The Guardian has reported that hospital patients could be asked to pay for their “bed and board” if funding does not match increasing demand. Apparently:
Rob Webster, chief executive of the NHS Confederation, which represents NHS commissioners and providers, said the health service would have to make “tough choices”.
It is suggested that fees of £75 a night are being considered.
But these are not fees, and nor are they a market based supply. Let's be quite clear what this is: it is a tax on the sick.
Of all the tax bases for raising funds the one I think most unsuitable to fund the NHS is a tax on the sick.
They have least, or at the very best reduced, capacity to pay in most cases.
It is hopelessly inefficient in that exemptions and allowances will make it incredibly hard and expensive to collect.
Defining a "stay" will be difficult and lead to severely distorted decision making by clinicians and patients. The tax therefore compromises the care the NHS is meant to fund.
And the amount raised will not go far. I would be surprised is after costs it could realistically raise a billion if all likely exemptions are taken into account, and the NHS costs £140 billion a year.
So, just about everything about this idea is wrong.
So why is anyone discussing it?
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If you were to look at the privatisation question purely on grounds of financial efficiency (“the market is more efficient” was the core argument for privatisation of public services, right?) how do you think the figures would come out?
It seems to me that the shareholder profit of NHS contractors adds an unnecessary overhead to the cost of treating patients, and so must represent an inefficiency compared to an equivalent state provided service. I do recognise this is a naive view, but what is the real (or at least a more informed) picture?
Look at Circle in Huntingdon
They are making a massive loss running the hospital
Where is the efficiency argument? Only in this being a public service
But if the efficiency argument fails so easily (as I take you to imply) then what IS the argument that supports this type of arrangement?
There is no argument for this tax
The idea is that profit will motivate better performance than simply saving and improving the quality of people’s lives.
It’s nonsense, of course, but most of the ministers who voted it all through will personally profit by huge amounts so they are just hoping no-one will notice. I’m prepared to believe that money making is genuinely the prime motivation for their actions, as they suggest it is for everyone else.
Likely to be true
I think the tax on the sick has been well underway for some years now Richard. This is just the latest grotesque manifestation of it. The precedents are:
1) Withdrawal of personal Independence Payments.
2) ATOS finding ill and vulnerable people fit for work (http://www.huffingtonpost.co.uk/2013/03/25/atos-fit-for-work-died-amputee-brain-tumour-denise-_n_2949061.html)
3) The peremptory cessation of ESA benefits for the merest of reasons.
4) The Bedroom Tax (two thirds of those affected are considered disabled/ill)
These are all ideological decisions. It is heartening to hear that the UN is going to investigate the UK Governments treatment of the disabled (Committee on the Rights of persons with Disabilities) -a committee that only investigates where there are ‘grave’ concerns.
Our culture is changing fast and reversing time’s arrow where to be sick is to be a burden and where the syphoning of wealth from communities is seen as productive. I think I know where the real sickness lies!
And I think I shear your view implicit in your last sentence
So why is anyone discussing it?
Presumably some bean-counter somewhere thought that evening up the scales of cost against a nursing home might prevent bed-blocking (£75/night = £525/week). To that extent it might work.
That or it’s an equality measure to ensure that those with private care (who IIRC do pay for bed and board) get the same treatment as the hoi polloi… 🙂
This is another section of what Webster is reported as saying, Richard:
“Do we think about increasing our tolerance for longer wait (for care), or do we say NHS funding is only for the health aspects of care and treatment, which means patients being asked to cover their hotel costs for bed and board?”
I particularly liked his conflation of hotel with hospital. Perhaps it was a Freudian slip – they both begin with H after all. Or more likely, given how deeply much of the senior management of many public enterprises are now also champions of private, for profit, forms of “public” service it’s yet another example of language and terminology being twisted and corrupted to mask and/or legitimise what’s actually taking place. How many times have I heard or read of government advisers and civil servants referring to the benefit and cuts to public services that have taken place so far as the “low hanging fruit” of public policy – as if they have nothing to do with visiting poverty, misery and suffering on hundreds of thousands of people. Or the closure of libraries, leisure centres and playing fields as “rationalisation”, as if there was an oversupply in the first instance.
Of course, nothing can beat describing the civilian casualties of war as “collateral”. But still, conflating hospital with hotel is yet another example of the neoliberal project to redefine (by which I really mean reduce) the quality of life of the majority, and the values and beliefs on which social democratic societies were based to a hollowed out shell. We should know by now that when such an idea as this is “floated”, despite, indeed precisely because of Department for Health denials, it’s usually on the way after a suitable period of softening up of public opinion’s occurred.
I fear your conclusion is right
This is softening up
And then it will be ‘unavoidable’
The NHS has for many years used “Hotel Services” as a description of the provision of non clinical bed and board particularly to patients recouperating after treatment. I don’t think we need to look any further than geriatric and end of life care requirements to see how lunatic (and or evil) the NHS Confed. proposal is. I cannot see that anyone with hands on experience of health care could make a suggestion like this.
Agreed
This is all part of a Neoliberal project for the NHS. New [private] hospital developments will be be further sweetened with opportunities to build adjacent hotels, conference centres, research [public/private partnerships] facilities, clinical testing, small scale manufacturing, rehabilitation/sport facilities all using public land and money tying the NHS through a web of contracts, tenders and political ‘deals’ – for surviving under Austerity.
As Ivan notes advisers and civil servants speak the language of this agenda and are the play makers to sheppard the public and staff of these organisations.
If you and Ivan agree, we need to worry as that increases the chance you’re right
I think the idea of paying for the bed is a bit far fetched because it clearly doesn’t cost very much and is rather difficult to separate from the treatment that is being received.
However I think there is an argument in charging for meals. Is this really a million miles from expecting children to pay for school meals? Obviously not all children have to pay for school meals, but maybe that is the model that could be followed?
Ask yourself a simple question, which is it worth charging in terms of the effort and is it worth it in terms of the impact on care?
Food is often a component in the treatment
But we all know that there are components and components, Richard. Or to put it another way, some components are of higher quality than others even if they might be passed off as the same. In a two or three tier system, which I have no doubt the new quasi NHS is well on the way to becoming, the quality of food as a component of a treatment will follow the same trajectory as other services. If you can pay, it’ll be good quality stuff aimed at complementing your treatment. If you have to rely on the state it’ll be just good enough to hit whatever hospital food standards happen to be in place (and probably worse if a hospital thinks they can get away with it).
Incidentally, and related to the above, can any of your readers give me an example of a public service where the quality and/or scope of the service improved after it was privatised/outsourced. That’s a genuine request, not a trick question 🙂
Ivan
It can’t be disputed that the scope of rail services has improved since privatisation
I am not saying it is because of it though
And I agree re food
Richard
Can we place a statement? Suckertown Hospital Trust PR dept.
We will now appoint a bed hire manager (BHM). He/she will be assisted by three ‘bed hire management assistants’ to cover nights and weekends. They will constantly update the service by extensive comparability studies in both NHS and private hospitals. The manager will also go to Texas to learn about the most modern techniques of bed management.
The BHM will also have a legal consultant ( Screwfix and Partners) in order to facilitate the payment for services from those who choose not to pay. Unfortunately often those who choose not to work as explained in the classical economics textbook as Quoted by the Chancellor on the Andrew Marr programme. We have no intention to let people freeload from the taxpayer.
Those on state pensions only and having no other income, will be offered cheaper accommodation as part of our service. This will be located in former workhouse premises which no one wanted to buy when the Trust sold off low earning assets. They have been tastefully refurbished albeit in an affordable manner.
We are committed to high standards of public service and transparency in all our patient business. From 2015 patients -an old fashioned Victorian term- will be replaced by “customer” but our advisory consultants to the BHM dept. (A. Ripoff Management Consultants) have suggested the term ‘Partner’. We are very excited by this groundbreaking use of terminology and see it as symbolic of our trust’s forward looking and dynamic engagement with a constantly changing business environment.
I am sure , Mr. Murphy, that you and that Horrocks chap will see the truth in what we say.
🙂
Double 🙂 🙂
@ Ivan Horrocks: You ask “can any of your readers give me an example of a public service where the quality and/or scope of the service improved after it was privatised/outsourced”. Well, yes, I can think of several.
When refuse collection was in the hands of my local council, the service was constantly interrupted by industrial disputes and the resulting piles of uncollected rubbish were extremely unpleasant to live with. Since outsourcing, the service has dramatically improved.
Or take telecoms – I’m old enough to remember the days when getting a telephone line installed/connected was an elaborate and very lengthy process, involving a high degree of hassle with a disdainful monopoly. I’m no great fan of the current BT, but I can tell you it’s a massive improvement on the old state-owned British Telecommunications.
Try and get a phone line now
It can take a very long time because it is all down to BT
You are guilty of rose tinted specs
Noted scope of rail services, refuse collection and phones. Also Richard’s rejoinder. Thanks.
I think I’m correct in saying that OAPs on housing benefit / pension credit who stay longer than 6 weeks in hospital are effectively charged B&B now as their benefits are stopped.
I think you’re right
It is assumed they have moved into care
Indeed, a friend of mine (who suffers from bipolar issues) went into hospital some months ago and came out to discover his benefits stopped. He couldn’t cope on his own and it took weeks with support of a social worker (himself often off with stress) to get things straightened out. I had to step in to offer help. Quite unbelievable.
And absurd
I think the accommodation costs are indeed a non starter. But I do wonder whether
drunks turning up on a Saturday night in A&E ought to be charged for medical services.
How would you collect it?
The NHS Confederation idea is simply iniquitous. The middle-class & wealthy will be able to afford to pay – the poor won’t, so what will they do? A stay in hospital will be unaffordable, just like it used to be before the NHS existed. Nye Bevan might just as well not have bothered. The whole principle of the NHS ‘free at the point of use’ will have been lost.
My mother, after she had her stroke, spent two years in a Nursing Home. As long as she was still a private patient, being paid for by the money from the sale of the house, she was treated well – but as soon as that ran out, she was treated as a second- or even third-class citizen at best. She wasn’t turned often enough in bed, so developed bed sores. Her catheter bag wasn’t emptied, so urine was deposited on the floor. Her incontinence pads weren’t changed frequently enough, and she was left to lie in her own faeces. I used to gag on the smell from yards away from her room. She became so depressed, she used her one good hand to pull the feeding tube out of her stomach. All that happened was that it was re-inserted and she was put on anti-depressants. The State-inflicted torment was compulsory. It was, indeed, a blessed release for her when she eventually passed away in 2001.
That is a vision of what is in store for every geriatric patient, for every stroke victim, for everyone unable to look after themselves and in need of care, whether health care or social care, in the near future, if the Tories have their way. It is a Hell on Earth.
Richard
And precisely why I worry about the involvement of private companies in that sector, many overladen with debt – as was Southern Cross
Attendance allowance:
Stops after 28 days unless you are a private patient with no NHS involvement.
Carers Allowance:
Stops as soon as admitted.
Disability Living Allowance (Personal Incapacity Payment):
Stops after 28 days admittance, again not for private patients.
Employment and Support Allowance, Incapacity Benefit or Severe Disablement Allowance:
Should stay the same for up to 52 weeks.
Jobseekers Allowance:
Stays for up to two weeks. But if you are unable to sign-on, you will be sanctioned for 90 days.
Pension Credit (basic):
Stays the same for 52 weeks (nursing home counts as hospital *IF* it is NHS (if your union provides such care it does not count)
State Pension:
Unaffected even for protracted care periods
Housing Benefit:
52 weeks, but very complex and may need to seek help.
As always, terms and conditions apply. Things change on a daily basis, and it is extremely difficult to find anyone who knows the true picture. If Age Concern doesn´t know, your local council almost certainly will not.
The only constant is that the state pension is unaffected, although the state SECOND pension MAY be affected by whatever other benefits you claim.
Thanks
I heard a story last week from someone whom I would trust that a DWP centre takes up to 10 days to process mail as their own post room was closed down for budgetary reasons. They formally opened the letters and distributed to the relevant people. Now it is ‘outsourced’ so when it is received it then goes to the private contractor and is then returned. Meanwhile ‘customers’ are left waiting, often with no money. The contractor is Atos by the way.
Once I would have been sceptical about such a story Now it seems only too likely.
And everyone no doubt ticked their performance criteria boxes all the way along to produce what remains a malicious outcome – by design
Ian, your story reminds me of the many concerning the “hidden” costs of contracting out that I’ve come across since the mid 1990s. Through that decade I routinely heard about or came across examples from across local government in particular, as many local authority were forced to outsource services – or ran willy nilly into it if they were Tory controlled. Almost always they concerned an internal service, such as IT or estates, that had been outsourced, with a resulting drop – often dramatic – in access to and the standard of the contracted service. By the early 2000s central government departments ans agencies had become similarly afflicted – and the tales of woe continue to this day. If I weren’t bound by an ethical duty to respect the confidentiality of the material I read in the assignments and research reports I’ve seen over many years from my many public sector students I could make public stories of wasted time, effort and money, of dire services, of obstruction and delay, and so on, that would make many of the stories that Private Eye prints sound like small beer.
But what I can say is this. Whereas back in the 1990s it was always possible to find people who spoke out about the hidden costs and dubious value of many of the outsourced/privatised services they had to work with, and sometimes something actually got done about them as a result, seldom if ever does that happen now. People know to keep their mouths shut and just soldier on. They know that career wise, to say anything publicly (or even privately to the “wrong” people) that might be construed as negative about the service or products being received from a commercial provider is anathema to management, and even more so to their political masters. And it’s worth adding that I know that plenty of people who work in the private sector providing such services are also well aware that what they provide is often sub standard or just a plain rip-off. And many are deeply uncomfortable about it. But they dare not admit that in public and frequently not privately either.
Ultimately neoliberal doctrine is now so dominant, so all encompassing, and so oppressive and destructive of values such as the truth, trust and honesty that it has become nigh on impossible to do anything other than acquiesce, rather as serfs did to their feudal masters. That’s the reality of the “developed” country in which we live, not the nonsense about charities being the enemies of enterprise that Osborne, the Tory party, big business, and much of the media would have us believe.
As usual, thank you
Ivan, Today’s FT reports even the masters can be “serfs” – a bitter irony 🙂 “Businessmen are ‘serfs’ in Putin’s Russia, warns Sergei Pugachev: …… The Russian economy, he argued, had been transformed into a feudal system where businessmen were only nominal owners of their assets.”
http://www.ft.com/cms/s/0/ab541ee8-4e4c-11e4-bfda-00144feab7de.html?siteedition=uk
Interesting case of feudalism
When will we be set free of the dogma of neoliberalism? When will its nostrums be challenged? The Labour Party refuses to do this, having accepted the neoliberal faith under Blair, and the Green Party is as yet too weak to have a realistic prospect of doing much more than keeping Caroline Lucas’s seat in Brighton Pavilion and possibly (if we’re lucky) gaining a couple more.
Apart from the SNP and Plaid Cymru MPs, and the SDLP representatives from Northern Ireland, that will leave the rest of the House of Commons in the hands of a whole swathe of neoliberal MPs of the UKIP, Tory, Liberal Democrat and Labour Parties. The prospect is almost suicidally depressing.
The worst moment is before the change