The grand NHS shake-up

[Delscottio]

It wasn't indeed a Cameron made a lot about not doing this type of reorganisation (watch how the phrase "top down" will be used to show this is different).

On a political note - I do find it rich how the Tories and Lib Dems used ot complain that Brown didn't "have a mandate" - neither the Tories or the Lib Dems got a mandate from the general election and certainly not for the radical reforms they are now introducing.

The problem with mandates is it's a load of old ****, they can vote pretty much what they like through. The only way to stop this is some proper civil disobediance - I am off to punch the nearest Lib Dem suporter in the face. (Not many Tories up here so the feeling will have worn off by the time I find one).

On a serious note, like I say we, as a country, will walk blindly into this with barely a wimper - RIP the NHS.

 

[Ivor the Engineer]

I wonder how much GPs will increase their salaries by when they start taking on the extra responsibility?

Probably why we haven't heard much from them. They know they'll be quids in (at least in the short term until UnitedHealth UK et al. start offering GP services using salaried doctors).

 

[Undesired Walrus]

The difference is that under the proposed reforms the GPs and the private companies they use could maximise profit by either denying treatment or providing access to less expensive (i.e. not as good) care.

So at the moment the GP does not have an option to send you privately? Do they get money for each person they send?

 

[Ivor the Engineer]

So at the moment the GP does not have an option to send you privately? Do they get money for each person they send?

Currently PCTs determine what services are available in an area. PCTs can commission services from private sector providers.

As for GP pay, it's complicated. Generally the renumeration of GPs is not related to the number of people they deny or refer for treatment, or the type of treatment they recommend. More information here.

 

[commandlinegamer]

I am off to punch the nearest Lib Dem suporter in the face.

I have voted LibDem on a couple of occasions, not recently; I won't be doing so again. But no, you can't punch me.

 

[Undesired Walrus]

I am off to punch the nearest Lib Dem suporter in the face.

No good. They are protected by a wall of self righteousness.

 

[Undesired Walrus]

Currently PCTs determine what services are available in an area. PCTs can commission services from private sector providers.

Why is this worse if GPs get hold of it instead?

 

[uk_dave]

Why is this worse if GPs get hold of it instead?

Perhaps because at the moment the GP isn't supposed to consider the cost of a treatment, simply prescribe whatever is best for the patient.

If the GP holds the funds and is responsible for staying within some notional budget, then perhaps GPs may become more resistant to prescribing expensive treatments.

 

[richardm]

if it results in better outcomes

That's a big if.

 

[LukeB]

I am off to punch the nearest Lib Dem suporter in the face.

Are there any left?

 

[Ivor the Engineer]

Why is this worse if GPs get hold of it instead?

Why is it worse if the person who recommends what treatment you require is in control of what treatment is on offer and benefits more from offering certain treatments than others?

Why is it worse if a private company (which by definition has as its primary motivation making as much money as possible) is given tax payers money to provide a service which only has to meet the standards set by an underfunded regulator?

Why is it worse if the marketing departments of pharmaceutical companies will be able to have a direct line to patients through their GPs?

I don't know about you, but I want my GP to be as free of bias and conflicting interests as possible and an advocate for my best interests with regards to healthcare, not a shill for UnitedHealth or pawn in the dirty tricks being played by pharamceutical companies.

 

[The Don]

Here's what's going to happen:

1) GP's get put in charge of commissioning patient care.

2) GP's employ private firms to do the commissioning because they want to make as much money as possible for the minimum amount of effort (i.e., they're human beings).

3) NHS hospitals, offering comprehensive treatment have to compete with specialist, high profit private hospitals for the money. Many of the firms used by GPs will have financial interests in the private hospitals.

4) The private hospitals take all the easy, profit generating work away from the NHS hospitals, leaving them with the complex, loss making stuff.

5) The "failing" NHS hospitals are effectively sold to the for profit companies, who drastically cut the loss making care to the bare minimum required by the regulator.

And that's how you privatise a national health service.

^^^ This.

Blair started the process, Gordon started to reverse it. ConDems will finish the job

 

[Undesired Walrus]

Alright, I'm still not getting this.

IIRC, at present the DoE gives the PCTs the NHS budget. Then they decide on where to purchase services from? Why would they be less likely to purchase private services than GPs?

 

[Delscottio]

Alright, I'm still not getting this.

IIRC, at present the DoE gives the PCTs the NHS budget. Then they decide on where to purchase services from? Why would they be less likely to purchase private services than GPs?

The immediate conflict of interest I can see is that the private service providers will start owning GP practices. They'll start referring to themselves.

A lot of this depends on the internal "best price/service auditing" that will go on, but the Tories can simply under fund the NAO (or who ever) to get around that one.

 

[Worm]

I have concerns about the way that services are commissioned as well. Are they likely to be done individually (slow, expensive and paperwork intensive) or in blocks?

To compare this to they way, for instance, road maintenance tends to get commissioned, private companies tender for the general contract, which they know they will lose money on, because it gives them access to the top-end high earning work as well. The problem being that they don't care about the day-to-day services, so they get neglected.

 

[MarkCorrigan]

Ah crap.

Why hello there folks in red. What? No, I've always been a Labour supporter, wouldn't see me soliciting for the Lib Dems...

 

[Mashuna]

I don't know about you, but I want my GP to be as free of bias and conflicting interests as possible and an advocate for my best interests with regards to healthcare, not a shill for UnitedHealth or pawn in the dirty tricks being played by pharamceutical companies.

I'd also like my GP to concentrate on medicine, rather than management and accounting.

 

[Francesca R]

Agreed - healthcare and profit motivation, in my opinion, should be kept as seperate as possible.

But health care and its cost (which is the other side of the same thing) should not and can not be kept separate, other than in imaginary utopias. The UK cannot sustain the rate of cost increase that the Labour government gave to the NHS budget between 2000 and 2009 (and this is true regardless of whether you view that as "correcting prior under-funding" or as expanding the service, or as waste). And Labour would not have been able to sustain it if it had retained power either.

 

[Undesired Walrus]

If you have healthier or older people paying into the system rather than being on ESA or dead, surely this is desirable? Can the NHS sustain itself?

 

[Francesca R]

No universal health insurer can sustain itself; it has to be supported by government compulsion (if that's what you mean)

As far as the ongoing cost of health insurance for a population like the UK, I don't recall seeing any projections that it will do anything other than rise in real terms. That can stil be sustained, but for it to rise almost three times as fast as GDP (which was the 2000-2009 effect, IIRC) it would overwhelm the economy within a generation or two.

IMO the major positive about private provision of med services (which provokes recoil from most people even if they occupy the political centre ground) is to increase the supply of health care services. We already know that the demand is going to soar. Mushrooming demand with unchanged supply needs to violate commonly accepted economics in order not to result in spiralling costs.

But the debate is too routinely hijacked by less than useful posturing about denying care and profiting etc etc. This thread isn't an exception.