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Started by barkis on Jun 9, 2019 9:07:06 PM
The benefit of Blair's NHS privatisation.
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fenderstrat - 09 Jun 2019 21:24:46 (#1 of 48)

No, it’s all good. We just need a grown-up conversation about this.

TinyMcSmith - 09 Jun 2019 21:25:04 (#2 of 48)

In 2012 Circle became the first profit-driven health firm to be put in charge of an NHS hospital when it took over the running of Hinchingbrooke hospital in Cambridgeshire. It handed the contract back to the NHS in 2015 after the hospital experienced financial problems and could not keep up with rising demand. The Care Quality Commission rated the hospital’s care as inadequate.

FFS!

Circle should be sequestrated and their assets turned over to public ownership.

TinyMcSmith - 09 Jun 2019 21:25:50 (#3 of 48)

We just need a grown-up conversation about this.



You just hate business. Lessons will be learned.

YorenInTheNorth - 09 Jun 2019 21:27:06 (#4 of 48)

I have have no objection to private involvement as it works just fine on the continent but if its opening up the market to profit makers US style (they spend twice the GDP as us for worse results) then sod off.

Ginmonkey - 10 Jun 2019 06:53:58 (#5 of 48)

Indeed Yoren - it is not the type of provider per se but the contract and incentives. GPs always been private providers to the NHS.

SinnerBoy - 10 Jun 2019 08:04:27 (#6 of 48)

The article says that, in Nottingham, they were running things according to all specifications, with a high rate of patient satisfaction.

Tagyourit - 10 Jun 2019 09:14:30 (#7 of 48)

The Hinchingbrooke rating was something of a political stitch up and a lot of the initial findings were later overturned.

What did fuck them up was someone made a cock up on the funding returns which cost them millions and they weren't allowed to correct it.

mingmong - 10 Jun 2019 10:25:58 (#8 of 48)

The PPP model, with its framework of tenders and inspections, has failed in nearly every sector to which its been applied, as most reasonable people could have predicted it would.

The private providers concentrate their resources in sales, PR and corporate-legal services. I used to work for one of these outfits, and I've seen how they do things. Contracts are bagged and the public sector client is, more often than not, stitched up with punative break clauses. Front line staff put on casualised contracts, on lower pay but also at greater cost (the agency invariably bagging more than the cleaner, nurse or care worker involved)

The result is a hollowed-out, under-resourced, low quality service staffed by short-term demotivated workers with only a fleeting acquaitence with (and committment to) the institutions and service-users involved.

One of neoliberalisms shitter innovations.

CarlosFandango - 10 Jun 2019 10:32:08 (#9 of 48)

Agree entirely, ming.

People airily cite practices and private service provision on the continent as evidence that marketisation can work, but they don't usually realise that a lot of providers are run as non-profits and have to adhere to closely scrutinised and tightly-set charging schemes.

TinyMcSmith - 10 Jun 2019 10:38:35 (#10 of 48)

What Ming and Carlos said.

It requires a suspension of the bleedin' obvious and tying oneself in knots to find arguments to defend the privatisation of a national health service. It's illogical as a premise (unless the goal is to try and make money for corporations) and evidentially doesn't work in practice.

fenderstrat - 10 Jun 2019 10:44:37 (#11 of 48)

There is a decent corpus of research on culture and cultral differences in the NHS, and most of us working in the field believe that organisational culture is a huge factor in patient care.

The main divide is between managers (corporation-centric, look to upstream managers) and clinicans (patient-centric, look to clinical colleagues). Practical outcomes of clinican behaviour include stuff like unpaid work, communication with patients - the stuff that keeps an underfunded service actually functioning at all.

Private providers simply don't do the work of the NHS - they cherry pick the easy stuff - which can be fine, but remember that this is only possible because the NHS maintains everything else. Emergency, critical care and so on. Virgin can't work without them.

The point about GPs being private contractors is a bit misleading. Yes, they are usually, but they exist in a tradition of professional practice and they're regulated by Royal Colleges, who do a very good job on ethics, professional culture and patient focus. You can't just read that across and assume that all private providers will be the same. USA HBOs don't have a culture that's anything equivalent. Or a Royal College.

And of course, the loyalty and focus of managers and Boards in private healthcare will always be corporate. And they exist to provide a ROI first.

Personally, my observation of private provision in the acute sector is that it's horrible. You end up with a mosaic, and an ugly one, and one you have to manage with contract negotiations, performance indicators - no added value to the patient. Honestly, I don't see the question to which this (private provision) is the answer.

FleurDuMal - 10 Jun 2019 11:18:51 (#12 of 48)

I would hate anything like the US system - the idea of people being sent home to die because they can't pay for (curable) treatment is simply barbaric.

If we have to have alternate funding, I'd prefer something like the French model, where you pay upfront initially, but have a carte vitale which is swiped at the same time, immediately reimbursing 80% (or more in some circumstances) of the cost. Any shortfall can be made up by the patient themselves, or a much more modest private insurance policy

FrankieTeardrop - 10 Jun 2019 11:27:59 (#13 of 48)

"Contracts are bagged and the public sector client is, more often than not, stitched up with punative break clauses."

Why is the public sector accepting such clauses? They're the ones buying the service.

Gotout - 10 Jun 2019 11:32:05 (#14 of 48)

Why is the public sector accepting such clauses?

Because the people making the decisions are probably in BUPA and are unaffected by their crap decisions.

Rendered - 10 Jun 2019 11:32:21 (#15 of 48)

In my experience, the people negotiating on behalf of the public sector are fairly clueless.

FleurDuMal - 10 Jun 2019 11:43:37 (#16 of 48)

That would be my take on it, too. 'Negotiating' is perhaps over-egging it; it's more likely to be an inability to realise that the contract wasn't set in stone, as presented.

mingmong - 10 Jun 2019 11:43:38 (#17 of 48)

One could of course argue that tax-payers money should be invested in better in-house legal teams for all branches of the public sector.

But there comes a point where it might be just be easier, fairer, more transparent and better value for money to run the whole service in-house, with a team of committed permanent staff, and keep the lawyers and 'corporate services teams' out of the whole business in the first place

CarlosFandango - 10 Jun 2019 12:37:57 (#18 of 48)

In my experience, the people negotiating on behalf of the public sector are fairly clueless.

I said pretty much exactly this some time ago and was roundly upbraided for it.

Supposedly the trusts are full of hotshot negotiators....

FrankieTeardrop - 10 Jun 2019 12:44:20 (#19 of 48)

"But there comes a point where it might be just be easier, fairer, more transparent and better value for money to run the whole service in-house, with a team of committed permanent staff, and keep the lawyers and 'corporate services teams' out of the whole business in the first place"

How would bringing in in house fix the problem of not being able to define the terms of service in the first place?

mingmong - 10 Jun 2019 12:50:11 (#20 of 48)

For clarity, by permanent staff I mean people like nurses, care-workers and cleaners.

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