Save the NHS!

(but I agree with you about demand/supply, although our devolved government would have us believe that this is Westminster's fault alone and can be easily solved)

It is not Westminster's fault alone but they do shoulder a great deal of the burden. The government's job is to do what is correct for the people not to be too frightened to tell the people something that is blatantly obvious and that everyone really knows.

The government needs to have the balls to stand up to the professions on plans and then reward them for doing a good job. You can't do one without the other. Most health professionals have little faith in their representatives (especially the nurses) and most would be willing to accept change if it meant they were paid the same as other professions and patient care was improved.

The people though hold a great deal of responsibility for the situation.

Plumber charging £40 per hr no-one bats an eyelid.
Experienced ITU nurse getting paid £15 per hour - everyone seems to take offence they get a pension ...
 
I just wish they would massively increase the price of alcohol and use that to make fruit and veg free. Not that this would stop people getting intoxicated they pay enough in the bars and the clubs as it is but it would do some good.

then theyd just make alcohol from the veg :p
 
So has the NHS been eaten by whatever I was supposed to save it from, yet?

Old question but it's getting there. Soon most/all hospitals will be privately owned, but the evidence is it doesn't work:

Francis Maude talks about mutuals and “mutual joint ventures” fairly interchangeably. He defines mutual joint ventures as “A co-owned joint venture to deliver public services, bringing together public service employees and private sector partners, may harness the best of both worlds in a new form of partnership.”

The first such joint venture was created in 2012, when the government transferred the Civil Service pension scheme to a company called MyCSP. The government called it a “mutual” after giving employees 25% of the shares, keeping 35% and selling the remaining 40% to a private company, Equiniti. But in October this year, the government decided to sell 11% of the total company from its share to Equiniti, conveniently pushing their holdings up to 51% of the company and majority ownership. Maude still calls it a mutual, though.

A similar trick has been played by Circle Holdings. Circle run the first NHS hospital to be franchised out. Maude calls it a “mutual”, because the original “Partnership” structure gave consultants and GPs just under 50% of the “Partnership”. Recent restructuring of the company (“Project Reset”) mean that now “staff” only own 25%. Ultimate control, however, always resided with an offshore Holding Company majority owned by private equity firms.

In spite of claims in the right wing Press, Circle is not a successful company. In 2012 Circle had to beg its shareholders for £46m of cash, on threat of insolvency. It got the money - but it’s still struggling to balance the books - and delivering poor service to boot, even as it’s held up as an exemplar of a health ‘mutual’.

The Cabinet Office pages present mutuals as a panacea, But in truth they are private companies and are subject to all the pressures and failings that are found in private companies.

Cornwall has been a testbed of privatisation. The failings of Serco as their out-of-hours provider are well known. But less well known is that the community services provider is a so-called mutual, and it is failing too:

“In Cornwall, Peninsula Community Health, a non-profit staff operated company that runs 14 community hospitals, is seeking a rescue through merger with Cornwall Partnership Foundation Trust.”

The social enterprise cannot balance their books. They reported a deficit of £328k this year. The local Lib Dem MP, Andrew George, said “the best outcome would be putting the whole community health sector back in public hands”.

Then there’s Central Surrey Health (CSH), regarded as one of the “successes” of mutuals and social enterprises. It had a fundamental weakness: its reliance on an assumption that its NHS origins meant it would still get NHS contracts. This assumption came crashing down when it lost a £500m contract to Virgin. CSH is reported to have failed in its tender because it could not provide a £10m bond as surety; the company was just too small to have access to such capital.

https://www.opendemocracy.net/ournh...lth-services-ever-announced-by-health-ministe

I recommend signing up to these weekly emails.
 
I have a friend who is a nurse and certainly for our local A+E the big issue is old people and mental health patients. Due to the cuts in local care and support the elderly are now in beds that used to be free.... because the elderly were looked after in their homes or supported in the community.

The cuts to social care also mean those with mental health problems have nowhere to turn but A+E and will self harm etc to get in, and sometimes it is simply because they are lonely, scared and need SOMEONE to care. This used to be done in the community but since the cuts our local MIND and other support have closed.

A+E cannot cope because of cuts in social spending, even the doctors on the news are saying it.

Of course the gov will spout on about there being safeguards and its all down to local authorities but its clear something has changed...
 
Someone I work for now and then he's a doctor, GP and surgeon, retired now. Hes said the thing that screwing the NHS is the extremely generous pensions paid to GP's stating a woman who's retired young, very young, lives in Babados or Bermuda spends her whole time playing tennis and will get full GP's salary until the day she dies.

Got to love the boy Millaband droning on on the tv yesterday, it's NHS, NHS, NHS. No mention of inefficiences, no mention of the budget deficit, credit crunch or anything vaguely related to even the slightest hint of understanding of the economy. Its just spend spend spend, tax tax tax same old, same old. The faces change and the presentation changes but the message is the same every single election since time immemorial.

Since they're likely to be the next government, God help us all. We'll probably end up cap in hand to the IMF.
 
Someone I work for now and then he's a doctor, GP and surgeon, retired now. Hes said the thing that screwing the NHS is the extremely generous pensions paid to GP's stating a woman who's retired young, very young, lives in Babados or Bermuda spends her whole time playing tennis and will get full GP's salary until the day she dies.

Well either you have misunderstood or he is full of carp. for 1 thing the pension is not a 100% of final salary pension, and if she retired "young, very young" it would be significantly less than 100%. You also need to take into account the pension contributions someone makes. A GP will be paying both employee and employer contributions which is around 28% of their income, so they are contributing quite a considerable amount towards their pensions I think you would agree.

Currently the doctors portion of the NHS pension is effectively overfunded by around 2bn a year. i.e. the amount paid in by doctors is 2bn more than all the retired doctors are taking out of it at present.

It is still currently a good pension scheme and I wouldn't argue about that, but it is certainly not quite as good as many perceive and by no way is it what is breaking the NHS currently
 
Currently the doctors portion of the NHS pension is effectively overfunded by around 2bn a year. i.e. the amount paid in by doctors is 2bn more than all the retired doctors are taking out of it at present.

To be fully funded it needs to consider not only current pensioners but all those in the fund not yet retired and their current pension entitlement.
 
I use "funded" incorrectly as with all the state pensions they are not a funded pension in the traditional sense as they are state guaranteed, but what I was trying to point out is that the amount paid in by doctors is significant and that given that currently they pay more than retired doctors take out you cannot argue that failings in the service are based on over generous pensions
 
Circle to walk away from Hitchingbrooke hospital. Presumably leaves the taxpayer to pick up the piecesabide by the contract that was entered in to.

Fixed that for you.

Perhaps the biggest problem with privatisation or any private subcontract is that (sweeping generalisation incoming) the public sector do not contract effectively and they do not monitor/maintain that contract effectively. The public sector lets contracts that no right minded private company would even contemplate.

Based solely on that article, it looks like circle entered into that arrangement on the basis that their losses would be capped at £5m. Funding cuts have pushed Circle to the point where that trigger is likely to be passed. So the public sector/government/taxpayer is getting exactly what it signed up to. If there is fault there, it isn't Circle's.

I'm no fan of this particular model, but blaming Circle for executing the contract that they entered into is somewhere between not fair and stupid. But then they are private so they must be evil...
 
Fixed that for you.

Perhaps the biggest problem with privatisation or any private subcontract is that (sweeping generalisation incoming) the public sector do not contract effectively and they do not monitor/maintain that contract effectively. The public sector lets contracts that no right minded private company would even contemplate.

Based solely on that article, it looks like circle entered into that arrangement on the basis that their losses would be capped at £5m. Funding cuts have pushed Circle to the point where that trigger is likely to be passed. So the public sector/government/taxpayer is getting exactly what it signed up to. If there is fault there, it isn't Circle's.

I'm no fan of this particular model, but blaming Circle for executing the contract that they entered into is somewhere between not fair and stupid. But then they are private so they must be evil...

I don't blame Circle - they're just trying to make as much money as possible, it's no bones to them if patients suffer as long as their shareholders don't. I blame the government that privatises everything with little thought and no evidence that it will actually work. My guess is that Hitchingbrooke will be the next East Coast Mainline i.e. brought back into public ownership, turned around into a good performing hospital then re-privatised so another private healthcare company can make some money.
 
You need only look at how the MOD or DECC (e.g. wind turbines) handle some of their contracts.

MoD is a lot better than it was. They still make some almighty cockups from time to time, but their general approach to procurement is much improved since the days of Astute and MRA4.

There is still a failure to properly understand and account for risk, but they have good partnership with main suppliers and the big overruns are mostly to do with requirements creep or capability hokey-cokey than poor contracting. The media prefer to paint it as BAE (or whoever) now charging OVER 9000!!! more than was originally agreed even when that is a fair cost for the changes that are being made.

Don't know anything about DECC.
 
Fixed that for you.

Perhaps the biggest problem with privatisation or any private subcontract is that (sweeping generalisation incoming) the public sector do not contract effectively and they do not monitor/maintain that contract effectively. The public sector lets contracts that no right minded private company would even contemplate.

Based solely on that article, it looks like circle entered into that arrangement on the basis that their losses would be capped at £5m. Funding cuts have pushed Circle to the point where that trigger is likely to be passed. So the public sector/government/taxpayer is getting exactly what it signed up to. If there is fault there, it isn't Circle's.

I'm no fan of this particular model, but blaming Circle for executing the contract that they entered into is somewhere between not fair and stupid. But then they are private so they must be evil...

Circle stated on the Radio earlier that it wasn't just the cuts that were the problem it was the sudden increase in patients turning up at ED. One guy had been there 15+ times since the start of December.
 
MoD is a lot better than it was. They still make some almighty cockups from time to time, but their general approach to procurement is much improved since the days of Astute and MRA4.

There is still a failure to properly understand and account for risk, but they have good partnership with main suppliers and the big overruns are mostly to do with requirements creep or capability hokey-cokey than poor contracting. The media prefer to paint it as BAE (or whoever) now charging OVER 9000!!! more than was originally agreed even when that is a fair cost for the changes that are being made.

Don't know anything about DECC.

I can't remember the details (read about it somewhere on these forums) but I think it was to do with the last Government awarding contracts for building wind turbines and paying them even if they don't generate any/enough energy (a very simplified explanation).

It's good to hear the MOD have improved.
 
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I can't remember the details (read about it somewhere on these forums) but I think it was to do with the last Government awarding contracts for building wind turbines and paying them even if they don't generate any/enough energy (a very simplified explanation).

Wind turbines have some features that seem odd at first glance (like switching them off when the wind is blowing too much) but one of the subsidies used to encourage investment in green energy is that, basically, you agree to buy all the energy even if you don't need it and have to tell them to stop production.

Gas, coal and nuclear only make money based on energy supplied to the grid. Wind in particular gets paid whether the grid takes the energy or not. If it didn't there would be less money made and so less incentive to develop the wind farms.

It's good to hear the MOD have improved.
It would be hard for them to have got worse!

It was a bit of a joke in the industry that you could win a contract based on bidding a pint of lager and a packet of crisps and then charge what ever you wanted. In some respects, that was a hangover from the days when it was public sector.

Then they went the other way and pushed out fixed price contracts that were never feasible.

Now its mostly cost-plus for development work like the carriers (standard MoD rate is 8% I think) but with incentives for both target cost and target schedule. Of course, by tying industry in on those terms, MoD and the politicians get tied in too.

Not perfect yet by any means, but much better than it was.
 
Circle to walk away from Hitchingbrooke hospital. Presumably leaves the taxpayer to pick up the pieces. Patients can suffer, shareholders mustn't. Crisis? what crisis?

Pretty damning article of circle here:

Hinchingbrooke - why did England's privatised hospital deal REALLY collapse?

An excerpt:

Some of the examples witnessed by the CQC in their two-day inspection were chilling.

“We heard the staff member say to the patient ‘don’t misbehave, you know what happens when you misbehave’. We later asked the patient what they thought the staff member meant by this; the patient became withdrawn and was unable to provide us with an answer.”

“A patient on Apple Tree Ward, who required support during the night to go to the toilet told us that staff were ‘often too busy’. They said ‘they tell me to go in my bed and they will change me when they have time’.”

Other patients during the two-day inspection reported similar experiences, or were witnessed being left dirty and distressed, and treated rudely or roughly.

Inspectors found a patient with ‘challenging’ behaviour had been sedated without any record of a proper assessment of their mental state or best interest.

Circle’s junior doctors were often labelling patients “do not resuscitate” without discussing the decision with patients or relatives, and without any apparent oversight from senior doctors. Sometimes the failure to discuss was because the patient lacked mental capacity, notes often suggested - but the CQC “saw no evidence that a mental capacity assessment had been undertaken in any of the patient records we looked at”.

The CQC notes “We found many instances of staff wishing to care for patients in the best way, but unable to … prevent service demands from severely impinging on the quality and kindness of care for patients.” It found Circle lacking “sufficient appropriately skilled nursing staff”.

Though the details are shocking, the general picture is unsurprising to anyone except those who bought the ideological hype about private sector magic dust. Circle won the contract by promising what the Public Accounts Committee called an ‘unrealistic’ and ‘unprecedented’ level of savings - urged on by government officials. Circle’s Full Business Case said it would achieve this by altering ‘nurse-patient ratios’ but exactly how was blacked out of the plan when it was eventually published. Leaks suggested plans to cut 320 posts in total.

Within 6 months of taking over Circle had already scrapped 46 full time nursing posts, then Chief Executive Ali Parsa (an ex-Goldman Sachs banker) admitted.

Why are we expecting private companies to run hospitals more cheaply without cutting quality again?
 
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