Choice in the NHS
Posted by Diane Abbott, MP for Hackney North and Stoke Newington, at 12:24, Tue 13 October 2009:
As the debate over healthcare rages in the US, here in the UK the NHS is undergoing major changes – many of them looking worryingly like privatisation. There is a presumption from both the Labour Party and the Conservative Party that more “choice” gives patients a better service. As such the Government has introduced Alternative Providers of Medical Services (APMS), which allows Primary Care Trusts to contract out the services they provide to a variety of health care providers – including private companies. Another change is allowing patients to choose which GP they see instead of the current system where you must attend the surgery nearest your home.
I am in no doubt that the NHS has been vastly improved over the last 12 years. I had my son in the Homerton Hospital in 1991. The doctors and nurses were lovely, but there was no doubt they were under pressure. Under a Labour government the buildings and the facilities at the Homerton have been improved out of all recognition. And it has an excellent record on issues like MRSA. Nationally we now have 89,000 more nurses, 44,000 more doctors and 100 new hospitals. But I am deeply concerned by the current trend towards allowing private companies to make a profit from providing health services. Profit-making companies may well find ways to perform a service more cheaply but the money saved does not get pumped back into the NHS to further improve services. Instead it goes straight into the pockets of the shareholders. And it is important to ask how private companies do things for less money. Very often it involves cutting corners – with staff wages and pensions, with substandard practice buildings or with the standard and variety of services.
Currently two big healthcare centres are planned for Hackney (the new polyclinic health centres) but there is a chance they will be contracted out to private companies. I have written to the Department of Health explaining my concerns over these plans and will be meeting with the Hackney and City Primary Care Trust. In the meantime I would welcome constituents’ views on the matter. I have already received a number of letters against the plans to allow private companies to run the new healthcare centres, but does anyone think otherwise? The argument for using private companies says that introducing competition improves efficiency, does anyone agree?
Comments
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Posted by Jo Homan, 12:45, Tue 13 October 2009: (Is this post abusive?) #
I agree with you that 'profit' and 'a health care system that really puts people first' are mutually exclusive.
If one of the new big healthcare centres planned for Hackney is the one on Woodberry Down (John Scott) then I'd have to come out against. The existing centre is extremely popular with everyone I've spoken to and we'd sooner keep that building. It should be kept and adapted rather than being rebuilt. (I think someone just wants to make money out of building on that land because it's right next to the reservoir.)
Jo Homan, Transition Finsbury Park
Posted by Ellen Graubart, 13:00, Tue 13 October 2009: (Is this post abusive?) #
I too am worried about the Government's plans to introduce the private sector into the National Health Service. As in education, when the profit motive is brought into the equation the public will inevitably be the loser, and priorities will not be for the benefit of the public, but of the share holders. How can such an idea be contemplated, seeing the mess the United States health 'system' is in?
Posted by Adam Di Chiara, 14:03, Tue 13 October 2009: (Is this post abusive?) #
I draw your attention to this article by Camden GP Iona heath written in the British Medical Journal earlier this month, what has happened and is happening in Camden around privatizing health care is a lesson that needs to be learnt before we loose any democratic control over public health
http://www.bmj.com/cgi/content/full/339/sep14_1/b3735
Posted by Simon Mills, 17:14, Tue 13 October 2009: (Is this post abusive?) #
I think this is a complete red herring - GPs are independent operators and as such they are private companies already contracted to the NHS so in the broader sense there is little difference. Currently GPs do not plough their own profits back into the NHS nor very rarely into their premises. GP opposition to polyclinics is generally to the threat of a loss of business and the effect on their own profits. Whilst I would personally prefer a non-profit, social enterprise model you need to address the broader system as a whole rather than protecting existing GP "private company" status to avoid them being exposed to competition which quite rightly is looking to drive up the quality and range of services available locally.
Posted by JM Garcia, 17:20, Tue 13 October 2009: (Is this post abusive?) #
I believe the issue is less private versus public than: what standards of service do we expect and what price are we ready to pay for these standards? Private companies will do what the NHS or the Government asks them to do. It simply has to be economical for them. And they have to be thoroughly and severely controlled. Let us also remember that in both cases, private and public, it's always people who end up paying the bill, either through taxes (public) or insurance premiums (private).
Posted by Francis McDonagh, 21:12, Tue 13 October 2009: (Is this post abusive?) #
On the whole I agree with your position on the two healthcare centres: I would prefer to see them as part of the NHS. Perhaps JM García has a point, that with both private and public service deliverers, it is important to have good cost control.
Fundamentally, for me, the NHS enshrines the principle that good health is a human right and shouldn't be treated as a commodity that can be sold for profit. As I understand it, this also makes economic sense: most of us contribute more than we will ever cost the NHS.
Posted by Adam Di Chiara, 16:07, Thu 15 October 2009: (Is this post abusive?) #
I heard a US Pharmaceuticals representative on Radio 4 the other night explaining why prices are so high for drugs. He said it was to put back into Research & Developement, presumiable so they can create some more expensive drugs that people can't afford to use! 18,000 people a year die in the US because they can't access affordable health care (not just pharma).
It is a classic example of putting company profits before peoples health. And the Republican right talk about UK style death panels, what a nerve.
Looking at the pharmaceutical industries massive profits also suggests that maybe they could drop prices and still afford to do valuable R&D, but that is where the neo-liberal ideology steps up — Private good/Public Bad, Tony Blair signed away the Public sector 10 years ago at the WTO, for what I don't know, ideology I suppose. One I think Ms Abbott is only half inclined to agree with.
What with PFI's and PPPs in the NHS, and Trusts paying through the nose for years to come, outsourcing of services, paying for car parking (even some staff) and "consultations" like the one in the article I posted before, we are getting more and more like the US system of "healthcare" a system that clearly doesn't work for vast swathes of the US population.
The NHS has been being destroyed from the inside and out, by layers of unnecessary bureaucracy, stupid targets, underpaid overworked staff, consultancy fees, and successive governments inertia, and privatising zeals.
Do we really want to go totally private because that is where we've been heading for the last 20 years, so much so that even "public Consultations" are fixed, where is this Afghanistan? Or do we want a properly funded public health service, democratically accountable, and not just free at the point of access, but free for all from cradle to grave paid for by Taxation.
So Tax the rich to KEEP THE NHS PUBLIC. Tax at least as much as Thatcher did, and close the corporate tax loopholes. That would make a few billion and save a few billion too.
Posted by Jonathan Hogg, 10:24, Fri 16 October 2009: (Is this post abusive?) #
> And it is important to ask how private companies do things for less money. Very often it involves cutting corners – with staff wages and pensions, with substandard practice buildings or with the standard and variety of services. <
And very often it is by working harder and smarter. There is a definite "commercial = bad" bias to this posting. As with any supplier of services, public or private, the key is measuring the results. What the NHS needs to work on is making sure it is getting value for money. If we're going to spend public money, let's spend it on good managers and independent monitoring - beyond that, I don't care if the money is spent on public or private service provision, provided that it keeps people healthy and doesn't waste money.
As noted by Simon, front-line health provision has been private forever, we just forget that GPs are little private companies.
Jonathan
Posted by Adam Di Chiara, 16:17, Tue 20 October 2009: (Is this post abusive?) #
"It is important to ask how private companies do things for less money"
You are correct to ask the question, but the answer is that they don't.
Working harder just means exploiting the staff more, which means lower pay, worse conditions and bigger turn over leading to less experience and a brain drain in the service, which is bad for all.
And smarter means having an expensive consultant ready to do the talk, and tell his masters what they want to hear. How to find more profits. The main way of doing this in industry is to cut staff costs, that is usually the biggest outlay. So reduce either them or their wages. That is what privatisation does, and that's how it manages to squeeze another drop of blood from the staff into their profits. Just ask any nurse or porter working in a hospital and they'll tell you things are getting worse for staff.
And all this is just the thin end of the wedge. It will get worse, look at dentistry, it is much more expensive now than before.
The public sector is an asset not a drain, and Labour should bloody know this.
Posted by John Callon, 11:34, Wed 28 October 2009: (Is this post abusive?) #
I've held off responding to this posting, Diane, as it is no simple matter - as much of the correspondence so far shows.
The role of the private sector in delivering health care has grown - it now provides everything from GP services (which is now more than just the GP him/herself) to hospital buildings. I think under Labour things have changed, but they have changed so much that no ordinary man or woman in the street actually knows what the NHS is anymore.
The discussions above centre on ideologies more than evidence. It is clear why budget cuts and the private sector will be coming - how can we afford, along with everything else, the 89,000 more nurses, 44,000 more doctors and 100 new hospitals that you mentioned. The country is going to be broke for some time to come.
We don't seem to see many useful comparisons with other national health services. I would think, from the little I've heard, that French, German and Scandinavian health services would produce as good if not better treatment outcomes for patients - how are their services structured and funded? The UK governments seem to keep tinkering with the NHS, building on the foundations of a very shaky edifice that was there in the beginning. Sixty years on, there needs to be a much more comprehensive think about how this service should be structured and funded.
My personal experience of using the service - fortunately only at the GP level - leaves me massively disappointed when I compare it with similar services I've used in NZ and Australia. Here, they have no time, no resources and, more than once, no solution.
GPs are a bit like other professions which have been downgraded - social work, teaching and police, to name but three. Fill up the lives of the skilled and qualified professionals with forms to fill in and then employ additional less qualified people to try to do the work which the others were employed to do in the first place. I'm not sure the public sector in this regard delivers on either outcomes or value for money.
Time for new hands at the tiller, I think.
Posted by David White, 19:59, Sun 1 November 2009: (Is this post abusive?) #
As noted above, private companies tend to pay floor level workers poor wages as that is often their single biggest cost. They use short renewable contracts to get around having to privide any fringe benefits like sick pay. They will also only allow work done as contracted, no matter what is actually needed. If the cleaning contract states wards are to be mopped twice a day it's just too bad if a ward needs it any other time. The failsafe is supposed to be that an "emergency cleaning" squad can be called upon (only within certain hours) but in practice a one man on callout means it's usually a long wait. A ward can have pee on the floor from 6pm to 8.30am the next morning and the nursing staff are NOT ALLOWED to do any cleaning. Contracts mean going back to strict demarcation with financial penalties for any that cross the line.
Private companies bottom line is profit, pure and simple, to meet contractual obligations while maximizing margins. Don't fool yourself there's any philanthopy involved, no matter what a private company's website may say.
The only way a private company could produce a better service, meet all environmental & H&S regs and pay decent wages with benefits is to charge more. It is only possible to make an increased profit if you reduce costs one way or another.
Unless a contractually built in profit margin is limited to a certain percentage, the pressure will always be one way.