Time and again we have been told that the presence of private health care in NHS hospitals was an issue about which we should have no concern.
Yesterday we learned that there has been a significant increase in the amount of that private healthcare in NHS hospital trusts. That, of course, is hardly surprising. NHS hospitals are now allowed to raise up to 49% of all their income from the sale of private health care services and whilst none do make sales at anything like that (at present) it would have been extraordinary if the directors of NHS Foundation Trusts (many of whom will, by self selection, approve of the broad thrust of government policy) had not taken the hint with regard to what has been expected of them.
The fact that those directors might embrace government policy, supposedly in the interests of the hospitals and communities they serve, does not mean that there is any obligation on us to agree with them on this issue and we would be wise not to do so. The reasons for that are, I should have thought, obvious.
Firstly, there is the simple and well known fact that when any issue is made for the target of attention behaviour towards it change. This is in the case of physics an idea enshrined in the uncertainty principle. In management it is well known that the moment you measure something it is automatically assumed that the issue has a higher priority than other issues. Inevitably, and almost invariably because management really do only measure things that are important to them, real on the ground behaviour changes to improve recorded performance. So, managers will undoubtedly be increasing their efforts to promote private medicine as a result.
Second, and as obviously, directors of NHS trusts also want to appease those to whom they report - which are not really the communities they serve but are actually the NHS's senior management and, in turn, Jeremy Hunt, whose reputation for micro- management is well known. That means they too will really focus on this issue.
And it is the focus that matters most. It means that mainstream care is not given the attention it deserves as priority is given to other activity that is both outside the NHS and has an ethos contrary to it. And the fact that care outside the NHS and with an ethos contrary to it is being promoted is not chance: this is, of course the basis for the US health care model to which this government seems dedicated despite its proven and profound inefficiency.
As a result it is not whether or not private medicine is wrong per se that matters. I would not ban it. I see no reason to. Nor would I VAT exempt it and so subsidise it either. What does mater is that management and services in the NHS are being distracted from their real task by private medicine. And that does matter, a lot. And that's precisely why the NHS and its hospitals should not be in this 'market'.
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Is there any good or service which in your view should be VAT exempt? I ask this because you are against VAT exemption for both health and education. If one does not support VAT exemption for both of those, it is difficult to envisage any circumstance where you believe it should apply.
These exemption are tax subsidies to the well off. Why are they necessary?
I do favour the zero rating of many existing items
I do not favour the exemption of banking but pragmatically it may be necessary which is why FTT is needed instead
VAT exemption for health is not a subsidy, as it means all VAT costs are irrecoverable. By contrast, the NHS is subsidised through its VAT regime (rightly so) as it is entitled to recover much of its VAT cost.
That is simply wrong
The majority of health care costs are people on which there is no VAT charge
That means private health care is subsidised by well over 12% in all probability
Why should we do that?
With knowledge of VAT and the sector, I have to disagree with you on that, Richard.
Agree private health care should not be subsidised, but that is a straw man argument here.
I’m sorry Nick but you are talking nonsense
Let’s assume 40% of health care inputs carry VAT so the current price is made up of cost plus VAT at 20% on 40% of prices (assuming break even – which will not be the plan
In that case base cost is 100/108 x 100 = £92.60
Then add 20% to that = £111.12
Now how in your wildest dreams is £100 more than £111.12?
Because health is a “good”. It is desirable that people are healthy. Likewise education. It is seen as good that the workforce is well educated. Parliament has decided that we should not levy indirect taxes on “goods” such as health and education. (I am not going to use the absurd word “subsdise” as simply not taxing something is not the same as subisiding it, however much you like to claim otherwise).
Sure tax and education are good
That’s why we provide them free to everyone
So there is no reason to subsidise anyone who wants to buy them elsewhere
And yes, tax spends are subsidies – it’s you who is ignoring the economics of this and is substituting the dogma
If you ever need a minor operation in a hurry and you ‘go private’, be sure to choose a clinic colocated in a major NHS hospital.
Any complications in a private operation are picked up by the NHS, and a prudent consumer should know that.
An economist or banker would immediately recognise a hidden subsidy in the transfer of an unpriced risk.
A cynic given to intemperate language would stop saying ‘partnership’ and ‘shared resources’ and consider terms drawn from zoology and the revolting ecology of obligate parasites.
Yes- risk of the private sector being transferred to the public-quelle surprise!!
The State is suddenly big when it comes to absorbing risk!
But (presumably) minor operations done in the NHS carry the same risk as those done privately. So the risk is allowed for as (again, presumably) the NHS knows how many minor operations are carried out privately as part of their risk analysis.
Also, is it not the case that the patient is a taxpayer & has therefore paid for his NHS treatment (including the minor operation) and (again, presumably) the NHS knows how much money it saves by not doing these minor operations.
So far the evidence is that outsourced operations cost more because they are bulk bought and not used
Richard
I’m not going to spar with you over numbers (you’d win hands down – I’m neither an accountant nor an economist). My point is simply that to use VAT exemption for health care as an example of subsidising the wealthy is a little bit lazy, particularly where there are numerous other better examples.
But I was discussing health at the time
In which case it was a very good example
The UK government is no more adopting the US healthcare model than Obamacare is a mirror of the NHS (apart from the abysmal failure of IT systems). I am sure that you do not want to sound like Karl Rove.
This government is making a few tentative steps towards permitting experiments in some NHS Trusts using the French model: that is all.
You may have overlooked the government’s failure to reintroduce tax relief for private health insurance, despite the massive savings to the NHS from the trebling of the number with PMI between 1979 and 1997. If it wanted a US-style system, encouraging private medical insurance would be the first step.
Respectfully, I know a fair amount about the NHS and am well advised
I think your claim that we are moving to the French mopdel is absurd
First of all we’re not eliminating GPs
Your claim is just wrong
Firstly, France has not abolished GPs.
Secondly I did *not* say we were moving to the French model – I said “This government is making a few tentative steps towards permitting experiments in some NHS Trusts using the French model: that is all.”
Thirdly there is *no* trace of any evidence that the Coalition is doing anything to move towards the US model of healthcare. Has George Osborne’s hair all fallen out? No, it hasn’t.
Your advice on the Norfolk NHS is doubtless excellent, but your advice on government policy seems to come from scaremongers in the Trade Union movement.
The French model is built around an absence of GPs
As for national view – I think the view is that of many in the BMA and Royal Colleges and you will certainly find it in many medical journals
But you’d rather ignore the fact that those organisations and unions are made up of people who know what they are talking about, wouldn’t you?
Of course I do not want to ignore those who9 know what they are talking about. However your advice on the Coalition’s policy, which does *not* include replacing the NHS with private insurance,and on the French system which does *not* involve abolishing GPs, but merely the *monopoly* of GP referrals to specialists, falls short of the expertise that you claim on tax. I am *not* wrong in denying a move or any wish to a move to the US system which (largely thanks to US lawyers) costs more than 90+% of the world can afford. 18% of USD/capita is nearly one-quarter of UK GDP/capita and more than total GDP/capita of two-thirds of all countries in the world. Although Cameron and Osborne attended less intellectual colleges than I they are not totally stupid.
Your arrogance reveals the folly of posting your comments
I’ll remember not to do so again
“I think your claim that we are moving to the French mopdel is absurd”
I have often noticed that your spelling goes completely to cock when you are on a foaming rant Mr Murphy.
Mostly it’s using an iPad that actually does that
But feel free to think whatever you will if it nurtures your own prejudices
Eliminating GPs in France. Are you sure? Mine is near the Bastille on Rue de Charonne and is alive and well. Has a great walk-in service and is open all day on Saturday. The only thing I don’t like is that they push homeopathy.
TP
The elimination is of the need to see a GP before a specialist
UK health care is 2% of GDP cheaper because we require that
That was what I meant
I remain unconvinced.
Private hospitals rarely have intensive or high-dependency beds, hence the interest in bringing NHS hospitals into the ¨fold¨ (at one time last year the local NHS trust hospital had nearly 50% of its IC beds taken with rejects of private health care) (which also rarely report their cock-ups).
I could continue along those lines….unavailability of expensive meds on the NHS is just one line to go into….
“But you’d rather ignore the fact that those organisations and unions are made up of people who know what they are talking about, wouldn’t you?”
Interesting that you ignore the opinions of those working in other industries when it suits you to do so….
🙁
I ignore those with deeply vested interests
Yep, no vested interests from the Unions, obviously…
We all gave vested interests
I am clear about mine
Who pays you.
‘So far the evidence is that outsourced operations cost more because they are bulk bought and not used’
That may well be true, but the point is about the risk & costs of problems with minor operations.
If it is true then NHS Management are not too hot.
Since you have told me I am no beancounter and think it only fair to return the complement and advise you that your claims to being a tax and accountancy expert are narcissistic delusions. How else does one explain your view that joy taxing someone is equivalent to a subsidy.
You might say so
Except you are wrong
Amongst experts the concept of tax spending as a subsidy is not just widely known but commonly used
I fear you are simply revealing what can only be called prejudice based on ignorance
“Firstly, there is the simple and well known fact that when any issue is made for the target of attention behaviour towards it change. This is in the case of physics an idea enshrined in the uncertainty principle.”
I rather doubt you would find a physicist who would put it like that.
You are suggesting that the uncertainty principle does not suggest that the mere act of measuring something changes it?
There is also the fact that management tend to measure things that are convenient to measure and that can be represented by a numerical value. Often the things they measure and the numerical value arrived at have little real value or are just plain wrong.
True
Quote from Liberal Conspiracy article: http://liberalconspiracy.org/2012/12/18/2012-how-the-nhs-became-privatised-and-the-impac-thats-had/
“All across the country treatments that patients used to receive are no longer available to them. Hip and knee replacements, tonsillectomies and cataract operations are among the procedures being restricted, forcing patients to wait longer, suffer in pain, or go private. Surgeries, wards, units and community services have been closed and clinical staff shed as the NHS desperately seeks to make “savings” of £20 billion.”
Anecdotally, a friend of mine resigned her role as practice nurse due to feeling disturbed by the fact that many patients aren’t getting the follow up care they need as treatments become minimized.
I find this very disturbing.
My local hospital in Taunton hired a private organisation to carry out eye surgery. Many of the people have reported problems. Compensation has been paid in some cases by the NHS. I hope they will get reimbursed by the private company.
You also need to factor-in the newly developed risk aversion to operations that have a higher probability of patient death. Operations on elderly persons and those with long-term chronic health problems.
As someone with an MA and PhD in Social Policy and Administration, who studied the NHS in some depth, and compared it with other country’s healthcare systems, I confirm that the Tories are NOT moving us towards the French system, but the _American_ one pre-‘Obamacare’, when over 40 million US citizens (12.74% of the total population) were without any form of health insurance, and were dependent on Emergency Room treatment for medical care. Health care costs were, and are, the single biggest cause of personal bankruptcy in the US. Yet the USA spends a higher percentage of its GDP (17.2%, $8,608 per capita, or $2.7 trillion in 2012) on healthcare than we do. If the EU agrees to the TTIP, the process of NHS privatisation will be complete, and furthermore, will not be reversible, which is what the Tories must be hoping for, and why the TTIP must be opposed. (That will be spoiled somewhat if we withdraw from the EU, but we will stay in at least until 2017.)
Thank you
TTIP. That to which the newly-bought labour party is struggling to come to terms with?
No political axe to grind there at all eh, Dr Blaber?
http://anewvisionofsocialism.blogspot.co.uk/
Your comment makes it rather more clear that you have one to grind but do not have the honesty to accept the fact
Sign the new campaign against “Vince Cable and the UK TTIP team” organised by 38 degrees.
https://secure.38degrees.org.uk/page/s/vince-cable-fix-ttip#petition
They are organising local campaigns you may be able to join one or deliver leaflets.
http://chpi.org.uk/patientsafety/
I sat in on a “ealth and wellbeing” committee at my local County Council.
Something I heard made me realise how Councillors are being fooled into agreeing to private tendering without question, and then something I read in the guardian later tallied with my suspicions.
There were three tenders for a particular service, two were NHS tenders and one was Virgin. A Councillor was concerned that the Virgin tender would cost more because it was private. The council official stated that in fact, the Virgin tender was the cheapest because, (in her words), Virgin were putting their own money into the service.”
I felt suspicious of this, as I am convinced that most privatisations are for money making, as I have yet to see, in my last several decades of watching Thatcherism, any rent seeker who was not out to make money.
I have since been advised that what Virgin does is to put in very heavily subsidised bids that do not cover staff costs to under cut the NHS. Once the contracts are established they cut staff and wages, and will in future increase costs.
The guardian articles are here
http://www.theguardian.com/society/2014/aug/09/former-nhs-carers-intensify-strike-over-pay
http://www.theguardian.com/society/2014/aug/09/care-workers-private-equity-targets-the-nhs
You are exactly right
I made much the same observation in the Observer recently
Update: I realise those are what you’ve quoted!
Not heading toward US style care?!
According to a family friend who was a No 10 advisor for 2 (opposing) governments, they as much admitted the direction of travel when he attempted to confront them on several occasions.
Also, read the National Archives 1982 Longer Term Options by the Central Policy Review Staff.
Also, I have seen Strategic Health Authority and PCT documents regarding outsourcing a few years ago and it was very clear that the driver was reduced staffing and wages.
¨Why should the private sector be any better at running NHS services than the NHS? The simple answer is; it isn’t. We know CircleBrook have had bungs to keep going. Because NHS staff come to work and wear a different badge does not make the systemic problems of the NHS go away. There are too many patients and not enough money. Sustainability is as much of a problem to the private sector as it is the NHS¨
http://myemail.constantcontact.com/Serco-.html?soid=1102665899193&aid=e6OXpV1xZ64