Sorry for starting a political thread, but those yellow bastads have abstained from voting to protect the NHS from being privatised.

Hardly representing the interests of their constituents are they?

At least the Tories are open about being greedy cut-throat mercenaries.

Yellow rosette for a reason.

Who would win in an election between a single issue brexit party and a single issue NHS party?

Who would win in an election between a single issue brexit party and a single issue NHS party?

Good point but my bet would be NHS.

Good point i really dont know and it surprises me the Libs did this.
Was it just a two fingers to labour or some other reason.
Fuctifano.

The thing with this chaos is Johnson is screaming for a Brexit election hoping it will entice people from Brexit voting areas although they may be traditionally either labour or Lib Dem voters and use this to keep the grubby Tory hands on no. 10 for another term inflicting another 5 years of more austerity, pillaging the NHS and social services. When will people wake up and see through this serial liar. The big prize for Johnson and his cronies is remaining in power, I don’t think they give a monkeys about the EU because hardships created by leaving will not affect them one iota, in fact many of them will benefit greatly

Question time from South Shields is absolutely depressing.

People are being distracted by the shiny get Brexit done light (if he gets it through it will years before it’s ‘done’ and even longer before we know what it’s actually ‘done’) while this deplorable and vile Tory Government continue to destroy areas like ours.

The current Lib Den leader voted with the Tories on several occasions with their austerity policies. Hardly a shock that she would avoid voting against them here.

This is so funny. Johnson is playing a fly game and the opposition are so dumb they’re running into his minefield. Don’t blame him for chancing it, blame the naivety of the opposition Party’s.
It politics kids.
I don’r rate ANY of them. We need practical government that just makes the everyday things work for everybody, but we’ve got half baked fuckwits offering their naive versions of how to run a country.
NONE OF THEM HAVE A CLUE, drop your brainwashed prejudices and realise ALL of them offer nothing.

VOTE SNOWY PARTY. at least their leader talks sense.

Bang on PJ, the people in that audience seem to be typical leave voters certainly from the north east. The referendum was a protest vote but now don’t seem to realise that they are being reeled in by the ‘get Brexit done’ chanting which, if they vote for the ‘get brexit done’ mob in an imminent general election they will be voting for dragging this area down even more than it is now, because for all Johnson’s carrots i.e. more money for NHS, social care, transport etc. austerity will continue, to attract votes we know this bloke and many around him are serial liars.
One of the audience suggested that the tories and the Brexit party get together to run the country, the mind boggles. If you asked each one of those baying for Brexit to explain what say the single market is or what they understand customs union means, the majority wouldn’t have a bars iron even now and they would have known even less 3 years ago.

[quote="RAY52"] they will be voting for dragging this area down even more than it is now, because for all Johnson’s carrots i.e. more money for NHS, social care, transport etc. austerity will continue, to attract votes we know this bloke and many around him are serial liars.

if you live down south you,ll get more of the financial crumbs left on the table than anywhere in the north. austerity has never really gone away in my lifetime never mind started.

Completely agree. Thoroughly depressing. Its a question I have asked many times and never had an answer from anyone that voted for it. That question was basically why would someone living month by month in a heavily depressed area be 100% fixated by getting brexit done? For a lot of people in hard hit areas it seems like they somehow believe all of their hopes and dreams will come true once we leave the EU. Its staggering.

I suspect that there is more to this than it seems. It appears the whole vote was an almost pointless one. Posturing if you will. Typical Corbyn in that he puts forward a motion that wouldnt have been enacted even if it had won the vote for no other reason than it was either stupidly worded or very carefully worded.

What Snowy said.

The NHS is to an extent already using privatisation. From basics such as catering, cleaning staff, car parks, IT equipment, security, infrastructure and purchasing medicines. Also let's not forget it was a Labour Govt which brought in PFI, which created a more direct model of privatisation where hospitals are owned privately until paid off finally in something like 2050. I know it's a delicate subject but in some circumstances, part privatisation of the NHS isn't a bad thing and has happened. For example they have a procurement model of any qualified provider, which opens up contracting to a number of organisations that, within certain criteria, can offer the service at a better price but still deliver the same service and then the NHS can save money to invest in front line care. It doesn't always work out and you certainly hear when it doesn't but you don't when it does work. It can be as simple as one company providing a service to multiple hospitals/CCGs. So that service has fewer overhead costs as produced in one place and can be better coordinated and a set standard than individual hospitals/CCGs doing it themselves. Therefore cheaper.

I don't think anyone politically would ever be willing to change the NHS from a public funding model. Even China are adopting an NHS style over the american insurance model. Equally after the Trump visit and the talk of opening up the NHS, Whitehall has moved to put in writing that the NHS is in no way part of a trade agreement (which affects all governments whoever they are), however, selling certain services to it might be.

Ultimately a balance has to be struck, whilst our NHS does have some poor health outcomes in some disease areas and is struggling with an ageing population, having free care at the point of need is a wonderful thing and should be valued and appreciated, and that must be protected. However, it cannot be seen as a holy sacred cow that no part of it can be touched as then we get into the Labour policy of the "medicines for all", which would in turn destroy our third biggest sector in the UK economy of R&D in healthcare and medicines. Any prospective government that proposes radical changes such as a 100% public funded institution or a fully privatised one are on very dodgy ground, and although well meaning, could have disastrous consequences to either the economy or public health as a whole

The NHS has been using privatisation for decades. Once hospitals get their own budgets, the ‘suits’ take over and start counting the beans. It’s all about the money and there has to be a balance, but I don’t want a fecking accountant having first say.
As for Labour saving the NHS, dream on. Blair brought in PFI hospitals, the biggest privatisation ever and shafted the NHS regally.
We need a ‘Common Sense Party’. Trust none of them.

Big cuts to the NHS ,Social care etc down here in the South-East too. We have 3 parents in different stages of dementia to look after.It's been going down hill for years.

I agree with this.

What this absolute shambles has shown above all is that our current political system is no longer fit for purpose.

As I’ve got time on my hands, I can watch the Parliament channel and the standard of basic intelligence of some of these Party hacks is utterly abysmal. I just love how they can talk without blushing.
The SNP have about four people allowed to speak, the rest look like central casting from. Rab C Nesbitt episode, so best if they don’t. Who’s the one who looks like Magwitch from Great Expectations? He is scary!!!! I love the equal partners song they sing, but with a population of 60,000,000, England is a tad bigger than Scotland’s 4,000,000 which is less than Yorkshire.
The Lib Dem’s .... Vegans at prayer and now more cult than Party.
The Tory’s ranks look like a Pay Day Loan convention or the waiting room for auditions for advisors for ‘Poor Man, Poor Man’.
As for Labour, they look like a night out for the school staff from cleaner to head. They all break into their respective groups and despise each other with a vengeance.
They are a joke.

The current Labour Party aren’t the same as the one under Tony Blair and even so, speaking from experience and by that I don’t mean reading the fucking daily mail, the NHS was a million times better under the last government than this shower of 'lovely lovely person'.s.

And this don’t trust politicians horse shite is one of the reasons for the rise of right wing populism, millionaires backed by billionaires saying don’t trust the establishment, trust me, the millionaire who has never used the NHS or a public service in their life

And a final point, right now, unless you’ve got thousands pugged away and excellent healthcare provision, which doesn’t preclude previously diagnosed conditions and you vote for Boris or those yellow rosetted wankers, you are a mentalist

Free health is a sacred cow and shouldn’t be questioned at any level, especially when we spend money on bombing the Middle East, pissing money down the drain on a never ending Ill conceived Brexit campaign, building unwanted rail links to the midlands and letting tax avoiders of the hook

If you think Labour are our saviours, you're a mentalist.

Keep doffing your cap, pal

Who needs the NHS anyway, £5 a month to Simply Health will see you right

Brexit I’m afraid, after drip feeding via the press for over thirty years that the forrins have ruined our country, people would happily see us out of the EU, even if it means any social care systems we have go for a burton

Maybe they aren't but surely you dont believe that baby trump and hitler look a like Rees mogg are men of the people? Only the mentally broken and seriously deluded could believe they are.

Where do you draw the line though? Are you are prepared to rule out private companies from providing Clinical Services? Just Front-Line Services? At the moment, Comeptitive Tendering is happening for some Clinical Services already, and the impact is one that we could be regretting for years to come.

Let's posit an example: an NHS Trust that is contracting for Child Public Health Services (ie Health Visiting and School Nursing Teams) for a local authority. They don't know if anyone is going to bid against them, so they have to go in with a low bid. That then gets squeezed to an even lower one next time. The nature of such agreements is that there are defined Service Levels; this means that effectively only those things that can be measured by SMART Objectives are concentrated on, while the rest is just allowed to go to blazes. So no to very little Public Health Promotion work gets done, because you can't measure its effectiveness over a 2-3 year contract; Nurses spend more time office-based making sure that paperwork is up to date (as that's measurable) than they do in the schools that they are supposedly serving - because a morning spent answering questions from parents at a drop-in isn't part of the SLA, even if it may help overall health in the longer term.

Concentrating services based on what you can measure means that only those things that can be measured are given priority. And an awful lot of the benefits of this sort of work can't be measured well - how will you know if measures to promote healthier eating habits in Primary-age children will have an impact on their levels of Obesity as adults for example? It might take decades of lifestyle studies to answer - but does that mean it has no worth?

The above is not a hypothetical example. My other half was one of those on the ground floor of it. She's now left the NHS (other than doing immunisations on Bank shifts) partly out of frustration with the above, and her only regret is not leaving earlier.

Heard an excellent quote on the radio a few weeks ago, can't remember who said, I think they were specifically referring to the Tory front bench but it could be applied to most politicians: "Educated beyond their intelligence". Hits the nail right on the head.

https://www.bbc.co.uk/news/uk-politics-50194676

We are all bone idle fuckers, according to him

https://en.wikipedia.org/wiki/Britannia_Unchained

But you know, no holidays, no breaks and fuck all in your pay packet, seems good to me, all good and you know JRM has your back

Just love how come up with insights to other people’s thought process’s to suit your own world view. You create little stereotyped scenarios of Daily Mail reading oafs with grazed knuckles in your cranial cavity to suit your own limited beliefs. One day you’ll right a post without the word ‘fuck’ in.
If I was as sure of anything as you are of everything, I’d die happy.
Cue foul mouth denunciations. etc, etc, etc,

You seem to have sneering contempt for everyone else’s posts, given by the overuse of the rolling eyes smilies

I make no secret of my contempt for hardcore Daily Mail readers, almost every front page is vile racist, homophobic or misogynistic and has stoked up hate for as long as I can remember



On a personal level I’ll use expletives, especially when it comes to what this current bunch are doing to healthcare and the NHS, frightens me rigid

I’ve had cancer once, it’s caused by faulty gene and can reoccur, my dads had it four times, if it happens again and I don’t have social healthcare, I’ll be worm food, so yes I fucking hate Tories (Lang with lists of other reasons, of course)

Our lass has worked in the NHS for nearly 20 years.

She was in a dementia outreach team for nearly 10 years, which was doing a canny job with very littlr resources. Lots of patients got what they needed really quickly.

Someone decided that the service was up for tender, and it was awarded to City Care, who have a long history of failing to deliver, and having contracts taken off them.

She jumped ship before they took over and moved to another NHS team.

Her former colleagues now spend lots of time on 'monitoring' activity ie filling in pointless paperwork and lots less time with patients.

The service isn't doing great and it could be another case where the contract gets cancelled.

Meanwhile the directors of City Care browse through their yacht catalogues.

Fuck privatisation, it simply isn't what we deserve.

Yeah but who needs experts PIN?

‘Sneering contempt’ for everyone else’s posts, roughly translated comes out posts you don’t approve of or which challenge your entrenched views.
As for the Daily Mail bollocks, last time I read that was with breakfast at a hotel in Birmingham on a course at Northrop’s in the 70’s, but what people read is none of my business, providing it’s not Mein Kampf.
The Gnome Sanctuary is beckoning.

I can't disagree with you on most of this. Hence why i've said there are examples of where this does go wrong. It's probably a lot behind the reason we're no longer measles free in this country and very little do with anti-vaxination. However, it doesn't mean we should stop tendering where things can be done better. There are those that play the system both sides, yet because we don't like privatisation in the NHS we focus on their failings. We don't focus on lung cancer outcomes being the second worst in Europe, only being rated worse than Bulgaria. We don't focus on woeful prevention programmes that cost millions of NHS money, but don't actually lead to any outcomes. look at Dementia Friends. Had £4m of government money poured into it. While it's well intentioned and raises awareness it's done nothing to improve diagnosis rates or care, and tried to shift the burden of care to the community rather than deal with it in social care, which it hasn't done either. There needs to be sufficient guardrails in place to ensure that services still reach a certain level, but saying that the NHS does everything brilliantly just isn't true and sometimes a number of providers can do things better and cheaper simply because of the way they are set up. And don't just cherry pick examples of where it doesn't work to support your argument, look at where it does work too. I'm not saying all privatised services are good, but some are and some really help the NHS achieve better things.

I'm not so much cherry picking as giving an example of something I have first-hand knowledge of. I can give other examples based on my own circumstances as well - such as the fact that the local CAMHS Service here is so ramshackle than we were on a waiting list for an appointment for my daughter for 18 months, during which the service was reorganised twice, including being run by a different NHS Trust; we finally got an appointment, only for it to be cancelled due to "Staff Illness" on the day itself. They are now having to contract the work out to a private organisation that charges approx. £1200 for the service they need, while the consultant we were supposed to see has set up a different private organisation asking even more for the same service. Or the fact that the local CCG is so far in hock that when one of the town surgeries closed down (after several years of knowing it would), it took the embarrassment of a Protest March that made it onto local TV to get them to do anything at all about commissioning a new service rather than just tell people that they'd have to travel 10 miles or more for the next nearest GP. Or that the local Out of Hours GP service has (due to tendering!) got to save so much money that instead they're getting people to head to the General Hospital if they want to see a GP (30 miles away from me) (Link: https://www.shropshirestar.com/news/loc ... -in-towns/) .

When does giving examples stop being "cherry-picking" and instead become a pattern?

This is the whole problem with 'New Public Management' and the attempt to run public services on market lines, and it's a well known problem. It comes down to the difference between outputs and outcomes. What we want are good outcomes (improvements in health, in the NHS context) but the only things we can measure are outputs. Outcomes are much too difficult to measure, in the context of a contract for services. While outputs may lead to better outcomes, there's no guarantee they will, and there's always going to be a degree of 'gaming' the contract to focus upon delivering outputs. Service delivery will, therefore, inevitably omit to do some things that are important for outcomes.

Like you said, take the easy way, the modern way. Everything is measured by indicators. "Hmmm, now what could we use as an indicator that looks impressive on a graph?"
A bit like exam pass rates in schools I suppose.

It's fair that you have first hand experience, great. So do i from the policy side of things working both inside and outside the NHS for providers. I'm just saying it sounds like you're making an argument with a pre determined dislike for privatisation and using examples to support this which given your personal experience is understandable, hence why i used the term cherry picking, although that may not be correct to do so towards you. I'm saying, hang on a minute, yes there are examples of where it hasn't worked which get targeted, but there are examples of where it has worked, and nobody likes to talk about that as it doesn't fit the narrative of privatisation bad NHS everything it does good. Also, it's a harsh reality that in order to offer better care to more people some things need to close if not efficient and only offer benefit to a smaller number of people in a way that doesn't really make sense. That's why things get shut down and although it looks bad there is usually a reason to do so, like why there was talk of North Tees and Hartlepool merging. On their own they offer some services at an OK level, but combined could be much better and yes more people will have to travel further to get the care. Where do you make the call? Benefit population health as a whole or benefit a few individuals and have weaker outcomes on a wider population based level? It's such a hard discussion when you're talking about people's health, especially when some lose out. But it is a finite budget and the best has to be sought from it for wider health.

So we can't throw out privatisation completely as it does have some benefits for the NHS. We can't go down the road of the NHS must be completely public owned etc etc as that leads to gross inefficiency, in some cases lack of accountability and doing some things that don't need to be done. Equally we can't go fully privatised because the interests at heart are not always the patients, and yes money needs to be saved to make it work, which ultimately comes a t a cost to perfect. There are many examples of good working like SPIRE in Scotland. Many of the Hep C elimination services which are run in partnership with private organisations. And as you rightly point out, some absolutely awful schemes that shouldn't have been commissioned as the route to the outcome was not achievable. I understand your argument and point of view but it's not absolute and other things need to be taken into account too, but it's very easy to slip into i don't like privatisation so i'll just bring bad examples to the table. We have to look at both good and bad, and admit that sometimes the NHS does bad things too. The end goal should be better healthcare for all, whatever that looks like, rather than clinging on to an ideal that in some ways could do more harm.

For every gross inefficiency I offer you quadruple profiteering. Give me a dose of inefficiency over private firms making a mint out of the NHS any day of the week. You want to know about waste what about the constant re-tendering of services? On an almost annual basis. What about PFI Hospitals? There are many many examples that are a national disgrace.

Not only that though it is without question that staff that belong to the service give a better service than those employed by private profit making firms. Even if you could argue that the NHS massively overspent at least it offered care and had the staff and beds to give that care. Put anything on a budget and you get cuts.

Some facts re. this Lib Dem thing...

https://fullfact.org/health/liberal-democrat-nhs-privatisation/

Absolute horsesh!t. Are you saying people who work in private hospitals don't give as good a service? Or people who now do the same job but for a private provider are now giving a worse service every single time? While i agree that 99% of people in the NHS do care, you can't make such a sweeping generalisation and that those on the ground delivering care from a private provider do not give a good service or care. So it is with question your statement as it is quite frankly offensive to some people who work at delivering patient care to the best of their abilities. So what if a company makes money out of it for doing it better and cheaper, i'd rather that saving goes into front line care than wasting it on stuff that isn't needed or is being replicated on a massive scale, taking away either services or medicines from the people who need them

It is a finite budget, but I query whether the approach taken to managing it is of benefit for wider health. The approach seems to be more quantitative than qualitative, and it does feel that an awful lot of potentially good work that is harder to measure is suffering because a straight Cost/Benefit Analysis isn't capable of giving out the right result.



How do you define "Inefficiency" though? This is where one of the big problems lies in my view. If I want to see my GP for something that might be non-urgent but still important, my view is that I want to be able to do so reasonably quickly - say within a week. However, that may mean the GP holding open appointments and underbooking - which in Management terms is an inefficient use of a costly resource. Far more efficient to have every single GP appointment is being used, even if it does mean that my GP currently has no appointments available until next Tuesday, and actually only about half a dozen free until the end of next week already.

As an aside - there does need to be a conversation about how much we as a nation are prepared to pay in taxes, and what sort of NHS we can fund as a result; no political party wants to be honest about this though. It reminds me of a friend who lectures in Risk Management, particularly in Fire Risk; he told me once of the horrified reaction of people when confronted with the fact that you could in theory save X number of lives by ameliorating certain risks, but we don't, because the extra cost is prohibitive - potentially millions to save one extra life per year. "But how can you place a value on a human life?" We're now in the same position with the NHS, but no-one wants to be the one that says to Person X "I'm sorry, but we can't justify spending £300K on keeping you alive for an extra three months"....

They may be 'just examples', but when you tie them to a rational explanation as why they happen (the important difference between outputs and outcomes, as I note above) then it does actually become a coherent narrative as to why the privatisation of front line services leads to unintended outcomes.

And as for the claim that public ownership leads to inefficiency, the whole point of the argument being made is that the market is not efficient in this context. Efficient markets, from a theoretical perspective, need perfect information between the parties. When it is not possible to measure the outcomes being pursued, there cannot be a fully efficient market. It's a different form of inefficiency, but it's still there.

I would also take issue with your implied claim that we need markets for accountability. This simply presupposes that there is only one form of accountability; that of the market and market discipline. This prioritises financial and quantitative audit style accountability. There are other models that could be used to manage any public body. We've just forgot about them in these neoliberal times.

Exactly. A market based efficiency looks to the maximum use of limited resources. Great if you're making cars, not so great in other areas of public life. These are public goods, and some degree of inefficiency can be useful. In healthcare, a perfectly efficient system would be a disaster. The perfectly efficient system would have just the right number of beds for the predicted uptake. What happens when there's an unexpected increase in demand? If there's no slack in the system, there's no way to respond. That seems to be happening more and more in the NHS, especially in winter. And it also removes something very important in the process; the human side . Front line workers do not have the time to engage with patients, so that they can be 'efficient'. It's dehumanising for both the professional and the patient. But it also ignores the possibility that good outcomes are more likely when the professional can deal with the whole patient, not just the problem in front of them, right now. This is a great example of the problem of outputs taking priority over outcomes.

Yeah i think this is the crux of the argument really and agree. We're kind of stuck in the middle, nobody wants to pay 60% tax in return for an excellent service, not does anyone want a crappy underfunded service and that budget question comes up time and again. Why save someone for an extra 6 months when they are in their 80s with an expensive medicine, when you can cure 20 20 year olds with another. The human answer is because its right and we should but sadly we need an economic one too in these times. I guess that's where all the 10 year plan and prevention strategy is going, but the NHS just isn't set up to think about prevention, is treating the ill here and now.

My personal preference is to bring back tertiary care where its not hospital but its not GP either so taking pressure off both ends...

I didnt say every single time as I have not been in everysingle hospital to see every single event of care. I was clearly generalising. Saying that is horseshit suggests you prefer the privatisation model. Having had a dying relative spend 3 months prior to death in hospital being "looked after" by numerous agency staff throughout this period makes me absolutley certain I am right. Staff shortages are criminal, and the cost cutting is utterly scandalous. Budget setting on how many people will need end of life care, those suffering dementia, is impossible to define or get right. Yet its there and it happens. And if you work for a private firm is this circumstance then its odds on you work for the firm that gave the lowest quote.

Any savings made by the ‘efficiency practicioners’ will be more than swallowed up by the cost of maintaining them and their bloated teams in the manner to which they are accustomed while supposedly trying to square the circle.
Aren’t we the recipients of such thinking, telling us closing our A&E and a good part of the General and telling us it’s making our lives better. Try telling a pensioner visiting her husband in North Tees, getting several buses ( if one’s running thanks to privatisation) on a wet Sunday night in January how her life’s better.

Dispatches on channel 4 tonight Trumps Plans For NHS. Eye opener indeed!,,