[Closed] NHS Reforms defeated in House of Lords - What does that mean?

I simply dont care what happens to the NHS in England

Fair enough. But you would do well to observe.

I have every confidence in my fellow Scots to set England adrift on its own sea of mediocrity come the referendum. 😉

Noteeth - a simple point really, confirmed by the Ali Parsa piece (patient x1 and in a passive phrase) and possibly, if I can find time to read the bills, in the governments documentation etc. I wish people would put patients first.

This debate seems to centre round lots of people - politicians, doctors, nurses, private suppliers, administrators ad nauseam.....and so rarely about the people who matter, the patients. Hence the word count. So, yes, confirms my "suspicion" of vested interests and conflicts of interest.

In contrast, it was interesting to read what Millburn said and where he focused!!!

"[b]And patients should become active participants in their healthcare, rather than mere passive recipients."[/b]

Surrounded By Zulus - Member
I have every confidence in my fellow [s]Scots [/s]residents of Scotland to set England adrift on its own sea of mediocrity come the referendum.

set England adrift on its own sea of mediocrity

Is it Scottish independence thread time already? 🙂

Teamhurtmore - and once again you start from the wrong premise. It really is funny watching you do this.

Opposition to these reforms from the professionals is all about the patients. Just read the press releases from them. I even quoted some a while back

In contrast, it was interesting to read what Millburn said and where he focused!!!

"And patients should become active participants in their healthcare, rather than mere passive recipients."

shows his idiocy.

Its been tested time and time again - the vast majority want good local services they do not want meaningless choice nor meaningless soundbites.

confirmed by the Ali Parsa piece

Parsa's CiF piece is platitude dribble of the highest order, coming from somebody who happily decries the NHS as 'broken', whilst his well-timed venture (Circle) profits off the back of NHS staff, expertise, workforce training and infrastructure. And Alliance Medical Milburn has got some nerve, given that NuLav helped lay the foundations for all this (see the woefully poor value ISTC contracts etc).

I agree that patients should be at the "centre" - unfortunately, they are likely to be at the centre of an impending cluster****.

This is the truth teamhurtmore - dedicated public servants are desparatly concerned about the health and social care bill because of the damage it will inflict on patient care.

RCGP

The RCGP has written to Prime Minister David Cameron to formally call for the withdrawal of the Health and Social Care Bill,[b] citing the ‘irreparable damage' it could cause to patient care[/b]

We cannot sit back. Instead, we must once again raise our concerns in the hope that the Prime Minister will halt this damaging, unnecessary and expensive reorganisation which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.

http://www.pulsetoday.co.uk/article-content/-/article_display_list/13381509/in-full-rcgp-statement

The RCN has clearly and consistently set out which areas of the Bill
must be changed, [b]not as a matter of self interest, but to guarantee
patient care [/b]and to retain the NHS as a national institution providing
high quality care, free at the point of need.
Due to the Government’s refusal to concede on sufficient points, and
the [b]risk we believe the legislation poses to patient care[/b], the RCN is
now moving to a position where we oppose the Health and Social
Care Bill.
The

The NHS that we know and love is under threat. The government plans to massively shake-up the NHS, which has the potential to cause [b]huge damage to patient care[/b] and waste vast sums of public money.

http://www.unison.org.uk/ournhs/

In 30 years working in the NHS I have never seen such united opposition.

Of course the government have very cleverly used the pensions nonsense they stirred up to attempt to portray the NHS workers as self serving. Its simply not eh case.

Of course the government have very cleverly used the pensions nonsense they stirred up to attempt to portray the NHS workers as self serving. Its simply not eh case.

Those dastardly Tories, and you all fell for their cunning plan, didn't you...

Cameron and Osborne pictured yesterday, before jetting off to a Bilderberg meeting with their lizard chums

[img] [/img]

The present government know they will never get support of the overwhelming majority of helth and social care workers so they have nothing to lose by angering them further. (they lost another voter yesterday when one of my friends, a dyed-in-the-wool son-of-a-conservative-councillor announced to us all his disgust with the H&SC bill and his disillusionment with his longstanding party of choice).

The reality for me is that as a frontline clinician, (failing me getting struck off for biting a politician on the leg or something), I will always have a job of some sort, albeit under rather worse condistions, pay and pensions than I signed up for, and the senior managers and SHA folk I have seen lose their jobs since the election are educated and very well-connected folk who I am sure can look after themselves. The [b]real[/b] losers in this bill will be the most vulnerable, who cost the state in welfare/benefits and contribute usually only by the VAT they pay on what they consume, and the least likely to vote for any party come elction time; that is the very old and infirm, and those with mental health problems. Funny that. 🙁

Cameron and Osborne pictured yesterday

It will be a wacky race to the bottom.

Ba-boom-tish - here all week, etc.

The real losers in this bill will be the most vulnerable

Indeed. It's going to be interesting when the [i]Daily Mail[/i] finally clocks that hiving off profitable elective services (e.g. tickbox ops in the generally fit) is not going to do anything for frail elderly patients.

Ok TJ, I accept that it is a subtle argument and that you will continue to do your best to mis-represent what I say. But even here, it is about [b]patient care[/b], not about [b]patients[/b] themselves. Where is the noun, the subject, in all of this?

I do not doubt the dedication of most of the people who work in the health service and am in awe of their skills and contribution. But that shouldn't blinker one to the fact that "service" is, at times, a misnomer.

And forgive me from starting with the wrong premise - the patient?????

If we want to start with the idea of premises lets take the NHS's vision statement (excuse the ghastly phrase):

a comprehensive service, [b]available to all[/b], free at the point of use, based on need, not ability to pay’

...and consider, "available to all." So is this true from the patient's perspective? NO, it is true from the governments and hospitals perspective. Who makes the choice.....the government devolves power to the medical staff who determine what they will make available and in what time frame. Again its a matter of perspective. And this is not the patients perspective.

One day, the patients truly will come first. In the meantime, the usual mess will prevail....

If Milliband is correct - that we are passive recipients - there are few services in the world that survive like that without reform.

Edit at 12 mins: [TJ - Opposition to these reforms from the professionals is all about the patients. Just read the press releases from them. I even quoted some a while back] ok very small sample but that's exactly what I did. Two links were made, neither put patients first. But fair to say that this was a ludicrously small sample 😉

there are few services in the world that survive like that without reform.

THN: simple question... how can there ever be a perfect (i.e. properly informed) market in healthcare? If I walk into A&E with abdo pain, there are any number of things which could be wrong with me. All I ask is that battle-hardened staff sit on me till it's resolved or solved - I don't want to be either over-investigated (ker-ching), or fobbed-off with Crapita-value provision.

I'm [i]all[/i] for patients being at the centre, always. But political platitudes about "choice and competition" can be utterly meaningless at the actual coalface - and we are seeing services fragmented for the sake of spurious soundbites.

The point is not that the NHS is perfect - it ain't - but these reforms will not improve matters. Moreover, they look suspiciously like a pre-prepared [i]blitzkreig[/i]. Indeed, much has already been [un]done.

Noteeth - I think we are in complete agreement.

Noteeth - I think we are in complete agreement.

I suspect that most of the world's ills could be sorted on one big STW ride. And on that day, Stoner and TJ will ride a tandem together.

That, or there'd be a massive fight. 😉

[i]One day, the patients truly will come first[/i]

🙄

Platitudes like this are half the problem; if you give people what they want, we would have a fully equipped state-of-the-art hospital at the end of every street, fully staffed 24 hours a day, 365 days a year with every medical speciality under the sun represented and available.

Bit of a dear do though.... and outcomes? Would be worse.

if you give people what they want

It's interesting how MPs say one thing... and do another, when it concerns hospital closures in their own backyard. For my part, I'd like more Burger Kings in hospital foyers. 😈

Lansley has already ducked/palmed off the difficult issue of (necessary) hospital closures and consolidating acute care into a smaller number of centres. And given that the Gov is apparently making funding available to cover some PFI debts, it makes one wonder what will happen in the event of a Southern Cross style failure among the new & willing providers...

How much did the Iraq and Afghan wars cost? And Trident? And bankers, dont forget the bankers. Basically, if folk would stop ripping the arse out of it the NHS would be grand.

On the contrary crikey - putting patients first is not the same thing as giving them what they want in extremis. Any person knows that health has a fundamental problem of unlimited demand BUT limited supply. The question is, how best to deal with this?

If you think that being available for all, should be determined by the supplier/government then so be it. Others may prefer it if the patients made those choices ie, putting patients first. Its a matter of perspective.

The one thing that everyone seems to be in agreement with (including the BMJ in the link above) is that governments are not very good at doing this!

Yes teamhurtmore - you are as usual coming from a totally false premise. seasoned by a refusal to listen to anyone who does not agree with you and then garnished with a bit of denigration of those who disagree with you.

The false premise is that the patients are not put first. Giving people "choice" does not put the patients first. It puts[b] some[/b] patients first - the noisy ones and and it makes strategic planning impossible.

its been shown over and over again that this is not what people want ( bar a very small minority) - they want good local services. They do not want to have to make a choice between services indeed such a thing is actually not possible as it is impossible for lay people to be able to make meaningful choices on care issues in this way 99% of the population do not have the background to be able to make meaningful choice.

The only way choice can be exercised is to give a democratic oversight into the running of the healthservice - withdrawn by this government.

You have been drawn in by this bogus concept - putting the patients first means a planned system that gives the best care for the least cost. Introducing patient choice make care more expensive and fragmented and does not actually achieve what you want it to - it cannot.

anyway these reforms will reduce democratic and patient iimput.

TJ - again? You are incorrigible? I really can't work out if your first paragraph is a joke or for real? Read this thread and look at the one person who has been rude and denigrating on it???? Hmmmm???

Meanwhile, nice to have a discussion with polite people...!!

**** you hurtmore 😉

I'm up in Scotland and work in the the Nhs but that's by the bye (or whatever the phrase is- not important in the context of the discussion). Anyways, I know this doesn't directly affect us but this bill and the changes being implemented scare me, a lot. Tons of points involved in this so I'll just jot them down in random- ish order and folk can flame me or whatever..
No1- did the libdems or torys campaign on a total overhaul of the NHS? Don't think so.
No2- bringing private healthcares into the NHS seems stupid, it's a service not a business. But then if there wasn't going to be profits involved why would these businesses be queuing up to provide healthcare services?
No3- on the topic of profits I do agree with the sentiment the private companies providing services will cost more in the long run than they do now under current provision- profits remember?
No4- if the privately provided aspects of the NHS take up proportionately more of the NHS budget non-private parts of the NHS will have less money to treat folk so patient care will suffer
No5- I agree that the majority of folk in the the NHS are against this, not because of vested interests, but because they already have a good insight into the current state of the NHS and probably have a decent idea of what the changes will do to their organisation..

I've prob got a few more points about Gp groups and political donors involvement with some of the private companies but my wee boy wants out the bath so have to go..

Evening JY - how are you?!?

Doing ok thanks for asking- these threads tend to be just folk espousing their left or right wing view Personally i dont actually believe the Tories have either the political or moral mandate to do this and they are making a pigs ear of it

it is obvious that any organisation the size of the NHS could always be improved and is imperfect but I doubt this will actually achieve it

These threads are just the same old same old
Not many [ on either side] are that rational or wiling to accept that sometimes the other person/side has a point

Well said.

teamhurtmore - Member

TJ - again? You are incorrigible? I really can't work out if your first paragraph is a joke or for real? Read this thread and look at the one person who has been rude and denigrating on it???? Hmmmm???

teamhurtmore - Member

Ok TJ, I accept that it is a subtle argument and that you will continue to do your best to mis-represent what I say.

thats pretty rude and denigrating. You are saying I am incapble of understanding yuor argument and that I am misrepresenting you .

I am not misrepresenting what you say. I am trying to explain to you where your lack of knowledge and understanding leads you astray. However you do not want to listen or understand - you prefer to denigrate.

Others may prefer it if the patients made those choices ie, putting patients first

But no - you know better that the professionals who work in this sytem do

Others may prefer it if the patients made those choices ie, putting patients first

so how is the person living with dementia supposed to make a choice?
How is the person with learning difficulties suppose to make a choice?
How is the person with severe mental health issues supposed to make a choice?

giving patients a "choice" means the shouty middle classes get their choice at the expense of those who cannot shout for themselves.

there is an important principle in the legal stuff that surrounds care which is that we as professionals should do for people not as we want but as they would want were they able to do so.

Your "Others may prefer it if the patients made those choices ie, putting patients first" means that the frail, the vulnerable and the old will get less.

One middle aged womans herceptin is 20 hip replacemnts not done. Thats what "choice" is about.

dog eat dog isn't it.

No not in teh NHS - we do our best to make sure its equal access for all

Now teamhurtmore - just have a think about this. Do you want whats best for all with objective decision making or do you want spurious choice that will disenfranchise the marginalised?

And forgive me from starting with the wrong premise - the patient?????

So the FT today:

Q: How will the reforms make life better for the [b]patients[/b]?

A: AL's [b]inability to find a compelling answer[/b] to this [b]simple [/b]question has done the most to undermine his own position and that of his bill....he has [b]never found a way to put a human face[/b] on the changes....became [b]too caught up in "NHS speak."[/b]

One day...... 😕

Sat between two consultants at dinner last night. Pro reform (desperately needed), but unsurprisingly not keen on these botched reforms despite promising starting point. Recognised conflict of interest but managed better than colleagues - NHS and private kept completely separate - but lamented the fact that all standards could not be [b]bought up[/b] to the private ones. But still justified the status quo with, "how else can I send three kids to private school." !!!! Hmmmm....

Totally agree TJ that, the "shouty middle classes get their choice at the expense of those who cannot shout for themselves." Exactly why the status quo should not be supported.

No teamhurtmore.
Your still starting from the wrong premises. Yo do not agree with me - thats 180 degrees from my position.
However its pointless attempting to explain it to yo as yo are so wedded to your far right view that you simply will not listen.

1) reform is not need bar removing the idiocies created by the last set of changes. See kingsfund research etc
2)Private healthcare is worse in terms of cost and outcomes
3)the spurious choice agenda is wrong because it ioncreases inequalities
4)This bill did not have a

promising starting point

TJ- you are 100% correct that I do not agree with you that the NHS does not need reforming as are the consultants I shared dinner with, but not correct that my premise is wrong or that it is a far right position (although I know you love to claim that!). For sure central planning by design is not consumer-oriented (in this case the patient, poor thing!) but that doesn't mean that a different solution has to be a FAR RIGHT one.

Agree with the idiocies of last (and more) recent changes and that the status quo that delivers (2) and (3) is not desirable. And yes, agreed with the consultants that the US model is not the one we want for the UK.

I am prepared to listen (if not agree with you) but having also spoken to many doctors on the issue (albeit different specialities to yours) I reserve the right to have a different viewpoint!!

Still struggle with your defence of the status quo when it currently delivers some of the outcomes that you abhor?

as are the consultants I shared dinner with

There you go again.......you just can't help yourself can you teamhurtmore ?

Still never mind, I'm sure some people will be impressed by your 'added-value' opinions. Do you think TJ will be ?

Can't help it if I have the chance to ask other medical professionals can I? Always good to have different opinions to complement TJ's. But we have traded views before 😉 on making the most of opportunities that face you. And I certainly leant a lot from them. Would have been a waste to merely talk about the weather.

No.

Not in the slightest.

For sure central planning by design is not consumer-oriented (in this case the patient, poor thing!) but that doesn't mean that a different solution has to be a FAR RIGHT one.

As I have explained to you - you cannot have meaningful patient choice in healthcare. If you want lay input it has to be thru the democratic process and in setting priorities adn processes

TJ

so how is the person living with dementia supposed to make a choice?
How is the person with learning difficulties suppose to make a choice?
How is the person with severe mental health issues supposed to make a choice?

The whole idea of "choice" in this sort of area is a far right idea. It means giving power to the powerful and taking choice away from the powerless. it is a meaningless bit of sloganeering from the right

What people chose is tohave the best possible service in their local hospitals.

Still struggle with your defence of the status quo when it currently delivers some of the outcomes that you abhor?

WTF are you on about? I said we need to get rid of the nonsense of foundation hospitals and the like from the last round of reforms. what the NHS needs more than anything is a period of stability

the reforms proposed make all the faults I see in the NHS far worse for no gain at all. Its all about privatisation. thats all it is.

Agree (mostly) with the first line of the final sentance and have stated that before.

But focusing businesses around the consumer if not Far Right, it's merely basic business sense. That's what frustrates me about the NHS and that is not a political thing, merely comes from experience as an end-user.

Inequality on provision of health care predates foundation hospitals surely?

ITS NOT A BUSINESS, THERE IS NO CONSUMER! this is the bit you seem unable to understand.

Its a service and there are service users who are at the centre of things and rightly so

again I ask you

so how is the person living with dementia supposed to make a choice?
How is the person with learning difficulties suppose to make a choice?
How is the person with severe mental health issues supposed to make a choice?

focusing businesses around the consumer if not Far Right it's merely basic business sense

Talking about universal healthcare provisions as a "business" is very much an extreme right-wing thing.

TJ - happy to disagree on consumer point, asked that specifically to the doctors (sorry ernie) and they agreed. I think the distinction between service users and consumers is not a clear as you suggest.

But (from here) perfectly happy for you to win the argument on STW.

Sure ernie -if you say so. Obviously should have just said common sense, if business is such a provocative word 😉

Just popping my head in. Is it going pretty much as expected?

Teamhurtmore

Please answer this

You want there to be patient choice in the NHS

so how is the person living with dementia supposed to make a choice?
How is the person with learning difficulties suppose to make a choice?
How is the person with severe mental health issues supposed to make a choice?

Or for that matter the old lady who is scared and in pain etc etc.

this is why the concept of patient choice is at best meaningless adn at worst increases health inequlities

Labour blogger John Rentoul in the IoS

Why, then, is it so unpopular? To answer this question you have to understand the politics of the NHS. This rests on these axioms. One, everyone loves the NHS. Two, everyone agrees that the NHS must be run more efficiently, to keep up with rising costs, the ageing population and, now, the slower planned growth in NHS spending. Three, any changes that impinge on the interests of people who work in the NHS will be condemned as privatisation, especially if they are nothing of the sort. Four, everyone will agree that this is the end of the UK as a civilised society/enough to make Nye Bevan spin in his grave/quite simply a disgrace. Five, the media will move on and eventually start again at step one.

Now, this cycle can be repeated indefinitely under Labour governments, because everyone knows that the NHS is Labour's greatest achievement and no one is allowed to point out that if the Conservatives had designed the NHS in 1948 they might have brought in something more like the social insurance model that tends to produce better results in continental Europe.

Or for that matter the old lady who is scared and in pain etc etc.

this is why the concept of patient choice is at best meaningless adn at worst increases health inequlities

or in other words because I dont think absolutely everyone will be able to make a choice, none of you are getting to.

Patronising statist nonsense. What do the French and Germans do?

mcboo

if some people make a choice that means the vulnerable only get whats left - ie not a fair share.

So the shouty midle class lady gets herceptin, 20 frail old ladies do not get hip replacements. thats the reality of "patient choice" in a cash limited system

that blog you quote is nonsense.

this reform is expressly designed to prepare the NHS for wholesale privatisation. it was designed for that purpose and no other. this was the avowed intent form the people who designed it who are all paid by private healthcare companies

What do the French and Germans do?

spend a lot more per person, spend a lot more on admin.

spend a lot more per person, spend a lot more on admin.

Oh I forgot TJ, your concern is always to save the taxpayer money isnt it. In this case the English taxpayer.

mcboo - whats your answer to this

So the shouty middle class lady gets herceptin, 20 frail old ladies do not get hip replacements. thats the reality of "patient choice" in a cash limited system

Oh I forgot TJ, your concern is always to save the taxpayer money isnt it.

But you on the other hand mcboo, want Britain to increase its healthcare spending to the level of France and Germany's ?

Well I never thought I would hear a right-winger like you claim that the government wasn't spending enough.....that's a turn-up for the books eh ?

IOf we had germanor french levels of money we would be so much better off - about 10 - 20% increase infunding.

THM I am not sure you can compare helathcare with business and choice. i may be able to get the elusive exact what tyre i want from all the choices. I may then be able to scour the internet and ask on a forum for the cheapest prices and codes to get it cheaper. Do i gain from this as a consumer of course.

Now with healthcare what do i do? Fly off to Ireland to be treated by CRC as they are better than the nearest provider of emergency heart surgery or dementia care?

As for choice i am not a medical expert and I would no more wish to overrule the experts than I would tell an electrician the best way to wire my house or tell the mechanic how to fix my brakes. I dont feel oppressed by this lack of knowledge I have the sense to see someone who knows more than me and let them get on with it.

Mcboo every day must be full of the oppression of people making decisions for you- whatever you do dont fly FFS that pilot wont listen to word you say about route choices and flight plans.

Well NHS Scotland did its best to let my mother die of bowel cancer a few years ago. Told her she had to wait 11 weeks for surgery......until my brother in law (consultant haematologist) started making threatening phone calls to the powers that be, telling them to pull their fingers out of their collective backsides, cancel that Friday afternoon four-ball and get busy. Had her op two weeks later and survived one of the most lethal forms of cancer.

That episode made me more sure than ever that health provision needs radical reform. Its all very well for a well connected medical family like ours, what if you are some poor bugger in the East End of Glasgow who doesn't know how the system works. You just do as you are told and are grateful for what you are given and sit in ignorance and watch your mother die.

so these changes have been designed by the Tory party to make outcomes better for the poor bugger in the East End of Glasgow who doesn't know how the system works

Well Gawd Bless em

I think we would all like to achieve what you would like an dhwat is fair but I dont see how this "choice" will actually help poor or ill-informed people to get a better service. They will continue to get the worse service as they are still poor an ill informed.
Perhaps they should try and treat the cause and eradicate poor and ill-informed people [ that is in a more leftist sense of education and redistributive taxes rather than a right wing final solution way for clarity]

http://en.wikipedia.org/wiki/Singapore#Health

Singapore has a generally efficient healthcare system, even with a health expenditure relatively low for developed countries.[177] The World Health Organization ranks Singapore's healthcare system as 6th overall in the world in its World Health Report.[178] In general, Singapore has the lowest infant mortality rate in the world for the past two decades.[126] Life expectancy in Singapore is 79 for males and 83 for females, placing the country 15th in the world for life expectancy. Almost the whole population has access to improved water and sanitation facilities. There are fewer than 10 annual deaths from HIV per 100,000 people. There is a high level of immunisation. Adult obesity is below 10%.[179]
The government's healthcare system is based upon the "3M" framework. This has three components: Medifund, which provides a safety net for those not able to otherwise afford healthcare, Medisave, a compulsory health savings scheme covering about 85% of the population, and Medishield, a government-funded health insurance scheme.[177] Public hospitals in Singapore have autonomy in their management decisions, and compete for patients. A subsidy scheme exists for those on low income.[180] In 2008, 31.9% of healthcare was funded by the government. It accounts for approximately 3.5% of Singapore's GDP.[181]

I think we would all like to achieve what you would like an dhwat is fair but I dont see how this "choice" will actually help poor or ill-informed people to get a better service.

How do you know? People make informed decisions all the time, but only once they know they have a choice.

Look I dont know that these current reforms are the right ones, I don't. What I do believe is that health provision is just another service for which I am a consumer. A lot of people think the NHS is sacred ground and should be immune from market forces. I remember thinking like that but I have changed my mind.

If you work in the NHS and you see the world through a prism where public sector workers in general and healthcare staff in particular exist on a wholly superior moral plane from those of us who grub away in the private sector, there isn't any amount of evidence that is going to change your mind. Me, I've worked in the public and private sector and seen plenty to admire and criticise in both.

singapore is a poor comparison with the uk
it has a much smaller, younger population
it also benefits from a much healthier lifestyle and low penetrance of western diet - the government controls this tightly

it also benefits from a much healthier lifestyle and low penetrance of western diet - the government controls this tightly

Oh there is always an excuse. You made this up. Singaporeans smoke like crazy, drink too much, eat salt drenched Chinese food and dont take any exercise.

Also singapore has a significant number of migrant workers who are not covered. the 3.5% of GDP is not the whole cost either - it is only the cost for the 31% of healthcare stae funded so the total costs are similar to us

I would be interested in knowing more about he Japanese system because it is cheap and seems to be comprehensive but i know nothing more than that about it

mcboo - you do relise in Germany you pay more taxes than us then you have to pay compulsory health insurance on top (of IIRC 15% on income) as your taxes do not conver most healthcare

Look I dont know that these current reforms are the right ones, I don't. What I do believe is that health provision is just another service for which I am a consumer. A lot of people think the NHS is sacred ground and should be immune from market forces. I remember thinking like that but I have changed my mind.

Almost everyone it eh health services are against them - this is unprecedented. the royal college of GPs even - an non trade union non political body as well as the BMA ad so on.

ye the NHS should be immune from market forces - it is a natural monopoly and no market can possibly work in healthcare.

People make informed decisions all the time, but only once they know they have a choice.

they dont see the examples I cite above there are areas where you know f all and you cannot make any choice beyond trusting the expert to fly the plane, fix your brake etc. Are they going to send me on a medical degree and do all the training to make me informed ? What if it is just so complicated I dont understand..I dont want you to explain programming language and protocols to me just fix the effing computer

at least you accept you just think choice is great and like the hypothetical public sector worker you lazily caricature there is no debating with you as you have made your choice

sometimes markets bring excellent consumer outcomes sometimes they bring really poor ones. The skill is know when to use which and not to be so ideologically motivated you always think one is best no matter what the scenario

The World Health Organization ranks Singapore's healthcare system as 6th overall in the world in its World Health Report

Why on earth do you want to provide a link which says that Singapore's healthcare is ranked at number 6 by WHO ?

Shouldn't we be looking at number one mcboo......or don't you think Britain is worthy of such excellence?

Go on. Tell me......why "Singapore" ?

Has it anything to do with Dan Hannan ?

Go on. Tell me......why "Singapore" ?

Has it anything to do with Dan Hannan ?

mmmmmmmmm Nope. My first child was born there. I almost died there.

Almost everyone it eh health services are against them - this is unprecedented. the royal college of GPs even - an non trade union non political body as well as the BMA ad so on.

This is why I'm not sure that these are the right reforms. As I understand it the plan is to put the GPs in charge, but the GPs either dont want to be in charge, or they do and would structure the reforms a different way.

ye the NHS should be immune from market forces - it is a natural monopoly and no market can possibly work in healthcare.

Possibly is putting it a bit strongly. So much so that it suggest you don't approach the discussion with an open mind.

My first child was born there. I almost died there.

So you think Britain should look at the Singapore model because of that ?

Unfortunately I reckon most people might not be bothered by your personal experiences and would prefer to look at the country which was ranked at number one by WHO.

Most GPs dont want to be in cheapen. Also most other healthcare professionals know the proposed sytem makes no sense 5 new layers of beurocracy to pay for. Billions to set up and billions annual costs

Its designed to privatise the system. GPs have neither the skills nor wish to manage the service so contract it out to management companies. The services commissioned by the management companies can be commissioned from anywhere so the same healthcare companies will create units to cherrypick work and then refer patients to these units leaving the NHS hospitals with the difficult and complex stuff only thus fragmenting the service making co operative learning impossible, making pallnning impossible ruining medicaland nursing training.

mcboo - how can market forces work in a natural monopoly? How can market forces work when the vast majority of transactions cannot be a result of any sort of meaningful choice?

I dont know how anyone could seriously consider healthcare a monopoly. If I needed say a hernia done, how many hospitals in London could my GP recommend? 10?.....20?

You and other health workers might LIKE the fact that NHS Scotland operates as a monopoly, but then you would, wouldnt you?

So you think Britain should look at the Singapore model because of that ?

Unfortunately I reckon most people might not be bothered by your personal experiences

No, but you asked why I brought up Singapore. Thats why, my own personal experience. You might not be bothered by it but it's my opinion which I formed all by myself. I'd rather not be told what to do by you or anyone else.

Thank god we all live in London and have a vast choice of hospitals close to us.

FFS it is not like TJ wont have a job [ or any other health worker] if this happens so what exactly is their vested interest you keep going on about. Do you perhaps mean expertise or knowledge?
You are just going oh look the people who work in this industry dont want the change and then you insult them then give us your polemic on them and choice. Repeating your obvious disdain for the public sector and its employees ad nauseum gives it no more weight than the first time you mentioned it/ insulted the workers.
Your are letting your politics and philosophy lead this discussion I think you and TJ should have some discussion on this
Enjoy

I'd rather not be told what to do by you or anyone else. That why I am forcing choice on you whether you want it or not

FTFY

mcboo - Member

I dont know how anyone could seriously consider healthcare a monopoly. If I needed say a hernia done, how many hospitals in London could my GP recommend? 10?.....20?

all of whom ( should be) cooperative and share knowledge and experience to bring everything to the best standard so are offering the same "product" at the same price hence its a natural monopoly.

Introduce competition and you remove the cooperation and drive down standards

Your are letting your politics and philosophy lead this discussion I think you and TJ should have some discussion on this

I have been warned off for obsessive arguing and as this thraad has arguably 😉 reched that point so shall bow out as all possible relevant points have been made.

I will just draw attention to teamhurtmores avoidance of answering this

Please answer this

You want there to be patient choice in the NHS

so how is the person living with dementia supposed to make a choice?
How is the person with learning difficulties suppose to make a choice?
How is the person with severe mental health issues supposed to make a choice?

Or for that matter the old lady who is scared and in pain etc etc.

this is why the concept of patient choice is at best meaningless adn at worst increases health inequlities

Junkyard - Member
so these changes have been designed by the Tory party to make outcomes better for the poor bugger in the East End of Glasgow who doesn't know how the system works

Designed by the Tory party?

Designed by those in the private sector who stand to gain £billions: [url= http://www.****/news/article-2099940/NHS-health-reforms-Extent-McKinsey--Companys-role-Andrew-Lansleys-proposals.html ]rubbing their grubby mits at the thought of privatisation[/url]

all of whom ( should be) cooperative and share knowledge and experience to bring everything to the best standard so are offering the same "product" at the same price hence its a natural monopoly.

Introduce competition and you remove the cooperation and drive down standards

Well thats not the same thing as saying healthcare cant operate with competition. You're just saying you dont like competition per se. We know TJ that you prefer collectivist solutions to pretty much any issue, but that doesnt get you anywhere. You might as well just say you want to turn the clock back to 1979 and take the country back to closed shops and an economy dominated by state monopolies.

collectivism =/= state monopolies

You are just saying you love choice and hat the state an the public sector.
he ha snot said he dislikes competition per se he has explained with an example of why it would hamper patients outcome in a naturally monopoly.
Your stupid argument about him wanting to turn it back to 1979 adds nothing to your view and makes you look a tad hysterical,prone to hyperbole and bluster and of course letting you political and philosophical views cloud your thinking
You may disagree with him but the caricature of him is inaccurate and lazy and a petty poor to say the least.

Why dont you just say you are right wing, pro choice and think competition makes everything better for everyone.
you dont care what anyone says as that is what you think

Shame why not e-mail TJ on this and let me know what happens when an immovable object meets an irresistible force.

Thats why, my own personal experience. You might not be bothered by it but it's my opinion which I formed all by myself. I'd rather not be told what to do by you or anyone else.

😀 Who's telling you [i]"what to do"[/i] grumpybollox ?

I just pointed out that Britain is unlikely to adopt the Singapore healthcare model on the basis that you almost died in Singapore.

If you had commented that WHO considers the Singapore healthcare model to be the best in the world, then there might have been some merit to your argument.

Shame why not e-mail TJ on this and let me know what happens when an immovable object meets an irresistible force.

Why dont you just say you are right wing, pro choice and think competition makes everything better for everyone.

Socially liberal, economically conservative rather than "right-wing" but yes definately pro market choice. A lot of people are you know.

Oh and thanks for the aggression and abuse. I'd take it seriously if I could understand what you are on about.

A lot of people are you know.

19% of people according to the latest opinion poll on the matter.

Sorry TJ watching a film. Answer, "they can't." x3

Personal experience is interesting though Ernie. You have lots of insights on Arg economics and military affairs from personal experience and family links, so the rest of us can learn from them. Perhaps others can learn from McBoo.