2015 UK General Election

[Tetenterre]

Latest post of the previous page:

On the £12bn welfare cuts: "the word" is that there is no way it can happen and that the figure was put so high so that it could be negotiated down to something less harsh but still draconian during coalition negotiations with the LibDems.

I think you underestimate the Tories.

Quite possibly; let's decide after we've seen what actually happens.

[Fia]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

[Alan H]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

+1

Nor one that is expected to turn a profit.

[Dave B]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

+1 Fia

I was groping for that above. It is not an industry in the same way that making cars is, being a "free" service adds to the stupidity of attempting to privatise it.

That it could perhaps learn from business practice however . . .

[Nick]

In the case of the NHS the incentive should, ideally, be only to provide the best possible service - bnot saving money or making a profit. Yes, budgets have to be met etc.

In an ideal world, we wouldn't need the NHS. We'd all be fit as fiddles. Unfortunately, that's not the case. Wouldn't it be wonderful if things were simple? But they are not. And cheaper services mean more money for other things. If money is saved, or services improved, then great. Why the hang-up about money?

In the case of a shop I expect the owner to take a profit. In the case of the NHS I expect any money left over to go back in or to the exchequer (or wherever). Hopefully it would be used to provide even better service. Likewise efficiencies should also benefit the basic source of funding - you and I - in terms of less tax or better service.

Do that, and the improvements disappear.

Why? Define improvements in this context.

If you do not give scope to the private sector by allowing them to make a profit, then they won't participate. (I should perhaps have said that improvements won't materialise.)

If ïmprovements" are better services roll them out!

Which is what the last few governments have been doing.

Private companies do not have a good record running public services from the evidence so far,

Hmmm... Don't they? You hear about the failures, but not the successes.

Please list us some notablen successes in the scale of a hospital, a large service such as Probabtion, benifit assessing etc.

From my personal knowledge, blood tests for major cancer hospital, shoulder operations and general surgery, physiotherapy. And that's just my experience.

chances are they have cost the tax payer more than they saved?

Why? If the private alternative is more expensive, why do it?

I will admit that I keep thinking of the canteen services at my last place of work. The company paid all utility charges, wages, maintanence etc. etc. but the staff were "managed" by Sodexo. So they also paid a management fee and we paid a similar price for one banana as a hand of five in the local Co-op because Sodexo controlled all food sources, and pocketed the discount in their regional office. It looked like maximising profit to me, the service did not improve when the Sods took over.

You'll always pay more in a canteen than in a supermarket. And why did the company use Sodexo? So that they could get on with their business, rather than run a canteen. If they were not satisfied, then fire the company and try another. Not something you can easily do in-house.

Let's include governmental costs (extra Civil Service effort, legal fees) and compensation of any other kind;

By all means include all relevant costs. But in no other industry are you suggesting that everything should be micro managed by the state.

But I suspect we still end up paying extra for privatisation fuck-ups, which will be inevitable I feel.

And the public sector doesn't make expensive cock-ups?! How about the NHS computer system? Nuff said.

plus possible loss of jobs etc.

Jobs are great for those in them, but for everyone else, they are a cost.

Yes, jobs are a cost, we have to pay wages. But we get a service from those jobs, is that service of the most cost effective to the end user (us) if part of cost is an excess that goes into the pockets of those who did not contribute directly?

Besides questioning the idea of "not contributing directly" the answer to your question is often yes. You do not seem able to countenance that possibility. As soon as any improvement arises, you want to remove the very thing which has given rise to that improvement.

And you seem to want to preserve jobs, just for the sake of there being jobs. Even though their contribution is not required. That is, by definition, "not contributing directly" .

Remember my tale of the privatised hospital cleaning? Wages reduced, employee standards reduced, constant professional monitoring required - and still basic hygeine levels fell. So they took it back in house to protect the patients . Thus service above profit or savings - alien to the privatised world.

Yes, I remember your tale. Do you remember my explanation, Ronald Coase and his Nobel prize? Whether or not any firm provides services in-house or not is a completely separate question to whether the private sector should be involved. For example, I would fully expect a private hospital to employ its own cleaners, rather than hire another firm. They certainly wouldn't ask the state to run their cleaning services, would they? But a firm of insurance brokers, say? I would fully expect them to outsource their cleaning.

I have to admit that I do not remember your explaination, it was probably academic in nature and bore little relevance to the individual experince.

Sorry, can't help being boring. Doesn't make it wrong, though.

Nick, the number of times your answer seem to be irrelevant, for a self coinfessed follower ofb things economic that's not so good. My mistakes vare bborn of experience and emotion I admit, but treat people like beans on the counting board and you do humanity, and Humanism, a disfavour.There has to be balance, but it is too far in the favour of the "haves" aty the moment.

Sorry, Dave, but you don't have a monopoly on what you think constitutes Humanism (not that I think it should have a capital H) I have no doubt that your heart is in the right place (with a bit of help from the NHS ) so I don't need to comment on that, but the NHS does use up billions and billions of beans, and can't function without them. So when I see a complete lack of understanding about beans, then I'll comment. Not sexy, maybe, but beans are still vital in producing the outcomes we want. You might be happy with a warm fuzzy feeling about hospitals. But that doesn't provide the best health system because too much is wasted if the system of provision is ignored.

[Nick]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

+1

Nor one that is expected to turn a profit.

But where outcomes can be improved, and costs lowered, why are you all so hell-bent on preventing such improvements?

[Fia]

But where outcomes can be improved, and costs lowered, why are you all so hell-bent on preventing such improvements?

Sigh. Because no evidence has been presented showing outcomes can be improved and costs lowered by involving the private sector. NHS England is being privatised because of Tory dogma, probably because they can't stomach the idea of the state being good at providing anything. Oh, and lining their pal's pockets.

What actually happens with privatisation? Only recently the private hospital who gave it back because they couldn't make a profit Smaller operators cherry pick the cheap and simple procedures and when they go wrong who puts it right? The NHS. Dunno about you, but I certainly don't want our NHS residing only in A&E and critical care.

My bottom line is that it is immoral to make a profit from health care in the way the Tories are decimating what was the very best service in the world.

[Alan H]

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

+1

Nor one that is expected to turn a profit.

But where outcomes can be improved, and costs lowered, why are you all so hell-bent on preventing such improvements?

Who's 'hell bent on preventing such outcomes'?

[Nick]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

No, it's a very expensive service, free to its patients at the point of need. Quite a difference.

[Dave B]

Yes, Nick, please educate us as to where and when the delivered service has been improved, whilst making a profit and keeping all else equal.

If Joe Bloggs Medical can deliver a service at least equal to that of the NHS for less money I see no reason not to opt for them. But I do not believe it is possible. If they also look after their staff well then nurses may also move to them. I do not expect to pay any premium though - at least until such a premium affkicts the NHS as well!

I paid £200 for a private appoinment happily to bypass a waiting list and several weeks of pain, but that is another matter.

[Alan H]

But in no other industry are you suggesting that everything should be micro managed by the state.

I've just realised why you have such difficulty with this, Nick. The NHS is not an industry. It's a free service to all at the point of need.

No, it's a very expensive service, free to its patients at the point of need. Quite a difference.

'Expensive' is a relative and pejorative term, Nick. It would be equally valid to call it a very cheap service given the number of lives it saves, the longer and higher quality lives it gives to many, the number of babies who survive birth and the number of those who are suffering less and in less pain because of everything the NHS provides.

[Nick]

But where outcomes can be improved, and costs lowered, why are you all so hell-bent on preventing such improvements?

Sigh. Because no evidence has been presented showing outcomes can be improved and costs lowered by involving the private sector.

1 million extra ops?

NHS England is being privatised because of Tory dogma,

which makes the actions of the last 3 Labour government rather strange...

probably because they can't stomach the idea of the state being good at providing anything. Oh, and lining their pal's pockets.

Oh, perleease.

What actually happens with privatisation? Only recently the private hospital who gave it back because they couldn't make a profit

No. What happened was that the nationalised industry failed to organise their side of the bargain, leaving the cost of bed-blocking to the hospital. In terms of successful ops., infection control and other criteria, they were successful. Until their budget was cut, meaning that all the benefits gained came to an end. It was government interference which killed it.

Smaller operators cherry pick the cheap and simple procedures and when they go wrong who puts it right? The NHS. Dunno about you, but I certainly don't want our NHS residing only in A&E and critical care.

A moment's thought.... If the procedures are cheap, then the operators will be paid a cheap price. It makes no sense to carry out cheap procedures in expensive facilities. That is why we have intensive care units, rather than have ICU facilities on every ward. By streamlining procedures, there is more money left for the NHS.

My bottom line is that it is immoral to make a profit from health care in the way the Tories are decimating what was the very best service in the world.

From what I can recall, since the Coalition came to power, the NHS rose from second to first in the world on a combination of various measures (sorry can't cite it for now...)

And according to you, no-one is allowed to make a profit from bandages, or building hospitals, or drugs, or operating instruments, or manufacturing ambulances. All of these are intrinsic to the provision of health services. All are provided by the private sector. Filthy capitalist bastards.

[Nick]

'Expensive' is a relative and pejorative term, Nick. It would be equally valid to call it a very cheap service given the number of lives it saves, the longer and higher quality lives it gives to many, the number of babies who survive birth and the number of those who are suffering less and in less pain because of everything the NHS provides.

No, not pejorative at all, Alan. It is accurate. It doesn't mean it's not the right thing to do, or that it's not great value for money. But it still costs shed-loads of money. And because of that, for the benefit of a the babies, elderly and patients everywhere, there is an obligation to seek efficiency.

[Ron Webb]

I see the discussion has moved on from our earlier exchange, so I have edited my reply somewhat. If you're looking for a particular response, let me know and I'll be happy to come back to it.

Bollox. Open heart surgeons are paid rather more than GP's wouldn't you say? And the only reason for an antacid being prescribed is to get someone else to pay for it. Different people are paid different amounts for their time. Why? Because if they didn't, insufficient people would be available to fill the posts. Yup, that profit motive again.

So my GP examines me and says, "I'm not sure about this. Better consult with a heart surgeon." The heart surgeon examines me and says to himself, "Hmmm, I'm not sure either. His heart's not in great shape, and a bypass operation might help. On the other hand, it might improve with diet and exercise, and the risk of surgery might exceed the possible benefit. Tough call... Oh well, let's do it. I could really use an extension on my cottage."

A moment's thought, please. If the suppliers were responsible for doling out the goods, then, yes, that would be a bad thing. But that is not the case, is it? It is the very fact that they are on opposite sides which increases efficiency. Where there are no consequences to profligate use, then wastage occurs.

So when a heart surgeon recommends a bypass operation, and then performs that operation, and makes a profit from it, do you not see the possible consequences of that system? Do you not see why it might be better to pay the surgeon a fixed salary/wage, regardless of whether he does the operation or not?

Of course bandages are relatively cheap. That's why it is a good example. You seem perfectly happy that bandage manufacturers make profits. Why should that be any different as the goods or services become more complex and expensive? You need to explain the distinction. And surely the plentiful supply, and the competition in bandages, is great news for the users of bandages. Would that that were true of more medical goods and services.

There are several distinctions to be made. The one I have been making is with regard to the provider of the service. As goods or services become more complex, the consumer becomes more and more reliant on expert advice. If the person offering that advice also stands to make a huge profit from one decision or the other, I see a conflict of interest.

However, I think most countries accept private for-profit providers (tightly regulated by government) within a single-payer system. Certain services are associated with basic human rights, and should not be auctioned to the highest bidder. A homeless man has just as much right to a bypass operation as a billionaire. This is the distinction that Fia is making, and I think she is right that it is more fundamental.

[Dave B]

Just how do the privateers reduce the overall cost to the tx-purse then, Nick. How do the reduce that shed-load to a mere barrow-load then?

[Dave B]

Good call, Ron, on the motive for carrying out an action.

I would suggest that it is not widespread but, in the cosmetic industry, IIRC there have been cases where surgeons have carried out procedures that should never have been done, butvthey have happily charged for. There have been similar cases in tbe dental field. Any possible chance of that attitude getting into the NHS needs to be squashed now.

Pay surgeons according to their abilities, not the number of ops undertaken - commercially the latter may be more efficient, but also very dangerous.

[Fia]

(typing this, rather crossly, before going out and crossposting. Sorry)

NHS England is being privatised because of Tory dogma,

which makes the actions of the last 3 Labour government rather strange...

Nick! Please change the record! I haven't voted Labour since I was stupid enough to think Blair might actually be left-wing and an improvement. We're doing far better in NHS Scotland with a progressive left-wing Holyrood.

probably because they can't stomach the idea of the state being good at providing anything. Oh, and lining their pal's pockets.

Oh, perleease.

OK Nick: if you stop the what-about-the-Labour snidiness I'll consider stopping the anti-Tory...

Smaller operators cherry pick the cheap and simple procedures and when they go wrong who puts it right? The NHS. Dunno about you, but I certainly don't want our NHS residing only in A&E and critical care.

A moment's thought.... If the procedures are cheap, then the operators will be paid a cheap price. It makes no sense to carry out cheap procedures in expensive facilities. That is why we have intensive care units, rather than have ICU facilities on every ward. By streamlining procedures, there is more money left for the NHS.

So the lovely shiny new NHS England will only be a provider of emergency and critical care. Like I said.

And according to you, no-one is allowed to make a profit from bandages, or building hospitals, or drugs, or operating instruments, or manufacturing ambulances.

NO! These are not health services you are talking about. The overworked and underpaid NHS front-line staff use paper, pens, computers, your precious bandages etc. They are tools for the service to work. It doesn't make a profit, nor should it.

[Alan H]

'Expensive' is a relative and pejorative term, Nick. It would be equally valid to call it a very cheap service given the number of lives it saves, the longer and higher quality lives it gives to many, the number of babies who survive birth and the number of those who are suffering less and in less pain because of everything the NHS provides.

No, not pejorative at all, Alan. It is accurate. It doesn't mean it's not the right thing to do, or that it's not great value for money. But it still costs shed-loads of money. And because of that, for the benefit of a the babies, elderly and patients everywhere, there is an obligation to seek efficiency.

No, Nick. It is pejorative and the language of those wanting to cut it back and want to give the impression its a Rolls Royce we can't afford. You're conflating 'expensive' with 'costing a lot of money': the former is certainly true (yet it's far, far cheaper per capita than many other western countries as you well know); the latter is a relative term as I already explained.

And, of course, 'cost effective' is something different, although related. A service can cost a lot of money yet still be cost effective and efficient.

[Alan H]

Good call, Ron, on the motive for carrying out an action.

I would suggest that it is not widespread but, in the cosmetic industry, IIRC there have been cases where surgeons have carried out procedures that should never have been done, butvthey have happily charged for. There have been similar cases in tbe dental field. Any possible chance of that attitude getting into the NHS needs to be squashed now.

Pay surgeons according to their abilities, not the number of ops undertaken - commercially the latter may be more efficient, but also very dangerous.

Of course, this is akin to what happens in the privatised healthcare regime of the US: unnecessary and useless testing, leading to unnecessary and potentially harmful prescriptions and unnecessary and potentially harmful operations. Money rules there.

[Altfish]

What I have never understood is why the NHS can't pay managers private sector wages, get the private sector staff, then instead of giving share holders the money, the nurses/cleaners/etc and the NHS gets any 'profits'.

Why do we have to have shareholders gaining in a caring industry?

[Dave B]

Why do we have to have shareholders gaining in a caring industry?

We don't so long as we can keep the money grabbers out!

It is unavoidable that suppliers of materiel etc. have to be paid and will make a (possibly excessive, because that's commercialism) profit.

Once again, do the job at least as well, for no extra cost to the taxpayer, and I can find little to argue about. Can this be achieved, Nick?