Panorama last night
in [UK Diabetes]
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From: Dave A on 11 Jul 2008 08:33 On Fri, 11 Jul 2008 07:30:43 +0100, Andy Hall <andyh(a)hall.nospam> wrote: >I am far more concerned about the NHS methodology of spreading >available funds as thinly as possible in order to maximise the number >of patients treated If the available funds aren't enough, the answer is to increase them. The last thing we need is to have the private sector involved in deciding which patients funds are being spread too thickly over, behind the cloak of commercial confidentiality.
From: Andy Hall on 11 Jul 2008 08:43 On 2008-07-11 13:33:55 +0100, Dave A <dave_a(a)NO~SPAMtiscali.co.uk> said: > On Fri, 11 Jul 2008 07:30:43 +0100, Andy Hall <andyh(a)hall.nospam> > wrote: > >> I am far more concerned about the NHS methodology of spreading >> available funds as thinly as possible in order to maximise the number >> of patients treated > If the available funds aren't enough, the answer is to increase them. The funding certainly does need to be increased. Along with that, needs to be a wholesale culling of non productive public sector employees in UK healthcare. This organisation is the third largest employer worldwide and the largest in Europe. Clearly that's a complete nonsense > The last thing we need is to have the private sector involved in > deciding which patients funds are being spread too thickly over, > behind the cloak of commercial confidentiality. Which is why appropriate Ts&Cs need to be in the contracts. When I buy private medical insurance, I know prescisely what they will cover and what they won't. I can get a complete list of treatments and procedures together with details of what they will cover for hospital fees, consultant fees, anaesthetists, ancillaries and all the rest of it. I get to choose which of these I will use, when and where. When I pay my taxes, in addition to my own insurance, it is not at all clear what I am going to get from the NHS, when and where. It doesn't even follow its own guidelines.
From: DaveT on 11 Jul 2008 08:45 On Fri, 11 Jul 2008 07:30:43 +0100, Andy Hall wrote: > On 2008-07-11 05:53:41 +0100, Dave A <dave_a(a)NO~SPAMtiscali.co.uk> said: > >> On Thu, 10 Jul 2008 21:27:05 +0100, Andy Hall <andyh(a)hall.nospam> >> wrote: >> >>> On 2008-07-09 07:37:17 +0100, Dave A <dave_a(a)NO~SPAMtiscali.co.uk> >>> said: >>>> >>>> >>>> but the private sector is much, much worse. >>> >>> That simply isn't true. >> >> ... according to your free market dogma. The facts argue otherwise. > > Relevent citation? > > > > >> >>> >>> >>>> And there is at least some slim chance that public services can be >>>> held to account for their mistakes and forced to change their ways. >>> >>> That isn't true either. There is virtually zero chance of holding to >>> account an organisation that actively markets that it is doing its >>> customers a favour and that they should be grateful for what they get, >>> >>> Most NHS bodies have had immunity from prosecution lifted as of last >>> year, but continue to operate as though they are above the law. >> >> So, just like private sector corportations, in the health sector and >> elsewhere. Except, unlike with private corporations, there is some slim >> chance of using the political process to bring pressure to bear on >> them. > > In your dreams. The way to handle this issue is for the private > sector contracts to contain sufficiently tight SLAs with appropriate > non-performance penalties. The risk factor would be with the > inability of civil servants to negotiate such a thing because they don't > have the real world commercial experience. > > > >>> You already indicated that several private sector firms had been >>> called to account in th courts, and within reason, that is a good >>> thing. >> >> Now you are simply making things up. My post never mentioned private >> sector firms being held to account by the courts. > > I beg your pardon, it was DaveT, earlier in the thread. > Read what I write before using me as a excuse, it was reported that one of the US companies that are worming there way into running not only the PCTs but are already running some of the private surgeries has been brought into legal disputes in the US I believe to point out the trustworthiness of these companies that are being handed the NHS to run. > > >> If I had, it would >> have been to argue that fines just don't cut it when corportations >> cause deaths by cutting corners in the chase for profits > > That's just silly hysteria. It's prfectly possible to negotiate > contracts that will address that and to measure them. There is less > motivation for a private sector company to cut corners unsafely because > of the resulting publicity. What rubbish, they get a fine (that the consumer eventually pays for them), publicity does not matter when there is no alternative, we are not talking about Jacobs Cream Crackers against Asda's own brand. The only one if ever a *person* is found guilty, is the one who ended up doing the dirty work not the ones who said how it had to be done or who got things in such a state it ended up with that person making the risky move. It should be the decision maker and the ones who accept that decision that should be prosecuted, might make them think a bit more about the full consequences of that brainwave they had. It should also mean instant dismissal by law, no side stepping within the company. Whistle Blowers are frowned upon and often are ostracised for the rest of their working lives after being black listed for doing it. When that attitude changes and all those who did not whistle blow are instantly sacked so committed people can be brought in. We will forever have the escape-goat business stature we have. Both in the private and public sector. I understand secrecy about the product being made but when lives are put in jeopardy no secrecy should be legally allowed. The same applies with the PCTs It is now a waste of time trying to get information from your local surgery unless they know you very well because those that surgery hop only get the PCT blurb because the person you ask would be instantly dismissed if the PCT found out. That is one very good reason for not having private surgeries it does allow for patients and medical staff to really get to know each other and find the ones that can be trusted. One of the complaints from a surgery that has been privatised was that they never see the same doctor twice. As a diabetic that should really concern you as the loss of personal involvement eventually you will need to know the doctor with contacts at your hospital the one who has contacts within the PCT The one who is willing to do minor surgery on the spot we even have one who does acupuncture who also is good with muscular problems. By knowing them you can make an appointment to see that doctor when you need his skill without making umpteen appointment's chasing a trail of doctors. > I am far more concerned about the NHS methodology of spreading available > funds as thinly as possible in order to maximise the number of patients > treated, while wasting a significant proportion on unnecessary > bureaucracy. There was an internal .pdf explaining how and who PCTs should answer to but it seems to have been removed from the net (I wonder why) as I can not find it now. It explained that no PCT should answer any questions without first getting permission *and the answer* from the main authority. No minister, MP, health worker has a right to ask and questions must go through a set course of channels. The information is not (contrary to what Panorama stated) available under anything like the data protection or the freedom of information act. So when that program states the PCTs do not know how many private surgeries there are they are just refusing to say, so one has to ask why. Where they frightened of the obvious second question. -- DaveT T1 Basal Beef Lente Bolus Humalog as required.
From: Dave A on 11 Jul 2008 09:05 On Fri, 11 Jul 2008 13:17:57 +0100, Andy Hall <andyh(a)hall.nospam> wrote: >Anecdotal evidence is not all that valuable because of the limited >number of data points and the non scientific analysis of the data. > >Anecdotally, my experience of private sector medicine has never been >less than exemplary. Anecdotally, my experience of treatment in NHS hospitals has never been less than exemplary either. So what? The anecdotal evidence that matters is about the *patterns of health outcomes* across the two types of provider. All of that evidence points to the superiority of public provision. > >> >> If it were cheaper to treat in the private sector, it is likely that >> the politicians who favour moving in that direction (i.e. virtually >> all of them) would be shouting this from the rooftops, instead of >> justifying it by pointing to patient satisfaction surveys saying their >> private sector treatment was good because the toilets were clean and >> they got definite appointment times. > >That would be a start. Multiple occupancy wards and shared toilets >should be replaced by individual rooms and separate toilet facilities. > A few years back, I had the misfortune to be treated for a few hours >in an NHS hospital, until I discharged myself and went to a private >facility. The NHS facilities were indescribably bad. > >The 1Bn a year that is being spent on hospital infections would be far >better spent on removing communal accommodation. > The money would be best spent first on getting all current provision up to the highest standard. If there's any cash left once this is done, by all means build individual rooms and even toilets - as long as they still leave wards for those of us who would choose to spend our time in the company of the rest of the hoi polloi when we need treatment. > > >>> <snip > >>> >>> In your dreams. The way to handle this issue is for the private >>> sector contracts to contain sufficiently tight SLAs with appropriate >>> non-performance penalties. The risk factor would be with the >>> inability of civil servants to negotiate such a thing because they >>> don't have the real world commercial experience. >>> >> Such a system would totally exclude any public scrutiny because those >> of us who actually fund the health service through our taxes, and need >> its services when our health goes, couldn't be allowed to know >> *anything* - because of "commercial sensitivity". > >It would be perfectly simple to build appropriate transparency into the >contracts. > Sure, if there wasn't commercial confidentiality. And still you accuse others of not having commercial experience. > >> >> One place that corporations chasing government contracts don't cut >> corners is in lobbying the politicians and civil servants who are >> responsible for handing out the contracts. It is also very strange how >> many of these politicians and senior civil servants carry on being >> insulated from the real world commercial experience of most of us by >> transferring into well paid jobs in the very corporations they have >> helped to give contracts to, once their term in office is up. > >Examples? > Tony Blair�s senior health policy adviser, Simon Stevens, moved to become European president of the US corporation UnitedHealth. Tom Mann, ex-head of the Department of Health�s �national implementation team�, in charge of imposing the first ISTC contracts on NHS Trusts, who moved on to become chief executive of Capio, which won a large number of these contracts. Patricia Hewitt moved to working for the healthcare venture capital group Cinven. Lots more examples from health, transport, education, defence and elsewhere are noted with tedious regularity in Private Eye. > > >>> >>> <snip > >>> >>>> If I had, it would >>>> have been to argue that fines just don't cut it when corportations >>>> cause deaths by cutting corners in the chase for profits >>> >>> That's just silly hysteria. It's prfectly possible to negotiate >>> contracts that will address that and to measure them. There is less >>> motivation for a private sector company to cut corners unsafely because >>> of the resulting publicity. >> >> Just like other anti-social types, they often think they won't be >> found out. MRSA and other bugs since hospital cleaning was >> privatised. > >Actually, a lot of that was because of excessive use of antibiotics, >but leaving that aside, again this could be dealt with via appropriate >contract provisions. > Sure, the overuse of antibiotics played its part. But the appropriate contract provisions would be to ensure that the staff who actually do the cleaning are not overworked and underpayed - the one area where there was room for cutting costs.
From: Andy Hall on 11 Jul 2008 09:32
On 2008-07-11 14:05:28 +0100, Dave A <dave_a(a)NO~SPAMtiscali.co.uk> said: > On Fri, 11 Jul 2008 13:17:57 +0100, Andy Hall <andyh(a)hall.nospam> > wrote: > > >> Anecdotal evidence is not all that valuable because of the limited >> number of data points and the non scientific analysis of the data. >> >> Anecdotally, my experience of private sector medicine has never been >> less than exemplary. > > Anecdotally, my experience of treatment in NHS hospitals has never > been less than exemplary either. So what? > > The anecdotal evidence that matters is about the *patterns of health > outcomes* across the two types of provider. All of that evidence > points to the superiority of public provision. Citation? >> >>> >>> If it were cheaper to treat in the private sector, it is likely that >>> the politicians who favour moving in that direction (i.e. virtually >>> all of them) would be shouting this from the rooftops, instead of >>> justifying it by pointing to patient satisfaction surveys saying their >>> private sector treatment was good because the toilets were clean and >>> they got definite appointment times. >> >> That would be a start. Multiple occupancy wards and shared toilets >> should be replaced by individual rooms and separate toilet facilities. >> A few years back, I had the misfortune to be treated for a few hours >> in an NHS hospital, until I discharged myself and went to a private >> facility. The NHS facilities were indescribably bad. >> >> The 1Bn a year that is being spent on hospital infections would be far >> better spent on removing communal accommodation. >> > The money would be best spent first on getting all current provision > up to the highest standard. That would be achieved by the construction of individual accommodation > If there's any cash left once this is > done, by all means build individual rooms and even toilets - as long > as they still leave wards for those of us who would choose to spend > our time in the company of the rest of the hoi polloi when we need > treatment. That would be reasonable if patients are willing to sign a disclaimer that they will cover the cost of treatment for any cross infection. >> >> It would be perfectly simple to build appropriate transparency into the >> contracts. >> > Sure, if there wasn't commercial confidentiality. And still you accuse > others of not having commercial experience. It's a simple matter of including appropriate transparency into contracts. >> >>> >>> One place that corporations chasing government contracts don't cut >>> corners is in lobbying the politicians and civil servants who are >>> responsible for handing out the contracts. It is also very strange how >>> many of these politicians and senior civil servants carry on being >>> insulated from the real world commercial experience of most of us by >>> transferring into well paid jobs in the very corporations they have >>> helped to give contracts to, once their term in office is up. >> >> Examples? >> > Tony Blair�s senior health policy adviser, Simon Stevens, moved to > become European president of the US corporation UnitedHealth. Tom > Mann, ex-head of the Department of Health�s �national implementation > team�, in charge of imposing the first ISTC contracts on NHS Trusts, > who moved on to become chief executive of Capio, which won a large > number of these contracts. Patricia Hewitt moved to working for the > healthcare venture capital group Cinven. Lots more examples from > health, transport, education, defence and elsewhere are noted with > tedious regularity in Private Eye. It's encouraging to hear that there are at least a few people able to advance their careers into the commercial world. >> > Sure, the overuse of antibiotics played its part. But the appropriate > contract provisions would be to ensure that the staff who actually do > the cleaning are not overworked and underpayed - the one area where > there was room for cutting costs. Poor contract negotiation. It isn't for the issuer of the contract to determine working conditions for the contractor's employees. They should simply ensure that the SLA is met. If it isn't, then there should be contract provisions to address that. |