I am amused (but only very slightly, and then sardonically) by the fact that Jeremy Hunt, the Health Secretary, is having to impose regulation on NHS Trusts to limit the impact of market competition upon their operations.
The whole reason for the vast number of NHS trusts we suffer from in the UK is that they supposed to create competition that exerts upward pressure to enhance efficiency in the NHS. That, though, is just theory. As anyone with real world experience could readily spot, the real outcome was bound to be increased administration, empire building, and most importantly, the collapse of the NHS's monopoly buying power and its replacement by a monopsonsitic situation where sellers hold all the economic power. This is exactly what has happened: agency suppliers of staff have faced many competing NHS bidders for limited resources and, inevitably, the price has risen as a result, entirely because of the artificial subdivision of the NHS imposed upon it by successive governments when, very obviously, central buying power is critical to its economic and operational success.
There is, of course, one very obvious answer to this, and that is to reorganise the NHS into regional authorities combining primary, secondary, tertiary and social care, and with central buying authority across the whole of their geographic domain and with responsibility to coordinate integrated supply of all services. Competition has no role to play in such an organisation, but this is not dogmatic choice: this is recognition of exactly what is needed to supply modern health care at the lowest cost. It is dogma, and dogma alone, that is preventing that happening.
Jeremy Hunt is demanding £22 billion of savings from the NHS: my suggestion is one of the best ways to help achieve that goal.
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Prof Allyson Pollock and her reinstatement bill to bring the NHS back into public service. Also looking at the 5 yr forward view of the NHS, NHS England is to read management speak taken to a higher level, exploring this and that.
Smaller hospitals coming to a community near you, but, I note, as well as NHS staff there will be ” other providers” .
Our health service is mostly privatised I believe, hiding behind the NHS logo. It is early days and the gold rush has only just started. I feel it in my bones. there were things needing addressing, always room for improvement
Remember that the commonwealth fund voted the NHS as amongst one of the best in the world for value for money and good outcomes.
I was a child pre NHS, my mother put money aside for a visit to the doctor. That such a magnificent safety net is being dismantled is deeply regrettable. Profits before patients. It will be free at the point of entry for the long term chronic sick, leaving health insurance companies free to pick and chose more profitable areas, elected surgery and such. I know other countries have a mixture of private and state, well good luck to them, ours WAS the best.
You weren’t the only one to be sardonically amused when news of this latest twist in the saga of the NHS emerged, Richard – and particularly as this intervention into a market comes from such a staunch neolib as Hunt. What will his old mate Murdoch be thinking!
But this is but one of the many outcomes of the willy nilly – entirely ideologically driven – policy choices of the previous government, the results of which will increasingly become apparent over the next year or so. Apart from a string of negative outcomes from within and across the NHS, we can add increasing homelessness, increasing dependence on foodbanks, more deaths/suicides related to DWP sanctions policy, a complete failure to hit housing targets, increasing child poverty – and poverty more generally, various scandals involving the maladministration and management of free schools and academies, assorted issues with the management (failure of) offenders, etc, etc. Not to forget the failure of the Universal Credit system, which for those of us who are interested in such things, has for several years now had all the hallmarks of the previous mega IT disaster – Connecting for Health (RIP).
There are more of course (Banking? And surely the misselling of all sorts of “products” related to the liberalisation of pensions).
What’s going to be intriguing to see, however, is the extent to which the Tory press report these issue, given they then expose the flaws in Tory policy. Additionally, I expect a culture of secrecy to descend on government the like of which will make even the limited degree of transparency we’ve enjoyed since the FoI act look like a golden age. Still, at least the Tories can blame the LibDems for any policy failures, so expect Clegg and his merry band of inconsequential MPs to be baited on a regular basis in parliament.
As usual, agreed Ivan
It’d be an interesting exercise in prediction if between the us (ie. you and the commentators on your blog) and using our collective expertise, we put together a list of all the negative outcomes we expect to flow from the policies adopted between 2010 – 2015. I only flagged a few but there are others that I expect to emerge from policies that were a lot less “public” than they ought to have been. For example, Private Eye recently reported that the pipeline and supply network for supplying fuel to military bases and other strategic facilities (I forget it’s name) was sold off just before Parliament rose so nobody noticed. Then we have the privatised air sea rescue service, and so on. I’m not expert enough in those areas to say what the negative outcomes might be – perhaps they’ll all be positive – but it’d be interesting to second guess what other disasters await this government beyond the obvious ones like the NHS and poverty.
The pipeline system was called sell the ‘Government Pipeline and Storage System’ (GPSS) and it was sold to the CompañÃa LogÃstica de Hidrocarburos (CLH) of Spain for £82 million.
The only reason CLH bought GPSS is to make a profit so instead of a state owned asset delivering fuel to military bases and some civil airports we (the taxpayers) are now paying the Spanish to do the same thing while making a profit. This looks like the same thing as an import to me but more damaging in the long term is that all the technical expertise will reside in Spain and eventually just have a few low level operatives on the minimum wage carrying out the menial tasks of keeping a pipeline system running under the supervision of an ex-pat Spaniard paying Spanish taxes!
Yet Philip Dunne MP said: “I am delighted with the successful completion of another Defence asset sale………..”
How is this sale a success?
A privatised air sea rescue service has no interest in safety at sea. In fact the more untrained or poorly trained people who go to sea in unseaworthy boats the more rescues there will be, therefore the greater the need for more rescue facilities, more cost to the taxpayer and more profit for the air sea rescue companies. Makes perfect Tory sense!
The Tory interference with the NHS has led to a situation where an increasing number of Trusts are in deficit, many of them then start recruitment freezes which of course lead to staff shortages. The extra pressure on front line staff caused by this is responsible for a significant increase in stress related illness which leads to increased sickness absence. When the situation gets bad enough Trusts have to resort to using “bank” staff and are then taken for a ride by the staffing agencies.
Not only that, the NHS/education system is not able to train staff quickly enough to supply the shortfall caused by people leaving for less stressful jobs and retirement.
In the Trust I work for some staff “on call” have worked a full shift beforehand, have been told the Trust cannot afford to pay them on call payments and must take time off in lieu and then been told they cannot have time off in lieu because of staff shortages !! (this is actually unlawful withholding of wages)
The endless criticism of the NHS (some but not most is valid I admit) in the press and by the Tory government have made it more difficult to recruit trainees than it was when hospitals were staffed by “doctors and angels” (remember those days?). Who wants to set themselves up to be the subject of some of the vile criticism thrown around?
Teaching suffered a similar fate under Michael Gove, to be continued under Nicky Morgan. State schools, previously responsible to LEAs, are being turned into Academies (Privately run state schools, no fees yet but what happens when the Academy companies decide their profit margins are not high enough), barely a whimper from the general public and the teachers trying to defend the state system constantly vilified by the press and public (“think of the holidays these 9-3’s get, whining b******s that they are!”) to the point where recruiting and retaining good teachers becomes too difficult – but hey, no worries, Academies can hire unqualified teachers now! I speak as a former teacher who left the profession but still despairs at the continuing destruction of our state education, cheered on by the Tories.
Will the public wake up before all the State infrastructure has gone?
I do not know the answer to your last question
I share all your concerns in the first para
Daniel- I left teaching in 2000 because the I was sick of the tidal waves of BS that were coming in wave after wave with Acadamies ‘competing’ with non-acadamies.
More seriously than that, I saw that teachers were under pressure to become ‘systems people’ and data collectors rather than individual inspirer and that league tables were obliging teachers to hammer square pegs into round holes. The system could no longer tolerate ‘mavericks’ who, in the past, were valued. Every time a new secretary of Sate would come in they would try to prove their metal by instigating meaningless and disruptive changes, so much so that ‘change fatigue’ was spoken about. I doubt people like Gove would last a week in a Secondary School.
Will people wake up before its all gone? Not much sign. Teachers themselves are too busy trying to survive and, as you say, many good ones get the hell out. We have a tired and cowed populace.
Let us not forget the Health & Social Care Act 2012. The brain child of Jeremy Hunt’s predecessor Andrew Lansley which now requires by law that all NHS services are put up for tender, throwing the doors to our NHS wide open for private healthcare providers to come in and cherry pick what they see as the most profitable bits. Some of them, such as VirginCare had never provided public health services before. The tendering process is not even operating on a level playing field and may be in breach of both UK and EU competition law.
Like any private company, private healthcare providers are able to register for VAT and therefore claim back all the VAT they pay on things like medicines, medical equipment, legal advice etc. However our NHS is not a business and therefore cannot register for VAT, meaning that they are unable to claim back the VAT it pays. So when putting a bid together to offer a service, the cost of providing that service will always be 20% higher than the cost to private companies.
Despite the governments repeated claims that they want to save the NHS and make it better for all of us, regardless of their repeated denials that they are trying to privatise our NHS, the writing is on the wall and it is telling a very different story to the one our government is telling us.
” wide open for private healthcare providers to come in and cherry pick what they see as the most profitable bits”
Not forgetting that they hire already-trained staff FROM the NHS. Agency nurses, NHS trained…..
Not so much a shortage of nurses, it’s a shortage of nurses working in the NHS, FOR the NHS.
Then of course there is the ridiculous bull**** of GPs’ being expected to not prescribe antibiotics…so a patient who needs antibiotic prophylaxis, and who the GP knows needs it, cannot be prescribed such by the GP, but has to go to hospital and be prescribed by the hospital….work out the chain of costs in that.
I could go on, and on….pathology taken over by a London hospital, so the team overseeing it is reinforced by another team from London, and everyone departs down to London for regular meetings….with the usual massive costs of transport and accommodation (has nobody ever heard of teleconferencing?) (ooops…team-building!)
I think that you give the Tories too much credit here Richard.
Bascially the Tories lied about the NHS in this election having lied to us previously in coalition where they said they would not reduce financial support (but they did really because inflation and the costs of the Lansleys ‘reforms’ actually eroded the value of the money the NHS got during that period).
All Hunt is doing is disguising the cuts they are making by blaming the agencies who provide staff to actually run the services during core staff shortages.
It really is as simple as that. I see no paradox at all about markets in any of this. It’s just another clever and subtle way of presenting a real cut in money to the public as well as helping to undermine the service in order to justify full privatisation (how long before horror stories about staff shortages and their impact on patient care make themselves known)?
My view is that any contradiction with their own market driven value system and their moans about agency workers is only an apparent one. I believe that these Tories have only one value – to get rid of any State enterprise – and I feel that they don’t mind ‘contradicting’ themselves in the process as long as their destructive goals are realised.
It feels like that, I agree
I agree Mark. Jeremy hunts reaction to questions put to him by queen guitarist, Brian May, was akin to that of a spoilt child. The Tories are not trustworthy and anything they do that may appear to be a contradiction is part of a long term plan.
When I worked at a local hospital in the late 1960’s, we were obliged to obtain supplies through a Central Government Purchasing Scheme.
I often found that some comparable items were available locally at much less cost than the hospital was being charged, but we were not permitted to shop around.
Clearly it is necessary for appropriate responsiveness to be built into the system
But overall the savings would be enormous, I am sure
The internal market in the NHS costs around £10 billion a year & PFI contracts much more and between then are destroying the NHS
Solutions:
1 – get rid of the internal market = £50 billion savings
2- use the savings to pay off PFI contracts.
is this too simple?
Janet
The numbers are estimates and too big
But both are needed
If my memory serves me correctly we’ve been here several times before re high cost of agency staff. Way back Barbara Castle made it illegal(?) to pay agency staff more than a basic staff hospital grade nurse. Of course immediately reversed by the Tories.
More recently and NHS agency was established so that it could undercut private agency rates, and had to be used as first option. Once it had become established and running well, and possibly profitably, when the Tories got in they sold it off! So now here we are again, only even worse scenario than before.
In answer to Simon above, the idea that teachers are becoming data collectors is spot on. My partner is a part-time teacher who works full time hours in order to teach AND colect data on her performance.
Stuff like this – over regulation and over-management of public sector services – is designed to put huge pressure on services that can cause a collapse and therefore justification to privatise further.
And when privatised, the institutions who invest in these newly privatised services then lobby Government for less regulation because of course they want to cut costs to deliver huge returns to investors. The privatised companies are increasingly regulated less than their publice equivalents.
Look what happened to the Audit Commission and Tenant Services Authority in 2010 in the housing sector. It was the concerns of instituional investors in housing associations (the banks) that led to the regulation regime in social housing being greatly reduced. Was it any surprise that a number of housing asscociations were latterly found to be managed badly not long after?
ED NOTE: A comment made at this point was deleted
Mark. Re your second paragraph, I have to admit that I’d never considered the performance regimes that have been forced on organisations and employees across the public sector in this way, mainly because I’ve seen them as a product of the neolib belief that all public services and public sector workers are by definition rubbish compared to their private sector counterparts, and therefore require overbearing oversight and control mechanisms to “correct” for this.
But thinking about it, you may well be right (or perhaps its a bit of both). Certainly it’s very noticeable that as soon as (or before) a public service is privatised or contracted out the lobbying starts to have the “red tape” reduced, and oversight becomes minimal by comparison to what it was.
That said, we’ll be paying for the bonfire of red tape, of that I have no doubt, and as we already see in housing, planning and environmental protection. But by then profits will have been made, of course, and we (ie. the state that the neolibs hate so much) will be left to pay for putting it right.
As long as I and my father before me can remember politicians have been promising to cut ‘red tape’. All they have ever achieved however, is to create more and more. This is, in part, due to their obsession with monitoring input instead of output for the reason give by Ivan (above).
What politicians do not seem to realise is that if they concentrated on output instead of input (as a commercial company would) they would achieve the efficiencies they want without handing out cash to profiteers.
Oh, I almost forgot; that’s the whole point of privatisation isn’t it!
Simon J
By way of illustrating the disjunction between the regimes of rules, regulations and performance measures those of us who are deemed second rate citizens because we work in the public domain have to endure, and those first class citizens who work in the private sector, I point to this from today’s Guardian:
‘HSBC’s procedures to prevent money laundering, sanction-breaking and criminal activity still have deficiencies so serious that to publicly disclose them would risk serious crime, the US Department of Justice has said.’
And this how many years after banks are supposed to have cleaned up their act. Self regulation: simply an excuse for sham regulation.
Indeed
Whoops – Sorry Richard but Mr Hunt…..oh dear, I’d better stop ‘cos I can feel the bile rising again…………..