Nhs Cuts Start In Earnest

[newbonic]

Given that average public sector wages have risen to 10% higher than private sector wages.. couldn't this just be considered a long term reversion to mean?

It seems that it's more like 17% higher. The ONS stats give a pretty strong hint as why public sector costs (mostly pay) have be reined in. From their website:

The difference between the median level of full-time earnings in the public sector (£554 per week) and the private sector (£473 per week) widened over the year to April 2010, following annual increases of 3.0 per cent and 2.0 per cent respectively.

And re the NHS in particular:

The full-time occupations with the highest earnings in 2010 were 'Health professionals' (median pay of full-time employees of £1,067 a week); followed by 'Corporate managers' (£757); and 'Science and technology professionals' (£704). The lowest paid of all full-time employees were those in 'Sales occupations', at £287 a week.

I know some mid 40s NHS middle managers in IT who are on >50k (plus pension to kill for and 30+days hol a year). This largesse is simply unaffordable to the nations real taxpayers. Especially the final salary pensions that are huge hidden costs. And PFI liabilities of course.

[Si1]

If you go into medicine in the uk for the money, and you have the capacity and A levels to get onto a med course and complete it, you're either an idiot or madly advised.

There a plenty of small minds who think that 70k a year is riches beyond the dreams of avarice, a massive overcompensation for a job that takes years to qualify for and requires the shouldering of significant repsonsibility the likes of which you can't really appreciate until you've experienced it personally.

The reality is, if you have the capacity for a medical degree, it's odds on that there are many other jobs you could do that would pay more. I'm guessing the archetypal 6 pound an hour porter's opportunity set is rather more limited, otherwise he'd walk from his job and go elsewhere. The fact that he doesn't speaks volumes.

that will explain the amount of experienced and able chartered engineers, lawyers and accountants earning 30k on account of the fact that some areas just don't pay so well

you really do not understand the jobs market, money, economics or morals

[Si1]

you greedy sh*ts in the NHS squealing that you have a right to earn an unreasonably large sum of money (OK not all NHS contributors on this thread), no better than the scum in the London financial sector squealing how important they are for the country [when in the long run they're not] whilst everyone else suffers to pay for you and your entitlement

[Bloo Loo]

that will explain the amount of experienced and able chartered engineers, lawyers and accountants earning 30k on account of the fact that some areas just don't pay so well

you really do not understand the jobs market, money, economics or morals

He cant understand anything....SELF is his motivation.

[Si1]

He cant understand anything....SELF is his motivation.

indeed

[SarahBell]

NHS manchester has a twitter account.

Wonder how much that costs.

(And they're working on a Sunday!)

[mdman]

If the NHS is entirely privatised and the tax used to fund it returned to taxpayers, that will mean tax cuts.

Those taxpayers will then have to pay for the cost of their healthcare. Whether or not they pay more or less will depend on how sick they are, and how efficient the private healthcare market is.

I believe an OECD study was quoted that indicate how poor the UK healthcare system is. There are other studies that refute that. One was published by the Commonwealth Fund

This ranked the UK 2nd out of 11 developed World healthcare systems overall, 4th for speed of access to doctor/ nurse, 2nd for access to OOH care, top for confidence is getting treated if sick, and 6th for waiting to see a specialist.

The UK is the only system that is free at the point of access. As the price is zero, this increases demand.

Given this performance, I have to query the evidence base for marketisation improving quality and outcomes here, particularly the sort of market structure implied by the White Paper (with conflicts of interest, poor evidence for commissioning emulating free market-driven innovation, complexity, and the malign influence of the business lobby on cronyism).

The areas where the NHS has been open up to competition include:

- OOH care, where costs doubled once GPs dumped it while patient complaints soared

- ISTCs for routine operations - cost more than NHS trusts despite taking on simpler patients, not following up complications and despite all that having high complication rates when adjusted for the patient clinical risk profile

- private WICs - where a consultation with a nurse costs nearly double a GP appointment

- private GP contracts (called APMS) - where the PCTs try to cover up the details of the contract, but what evidence exists points to much much higher payments per patient coupled to high staff turnover

Other areas where private companies have got their hooks in include

- PFI, that even a banker involved described as a licence to print money - PFI contracts are paying lenders a far higher cost of capital than they are entitled to given the risk. The maintenance contracts are also extremely expensive for the taxpayer

- the national IT program - a big White Elephant

- the liberal use of management consultants by PCTs, strategic health authorities and the department of health - a culture that absolutely corrodes any notion of public service and provides a jobs merry-go-round for senior civil servants and managers. The incentives of these consultancies are not aligned with the interests of taxpayers; usually they are in complete conflict

My suggestion for improving costs immediately includes:

- abandon the IT program

- abandon PFI. Look for legal means to renege on contracts, even if that means passing legislation to create a new class of bankrupt trusts

- stop using management consultants

- give up on the idea of commissioning being fit for purpose for driving market reforms. A bunch of GPs in a room deciding how to commission hospital services does not a free market make.

- stop treating foreigners/ those not entitled to NHS treatment

- close down WICs and other free points of entry that simply stoke demand and increase cost without improving quality. Put the burden back on GPs

DOI - GP board member of one of the new clinical commissioning groups

[White Craw]

If the NHS is entirely privatised and the tax used to fund it returned to taxpayers, that will mean tax cuts.

You reckon?

Those taxpayers will then have to pay for the cost of their healthcare. Whether or not they pay more or less will depend on how sick they are, and how efficient the private healthcare market is.

Certainly would happen for taxpayers, would be mitigated or excused for "those most in need".

[aa3]

its a fallacy until YOU make a decision and someone else would have a different opinion on what is viable, and what isnt.

Going to extreme, you mention intervention when the mothers body rejects a pheotus/baby/young person.....where does this line drawn at natural decision exist....its not natural to take a paracetamol for a headache...nature is telling you to rest, yet we intervene with a pill.

Basically we need a seperate small ministry of enlightened staticians, health ethicists, people who have overseen clinical trials.. and so on. And get them to determine where to draw the line, for when to stop doing surgeries and other treatments.

People are going to disagree.. especially those people who have like a child suffering and they keep holding out hope that the child can be saved. They don't want to hear that the system is stopping trying.

But I still think those people should be able to pay for whatever treatments they want. Just there will be a limit from the public system.

[ChumpusRex]

Maybe if by privatisng parts of the health service we then go on to offer a pre-eminent service that the rest of the world wants, your (tongue in cheek) proposal may work. But we would have to do it with that specifically in mind.

Would it surprise you to hear the that the NHS actually already does this?

Many NHS hospitals with special facilities are regarded as pre-eminent centres of world regard, and they do take paying private patients from all over the world, mainly the Middle East. In some cases it's over 10% of the hospital's work. The management at these hospitals have worked hard to market themselves abroad.

[libspero]

The areas where the NHS has been open up to competition include:

- OOH care, where costs doubled once GPs dumped it while patient complaints soared

- ISTCs for routine operations - cost more than NHS trusts despite taking on simpler patients, not following up complications and despite all that having high complication rates when adjusted for the patient clinical risk profile

- private WICs - where a consultation with a nurse costs nearly double a GP appointment

- private GP contracts (called APMS) - where the PCTs try to cover up the details of the contract, but what evidence exists points to much much higher payments per patient coupled to high staff turnover

Other areas where private companies have got their hooks in include

- PFI, that even a banker involved described as a licence to print money - PFI contracts are paying lenders a far higher cost of capital than they are entitled to given the risk. The maintenance contracts are also extremely expensive for the taxpayer

- the national IT program - a big White Elephant

- the liberal use of management consultants by PCTs, strategic health authorities and the department of health - a culture that absolutely corrodes any notion of public service and provides a jobs merry-go-round for senior civil servants and managers. The incentives of these consultancies are not aligned with the interests of taxpayers; usually they are in complete conflict

My suggestion for improving costs immediately includes:

- abandon the IT program

- abandon PFI. Look for legal means to renege on contracts, even if that means passing legislation to create a new class of bankrupt trusts

- stop using management consultants

- give up on the idea of commissioning being fit for purpose for driving market reforms. A bunch of GPs in a room deciding how to commission hospital services does not a free market make.

- stop treating foreigners/ those not entitled to NHS treatment

- close down WICs and other free points of entry that simply stoke demand and increase cost without improving quality. Put the burden back on GPs

Interesting post.

I don't think many people here would be in favour of a private welfare system, simply a smaller more efficient NHS. We have just pumped in too much money over the last few years and this needs to be bought back under control.

Your suggestions for cost saving sound excellent BTW. I would personally cut the drug budget too.

[aa3]

Would it surprise you to hear the that the NHS actually already does this?

Many NHS hospitals with special facilities are regarded as pre-eminent centres of world regard, and they do take paying private patients from all over the world, mainly the Middle East. In some cases it's over 10% of the hospital's work. The management at these hospitals have worked hard to market themselves abroad.

You have to give them credit for keeping their reputation up and developing a new market for themselves.

[Si1]

Interesting post.

I don't think many people here would be in favour of a private welfare system, simply a smaller more efficient NHS. We have just pumped in too much money over the last few years and this needs to be bought back under control.

Your suggestions for cost saving sound excellent BTW. I would personally cut the drug budget too.

sounds good to me too

[ChumpusRex]

Excellent - how much comes into the Exchequer? Must virtually pay for the entire health service, the buildings, everything.

Oh no - wait a moment is this where 'private' doctors make use of the public facilities at below the real total cost?

You are confusing two separate things:

1. NHS trusts actively seeking out private patients. They do this, because they can charge private patients far more than they can charge central government.

Central government pays NHS trusts per 'correctly treated illness'. E.g. if someone comes through the doors with a heart attack, and the hospital treats it correctly, they can submit a bill to the exchequer for 'treated heart attack'. The exchequer then pays what they judge to be 'cost price' for that treatment. If the hospital paid more than that - then tough.

Private patients will pay considerably more than this. This is used to subsidise costs where the government's tariff doesn't actually cover costs, and is also used to fund new building projects/equipment upgrades, etc.

It is worth noting that a number of trusts have noticed that their private income has dropped significantly with the recession - this is probably a combination of fewer self-funding patients, fewer coming from overseas, and aggressive cost-cutting among the fully private hospitals.

2. Doctors can do private work using NHS facilities. Doctors need consulting rooms, operating theatres, etc. to do their own work in their own time. They could go to Harley street and rent rooms there. However, why not rent those services from the NHS? Many trusts have woken up to the fact that they could have their operating theatres and MRI scanners sitting empty at the weekend, or they could rent the equipment out at commercial rates.

It's a simple business decision for the NHS trusts involved. In fact, many NHS hospitals go so far, that they write into their doctor's contracts that if a doctor does private work in their own time, they must give first refusal to their employer for any facilities required.

Edited July 31, 2011 by ChumpusRex

[cockrobin]

Interesting then that I have just won a large contract - which had bidders from both public and private sectors. So was I cheaper? Better? Best value for money?

CT scan cost in the NHS: average cost per CT scan ranged from £54 to £268 from http://www.nao.org.uk/publications/1011/nhs_high_value_equipment.aspx

CT scan cost in the private sector: Body scan £650

Heart scan £350

Lung scan £350

Scan of the large bowel (colon) £500 from http://www.privatehealth.co.uk/private-healthcare-services/diagnostic-imaging/ct-scans/ct-scan-prices/

So 2-3 times as expensive in the private sector as a very rough figure.

Why do I find that difficult to believe?

Think of it in these terms, I pay NI in order for me and millions of others to receive "free" NHS treatment. I am very rarely ill, have been to hospital twice in my life. If I had been able to opt out of the NHS and make reduced NI payments, the equivalent private health care cover would cost me much much less.

[Analysis]

You are confusing two separate things:

1. NHS trusts actively seeking out private patients. They do this, because they can charge private patients far more than they can charge central government.

Central government pays NHS trusts per 'correctly treated illness'. E.g. if someone comes through the doors with a heart attack, and the hospital treats it correctly, they can submit a bill to the exchequer for 'treated heart attack'. The exchequer then pays what they judge to be 'cost price' for that treatment. If the hospital paid more than that - then tough.

Private patients will pay considerably more than this. This is used to subsidise costs where the government's tariff doesn't actually cover costs, and is also used to fund new building projects/equipment upgrades, etc.

It is worth noting that a number of trusts have noticed that their private income has dropped significantly with the recession - this is probably a combination of fewer self-funding patients, fewer coming from overseas, and aggressive cost-cutting among the fully private hospitals.

2. Doctors can do private work using NHS facilities. Doctors need consulting rooms, operating theatres, etc. to do their own work in their own time. They could go to Harley street and rent rooms there. However, why not rent those services from the NHS? Many trusts have woken up to the fact that they could have their operating theatres and MRI scanners sitting empty at the weekend, or they could rent the equipment out at commercial rates.

It's a simple business decision for the NHS trusts involved. In fact, many NHS hospitals go so far, that they write into their doctor's contracts that if a doctor does private work in their own time, they must give first refusal to their employer for any facilities required.

This is exactly what is happening - a great way to balance budgets with a decreasing government spend. What it means in reality of course is that the 'free' component of healthcare will be wound down. People have perhaps forgotten the regular '24 hours in A&E sitting in their own excrement' headlines of 15 years ago and I hope we don't get back there any time soon, but the signs are there already that the public service is going to get quite a bit worse.

Those who are unhappy with the state of affairs will then go private and this will relieve the burden on the taxpayer. No problem perhaps (except that private healthcare seems to cost double or more state healthcare for an equivalent or worse outcome - but that's another argument).

I just think the coalition should be honest about this. The UK public do genuinely have some choices here. We could keep bailing out banks and financiers (£1.5trn at last count: http://www.telegraph.co.uk/finance/newsbysector/banksandfinance/8262037/Bank-bail-out-adds-1.5-trillion-to-debt.html). Or we could take some of that money an invest it to maintain a better state healthcare system. Even if you stopped those £950M bonuses at RBS you could pay a year's budget for a few NHS Trusts.

At the moment, people are not being given the choice.

[Analysis]

I don't suppose you could respond to my earlier response to a point you erroneously made.

Anyway, you have again put forward a false choice (in bold).

The simple fact is we cannot afford the public services we have. We have to reallocate resources away from the public sector AND financial services toward sectors that will help us pay our way in the world.

For me this is nothing to do with 'public' versus 'private' provision which is totally misunderstood particularly within the public sector. This is to do with whether we are consuming whatever it is or whether we are trading it externally for things we need to survive with (oil, food etc).

So why not privatise healthcare and education to make profits? You still haven't explained that?

[cockrobin]

You obviously don't work for the same private sector employer my other half does then.

Which poll did you derive this little nugget from?

No I don't work for the same private sector employer your other half works for. I work for a small private sector company that offers a good value service.

Perhaps there should be a poll. The amount I would pay for private health care would be a lot cheaper that the amount I current pay into the NHS via NI. I pay around £750 NI every month, I know not all of it goes to the NHS but a large percentage does. I would definately vote to opt out!

[Analysis]

No. no, no. You are betraying the group think from whence your thoughts emanate.

I said - "to help us pay our way in the world". Our key issue is the trade deficit which features in the sum of the public and private sector deficits.

Maybe if by privatisng parts of the health service we then go on to offer a pre-eminent service that the rest of the world wants, your (tongue in cheek) proposal may work. But we would have to do it with that specifically in mind.

What you are suggesting is re-arranging the deck chairs on the Titanic. It is unlikely that the profit motive would work particularly well.

Having said that, the reason that public sector health provision worked in the past (from an economic perspective I should add) was actually the ability to bear down on costs and wages and to strictly ration availability. This has been turned completely on its head over the last 15 years such that it is no more effective at doing this...in fact quite the reverse.

I think people want this though because they're currently all caught up in the whole deficit thing. Cut the public sector. More private sector.

They're not too pleased about the £1.3bn half year profits from Centrica mind (cue list of profits from other privatised utilities), so I don't think they've perhaps thought it though that carefully.

[Analysis]

No I don't work for the same private sector employer your other half works for. I work for a small private sector company that offers a good value service.

Perhaps there should be a poll. The amount I would pay for private health care would be a lot cheaper that the amount I current pay into the NHS via NI. I pay around £750 NI every month, I know not all of it goes to the NHS but a large percentage does. I would definately vote to opt out!

The last time WHO looked at this, healthcare in the UK and France (public) cost around $3000 per capita per annum. In the USA the cost is $6000. All of the healthcare indicators in their study showed that healthcare in the USA was less effective (Infant mortality was higher, life expentancy lower etc).

Even my own quick look at cost of CT scans the other night showed that the cost in the NHS was around 2-3 times lower than in the private sector (see earlier post).

You may aspire to opt out, but I would spend a little time studying the facts first.

[cockrobin]

The last time WHO looked at this, healthcare in the UK and France (public) cost around $3000 per capita per annum. In the USA the cost is $6000. All of the healthcare indicators in their study showed that healthcare in the USA was less effective (Infant mortality was higher, life expentancy lower etc).

Even my own quick look at cost of CT scans the other night showed that the cost in the NHS was around 2-3 times lower than in the private sector (see earlier post).

You may aspire to opt out, but I would spend a little time studying the facts first.

The last company I worked for offered a private health care scheme, the cost to the employer was about £75 per month for a family cover plan. I paid nothing.

[jammo]

Back to the OP. When will we start to notice the effects on the ground. NHS doctors seem to be good at making people out to be liars (friend with back pain after a car accident where he was hit) trying to milk the system. Making them feel small, despite never actually curing anything. Good at giving us the latin name for the problem we already told them about, as if I'm actually impressed. E.g. have you ever had a medical problem and googled it - found the array of distrassing possible causes and gone to the doctor. Then been told that you have a <part of body in latin> syndrome, or a <part of body in latin> itis, or even <part of body in latin> infection? Has being told this made you feel better. And then there's the question at the pharmacist: do you pay for your medicine? Well actually if you are offering, no... but they aren't, there is obviously a sponger's pass that I don't have access to.

Cut them to ribbons I say. I've gone private.

[ChumpusRex]

The thing is these are an accountant's trick that in no way pay for the full costs.

Yes, by paying more (in a different way), they can treat people from overseas and 'generate additional income' - but possibly on occasion by not doing other work for which they are intended and for which all the fixed costs (buildings, training etc ) have been sunk and are being utilised.

Whether it pays for the full costs, or not, is irrelevant - it's certainly not an accounting trick. What is important is that the productive assets (operating theatres, medical equipment) are appropriately and efficiently utilised. In practice, their competitors are the private health providers, which are far more expensive - so, they end up charging market rates, which comfortably covers all the external costs.

At present, facilities and staffing are based upon a 5-6 day working week. This means that the facilities have spare capacity, and staff is the limiting factor. One way to improve utilisation would be to employ 30% more staff, so that the weekends and evenings could be fully staffed. Another way is to sell void time.

NHS trusts are not permitted to accept private cases where they could compromise the operation of NHS work. So, time for facilities is only sold in idle time, where it can't compromise NHS work. Similarly, the staff will be operating as independent contractors working outside of their NHS time.

In practice, many trusts which take on large amounts of private work, end up building entire private wings. This way, they clearly demarcate all the costs of their non NHS work.

Your other point was that we spend too much on healthcare - and that is probably true, although in comparison to many other countries, it isn't that bad. What really is needed is a rethink on just what the NHS should cover, and what it shouldn't. mdman said things better than I could.

Edited July 31, 2011 by ChumpusRex

[Analysis]

I have - did you not read it?

From an economic viewpoint, the public provision of healthcare was historically very effective at bearing down on costs, wages and strictly rationing availability. It has lost that advantage over the last 15 years such that to the untrained eye it would suddenly make sense to bring in market reforms.

Whereas it would actually be better to bring in better processes and management - privatising fully somehting where people would spend every last penny of their money and more for just a few extra painful gasps of air has not been proven to be particularly sensible when you look at America - where healthcare expenditure as a % of gdp is (was) much higher, its availabilty (was) patchy and outcomes not proven to be better. Indeed healthcare is the greatest cause for company bankruptcy which is not great.

What we lack as a nation is a common understanding of what needs to be done, of our problems, of how to get out of them. Why we run a public health service. The pros and cons, why we accept the cons for the pros and how we try to mitigate them.

All this understanding has been lost over time and replaced with wishy washy thinking and 'spin' like your own. I don't know whether you are representative of thinking in the healthservice or a fully paid up campaigner for New Labour or both, but it is extremely frustrating as you see the world in such a narrow compass. I don't harbour any expectations that our discourse will make you understand any more, I feel to do that, you have to want to rather than just pushing your own point about the fight between public versus private, with healthcare or without, 'Tory waiting lists' versus 'caring Labour'.

EDIT: I see that you have found it now. You see what I mean don't you?

Fairly patronising, but I think the gist of your reply is that you can run healthcare on the cheap as long as you have enough mugs to work in it on a low salary and you don't make it too good.

My point was really that people are sleepwalking into a situation where healthcare is being run down and making your own private provision will be pretty important, whilst apparently having no choice over adding £1.5tn to the public bill to bail out banks, or £950M to RBS staff just in case they leave the country. They are not being given the choice. Did you ask to bail the banks out and pay the bonuses? Did you ask to have a cut in NHS services? Or were you told that you had to pay the bonuses as the alternative wasn't worth thinking about, and that there will be no cuts to NHS services; ringfenced budget etc etc.

Give the people the facts and let them decide.

[Analysis]

The last company I worked for offered a private health care scheme, the cost to the employer was about £75 per month for a family cover plan. I paid nothing.

Good luck on getting that when you're 50 and two of your blood relatives have died of cardiomyopathy. You may want to look at the 'exclusions' section of the policy.

Not covered? I guess the NHS will pick up the tab as usual then...