Just when the government is discussing the right mix of public, private and charity sector provision i n health,Ā fly on the wall spy camera documentaries reveal cases of private sector maltreatment or poor performance. Channel Four does do a similar operation on an NHS hospital and shows some nurses in a bad light, but it does not have the same impact.
I fear there are cases of poor treatment, abuse of patients, low quality careĀ and inefficiency inĀ both the private and public sectors. The BBC treats these very differently. They rightly gave tough interviews to private sector institutions that had performed badly, not letting them off the hook. Yet when it came to the Care Quality Commission, the public sector regulator of care , they were asked by the Today programme if they had insufficient funding and insufficient people to monitor and control the wicked private sector.
The provision of public service in the UK is much more complex than a simple division into public and private would suggest. The NHS relies on for profit drug companies to supply the treatments. It relies on private sector businesses to supply everything from bandages to replacement body parts, from crutches to ear grommets. Many GPs are private sector contractors, and the NHS now contracts out some operations and medical treatments to private sector institutions.
Public service in the UK is supplied by a mixture of monopolies and competitive businesses, by a mixture of institutions employing public sector and private sector employees, and mixture of provision between freeĀ at the point of use and customers paying for what they need. The NHS itself is largely monopoly butĀ now contains competitive elements. It is largely free at the point of use, but charges many for prescriptions, dentistry and glasses. Private companies deliver cleaning and catering, banking and consultancy to it.
It is high time journalists accepted that the public and private sectors are much more muddled up and interwoven than they often allow, and important that we should recognise that both the public and private sectors can do a bad job. It would help theĀ public debate if we had more fly on the wall documentaries about parts of the public sector.When it comes to health, we should remember the dominance of public provision, and expect more exposure of what they are up to.
June 11, 2011
Actually I am very encouraged by your very timely reminder of how complicated the NHS and other public bodies actually are. I must admit that I had overlooked this and just assumed that nationalised and commercial organisations were what they said they were. The BBC, I agree, ought to have known better in its very Church of England/leftie reporting.
Having said all that, it says a lot for our public services that they have adapted to real life. I look for a lot more commercial inroads myself. Especially in Free Schools where the Master Of Wellington has come out in favour of sponsoring “State” Academies.
All this is most encouraging.
June 11, 2011
Mike ,
I live about 5 miles away from Wellington and admire what they do there .
By making the fees as inclusive as possible parents know what they are in for .
Without wishing to sound like a politician I admire the way they connect privilege with social responsibility . I admire it even more that they manage to do it in such a way that does not involve reducing expectations and dumbing down .
This is far removed from an independent school a mate went to where they made every effort to instil an unjustified sense of superiority in their pupils .
All a bit different from the comprehensive I attended which was a feeder school for the local borstal .
Mike , my point is that Wellington has a charitable status . When you said you look for more commercial inroads do you really mean commercial or do you mean not for profit like Wellington or both ?
June 11, 2011
Well, what I voted for, with very good reason having done a lot of research in the British Library, met Michael Gove in person, etc etc, was the Swedish system where, as far as I can understand, the government simply opened the doors to anyone to open a school. The government allocated a voucher to each parent and told them to get on with it. This was in 1992.
I discovered (I’ve never been to Sweden myself) that it was such a success that even the Swedish Labour Party was claiming that it was their idea in the first place (it wasn’t).
Some of the organisations were definitely under shareholders and were making money. But they used the money to expand their system. I have met the CEOs of one organisation and they are magnificent people by any standard. One is, in fact, English.
That is what I expected to happen here…….
June 13, 2011
“The government allocated a voucher to each parent and told them to get on with it. This was in 1992.”
That might well be the key difference .
I did not know that politicians who readily admit they do not alway know best and do not insist on interfering with everything existed !
June 11, 2011
Where the private sector fails in these areas it is usually because the state sector has purchased badly (one often wonders about how honest and unbiased the purchasing decisions actually are) with a poor contract, a poor system structure and total failure to check that they were actually getting value for money. It is not their money after all.
Anyone can employ some one and get very little in return – it is up to the buyer to make sure they are getting what they wanted and contracted for – or not to pay and find someone else.
He who pays the piper calls the tune or he is a fool (0r just does not care so long as he has a good income, pension and less hassle).
June 11, 2011
I am still puzzled by why Cameron is taking his any growth big state line when he has little to gain from it.
1. Is it that he is just mad/confused and actually believes his “anti growth” big inefficient state policy will work?
2. Is it that he sees his loyalties as purely to the EU not the UK?
3. Is is that he has to take this line due to being stuck with the ironically named “Liberal Democrats” (entirely through his own fault and lack of vision)?
4. Is that he mixes entirely with other politicians, bureaucrats, BBC types, Charity officials, “experts” (who know what line is wanted) and the state sector representatives that he simply ignores the needs of the vast majority of the
population in this way?
None seem a good explanations to me but I cannot see many others can JR shed any light on this?
June 11, 2011
On the BBC they are unbelievably biased on everything they report the line they takes is virtually always:
Pro the green religion
Pro ever bigger state sector
Pro any overseas aid programs
Pro higher taxes
Anti landlord
Pro tenant )though actually the policies they push harm tenants too more)
Pro more employment regulation ( though this mainly harms employees too)
Pro the NHS in its current dis-functional form
Pro, poor quality, same dross for all, education with indoctrination within all the syllabus.
Pro EU and all Human “Rights” (save the right to keep the fruits of their labours)
Pro ever more regulation to control everything (even breathing going to the loo or similar)
Pro enforced “equality of outcome”
Pro all “oppressed” minorities other than working white males
Pro thought crimes and enforced “right on” language restrictions
Pro unfair competition in broadcasting.
Pro the locking up or any man on the sole say so of a single uncorroborated anonymous woman.
I could continue ……….
It is most evident in Radio 4 “Comedy” where the punch line of about 50% of the jokes is the “Daily Mail” or “Daily Mail Reader” the others have climate change realists as the punch line.
“It’s the Tories who have put the ‘n’ into cuts” – being a recent typical example of their level of humour and general abuse to the Tories. Even though the current Cameron Tories are virtually in line with the BBC on all the above points anyway.
June 11, 2011
What does Lord (Chris) Patton have to say I wonder?
June 11, 2011
The time must fly with you Lifelogic. Absolute and utter trite to use one word you could use for the daily Mail. You do not know what is funny about racist, anti-immigrant, right-wing, middle-England, misogynist, homophobic, anti-intellectual, colonial, scaremongering, sanctimonious, authoritarian mind-sets amongst a mass of contradictions, untruths and appalling journalism?
June 11, 2011
Detain immigrants indefinitely under the Terrorism Act, and then give them an on-the-spot fine. And charge them for it.
Fit prisoners with electronic tags, and then try them in secret.
Issue everybody with compulsory ‘Entitlement Cards’, and then jail them. And charge them for it.
Send innocent people to an offshore processing centre, and then issue them with compulsory ‘Entitlement Cards’. And charge them for it.
Put paroled prisoners under a curfew order, and then give them a ‘Citizenship Test’.
June 11, 2011
Give children a ‘Citizenship Test’, and then deny them the right to trial by jury.
Give Muslims a ‘Citizenship Test’, and then lock them up.
Detain anti-globalisation protesters indefinitely under the Terrorism Act, and then try them in secret.
Arrest the BBC, and then put them under a curfew order.
Give homeless people an on-the-spot fine, and then try them in secret.
Send airy-fairy liberals to an offshore processing centre, and then deny them the right to trial by jury.
Give homeless people an on-the-spot fine, and then issue them with compulsory ‘Entitlement Cards’.
Give foreigners a ‘Citizenship Test’, and then try them in secret. And charge them for it.
Fit prisoners with electronic tags, and then pre-emptively convict them.
and so on.
June 11, 2011
What gets me are the mockney estuary accents which, from time to time slip. Also, this evening, the very well heeled people assuming that the poor little Indians in the slums of Bombay (sic: Mumbay is the corrupt modern city which they hate) were happy and virtuous. another thing is the terribly false flattened Manchester “a” when they talk about their working class backgrounds.
June 12, 2011
Bazman
I do not know much about the Mail as I do not read it but when I have seen it it seems to be aimed mainly at the slightly dimmer conservative women. Clearly you know more about it than I do. But it does not really make it of a punch line for endless BBC “Jokes”.
June 11, 2011
John
There will always be a difference in the way Public and Private organisations are reported upon for a very simple reason.
The customer pays over money (hard earned cash after tax) for a private service, the full cost of that service is thus known, and a value, good, average, poor, can be put upon it.
Public sector costs are unknown to the user, as they are simply hidden in general taxation, are promoted as a free service, although clearly they are not, and thus a lesser value is put upon it.
The cusomer is therefore often surprised when good service is delivered for nothing and will freely speak about what a good deal they have had !.
The private sector will always have to outperform the public service, to avoid any criticism when a comparison is made.
The only way to hammer home the true costs of any public service, is to provide a receipt to the customer at the end of the task/treatment, but this will of course increase the cost of tht service slightly.
Anyone who has had Private health treatment, and who has been presented with a detailed breakdown of the costs (theatre time, surgeons time, medication prescribed, even down the the cost of a plaster, the room and meals) will confirm the above.
In addition, if you have chosen to use a private sector service you have already paid (if you are a taxpayer) for the public sector service you have chosen not to use, thus your expectation of treatment/service will automatically be higher, if not, then you will of course complain, as you will feel you have wasted your money.
Private nursing home care is another good example, they are expensive Ā£500-Ā£1,000 per week.
Very often the resident has had to sell the past family home to pay for such, a home which some family members may even have have been born in, so of course some resentment exists (apart from the disappearing inheritance) expectation and emotions run high, and if for any reason care or treatment does not perform to expectations, complaints are rightly made.
June 11, 2011
Yes this is a helpful post to remind us of the complex relationship between the private and public sector in the provision of health care.
June 11, 2011
It’s high time the government called the bluff of left-wing politicians, unions and the liberal media about the realities of the NHS, rather than continued to genuflect at its altar for public consumption. Based on conversations with others who have benefited from its “service”, I suspect the government would be surprised by the amount of public support it uncovered.
Of course, that would require Cameron to show courage and the convictions of a truly conservative prime minister, and we all know that he has neither.
June 11, 2011
From the other side of the fence:
http://insidecroydon.wordpress.com/2011/06/08/3000-carers-job-cuts-proposed-at-southern-cross-homes/
I’ve added stuff in the comments as well. And I’ll also add this:
So how do you create a Public Sector body that can bid in the event of a decision to Privatise? So that the Public Sector can compete fair and square.
This is theoretical, as it is already too late, but I just want to show the point that The Public Sector bidding for contracts is possible.
With Care Homes itās really easy. Each home will have a rating. 2 star, 3 star, 4 star, that kind of thing. Theyāre regularly assessed. So you keep the 4 and 5 star homes, get them to form a Consortia, and now they can bid for contracts. The Council Management Team for the homes shrinks, but some will stay on as some homes have survived the cull.
So you have a ācompanyā that can expand if it wins new contracts, and it is still 100% Public Sector.
All the best practice from the Public Sector is saved. And they can take over ailing homes and introduce that best practice to them. Replace bad staff, save those that were good, that kind of thing. It stops ājobs for lifeā culture ( and the laziness it can breed ), and at the same time allows the Public Sector to keep itās excellence and try to expand it.
Well, that was easy then wasnāt it?
June 11, 2011
It is of course easy to read into journalists’ reporting a (public sector leaning) confirmatory bias, or at a really simple level no conceptualization of anything like a contingency table. But, I wonder whether like many a new MP, some may just have little real world experience (from the inside).
On:
“It would help the public debate if we had more fly on the wall documentaries about parts of the public sector.”
I know I would benefit from plenty of fly on the wall documentaries about all kinds of organizations that are both performing and not performing. Based on a sample of one (me), I know industries and organizations in which I have worked but there are few others of which I understand the processes. Of course documentaries would need to be careful, another tendency can be to find blame in an individual or an individual responsible for a culture, sometimes blame is fairly levelled, but on other occasions the need to recognize emergent behaviours or external context.
June 11, 2011
Not just the media, but politicians are just as biased. Rightly Railtrack was hauled over the coals for their shoddy work that cost people their lives, yet when Railtrack killed a few people, the NHS has been killing people on an industrial scale. Dirty hospitals were killing thousands of people a year, yet no politican could muster any where near the anger they leveled at Railtrack
June 11, 2011
You should also add that Gordon Brown ensured that all Hospital trusts were registered for Corporation tax.
No need for such a registration if the bodies are non-profit making
June 11, 2011
Obviously saw where it was going.
June 11, 2011
The BBC is rabidly anti-business; is this news to anyone? They are a closed clan of left-of-centre arts-biased people who live well from the public purse. Their biases are an inevitable result of that. How about mandating that 75% of BBC new hires should be of people who a) have a non-arts background, and b) have had a private sector job. This may make it more representative.
There is the (tempting) option of just phasing out state support, saving every household over Ā£140 a year, but I suspect there is too much public affection for the organisation for that.
June 11, 2011
Indeed it is hugely art biased at least 80% of employees should have worked mainly in the private sector & pay should be similar to UK average wages (not as often well over double). It should be far less arts based so they did not fall for every statistical and global warming con so very easily.
Melvyn Bragg for example presents “In Our Time” a mainly science program and seems to have as much understanding of science as I do of Beowulf. He spends most of his time pointlessly interrupting the, usually excellent, experts on the program with silly irrelevant questions usually showing he has missed the point totally.
June 11, 2011
Rather like Kirsty Wark on Newsnight in fact.
June 11, 2011
I would warmly support this.
June 11, 2011
How about non Guardian people who believe green issues are about restricting the green belt to increase their house prices and internships are a way of helping their middle class children up the ladder. What will all the chaps do?
June 11, 2011
Perhaps it is high time that the public and private sectors became less muddled up. Let us discuss whether Public Private Partnership is every a good idea; for case studies, we could do worse than start with the 3 collapsed London Underground contracts. Then extend the analysis to PFI, where one company with 14 employees, with a big share of the NHS hospital PFI market, is earning 100% per annum on its investments.
Is it not the case, Mr Redwood, that nearly everything the public sector touches turns to dross? Perhaps it should stick to maintaining the value of the currency, managing the money supply with just a little competence, and defending the monarchy and the realm – which includes Northern Ireland.
June 13, 2011
No doubt there are cases where PFI is appropriate .
However , in it’s current form it is far too susceptible to abuse as a way of keeping expenditure commitments off the published .
Government Accounting practices must be reformed so that expenditure is reported on an accruals basis and not a cash basis .
June 11, 2011
Vis a vis the Bolshevik broadcasting corporation,I just got a huge round robin email,which I sent on another 8 times.It was from a piece by a professor from Australia Ian Plimer in which he said that it has been shown that the Four day Eruption in Iceland recently totally negated
the co2 saving measures made across our Whole Planet for the last 5 YES FIVE YEARS,he also talks about the Mount Pinatubo eruption in 1991 [which I have written about on here and other sites]which put More pollution in the atmoshere in it’s eruption than Mankind had since appearing on the planet. My point is does anyone seriously think that the BBC will report this AT ALL unless forced to by it’s reporting elsewhere and then finding a way to DISCREDIT it. The BBC should be sold off commercialised and Sanitised of leftwing
GROUPTHINK
June 11, 2011
I passed on Ian Plimer to a friend who is passionately in favour of global warming (Anthropocentric). His comment? Well, what can you expect from a rich director of mining companies?
June 11, 2011
And by the way I no longer write in my own name on Conservative home because they Censor
me,this I wrote above would probably not see the light of day WHY ????? . but ha ha ha a friend now writes in for me with a Pseudonym and slightly garbled but carrying the same ideas,I call him my amplitude modulated carrier wave.
June 11, 2011
If it where to be run like a real business then it should be focusing on paying the least for services done by private contractors and using ‘in house’ wherever possible not supporting other peoples businesses. The nurses job is not a ‘business’ as fantasists would imply. Nor is an agency nurse self employed. The right wing class fantasy of ending free at point of use is going in the wrong direction. Ending of charges for prescriptions etc like in Scotland and Wales should be implemented. What makes the right wing think people will pay? In many cases they will not seek treatment or investigations for illnesses and will seek over the counter remedies in the long term costing the state and themselves dear. We will be heading for another rail fiasco or at the very least a system as bad as dentistry. In my town there must be ten dental practices all private and expensive. The ones that are NHS providers leave a lot to be desired and some are out of town. Nothing can be proved, but I have been to a number of dentists over the years and know the good from the bad. My wife was sent away from a NHS one in pain last year. I chucked a hundred quid at it and the problem was solved. Funny that. They want to be doctors but are more close to tradesman. The expensive car magazines and often light aircraft magazines in the waiting rooms are telling. I can afford private, but what is national insurance for. Not to buy porches for dentists using NHS work to subsidise their lucrative private practices. Have you noticed that there is always a Porsche parked at their surgeries It ain’t the receptionists or the patients that’s for sure.
June 11, 2011
Why would beeboids be concerned about maltreatment or poor performance in the NHS? The BBC have private healthcare provision compliments of licence tax payers.
June 11, 2011
Do they all have private medicine?
June 11, 2011
Probably vote Conservative too. In fact you can count on it.
June 11, 2011
The BBC will never stop using our money to promote its agenda; nevertheless filming some documentary ‘exposes’ of the standard of care in some institutions would be akin to a duck shoot. Many members of the public are more than aware, through first hand observation or experience, of very poor treatment by both public hospitals and private care homes. Poor care standards are symptoms of a much deeper malaise, however, which go to the core of the bases by which care is provided in this country: private care homesrun by entrepreneurs seeking to maximise profits at the expense of payers and patients alike; NHS hospitals with irrelevant, but stifling bureaucracy, coupled with inadequate leadership and supervision. In both cases, it comes down to who exactly has the duty of care toward patients, and by the same token, who should answer to criminal charges in the event of gross failures. It is quite clear that with regard to private care homes, that duty should go right to the top where decisions on administration, recruitment, budgets and ethos are determined and ignorance of good practice should be no defence. With regard to NHS hospitals, we have a hierarchy controlled by civil servants in Whitehall all the way down to the hospital administrators under whom come the medical resources. If our private schools are run by headmasters not bursars and without a complex hierarchy of non-medical dweebs orchestrating their activites and yet conspire to be some of the best in the world rather than worst in the country, why is it that the very opposite is is expected to work satisfactorily with NHS hospitals? Unless those who run our hospitals are prepared to accept penalties if things go wrong, they should not be involved in the first place: responsibily should be concomitant with power.
June 11, 2011
The BBC no longer make even a token attempt to show the “Ā£due balance” their Charter requires. It is openly fraudulent to demand licence fees under a Charter that has been vitiated.
June 11, 2011
The situation is, indeed, complex, aka disorganised.
In the area of mental health, for example, there is no patient-centred Consultant to tie together the responsibilities of nurses, carers and managers in a private home for dementia patients, with a patient’s GP, public sector mental health community nurse, social services and CQC checking the quality of care in the home.
Each of these has some input, overlapping in some cases, but nobody takes ultimate responsibility for the patient, and there are no formal links between the disciplines, meaning lack of co-ordination and patients slipping through the net.
The NHS in it’s day-to-day sense appears to consist of lots of low to semi-skilled people running around diligently following the rules and ticking boxes, with a few more highly skilled folk interjecting to add or subtract from the ongoing picture.
This picture is transferring itself slowly to the private sector, who then trim a tad here and there to make a turn for shareholders, now that property related profits have gone a bit sour.
A GP, for example, can prescribe an anti-psychotic drug requested by the mental health nurse, to be administered by the home nurse, but there is no strong clinical monitoring of the effects of that drug excepting by the staff at the home, or by the patient’s relatives. The GP defers their responsibility to the mental health nurse who requested the drug, who in turn relies on the home nurse, who relies on the carers to monitor the patient on an ongoing basis. Unless called on by the home, neither the mental health nurse nor the GP will be called on to see the patient, excepting a quarterly or so visit by the mental health community nurse. Patients can become immobile within a few weeks on anti-psychotic drugs. And the CQC might visit once every 2 years or so. A long time in a dementia patient’s life.
Lack of monitoring or a transparent and defined heirarchical system of responsibility leaves patients being administered with anti-psychotic drugs in a deteriorating state. Immobile, prone to UTIs and other complications.
Never mind that you are, like my mother, middle class, born and worked in the UK and saved all your life, with a six-figure sum in the bank. That makes the situation worse.
All-in-all, in the UK be afraid. Be very afraid.
June 11, 2011
The BBC needs putting in its place. It seems to have forgotten that it should be impartial.
June 13, 2011
Good article.
If, as you repeatedly write, the NHS spending hasn’t gone down and the employee pay above a certain level was frozen, why are waiting times extending, why is productivity going down? Can’t you target one or two hospitals where waiting times are extending and do an audit? How many operations did they perform per week during Labour tenure for how much money and how many operations are they performing in the year after the Conservatives took power? If there are less – why, if there are more then tell people that x% more operations are being done and that is why there has been an extended waiting list.
When Labour are in power, a political power that is mainly funded by the public sector unions, do the NHS workers raise their productivity when they are in charge of all decision making and spending commitments but when the Conservatives take over the staff work to rule and reduce productivity and if so what are you going to do about this?
June 14, 2011
JR wrote: “Yet when it came to the Care Quality Commission [“CQC”], the public sector regulator of care , they were asked by the Today programme if they had insufficient funding and insufficient people to monitor and control the wicked private sector.”
I did not listen to the programme, but did they raise any of the allegations published in today’s Daily Mail?
http://www.dailymail.co.uk/femail/article-2002822/Cynthia-Bower-Care-Quality-Commission-quit.html