Where do we want the boundary to be between the public and private sectors

Labour wants to change the current boundaries between public and private provision of public services.

They have to accept that the bulk of public service will continue to be supplied by the private sector, as they acknowledge they cannot buy up all business in the UK to provide everything from the public sector. Bread and circuses would remain privately supplied were there to be a future Labour government as they always have been.

The two most sensitive battlegrounds where they wish to change things are health and railways. It is important to understand where the current boundaries are. These are boundaries agreed by both the previous Labour governments and the current Conservative government.

In the case of health, the private sector makes and supplies all the drugs. Most GPs are private sector contractors of the NHS, some with private practises as well and many with for profit pharmacies alongside. Most pharmacies are for profit private sector businesses, dispensing over the counter medicines.

Many hospitals use private sector cleaners, caterers, computer service providers and other suppliers from the private sector. Labour introduced the idea of buying in operations from the private sector where they were good or where the NHS lacked capacity.

The public sector owns and runs most of the hospitals, but not the surgeries. It provides many of the operations, and pays for most of the care however delivered.

What do you think about these current boundaries? Are there bits which you think should be done entirely in house in public sector owned assets with public sector staff? What parts of current private sector healthcare would you want a government to nationalise?

Should GPs be made to be salaried NHS employees? Should surgeries be bought up by the state? Should all pharmacies be public sector businesses?

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91 Comments

  1. Sir Joe Soap
    Posted February 13, 2018 at 6:05 am | Permalink

    Again, this is looking through the wrong end of the telescope to find the optimum solution.

    It’s pretty broadly agreed that the Swiss system provides the best healthcare in the world. It has public, private and semi-private elements to it, but the keys to its success are two-fold, and both down to increased public choice rather than doctrinaire ownership policies:

    1 the patient pays insurance to a regulated private company, and he/she chooses the level of service they want to receive, with a government-set minimum and

    2 the patient co-pays a small amount for treatment according to the level of service they want.

    So it really doesn’t matter whether staff work for the government or not, except that if they offer a low level of service for the price involved they shouldn’t be in work at all. Somehow the NHS has gotten away with being poor for years because there’s no adequate competition, and clubbing-together amongst unions of doctors, nurses and others hasn’t helped.

    The key is to allow private medicine to compete on an even keel with public facilities for patient care. Public facilities at the same time can be good for blue-sky R and D and newer riskier forms of treatment, to push the boundaries forward. Let practitioners work for either, because there’s a place for both.

    • Adam
      Posted February 13, 2018 at 12:08 pm | Permalink

      Sensible, well-reasoned opinion.

      • Hope
        Posted February 13, 2018 at 2:52 pm | Permalink

        How about the millions of immigrants not having paid a bean? Rudd sent a letter to EU citizens inviting their families at any time during their life. What happens when they stroll up to A and E? Health tourism is still a huge issue, gonto any A and E and find out. Staff ask have you lived here more than a year? Guess what, they say yes. They also collect free prescriptions at the pharmacies as well.
        Once more, no mention by JR of the govt’s mass immigration policy that will need public services and housing. We know it exists because the Treasury relies on it for its forecasts! Despite May living to us she will cut immigration to tens of thousands. Her record as HS demonstrates she is not telling the truth, historic record numbers under leading the policy!

        Where is the money going to come from to pay for this health care private or public? Presumably Hammond will give us more tax increases to pay for those who stroll up at the door.
        You need to know the numbers to be able to provide the service. The catistrophic mess of public services and housing brought by the thoughtless taxing Tories.

        • Adam
          Posted February 13, 2018 at 8:02 pm | Permalink

          Response to Hope:

          NHS denotes National. International would be a separate dimension. A civilised country properly assists guests in an emergency, but not those who seek solely to inveigle & exploit other services free. If NHS nos were issued only to those who are NHS-eligible, verification should eliminate risk reaching beyond the reception desk instantly.

          Whereas immigration has swollen demand, Conservatives tend to avoid mentioning it, as doing so reflects as blame on their own recurring lack of control.

          Promoting better health would have most effect on reducing costs, by prevention, yet takes many years to achieve & sustain efficient performance. However, starting now would effect much improvement.

          • Hope
            Posted February 14, 2018 at 9:44 am | Permalink

            JR wants us to pay private premiums and through taxation for his party’s mass immigration policy. No. Too much already. Sort out immigration and stop lying to the people.

            Reply Not true. I support the government’s stated aim of a reduction in net migration, and look forward to a new policy on borders when we leave the EU. Nor do I propose making people pay health premiums!

    • Lifelogic
      Posted February 13, 2018 at 5:10 pm | Permalink

      In Hong Kong they spent about half what we do on health care about 5% of GDP and yet have a life expectancy that is about the highest in the World. Despite being fairly polluted too.

      The NHS is a dreadful system or rationing, the envy of no one sensible and copied by no one (thank goodness).

    • NickC
      Posted February 13, 2018 at 9:26 pm | Permalink

      Sir Joe, Even if the NHS were completely privatised it still wouldn’t work properly because the government wouldn’t be able to stop itself interfering on a daily basis.

      Just look at the supposedly privatised electricity supply industry. That whole system is falling to bits because the government is forever setting political, in this case supposedly “green”, targets.

  2. Mark B
    Posted February 13, 2018 at 6:22 am | Permalink

    Good morning.

    Where does patient care come into this ? One would have thought that this would be the first thing on most people’s list.

    Whether it is private or public it is the outcome that must come first. ie Which one of the two, offers the best outcome. Outcome for the patient, and outcome for the NHS and the taxpayer.

    Clearly offering equipment via the NHS (Public) is not working. Perhaps it would be better that this was done by private enterprise charging the NHS for its use. Many private contractors could compete for the service where the NHS stops paying once they deem that they patient has no further use for the equipment. It would therefore be in the interests of the private company to reclaim their equipment. Thereby reducing costs to all.

    But until we address the issue of FREE AT THE POINT OF SERVICE healthcare to ALL AND SUNDRY and not just to those that are truly eligible, then the underling problems will persist and no amount of public vs private action will help.

    • Lifelogic
      Posted February 13, 2018 at 5:12 pm | Permalink

      FREE AT THE POINT OF RATIONING, DELAY, OBFUSCATION, PUSHING FROM PILLAR TO POST OR TOTAL INCOMPETENCE. That is what many get for all their taxes and NI.

    • APL
      Posted February 14, 2018 at 5:04 am | Permalink

      Mark B: “Which one of the two, offers the best outcome.”

      You are omiting on crucial fact, the public health system is not run for the benefit of the patient, it’s run for the benefit of the public sector unions.

      … and the Government doesn’t mind if the Health service employment role is inflated because that implies its economic policies are good because the employment figures look better.

  3. duncan
    Posted February 13, 2018 at 6:41 am | Permalink

    This isn’t an issue of provision. Labour care not one jot about outcomes for the patient and or the end-user. They care only for political control of assets that they believe affords their party and their unions political and economic leverage. I have no idea why John Redwood cannot see this?

    Labour have been taken over by a hard left, union backed clique. They are indoctrinated and ideological to their soul. For these people it is not what about what works (in terms of cost and efficiency of provision) but what affords them maximum political control. Their aim is to take-over, infect and reconstruct to prevent future reform by their political enemies

    If Labour achieve power they will completely reconstruct the state to achieve their socialist aims. Allies will be placed into pivotal positions of power. Most will be union backed

    The Tories need to wake up from their slumber. If the Tories plan is to allow Labour to achieve power, bankrupt the country and then ride back into power on the back of this disastrous socialist experiment then you will not be forgiven. This socialist tosh nonsense as been experimented with before. It doesn’t work but then this Labour party know this. As ever, it’s about creating a state that benefits Labour and their union backers

    Blair has succeeded in a similar manner with his liberal left social re-engineering program. He’s managed to replaced people in important positions of power with a conservative stance with people of the opposite bent. This pattern has been replicated across the State to disastrous effects

    In many ways, the problem, as I see it, is a Tory party, who, instead of confronting these changes, have capitulated to it and even embraced it.

    If Labour achieve power, nationalise across the board and then wholly reconstruct the State to benefit itself and its backers then we will see a new dark age in the UK. Nationalisation equals centralisation, greater political power and a massive in political control in many other areas of society.

    This is about political power to achieve certain aims and the use of it to destroy the enemy. Liberal left politics today is designed to silence the enemy, it has worked. A new age of authoritarianism is just around the corner and there is no one to defend us against it

    • duncan
      Posted February 13, 2018 at 6:59 am | Permalink

      ‘massive increase in political control in many other areas of society. ‘

  4. Harry
    Posted February 13, 2018 at 7:01 am | Permalink

    He who controls the captcha controls the world..as Jr would like us to think..what Labour might do? such nonsense

  5. Dave Andrews
    Posted February 13, 2018 at 7:13 am | Permalink

    I would like to see company healthcare promoted more. Currently it’s taxed as a benefit, even though it relieves the state of responsibility. It should be subsidised, but at least allowable as a business expense.
    I would add two constraints though – it should cover all healthcare needs and be extended to all employees, not just the managers.
    Companies are interested in keeping their staff fit, and favour acting before a condition becomes serious. The over-stretched NHS on the other hand wants to deter patients being referred to their services, until the condition becomes an emergency and costs far more to treat.

    • Leslie Singleton
      Posted February 13, 2018 at 11:46 am | Permalink

      Dear Dave–I disagree fundamentally, being, as I am, unable to understand why employers should be forced to do anything relating to their employees’ personal desires away from the workplace–Yes that does include Pensions–At least that ghastly advert promoting “Work Place Pensions” now omits that positively evil stirring up of animosity against employers (“…and the best bit is that your employer is forced to contribute..” or something very like), who of course are providing the jobs in the first place.

      • David Price
        Posted February 13, 2018 at 2:51 pm | Permalink

        Company health schemes, pensions, vehicles and other perks are just that, perks. Companies do it to differentiate and compete so if anything is forcing companies to do this it is the marketplace and the need to have employees back on the job as quickly as possible.

        The issue is that an employee who has health cover must pay tax on it as a perceived monetary benefit (BIK) which it isn’t until it is needed when it can alleviate the load on the NHS but the employee and employer are also forced to pay for that as well.

    • Lifelogic
      Posted February 13, 2018 at 5:18 pm | Permalink

      We under Thatcher we had tax relief for medical insurance cover and paid no NI on it either and no National Insurance Tax on it either.

      Under tax ’til the economy dies Hammond we pay tax for others medical cover, then tax and NI on the money we earn for our own insurance premium, then 12% IPT tax on top to add insult to injury. It is economic lunacy we should encourage more to opt out of the NHS to free them up and get more competition in the market.

      But May and Hammond are alas PC, virtue signaling dopes who think the NHS is just great! Does May have private cover I wonder?

      • Adam
        Posted February 13, 2018 at 9:49 pm | Permalink

        Tax relief on medical insurance deducts some income from Govt, yet the saving on NHS costs its cover enables is likely to be far higher. Further, it reduces congestion in the system for those seeking NHS services. It is strange that the tax relief was withdrawn.

        There was similarly, in education, an Assisted Places Scheme, contributing in part for private schooling fees. Those who used it also contributed to state education via normal taxation, but freed up school resources for the majority. The Blair govt abolished the APS, apparently in a skewed belief of it being perceived as unfair. Efficiency suffered at the expense of errant ideology.

        • Lifelogic
          Posted February 14, 2018 at 5:23 pm | Permalink

          Indeed the more people the government encourages to get private education and health care the better for every one.

          Give education or health vouchers that can be topped up for all and tax relief too.

  6. sm
    Posted February 13, 2018 at 7:28 am | Permalink

    If a Corbyn/McDonnell administration wishes to nationalise water services (which are surely one of THE most vital services in our lives), should they not logically also be planning to fully nationalise food production and retailing?

    • Captain Obvious
      Posted February 13, 2018 at 5:10 pm | Permalink

      Even Lenin wasn’t stupid and ideologically bent enough to nationalise food production. Yeah sure, Corbyn/McDonnell will have “Walk Like a Venezuelan” as Number Two on their Top Ten

      • Mitchel
        Posted February 14, 2018 at 10:35 am | Permalink

        I think he(Lenin) did -or tried to-under “War Communism” but soon reversed it when starvation almost provoked a further revolution -“The private market has proved stronger than us”-Oct,1921.

    • Lifelogic
      Posted February 13, 2018 at 5:23 pm | Permalink

      Keep quiet or they will. After all it is all free and at no cost to the tax payer as Mc Donnall assures us. So they might as well steal & run everything from cradle to grave! I had better get my name down on the waiting list for a pizza delivery & new Trabant car in five years time.

  7. Peter
    Posted February 13, 2018 at 7:30 am | Permalink

    Related to all this is Private Finance Initiatives.

    We don’t want any more of them.

    They were a racket to make the books look good. They cost an absolute fortune. The big accountancy corporations promoted these and made good money for themselves on the back of it. The same firms that failed to see problems at companies like Carillion and now claim it was not their responsibility.

    • libertarian
      Posted February 14, 2018 at 11:14 am | Permalink

      Peter

      Correct they were a racket, dreamed up by the STATE, administered by civil servants and cost the taxpayer dear. Thats why the state/public sector should run as little as possible, they are totally incompetent

  8. Peter D Gardner
    Posted February 13, 2018 at 7:41 am | Permalink

    There is little reason to suppose the civil service can run services like health or schools any better than private enterprise. Obviously socialists would disagree on principle because they abhor enterprise, they abhor some people succeeding better than others and they hate the concept of profit. Major advances in any field have rarely if ever come about through public sector initiatives, they are almost invariably the result of individual enterprise. The fundamental question is not where the boundary should be but why the state should be involved at all.
    Clearly it needs to regulate, to be concerned about standards and to provide funding for the poor. There is no requirement for the state to manage anything beyond that either in health or in education. In both cases the government structures both supplier and customer, denying both freedom to innovate and develop and to respond to each other.
    There are many ways of providing funding, some involving the private sector, which in general understands money rather better. On the question of money ‘free at the point of delivery’ would be fine if the NHS were a basic service meeting only essential needs but it goes far beyond that. The main issue is that funding does not follow the patient. Surveys and feedback mechanisms are no substitute for putting the money in the hands of patients. Doing that and ensuring all suppliers then have to compete for patients is essential

    • Mitchel
      Posted February 13, 2018 at 11:44 am | Permalink

      The Soviet Union had many scientific achievements to it’s name(although that begs the question of whether the USSR was really socialist!)

      • libertarian
        Posted February 14, 2018 at 11:18 am | Permalink

        Mitchel

        The USSR had many scientific achievements indeed. However they turned none of them, zero, into usable , sustainable , quality products.

        • David Price
          Posted February 14, 2018 at 1:09 pm | Permalink

          Phages, AK47, RPGs, first space station, first planetary rover (Lunokhod on the moon), Robot cargo capsules, 1970s advances in semiconductors (Nobel prize in 2000) … Russian rockets are servicing US space transport needs.

          It strikes me that the Russians have the same problem we do – good at invention but not so good at innovation, ie translating an invention in to a market leading product. However we both have our successes – ARM and AK47.

          Then again, commercial success is not necessarily the pinnacle of achievement but does depend on precursors in many areas and many places. Apple would have had no iPhone success without the preceding years of work and investment in mobile networks in which they invested nothing.

  9. alan jutson
    Posted February 13, 2018 at 8:00 am | Permalink

    No problem with using private care through the NHS as long as it is cost effective, and it meets or exceeds the standards of what the NHS should meet themselves in house.

    I would have thought the biggest problem the NHS faces is the post code lottery of treatment, it seems an absolute nonsense that different rules and treatment schedules apply in different parts of the Country.
    The same goes for Social care after leaving Hospital, again a post code lottery.
    Surely treatment and aftercare should be standard throughout the Country.

    Goes without saying that the NHS should have the capacity to deal with the demand put on it by the population, without undue lengthy waiting times.

  10. Narrow Shoulders
    Posted February 13, 2018 at 8:10 am | Permalink

    Agree fixed prices for each intervention.

    Each private or public hospital can then invoice HM Government for every intervention they perform which has been instigated by a GP or other practitioner referal. In the manner that private insurance works at present.

    Still free at the point of delivery but much requirement for managers removed. Sales, after care and routine finance staff only required.

    NHS paid for delivery only and competition drives excellence. Some anti fraud measures would be required.

  11. alan jutson
    Posted February 13, 2018 at 8:10 am | Permalink

    I would just wish that we could have a cross party consensus on what the NHS should actually provide.
    So that it is taken out of politics, and not treated like a political football.

    That its buildings, purchasing and management be run on a cost effective commercial business basis, but with all clinical input on treatment, by the professional and qualified medical staff employed.

    The big problem appears to be (from my personal experience and that of many friends) with the actual administration, Hospital – Patient relationship and communication, which has been in many cases simply diabolical.

  12. Edward2
    Posted February 13, 2018 at 8:10 am | Permalink

    Dentistry Opticians Chiropody and Physiotherapy services are mainly privately provided.

  13. Sakara Gold
    Posted February 13, 2018 at 8:13 am | Permalink

    To put this into perspective, about 10% of GDP is spent on the NHS. 60% of the NHS budget is used to pay staff. A further 20% pays for drugs and other supplies, with the remaining 20% split between buildings, equipment, training costs, medical equipment, catering, cleaning etc.

    The NHS is a national institution dear to the public’s heart, with a model that is emulated across the EU. It has been highly effective at extending people’s lives through medical intervention and long may it continue to do so. Many doctors and consultants successfully combine private practice with NHS work and my view is that the current balance is probably about right.

    • Lifelogic
      Posted February 13, 2018 at 5:27 pm | Permalink

      In Hong Kong they spend about 5% of GDP and have rather better outcomes and far higher life expectancy too. The NHS is near the bottom of the league tables in outcomes for a developed nation. Look at the facts for a change take you gold tinted glasses off!

    • libertarian
      Posted February 14, 2018 at 11:23 am | Permalink

      Sakara Gold

      Really? The NHS has amongst the worlds WORST health outcomes. The NHS isn’t modelled or emulated anywhere else by anyone ( only the Irish system is even close). True most European and indeed world systems offer universal healthcare , but nothing like the NHS they are ALL far superior. Thats why the NHS is a LONG WAY down the list of quality health care systems.

      One day the people of the UK will wake up and realise what they could have had in terms of quality healthcare

      • Lifelogic
        Posted February 14, 2018 at 5:26 pm | Permalink

        Indeed but the BBC keep telling us it is “the envy of the world”.

  14. duncan
    Posted February 13, 2018 at 8:27 am | Permalink

    My anger at seeing my party capitulate to the scum liberal left, Labour’s ‘big state know’s best’ mentality and their obsession with identity politics breaks my heart

    This PM is destroying a great party of government.

    • libertarian
      Posted February 14, 2018 at 11:28 am | Permalink

      duncan

      The Conservative Party has been in decline for 20 years or more. It has no connection to and no input from its voters. Its like running a business when you dont know what your customers want to buy, how much they wish to spend or indeed even who they are. CCHQ and the Parliamentary party are in a bubble. Playing politics, devoid of guiding principle or real leadership and virtue signalling along with the rest of them.

      There is no real difference between our political parties.

      We need a wholly new approach to politics, democracy & government , fit for the 21st century and beyond

  15. Lifelogic
    Posted February 13, 2018 at 8:29 am | Permalink

    Almost nothing should be run by the state. Certainly not health care, the bbc propaganda outfit or education. The state should concentrate on defence, law and order, a sensible criminal justice and legal system and some organisation of basic infrastructure. A basic safety net for some people who cannot work for health reasons. Currently they are dreadful at even those things.

    In other areas they should be just a referee intervening occasionally to prevent monopolies exploiting situations. The state should spend about 20% of gdp and not waste nearly 50% of gdp as now. Not only does the government kill efficiency by wasting most of this money but much of it is spent getting in the way or the private sector, over regulating them, forcing them to deal with absurd tax complexity, moronic employment laws, gender pay reporting drivel, expensive religious energy, restrictive planning and countless other inconveniences.

    The radio four propaganda unit had a huge piece on HS2 yesterday saying how wonderful this insane waste of money was for Birmingham.

    Buy to let investment down 80% in two years it seems due to moronic taxes. So less choice, fewer builds building jobs and higher rents for tenants. Well done to the economic illiterate in no 11! Get the damn parasitic state sector out of the way please.

  16. Mick
    Posted February 13, 2018 at 8:41 am | Permalink

    Off topic
    https://www.express.co.uk/news/politics/918117/Brexit-news-UK-EU-Michel-Barnier-Iain-Duncan-Smith-Theresa-May-news-latest-politics
    That will be a New Year’s Eve party I will be part of , so it’s party time March 29th 2019 then the big one December 31st 2020 bring it on and let the good times roll😁😁

    • NickC
      Posted February 13, 2018 at 9:35 pm | Permalink

      Mick, Theresa May promised that we would leave the EU on 29th March 2019. Now it’s to be 31st Dec 2020, 21 months late. Can you believe anything she says? Any bets on 2021? 2022?

  17. Lifelogic
    Posted February 13, 2018 at 9:07 am | Permalink

    What has Hammond got against tenants? (by restricting the supply and choice of properties through this absurd taxation) and what has he got against people who want to buy or just move? Mugging them for up to 15% stamp duty? This is an absurdly high turnover tax and means people simply do not move and do not buy. Why is is chasing the rich and Non Doms out of the UK? It is hugely damaging to the economy and jobs. Why can he and the treasury not see this?

    We need a good market in both types property for sale and to rent (for sensible job mobility and flexibility). We need investment in the country and in more building. When will Hammond go? He is profoundly misguided on economics and on the EU too. Will someone save us from these half witted, big government, PPE graduates?

    • Lifelogic
      Posted February 13, 2018 at 9:08 am | Permalink

      Sir John Hicks, LSE Nobel Prize winner, in the brief biography required of winners by the Nobel Prize Committee wrote:

      “Philosophy, Politics and Economics” was not a success. I finished with no adequate qualification in any of the subjects I had studied.

  18. ChrisS
    Posted February 13, 2018 at 9:25 am | Permalink

    State control is a discredited failure – except in the eyes of the far left which simply cannot accept that Marxism has never succeeded anywhere in the world.

    Ask the Shadow Chancellor – the only member of the extreme left that might potentially be given the reigns of the economy in fifty years – then we have Corbyn who seems blind to recent events in his beloved Venezuela.

    However, Privatisation has its limits as well. It only really works when there is proper competition and when you look at our utilities you have to have severe doubts as to whether prices v profits can ever be brought into an equitable balance.

    But then you look back at the period between the 1950s and 1979 to see that these industries were starved of investment and were grossly inefficient.

    I don’t know the answer but going back to Nationalisation certainly isn’t it !

  19. agricola
    Posted February 13, 2018 at 9:26 am | Permalink

    Within the NHS much could be done in obtaining value for money in purchasing and reuse of capital equipment.

    Outside the above, doctors at consultant level can opt to work exclusively privately , exclusively NHS, or a contractual combination of both. My instinctive thought is that it must be difficult to serve two masters, giving 100% of contracted time to each. Travelling between hospitals must waste a lot of valuable time. better I think that NHS and private be separate, but allow the NHS to contract with private consultants where the NHS workload exceeds capacity. This could be extended to continental European hospitals where capacity is available, but where there is a shortfall of NHS capacity.

    Finally I would suggest that the NHS has some very expensive capital facilities and ask if these are being used on a twenty four hour basis. If similar capital amounts were employed in industry you could not afford them not working around the clock. You might have to raise staff levels by a commensurate amount, but if it solves a demand problem then do it. If done the unit then becomes more productive, to use a phrase.

  20. a-tracy
    Posted February 13, 2018 at 9:42 am | Permalink

    In the case of health:
    GPs are private sector contractors – can they access and buy into defined benefit public sector pensions? if yes, how?
    You didn’t mention private sector contractors in Optometry and other eye checkups that are done by private eye hospitals for the NHS (that many people actually prefer telling me they prefer feeling like a customer rather than a burden or a free loader which some NHS staff can make you feel – like they’re doing you a favour); dentists (privatised by Labour); now hearing checks are privatised (some hearing aids are free and others not), in the main pregnancy tests are now private and paid for over the counter when the NHS GP surgeries used to provide free tests for us. How long will it be before breast examinations, cervical smears and blood tests are privatised and chargeable? Even hospital car parking is private and I believe it won’t be long before you’re charged for your meals with a microwave ping meal option 3 meals for a £10. When we’re comparing spending with other Countries do we add back in all of these costs and turnovers of our optometrists, dentists, pharmacists, and services that other Countries health cover provides under their insurance, do we compare apples with apples or apples with pears? As long as the check-up is free I don’t believe most people that don’t work in the NHS or have a vested interest with a family member working in the NHS really care about whether the service is delivered by a private company or a public company.

  21. BOF
    Posted February 13, 2018 at 9:51 am | Permalink

    Should Labour drag all these sectors and services into direct government control then the NHS would soon collapse into complete chaos with costs to the taxpayer rocketing out of control. No, what is required is more health insurance by people who can afford it to ease the burden on the NHS.

  22. Bert Young
    Posted February 13, 2018 at 9:55 am | Permalink

    The link between surgeries and supply 0f prescribed medicines is close and critical ; since the separation of these two services locally there have been several mistakes and delays – all down to the right hand not knowing what the left hand is doing .My experience is by no means unique .

    My medic friends at hospital are also very critical of the use of certain bodies in the administration that occurs there ; the recent experience of their Human Resources Department being moved several miles away has resulted in stupid errors and lack of communication .

    Yesterday I responded about the lack of co-ordination between the different rail operators ; yet another example of how an overall control needs to be instigated .

    John’s blog today is a timely indication of the need to go back to some grass roots thinking and decision; things simply cannot go on as they are .

  23. stred
    Posted February 13, 2018 at 9:59 am | Permalink

    The arm’s length nationalised rail network should serve as a lesson as to what happens when a state owned monopoly is run by an ex bus manager and a bunch of accountants. Salaries of getting on for a million are paid with bonuses set up to succeed. Then they dabble in finance and lose a shedload while no-one takes responsibilty. The management could be put out to tender and require railway engineers to be on the board, as in countries such as Switzerland, where clean trains with seats run on time.

    The banks own the rolling stock. Where banks are in debt to the government after the bailout, the stock could be brought back under government ownership in lieu of debt and make a profit or keep rail fares down.

    The rail companies could be brought back under government ownership and run by the above board of railway engineers and managers at far less cost. All the claims lawyers working for each side arguing about blame for delays could be dispensed with.

    Same for the NHS. Put management out to tender for a fixed period. No performance- no job after 5 years

  24. Prigger
    Posted February 13, 2018 at 10:01 am | Permalink

    “The rising price of going to zoos and gardens pushed up UK inflation at the start of 2018”
    Business Insider 13 February 2018

    The Bank of England has many like-minded friends for its analyses. But no doubt with the added vital metric of entry costs of visits to circuses and butterfly sanctuaries.

    • Lifelogic
      Posted February 13, 2018 at 5:46 pm | Permalink

      What happens almost everywhere nowadays with (zoos and the likes and indeed trains) is that standard admission price rises but there are endless offer and discounts, vouchers, group tickets …. if you hunt them out!

  25. Epikouros
    Posted February 13, 2018 at 10:03 am | Permalink

    If I had my way there would not be a public sector or solely funded public services paid for by the taxpayer. In fact us the public should be weaned off being subsidised by taxpayers be it provision of things like healthcare even welfare unless it is under very special and limited circumstances. That statement will not find favour or win me any friends.

    For a start I would be told that it is totally impractical and only government can ensure that the likes of healthcare and welfare can be universally made available. Then of course I would be decried most vehemently for having the temerity of suggesting that the rights and privileges currently enjoyed granted by the largess of government bestowed with the copious use of taxpayers money should be ended.

    Both rebuttals are fallacious and are based on misplaced, illinformed perceptions and beliefs and the fact that no one will turn down having their living standard paid for by others. The former presoposes that society cannot without government help look after itself which of course is nonsense. As before government took more and more onto itself that is precisely what it did but prudently and therefore slowly and therefore not to the liking of the left so they hijacked the process and wrecked it. Government then became the problem not the solution. The latter is predicated on unrestrained opportunist greed and therefore once let loose becomes a never ending demand which only is eventually curtailed by the largess running out of other peoples money.

  26. BOF
    Posted February 13, 2018 at 10:07 am | Permalink

    Off topic. With the much vaunted speeches to spell out the direction of Brexit, I am quietly confident that Messrs Hammond and Rudd have been left out of the line up, not to sideline them, but so as not to alarm Brexiteers. Meanwhile trusted Mr Johnson and Mr Gove are being used to soften us up to accept damaging inclusion in a customs union (to be defined) and oversight of ECJ with regard to the EAW. Without much optimism, I hope to be proved wrong.

  27. APL
    Posted February 13, 2018 at 10:17 am | Permalink

    JR: “Labour wants to change the current boundaries between public and private provision of public services.”

    Yep, and the Tory party will just go along for the ride.

    We’ve had Seven years of a Tory administration. we’re still paying for RBS, at a rate of ~£6bn pa.

    Tories are too scared to make changes to the Health service, not even modest reforms to ensure ‘health tourists’ only arrive in this country with health care insurance.

    In short, the useless party.

    • APL
      Posted February 14, 2018 at 11:06 pm | Permalink

      “Tories are too scared to make changes to the Health service,”

      Of course the choir master orchestrating the outrage would be the BBC, another overstaffed, overpaid, wasteful public sector operation …

      Which the Tory party has done nothing in the last seven years to address.

      Truly, the Useless party.

  28. Denis Cooper
    Posted February 13, 2018 at 10:20 am | Permalink

    Off-topic, I read that the French government may be deliberately delaying Article 50 TEU negotiations on the UK’s withdrawal from the EU. If this is true, rather than being just another myth propagated by the media, then perhaps somebody should officially remind them of their duty of sincere cooperation under Article 4(3) TEU:

    http://www.lisbon-treaty.org/wcm/the-lisbon-treaty/treaty-on-european-union-and-comments/title-1-common-provisions/5-article-4.html

    “3. Pursuant to the principle of sincere cooperation, the Union and the Member States shall, in full mutual respect, assist each other in carrying out tasks which flow from the Treaties.”

    The UK is still an EU Member State, with the same rights and obligations as before; the UK and the other EU Member States and the EU institutions are engaged in carrying out a task which flows from the Treaties, namely the withdrawal of the UK from the EU by the procedure laid down in Article 50 TEU; therefore the UK has a right to expect full respect and sincere cooperation from France.

    Interestingly it seems that insertion of this kind of “loyalty clause” into the original Treaty of Rome was on the initiative of the German delegation, and against the background of the German constitutional principle of “federal fidelity”:

    http://www.oxfordscholarship.com/view/10.1093/acprof:oso/9780199683123.001.0001/acprof-9780199683123-chapter-1

    “The principle of loyalty in EU law”

    • Peter Wood
      Posted February 13, 2018 at 12:25 pm | Permalink

      Your frustration with the EU’s repudiation of its own laws is understandable; however your anger should be at our own government for its acquiescence.

      This government seems to have forgotten that they represent a nation. It accepts insult and instructions from individuals who represent nothing more than a confidence trick. The EU is not a nation, it does no trade, and is incompetent.

      Our government should, right now, demand a meeting of the EU Council to which it should propose the terms of our FTA. No further discussion. Agree our terms or no money.

      • Denis Cooper
        Posted February 13, 2018 at 2:07 pm | Permalink

        The heart of the current problem is that the UK establishment was and still is strongly in favour of participation in the EEC/EC/EU/USE project, and it is hard for them to act against their ingrained preference just because of what a majority of the voters said when asked directly in a referendum.

    • alan jutson
      Posted February 13, 2018 at 12:44 pm | Permalink

      Dennis

      Cannot understand why we have made ourself absent from all things being discussed in the EU whilst we are still members and still paying in.

      As far as day-day input is concerned we seem to have thrown in the towel, instead of getting involved and at least making our voice and opinions heard.

      • Dennis
        Posted February 13, 2018 at 5:39 pm | Permalink

        Who me, guv?

      • Chris S
        Posted February 13, 2018 at 8:59 pm | Permalink

        The government have rightly surmised that we would be wasting our breath. As far as they are concerned we’ve already gone. All they want is our money.

  29. Colin
    Posted February 13, 2018 at 10:30 am | Permalink

    NHS hospitals should become independent charitable trusts, with senior medical and nursing staff in charge and managers and administrators reporting to them. Junior doctors and nurses would be employees of the hospital and consultants would be self-employed. GPs’ surgeries should remain private professional partnerships. Other health professionals such as physiotherapists or clinical psychologists would either be self-employed or employed by a hospital or GPs’ practice. Pharmacists should be private businesses.

    All of these should charge fees for their services, and everyone should have comprehensive health insurance, with state subsidies for those who cannot afford the premiums. There should be a choice of insurance provider and of excess and co-payment options. The money should follow the patient, who should have a free choice of service provider. This is how things are done in sensible developed countries (i.e. those that aren’t the UK or USA) which somehow manage not to have their streets littered with the corpses of the poor.

    • forthurst
      Posted February 13, 2018 at 12:57 pm | Permalink

      It’s an unfortunate fact that the Tories would like to turn every provision into a money making racket. However, private provision does not have to be motivated by profit and in areas like education and healthcare, competition in respect of the major provision to the majority would be impractical, consequently not-for-profit offers relief from political meddling as well as foreign takeover and profiteering.

  30. Bob
    Posted February 13, 2018 at 10:37 am | Permalink

    Any enterprise funded by the taxpayers will become inefficient and bloated until it collapses under it’s own weight.

    Private health insurance should be tax deductible, and the tax system should be structured to encourage more private hospitals, GPs and elderly care homes with business rate exemptions etc. to a point where the NHS becomes the provider of last resort.

  31. David Murfin
    Posted February 13, 2018 at 10:37 am | Permalink

    Small pharmacies sell all sorts of stuff which presumably goes towards making them profitable. Is the state really going into competition with other shops selling toiletries, beauty preparations, health foods, even small child’s toys?
    The likely end scenario is many small pharmacies closing. Will there be state-run pharmacies within supermarkets? Will there be fewer places where a qualified pharmacist is available? Would they all be attached to GP’s surgeries, removing the need for separate sites?

    • a-tracy
      Posted February 13, 2018 at 2:41 pm | Permalink

      All of the small pharmacies did close down in my town, the local (previous three GP clinic) large conglomerate surgery put alongside a pharmacy – that actually treat their patients like cattle, with long queues waiting, miserable service. I never go there now after a couple of attempts to get prescriptions, I go to a town 30 minutes away which isn’t always convenient but I won’t put up with poor quality generic drugs being substituted for those which the GP prescribed.

  32. Prigger
    Posted February 13, 2018 at 10:41 am | Permalink

    #Question
    “Where do we want the boundary to be between the public and private sectors?”
    #Answer
    Where any general boundary suffers inflammation
    #Examples ( real ones )
    High-ranking NHS doctor ” The charges for treating ineligible foreigners for free is only One and a Half Billion pounds per year. It is a drop in the ocean”
    High- ranking Local Authority person ” The cost of the annual garden competition is just over One Hundred Thousand pounds. It is a drop in the ocean.”
    Same High ranking Local Authority person “The cost of the mini-referendum ( non-binding ) to get a local idea on a regional mayors is two hundred thousand pounds or thereabouts. It is a drop in the ocean.”
    First, we must rid our political system of the causes of inflammation. Reducing certain salaries to rather less than “a drop in the ocean” would be a good start

    • a-tracy
      Posted February 13, 2018 at 2:42 pm | Permalink

      I agree, the way some Councils waste money on themselves and their own pet projects stinks.

      • Dave Spart
        Posted February 13, 2018 at 6:51 pm | Permalink

        On my former council housing estate..now an ALMO…the waste is greater than it has ever been ….literally…in living memory. Out of their heads! Council Tax goes up every year and they spend it on idiocies. Central government could stop it but doesn’t. Instead they hand out knighthoods, OBEs and MBEs

  33. Adam
    Posted February 13, 2018 at 10:43 am | Permalink

    Govt exists, not for ownership, but to protect its citizens. It needs power to raise funds to fulfil its responsibility. It has to moderate the behaviour of those whose actions risk harming others, with monitoring & incentive, yet with force at last resort.

    Govt funds should be collected simply, fairly & efficiently, via a few fundamental sources, without the extreme complex multiplicities presently involved that generate waste.

    If Govt can protect, moderate & ultimately, control behaviour & resources via its citizens’ collective consent & happiness, it needs to own nothing beyond their own loyalty to quality of purpose.

  34. Kenneth
    Posted February 13, 2018 at 10:46 am | Permalink

    I think we should leave the NHS as it is when it comes to the balance between various private and public parts.

    However, it needs to place more emphasis on outcomes. It is very easy for the govt to be lured by the Labour/BBC philosophy that that measures the NHS’ performance by how much money is going in.

    The government should rise above that nonsense and think about the health of patients and not about the latest BBC moan.

    The govt should also prune bloated empire-building management and should stop paying £80K GPs for carrying out a £45K triage service.

    GPs need to be freed from being tied down at the surgery and properly look after their register using prioritisation and allowing nurses to do the triage surgery.

    • Adam
      Posted February 13, 2018 at 11:58 am | Permalink

      Highest amounts of money spent on the NHS may indicate failure. The NHS has become the National Illness Service.

      A nation requiring least expenditure would have fitter, healthier citizens, whose lifestyles avoid need for such remedy. Prevention is easier, better & less expensive than complex procedures aimed at corrective outcomes.

      Zero expenditure on NHS might be a better target.

      • Kenneth
        Posted February 13, 2018 at 4:34 pm | Permalink

        Not sure if prevention is cost effective as it often results in screening people who otherwise would never have had any contact with the health service.

        • Adam
          Posted February 13, 2018 at 8:31 pm | Permalink

          Response to Kenneth:

          Any undertaking set by a budget is rationed. Screening folk who are least at risk does waste resource.

          Prevention is, however, much wider in scope, including:

          Achieving: Physical fitness & healthy body weight.
          Cutting: Knife crime & other violence.
          Avoiding: Drugs & alcohol excesses, dangerous practices & accidents, unhealthy foods & contact with hazardous chemicals.
          Observing: Elderly neighbours at risk.
          Educating.
          Providing: Facilities, incentives, rewards & penalties, suited to maintaining good performance.

  35. Tom
    Posted February 13, 2018 at 11:01 am | Permalink

    “Labour wants to change the current boundaries between public and private provision of public services”.

    Indeed and in totally the wrong direction. It would damage everyone’s living standards hugely (other than perhaps a few in the rail and state sector unions).

    Unfortunately May & Hammond are just the same. Essentially they are socialists just not quite as bad. So it is rather hard form them to make the sensible case against Corbyn and his idiot trip to become a new Venezuela. A case that desperately needs to be made.

  36. old salt
    Posted February 13, 2018 at 11:07 am | Permalink

    Remember the old adage: Nationalised and paralysed. True or false? ‘Sayings’ don’t come out of nowhere.

    • Lifelogic
      Posted February 13, 2018 at 12:56 pm | Permalink

      Nationalised – means run for the benefit of the staff. The “customers” can get just lost they are a nuisance no one give a damn about them.

      We will just force them to pay taxes (under threat of imprisonment instead) to carry all these state sector “workers” – until the tax base dies fully that is! Thus killing any fair competition and leaving us a dire state monopoly.

  37. Sarah
    Posted February 13, 2018 at 11:15 am | Permalink

    A Royal Commission is required on the sustainability fo the NHS. This would include as part of its remit – sustainable financing, procurement practice, the boundaries you describe, training and working conditions in NHS including sustainability of pensions, funding and so forth, the role of PFI and most of all the improvement of health outcomes and scope of provision. it needs to take into account social care provision.

    Politicians have succeeded in weaponsising the NHS. It does the citizens of this country no service. We will all need it and depend on it an so will our children and our childrens’ children. The lack of vision is startling for a service presently consuming £1 in every £6 of taxpayer money but which is “underfunded”.

  38. Denis Cooper
    Posted February 13, 2018 at 11:29 am | Permalink

    https://researchbriefings.parliament.uk/ResearchBriefing/Summary/SN02792

    January CPI was unchanged from December CPI at 3.0% year on year, but the most useful information is in the chart going back to 2007.

    For most of 2015 CPI was close to zero, it started to lift off in the autumn of that year and was already rising quite quickly by the time we voted to leave the EU.

    So by roughly how much did that result increase CPI, over and above the pre-existing upwards trend? By about 1% out of the overall 3% rise, I would guess.

  39. Norman
    Posted February 13, 2018 at 11:59 am | Permalink

    Accountability is the issue.
    At the personal level, many in the public services or caring professions give of their best, even when its against the grain of the organization.
    Financial accountability is obviously right, but the people beneath its yoke become disillusioned and want to break the mold (hence the iniquitous lure of the Magic Money Tree, and politics of envy).
    We do need something more than raw monetarism – something that unites and justly rewards all involved in a transparent and inclusive way. If the government does not soon get the vision to address this (and that will take a revolution in itself) the unthinkable will happen. Visiting a large city teaching hospital the past few weeks, I’ve seen it stalking the pot-holed, graffiti ridden streets already.
    A huge challenge, for any mere mortal!

  40. Nig l
    Posted February 13, 2018 at 1:02 pm | Permalink

    I listened to Alan Johnson and Anna Soubry in a discussion about the nhs with an independent woman and any interventions by her on possible alternatives etcwere shouted down. Politicians minds are closed so until that changes nothing will.

    • mike fowle
      Posted February 13, 2018 at 2:35 pm | Permalink

      I remember when Johnson was Health Secretary any attempt to make co-payments resulted in the patient being charged for the WHOLE cost of their treatment. With that sort of mentality reform looks a long way away.

  41. Rien Huizer
    Posted February 13, 2018 at 1:06 pm | Permalink

    Good regulation (close to state ownership and not captured by producers) is less prone to various inefficiencies (entrenchment and over treatment on the one hand and rationing-waiting lists on the other). Health care is too complicated to be treated as a state utility, more so than power, water and rail. I would even rank day to day transactional banking (but not credit) as easier to run as a state utility than health care. There is no reason governments should employ doctors as long as their hourly rates and capacity costs are controlled (owning hospitals would look attractive as a state activity since the government should have the lowest borrowing costs, but that ignores technology and competition between hospitals might promote innovation and hence be ultimately more cost efficient).

    That would also afford space to close the gap between public and private healthcare in the UK. In a well regulated “all private” system there is not much room for fat cat consultants or overmanning due to union influence for instance. A case could be made for a central pharma purchasing function, like Australia’s PBS. But that may not be to the liking of the UK pharma industry that should expect to have some sheltered conditions in their home market, especially after brexit. Otherwise they could easily redistribute their international value chain to allocate more added value to more sympathetic countries, such as Singapore or Ireland. And of course the scope of an FTA with India would be relevant for this.

  42. lojolondon
    Posted February 13, 2018 at 2:28 pm | Permalink

    John, I want to define the boundaries between government and private with respect to charities. I want NO taxpayers money EVER to be given to ANY charity, no matter how noble a cause. I want charities to be fully funded by the public, as they always have been. I do not believe that this will make the charities any less effective or helpful to the communities they want to serve, but I do believe it will reduce their attractiveness to the shysters of the world as the number of staff they employ on salaries over £100k. Also, it will stop the charities from taking sides in political discussions as they have been reently, siding with the political party that promises them the most money.

  43. Andy
    Posted February 13, 2018 at 2:53 pm | Permalink

    I want top quality healthcare for me and my family which is free at the point of delivery.

    However I genuinely do not care who provides that healthcare.

    One thing I do want is for politicians to stop playing politics with the NHS.

    We need an independent, cross party, body to set its budget based on need.

    I want Labour to understand public is not always best.

    I want Tories to understand private is not always best.

    I want you all to stop taking cheap shots at each other about it.

    • APL
      Posted February 14, 2018 at 4:57 am | Permalink

      Andy: “We need an independent, cross party, body to set its budget based on need.”

      Not possible if you’ve got open borders, leading to health tourism which effectively means infinate demand for that ‘free’ thing. You can’t set a fixed budget for the provision of that service, regardless of the service in question

      Same with education. The education budget is probably perfectly adaquate, except not only do you have to educate everyone in the country of school age, you’ve now got to educate people who’s first language isn’t English, and cater for any number of languages and to children who may have had essentially no education at all in their country of origin.

      In that scenario, something’s got to give, that something will be quality.

      Quality healthcare, or quality education.

  44. MikeP
    Posted February 13, 2018 at 4:29 pm | Permalink

    Whilst no Labour Government or Opposition would ever agree I believe the private sector should be given all elective surgery like hips, knees, shoulders, cataracts, cosmetic surgery, etc. By giving this to independent hospitals it would free up public sector hospital capacity and allow them to focus on accidents, emergencies and more complex acute conditions. It would also help the public see what the private sector can provide when given the chance as only privately insured or NHS referred patients will have experienced them to date. In my experience they have far superior patient administration and procedure scheduling systems and processes and with a predictable workload can take huge advantage of that. All the care would remain free to those using the service, funded out of general taxation.

  45. mike fowle
    Posted February 13, 2018 at 7:00 pm | Permalink

    The thing is when the NHS was founded in 1948 there was only so much medical science could do. The recent series of Surgeons At the Edge of Life would have been science fiction in 1948. Stopping people’s hearts for instance, transplant surgery etc. But such procedures are hugely expensive with sophisticated equipment, TWO top surgeons and supporting teams etc. I am not suggesting that anybody should be denied such surgery, but the stuff at the lower end could be delivered on a (part) fee paying basis, which would also be an incentive to carry out more procedures and to enhance competition.

  46. Edward2
    Posted February 13, 2018 at 7:17 pm | Permalink

    Return the ability of employers to provide private health cover for their staff without them or their staff being liable for corporation tax and benefit in kind taxation.
    It would reduce pressure on the NHS
    It would be a vote winner too.

  47. nigel seymour
    Posted February 13, 2018 at 7:33 pm | Permalink

    It wont be in my lifetime but after brexit and having left the corrupt EU:

    * referendum for ROI to leave the EU
    * referendum to unite the ROI and NI
    * do away with UK/GB – the world will address us as the GREAT BRITISH ISLES
    * do away with the union jack and get the commonwealth to agree an alternative

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    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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