Junior Doctor's contracts petition
Discussion
turbobloke said:
spaximus said:
I have a problem with the slow creep of privatisation in the medical services as profit should never come before patients.
ISWYM but here's a thought experiment.The NHS budget is approx £115bn.
Assume for the sake of this thought experiment that all back office functions are privatised.
Assume also that this change leaves the quality of NHS service delivery unchanged neither better nor worse but reduces total costs for the same service delivery by 5%.
That's a saving of £5.75bn according to the back of my fag packet.
Then let's say that under the terms of the agreements a total of £2.75bn is retained by the private sector in total as profit and £3bn is re-invested to treat patients within front line service delivery, patient treatments that would not otherwise have been available.
This is supposedly a bad thing even in principle.
Apart from anything else it makes you think on about the losses due to waste, fraud and error which are put at around £10bn - £20bn in total but that's a different thought experiment.
It is in the medical arena that I have concerns. Cherry picking the easy profitable is not right, when you split it all out the NHS would be left with what the private companies left. If there was a saving and a watertight contract was signed, something the NHS is poor at, to give half the savings, do you think he government would allow that to be kept or would less year on year be budgeted for.
The NHS is a monster and it is the shear size that has allowed empires to be built which leads to waste but the Dr's are not the problem. What Dr's get paid is not the problem but Hunt has attacked them to fill a hole knowing he will do the same to every workers if he wins.
mph1977 said:
Herein lays the problem,
Many on the Left deliberately confuse the concept of, and what what people want ( on the broadest level) from , the NHS
Which is a service free at the point of clinical need ( or at least within the current charging regime - as misguided as parts of it are at times)
The provision of that service does not have to be made by the lumbering monolithic dinosaur that is the NHS 'owned' services
Many NHS services were never nationalised - it's only really hospitals, ambulances and some community services that were ( and prior to trusts a lot of those apart from District Nurses and health visitorswere an extentsion of a hospital service ) even then Ambulances, district nurses , health visitros etc only came under direct NHS management in 1974.
GPs are overwhelming 'private' and have been continuously since 1948, same for dentists, opticians, community Pharmacy ...
Interesting thanks. I certainly wouldn't wish the US system on anyone but I don't understand this wailing about privatisation of the NHS when almost everything they buy or lease is from private companies already.Many on the Left deliberately confuse the concept of, and what what people want ( on the broadest level) from , the NHS
Which is a service free at the point of clinical need ( or at least within the current charging regime - as misguided as parts of it are at times)
The provision of that service does not have to be made by the lumbering monolithic dinosaur that is the NHS 'owned' services
Many NHS services were never nationalised - it's only really hospitals, ambulances and some community services that were ( and prior to trusts a lot of those apart from District Nurses and health visitorswere an extentsion of a hospital service ) even then Ambulances, district nurses , health visitros etc only came under direct NHS management in 1974.
GPs are overwhelming 'private' and have been continuously since 1948, same for dentists, opticians, community Pharmacy ...
spaximus said:
No argument on the back office functions which are measurable and are already being split off. No argument with waste there are huge savings by for example every hospital has the same it supplier. At the moment where my wifes job takes here there are at least 4 different systems. all producing reports that have to be redone to send in one format to NHS England. If you had one procurement that would not happen it could be all drawn off centrally.
It is in the medical arena that I have concerns. Cherry picking the easy profitable is not right, when you split it all out the NHS would be left with what the private companies left. If there was a saving and a watertight contract was signed, something the NHS is poor at, to give half the savings, do you think he government would allow that to be kept or would less year on year be budgeted for.
The NHS is a monster and it is the shear size that has allowed empires to be built which leads to waste but the Dr's are not the problem. What Dr's get paid is not the problem but Hunt has attacked them to fill a hole knowing he will do the same to every workers if he wins.
I live in an area where the ambulance service has been privatised. The standard of service has left a bit to be desired, with dialysis patients not being picked up, others late for their appointments and many not having transport home. It is in the medical arena that I have concerns. Cherry picking the easy profitable is not right, when you split it all out the NHS would be left with what the private companies left. If there was a saving and a watertight contract was signed, something the NHS is poor at, to give half the savings, do you think he government would allow that to be kept or would less year on year be budgeted for.
The NHS is a monster and it is the shear size that has allowed empires to be built which leads to waste but the Dr's are not the problem. What Dr's get paid is not the problem but Hunt has attacked them to fill a hole knowing he will do the same to every workers if he wins.
The quality heath commission has had one or two things to say about nursing homes in the south east, with those at the bottom of the list for quality being mainly private ones.
My younger son-in-law works as a local authority carer for those who can't cope on their own. He's well qualified, having completed a number of courses over the years. He is well trained as there are emergencies that he has to respond to. With the new round of cuts to local authorities coming in next year his charges will be put out to tender. They will get visits, sometimes just once a day but those that need full time care will be given a button to press and four visits a day. These visits will be for 30 mins but that includes travel time across a crowded and congested city.
Not NHS I agree but definitely privatisation.
I was in charge of a police control room and had a budget for overtime. I was instructed that I had to be fair to the civilian staff and use a rota when distributing the overtime as I could not favour police officers just because they would have been cheaper.
Many people have had experiences of privatisation and know what it means. Perhaps that's why so many are against it for the NHS.
Or perhaps it is those who know about PFI. The prosecutions department in my force was PFI'd. Since the police budget was slashed the number of police officers has been cut and therefore so has the work going through to the PFI leech. They still get paid the agreed amount. If it had been run by the police, there could have been massive savings.
turbobloke said:
spaximus said:
I have a problem with the slow creep of privatisation in the medical services as profit should never come before patients.
ISWYM but here's a thought experiment.The NHS budget is approx £115bn.
Assume for the sake of this thought experiment that all back office functions are privatised.
Assume also that this change leaves the quality of NHS service delivery unchanged neither better nor worse but reduces total costs for the same service delivery by 5%.
That's a saving of £5.75bn according to the back of my fag packet.
Then let's say that under the terms of the agreements a total of £2.75bn is retained by the private sector in total as profit and £3bn is re-invested to treat patients within front line service delivery, patient treatments that would not otherwise have been available.
This is supposedly a bad thing even in principle.
Apart from anything else it makes you think on about the losses due to waste, fraud and error which are put at around £10bn - £20bn in total but that's a different thought experiment.
As I've posted in this thread, my other half has been being treated in various ways for 15 years - being told that all they can do is relieve and delay the inevitable. 15 years of multiple interactions per week/month, all without effect. Until the right person looked at her in the right way, which only occurred due to a chance encounter and a GP who was willing to spend a goodly amount of NHS funds at the local Nuffield. Just think of the pounds that could have been saved if the eye wasn't on the pennies.
The opportunity, if it were possible to realise (my previous post explains why I feel this is impossible) would be a true paradigm shift - 30-50% reduction in costs, for immensely greater outcomes as defined by the customers.
The fact no one else does this is irrelevant - one of the core cause celebres of the NHS is it's difference to other nations approaches and ethos. If only it hadn't stopped being as innovative as it used to be.
mph1977 said:
fblm said:
Out of interest what does this talk of privatising the NHS include? Presumably they don't make their own beds, or paperclips, or drugs, or CT scanners. We accept those are usually things best developed, produced and sold at profit, but still more efficiently than the NHS could do it, by rapacious and evil private companies. Is it possible that said capitalist scum are able to actually do quite a lot of things more efficiently than the NHS and still turn a profit? Why is the NHS apparently so sacred that it can only possibly be delivered well by the public sector?
Herein lays the problem, Many on the Left deliberately confuse the concept of, and what what people want ( on the broadest level) from , the NHS
Which is a service free at the point of clinical need ( or at least within the current charging regime - as misguided as parts of it are at times)
The provision of that service does not have to be made by the lumbering monolithic dinosaur that is the NHS 'owned' services
Many NHS services were never nationalised - it's only really hospitals, ambulances and some community services that were ( and prior to trusts a lot of those apart from District Nurses and health visitorswere an extentsion of a hospital service ) even then Ambulances, district nurses , health visitros etc only came under direct NHS management in 1974.
GPs are overwhelming 'private' and have been continuously since 1948, same for dentists, opticians, community Pharmacy ...
The problem is that there are too many examples of very poor contracts for the NHS, particularly some of the PFI initiatives. They have tarred the system with a bad reputation, correctly in some cases but not in relation to the principle.
My own view is that if a commercial organisation can provide a service to an equal standard at lower cost then it has to be considered, and also if they can improve the service for the same cost. Purely taking the example of the move from NHS Logistics to DHL a few years ago it should be easy to gain cost savings through the scale and capability of DHL that the NHS could not replicate, and as a health service why should they be world class in logistics, that is not what I want from them, just as I wouldn't want DHL providing health advice (I have no idea about the actual effectiveness of the change, however).
andyps said:
The problem is that there are too many examples of very poor contracts for the NHS, particularly some of the PFI initiatives. They have tarred the system with a bad reputation, correctly in some cases but not in relation to the principle.
I don't know if the NHS was treated in the same way, but the PFI contract for the police I know about was restricted as to what we could do. I was part of a working party to come up with how to get the best out of the PFI and the police negotiating side, we hired professionals, virtually ignored everything we suggested because it wasn't in there power to demand. One specific department I was involved in was the ID unit. I was lucky in that it was a bit of an add-on. The other side didn't know anything about it so I went for what I thought would make things easier and smoother.
Nine months later the government changed the Codes of Practice, making the ID design unuseable for 90% of the time.
Still had to have it though.
Derek Smith said:
I don't know if the NHS was treated in the same way, but the PFI contract for the police I know about was restricted as to what we could do. I was part of a working party to come up with how to get the best out of the PFI and the police negotiating side, we hired professionals, virtually ignored everything we suggested because it wasn't in there power to demand.
One specific department I was involved in was the ID unit. I was lucky in that it was a bit of an add-on. The other side didn't know anything about it so I went for what I thought would make things easier and smoother.
Nine months later the government changed the Codes of Practice, making the ID design unuseable for 90% of the time.
Still had to have it though.
That does sound pretty crazy. I don't know specifics but have heard stories about how much it costs to get a light bulb changed or to move a plug socket and similar and it seems that there were some contractors who must have known that they could get away with anything as the charges are so unrealistic they would have expected to be laughed at if someone read the tender properly.One specific department I was involved in was the ID unit. I was lucky in that it was a bit of an add-on. The other side didn't know anything about it so I went for what I thought would make things easier and smoother.
Nine months later the government changed the Codes of Practice, making the ID design unuseable for 90% of the time.
Still had to have it though.
andyps said:
That does sound pretty crazy. I don't know specifics but have heard stories about how much it costs to get a light bulb changed or to move a plug socket and similar and it seems that there were some contractors who must have known that they could get away with anything as the charges are so unrealistic they would have expected to be laughed at if someone read the tender properly.
it's not a legitimate comparison under the NHS something like the provision of a new socket or new drug cupboards ( which is a none trivial task as there are hefty secuirty requirements and all Controlled drug cupboards and some other drug cupboards are wired into the alarm / call system to indicate when they are open would not necessarily have drawings etc drawn up and the 'cost' would be materials and a nominal hourly rate
under the PFI any modification is logged properly in the documentation etc ( as happens in well managed comercial premises ) and not only does the cost cover materials and time to do the modification it includes an element of ongoign costs and provision for reversion of the modification at the end of the term if the trust wants it reverted to the original design
the lamp change stories are also a degree of bull - sometimes it;s been because staff have demanded that the lamp be changed immediately - even if it;s not something that the shift maintainance person can do ( high ceilings, shiftie isn;t a spark so shouldn;t be dismantling light fittings etc ) of becasue a circulation space in a ward or dept has been classfied wrongly as a corridor or ancillary space and afforded a lower priority for repairs but people have insisted on immediate fix etc and therefore it reaises an 'exceptional item ' charge - ditto with stuff like moving furniture around at short notice ...
turbobloke said:
e21Mark said:
I really don't see how the potential privatisation of the NHS can be denied when companies like Virgin already runs 15+ health facilities under the NHS logo. Anyway, time will tell I guess?
It's well-known that a small percentage of privatisation already exists, most of it happened under Labour. That's not denied by anyone.In terms of 'potential privatisation' the question therefore becomes how much more, in what area(s) and when. No potential can be denied and it isn't but those questions are pertinent as well as how likely the events are.
e21Mark said:
Before the election there were repeated denials of NHS privatisation from the Mr Cameron. He claimed that the amount of the NHS privatised under Labour was 5% and it has now risen to only 6% but these figures are before the impact of the Health & Social Care Act. In fact privatisation has soared by 500% in the last year. He said that the NHS would remain in the public sector yet the best bits are being cherry picked by private firms.
5 times as much privatisation in the last year compared to under Labour?Please show your workings....
What % is this of the overall NHS budget?
Dixy said:
And how much of any of this has what to do with the Junior Doctors contract?
According to certain people, the JD dispute is evidence of the Tory plans to privatise the NHS...How about this then:
http://order-order.com/2016/04/26/junior-doctors-i...
mph1977 said:
it's not a legitimate comparison
under the NHS something like the provision of a new socket or new drug cupboards ( which is a none trivial task as there are hefty secuirty requirements and all Controlled drug cupboards and some other drug cupboards are wired into the alarm / call system to indicate when they are open would not necessarily have drawings etc drawn up and the 'cost' would be materials and a nominal hourly rate
under the PFI any modification is logged properly in the documentation etc ( as happens in well managed comercial premises ) and not only does the cost cover materials and time to do the modification it includes an element of ongoign costs and provision for reversion of the modification at the end of the term if the trust wants it reverted to the original design
the lamp change stories are also a degree of bull - sometimes it;s been because staff have demanded that the lamp be changed immediately - even if it;s not something that the shift maintainance person can do ( high ceilings, shiftie isn;t a spark so shouldn;t be dismantling light fittings etc ) of becasue a circulation space in a ward or dept has been classfied wrongly as a corridor or ancillary space and afforded a lower priority for repairs but people have insisted on immediate fix etc and therefore it reaises an 'exceptional item ' charge - ditto with stuff like moving furniture around at short notice ...
Anything that is to do with spending money in the NHS or ay government run set up is disproportionate. The only companies who can bid are on a list, they all know the charges to get on the list so they have to bid to cover those costs. If you as a contracts manager see, to change a light bulb, £40 from 10 companies, it is reasonable to expect that to be the "going rate". Yes there is a lot of numpties who will sue at every opportunity, but private health care companies will use who ever they want, they are free to do so, so if a bulb needs replacing a competent person will do it at reduced cost.under the NHS something like the provision of a new socket or new drug cupboards ( which is a none trivial task as there are hefty secuirty requirements and all Controlled drug cupboards and some other drug cupboards are wired into the alarm / call system to indicate when they are open would not necessarily have drawings etc drawn up and the 'cost' would be materials and a nominal hourly rate
under the PFI any modification is logged properly in the documentation etc ( as happens in well managed comercial premises ) and not only does the cost cover materials and time to do the modification it includes an element of ongoign costs and provision for reversion of the modification at the end of the term if the trust wants it reverted to the original design
the lamp change stories are also a degree of bull - sometimes it;s been because staff have demanded that the lamp be changed immediately - even if it;s not something that the shift maintainance person can do ( high ceilings, shiftie isn;t a spark so shouldn;t be dismantling light fittings etc ) of becasue a circulation space in a ward or dept has been classfied wrongly as a corridor or ancillary space and afforded a lower priority for repairs but people have insisted on immediate fix etc and therefore it reaises an 'exceptional item ' charge - ditto with stuff like moving furniture around at short notice ...
The NHS does waste but it is not simple as there are lots outside their control.
spaximus said:
mph1977 said:
it's not a legitimate comparison
under the NHS something like the provision of a new socket or new drug cupboards ( which is a none trivial task as there are hefty secuirty requirements and all Controlled drug cupboards and some other drug cupboards are wired into the alarm / call system to indicate when they are open would not necessarily have drawings etc drawn up and the 'cost' would be materials and a nominal hourly rate
under the PFI any modification is logged properly in the documentation etc ( as happens in well managed comercial premises ) and not only does the cost cover materials and time to do the modification it includes an element of ongoign costs and provision for reversion of the modification at the end of the term if the trust wants it reverted to the original design
the lamp change stories are also a degree of bull - sometimes it;s been because staff have demanded that the lamp be changed immediately - even if it;s not something that the shift maintainance person can do ( high ceilings, shiftie isn;t a spark so shouldn;t be dismantling light fittings etc ) of becasue a circulation space in a ward or dept has been classfied wrongly as a corridor or ancillary space and afforded a lower priority for repairs but people have insisted on immediate fix etc and therefore it reaises an 'exceptional item ' charge - ditto with stuff like moving furniture around at short notice ...
Anything that is to do with spending money in the NHS or ay government run set up is disproportionate. The only companies who can bid are on a list, they all know the charges to get on the list so they have to bid to cover those costs. If you as a contracts manager see, to change a light bulb, £40 from 10 companies, it is reasonable to expect that to be the "going rate". Yes there is a lot of numpties who will sue at every opportunity, but private health care companies will use who ever they want, they are free to do so, so if a bulb needs replacing a competent person will do it at reduced cost.under the NHS something like the provision of a new socket or new drug cupboards ( which is a none trivial task as there are hefty secuirty requirements and all Controlled drug cupboards and some other drug cupboards are wired into the alarm / call system to indicate when they are open would not necessarily have drawings etc drawn up and the 'cost' would be materials and a nominal hourly rate
under the PFI any modification is logged properly in the documentation etc ( as happens in well managed comercial premises ) and not only does the cost cover materials and time to do the modification it includes an element of ongoign costs and provision for reversion of the modification at the end of the term if the trust wants it reverted to the original design
the lamp change stories are also a degree of bull - sometimes it;s been because staff have demanded that the lamp be changed immediately - even if it;s not something that the shift maintainance person can do ( high ceilings, shiftie isn;t a spark so shouldn;t be dismantling light fittings etc ) of becasue a circulation space in a ward or dept has been classfied wrongly as a corridor or ancillary space and afforded a lower priority for repairs but people have insisted on immediate fix etc and therefore it reaises an 'exceptional item ' charge - ditto with stuff like moving furniture around at short notice ...
The NHS does waste but it is not simple as there are lots outside their control.
Getting light bulbs changed does cost a silly amount of money (something like £70 from memory), but, and it's a big but, that £70 fee also applies to other 'minor' faults which may cost a lot more. From what I can understand chatting to the blokes that do the job, faults come in various categories,each with a flat fee. By comparison, we had a new water heater fitted by our sink last month, and that fell into the same category as a light bulb. Some you win, some you loose.
One other point regarding these contracts that isn't often mentioned, is that they are generally for repairs only, not maintenance, so things only get looked after once they've broken.
e21Mark said:
Sway said:
Seems about as evidence free as the assertion I saw on Facebook this morning
How did you determine it was evidence free?The NHS budget is over £100B. Current private provision is therefore valued at just over £5B, including that already driven by the Tories.
So, am I expected to believe that contracts have been signed within the last 12 months worth £20B a year, without a source given and without the left screaming from the rooftops at every opportunity? Especially when all NHS procurement contacts are in the public domain.
I've often accused the Labour party of being inept, but I struggle to believe they are that inept. If it were the case they'd be shouting that number in every interview, speech, publication, etc.
The fact they're not leads me to strongly believe that there is no evidence for this claim. Of course, I'm open to being proven wrong...
eccles said:
I work in MOD buildings which are maintained by private companies, much like the ones that look after the NHS I suspect.
Getting light bulbs changed does cost a silly amount of money (something like £70 from memory), but, and it's a big but, that £70 fee also applies to other 'minor' faults which may cost a lot more. From what I can understand chatting to the blokes that do the job, faults come in various categories,each with a flat fee. By comparison, we had a new water heater fitted by our sink last month, and that fell into the same category as a light bulb. Some you win, some you loose.
One other point regarding these contracts that isn't often mentioned, is that they are generally for repairs only, not maintenance, so things only get looked after once they've broken.
It's all about comprehensive cover. Getting light bulbs changed does cost a silly amount of money (something like £70 from memory), but, and it's a big but, that £70 fee also applies to other 'minor' faults which may cost a lot more. From what I can understand chatting to the blokes that do the job, faults come in various categories,each with a flat fee. By comparison, we had a new water heater fitted by our sink last month, and that fell into the same category as a light bulb. Some you win, some you loose.
One other point regarding these contracts that isn't often mentioned, is that they are generally for repairs only, not maintenance, so things only get looked after once they've broken.
There will be a list of xyz things which are covered and if it fails then it is replaced, or you can have say the first £100/250/500/1000 of a job is included within the annual fee any cost over and above is then chargeable.
However IF you have a situation whereby all the assets a knackered and beyond Recemmended working life/beyond economical repair then clearly the NHS will be on the hook for the full cost and rightly so thereafter it's maintained properly. I think the issue is for far too many years boilers chillers air handling units BMS fan coils have simply been neglected (be it through choice OR nativity) so everything is knackered so the choice is massive replacement costs or sticky plaster - but even then there is the issue that the widget which breaks is obsolete so they are running sites at risk and could shut a site for days/weeks/months until the replacement asset is procured and installed.
Planned preventative maintenance not carried out
No life cycle replacement plan
No single point of failure
No disaster recovery plans
No capex plan and funding for the next 5-10/25 years
No energy plan so we're burning cash now on very inefficient kit pumping out CO2 and it breaks down often all at huge cost.
The costs they have probably spent so far on many things patching it up and inefficient product could have paid for a new one many times over.
Sway said:
Seems about as evidence free as the assertion I saw on Facebook this morning that 70k operations were cancelled last year due to 'underfunding'.
What was that Churchill quote about the speed of truth again?
I would suspect the 'underfunding' there is not in fact 'underfunding' but the inability of social care to actually do what we the tax payers pay them to do ... What was that Churchill quote about the speed of truth again?
Unfortunately my experience is that , like the NHS, anything social care achieves is despite the systems not because of them.
Gassing Station | News, Politics & Economics | Top of Page | What's New | My Stuff