NHS 101 please!

[art-of-the-table]

Private provision will inevitably disadvantage the poor.

I think you are confusing two things here.

1 - THE PRIVATE sector i.e. patients who have to pay themselves to see doctors, i.e. like the private UK sector such as BUPA in the UK, or the US system. You are correct that it acts against the poor.

2 - NHS care being run by private companies but paid for by the NHS i.e. tax money. Here the patient still gets the care for free but the provision of the care falls to the private sector. So the principles of the NHS remain i.e, free care for all etc. But the NHS delegates responsibility for running the system to others.

[ben_]

Your #2 is the PFI model. Thus far, it has turned out to be something of a disaster. Why? Because the incentivization you have just described as the key benefit of private care is removed completely. The state pays corporations because it has the misguided belief that corporations are automatically more efficient - forgetting that the efficiency motive is directly linked to the profit motive. The corporation's profit is secured - the state will pay anyway. Why bother providing a quality, efficient service?

This system is the profiteering of the private sector combined with the inefficiency of the public sector. It is the absolute worst of both worlds.

[art-of-the-table]

Your #2 is the PFI model. Thus far, it has turned out to be something of a disaster. Why? Because the incentivization you have just described as the key benefit of private care is removed completely. The state pays corporations because it has the misguided belief that corporations are automatically more efficient - forgetting that the efficiency motive is directly linked to the profit motive. The corporation's profit is secured - the state will pay anyway. Why bother providing a quality, efficient service?

This system is the profiteering of the private sector combined with the inefficiency of the public sector. It is the absolute worst of both worlds.

This is not necessarily true.
Firstly, it is a lot more than PFI. PFI (Private Finance Initiative) is exactly what it says on the tin. A Private finance. I.e. an opportunity to borrow money to achieve greater projects (such as the building of new hospitals) THis is private money financing hospitals, nothing to do with privatised care. The only reason they are proving a problem is that essentially they are mortgages and when you take a mortgage for £21bn then obviously you need to ensure that you get enough money to pay it back.

Privatised care is different and relates to private companies seeing patients on behalf of the NHS. They are not guarantees a profit at all. Under the new system, the NHS pays a fixed amount for a particular procedure (so for example, if you want a catarac operation, the NHS will pay the care provider £500). If you work for an inefficient hospital you may actually spend £550 and lose £50 for every operation you do(which the NHS then needs to pay more money for). So the actiual cost is £550. What the government is saying is that by introducing the private sector, they will be able to do it for £475 and make a £25 profit for each operation. The cost is capped at £500 full stop. THerefore this lead to money savings.

Ultimately it is not necessarily true that profits lead to poor care PROVIDED the right system of checks is in place. One also need to keep in perspective the need not only to provide the best possible care, but to do so within the limits of the budget available. Where is the priority? To have the best care but then pay 80% tax? Or to compromise and settle on a more affordable tax rate? This is precisely where the different political parties differ.

If you want efficiency, there is no doubt that the state can't provide it (they can't even control their own ministries!) so there is a need for more stringent ways of working such as the private sector. On the other hand of the spectrum, as you say, there is a risk that quality suffers in the quest for profit. But then again, quality suffered under the NHS too, through inefficiency, lack of motivation of poorly paid staff etc. So I guess that the stance the government is taking is that the risks of introducing the private sector cannot be as bad as the problems the NHS was facing before by trying to handle everything by itself.

[Singh.Simran]

As far as i have seen the private sector in no way has proved inself in the NHS (as PFP, PPI, privatisation and subcontracting, etc) except as money-grabbing and incompetant.

I think the most obvious vindication is that pretty much every study and metric says standard of care here and in other public health systems (cuba, anyone?) is as good if not better than in private, competitive health systems, at a far lesser cost to the user.

[jcarver1]

So, to clarify; Art-of-the-table, You argue that the State employed managers of the NHS have become complacent and waste money. Therefore, you should allow Private companies to manage it instead beacuse they have a financial incentive to cut out beurocracy and inefficiency because otherwise they will not make a profit.

The problemn here, I think, is that the Private companies will have a greater allegience to money than to the quality of care. The only possible reason a company would be involved is for the money, its hardly going to do it out of the goodness of their hearts. When quality of care and potential profit starts to conflict, as it inevitably will, quality of care will be the losing party.
Is there really SO much money wasted that there is enough to not only profit a private company but also reduce govenment spending?

I also fundementally disagree with giving out tax money to profit private companies is general (even though it is rife elsewhere). Is it really the sad truth that without financial incentive, institutions become completely inept?

[NorthernLight]

If you want efficiency, there is no doubt that the state can't provide it

Gross generalisation which you back up with no evidence. There will always be problems with inefficiency in any organisation as large as the NHS - the cost of controlling everything to the nth degree would more than wipe out any saving made.

And as for the idea that private companies are inherently efficient because they are private, I give you :
Privatised Railways.
Privatised Water companies.
Er, all the banks which the govt just had to bail out because of their horrendous incompetence at lending out money they didn't have to people they weren't sure would be able to pay it back.

Pound for pound, I think the NHS compares pretty well with any other system in the world for quality and level of care given for the amount we spend on it. You can fiddle around the edges perhaps and improve things here and there but to say that a free NHS has "failed" is to contradict the evidence around us every day.

[Arch_Angel]

This is not necessarily true.
Firstly, it is a lot more than PFI. PFI (Private Finance Initiative) is exactly what it says on the tin. A Private finance. I.e. an opportunity to borrow money to achieve greater projects (such as the building of new hospitals) THis is private money financing hospitals, nothing to do with privatised care. The only reason they are proving a problem is that essentially they are mortgages and when you take a mortgage for £21bn then obviously you need to ensure that you get enough money to pay it back.

Pound for pound the taxpayer pays back seven times what it would cost the government if they paid for it upfront. The financial power governments are supposed to hold should make it so such things aren't necessary, and they aren't, but without spending too much the government is delivering new hospitals for us now but selling us short in the long term massively.

It's an insane waste of money...

I doubt you could ever argue to anyone that's not a CEO of a PFI that it's a good idea.....

It is privatisation of the buildings (not actually of healthcare) but a central part of the NHS -> Private argument.

[BeanOfJelly]

pharmaceutical companies are all the evidence you need to see the effects of prioritising profit over patient care. A private sector will ALWAYS prioritise its own financial interests. I don't have a problem with private healthcare existing, as long as it keeps its dirty paws off our beloved NHS.

[art-of-the-table]

Ok guys. So what is the solution?

You can argue to death that the Private Sector is a load of tosh but no one can dispute that the NHS has not been able to cope.

In this case, no solution is good. So what is the answer?

jcarver - my approach was not that we should blindly delegate to the private sector, but that if done in the right way then it can be beneficial. I think it IS the sad truth that without financial incentive nothing gets done. The NHS tried this and failed miserably with it, leading to massive waiting lists.

northern light - Don;t lecture me on generalisation when the rest of your message is full of generalisations. The issue of the banks has nothing to do with all this (though I accept your argument on privatised utilities). The banks were simply not controlled. Hence why I was arguing for a controled private sector.

Arch-angel - Well done for understanding the principle of mortgaging. Of course you pay more, in the same way that you pay more for your house when you take a mortgage. But you have the ability to use the facilities straight away. Of course you could pay upfront, but you need to find the money for that (though, to counter this argument, one has to wonder why we didn't use the money spent in Iraq or to rescue the banks on the NHS in the first place.

[BeanOfJelly]

What do you mean the NHS has failed to cope? Its not perfect but we have one of the best healthcare systems in the world. Compare yourself to an American/Australian without insurance. Compare yourself to someone who can't afford cancer treatment, or can't afford to vaccinate their children, or doesn't go to the doctor when they need to because they're worried about the cost. These people exist, they live in countries where there isn't a public health service