'Planned 49% limit' for NHS private patients in England

http://www.bbc.co.uk/news/health-16337904

A quick google around the net, uncovers a few interesting statements.

"It seems quite clear that the government envisages hospitals in which many more than 50% of all patients are private (thus opening up a future narrative for the near future that the NHS-funded minority are scroungers)."

Is the NHS as we know it, effectively dead?

I don’t see major industrial unrest stopping it in its tracks at this stage, and many of the crucial parts of the NHS infrastructure has already been dismantled or will soon be beyond repair.

Thought provoking comments, welcome.

Saw this myself. And thought the exact same thing.
Let the bun fight commence.
One can only hope that wherever you are in employ that your gang is bigger and better than the others in order to survive.
But isnt that what the man wants us to be like in life in general.
Ask yourself why are private industry there? There is only really one true answer.
Then ask yourself why service industries are there, again there is only one real answer.
I hope those concerned can sleep at nights, but then again I tend to think whatever they say they have no social conscience.

I find it surprising that there has not been more debate over this amendment to the Health & Social Care Bill.

So, the taxpayer undertakes to foot the bill for PFI built NHS Hospitals, and private healthcare providers then rent back bed space and theatre slots, using NHS equipment and staff at the expense of patients on NHS waiting lists.

Its perfectly clear that "PFI" doesn’t represent "value for money" to the taxpayer, and in many cases Trust's (in financial difficulties) are trying to renegotiate their PFI repayment's with a view to achieving Foundation status before 2015.

The only way to achieve this will be to rent out taxpayer funded beds and slots to the private sector.

Successive mismanagement at senior public service and parliamentary level has left your NHS in a very parlous state, with very few financial options.

Need an operation? There is a waiting list, but if you prefer to go private within the same NHS Hospital we can see you straight away. We take all major credit cards.....

There is a perception from those outside it that, as it stands, the NHS is run primarily for the benefit of the staff. But having said that, it doesn't mean that we should stand by and watch "our" NHS go down the pan. In short, it needs to get back to the basics of providing decent public healthcare.

Of course "PFI" has been a disaster, just as many of us knew it would be. It's a gravy train, pure and simple.

But what is being discussed here is just a fraction of what is wrong with the so-called United Kingdom today. It has become an unpleasant place, populated by and large by unpleasant, greedy, selfish people. The bankers and their pals the lawyers are in charge, money is king, and nothing else seems to matter.

Unfortunately, I don't see it being brought back on an even keel (if indeed it ever truly was) during the remainder of my lifetime, and that of most folk who get on here. The malaise is too widespread to be put right quickly, even if we started today. And frankly, I don't see much sign of that happening. The political will is simply not there.

This country lost it's only chance of real reform when the servicemen returning from the Second War War handed in their weapons.

Hello Geoff, (Hope you had a Good Christmas).

Private Finance Initiative
http://en.wikipedia.org/wiki/Private_finance_initiative

Makes an interesting read.

I wont debate the why's and wherefore’s of this present mess Society is in, but I am interested in your views towards solving the current NHS budgetary crisis. If we need to radically change the way we run the NHS, so be it. (It can hardly be left in a worse state, than the so-called consecutive government "custodians" have left it).

Hello Sean. Thank you for your kindness. I hope you are also enjoying the "Holiday Season", or whatever it is we are "allowed" to call it these days.

I shall refrain from further comment on this thread, for three reasons:-

1) Sensitive folk won't like to hear about my remedies.
2) With only thirty or so posts to make before I hit 10,000 (and therefore call it a day) I have to ration them a bit now.
3) I'm sure that the "fresh audience" (whomever they may be) have something far more exciting to say.

Compliments of the Season to One and All.

O Dear have i missed something?

I think you shouldn’t refrain from using this forum to air your views (free speech, and all that).

Reasons not to limit your ebme forum responses in 2012

1) We are way beyond being sensitive; a pragmatic approach is the only solution.
2) 10,000 (it’s only a number, and there have been some pearls of wisdom amongst your prolific efforts).
3) People only comment when there is lively debate. Lively Debate requires alternative solutions coupled with a sense of humour

I have had occasion to disagree with your views over some issues, but so what. I would not expect you to refrain from commenting on a subject which stimulates interest amongst others.

Feel free to comment on topic, as required, matey

I agree with all that you say there, Sean.

I am not hacked off, but it's just that I don't always have too much time available for this stuff now. And 10,000 just seems like a nice round number!

Back to the thread ... I believe that we have to take a more global view of things these days. "Thinking outside the box", or whatever you want to call it.

In my opinion, Britain needs real change (that is, something akin to a Revolution). We need to move on (at last) and become a truly Modern State, and one in which everyone gets a "fair go". But (as I say) I don't see anything like that happening any time soon ... unless it is forced upon us by something *cataclysmic.

* Like if the coming rounds of warfare get out of hand (and we bite off more than we can chew).

The NHS is similar to other Public Utilities prior to their privatisation in that the management are enjoying a rather comfortable Gentlemens' Club culture (or to be more accurate in the NHS, a Gentle Ladies' Club). Having worked for a large utility prior and after privatisation in the early 1980s I noticed changes were made to make management accountable. Some divisions that imported Americans to shake up the culture adopted an appraisal system of the managers by their workers with many uncomfortable questions being asked. Another method of breaking up complacency was to rotate managers every 2 years, the incomming manager being expected to perform better than the last. NHS managers can make poor decisions that lead to loss of productivity with no sanctions being taken. Poor managers can upset their staff leaving low morale and performance without it affecting them whatsoever. A system of measured performance related pay would sort out the sheep from the goats.

"Sheep and goats"? Thanks for reminding me of (as I may have mentioned before) the "Saudi model" of having government hospitals run (that is, operated and maintained, under the supervision of a small government team) by contractors of two or three years duration.

Contractors had to pre-qualify, and there was an open bidding process.

Contractors who failed to shape up got penalised *financially, and (at worst) there was a thorough sorting out at each handover (that is, every two or three years).

Again, as mentioned before, the "secret" was (is) in the quality of the contract documents, and then to that of the supervising team.

* Or even booted out!

Good God Barney!
Return of Performance related pay in the NHS?
We only just managed to get rid of that approach recently, where the statistic fiddlers cut corners to get the numbers up, compromising patient care. Leaving patients in Ambulance's outside A&E because after they are admitted they must be found a bed within a certain time slot.....

The massaging of Patient throughput targets figures to justify your pay........

Forget it Barney, it has been tried and rightfully discarded.
Concentrate on the quality of service delivery; don’t compromise patient care by re-introducing PRP for Senior Managers whose prime motivator will be money.

"Targets" are not the answer ... they need to be shot down!

Neither are *"quotas", whether in pretending to treat the sick and needy, "race relations", university places, admissions to the police "service" ... or any place else!

@Sean: the word is leadership!

* And here I am, using up my precious posts!

Spot on Geoff

You can forget American 80's style management, and all their mantra's (adopted by New Labour, amongst others).

Remember, "Things will only get better" Ha ha ha.

What we dont need (in my view) is a return to that style of management.

In my humble opinion, all salaries in the Public Sector should be just that:- salaries. They should also be "reasonable" (that is, rather than obscenely inflated). The idea being that the "salary man" forgoes riches in exchange for security of tenure.

There should be no such thing (again, in the Public Sector) as bonuses, or any other sort of handout, for that matter.

Instead (and as a way of keeping managers on their toes), there should be deductions from any who fail to shape up. And if they don't like that:- tough. They can always (try to) take their services elsewhere.

Meanwhile, corrupt staff should be fired, with loss of pension rights.

On the other hand, managers working in the Private Sector (that is, often in an insecure, risk-driven environment) should have no limits imposed on their earning potential. Especially because, if they fail to deliver the goods, they'll be out on their [censored] anyway. And quite rightly too.

I don’t think changing localised NHS management is the solution.
Management at a Trust Board / strategic / regional level needs examining, and if needs be downsizing.

There seems to be layers upon layers of management where responsibilities are duplicated, and restructured to be duplicated again (on a frequent basis).

If a Trust Board fails to achieve their quotas or fiscal targets, perhaps they should be "stood down".

Financially, the biggest overspend (apart from PFI repayments) seems to be the drugs budget which causes "CRES" shortfalls year in, year out. I believe that negotiations are proceeding on a national basis to sort out a better deal for the NHS. Not before time.

The "Survival of the Fittest" is what Life (in what we might call the "David Attenborough" sense) is all about. Be it a tribe in the jungle, a nation, a business, a hospital ... or a herd of cows.

"What doesn't kill you makes you stronger", and all that stuff.

Saint Margaret espoused that failing businesses should be left to sink in their own mire.

Trouble is, in a civilised society you don't just leave the sick and needy to their own devices.

So ... there's the dilemma.

As I have said, perhaps the NHS needs to cut away all the non-essentials (and that includes a fair chunk of the payroll) and get back to the basics of providing a solid service for those in real need. And by that I don't include "gender reassignment", bribing people to stop smoking, "cures" for obesity, support for "alternative lifestyles" ... and [censored] like that.

Agree with most of what has been said, so eloquently, above.
As far as management goes I have a simple theory.

Once you get to a certain level, within the NHS, then that post should be accountable, responsible and open to scrutiny and, as a minimum, for a fixed term, say 2 years.

After that the person should have to re-apply, not to the cronyism way of Trust Boards but to the people it serves, its community.

A bit like in the US of A, Vote for your Sheriff.
Too often I have seen the "I have arrived, how long till retirement" mantra applied once an individual "occupies" a position of seniority within the NHS.

Performance is closely linked to accountability.
If you are not accountable then the threat of losing a "cushy position" doesn't materialise.

I am also a firm believer that "senior management" should move around more frequently than it does at the moment, fresh blood is required to keep ideas new and improvement continuous.

Yes. Why not have elections for all senior Public Sector posts now and then? Most are "political" in many respects, after all.

No doubt we still have a Sheriff of Nottingham. But I haven't a clue how that person gets to be in that position. And I expect that the "job" is purely "ceremonial" anyway. Meaning:- waste of tax-payers' money.

Personally, I'm looking forward to seeing directly elected* Police Commissioners in a year's time. Surely a step in the right direction (I hope). So why can't we have directly elected heads of hospital Trusts as well?

I believe it was Thomas Jefferson who said something like:- "Democracy is when the government fears the people" (meaning:- not the other way around, as is generally the case).

* In England and Wales.

Nice article regarding "NHS Production Lines" in the Daily Telegraph echoing some of the thoughts and concerns raised so far.

http://www.telegraph.co.uk/health/healthnews/8983505/Scandal-of-NHS-production-line.html

This illustrates the folly of NHS Trusts focussing on target driven management, as opposed to concentrating on patient outcomes. More haste, less speed?

And if patients could afford to "go private" ... would the outcomes be better, or worse?

I am amazed how quickly post-operative patients are back on the bus these days. But, on the other hand, perhaps it's a fair risk, when balanced against the possibility of picking up "something else" during the 48-hours you are in there, sweating away.


Yes ... no doubt we've all seen examples of that. But as Mr. Lansley has now been in charge for a while, one wonders when he is going to do something positive about it!

Oh! He is. It seems that more "goals" are being set up (perhaps I should have said "yet more"). You couldn't make it up, could you? If it wasn't so serious, you would think they are having a laugh!

Anyway Sean, if you're planning to keep this thread running, maybe you need to check-out some of the figures first. And, whilst you're at it, take a look at what happens in other parts of the world. Here, for example. Or, take your pick. But any way you look at it £ 120-odd billion a year is a lot of dough (hey, I could retire on that ... then everyone would be happy)!

I have two things to ask here (neither of which has to do with the original post..... sorry Huw)

1/ seems your post counter has got stuck at 9979 there Geoff and...

2/ what happens if you pass 10K, do you turn back into a pumpkin or something?

Hopefully it causes a hard reset and then when it re-boots all post counters come up as zero. You know, just like that other Non-Event failed to do (the so-called Y2K nonsense).

Hopefully Huw is working on it even as I write.

Meanwhile ... how about some input on the topic being considered? The state of government healthcare Down Under, for instance.

soon, grasshopper, soon.............

but not 'til next year perhaps

Hi Everyone & Happy New Year.
Interesting debate which has covered a lot of areas, however, getting back to the original point regarding up to 49% of total patients in one Trust being "private", there needs to be some logic applied to this statement and also some reading between the lines.
Firstly, La La Langsley does not have a clue about what really happens on the "shop floor" despite all of his "listening" exercises. He doesn't listen and he speaks to the wrong people.
All NHS Trusts have to meet 18 weeks treatment times for all patients and from April the thresholds are tougher and penalties will be applied. As most Trusts are running at 95%+ capacity and cannot meet 18 weeks for all specialities, especially Trauma & Orthopaedics, then logic dictates that they can't cram in private patients as well as they don't have the capacity to accomodate them!
Secondly, any patient that is re-admitted within 30 days of discharge will not be paid for. Therefore, hospitals will not try and get them through the system any quicker, in fact the reverse. This will reduce capacity.
Lastly, the section of the bill that alludes to lifting the 9% current limit on the number of private patients treated by Trusts is good example of Langsley's loss of reality as there are only a handful of Trusts that are actually at that level now and most only have 5% or less.
Unfortunately, the NHS Bill, if it is passed in time, will only destabilise the NHS more than it is now as the GPs do not have a grasp of the complexity of commissioning and contracting, they only know that they wish to alter clinical pathways to keep patients out of hospital and hopefully line their own pockets!!
For Trusts to survive they need to co-operate with the GPs and Commissioning Boards, get lean and operate efficiently.
I could go on about lean efficiencies but I might upset too many people!!??
Anyway, I'll climb down from the soapbox and let someone else have a say.

No ... please feel free to upset as many as need be!

Having just read your post there Kawa I can't help but notice lots of percentages and stuff like that.

And it seems that the only remedies you have to offer are along the lines of "co-operation", "efficiencies" and suchlike.

OK ... neither of us hold the office of Health Minister, but I would suggest (as I believe that Sean may have intended when he kicked off the thread) that by now we should have moved on from "lessons shall be learned" ... and more into the realms of "major surgery required".

Meanwhile, I would encourage all those still involved in the "below decks" world of the tech support of (and even fixing) kit to just ignore (as much as one can) all this scare-mongering stuff and just crack on with the real work.

I'm with Kawa on this. My initial thoughts were, where will the private paitents go? We are understaffed at the moment and run at near 100% capacity. We already have a shortage of Doctors & Nurses in this country. Does this mean we will have to pinch staff from private hospitals, forcing some of them to close down or will it open the floodgates for more foreign nurses & doctors to come in? I'd imagine that private healthcare companies would be angry at the NHS pinching their business and probably seek some sort of compensation from their (sorry, our) government. Have I just managed to turn the argument around, making it sound like a good idea? I can't see the NHS competing (or being allowed to) with the private market.

To be honest Bill, I'm not even sure what the "argument" is!

I would suggest that the real issues here are:-

1) Over population (that is, they keep letting them in)!
2) Ageing population (that is, they keep hanging on)!
3) Fat, lazy population (that is, demanding much more than before)!
4) Drunken, violent population (that is, wasting limited resources)!
5) Feckless, dependent population (that is, can't be bothered to look after themselves)!