Save the NHS!

[scorza]

Some of you may remember that earlier in the year the government had to postpone its hated plans to reform the NHS amid GP concern, large scale protests, and even a rap record criticising the Health Secretary Andrew Lansley. The government agreed to a postponement as part of a "listening exercise" and now that exercise has been completed and in one week our MPs will be voting on a massive change to the NHS. I signed a petition against the reforms and today I got an email from the slacktivism site 38 degrees stating the following:

In just one week, your MP has to vote on massive changes to our NHS. But 38 Degrees members now have something our MPs don’t – thorough, independent legal advice about what these changes really mean.

Our expert legal advice is sobering. Despite the “listening exercise”, the government’s changes to the NHS plans could still pave the way for a shift towards a US-style health system, where private companies profit at the expense of patient care.

Conservative MPs like yours are being told by their bosses these changes fit with party ideology. But many would be horrified to know that the NHS would be subject to European competition laws and front-line services could be held up with procurement red tape. Let’s work together to show them the evidence right now!

If enough of us email now, it could tip the balance:
https://secure.38degrees.org.uk/email-your-conservative-mp

Our independent lawyers identified two major problems in the new legislation:

- The Secretary of State’s legal duty to provide a health service will be scrapped. On top of that, a new “hands-off clause” removes the government's powers to oversee local consortia and guarantee the level of service wherever we live. We can expect increases in postcode lotteries – and less ways to hold the government to account if the service deteriorates.

- The NHS will almost certainly be subject to UK and EU competition law and the reach of procurement law rules will extend across all NHS commissioners. Private health companies will be able to take new NHS commissioning groups to court if they don’t win contracts. Scarce public money could be tied up in legal wrangles instead of hospital beds. Meanwhile, the legislation lifts the cap on NHS hospitals filling beds with private patients.
So who are MPs going to listen to when casting their vote – you, or lobbyists from private health companies? This is our NHS, and it’s up to us to defend it. Email your MP now:
https://secure.38degrees.org.uk/email-your-conservative-mp

It’s pretty extraordinary what we’ve managed to achieve together already. Nearly half a million of us have signed the petition to save the NHS. And after Andrew Lansley announced the last round of changes, thousands of 38 Degrees members immediately chipped in to get top independent legal advice on the new plans.

Barrister Rebecca Haynes found that the government's plans could pave the way for private healthcare companies and their lawyers to benefit most from changes, not patients. Another barrister, Stephen Cragg, found that we were right to be worried that Andrew Lansley was planning to remove his duty to provide our NHS.

This is the conclusion of a top legal team paid to have no other interest at heart but yours.

MPs vote in just seven days. Seven days to not only get the evidence, but be convinced there’s way too much public concern to ignore it. The good news is, with over 800,000 of us now armed with expert legal advice, we are just the people to speak up. Our message is clear: we have the facts, so politicians can’t hide behind spin. Let’s give MPs from all parties the mandate they need to think again and vote against these changes to the NHS.
https://secure.38degrees.org.uk/email-your-conservative-mp


Thanks,

Here's the legal advice in more detail: http://www.38degrees.org.uk/page/content/NHS-legal-advice/

I urge everyone who doesn't agree with these changes to contact their MP using the links above (I think it can be used even if you don't have a Conservative MP).

 

[scorza]

Does this mean private companies could bid for services and if they are the best option win (and take legal action if the established NHS organisations refused to work with private companies or follow a fair and equal procurement process)?

No it means that private companies will win if they're the cheapest option, so they'll take the cheap, easy work as that's where the profit is - and leave the NHS with the expensive, difficult work.

 

[scorza]

Independent citation, with examples where the same thing has occurred and quality has suffered, needed.

Royal Mail. Private companies take the easy, profitable work i.e. mail pickup from city centres, leave the difficult bit, delivering to anywhere in the country, to the Royal Mail. Privatisation means privatise the profits, leave the liabilities socialised.

 

[scorza]

The NHS is a cash-guzzling disaster saved from utter failure only by throwing ever-increasing sums of money at it.

Same as every healthcare system then. Healthcare costs have increased dramatically across the world over the last few decades, why should the NHS be immune from that? Part of the problem with the NHS is that between 1980 and 2000 we didn't throw enough money at it, we've been playing catch up ever since until now when we've started going backwards again.

 

[scorza]

That simply isn't true is it? The procurement process should lay out requirements and standards - if somebody else can do that at a lower cost and there's no reason to believe they will fail to deliver then there's no reason why they should not be given a chance.

Can you explain why private companies would do the easy work and leave the public sector with the hard work and why if this were the case it would be a bad thing? The requirements and standards would be the same whoever did it so surely if private companies are doing one thing more cheaply it would leave the public sector with more money to do what they do?

No because the private company gets the money that would otherwise go to the public sector. In other words the NHS will have less money to do work of a greater overall complexity. You don't have to be a management consultant to know what the result of that will be - less inefficiency. It's a shame because the NHS is the most efficient healthcare system in the developed world, I wish more people in this country would recognise this and realise the NHS is worth investing in.

Again, I don't care if somebody is making a profit if I'm getting the same service or better and the government saves money to pay for more important things.

Important things like what? Your local cardiac department which will almost certainly close as it's not cost effective to keep it open now all the profitable heart work get done at the private company down the road. Great if you are lucky enough to have a profitable heart condition, not so great if you don't.

 

[scorza]

That's an example of incredibly stupid regulation which forces the Royal Mail to subsidise private companies.

If you have similar examples for the governments plans for the NHS I'd suggest they should be the crux of your argument, that'd be killer material and would stop the governments plans dead.

That's pretty much what any willing/qualified provider means. If a private company sees a business opportunity doing say, hip replacement operations, it can force the NHS into a bidding war for all the hip replacements ops in an area. The NHS will inevitably not be able to compete on price because the orthopaedic dept has to treat a range of conditions while the private company can set up a production line of one type of treatment. Net result, NHS is left with the difficult, expensive work (liabilities), the private company gets the cheap and comparatively easy work (profit).

 

[scorza]

Good lord that is a corker!

You should do stand up, it's sig worthy at the least!

My apologies, I should have said second most efficient (after Ireland): http://www.guardian.co.uk/society/2011/aug/07/nhs-among-most-efficient-health-services

 

[scorza]

NHS wastes loads of money so its efficent?

Did they get the special school to write this report?

I'll save my apology for someone who doesn't think overspending and waste on bureaucrats equals efficency.

LOL

Uhm no - it means we waste less money because the money we do spend on healthcare tends to be spent on actual healthcare services and less on healthcare administration and insurance.

 

[scorza]

So I can get basic medical care and pop along after hours for a few stitches after a **** up but I will still be waiting for specialist care, which is generally along the lines of cancer treatment, heart conditions, you know the kind of stuff that saves your life.

That's a great deal!

Efficiency was measured by looking at total national spending on health as a percentage of gross domestic product (GDP), as well as the amount spent on health administration and insurance.

That quote doesn't say that more money spent on administration and insurance equals more efficiency, just that it was looked at as part of the equation. By every definition of efficiency the more money you spend on overheads, such as administration and insurance, the less efficient you are.

 

[scorza]

The labour system of spending 3 times more so you can still die but in a room is somehow better?

Of course it's better. I can't believe you'd suggest otherwise. Labour might have spent three times more on healthcare but so did every other developed nation. The results achieved might not have been spectacular but look at the effect of a freeze in spending now - waiting times increasing, operations cancelled, people suffering in the mean time.

 

[scorza]

Average time to treat increased under Labour, because they cut headline waiting lists by making people with urgent conditions wait longer, and people with minor conditions wait less time. In other words, they spread the suffering around based on politics as opposed to clinical need rather than reducing it.

Personally, I'd rather be looking at a system with better clinical outcomes, rather than just an alternative place to die a preventable death.

So increase spending on the NHS to at least OECD average then.

 

[scorza]

Working as a contractor for the NHS I can see where the money gets wasted.

but this appears to address none of it. Because most of the problem with the budget and it being a cash cow is down to suppliers treating it as a cash cow and making prices up as they go along, and the NHS accepting them because its not their money they are spending.

Most likely the NHS accepts the prices because they have preferred supplier agreements with those suppliers which reduces the total cost of procurement for the NHS. Private companies have been doing this for years which means when I order a new laptop at work, it costs £1.2k for a spec that would cost me personally about £350 if I got it from somewhere like OCUK. There's a lot more to procurement than just getting the cheapest price though.

The NHS' problem is not that it needs more money.

A comparison with healthcare spending in other developed countries would suggest otherwise.

 

[scorza]

The people with those preferential supplier agreements take the **** though. Because they know its the NHS, they could quite reasonably supply your laptop for .. say £500 instead of the £350 from OcUK.

But because its the NHS they deliberately push it up to £1.2k knowing the NHS will just pay it.

This sort of behavior is rife right through the NHS and its disgusting.

And don't even get me started on the wage bill.

You've misunderstood. I don't work for the NHS, I work for a private company that has a preferred laptop supplier who "overcharge" us for equipment. This is private sector best practice which it sounds like the NHS have, or are trying to, adopt. Why is it best practice? Because it brings down the total cost of procurement for the buying organisation. How? For example, a part of the procurement process should be to establish the risk of a supplier going out of business, this process can cost an organisation quite a lot of money especially if they have as many suppliers as the NHS. By reducing the number of suppliers the NHS reduces this cost. That's just one of the advantages of the preferred supplier approach.

 

[scorza]

Exactly my point from earlier, they pay on average more for everything.
A few procurment specialists paid a percentage of what they save could likely save billions overall.
Be a good first step.

mOD should be doing the same, fifty pounds for a lightbulb and all that.

It wasn't fifty pounds for a lightbulb was it though? It was £50 for an maintenance technician to arrive on site, examine the fitting, procure the right light bulb and fit it. To be fair, this sounds like something that should have been covered under a maintenance agreement, but that would have cost the NHS money too.

I know someone who got charged £60 when he moved out of his flat because one of the light bulbs needed changing.

 

[scorza]

Can someone explain in simple terms what the proposal is?

Have a read of http://www.38degrees.org.uk/page/content/NHS-legal-advice/

To summarise my understanding further, there are two controversial proposals in this legislation:

1. Secretary of State for Health will no longer have a duty to provide or secure the provision of healthcare. This means when there's a major scandal in the health industry in future, the minister responsible for health will basically say "not my problem guv, it's up to your GP's surgery to sort it out". He will be required by law not to do anything that might mean a repeat of the scandal does not occur.

2. Opening up the NHS to competition. At the moment it's the Primary Care Trusts (PCTs) that commission i.e. buy health services for us. These are being dismantled and replaced by consortia of GPs surgeries who are allowed (possibly encouraged) to outsource this responsibility to private for-profit companies. In future the GPs must choose who to commission health services from "any qualified provider".

Any qualified provider means that private companies can poach the parts of the NHS it thinks it can make a profit from e.g. if I set up a production line operating theatre doing nothing but hip replacements, this will cost me much less than the NHS osteopathy department does it for. The NHS has to provide a universal healthcare service though, so the osteopathy department loses all the money from hip replacements and is left doing the difficult, expensive work that the private companies don't want to do. The NHS becomes more inefficient and costly to the taxpayer, which means it will lose even more work until we get to the point where the NHS no longer exists and Cameron, Osborne and Lansley all smoke a big cigar and pat each other on the back for a job well done.

 

[scorza]

Bizzarely I doubt it.
I am quite certain our special and black ops come form a budget within a sealed folder, and I doubt they pay fifty pounds for a lightbulb.

As for the we overpay to make sure our supplier stays in business, what a ridiculous situation to be in! The rest ofbthe world is full of suppliers also, and I think you will find that few medical equipment providers that actually make and produce correctbequipment will go bust.

Sigh that's not what I said. The NHS will likely do a credit check on a potential supplier and judge how likely it is they will stay in business. Now for lightbulb suppliers it probably doesn't matter too much but as I said they didn't buy a lightbulb did they? the NHS buys a service from a private company that offers lightbulb replacements and lots of other things. If that service company goes bankrupt then there are very real consequences for the NHS.

As for the instruments made in Pakistan, they are not fit for purpose, and thus won't be paid for, a simple inspection of the materials revealed that. You want approved, seek bs marks etc, but don't pay list price when no one else does.

This is the article associated with the Panorama programme: http://www.bbc.co.uk/news/uk-13894880 That you think these sort of defects could be found by a simple goods-in inspection indicates you have no idea about the procurement process.

This highlights my point also - no doubt some bright spark thought they could improve the NHS' efficiency by importing surgical equipment from abroad without doing the proper checks on the supplier in the first place. The cheapest product is not always the best value product.

 

[scorza]

Scorza you missed my point, as with the mod, as with the nhs, as with main civil service depts, they pay too high an amount from their current suppliers as they dont argue the point. It is no one job to do it, so no one does it.
Transfer to people whi already run their own depts or surgeries, might help, a little, but it will only scratch the surface.

You dont have to buy cheap foreign imports to save money, you can save money on everything you buy already.

As i said we pay a tenner less per box of local anesthetic than the biggest hospital in northern ireland, thats a saving of fourty percent, we buy from the same company, through the same rep. Why do we pay less, we asked for bulk discount.
The hospital is sure to buy hundreds times the amounts we do, maybe thousands.

This isnt about gyne instruments from pakistan as opposed to good british steel, this is about common sence. That starts by outting people in charge of budgets and currently the system doesnt do this effectively,

I understand your point completely - you're looking at the cost of product when you should be thinking about the cost of managing all your suppliers across the whole of the NHS. Decentralising procurement responsibility (what you're proposing) will result in better quality but it will be much more inefficient and end up costing the NHS more. Centralised procurement is recognised as the being the cheapest for an organisation. Personally I'd like to see the de-centralised approach adopted too but it can't be argued it should be done as a cost saving measure.

 

[scorza]

We're not stupid you know.

The whole point of having a flaming procurement department is that if someone goes out of business they find someone else.

If it gets to that point I'd say the procurement department have already failed I'd say.

Personally I think NHS procurement needs a massive shake up. ANYONE who signs these deals knowing how much of a rip off they are should be fired.

Procurement should be about tough and gruelling negotiations in getting the best possible deal for the NHS and the taxpayer, not just being a ****ing lazy ****wit and signing any old contract cos they can't be arsed to do their jobs properly and negotiate.

Whenever I order up stuff for us, I ALWAYS ALWAYS manage an extra discount on stuff. If you dont ask then you dont get!

Best discount I ever got for one of our bigger purchases was 41%. Had I not pushed and pushed this would have never happened.

If I can do it for my department, why cant the utterly useless, lazy ****wits who are signing off the big stuff do it?

Its pathetic. They should all be fired. THEY are part of the problem and they should be disgusted with themselves.

The NHS potentially has mega bargaining power, they should be using it.

How do you know they don't negotiate discounts? BTW, biggest discount our procurement guy has ever got is 68% For bespoke stuff like the doomed NPFIT project you probably won't get any discount however. Incidentally if you're looking for someone to blame for the NPFIT fiasco I suggest we start with the Management Consultancy who said it was all possible in the first place - McKinsey.

 

[scorza]

Mainly down to the Labour government who got rid of loads of nurses and created lots of middle manager non jobs.

Sorry, under Labour the number of qualified nurses working for the NHS rose by almost 100,000 (Source)

 

[scorza]

No trolling. I didn't specify doctors. Nor tube drivers (have a problem with them?). Nor did I specify pay.

I specified the grossly unfair and unaffordable nature of defined benefit public sector pension schemes.

Your comment on private sector salaries for doctors seems to suggest that you'd be an advocate of private sector healthcare.

Nothing unaffordable about public sector pensions (Source). What's unfair imo is that private sector pensions are so crap for the vast majority of people.