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The future of the NHS (if any)

...on serious topics that don't fit anywhere else at present.
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Tetenterre
Posts: 3244
Joined: March 13th, 2011, 11:36 am

Re: The future of the NHS (if any)

#1721 Post by Tetenterre » May 12th, 2017, 10:56 am

Latest post of the previous page:

Nick wrote:If they hire locums it comes out of their own money.
Except there's already a national shortage of GPs (including locums). It's even been getting "tricky" at my local surgery which, being small-town, tends to be a more attractive option. It's worse in Bournemouth according to GP friends.
Steve

Quantum Theory: The branch of science with which people who know absolutely sod all about quantum theory can explain anything.

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Alan H
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Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1722 Post by Alan H » May 12th, 2017, 11:09 am

Tetenterre wrote:
Nick wrote:If they hire locums it comes out of their own money.
Except there's already a national shortage of GPs (including locums). It's even been getting "tricky" at my local surgery which, being small-town, tends to be a more attractive option. It's worse in Bournemouth according to GP friends.
But hasn't Jeremy 'liar' Hunt promised thousands of new doctors in the next few years?

Speaking of Jeremy 'liar' Hunt: Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records
Evidence before this study
We searched PubMed for publications from inception up until June 15, 2016, with the terms “weekend” AND “admission” AND “mortality”, with no language restrictions, and also reviewed references from retrieved articles. Weekend emergency admissions have been associated with an excess risk of dying in the next 30 days compared with weekday admissions (after adjusting for patient-level factors available in administrative datasets) in large national and international studies, in all admissions and in subgroups defined by elective admissions, emergency admissions, and clinical subgroups (eg, stroke). The excess mortality is often attributed to differences in staffing levels or service provision at the weekends. However, there is indirect evidence that the excess mortality could be attributed to inadequate adjustment for how sick the patients admitted at weekends are.

Added value of this study
We used a large comprehensive warehouse of electronic health records to adjust individual-level analyses for factors not previously considered, including haematology, biochemistry, and microbiology tests, and time of admission. We found that adjustment for 15 routinely measured haematology and biochemistry test results could explain a substantial proportion of the excess mortality effect associated with weekend emergency admission. The remaining excess deaths predominantly occurred in patients admitted as emergencies between 1100 h and 1500 h at the weekend. The excess mortality was not associated with multiple measures of hospital workload.

Implications of all available evidence
These results are not consistent with staffing or service provision being the primary driver of the weekend effect, and suggest that much of the remaining excess mortality could be accounted for by other characteristics of the patients, their health-seeking behaviour, or availability of services outside the hospital.
Hopefully, Jeremy 'liar' Hunt will correct his lies in light of this new study. But will he drop his plans for his '7-day NHS'?
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

Nick
Posts: 11027
Joined: July 4th, 2007, 10:10 am

Re: The future of the NHS (if any)

#1723 Post by Nick » May 12th, 2017, 11:22 am

Tetenterre wrote:
Nick wrote:If they hire locums it comes out of their own money.
Except there's already a national shortage of GPs (including locums). It's even been getting "tricky" at my local surgery which, being small-town, tends to be a more attractive option. It's worse in Bournemouth according to GP friends.
Certainly. But one of the reasons for the shortage is GP's leaving the NHS. If some of those go into private work, it will increase overall capacity.

But that is a different point to the one being addressed by my original post: that this is not the privatisation of the NHS!

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Alan H
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Re: The future of the NHS (if any)

#1724 Post by Alan H » May 12th, 2017, 11:26 am

Nick wrote:
Tetenterre wrote:
Nick wrote:If they hire locums it comes out of their own money.
Except there's already a national shortage of GPs (including locums). It's even been getting "tricky" at my local surgery which, being small-town, tends to be a more attractive option. It's worse in Bournemouth according to GP friends.
Certainly. But one of the reasons for the shortage is GP's leaving the NHS.
What are they doing that?
If some of those go into private work, it will increase overall capacity.
Why?
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Tetenterre
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Joined: March 13th, 2011, 11:36 am

Re: The future of the NHS (if any)

#1725 Post by Tetenterre » May 12th, 2017, 4:56 pm

This, from Ben Goldacre. The places to look are 1997 and 2010. (Wait for the graph on the right to render.)
Steve

Quantum Theory: The branch of science with which people who know absolutely sod all about quantum theory can explain anything.

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Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1726 Post by Alan H » May 12th, 2017, 5:18 pm

Tetenterre wrote:This, from Ben Goldacre. The places to look are 1997 and 2010. (Wait for the graph on the right to render.)
His colours are dreadful, but how interesting. How very interesting...
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1727 Post by Alan H » May 12th, 2017, 5:50 pm

A slight diversion: NHS cyber-attack: GPs and hospitals hit by ransomware

This seems to have affected companies worldwide including Santander in Spain.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1728 Post by Alan H » May 12th, 2017, 8:04 pm

Massive Global Ransomware Attack Underway, Patch Available
How Can You Tell If Your Computer Is Infected?

The most obvious way to tell if your computer has been affected is if you are seeing a ransomware pop-up screen when you start up your computer. But because we don’t know how long the malware sits on your computer or network, not seeing this pop-up isn’t necessarily an indication that you haven’t been infected. The bottom line: if your Windows computer has connected to a shared network, such as those found in schools, public places, cafes and businesses, and you don’t have complete control over every computer on that network and haven’t been keeping Windows up-to-date, your computer may be infected.

How to Protect Yourself From the Vulnerability

According to Microsoft a fix for this vulnerability was released on March 14th for all affected versions of Windows. If you are running Windows and have automatic updates enabled you should be okay. If you don’t and haven’t updated recently you should update to the most recently released version immediately. It is important to note that unsupported versions of Windows, like XP, did not receive this security update. Those systems should either be isolated or shut down.

Please pass this along to your friends and family. Those that are less technical may not have updates auto-enabled, and may need a helping hand updating their operating system.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1729 Post by Alan H » May 14th, 2017, 7:56 pm

When was the four-hour A&E target last hit?
Claim
The four-hour accident and emergency target has not been hit in over two years.

Conclusion
The four hour A&E target hasn’t been met in England since July 2015, and the last time it was met over a full year was in 2013/14. The target hasn't been met at “major” A&E departments since June 2013 and hasn’t been above 95% annually since 2010/11.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1730 Post by Alan H » June 1st, 2017, 6:32 pm

Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1731 Post by Alan H » June 21st, 2017, 10:57 am

Leak shows 'devastating' impact of planned NHS cuts in Londo
Patients will be denied treatment, waiting times for operations will lengthen and A&E and maternity units may be shut under secret NHS plans to impose unprecedented cuts to health spending in London.

According to an internal NHS document seen by the Guardian, doctors in five London boroughs will have to spend less on drugs, fewer patients will be referred to hospital and support for people with severe health needs will be cut as part of the plan.

It outlines the “difficult choices” NHS bosses nationally are forcing the 10 hospital trusts in north-central London to make in the next few months in order to plug a £183.1m gap in their finances.

The 31-page document was circulated among dozens of top NHS officials in the area on 25 May. It outlines how the “capped expenditure process” will hit the provision of NHS care to the 1.44 million people who live in the boroughs of Camden, Islington, Haringey, Barnet and Enfield.

It admits that pushing through such cutbacks will be unpopular and hard to explain – and result in poorer care. “We recognise that these choices may be difficult for a number of reasons [because they include] … options that impact on quality of care [and] options that would be difficult to implement,” it says.

The hospitals that have been told to implement draconian cost-cutting measures include some of the NHS’s best-known names, such as the Royal Free, University College London and Great Ormond Street children’s hospital.

North Central London (NCL) is one of 14 areas of England where NHS England and NHS Improvement, the service’s twin regulators, are forcing hospital trusts to make far-reaching cuts during 2017-18 as part of the “capped expenditure process”. They have told local NHS leaders to “think the unthinkable” in their quest for savings.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1732 Post by Alan H » July 15th, 2017, 12:02 am

NHS ranked 'number one' health system
The NHS has been ranked the number one health system in a comparison of 11 countries.

The UK health service was praised for its safety, affordability and efficiency, but fared less well on outcomes such as preventing early death and cancer survival.

The research by the Commonwealth Fund, a US think tank, looked at countries across the world, including the US, Canada, Australia, France and Germany.

The US came bottom.

It is the second time in a row that the UK has finished top.

Three years ago, when the survey was last done, the UK was also number one.

It comes despite the NHS being in the grip of the tightest financial squeeze in its history with lengthening waiting times.

The good and the bad

The NHS was praised for the safety of its care, the systems in place to prevent ill-health, such as vaccinations and screening, the speed at which people get help and that there was equitable access regardless of income.

Only in one of the five themes looked at did the NHS perform poorly compared with the other nations - health outcomes. This covers general health of the population, early deaths and cancer survival among other measures.

The ranking
1 UK
2 Australia
3 Netherlands
4 = New Zealand
4 = Norway
6 = Sweden
6 = Switzerland
8 Germany
9 Canada
10 France
11 US
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1733 Post by Alan H » August 19th, 2017, 12:00 pm

Lying liar, Jeremy 'Lying' Hunt lies again. Who'd have thought it? Jeremy Hunt literally just said Stephen Hawking was “wrong” on scientific basis for NHS reform
Deeply unpopular Tory Health Secretary Jeremy Hunt has once again been the subject of uproarious ridicule on social media today after claiming that world renowned scientist, Professor Stephen Hawking, is ‘wrong’ about the scientific evidence for NHS reform.

Yesterday Professor Hawking had torn into the Tories’ management of the health service, accusing the Health Secretary of “cherry-picking” scientific research to justify his department’s massively damaging policy of underfunding.

Professor Hawking also claimed that Hunt had cited some studies whilst suppressed others, purely to suit the Tories’ own agenda.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1734 Post by Alan H » August 19th, 2017, 6:07 pm

Strong words from the mouth of a liar: Jeremy Hunt accuses Stephen Hawking of 'pernicious falsehood' in NHS row
The former Liberal Democrat leader Tim Farron said: “A renowned scientist such as Stephen Hawking questioning your evidence might normally be cause to think again, but sadly it looks as though Jeremy Hunt has joined the chorus of those who have had enough of experts.
Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, responded directly to Hunt, citing studies and articles that contradicted his argument.

McKee, who said he has been writing on the subject of hospital mortality for 22 years, added: “I’d appeal to those commenting not to personalise this with attacks on Hunt – let’s stick to evidence – it’s strong enough on its own.”

Trisha Greenhalgh, professor of primary care health sciences at Oxford University, said: “Awake to tweet from Jeremy Hunt telling Stephen Hawking he doesn’t know how to interpret evidence. Replies are good.”
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1735 Post by Alan H » August 26th, 2017, 12:26 am

Outsourcing firm and US healthcare insurer team up to run STP
An outsourcing firm – whose work for GPs was described by a minister as ‘entirely unacceptable’ – and the UK arm of a private US healthcare insurer are to lead the development of an STP.

The Nottingham and Nottinghamshire STP (sustainability and transformation partnership) has awarded a £2.7m contract to Capita to help turn the STP into a more formal health body in charge of local budgets and healthcare – because it said it did not have the expertise in-house.

Last year, GPs criticised the ‘shambles’ which followed Capita being handed a £700m contract to provide back-up services for practices across England. There were shortages in basic equipment and delays in the transfer of medical notes.

In a Parliamentary debate Coventry North West Labour Party MP Geoffrey Robinson said the NHS had ‘ended up with a terrible service that is costing more than the previous service ever would’ because Capita was not ‘properly prepared … did not have a commitment to providing the service, and was unable to do so’.

Then minister for public health Nicola Blackwood described Capita’s performance as ‘entirely unacceptable’.

The deal is part of the STP’s development into an ACS (accountable care system) which would take control and responsibility of budgets and commissioning for the entire population of the area – as part of an England-wide drive to meet targets for vast budget cuts and meet pledges to improve local healthcare.

Capita has handed large parts of the contract, which runs during this financial year, to Centene UK, which is part of the major US healthcare insurer Centene Corporation – a firm with the strapline ‘better health outcomes at lower costs’. BMA News understands Capita will mainly be involved in the ‘assurance’ work necessary but Centene will be the ‘boots on the ground’ in developing the ACS.

Doctors leaders said the announcement was ‘extremely concerning’ and potentially validated concerns of health campaigners that the STP process could lead to greater privatisation of the NHS.

BMA East Midlands regional council chair Peter Holden said: ‘Capita’s reputation among doctors is frankly appalling – and it’s even more worrying that they are allowed to sub contract further and that’s compounded by the fact that the firm in question is involved in private healthcare.’

The Matlock GP added: ‘This seems, in some ways, to be a real kick in the teeth for the profession.’
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1736 Post by Alan H » August 26th, 2017, 10:58 am

The latest position papers: where are we now?
The slew of government Brexit papers has continued this week, with much accompanying comment. I have the sense that, in very general terms, the quality of comment and debate about Brexit is improving compared with that during the Referendum. Admittedly, that is a fairly low base to judge by and in any case it is ridiculous that we are only now – perhaps since the election - beginning to have anything like the kind of national conversation that should have happened before and immediately after the vote. When, during the campaign, was there any detailed discussion of what leaving would mean in terms of, for example, data protection, customs or dispute resolution?

Even now, it is shameful that the government are keeping secret the some fifty Brexit impact assessments they have made. As Molly Scott Cato asks, writing on politics.co.uk, what is the government scared of us knowing? Not, I think it’s fair to assume, that the assessments show that the impact is going to be positive.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1737 Post by Alan H » August 26th, 2017, 11:01 am

Although from the end of last year, this is a useful categorisation of the different Brexit stances. I say stances rather than options deliberately. Some may hold those positions but many are not in the slightest bit practicable: Varieties of Brexit
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1738 Post by Alan H » August 26th, 2017, 11:08 am

Boris Johnson concedes UK will have to pay for Brexit
The UK will pay money to the EU as part of the Brexit process, Boris Johnson has conceded, having previously said the EU could “go whistle” over a reported bill of between €60bn and €100bn.

The issue of the “divorce bill” has split the pro-Brexit camp, with some leave supporters demanding that the UK decline to pay a penny, and Johnson told the Commons last month that a demand for €100bn (£92bn) would be extortionate.

On Friday, the foreign secretary said he did not “recognise” that figure, but added: “We will certainly have to meet our obligations”.

“Some of the sums that I’ve seen seemed to be very high and, of course, we will meet our obligations,” he told BBC Radio 4’s Today programme. “We are law-abiding, bill-paying people. The UK has contributed hundreds of billions over the years.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1739 Post by Alan H » August 30th, 2017, 7:19 pm

Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1740 Post by Alan H » September 2nd, 2017, 11:47 am

GPs told all hospital referrals will be scrutinised in NHS money-saving measure, shows leaked memo
GPs are being told all their hospital referrals will be scrutinised by a panel of other doctors as part of a new bid to reduce costs, a leaked document has revealed.

A letter sent by NHS to England to Clinical Commissioning Groups (CCGs) and seen by Pulse magazine, asks that all family doctors in England to seek approval from a medical panel for all non-urgent hospital referrals.

A “clinical peer review of all referrals from general practice by September 2017”, will be required, it said.

To incentivise the scheme, it said that there will be “significant additional funding” for commissioners that establish peer review schemes this year. It added that it could reduce referral rates by up to by 30 per cent.
Warning: DM: DR MAX THE MIND DOCTOR: Why do health bosses waste so much GP time?
Should you require evidence of the utter contempt in which senior NHS officials hold the public, look no further than a ‘peer review’ scheme being rolled out next week.

The new plans require GPs to seek approval from a panel, made up of other doctors, before being able to refer patients for all non-urgent hospital appointments.

This means that referrals for things such as X-rays, hip and knee surgery, and cataracts may be rejected by a group of people who have never seen the patient. They also will not review the patients’ medical notes, but instead base the decision on the referral letter.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

User avatar
Alan H
Posts: 24067
Joined: July 3rd, 2007, 10:26 pm

Re: The future of the NHS (if any)

#1741 Post by Alan H » September 27th, 2017, 6:31 pm

What we talk about when we talk about privatisation
That privatisation is occurring in the NHS, as in education, council services, and a host of other areas, is indisputable. Privatisation involves the transfer of public assets into private hands or the transfer of public functions to the private sector. There is no shortage of examples. Patients are transported in ambulances with a G4S logo. Laboratory and pharmacy services are outsourced, as well as administrative functions, cleaning, and catering, to companies like Serco and Capita. Private companies like Virgin Healthcare are winning contracts to run healthcare and sue the NHS when they are not awarded them. The Private Finance Initiative is itself a form of privatisation, where Government abdicates its role to raise cheap finance publically, instead outsourcing this to private arrangements at higher interest rates. A recent report from The Centre for Health and the Public Interest found that between 2010 and 2016£831 million haemorrhaged from the NHS as PFI company profits.

In this context there remains a curious strain of privatisation denial, some coming from sensible, serious sources. So what does it mean to respond to the question “Is the NHS being privatised?” with the answer “no”?

1) Use of an incomplete definition of privatisation: “If you see Sid, tell him” ran the slogan from the 1980s campaign to promote British Gas shares when it was privatised. Since there has not so far been and is unlikely ever to be an NHS share issue, by this limited definition, privatisation isn’t happening. This example from asenior commentator at the HSJ, describing talk of NHS privatisation as “silly”—“Hate to have to say it yet again, but the NHS is being underfunded, denationalised, and outsourced. It is not being privatised.” The problem of course is precisely that denationalisation and outsourcing are aspects of privatisation. Railway privatisation, which no one would dispute happened, did not involve a share issue either. Defunding a service so it is failing and patients need to seek support elsewhere is also de facto privatisation.

2) Taking a narrow focus on healthcare provision: A recent King’s Fund report “Is the NHS being privatised?” concludes that there is only modest change, “from 7.3% in 2014/15 to 7.7% of the budget in 2016/17”. However it may not be immediately clear that this refers topurchase of healthcare from non-NHS providers, rather than the more extensive spend by the NHS in the private sector on things it would previously have done in house. The use of private healthcare providers is an entirely legitimate area of interest, but it is important not to confuse a part for the whole.

3) Conflating privatisation with “free at the point of use”: Many people protesting the rise in private sector involvement in the NHS do also fear the coming of an increasingly rationed NHS, with charges for additional care. As the King’s Fundreports: “the NHS can no longer maintain quality of care and meet performance standards within its current budget.” However this is bait and switch in discussions about privatisation. Before the railways were privatised you still had to buy a ticket. An outsourced health service doesn’t necessarily need to charge users upfront.

4) Declining to believe in the direction of travel: This relies on the semantic argument that the NHS is not beingprivatised because there is no intent to completely privatise it or because privatisation so far has been limited. The 2012 Health and Social Care Act was intended to increase marketization in the NHS. Although there have been attempts to dismiss it as a “mistake” it formed a continuation of neoliberal policies and ideology stretching back to the 1980’s. Even theIMF now acknowledge the hazards of neoliberalism, not least worsening inequality. The recent decision to abandon the privatisation of NHS Professionals is welcome but is likely to be a question of timing and political tactics rather than a change of heart on the government’s part.

5) No, it’s already been privatised: Since the 1980s, as outlined in the introduction, many aspects of the NHS have been transferred to the private sector and many people in supporting roles who would have been employed by the NHS are now employed by outsourcing companies. For example, a recent study showing that outsourcing cleaning services was associated withincreased MRSA incidence, found that in 126 acute trusts 51 outsourced cleaning and 75 retained it in-house.

People objecting to privatisation have specific concerns about how this will function in the NHS. How will relationships of professionalism and discretionary effort be preserved in a system where activities are increasingly monetised? What is the opportunity cost offunding competitive tendering and other aspects of market infrastructure? Onora O’Neillhas highlighted the dangers when there is a change from a system of trust to a system of regulation and performance indicators.They also have general concerns about the diminishing role of the public sector—loss of accountability, reversal of gains in conditions of employment and other rights, reduction in equitable access and a reduced multiplier as money is siphoned offshore rather than recycled through the tax system.

Sensible consideration of these issues requires a holistic view and transparent definitions, so it is clear what is actually being discussed.
Alan Henness

There are three fundamental questions for anyone advocating Brexit:

1. What, precisely, are the significant and tangible benefits of leaving the EU?
2. What damage to the UK and its citizens is an acceptable price to pay for those benefits?
3. Which ruling of the ECJ is most persuasive of the need to leave its jurisdiction?

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