National Health Service (NHS)

Any chance of starting a "Jeremy Hunt is a lying cunt" thread along Rod Liddle lines?

I've been intermittently been feeling v. ill for the last few months. First time I've really confronted anything particularly chronic/debilitating and although I'm relieved the NHS is here, I'm pretty sad just how conditional and costed treatment. Having been fobbed off for months with 'it's just a post viral symtoms, you just need to wait it out' I've had to argue really strongly for actual tests to be done and basically self-diagnose to a massive extent, print off peer reviewed journal articles, and guidelines published by international public health organisations.

To achieve the desired testing the doctor basically had to lie to the unit required as she agrees with me but can't get them approved without saying I've had symptoms that medical professionals know don't even manifest in over 30% of cases, as without them the lab concerned will refuse to do the tests. Now one sample of blood goes to one end of the country, and one goes to the other, and one goes to... France. Because "we stopped doing that test".

Confusingly, the lab that had to give her approval also didn't want her to give me medication without clinical proof of need, but didn't want to perform the tests that would confirm the same. I was then offered a referral to a specialist unit that might see me within 2 weeks or might not, but would only be able to ask the same people to do the same tests, with the same need for the same non-visible symptoms to be present before they'd agree to do them.

Now that we've negotiated this Kafkaesque situation, it also has to be noted that because of the costs involved the NHS doesn't perform these tests to the same sensitivity as, say France, Germany or the USA, and as such has a far higher risk of returning false negatives. So if they come back negative, I may have to go private anyway just to get access to an accurate diagnosis and appropriate medication. Great.

I then come home to discover on my FB feed (eerie) that Cameron quietly sold off a section of the NHS that processes blood plasma in 2013 to an American Venture capital firm called Bain Capital for £90 million despite it being valued at £150 million. Now having retired Cameron is earning undisclosed sums for doing speeches to Bain. Stink, much?

How can the fuckers responsible for creating such a disfunctional mess out of what by all accounts used to be a very sensible and effective organisation and was respected the world over, be allowed to profit like this? The conflict of interest is undeniable.

TL:DR Tories are cunts, the NHS is getting fucked, people's treatment is suffering.

And today:

The Tories just tried to sneak out the biggest EVER privatisation of the NHS
OCTOBER 18TH, 2016 Steve Topple STEVE TOPPLE UK
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The Tories just tried to sneak out the biggest EVER privatisation of the NHSUK
The Conservative government has quietly announced one of the biggest sell-offs in the entire history of the NHS. On Friday 14 October, the government’s website released details of nine NHS contracts that are up for sale. And they are worth a staggering £7.9bn; 7.3% of the total NHS budget.

Staggering amounts of money

The contracts, in the North West, South West, London, Yorkshire and Humber, two in the South East, and three in the East Midlands with no current value, are for what’s known as “prescribed specialised services”. While the government has not given specifics as to what services are up for sale, they fall into these categories:

Cancer.
Mental Health.
Trauma (A&E).
Women and children.
Blood and infection.
Pharmacy.
The values of the two-year contracts are as follows:

South West: £1,250,567,024.
North West: £1,304,170,076.
South East: £779,026,586 and £1,779,914,071.
London: £2,792,976,480.
Yorkshire and Humber: £769,411
The NHS says this type of sales are to “deliver consistent care standards across the country”, in line with what’s called the “Five Year Forward View“. NHS England and the Department of Health (DoH) say of the “view”:

There is now quite broad consensus on what a better future should be. This ‘Forward View’ sets out a clear direction for the NHS – showing why change is needed and what it will look like.

This isn't privatisation, its required by law to publish details of contracts being offered for healthcare provision over 750k euro after April 18th under (Public Contracts Regulations 2015) for healthcare contracts.

If you wanted to bid you'd have to bid for the whole service across provided by each current hospital and be ready to replace them on 01st April next year, and be able to do it cheaper than current providers so thats quite a big barrier to entry of the "market".

extract from NHSE letter to providers here.

"The lots are being advertised as “suites of services” to be provided in specific geographies at contract level - expressions of interest are invited at Lot level only. Therefore expressions of interest will not be accepted for individual services.
The PINs will signal our intent to award whole contracts for 2017-2019 using the NHS Standard Contract to the incumbent providers without further publication, unless; expressions of interest are received from alternative economic operators. "

Steve Topple needs to calm down basically.

And yet, previous sales of similar 'suites of services' have resulted in private companies pulling out after falling standards in a bid to create profit-see Hitchingbrook and Circle:

https://www.opendemocracy.net/ournhs/caroline-molloy/hinchingbrooke-why-did-england's-privatised-hospital-deal-really-collapse

Seems to be pretty wide consensus that chipping services off and offering them out to tender is privatisation via the backdoor, and consistently results in poorer standards?

In the one particular area of London where I have NHS procurement experience I know that patient satisfaction is significantly higher in GP Practices that were outsourced. To the point that patients leave other practices in the area to sign up to the privately owned ones. The main reason for this is that the practices owned by the large private healthcare companies can afford to recruit the best doctors. I know this is a very specific example but I wanted to offer a counter argument to your claim that privatisation offers consistently poorer standards.

In the one particular area of London where I have NHS procurement experience I know that patient satisfaction is significantly higher in GP Practices that were outsourced. To the point that patients leave other practices in the area to sign up to the privately owned ones. The main reason for this is that the practices owned by the large private healthcare companies can afford to recruit the best doctors. I know this is a very specific example but I wanted to offer a counter argument to your claim that privatisation offers consistently poorer standards.

When I was in London I saw the underinvestment in GP services (I think this was round the time several flagship 24 hour clinics were being closed) and pressures on A&E that resulted, and it was quite shocking how poor provision was in comparison to Scotland's NHS which is ring fenced and fully devolved.

It seems inevitable that subsequently offering these services out to private contractors will create higher satisfaction ratings just because what they're competing with has purposely been run down? I think what Hunt's doing to junior docs and May is doing to foreign NHS staff's motivation will further bolster the private health industry.

Hinchingbrooke took three years to set up after the contract was let in 2009 and was some mad franchise scheme where NHS owned the hospital.

As Hitchingbrooke's the creation of the PFI fiasco doesn't that really mean that all the NHS owns is a crippling debt repayment for what's likely to be a substandard building though?

The main reason for this is that the practices owned by the large private healthcare companies can afford to recruit the best doctors

I worked for such an outfit. My take on it was that management was more responsive, focussed and being provided by a bigger organisation possibly had some more clout with things like digitalisation etc.

I am pretty much unbiased - I'm back in the NHS atm. Personally I was really impressed with private provision of NHS care. I saw monitoring of quality that puts the NHS to shame. There is a bit of knee jerk 'NHS good, private bad' - not my experience.

Interesting. What area do you work in (medical/admin/managerial) and what brought you back to the NHS if you don't mind me asking?

I think the knee jerk you describe could also be that rightly or wrongly you don't hear of many privatisation success stories in the media...

Manager type
I worked my arse off in the private sector for 2.5years, loved it, nearly made Director and got sacked instead (pre election business downturn)
Came back to the NHS because all the job adverts are in one place, wanted my pension back, wanted to stay local etc. Find it pretty uninspiring in comparison but have more of a life

https://www.lightbluetouchpaper.org/2016/12/05/government-u-turn-on-health-privacy/

Methods for opting out of NHS distributing your medical records to private companies...
https://medconfidential.org/2016/opt-out-process-update-december-2016/

Hawking accuses Hunt of cherry-picking his evidence. Hunt responds by cherry-picking evidence.

https://www.theguardian.com/politics/2017/aug/19/jeremy-hunt-says-stephen-hawking-is-wrong-on-the-nhs

The shadow health minister, Justin Madders, weighed in on the row: “It doesn’t take a genius to work out the Tories are wrecking the NHS.

“Professor Hawking has given us answers to many of the universe’s most challenging questions, and even he can’t work out why Jeremy Hunt is still in his job.”

From Twitter - Jeremy Hunt: "Stephen Hawking is brilliant at his only job which is to analyse evidence but he's not brilliant at analysing evidence"

Hunt's brand of mendaciousness wrapped up as stupidity is infuriating. He knows exactly what he's doing and he's very dangerous.

Every one I know working for the nhs is convinced that its being destroyed slowly to be replaced with a us style insurance system.
The scary thing us that some approve of the changes in that it may mean better pay and conditions. And not the monopolistic employment market at the moment... I'm not convinced.

I wouldn't be here if it wasn't for the NHS, so I literally have them to thank for my life.
However, when I first went to my GP, when I thought there was something wrong, I was told there was a 4 week wait to see a doctor.
I paid £80-odd quid to see a private doctor in one of those walk-in clinics, and they knew immediately what was wrong with me. They told me to bugger off back to the NHS and make a fuss until I was listened to.
How many people give up at the 4 week wait, or don't take it any further because they don't want to be any bother?
Once I was in the system, under an NHS oncologist, I was fine. But I really wonder how many people die of cancer because the initial meeting with a GP is such bloody hard work.

That's only relatively recent though isn't it? I agree that waiting weeks for an initial GP appointment should be simple, straightforward and quick. In some places it's still a day or two as it should be but increasingly people complain of long waits. To me that service should absolutely be NHS provided and free and is something that should be fixed rather than left to private to pick up. I used to believe it was because the medical training filtered and produced fewer people who wanted to be GPs (as opposed to the more competitive specialisms) but seeing the proliferation of private services advertised in London, I guess that can't be true. It's not that doctors don't want to be GPs, it's that the system is forcing them out or is less attractive than private. Is it because practices became bigger? Or the job requires more practice management and less doctoring? What are the conditions that are the problem? I think most doctors would rather be NHS than private. (Not really questions for you specifically just a general response! Any GPs on here?)

Very much convinced it's happening, and it's been going on since the 80's. Although some approve due to the financial aspect, a lot don't. I'm a med student, and a lot of my friends/Drs I meet are massively opposed to a more US-style system because it means making often arbitrary decisions about helping someone based on whether they can pay/have insurance. This goes completely against the values that bring a lot of people in to healthcare in the first place. It's why NHS workers are generally okay taking real terms pay cuts for 12 years, but really kick up a stink when the government start openly taking the piss, as they have been the last couple of years.

Long story short, govt are cutting funding to GP's while asking them to do more and more (a lot of recent health policy relies on preventing/treating illness in the community). As demand has outstripped resources, the burden to try and close this gap has fallen on GP's, which has made their working life increasingly intolerable. Consequently fewer people go in to it as a specialty and practicing GP's burn out and leave. This has been compounded by a lot of older GP's seeing what a shit-show it's becoming and pulling the eject cord to early retirement.

I was on placement in a GP practice recently and there is some scope for improving working practices to avoid the kind of problems you had. However it really needs to be sorted out with proper funding and sensible workforce planning. Unfortunately the current govt. are ideologically hell bent against the NHS (despite it being one of the best systems out there when properly funded) and would rather defund it and let the private providers prey on the dissatisfaction of the (understandably) frustrated public. If this goes on long enough the public gets used to private provision 'saving the day' and being 'inevitable', and voila, mission complete for the Tories.

I'm really sorry to hear you had such a horrible experience - I personally think its absolutely reprehensible that the government are happy for situations like yours to happen as collateral damage in achieving their aims. They've been incredibly devious in how they've pushed through all the changes to get us to this point, and I can only hope that people wise up to it ASAP and vote them out before they cause any more damage!

Interesting thread. I work in public healthcare in Sweden and though I have no experience of the NHS or know the scope of its underfunding &/or privatisation, the issues discussed in this thread largely apply over here as well. I'd imagine many commenting are convinced it's to do with left/right government being in charge atm but I'm not so sure. I think many of the issues facing public health care are built into the way it's managed regardless of political colour. Read up on new public management. It's my mantra to bring this up as the root of all evil in publically funded services. Some silly cunts back in the late 80s borrowed the language of management consulting, mixed it up with soviet budget planning and threw in a large dose of mistrust in the professionals working within health care, schools, police etc and the result is what we see today.

I agree that privatisation of health services has generally not benefited society as a whole but I think it could, especially on the GP level as it could make primary care personnel more in charge of their everyday situation. The trouble is the politicians poor ability/cluelessness of crafting solid contracts to ensure best bang for buck for people. I.e. only basing selection on which provider claims to offer the service cheapest and not factoring in continuity, long term interest & future plans etc.

Completely agree about new public management/internal market - vast amounts of money is wasted on administration, and this is what should be cut in the name of 'efficiency savings'. And yeah, it's not a matter of R vs. L so much - the previous Labour govt. did just as much to advance the management structures/reorganisations that we are reaping the (grim) rewards of now. However the current batch of Conservatives are a particularly nasty bunch who are hell bent on destroying the NHS for ideological reasons alone (Letwin/Refeood et al).

Regarding GP's they have actually been independent organisations since the inception of the NHS for precisely this reason - but you're right in terms of inept politicians/managers making short sighted decisions which end up doing a lot of damage in the long run.

If you want more insight in to this, I'd recommend checking out the videos of the debates from the recent TalkNHS event on the royal society of medicine FB page - super interesting and some good solutions too.

Thanks for the tip, will check out. Didn't know your GPs are independent, that's mostly not the way here.

If there was any doubt that the poor NHS is broken, have just had a fifth appointment cancel (glaucoma test) and the ‘sorry, etc’ letter arrived in the same post with the same post date (15th) as the confirmation letter. So a year later am still no nearer getting the test done the optician’s said needed doing.
This must be hell for people with serious problems who just have to keep hanging.
If there was an election coming up I’d have something to say.