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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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Nick
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Re: The future of the NHS (if any)

#81 Post by Nick » April 25th, 2012, 11:59 am

Latest post of the previous page:

Alan H wrote:For the avoidance of doubt, what I am trying to establish is what Lansley thinks needs changed, why, and what evidence does he have that the HSCB will achieve those changes.
Fair enough. And what I am trying to do, is to show that some of the points you raise have different interpretations and reasoning than what you may suppose. I am not, however, Secretary of State for Health! I do not know if I would have done the same if I were. It is not my role in life to determine the best NHS model, nor to defend a particular government policy out of any loyalty. So if I don't know something, or can't find something, it proves nothing. I will see if I can find some evidence, but it is as much your responsibuility to look for evidence as it is mine. I know I repeat myself, but I am saddened that your tenacity to research and evidence, which I so admire in your efforts to expose medical nonsense, seem to be left resting in bed when it comes to economic matters.

Lansley thinks things need changing to improve the cost efficiency of the NHS. His estimate is £4.5 billion a year. He also thinks that health services can be improved my making the decision-making closer to the patient. Put crudely, patients and their doctors should determine what services are required, rather than bureaucrats in London. I think they are also trying to make the health service more flexible.

I don't have all the evidence at my fingertips, but I've seen some, and I'll try to find more. But at the same time, in engineering terms, just because you have a mousetrap that works, doesn't mean there is not a better way of catching mice. You seem reluctant to explore that possibility.
Alan H wrote:What am I to do? Believe you when you tell me there has been research?
Well, yes, actually! Firstly because I would hope you would not say something without reason to do so. Secondly, because the alternative, (that no research has been conducted before making major changes,) seems ridiculous. Do you really believe that?
Believe Lansley (although I'm not aware he's ever said there was research)?
As a public figure, I would expect virtually all his pronouncements to be about changes and benefits. I think it is unreasonable to accuse him of going without research, just because he does not spend his time discussing research papers with the public. Does the Energy Secretary shower us with research papers on nuclear safety? No. Has any research on nuclear safety been done? I hope so!!!

Or should I - as a good skeptic - ask for that evidence?

Of course, it is perfectly OK for you to ask for evidence if you want to know more. Try asking the department for suggested reading. I am not a source of such evidence. However, I can point out a few economic factors which have profound effects, and are IMO, crucial in understanding some of the changes.
Where is that evidence, Nick?
And where is your evidence that the old system is the best? Why not go back to the old system which pre-dated Blair's reforms?
Where's the evidence that these 'reforms' will achieve what you say they will?
It's not me saying it, but I expect it's out there...
The biggest top-down reorganisation in the history of the NHS and you expect there's evidence? Give us a break, Nick.
Take any break you need, Alan :D Do you honestly think there isn't such evidence, that no work has been done, that Lansley just thought it up while playing with his duck in the bath? I said I expect there is evidence because (like a good skeptic) that is a suitable word to use. I have seen some evidence, but it has not been my life's work to analyse it. How can you justify you apparent position that there has been no research? Is that really the most likely?
Where's your evidence (not opinion!) that it won't?
As I always would say to a quack, the onus is on you/Lansley to provide the evidence that the 'reforms' will do what is asserted for them. Where's the evidence, Nick?
What we have here are two competing hypotheses. So it is just as reasonable for me to ask for your evidence. Let's see what we can find....
And all that with greatly increased bureaucracy.
Except that eliminating a whole layer of bureacracy is the main aim and result of the reforms.
But there are now far more bodies now than there ever were - if it was a main aim of the 'reforms' then it's failed already.
But Alan, the reforms have hardly begun. It can't have failed before it starts can it?

And the vast majority of GPs don't want this extra responsibility and bureaucracy.
I'm not saying that we should ignore doctors completely, but they have a history of objecting to every change
What happened in a different situation about different changes at a different time and with different people is irrelevant. We're discussing these changes now and their effect on the NHS.
They objected to the NHS in the first place.
For pete's sake, Nick. The 'they' you're referring to might just about be the grandfathers of the ones objecting to it now.
The point I am makingh is that people don't often like change. Of course ther poeple are diffferent, but that characteristic remains. It also demonstrates that sometimes change must happen in the face of dissent. That is as valid today as it was then. Hence my allusion.
And the vast majority of other healthcare professionals don't want it and say the NHS and patients will suffer.
Hmmm... the vast majority of those who don't want it have said they don't want it, which isn't quite the same. And just because someone doesn't want something, doesn't mean it should not happen because of that opinion.
Of course not. And just because Lansley says it's good for us doesn't mean it's good for us.
OK Alan. It is your assertion that patients will suffer. Evidence? :wink:

Some organisations are attempting to sabotage the changes for political reasons,and sod the patients.
Who? Evidence, please - not that that makes any difference to whether the 'reforms' are actually going to do what we're told they will - but your answer might be interesting.
I came across this the other day. Can't recall precisely where, but I will endeavour to find it again if I can.
We will see soon enough how effective the changes are
Will we? I suspect it'll take several years before we really know.
Probably. It won't be overnight, certainly.
but it's a racing certainty that any set-backs will be yelled about from the roof-tops, while increases in efficiency and health provision will just be accepted and go unpraised. The whole idea is to improve the NHS, for the benefit of patients.
That's what we've been told, certainly, but yet again, there has been no evidence that that is what is likely to happen.
Well, yes there is. Compare the virually non-existent praise for the raising of personal allowances, with the ridiculous outcry over the so-called "pasty-tax". I think that demonstrates my point very well.
The Government believe their reforms will do so. We shall see.
The Government no doubt believe lots of things - is it too much to ask for the evidence they based their beliefs on? And if they won't supply that evidence - or don't even have it - does that not make the whole exercise one of pure ideology?
Have you asked them for their evidence?
Lansley says it'll be good for us. That's OK then. All we are left with is to trust him. That is, trust a Government who promised that there would be no top down reorganisation of the NHS and who seem to be up to their necks in conflicts of interest. Sounds a lot more like dogma and ideology.
"Top down" is used as a perjoritive statement.
Wasn't it Cameron who used the phrase?
His point was that the health service should not be run by Whitehall. That is what he meant by "top-down". The opposition are calling anything "top-down", just to make their objection seem valid, whereas in fact, all they are objecting to is any change at all.
Are you saying that any reform should be banned?
No, why should I say such a stupid thing?
Well, I was beginning to wonder.... :wink:
But I would like to see what they think needed reformed, why and how they think their 'reforms' are expected to achieve those changes. Is that too much to ask?
No, but see my responses above. The government wasnt to see improvements in health provision, and a reduction in costs, so that billions of pounds of extra services can be provided. (As I said before)
And as for dogma and ideology, the Labour Party are just criticising it for party political reasons, and just stirring the pot generally. And the public sector unions are thinking not about patients, but there own union power.
I'm not sure what special insight you have into the Labour Party's reasons - or do you mean that's what you'd like to think their reasons are.
Come, come. That is what oppositions do, isn't it? Does one really need "special insight" to discern the bleedin' obvious? This is reinforced by the fact that there has been a total silence from Labour when asked how they would find an extra £4.5 billion. Their ideas cupboard is bare.
As for conflicts of interest, I don't see how the Labour Party, utterly dependent as it is on public sector unions, can claim to be free of claims of conflicts of interest either.
Whitabootery again, trying to divert from the actual issues. The Labour Party isn't making these changes, are they?
No, but they are objecting to change. So their reasons for objecting to change are just as relevant. It is not a divertion, merely a response to an accusation.

I'll see if I can dig out that web-site I found a while back. May take a while, though...

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

#82 Post by Alan H » April 25th, 2012, 12:21 pm

This is getting too long (and tiresome) to take each bit apart. However, it still boils down to me - being a good skeptic - asking for evidence of what Lansley's 'reforms' were intended to do and how they were going to achieve it. I have looked - as have many others - and found none.

All we have are vague, woolly assertions that drastic changes had to be made and this is the only way to achieve them.

Am I to sit back and accept that, well, Lansley and Cameron are doing all this for our own good, aren't they? I'm not good on matters of faith - it's called being a skeptic. Or is it reasonable to expect the Government to actually be able to convince the electorate that they based the Bill on sound evidence?

Where is that evidence? It's a simple question. The answer, however, seems somewhat elusive. If you want to continue this discussion, can we concentrate on this central issue and not get diverted?
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
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Re: The future of the NHS (if any)

#83 Post by Nick » April 25th, 2012, 2:02 pm

Alan H wrote:This is getting too long (and tiresome) to take each bit apart.
I'm inclined to agree....
Am I to sit back and accept that, well, Lansley and Cameron are doing all this for our own good, aren't they?
Given the level of hostility to change, I don't see this as anywhere near the likeliest explanation, nor a reasonable default position.
I'm not good on matters of faith - it's called being a skeptic. Or is it reasonable to expect the Government to actually be able to convince the electorate that they based the Bill on sound evidence?
It's reasonable to ask them to try, but given some of the loons in the electorate, it's not reasonable to expect them to succeed...

Maybe more later....

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

#84 Post by Alan H » April 25th, 2012, 2:32 pm

Nick wrote:
I'm not good on matters of faith - it's called being a skeptic. Or is it reasonable to expect the Government to actually be able to convince the electorate that they based the Bill on sound evidence?
It's reasonable to ask them to try, but given some of the loons in the electorate, it's not reasonable to expect them to succeed...
What on earth has whether there are loons in the electorate got to do with whether we should expect a democratically elected Government to provide evidence for the most wide-spread top-down reorganisation of the NHS?

Where is the evidence?
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
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Re: The future of the NHS (if any)

#85 Post by Nick » April 25th, 2012, 3:06 pm

Sorry, Alan, but you've completely missed the point I was trying to make. I wander what that is evidence of.... :wink:

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

#86 Post by Alan H » April 25th, 2012, 3:39 pm

Did you mean that some loons in the electorate would never be persuaded by any evidence supplied by Lansley? I couldn't care less whether some 'loons' would or would not be persuaded by the evidence: I've yet to see any evidence.
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)

#87 Post by Nick » April 25th, 2012, 7:42 pm

Alan H wrote:
Nick wrote: Some organisations are attempting to sabotage the changes for political reasons,and sod the patients.
Who? Evidence, please - not that that makes any difference to whether the 'reforms' are actually going to do what we're told they will - but your answer might be interesting.
Dunno whether it will be interesting or not, but here's an example of the sort of crap which is being peddled. In this case, it is from our old friends "38 degrees". see here.

They state:
Right now, the government is pushing through changes to our health service which could spell the end of the NHS as we know it.
Now WTF does that mean? There is no indication of whether that is good, or bad, or just different. And certainly no mention of, say, clinical excellence, patient care, medical advances..... in fact it says bugger all.
Meanwhile, a funding squeeze means wards are closing and doctors and nurses are being laid off.
Well, hello! Gordon Brown increase the NHS budget spectacularly from 1999 to 2008. IIRC, by something like 200% in cash terms, from £40 billion to £120 billion. And productivity, in terms of health outcomes, fell. Certainly an increase in funding was justified, but the figures suggest that the increase in cash was not accompanied by advances in health delivery. Since 2010, the NHS budget, in spite of the need to rescue the nation from the spectacularly irresponsible profligacy of Gordon Brown, who, after all, did not abolish boom and bust, (presiding as he did, over the longest boom and the greatest bust in generations,) has been preserved. Not just in cash terms, but in real terms, after inflation. True, the demands on the NHS have increased, as the population gets older, and as new, expensive treatments become available, but in the circumstances, the government's stance is heroic, in defence of the NHS.

38 Degrees don't give a stuff about health outcomes however, they just state that wards are closing (maybe because health treatments are changing? More day-case surgery, perhaps?) and "doctors and nurses are being laid off". Again, no contact with health provision, just crude employment. They seem to be more concerned with job preservation than health.
On Monday afternoon, the House of Lords starts its final votes on the NHS changes. An influential crossbench Lord, Lord David Owen, has agreed to receive a copy of the Save Our NHS petition.
Last in office in the 1970's, over 30 years ago, and most memorable for being not bad looking (apparently). Is that their best shot?
Our petition will remind Lords that the public care about these risks to the future of our health service.
Except that no risks have been outlined, except the possibility that fewer staf may be needed. Is that the greatest threat to the health of the nation? Is that the sole measure of the "attack" o the NHS? Utterly patheitic!

I'll see what else I can find.....

Nick
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Re: The future of the NHS (if any)

#88 Post by Nick » April 25th, 2012, 8:00 pm

It gets worse:
The Petition Text

To the Coalition government,

Our NHS is precious - we won't forgive you if you ruin it


Don’t break up our health service and hand it to private healthcare companies
They are not. An internal market is not the same thing at all.
Listen to the real experts - doctors, nurses and patients -
So I'm now a "real expert", am I? You're having a giraffe! I'm a patient, but I'm ot an expert. Not even close! In one breath it is claimed that doctors are clinicians, not accountants. In the next, they are being called "real experts". The reforms are designed to put 80% of the NHS budget in the hands of GP's ("real experts", remember!) What could be wrong with that? They can't both be true, can they?
Don't rush through massive changes without testing them properly first
Lansley has been working on this for 9 years. Hardly a rush.... How many lives are you willing to sacrifice, just to take things slowly? That's not inevitable, of course, but you'll have to have a figure in mind, in order to assess the risk, wouldn't you?
Protect patient care - don't cut beds, wards, doctors or nurses
Pathetic. Advances in medicine have rendered such measurements ridiculous. 30 years ago, when I had n op (to remove my wisdom teeth) it took 3 days in hosptal. Ten years (or so) ago, when I had an op on my knee, I went in at 10 am and was pushed out by 4. The same is true across wide stretches of health care. Reduction in "beds"? Been declining for years. And a jolly good thing too.

38 Degrees? Pathetic, dangerous, and malevolent.

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

#89 Post by Alan H » April 30th, 2012, 1:23 am

Serco is one of the companies being given contracts to run chunks of the NHS: The Biggest Company You've Never Heard Of

Their Chief Executive is Chris Hyman:
He's devoutly religious, attending the Pentecostal church in Surrey, where he lives, and giving 10% of his salary as a tithe to the service of God.
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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Dave B
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Re: The future of the NHS (if any)

#90 Post by Dave B » April 30th, 2012, 10:11 am

It is bloody terrifying that one company should be allowed so much power - even if the boss were not a god-freak! His god-freakiness does not seem to have done a lot for his quality of humanity it seems.
"Look forward; yesterday was a lesson, if you did not learn from it you wasted it."
Me, 2015

Compassionist
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Fairtrade

#91 Post by Compassionist » April 30th, 2012, 7:48 pm

I see your point Nick. What about socialist health care systems like the British NHS? Michael Moore praised the British NHS in his documentary Sicko and wished the USA had a similar system.

Nick
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Re: Fairtrade

#92 Post by Nick » April 30th, 2012, 8:11 pm

Compassionist wrote:I see your point Nick. What about socialist health care systems like the British NHS? Michael Moore praised the British NHS in his documentary Sicko and wished the USA had a similar system.
Well, that's quite a big question! In a short answer, I'd ask you to think about possible scenarios. It is not so much what outcome you want to achieve (access to medical treatment for all, say), but how such treatment is provided. Current government policy believes that an efficient health service is better provided by markets, (which don't have to be capitalist) not by socialist central planning. Many opponents would rather have socialist provision than effective health-care. The NHS may be preferable to the US model, which is fabulous for most, but doesn't work for many, but it doesn't mean it can't be improved.

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Re: Fairtrade

#93 Post by Compassionist » April 30th, 2012, 8:21 pm

Nick wrote:
Compassionist wrote:I see your point Nick. What about socialist health care systems like the British NHS? Michael Moore praised the British NHS in his documentary Sicko and wished the USA had a similar system.
Well, that's quite a big question! In a short answer, I'd ask you to think about possible scenarios. It is not so much what outcome you want to achieve (access to medical treatment for all, say), but how such treatment is provided. Current government policy believes that an efficient health service is better provided by markets, (which don't have to be capitalist) not by socialist central planning. Many opponents would rather have socialist provision than effective health-care. The NHS may be preferable to the US model, which is fabulous for most, but doesn't work for many, but it doesn't mean it can't be improved.
I don't understand how an efficient health service is better provided by markets. Do patients get to choose from competing medications, diagnostic tools, doctors, nurses, etc?

Nick
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Re: Fairtrade

#94 Post by Nick » May 1st, 2012, 1:04 pm

Compassionist wrote:I don't understand how an efficient health service is better provided by markets. Do patients get to choose from competing medications, diagnostic tools, doctors, nurses, etc?
Interestingly, Michael Shermer provides a good parallel example in the video clip you recommended, between about 39-43 minutes in. The idea of markets is to allow constant data and constant small decisions, to help direct the best, most efficient solutions. It allows for more possibilities, with the good driving out the bad, rather than a committee deciding beforehand which is the best and allowing no deviation. This will involve greater patient choice, and greater opportunity for doctors to make choices on their patients behalf.

No-one would want their weekly shop at the supermarket to be done by a committee, and markets are demonstrably better at satisfying consumers, so, the idea goes, it will be with healthcare. The idea might sound counter-intuitive in some ways, but that is mainly because we have got used to an existing system. It will be interesting to see how it al works out in practice.

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Alan H
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Re: Fairtrade

#95 Post by Alan H » May 1st, 2012, 1:16 pm

So, under the 'reforms', who decides the treatment standards and the costs?
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
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Re: Fairtrade

#96 Post by Nick » May 1st, 2012, 1:33 pm

I am not an expert on the reforms, but I think I am right in saying that costs and service standards are set by those qualified to do so. In anticipation of your next question, the internal market will provide feed-back to allow better judgements, which would be much less apparent without it.

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Alan H
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Re: Fairtrade

#97 Post by Alan H » May 1st, 2012, 2:01 pm

Who gets the contract? The lowest bidder, commensurate with meeting whatever standards are set? Do you think that's the best way to improve healthcare?
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: Fairtrade

#98 Post by Nick » May 1st, 2012, 2:11 pm

Alan H wrote:Who gets the contract?
Under the new system, the most important person by far will be the GP, who will control 80% of NHS expenditure.
The lowest bidder, commensurate with meeting whatever standards are set?
Nope. That is specifically excluded.
Do you think that's the best way to improve healthcare?
Dunno, but maybe worth considering.... :wink:

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Alan H
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Re: Fairtrade

#99 Post by Alan H » May 1st, 2012, 2:27 pm

Nick wrote:
Alan H wrote:Who gets the contract?
Under the new system, the most important person by far will be the GP, who will control 80% of NHS expenditure.
That wasn't what I was asking, but who decides which companies are given contracts?
The lowest bidder, commensurate with meeting whatever standards are set?
Nope. That is specifically excluded.
I know. Maybe others probably weren't aware that contracts are not determined by competitive tendering, but according to a preset price tariff (with some allowed local variation on some contracts). It will end up that many services become available from several or many different providers, all being paid the same rate for doing the same job to supposedly the same standards, offering 'choice' to the 'consumer'. In some cases, it seems likely that there will be no resultant choice but to go with the one Qualified Provider. It is unclear how this will drive down costs, provide any meaningful 'choice' or improve standards.
Do you think that's the best way to improve healthcare?
Dunno, but maybe worth considering.... :wink:
Why? Does that work well elsewhere?
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?

Fia
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Re: Fairtrade

#100 Post by Fia » May 1st, 2012, 2:29 pm

crossposted with Alan but saying it anyway...
Nick wrote:Under the new system, the most important person by far will be the GP, who will control 80% of NHS expenditure.
Well I dunno about anyone else, but I'd prefer my GP, who has done 5+ years training in medicine to be actually practising medicine, not wasting their education in being glorified accountants/pen pushers :headbang: I would also guess that this will stop many good Drs who could be excellent GPs from taking on a community post.
The lowest bidder, commensurate with meeting whatever standards are set?
Nick wrote:Nope. That is specifically excluded.
Interesting. So if the lowest bidder is specifically excluded the costs are going to be higher anyway. Dearie dearie me. Thank goodness I live in Scotland, where this nonsense is not happening.

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Alan H
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Re: Fairtrade

#101 Post by Alan H » May 1st, 2012, 4:45 pm

Fia wrote:
The lowest bidder, commensurate with meeting whatever standards are set?
Nick wrote:Nope. That is specifically excluded.
Interesting. So if the lowest bidder is specifically excluded the costs are going to be higher anyway. Dearie dearie me. Thank goodness I live in Scotland, where this nonsense is not happening.
There are no bidders, per se. After a supplier has become a Qualified Provider, they can sign up to a contract with a CCG (Clinical Commissioning Group) and get paid for providing that service according to a national tariff (with some local variation, but it's not clear to me how and why). Of course, if there are, say, 10 QPs signed up to provide a service, they will inevitable share the customers patients between them. What is not clear at the moment is how those tariffs have been set and how they will (inevitably?) be driven down in the future. However, as I said, we will be in a position where we have to discuss with our GP which of the plethora of providers might be best for us for some treatment (but they all have to meet the same standards, of course) or, as I suspect, in most cases, there will be just the one provider meaning that there is no choice.

Of course, depending on how these tariffs have been set, each QP has to not only provide that service, but run the company and provide profit to its shareholders. Did you see the video about Serco I posted elsewhere?
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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