Will doctors need MBAs in NHS reforms?
One thing you discover as a hack covering the present health debate and the publication of the health white paper today is that it is so big a subject and so complex a bill that it is almost impossible to get on top of it. Interviewing ministers and medics about it is no easier.
So you are left with strange generalisations on all sides – and intriguing discoveries. For example the epic growth of private health companies now running vast chunks of the NHS.
You also find yourself wondering about the doctors who will run these vast consortia. Six years to learn the medicine…another one to secure the MBA? And will medical students strive for the ultimate accolade “good at admin”?
Then there are the politics. Word down at Westminster is that Andrew Lansley is a relatively isolated figure. Even now it is being said that he may not survive the next re-shuffle. Further that Mr David Cameron had very little idea of just how big the Lansley revolution was planned to be.
Many of the building blocks for what the Coalition is now doing seem to have been laid by the Labour Government. In some cases without many of us noticing. After years of reform, many argue it’s time to let the NHS bed down a bit – to coin a phrase.
More or less anyone you ask will tell you that the NHS is a far, far better service than it was a decade and a half ago. I don’t myself run into much dissatisfaction with it. So why the hurry? What about letting the first 141 GP led consortia (currently running alongside PCTs) run for a bit, then evaluating them and deciding whether to go on?
There are moments when all this feels like something of a looming train wreck in the making. Yet there appear to be few divisions inside the Coalition about the direction of travel. It’s going to be quite a challenge to cover it all.
Read more about the NHS on the Channel 4 News special report.
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First, as a generalisation, the NHS is extremely badly managed. It is overly bureaucratic, has far too many people in it and is populated by people who would have a problem finding such lucrative work in the private sector. They are not ambitious for change!
As a result, it is far too expensive.
Competent nurses and doctors (and some managers) will admit this.
GPs now earn over £100K. If they cannot grasp simple arithmetic then we are in a bad way. I was a school governor when budgets were introduced. OK, the local vicar who was the Chairman of the Governors, as an accountant, made a good milkman’s horse! But there were many others who had no problem with setting and managing the budget.
My wife, a business oriented HR Director, has recently been contacted by headhunters to ask if she would be interested in joining 2 different NHS trusts.
Her replies are unprintable but a rough translation would be ‘not as long as my bottom points to the floor!’ Her view is that it is not possible to make significant improvements in state run organisations.
Smaller, GP run entities may be more attractive to competent people who want to make a difference.
The NHS may be overly beurocrtic – to waht extent I do not know – if any – but If it gets the job done , that is the main thing . If you want to know what expensive is – get rid of NHS – and u will soon find out . Compared to what the banks have cost I would think the NHS is a good deal .
In ROI – the state health system was allowed run down – now everyone or near so has Private Health Insurance – and that costs [ a lot ]- and rises all the time . It is also open to corruption via overcharging by hospitals / specialists etc – and dont trust every GP is not above that aslo . It happened in my own case – when a ten minute routine procedure cost £ 120- but for those GPs who want to run an effeicient service – and they are in the vast majority hopefully – their time is vital and they will need staff to source the BEST treatment – for the patient .
However I do not see the NHS surviving in anything but name .
“Competent people who want to make a difference” – when private healthcare rules the roost, big pharma gets a hold as in the US and everything is better (just like it became with the profiteering rail companies and energy organisations), you can rest assured that the difference will have been made.
I find the whole revolutionary concept terrifying. Health like education is not a subject that you can ‘suck it and see’ – by the time you realise you are wrong, thousands of lives have been blighted.
We’ve seen it before with the constant shuffling of teaching methods that have left generations with a poor grasp of reading, grammar and spelling and which are now turning back to the methods used when I started school 60 years ago.
While it is easy for Lansley, Gove and Pickles to earn cheap applause by blaming expensive bureaucrats, don’t massive budgets like health, education and local government need to be professionally managed?
Of course they do and all the government is doing is replacing public managers with private. Doctors will have to hire individuals or companies to run their administration, so it will probably end up costing more as there will be fat ceos and shareholders to satisfy.
But of course it will be the doctors not the politicians who then get the blame.
Isn’t it extraordinary that prior to the election there was such a clamour to remove the bureaucrats from the health service, yet now that they are going, there is a clamour to retain them?
I totally, utterly, dispute that we need ‘professionals’ to manage budgets. Understanding how xls works isn’t hard, and frankly, I finding it staggering, that, given the intellectual rigour required to master a medical degree – let alone any kind of specialisation – our people cannot ‘do the math’. If they can’t, we should question how they hell they became qualified in the first place.
The worst, absolute worst offenders in this debate are the BMA. All they care about are pay rises, and keeping a closed shop for the existing profession. How I wish that Labour had put the boot in properly when they could have. They took golden reform PR opportunities like Alder Hey and Harold Shipman, and turned them into a massive pay rise for some of the most well off people in Britain while at the same time wrecking GP services with an ‘improved’ contract that shut down surgeries – making our medical professionals, who don’t turn in the best service in Europe (sorry its true) into the most highly paid.
How are large private health companies, of USA or other origin as well as UK companies, to be prevented from undercutting the existing NHS hospitals and other NHS providers/services until they have no NHS competition and the NHS is effectively in their hands (probably having contracted to retain the designation ‘NHS’) ?
‘Then there are the politics. Word down at Westminster is that Andrew Lansley is a relatively isolated figure. Even now it is being said that he may not survive the next re-shuffle. Further that Mr David Cameron had very little idea of just how big the Lansley revolution was planned to be.’
According to a sniggering Eamonn Butler, head of Adam Smith Institute, on this morning’s R4 Today programme, Tory NHS ‘reforms’ have been ’20 years’ in the planning’. There we have it, if proof were still needed that today’s outpourings from Lansley have nothing to do with deficit-reduction (that’s the smokescreen) but everything with ideology and the ending of public provision of a national health service. Lansley’s merely the willing vessel – his CareUK financial backer supported David Davis against Cameron in the 2006 Tory party leadership elections.
Re private health companies: CareUK is one of only four of the largest waiting to grab even more of the NHS; others are: Nestor Healthcare Group, United Healthcare (includes Aetna and Humana) and Atos (inc. Assura and at least one other), not to mention Big Pharma.
Even at this 12th hour, Labour have produced no proposals for a C21 NH(ealth)S
Meg, The NHS used to be the envy of the world and rightly so. But now it is simply a bloated, sacred cow with some areas of excellence.
Governments over the years have thrown billions at it for a trivial inprovement; the last time through incompetence, it was mostly absorbed in salaries!
The private sector cannot do worse if it wishes to remain in business and to be profitable.
I hear the NHS supporters cry “What has profit to do with the NHS?” Well, much the same as those huge numbers who work in it and demand pay for doing so!
Any self respecting business ought to be able to deliver a much better, more efficient service than the NHS at a fraction of the cost and still make a profit.
Jon,
I previously posted the following on Gary’s blog:
“I believe most of the forthcoming Bill and its details are designed for a specific purpose: To deflect attention from the real Tory intention.
This is to create a generation of doctors of the self-interested profiteering type prevalent in the US. The method is one-step-at-a-time, known as “the salami method.” Firstly, separate them from genuine democratic responsibility. Secondly, create a climate of private profit in doctors’ surgeries. Thirdly, allow the “reorganisation” to bed in and doctors to profit. Fourthly, separate all doctors into private practices of the pre WW2 type, the kind that led to creation of the NHS in the first place. The Tories and their American “health” companies backers know very well they daren’t openly seek NHS abolition, but they can lie, mislead and rig the economic system – all of it backed by adverse propaganda churned out through monopoly control of media. Anybody who trusts CamClegg in this and other matters deserves the kind of ultra right society they will suffer.
Aneurin Bevan was exactly right in his famous 1948 speech.”
It still applies.
Philip,
you were right then, right now, and right going forward.
Most of the modern problems (was there anything like this before 1979?) in the NHS started with the internal market, an 80s reform to replicate the American medical market within the NHS, which utterly failed. Then the management level brought in to run the fake market mutated in the 90s and seeped in to all areas and all decisions within the NHS sucking up money by running services down. Finally the pseudo-privatisation turned lethal when the 00s targets lead to serious gaming of the system, death, cover-up, and scandal.
As messed around as the NHS has been it is still delivering a brilliant service (though quality is highly variable around the country) and as C4 reported in the summer (but not last night???) it is also the most efficient public health system in the world. Why not take the time to find out a way to protect what works? Why not give the NHS a time-out to catch breath from the decades of rolling and short-sighted reform? Well we know why…
Cameron a complete incompetent. Since Lansley’s been talking openly about abolition of PCTs since November, why didn’t PM step in then and say ‘Stop’:
http://www.guardian.co.uk/society/2011/jan/19/nhs-cuts-scale-shakeup-surprise
Also, from today’s Pulse (GP mag), a live link to today’s proposals:
http://www.pulsetoday.co.uk/story.asp?sectioncode=19&storycode=4128274&sp_rid=NjcxMTQ1NzA3OQS2&sp_mid=36189802
Jon,
Additionally, congratulations on an excellent interview of the Tory Lansley last night. By the end of it your politely insistent questioning had him squirming and plainly avoiding the issue of political donations from “health care” companies. The only thing he didn’t say was, “It wasn’t me, guv.” What a shyster.
Next time, perhaps you could ask him which individuals in the Tory Party allocated the funds to him, and when. This could then be aligned with his appointment to the Health portfolio. You might even trace the money to its ABSOLUTE root in the “health care” company.
You could even consider a full segment on “health care” companies – particularly the American owned version – and how much they rip off the NHS and how they are connected to Tory MPs.
Nor should we forget this whole rotten business really got traction under Alan Milburn and other New Labour subverters of Labour Party founding principles. They are every bit as culpable as the Tories.
Nurses.. 3-4 years to learn medicine, continuing education . 10 years to do degrees, continuing practice, on the job learning in ‘management’ .. wards etc and fund holding and budget holding, management degrees , research degrees, practicing as inferiors whilst still making big decisions and getting paid as little as organisations can get away with .
Education . teaching medical students , nursing students , making sure that these new docs and nurses don’t make mistakes year after year.
Nurse prescribing . A formal qualification for Nurse to practice more openly a job they have been doing for years.
Undertaking of all clinical tests and recognising changes enough to warrant action in a crisis and long term , adjustment of medication and controlling long term conditions backed up by specialist degrees.
Many years history in running hospitals which were well managed and community orientated.
Paid as slaves for large amounts of responsibility.. We did it but they greedily take all the credit and money for it .
John – Domyou think you could take over from Lansley when there’s a reshuffle? The idea of trialling this seems eminently more sensible than the gadarene rush to an unproven system which may well end up in an expensive train crash. While the NHS may be relatively bureaucratic (but this is often exaggerated for political purposes), it has been through a vast number of structural “reforms” over the last 20 years, which has required too many people to make the structures work & not enough time focussing on pateint care & prevention. This will end up being run by private sector consortia who will expect to make a profit (so whatever the overhead costs of the NHS bureaucracy, they are likely to be at least matched by the profit requirements of the new largely privatised NHS. Why can’t we focus not on messing around with structures but on getting the best for Britain’s health?
Philip it is precisely because of the structures and the messing about , that the NHS is failing.Dirty hospitals , post code lottery.If you can not see that to maintain a service free at the point of use, that something needs to be done,you are too enshrined in Socialist dogma.There needs to be change in a system where there is no body experienced to administer the care to patients, because nurses whose primary job it is are too experienced and want to stand around discussing patients.The same old problem with public services , too many chiefs not enough indians
The old adage , if its working don’t mess with it comes to mind.
The problem is, is it working?We certainly if in need get treated,but how many lives have been lost because of dirty hospitals, doctor error,or just pure inefficiency.Is it cost efficient and value for money.The answer has to be no.There is far too many managers on inflated salaries and far too few workers on relatively loww salaries by comparison.Just as in any public sector environment , where the individuals are not earning the cash.
There is a need for major changes without losing the overall reason for being there.Whether doctors are the right persons to run the hospitals, is debatable.A super matron with accountancy and nursing knowledge is the answer,and the NHS has to stay within the public sector even with vast private sector input.
Adrian, there may well be waste in the NHS and even too many managers, but that is not an excuse to rip it apart and start again.
If you have trouble with your plumbing at home, you don’t knock down the house and build a new one, you tackle the problem.
We glibly talk about too many managers and bureaucrats but this is one of the biggest budgets in the country. Any business with this much turnover would have a lot of management.
And I am not sure the government plans will get rid of the management – it will just privatise it.
The tories say they are forced into this by the economic crisis yet one of them admitted on the radio today that they have been planning this for 25 years. Which is it?
They ramble on about the market giving patients choice. But this isn’t a restaurant where if you don’t like the service you don’t go back. This can be a matter of life or death and only one chance. What we want is not choice but a high quality service wherever we live. And will we be able to trust our GP’s advice when he might be just choosing the cheapest to help his budget?
Adrian it doesn’t need a Nurse do dole out a bed pan. We were trained for medical management. We were State Registered Nurses, who had Enrolled Nurses as the bedside Nurse and auxillaries to aid that process , the dosmetics and other ancillary staff to help us.
We held the hospitals up with our specialised disease based training and organised our wards accordingly. Do not undermine my profession.We are ther to ensure all neeeds are met , but not personally DO THEM. I with many others have executed every task in the book , but we have built our expertise on many years of education ongoing expert training and all you can comment is some don’t get bedpans on time. Think Auxillary Adrian.We made sure people were safe and staff looked after pts.
Sorry Margaret,i often agree with you , but if you believe being trained as a nurse to whatever degree is a reason for not doing, you have hit the nail on the head,why the NHS is not producing the results we the public expect of it.The fact is there are obviously not enough people doing the DOING.I was an Executive officer in the civil service in the early 70′s, it didn’t stop me visiting claimants and assessing them .I was a Police Sergeant in the late seventies , it didn’t stop me doing routine policing.I was a Sales Manager in the late 80′s , it didn’t stop me selling.
If you are a nurse ,you are trained to nurse and that includes looking after the needs of patients , and ensuring needs are promptly addressed.From your argument ,there are obviously more chiefs than i ever imagined and clearly not enough indians
If you look at my reply you will see that I said that there was not a task I have not executed , but we have to acknowledge that there are job roles and we cannot possibly do everything and everybodys role all at once no matter how clever we think we are.It is arrogant to think that your services are needed everywhere and that is what we have to get away from .
Bed pan doling is not a Nurses role pursae it is undermining and laughs at all that money spent on education.
I’m sorry Margaret , that whilst i admire and respect what nurses do and the fact that some take courses to improve both their prospects(my sister is a state registered nurse)and abilities i still believe that when called upon or needed, be it bed pans or not , it is a duty to look after ,often very infirm patients.Someone in need can not wait for an auxillary ,and if there is a nurse of any standard in attendance , they should react to that need.
Perhaps you have hit upon the main problem with the NHS.Everyone is too qualified or too tied up with their own importance ,to do the job of nursing,and basics that are needed.It strikes me that what was once a vocation is now a superior career path into being in charge and DOING nothing.
Adrian I don’t think you get the point. It is the job of Auxillaries and HCA’S . We all help out now and again , break off from paper work or discussing , checking or planning care and clinical interventions but staff are employed for those roles ..why take their job? It is not fair to those who dedicate their lives to basic care.How would you like it if someone took over your job?
You wouldn’t ask a doctor discussing care at the station to get a bedpan, then why a nurse discussing care? Employ the staff whose job it is.
Margaret , that reply says all that is wrong with the NHS.It is not my job , i am too important to do routine nursing .So in the end there are no nurses nursing, yet i will repeat they are nurses, that is their job ,to nurse(look after) the patients.There are plenty of junior doctors to discuss and plan care and intervention with a consultant.How can anyone carry out those functions if there is no one at the front end ,in close contact,other than an inexperienced person.It needs highly qualified nurses , dealing with the patients every need and my understanding of dedicated nurses , that is exactly why they enter the profession
Yes – as Milton Freidmann said – a time of crisis is a great opportunity to get thro’ unpopular legislation .
What realy gets me [ well besides Cowen last nite ] was the way Cameron at some meeting or debate on TV prior to the election and speaking of his own sad loss – and his expierince with the NHS said ” the NHS was safe in Tory hands ”. It seems now this is not the case . Time will tell – but if health is to be a market commodity – what morality is there in that – it is as Sam says ” Terrifying ”. All the gold in the world is not worth ones health .
It seems we [ Western countries in general ] follow the US blindly – this has been proven to be a dangerous practise on all fronts .
This is IMO leading to Privatistion of healthcare- [ tax didging, profiteering ]. Why not Privatise the Army and Navy etc ??. I wonder what entrepeneur would finance the war in Afgahistan or Iraq ?
All the gold in the world is not worth ones health .
I agree Jim , but that does not mean the NHS is either free or does not have a finite budget.It is a great institution,that my family has used on several occasions.Yet i have never seen a manager.Nurses stand around a nursing station and make many patients wait for the likes of bed pans when they are desperate.Unlike in the private sector there is no rush or desire to present the best service possible.There are neither incentives to provide a stirling service nor disincentives to stop poor service.
Reform and a sense of pride need to be established.The cost of management needs to be capped in favour of front line services.It remains to be seen whether the proposed reforms tackle the problems
The Taliban
Adrian you do not agree at all ,you want all staff to be doling out bed pans and not attending to the many other requirements a ward needs. No wonder staff are frustrated with these comments as sisters work a 14 hr day, order coffee because they have not had time to have one break, manage staff and facilitate courses ,attend courts ,tend to mountains of paper work , ad infinitum.They keep pts alive, with highly clinical technical requirements. Do you fully understand the amounts of planning / paperwork 24 hr care needs. No nurse can get by without discussing the patients frequently and have constant interruptions from visitors ,telephones, other health professionals, managers and not least of all the pts. I am afraid you cannot have all staff doing everything Bedside care workers should be respected.No one job is more important than another , but medical management ensures that the correct people for the job are doing the right job in an organised fashion.
By actually saying that staff are full of their own importance is stating that you think some things are less important than others.It reminds me of a police officer talking about “my superiors” no one is inferior.
Margaret , you have not looked at my argument at all ,but can you tell me the number of auxillaries and HCA’s on duty at one time and the number of supervisory nurses,supposedly discussing cases , clinical need etc and too busy to nurse???When i visited my son on a regular basis over a month recently,non of your so called supervisory ,clinical care nurses could (or would)give me an update on his condition and despite there being several nurses chatting at the nurse centre , it took ages for him and other patients to receive basic urgent attention.As much as i believe the hospital saved his life , at grass roots the service was disgraceful.ARE YOU BLAMING THE AUXILLIARIES FOR SUCH LACK OF CARE.?
i DO NOT THINK ANY NURSING STAFF IS LESS IMPORTANT OR MORE IMPORTANT THAN ANY OTHER, BUT YOU CLEARLY DO AS SOME ARE TOO IMPORTANT TO CONSIDER BASIC NURSING
Hi, where can I find more of the cartoon of Hu
measuring for curtains in the Whitehouse?
(brief clip on C4 news about 30 minutes ago)
Thanks.
Curious, Moonbeach: what’s a ‘self-respecting business’?
One which respects its staff, its customers, its suppliers and its owners. There are many of these in the UK.
You clearly have experience in the NHS. I will believe you if you tell me that its structure, its operations and staff levels are efficient.
You will, however, have to overcome my experience in trying to take over hospitals.EG. Duplication of nursing staff sitting behind desks, surly non-medical staff, ignorant sisters who will finish ordering coffee on the phone rather than deal with visitors waiting for service. Dirty wards; the excuse being that privatised cleaning is to ‘blame’.
It’s not. It’s badly administered contracts and nurses who don’t want to insist on high standards.
You will know that good ward sisters run brilliant wards, patients are ‘nursed’ and treated with respect. Senior citizens are not called by their first names but are given some consideration for their age.
You might also compare performance in, say, the North West with anywhere in the land to see that post code lottery already exists in the NHS.
Businesses are profitable because they deliver what their customers want. There is no such ‘driver’ in the NHS.
Moonbeach i quite agree , see my reply above to Margaret .
Only first-hand experience of NHS is as patient/mother/friend, not as employee, Moonbeach.
I believe passionately in socialised health-care, however – some things are too important to be left to profiteers. That doesn’t mean no changes/reforms are necessary (see postings elsewhere on this page) to present sickness-based model. As in every aspect of contemporary life, we’ve become like co-dependents – the health needs multiply in a society that’s making us sicker – obesity, diabetes, rickets, antibiotic resistance etc – so unless we re-define what the NHS is for, the system which has served UK citizens so well – have you/family been its beneficiaries or do you exclusively use private facilities? – will collapse under the strain of increasing and unsustainable demand.
‘Businesses are profitable because they deliver what their customers want. There is no such ‘driver’ in the NHS.’
Big Pharma is highly profitable. It’s leaching millions from the NHS – see links elsewhere, as New Tories’, aka New Labour’s PFI programme – £30m a year in rent alone in 2008 for London’s UCH. Money-making is in contradiction with needs of citizens’ good health and for the NHS.
The emotive clamour about ‘privatising the NHS’ is misplaced, similarly the new proposals do not change that key basic principle of ‘free at the point of need’. All that the new Government is proposing is a different method of service delivery and management – and if that includes some aspects delivered by private companies, then that is not inherently bad, it only becomes bad if it is a worse service or at a higher cost.
Whether this will actually prove more successful will only become evident after the fact – at the moment we have two sides, one puffing up the potential benefits of the change, the other resisting change from habit.
What cannot be denied is that, for the amounts currently invested in the NHS, the outcomes do not compare with similar nations, so we must be doing something less well than they are.
If the ‘free at the point of need’ mantra remains sacrosanct (which it should), then it becomes a management and organisational challenge to improve the service value derived from the cash invested.
Whether your local ‘Harold Shipman’ is the right lead-agent is a moot point, but most other configurations have demonstrably failed, so it might just work.
Interestingly, More or Less on Radio4 on Friday examined the claim about outcomes being worse than in Europe and found that it was very dodgy statistics that fail to take into account the fact that, for example, France and England register cause of death in a very different way.
In fact the overall health outcome (which the government claims is its aim) is very similiar in both countries.
Also interesting that the comparison with likelihood to die of cancer being lower in Europe is used as the benchmark to justify change.
However the fact that our youth unemployment is higher than Romania’s is not considered a worthwhile benchmark to put more resources into tackling that problem.
The truth is that we have an ideologically driven government that doesn’t give a toss about the pain it is causing.
Clearing the deficit at such a pace and at such cost is like me cutting out everything but bread and water in order to pay off my mortgage in a couple of years instead of the 15 I took it out over. It’s unnecessary and will do more harm than good. But to the tories it is a great excuse to dismantle the state.
Marx?
The foundation of Marxism is an ideological ‘ truth ‘ which may or may not be true.
i.e. Materialism.
So before you have even started you have imposed ‘truth ‘ on the whole population that may or may not be true. And presumably in order to uphold the system this ‘ truth ‘ would have to be ‘ policed ‘ so you would most likely end up like any other communist state in squashing dissent and so free speech.
Presumably you would also ban all religious and spiritual endeavours etc etc? Philosophical systems and creative works that challenged the materialist notion?
Sounds like a very ‘ free ‘ society.
But at least we would all be nice and poor!
Well, apart from the bosses!
The Statins available are wide and varied.In many people they not only help those with high total cholesterol , but correct the balance of high density lipoproteins , low density lipoproteins and triglycerides. One of the problems is that until the medication is given we don’t know how effective it will be, as there are many forms of dyslipidaemia/ hypercholesterolaemia. To leave it to chance and not give, could lead to macro and microvacular difficulties as life progesses and once vessels are damaged due to these effects,reversal is almost totally impossible. Remember blood vessels supply all major and minor organs.
The side effects of statins are most commonly alteration in liver function tests and muscle problems, but these can be monitored. To start a scaremongering scam with these life saving drugs is wrong in itself.Generally the good results they produce outweigh the bad. I would not leave any pt to chance where I am sure I could make an impact on there chances of surviving longer without organic or vessel damage.
btw, sorry that was obviously meant for jon’s previous blog.
still, any comments ?
Egon, what a shame its in the wrong blog! Nice comment.
Has anyone considered the effect on the relationship between doctor and patient when we don’t know if the treatment they are recommending is what is best for what ails us or is because their budget is low or they have a special deal with a local provider?
And given the way market forces have destroyed our manufacturing industries, and the way market forces have distorted banking at the cost of thousands of jobs, do we really want market forces to control our health?
The more I look at this, the more frightened I become. How long, I wonder, will it be before it is as hard to find an NHS GP as it is now to find an NHS dentist?
Saltaire have you ever been shopping for an item and found the differing costs for the same item from different sources?I understand not only is it the same with medical items and even with drugs.Plus take the current medical discussion with statins.A drug given to millions where it is only beneficial to thousands.The number of houses i visit where they have boxes of drugs and are taking anything up to a dozen different ones a day.When my wife was alive she had four prescription pain killers(plus other drugs)that she could take up to six of each a day.Can the body seriously cope with such amounts?Are doctors serving their patients or reacting to stated symptoms?Is there any real control?There certainly doesn’t appear to be any financial control.
What is the point of pumping billions of pounds into an organisation without control?
Just look at what happened to the banks and bankers without financial controls, and is still happening.That is a private sector organisation ,much of which should have been allowed to go to the wall.It just shows how much more important it is to control the finances of a public organisation.
But, Adrian, they are handing the control to GPs, the people who are prescribing the drugs at moment. Of course the NHS needs controlling but someone who has trained as a doctor is not necessarily the best person to manage the budgets. This government is getting away with dreadful cuts by saying it is only management or back office staff yet if you look through their expenses they all rely on back office staff.
And of course I have ‘shopped around’ for something I have wanted to buy but you have to know something about the product to be able to judge if it is good value or not. How am I supposed to know if one hospital or one surgeon would provide me with a better operation than another? Logic tells me that my GPs would be a good judge, but would that still apply if they have to take into account their budget or the fear of being sued by another provider if they don’t go for the cheapest option?
I’m sure the NHS can be improved but I have seldom seen any organisation made better by turning it upside down and starting again.
This speak Sam is to direct pts to a Bupa style surgical process and there are far more medical issues than surgical ones. The whole point of THE NATIONAL HEALTH SERVICE IS TO PROMOTE NATIONAL HEALTH.
Working with Quality outcome frameworks has been in existence for almost 10 yrs now . Success and ongoing observation of conditions is closely monitored with added incentive if a patients conditin is improved.This is a good system and ensure all pts are seen frequently and monitoring of medication is ongoing. This ensures that pts are not simply discharged from hospitals with a conglomertae of medications they don’t often need and which have lasting damaging effects which can impact on pt health in the long term.
I have enjoyed working with this method for many years now. It develops understanding of conditions , collects data and evidence and furthermore it widens the scope for improved preventitive practice . It hasproved to be succesful in that private drug firms bring evidence of new drugs , provide courses for the clinical staff and enable all to keep up with modern ideas and changes. There is less availability of update courses either hospital or university.
The problems which can be forseen though are the ones which will impact on the GP’s budget and be withheld when there is a solveable problem
I’m an American but love Britain my surname and my Great Grandmother are from there. In Britain the health system still costs about about 50% less than it does in the US. The US is run by private insurance companies who rip off the public and Medicare which is health care for the elderly. I would focus on improving the NHS rather than private Insurance if I was Mr. Cameron.
Of course the NHS can be improved, its Big Pharma and unnecessary treatment bills slashed. A link to our very own C4 News:
http://www.channel4.com/news/nhs-wastes-tens-of-millions-on-expensive-diabetes-drugs
gives the Dec results of its joint investigation with the British Medical Journal. Around £250m – a quarter billion! – overspent on the latest diabetes drug, of no greater benefit than the one it replaced & against NICE and WHO advice. The same month, the GPs’ mag Pulse suggested patients be advised to reduce salt-intake as an alternative to drugs (personally, I thought the value of less salt in our diets had been common knowledge for some time). And why should infertility treatment be available on the public purse? It’s neither a disease nor a condition requiring emergency treatment.
What we need surely is a de-medicalised C21 NHS, with health, not treatment at its core. The scenario Adrian draws is widespread, and deplorable. We’ve allowed the medicalisation of health to creep upon us, antibiotic resistance being a prime example. Nor has medicalised health prevented the return of rickets. Time to reclaim our health, and our bodies, for ourselves & no to Tory juggernaut.
It is a womens right to become pregnant but how many times is debateable.A large proportion of infertility both primary and secondary infertility is born out of a disease ‘polycystic ovaries’ this needs treatment as any other disease.
One of my previous posts was a Specialist Fertility Nurse. You would not understand the grief infertility causes.
Meg , the whole point of the NHS is to respond to illness.To treat and help.Nothing more .I agree fertility treatment is not a health issue,nor are sex change operations or cosmetic surgery.I am afraid that equality,diversity and ethnicity are getting in the way of the reasons for a NHS.
Anything like preventive remedies,general health etc should fall outside the NHS and be privately funded
Fully understand, Margaret. But grief has many causes, I’m sure you’d agree. That in itself can’t be a basis for social policy.
The urgent debate we surely need about the NHS is what it’s for, and what it should encompass.
I cannot support the very large amounts of money given to self imposed problems like drug and alcohol abuse, smoking, obesity and deny support to those who have problems with fertility due to thyroid problems , diabetes , polycystic ovaries etc. The balance is immoral.
The masses who self abuse ther bodies in this way are denying those young women a right. Remember fertility treatment asks that these women do not partake of any of these bad habits.
No I don’t agree Meg. The grief caused by infertility is usually simply due to that, without any other social cause. It is a get out to suggest women do not have the right to become pregnant due to ill health.It is discriminatory . I respect all pts rights and the brillint NHS I have had the privilege to be part of since 1968.
There are too many opportunists trying to privatise not for better all round health , but for their own ulterior motives.
I have also been through a system where organisation was excellent until highly paid managers came in and wrecked it and took the money.
Unfortunately academia presents evidence which it has prepared for its own self serving puposes and self aggrandisment., and does not refect reality.
First of all please excuse the many replies in this section . looking after the health and well being of people in this Country has been my life and my experience has been for over 40 yrs .
NICE Guidelines are excellent and I have used them many times, however they are simply that Guidelines.
The types of medication available though are not sufficient for the increasing Type 2 diabetics we have to treat. The problem will become more and more expensive if we don’t hit it hard with available medications initially.
As the disease progresses , kidneys fail, eyes fail , circulation fails, hearts fail and notwithstanding the vast amounts of money required to the correct the problems at this stage , there is also the distress of not being able to find spare hearts , kidneys and eyes to transplant.
We as Nurses and Doctors who monitor Diabetes are finding it increasingly difficult to keep glucose levels down. We need a wide variety of drugs to be able to do this.
For those that can’t remember… the system of GP’s controlling budgets has been tried before in the NHS in the 1990′s…. GP fundholding ring a bell with anyone.
Well wouldn’t it be interesting to see how well GP’s did in improving clinical outcomes, controlling spending etc last time. This may well give an indication of how it might pan out this time.
Guess what there is suprisingly a great deal of published research…. the journalists must be to lazy (or Tory) to be bothered looking.
Thats because the evidence suggests that GP fundholding had no impact on clinicla outcomes and no impact one way or the other on efficiency.
As you’ll hopefully see from the links below. The evidence on success or failure is generally deemed to be inconclusive. So if Mr Lansley is claiming to have any evidence I would suggest he is doing a George Osborne and misspeaking (Google this and you’ll get my drift).
While there was little robust quantitative analysis at the time
(Dowling, 1997), a recent study of data from one health
authority covering 1993 to 1997, concluded that fundholding practices were able to secure reductions in waiting times of about 8% for their patients requiring procedures included in the scheme, compared to all other
patients (Propper et al, 2002). These waiting times relate to the period from the decision to admit to admission, but,arguably, the impact of fundholding budgets on GPs’decisions to refer is also important. There is anecdotalevidence that some fundholder referrals were delayed due
to budgetary constraints (Bagust, 1994). More recent research comparing the period before and after the abolition of the fundholding scheme has shown that fundholding status reduced the waiting times of fundholders’ patients by 5-8% and that these practices would probably have had higher waits than nonfundholders had it not been for holding a budget (Dusheiko
et al, forthcoming).”
Two tier system… remember, this was when common to wait 18 months, what impact would they have when patients only wait 18 weeks.
Resourcing
Research evidence supports the hypothesis that the more successful primary care commissioning organisations have higher levels of management and other professional support (Malcolm et al, 1999; Wilkin et al, 2001; Weiner et
al, 2001; Regen et al, 2001; Mays et al, 2001; McClelland
et al, 2001; Dopson and Locock, 2002). The national evaluation of total purchasing pilots showed a statistically significant association between a pilot’s ability to achieve its
commissioning objectives and its per capita management
costs (Mays et al, 2001, p85). Adequate management support is considered to be vital if primary care commissioning organisations are to gain the confidence of secondary care colleagues in purchasing negotiations, and of their constituent practices which expect the organisation to properly support primary care-led commissioning activities. UK commissioning organisations, in general, have had low levels of management support when seen from an
international vantage point (Weiner et al, 2001), and the issue of commissioning capacity is regularly cited as a reason for the perceived lack of progress with commissioning in the NHS.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314221/pdf/11885824.pdf
One early review of the available fundholding literature concluded that there were ‘extensive gaps in current knowledge about the impact of the scheme’ and that the claims that ‘GP fundholding has resulted in improvements in efficiency,responsiveness, and quality of care are in general not supported by the evidence’. Another review argued that ‘few reliable conclusions about fundholding, either positive
or negative, can be drawn from existing research’. A review two years later also concluded that there was a dearth of
high quality evidence on many aspects of the fundholding scheme, particularly in relation to referral rates, patient outcomes,
and service quality. A review of the scheme’s
effects on prescribing found that, in the short term, many early-wave fundholders had managed to secure economies in their prescribing by switching to cheaper, generic drugs.
However, in the longer term, such savings may not have been sustainable.
http://www.york.ac.uk/che/pdf/streetmanaging.pdf
Evidence from the GP fundholding
experience about the effectiveness of budget-holding at practice-level is mixed (12) .
GPFHs were able to achieve some benefits for their patients, notably with respect to… See More
better access (13, 14). But observed differences in referral rates between GPFHs and
non-GPFHs were due more to other characteristics of practices and the more generous
funding received by GPFHs, than to holding a budget (15, 16).
Note: the more generous funding comment and my previous mention of two tier system.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410181/pdf/brjgenprac00086-0043.pdf
However, from the review presented in the present paper, one can draw some tentative conclusions. Although costs have been
contained in some areas, such as prescribing, it is not clear if this has been at a net saving to the NHS.8 Nor is it clear that changes
in referral, contracting or prescribing have led to improved health outcomes, or that patient involvement in their care has improved.
http://www.gloslmc.com/guidance/previous/PC%20led%20commissioning%2005.pdf
To achieve this, commissioning organisations need
to be given a degree of organisational stability and a chance to prove themselves. Providers have had relative stability for some 15 years whereas
commissioners have been subject to numerous major imposed reorganisations.
As noted in the previous section, one of the main reasons for the limited availability of research evidence about the
effectiveness of commissioning is the regularity with which NHS commissioning bodies have been subject to structural reorganisation. There is however extensive to support the need for NHS (and other) organisations to have structural
stability if they are to be able to deliver on longer term strategic objectives and avoid the inevitable distraction, loss of momentum and morale, and costs associated with
reorganisation (Smith et al, 2001, Fulop et al,2002).
commissioners have therefore been in
something of a vicious circle – damned for not achieving adequate change in secondary care services, yet destabilised by reorganisations that undermine local relationships..etc
Thankyou for your patience in reading this evidence.
The central plank of the Tory led government re-organisation is based on improved outcomes for patients it seems. (We know different really…its letting private health providers take over commisioning and set hospital against hospital with differential pricing to attract business and have private sector providers mop up failing organisations)
Assuming the first bit is correct, well research suggests that giving GP’s control of £80 billion worth of expenditure will by and large not achieve improve outcomes for patients. The research i’ve quoted says so.
Could the theory in brackets therefore be true.
Very interesting but who funded the research that you so obviously believe?
Other research showed that hospitals in Liverpool and Manchester were at the bottom of the ‘outcomes’ table. Do you believe it? And if so, how many doctors, nurses and managers were sacked?
First hand evidence can be obtained by visiting an NHS hospital and comparing it with a private one. The whole experience, from the attitude of cleaners, support staff, nurses and doctors, is different.
People who work in the public sector and are financed by taxpayers want to defend the Status Quo. I don’t blame them for that. Turkeys really don’t vote for Christmas.
But nobody in the public sector has any reason to be efficient and some antediluvian trades unions will work their hardest to ensure that change does not happen!
A created ‘Offpat’ (Office for Patients) could, however, monitor charges and consultancy fees as is presently done with Energy, Communications and so on.
And here’s an idea. GPs could create ‘Practice Governors’ from their patients with a similar role to those in schools; Big Society involvement or what???
Interesting that the government that plans to give GPs control of the biggest budget is about to take back the ordering of flu vaccines because GPs made a mess of it.
Indeed, Sam. These links from current Pulse are also interesting:
http://www.pulsetoday.co.uk/story.asp?storycode=4128304&cid=Latest_headlines_1_210111&sp_rid=NjcxMTQ1NzA3OQS2&sp_mid=36199099
http://www.pulsetoday.co.uk/story.asp?storycode=4128303&cid=Latest_headlines_2_210111&sp_rid=NjcxMTQ1NzA3OQS2&sp_mid=36199099
It is, I think, time we analysed how bureaucracy arises in this and other public services. There is a strong case that much of it directly arises from parliament’s endless meddling.
In the past, I’ve quoted these figures about Job Seekers Allowance (a supposedly simple benefit paid to unemployed people) – the current description of that benefit is 838 pages long, uses 288 abbreviations and refers to 66 statutes and 134 statutory instruments. So, the “rules” for paying JSA to the claimant reflect 200 separate pieces of legislation.
It’s hardly surprising that the resulting benefit is costly and difficult to administer – the cost and difficulty was built in by the process used to create and modify it. Every area of the public sector is faced with this same core problem.
The idea that professionals (eg GP’s) could manage commissioning without either hiring managers and administrators en masse from the PCT’s, or subcontracting the work to the likes of Serco, seems hopelessly optimistic to me, unless the “rules” are drastically simplified. My suspicion is that, yet again, a public service will be exposed to turmoil, while the true causes of inefficiency survive the “reform”.
I agree, Paul. I am convinced that most of the jobs ‘saved’ by closing PCTs etc will merely shift to the private sector and be employed by GP practices. The difference will be, if things like Margaret Thatcher’s privatised companies are any guide, that the wages will be higher and the state will end up paying more than it was in the past. In the case of the NHS that will mean less available for treatment.
I repeat my fear – in five years time it will be as hard to find an NHS GP as it is now to fnd an NHS dentist.
The reason I doubt the government’s motives are anything other than privatisation is that I cannot imagine any comparable sized business in the private sector going about reform in the same way. Can you image Barclays sorting out their problems by handing control to branch managers?
Agree with both Paul and Sam.
Cutting costs of time-consuming bureaucracy in benefits payments is a sound reason for supporting a Citizen’s, sometimes called Basic, Income, an idea spreading steadily even in some initially surprising quarters, eg FT’s Samuel Brittan, a thoughtful capitalist and a decent man, as far as I can tell. No time now to develop the CI idea but recommend look at http://www.citizensincome.org
Excellent analogy with Barclay’s, Sam.
Sam that is exactly what a branch managers job is , to manage his branch and his customer base.That does not mean there is not a management structure above him.That is how the private sector runs .Managers manage small areas , though sometimes 1-4 to a county and they compete against each other for results.It is easy to spot failing managers and either support or move them .That way there is also more pride, more effort and more cost efficiency.The private sector(unless it is banks) can not rely on government hand outs.I believe the banks were helped because the government were too reliant on their income
2 Points.
First SERCO is a brilliant Company. Just look at its track Record. There are others in the Service Sector that are just as good and also ambitious for change.
Secondly, Sam, you are quite wrong. Banks and businesses have been ‘empowering’ their managers and employees for years.
Why? Because every person has at least one great, profitable idea in them and this is a way of developing them.
Even the Civil Service has a suggestion scheme but loses momentum by ‘staffing it to death’ instead of just doing it.
Privatisation may not be a panacea for all ills but it may just breathe life into the near moribund NHS!
Adrian, I’m not sure you are right. In the trade I knew best, bookselling, the branch managers certainly don’t have much say and I suspect that is true in most large companies. Bookselling chains do more and more of their buying at central level and send out to branches and even when I was starting out in WHS 45 years ago they were introducing a stock control system that meant all the branches had pretty well the same stock.
You really can’t image Tescos or Asda allowing their branch manager to source meat locally when they have massive contracts with national suppliers.
Eric Pickles is urging local government authorities to combine ‘to use their collective power to get better prices’ but for some reason the government says the NHS is going to work better by giving control to a larger number of consortia.
The more I look at the NHS proposals, the more it looks like privatisation by another name.
Sorry Sam, but if you go into an Asda store in South Wales, you’ll find it sells Lava Bread, the local delicacy. But in your own local Asda in Shipley, there’s not an ounce of Lava Bread to be found (fortunately, as it’s horrid).
But that’s how the private model works – sure they use their mass purchasing muscle to get the best deals on things they know will be needed everywhere, but local managers have the authority to complement that to respond to local needs.
I’m not confident that the Coalition’s proposals will prove quite as successful as Asda or Tesco, but Health is also an issue which has a common core but with local variations. If they set out to mirror the methods used by the best of the private sector, they could actually achieve something.
However, as we have seen with the last 20 years of PFI disasters, when Government tries to be smart, the ‘vulture element’ of the private sector always proves smarter – and that’s the major risk in the current proposals. That’s not a party political point, it’s just how it is, and that’s sad.
No disrespect Moonbeach, but do you use a high street bank? Thirty years ago the staff in the local branch could make decisions about whether you were a good risk, based on your track record and their personal judgement. Now they essentially fill in forms, and you get the loan based on some set of inflexible rules applied in some remote location. It’s hard to see any “empowering” of employees in this, more like deskilling.
See report from surgeon -http://www.channel4.com/news/nhs-surgeon-lansley-reforms-are-a-phony-revolution
Andrew Lansley has promised replies to all email questions about his ‘reforms’. Snowbloggers could get writing pmquestions@dh.gsi.gov.uk
Paul, i agree .It is the same in every sphere of public operations.The problem is a parliament that sits all year , seems to believe there is a constant need to produce legislation.That is new legislation ,changes to old legislation ,Why?
Last week the Police prosecuted someone , using 19th century legislation.There is plenty of legislation in every walk of life.There is no need for more.Legislation of any shade is the mecca for lawyers and judges.Not only is our own legislation far too much, far too complicated , but the ability of European judges to over ride or pass binding comments on it beggars belief.
I was thinking this morning how hard it is for those of us who take an interest what is going on to keep the big picture in focus. Or perhaps it’s just me.
The frustration of student fees, loss of educational maintenance payments and the fear of the NHS being privatised all press in and fill me with alarm. Then there’s the frisson of Coulson and Johnson/Balls and what they might mean.
It took Mr Blair’s self-seeking performance at the Chilcot enquiry to remind me that the government who are slashing and burning public services are still maintaining nuclear weapons and still fighting an unwinable war in Afghanistan.
Without the Iraq/Afghanistan wars and the bankers, we wouldn’t have a financial crisis. Obviously neither is the present government’s fault (though they did nothing about either in opposition) but their choose of who pays the price is.
If nothing else, Mr Blair’s testimony should tell us that there must be much greater safeguards put in place to prevent people like him taking us into an illegal war with lies.
Andrew Lansley has promised to reply to every email about his NHS plans – pmquestions@dh.gsi.gov.uk Get emailing, Snowbloggers!
Thanks, Meg. Email on its way
The NHS, the biggest employer in the UK,and almost the biggest in the world.It was set up because of poor health care pre 1948,and the inability of the man in the street to get adequate health care.It has evolved over 63 years into an organisation that we all want and all believe in.Yet has it got any better,any more caring,and are we the public getting value for money.There have been many quotes on this blog from various periodicals,studies and a nurse.I read one, it is a socialist organisation .Thank god it is not , for all the Socialists are capable of is a mantra of interfere and spend.They always cost money , destroy treasured institutions and make them unworkable and too expensive.
I have read that for the NHS to buy privatised treatment ,still keeping the service free at the point of use ,is privatisation.If that privatised treatment is cheaper, better and free to the user , why not use it?
cont/
The worst comment i have seen is that nurses are too grand to nurse ,because they are too experienced.What a load of c**p.If i am ill in hospital, i want the best care available,when i need it.If i need the toilet and can not wait i do not want a too qualified nurse standing around chatting about my condition whilst i suffer the ignomy of soiling my bed.I do not want unqualified, unsupervised people doing the menial tasks because it is too beneath someone who chose nursing as a vocation.For that is what nursing should be; a vocation.I believe if we cut down the bureaucratic costs of the service it could and should result in better remuneration for those at the bottom.
The NHS should concentrate on the primary job of restoring and maintaining the publics health.It should not be used for cosmetic reasons ,for fertility or anything that is not health related.There is an excellent private sector for that.
I also believe that the private drug companies have far too much power and say over normal GP’s.
Adrian, I’m delighted you still have so much faith in politicians.
You only have to see the way NHS dentistry, opticians and prescription charges have gone to be afraid that ‘free at the point of delivery’ is not a cast-iron guarantee.
When private companies get involved in running GP practices, as they certainly will, how long do you think it will be before they start finding ways of increasing the profits by suggesting that doctors, like dentists, could provide a ‘better service’ if they went private and sold their patients an insurance scheme? It will start with small things and gradually expand.
The only way I could find a good dentist when I moved here just over ten years ago was by paying such an insurance. It started off at $10 a month and is now up to £32. How much do you think an insurance to cover all medical eventualities will cost?
I’m all for efficiency and we could save a fortune if we regulated drug companies better, but this is going too far and too fast.
Sam it is nothing to do with having faith in politicians , for i certainly do not.That includes the current lot too.
Neither have i been arguing for these particular reforms,but i know that if people want the cherished cow of a free NHS that something needs to be done .It can not continue in its present expensive bureaucratic form.The country can not afford it.
You say “I’m all for efficiency and we could save a fortune if we regulated drug companies better, but this is going too far and too fast.”
yet you decry ,as most Socialists do the Private sector,where streamlining, economy is an absolute must to survive.If the NHS is to survive ,free at the point of use , it needs some of those economies
But Sam, private companies are already ‘involved in running GP Practices’. Chances are your local GP Practice is actually a private company, technically a partnership, which is paid amounts of money by its main customer, the NHS, based on a Capitation Fee, plus extras, for the patient list is has.
The ‘partners’ then employ other staff, pay rent and overheads etc. and, at the end of the year, share out the profits between the partners (i.e. shareholders)- the ‘profit’ being the excess between what the NHS pays them and what it costs to run the ‘business’.
The only difference between this ‘private’ model and the one you fear is that some of those shareholders would be external – but even that happens now, as retired GPs often retain their partnership-earner long after they have put down the stethoscope.
We need to be careful not to cloud objective analysis of the NHS with emotional views of what we believe it is, rather than what it really is.
At the sharp-end, it really is a group of privately-managed services, paid for by taxation, from which the shareholders take profits. And that’s private enterprise in the NHS, whether you like it or not.
Question: If a medical degree requires 6yrs training, does this mean medical undergraduates are:
a.Peculiarly clever;
b.Peculiarly thick?
Ask yourself – is there any serious comparison between what a GP does (prescribing valium/getting you in touch with a ‘specialist’), and what a nurse does (pretty much everything).
This society’s debunked lawyers and bankers – maybe it’s time to debunk 100k (average) doctors.
Glad we agree on the role of Big Pharma, Adrian. Would be interesting to know the figures.
Meantime, this report http://www.channel4.com/news/nhs-surgeon-lansley-reforms-are-a-phony-revolution is telling on the waste of time/resources that results directly from patient choice in the surgery in one area alone. This cannot be blamed on the NHS, am sure you’ll agree.
Meg i read the artucle with interest until i came to “In 2008 David Gray was killed by lethal injection by a Nigerian doctor registered in Germany, working for a private firm called Take Care Now, on behalf of the NHS in Cambridgeshire. “and realised the amti bias in the article.If you go back over that case,the doctor concerned had to be employed because of EU rules.
Take Care Now was a private out-of-hours service, Adrian. EU rules had nothing to do with that.
Meg if you go back over the case we were aware that the doctor was not up to UK standards but under EU rules he had the right to practice in the UK.”Take Care Now were an organisation authorised to do out of hours work, by the Labour government who despite giving large salary increases to doctors ,did not stipulate that this would also mean doing out of hours work
Adrian, foundations of the ConDems juggernaut out to destroy socialised health care were laid by New Labour, aka New Tories, including the PFI infrastructure arrangements, a sleight of hand to keep the expenditure of the books. Please don’t assume that all who are critical of ConDems are automatically Labour party supporters. NB Labour Party is not a socialist party, by the way. Ask Tony Benn.
Meg, as ever you have hit the nail on the head. Ever since I’ve been on this blog I have been trying to tell Adrian that opponents of his tories are not necessarily supporters of the current labour party. Throughout the election I was complaining that there is nowhere for people of the left to go since Tony Blair infiltrated the ranks like some undercover cop.
So, Adrian, please take on board – New Labour is not a socialist party. It is scarcely a left wing party. If it were, we would not have had tuition fees, private health providers invading the NHS and the gap between rich and poor growing wider on their watch.
The problem for people like me, and I suspect Meg, is that the alternatives are worse. Many flirted with lib-dems because they appeared to be of the left but turned out to be a load of chancers who would say anything they thought would get them elected.
And before you point out that I admitted to voting labour, it was only because we have an ultra right wing tory MP and even you, died in the wool tory that you are Adrian, would be preferable to him.
Meg and Sam , it is strange that when i first started blogging, only two years ago,there was not the big outcry against Labour that there is now .Not until some realists realised what a god almighty mess Labour had infact made of the economy.Were we in better financial straits than we are now ,those same voices would still be praising Gordon and his cronies.Except for maybe Jim , there was no one , particularly you Sam and Meg crying out for a different Socialist party.I wonder what form that Socialism that you crave would take?Would it be the late Soviet model, the late Chinese, or do you favour the current Cuban model?
I find it very strange that the Chinese and Russians ,and for that matter New Labour are and have cast off their Socialist image as being unworkable in a modern expansionist world.Perhaps because it is an unworkable utopian ideal in a capitalist world.I have never argued for the greed of many capitalists such as bankers , or footballers who neither work nor on the whole have the ability to earn , other than by kicking a ball around,to be continued
cont/ I do not believe that bankers should be allowed to keep their ill gotten gains(bonuses)nor sportsmen receive such remuneration for playing games.In fact to the contrary i believe that such monies should be highly taxed.We might even get less foreign footballers and a decent England team that way.
My problem with the Socialist utopia you seek , is where is the money going to come from to pay for all the state jobs.For at this moment in time even the Capitalist system can not supply sufficient to maintain the state in its current form .As Meg well knows as in LVT, if you can provide a convincing argument for a better system i would support it.I am not the died in the wool tory you believe i am Saltaire, but at this moment in time i do not know a better way forward for this country i love.
Incidently i am no supporter of Cameron , the coalition ,nor their views particularly on Europe,but anything is better than the old(new) labour party and many of their cheating , lying members
So, Adrian, I’ll ignore you saying I never criticised labour when they were in power – you were only reading what you wanted to read, methinks. And it wasn’t just labour who weren’t asking any questions when the so-called boom was happening. I don’t remember Mr Osborne calling for house prices to be regulated or banks to be reined in.
I’ll also ignore the fact that you cannot write socialist without adding utopia. It should not be utopian to believe that everyone has a fair chance in life and at least a reasonable standard of living.
But it is interesting that you to the right and I to the left both feel that our natural parties no longer represent us but they are better than the alternative.
This presumably means that in chasing the centre ground all the parties are failing to represent quite a lot of voters’ views. Or perhaps, as Andrew Neil said in his excellent documentary, politicians are all from such a privileged background that they just don’t understand the real world.
http://www.bbc.co.uk/iplayer/episode/b00y37gk/Posh_and_Posher_Why_Public_School_Boys_Run_Britain/
Now Saltaire,those comments were more like it.In reality i believe you and i and probably many others , have no true party to represent our views,because within party politics there are cherished little beliefs.Take a simple matter.People see the tories as being rich and privileged and only for their own kind and Labour being poor and cloth capped and only for their own.
That is of course rubbish with elements of truth.
Really i think you and i want the same thing ,which is a fair prosperous society that all can live a life of comfort providing we have given our part to it.There are of course differences as to what is fair and how we get there.I do not think either the tory, labour, socialist,green or any other party way gets us there.I also think a coalition is the worst of all worlds where everything is watered down to accomodate others.The problem is a lack of true democracy.partially caused by the party system.
I have espoused many times my view of democracy,rule of the people by the people for the people and an argument as to how it could be achieved in a technological age
Jon,
If you want to see what privatised “health care” can do to media culture and to a so-called civilised society – just take a look at this, bearing in mind its ranting righty perpetrator often appears on Rupert Murdoch’s extreme right wing Fox News mainstream TV channel in the USA:
http://www.youtube.com/watch?v=YA7-BvVDV10
Make no mistake, this will be our future if this nation is ever foolish enough to fall for Tory/LibDem/New Labour piece-by-piece privatisation of our National Health Service.
Nobody can claim there haven’t been enough warnings of this right-wing insanity. After all, it is a smaller version of how the Nazis started out…….only this time without the brown shirts, jackboots, crazy banners and military marionettes. It is Umberto Eco’s ur-fascism in embryonic action.
There is a logical, sickening conclusion to this evil and it will be reached soon enough if our citizens do not use what is left of our democracy to resist it.
Great and good pastor Dietrich Bonhoffer once said, “I stopped arguing with the Nazis when they became too stupid to argue with.” We are approaching that dangerous state once again.
what a typical load of socialist clap trap
From today’s Telegraph, the dire results of PFI – introduced by Tories and pursued ardently by New (Tory-) Labour:
http://www.telegraph.co.uk/news/newstopics/politics/8279974/Private-Finance-Initiative-hospitals-will-bring-taxpayers-60-years-of-pain.html?sms_ss=email&at_xt=4d3efb5e99b7e7ac%2C0
Cost to UK taxpayer of this short-term attempt to keep new-buildings (many unnecessary, it seems) off the books will be a staggering £229 billion, or four times the ‘asset’, ie resale value, of £56 billion. This is a financial crime against the public. The contracts be ripped up, the buildings brought back under government ownership. And before folk start shouting about legal suits etc, it’s the public who’ll be paying the price, particularly our children, for something we didn’t vote for. Any representative government must legislate the necessary changes.
This PFI rip-off is surely on a par with the bankers’ bonuses obscenity. It needs ending now.
It always seemed obvious to me that allowing a private company to build a road or a hospital which the public purse eventually paid for, would be more expensive. Shareholders had to have their share.
You are quite right Meg,but what irritates me is the” PFI – introduced by Tories and pursued ardently by New (Tory-) Labour:” comment.At the time of the hospital and building program, bought in by Brown, to spend and keep it off the books,the Tories voted against it.
In some respects there is absolutely nothing wrong with PFI.It gets building projects ,that government can not afford ,that are needed, done.
The problem is the terms within which those projects are done and whether in reality they are needed.When a three year old school is completed ,and closes because there are not enough pupils,but the tax payer picks up the extortionate cost for another 30 years something was wrong with the terms and need of the contract.
The only way that can be put down to politics is to say Labour, be they new,old or in tory clothes,can not run the economy
We read today (Feb 2) that the NHS is wasting around £500m by inefficient buying.
That needs to be addressed.
But I can’t see how government plans to spread 80% of NHS budget among GPs is going to lead to an improvement.
The implication is that the NHS, like most big companies, should centralise its buying in order to maximise the muscle it has when negotiating discounts.