the users who can only speak as individuals.

    When it comes to the question of NHS reform, what concerns the Government is cost, and what concerns the patient is speedy and successful outcomes which are “Free” at the point of use.

    If one recognises that the nature of the NHS is that it is a “Worker Co-operative”, where all the profits go to the workers, it helps to understand better how costs can be controlled.

    The simple solution is to set up a parallel organisation to compete with the NHS, and leave the NHS to reform itself or go the way of all unsuccessful businesses.

  20. English Pensioner
    Posted November 23, 2014 at 10:56 am | Permalink

    If my wife’s experience with the local privately run “NHS Diagnostic Centre” is anything to go by, bring on more privatisation!
    From seeing her GP about a severe back problem to the GP getting the results from a scan carried out at the Centre took just over a week. They phoned her to arrange an appointment and when she attended they saw her exactly at the agreed time. Nothing fancy about the Centre, it’s in a unit on an light industrial estate and there was free parking. As it was free at the point of use, as far as we are concerned, it is irrelevant who actually runs the Centre if they are providing great service like this.

  21. mike fowle
    Posted November 23, 2014 at 11:00 am | Permalink

    Something that never seems to be mentioned about the NHS is that nearly everybody who works in it belongs to a trade union. These may have important sounding names, the BMA, the RCN, RCS etc., but so often they have the outlook of 1970s shop stewards.

    • Lifelogic
      Posted November 23, 2014 at 6:21 pm | Permalink

      Indeed and Labour & Miliband seems to represent mainly their interests against those of the 80% in the relatively under paid and pensioned private sector.

  22. DaveM
    Posted November 23, 2014 at 11:05 am | Permalink

    As long as the NHS is free at point of delivery I don’t think most people care about privatisation of many areas of the organisation. In fact, most people recognise that privatisation creates competition and lower prices from suppliers. Working in the MoD, though, it is very clear that privatising certain operations but giving 10-year contracts to single companies has the absolute opposite effect. It’s often enlightening to look at the directors and major shareholders in said companies!!

    I want continued free healthcare (the occasional times I have to use it – once every few years), and will continue to see huge amounts of my wages going on NI. But the bit that affects me (with family members having asthma, etc) is the fact that prescriptions cost a fortune. Only in England though!!

    Curious that you should write about the NHS this morning – the discussion on the 5Live politics show this morning showed the Tory to be very lucid and insightful. (I’m presuming he was a Tory – missed the start of the programme.) However the mega-pro immigration Labour man managed to bring the NHS in to every single (badly presented) statement. If the moon exploded, would Labour say it’s because the govt hasn’t spent enough money on the NHS recently?!

  23. Margaret Brandreth-J
    Posted November 23, 2014 at 11:33 am | Permalink

    Would you pay £18,000 pa to someone who looked at your relative and thought the symptoms resembled leukaemia , took the relevant blood tests and got the diagnosis which allowed life?

    Would you pay £18,000 pa to someone would looked at your mature daughters symptoms and investigated problems which culminated in a diagnosis of cancer of the ovary?

    Would you pay £18,000 pa to someone who examined a breast ,sent an urgent referral and saved a life with a mastectomy?

    Would you stamp on a profession which started their career with £10/ mnth and 60 hours a week? No , but private individuals and the private sector would.

  24. Bert Young
    Posted November 23, 2014 at 12:19 pm | Permalink

    In my professional training and subsequent experience , I found that any organisation that was oversized became more efficient if decentralised . This was true both from an operational efficiency standard and from a profit point of view . The NHS centrally organised is a mistake and should be disbanded .
    The private sector has an important role to play in the ever increasing responsibility of the NHS and in maintaining its standards of skills and operating efficiency . It should be encouraged and not abused by short term politics .

  25. Mike Wilson
    Posted November 23, 2014 at 12:54 pm | Permalink

    While Labour was in power I had a minor operation. I saw my GP and was referred to a consultant. A few days later a woman from the NHS rang me and said ‘Do you want to be treated in the local NHS hospital or in a local private hospital’. I asked what the difference was, from my point of view. She said a longer wait if I chose the NHS hospital. So I chose the private hospital.

    Saw the consultant, had an MRI, saw the consultant, had an operation, saw the consultant, had four sessions of physiotherapy.

    I asked the consultant how the money worked and he said that they give the NHS an all-in price for various surgical procedures (that include the visits to the consultant, the scans, and the physio). I imagine the NHS, being a truly massive organisation, would have trouble costing my treatment down to the last penny – but outsourcing it allows them to do precisely that.

    Now, what do Labour mean when they scaremonger about the Tories ‘privatising the NHS’. As far as I can see, Labour have already done that.

  26. boffin
    Posted November 23, 2014 at 3:19 pm | Permalink

    Doctors (private sector GPs etc.) bear individual accountability – any doctor upon whom is laid a valid complaint of misconduct stands to suffer a dreadful ordeal at the Star Chamber of the GMC (even if in the end exonerated).

    Not so (public sector) NHS “managers” who can it seems get away with (high death rates ed) with impunity …. (do these ever constitute a case of ) corporate manslaughter anyone?

    Surely, the curse of our age is the progressive wane of individual accountability (in both sectors) … the NHS would be a good place to start its restoration.

  27. Denis Cooper
    Posted November 23, 2014 at 4:04 pm | Permalink

    I’m not dogmatic about the provision of public services by private contractors, either one way or the other, but naturally the investors in the private company will expect to take out a profit and so it only makes sense for the taxpayer if the profit motive really does drive genuine improvements in efficiency which not only pay for their private profit but also leave some cost benefit for the public. In too many cases that doesn’t seem to work anything like as well as the ideological advocates of privatisation suggest that it always should, maybe because some parts of the public sector are not actually as inefficient as they portray or maybe because those responsible for negotiating the contracts with the private companies are far too generous. However I am concerned as a matter of principle that those who push certain public policies should not then make private profits from their implementation, either at the time or later, and either directly or indirectly. There has been far too much of that going on, and involving politicians at the highest levels, which conveys an impression that our entire political system is corrupt.

    Reply Private contractors bidding for NHS business in areas like cleaning often compete against an in house team, so they only win if they are cheaper.

    • ian wragg
      Posted November 23, 2014 at 4:44 pm | Permalink

      Problem is with cleaning John, when we visited my Father in Law, we cleaned his area as it was absolutely filthy. No one seems to effectively police NHS standards.

      Reply Indeed, managers should inspect and supervise – was that particular hospital cleaned by in house people or by external contractors?

  28. Denis Cooper
    Posted November 23, 2014 at 4:12 pm | Permalink

    Off-topic, JR, I see this kind of SNP line being increasingly pushed:

    http://blogs.spectator.co.uk/coffeehouse/2014/11/the-politician-who-can-fill-a-venue-quicker-than-kylie/#disqus_thread#

    “The sovereign will of the Scottish people is to be respected.

    That sentence says it all, it concedes or confirms the Scottish people are Sovereign and that they have a will and it is to be respected. It follows therefore the date of the next referendum will be their choice alone.”

    But I don’t see it being refuted by any UK authority, not the UK government nor the UK Parliament nor the UK courts, and not the supposedly British Unionist parties either, and in the absence of any such effective refutation it may well become the accepted view of the general public in Scotland simply by default.

  29. Lithgae Dave
    Posted November 23, 2014 at 6:11 pm | Permalink

    It’s interesting that whenever the NHS subcontract work it is always referred to as privatisation. Privatisation is a completely different thing from subcontracting.

    The MoD subcontract a huge amount of work to private contractors e.g.BAE Systems yet nobody claims that we are “privatising” our Armed Forces.

  30. Iain Gill
    Posted November 23, 2014 at 7:10 pm | Permalink

    The problem with the NHS is that it does not have a feedback loop which works.

    Regulation, top down control, and pseudo political control do not drive up quality of service.

    The only feedback loop which can ramp up quality over time is giving the end patients buying power, and the real ability to take their business elsewhere and the money following the patient. In everything from GP appointments, to which consultant you see, to which hospital you use.

    The fantasy put about by the political and journalistic class that we all love the NHS is nonsense, you only have to go and sit in the typical eye patient outpatients queue (for instance) to hear just about every single patient complaining about the rubbish service they are getting. You only have to listen to foreign eye consultants who have seen the handiwork of UK eye surgeons to know that they are far from first rate. None of this is ever going to be fixed by the status quo or regulation or league tables.

    Give the patients buying power its the only road to success.

    And stop giving free healthcare to those without permanent residency from countries which do not provide free care to Brits.

  31. CHRISTOPHER HOUSTON
    Posted November 23, 2014 at 8:57 pm | Permalink

    The picture painted of the NHS is detailed. The information given is most certainly either not known or not understood by those eligible to vote in the UK; hence, the rhetoric of say Labour’s “Saving the NHS from privatisation ” meets unearned applause in some quarters.

    So the NHS, its running, funding and organisation is there without any real democratic mandate, except in the sense of the structural imperatives of Parliamentary representative democracy. It may be best if these facts are placed anew before the 61% of the electorate who voted for anyone at all in the last national election and also to the 49% who decided not to vote but were willing nevertheless to remain in residence in a country purporting to be free and democratic. The difference between representative democracy and democracy can be explained.
    The drug suppliers ( private ) may indeed provide their wares to the NHS and benefit from contracts. I am sure these companies do not have cynical attitudes but it is obviously not in the funding criteria of their Research and Development departments to “act on a hunch” and fund that hunch for example in finding a chemical compound drug which would be a universal remedy for the maladies which 95% of their other drugs were being used throughout the world especially if the chief constituents of the drug were a combination of generic aspirin, generic codeine and wild apple blossom esters.

    Innovation and long-term solutions are not necessarily the hallmark of private companies except in an ongoing function of “laws” governing the progress of capitalist expansionism. All drugs, even dangerous ones can have beneficial effects in limited quantities as part of a controlled intake of other items. What news, at all, from anywhere, of the beneficial uses of nicotine? There are indeed some. But when one has state machines providing funding to drug companies ( and one way or another to doctors and being the permission-giver to a doctor being allowed to work at all) who also act as last resort for fire insurance damage, private companies are unlikely to engage in the slightest bit of research. Not in their commercial interests. Not in a government’s interests. Such distortion of the scientific-governmental -commercial relationship leads to bizarre and almost inexplicable outcomes take the legalisation of marijuana in certain states of the USA . Ostensibly for medicinal purpose but of course used otherwise.It does not require a delivery system such as syringe. But custom and practice dictate it is mixed with tobacco; yet it is still legalised without cautions about of the nicotine element. The nicotine of course acts as a veil of sorts to psychological damage caused by over-use of and perhaps “normal” use in some people by marijuana. A perfect hell.As is the structure and governance of the NHS.

  32. Julian Hodgson
    Posted November 23, 2014 at 9:00 pm | Permalink

    And the whole thing is paid for, as is everything, by the private sector.

  33. Chris S
    Posted November 24, 2014 at 12:51 am | Permalink

    The French system is well liked by the consumer but is impossibly inefficient because of very expensive restrictive practices and patients whose demands are not effectively managed. As a result, costs have spiralled out of control and are unsustainable.

    The German system is a better model as it is efficient and insurance based. It would be completely unacceptable to the left here because, above the basics, the people chose a level of service and cover they are prepared to pay for.

    When we lived in Germany my employer paid for a very high level of cover and it was superb. Our first son was born there and, again the service was hard to fault.

    Our second son was born in a Southampton NHS Hospital and the only difference was that it felt like a production line process whereas in Germany we felt like customers.

    That sums up the difference.

    Because the service is free at point of use, I tend to think that patients often don’t value the NHS and frequently put up with inferior service. On the staff side, I have a suspicion that a sizeable proportion of the staff think they are doing the patients a favour by treating them “for free”.

    I think it would be a good move to make National Insurance into an NHS-specific flat tax payable by everyone over the age of 18. Obviously pensions and benefits would have to be raised to enable some people to pay their contribution.

    Everyone would then know exactly what they are paying for.

    It’s a scandal that I have no idea how much that flat tax would actually cost me !

    • Iain Gill
      Posted November 26, 2014 at 10:29 pm | Permalink

      Re “put up with inferior service” there is nothing you can do. Even if you complain and are proven correct nothing ever changes, you will still end up back in front of the same staff who will by then hold a grudge against you.

  • 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.

  • John’s Books

  • Email Alerts

    You can sign up to receive John's blog posts by e-mail by entering your e-mail address in the box below.

    Enter your email address:

    Delivered by FeedBurner

    The e-mail service is powered by Google's FeedBurner service. Your information is not shared.

  • Map of Visitors

    Locations of visitors to this page