NHS 101 please!

[ben_]

The key to this is gradualism. It has already happened with dentistry and there was no outcry over that and certainly no revolution, electoral or otherwise. Privatization of a huge institution like the NHS is a necessarily creeping process and as I say, it has already begun.

[jcarver1]

It IS relevant to the future of the NHS! The fact that privitisation of the NHS would undoubtedly lead to collapse of any political party that tried to do so is th beswt safeguard we have. By suggesting it is irrelevent, you are saying the parties collapse, due to overwhelming public pressure, would not prevent it from governing! It would! I dont think Briatin has quite reached the stage where the Govenment can do whatever it wants without public support. I'll admit, there are huge areas where the Government has lacked accountability (Iraq,Bellmarsh) but to remove the NHws would be 10 times worse than the poll tax, which resulted in massive riots.

Your point about gradual change is well taken, and youy clearly have more experience in the matter. I just cannot see a democratic nation where the public have so little say, they cannot keep THE most important service available to them from being taken away.


Would still really appreciate help with NHS structure! What the **** is a primary care trust!?

[ben_]

I think you vastly overestimate the ability of the public to influence government policy on matters such as this, as well as underestimating the ability of the government to obfuscate the issue until it is too late to be reversed. The NHS is a massive drain on public finances and any government will be keen to get it off the balance sheet. Like MoD training, the prison service and the state school sector, the introduction of private investment has already begun, with the encouragement of the government.

No-one is going to riot over the NHS.

Primary care trusts are the devolved local bodies with responsibility over the majority of NHS budget.

[Singh.Simran]

Singh Simran, I fear you are being a little optimistic. The state is taking steps to dismantle and privatize the NHS - within a generation, two at the most. The infrastructure for LIFTs (Local Improvement Finance Trusts) is already in place. These are essentially methods of channelling private investment into primary healthcare. They are the next phase of PFI for the NHS. I know this because I am involved with it at work on a daily basis - much to my regret.

If you look at the way the state has forced PCTs to go to private finance in order to obtain funding for infrastructural improvements - often at usurious rates - it's hard to avoid the conclusion that it is a deliberately run long-term project to destroy the NHS as a financially viable institution. The service is in debt to private organizations to the order of tens of billions of pounds. This is not a debt the government will service forever.

True and i think it is a national disgrace. Same goes for privatisation/part of the rail, ultilites, etc. However i still believe that while this contract and that building might go down the horrible disgusting route of which you speak - the fundamental basis of the NHS is to provide care and to do so in a centralised, state-run, free at point of treatment manner - and that it is so much an institution and almost a birthright here that that will not change.

As to debt, and financial mismanagement generally, i would cf. the banks. I HOPE that a government willing to bail out flipping bankers would eventually cover or at least mitigate such things in the health service. Isn't it going to make a profit this year anyway? (Only at dire cost, i know..)

[ben_]

Unfortunately 'this contract and that building' is the stuff of which the NHS is made. Of course, for as long as possible the pretence will be made that nothing has changed, that the fundamentals of service are the same as they ever were. But private organizations will want to see a return on their investment and that means turning healthcare into a profit-making industry.

Re your second paragraph: I think it's interesting that many people (not you, necessarily) seem to read the bail-out of the banks as symptomatic of a renewed willingness of the state to interfere in areas from which it has recently made efforts to disengage itself - healthcare being one of these.

In fact, the propping-up of the financial system was an ideological decision made on the basis that supporting the free market - even with public money - is always the optimal choice. This is exactly the same logic that is employed in the privatization of the state sector. The belief in goverment appears to be that publicly-run services are necessarily less efficient than private ones. Hence I don't think that comparing the situation with the NHS to that with banks is a useful guide.

[ben_]

It is impossible for the NHS to 'turn a profit' as it is funded by the taxpayer; do you mean that it will come in under budget?

[jcarver1]

I agree that while government spending usually seems like big government, in this case it is infact enforcing the rather more right wing principles of the free market.
However, I do not think I am overestimating the ability of the public to influence the govenment. I think you are also underestimating the vehemence with which the general public would reject the privitisation of the NHS. Outrage has already been sparked after the smallest of attempts with the top-up medication. To suggest that somehow the govenment could sneak the NHS into private hands without people knowing is far fetched. A cabinet proposing such measures would surely lose their jobs at the next election, as would the MPs voting for it. The House of Lords would obviously reject it, and by the time the bill had been rejected 3 times by them, the debate (and the protests) would be raging.

I think governments are moving in the opposite direction. Forget principles and move towards ground that can gain votes. New labour and the torys new image are blatant examples, as is the current lib dem move to the right. Privatising the NHS will never win votes.

[ben_]

I hate to labour a point but you're talking as though this is theory. It's not, it's already happening through PFI. The NHS is already in hock to private finance because the government could not or would not provide necessary funding. Mental health provisions have already been hived off to private organizations (I am employed by one on a casual basis). Dental care is overwhelmingly private now. Virgin Healthcare and Assura are positioning themselves to take over GP care from the state.

It's not a matter of the government simply saying one day 'the NHS is through'. As you correctly say, this would cause an outcry. It is happening incrementally, not through one piece of legislation but through a gradual shift in how the service is funded.

[Singh.Simran]

It is impossible for the NHS to 'turn a profit' as it is funded by the taxpayer; do you mean that it will come in under budget?

It's perfectly possible; taken as a closed system it surely can make a "profit" insofar as that means anything in any system. But yes, under budget. To the tune of a relatively minimal half billion or something i thought?

[ben_]

I must admit that I don't know whether the NHS will come in under budget, it wouldn't surprise me at all. Speaking in general terms though this could easily be construed by politicians as a reason for why the NHS 'should' get less money, not more.