NHS 101 please!

[NorthernLight]

Okay, here is an example: An hearing test at St Helier's Hospital in Carshalton. Simple stuff. Waiting list 565 days. Almost 2 years!

I said "failing to cope on a large scale."
Individual, anecdotal failings don't fall into that category.

You have claimed that the NHS cannot cope. The fact that some things are better than others simply indicates that a service with limited resources has to prioritize some things over others. In a Nationalized Health Service, these priorities are decided either at local health authority level or set centrally by elected governments. It is the best system we have.

There may be an argument for local agreements where the NHS contracts out simple procedures for a fixed fee, but unfortunately this tends to lead to training opportunities for students like me to become more limited. The private sector, you see, has neither the desire nor the responsibility to train the next generation of doctors. Not only that, but these private contractors then don't have the responsibility to sort out the follow-up for any people who have problems, side effects or other problems arising from their treatment.
It's a false economy in my opinion.

[ben_]

Saying that you end up paying 7 times more is misleading and scaremongering if you don't put this figure in perspective.

Of course you will end up paying more, like for any mortgage. When you buy a house at normal interest rates you probably pay twice what you would have paid if you;d bought it cash. Official statistics show that the cost of PFI is 30% more than what it would have been if publicly funded. Still more money than would normally be spent, but with some added benefits.

Where some Trusts went wrong with PFI is that some of them had to borrow money to make the first repayments. And we all know what happens when you borrow money to repay existing debts. It's called the credit crunch. But that is not the case for everyone.

Could you perhaps explain what the 'added benefits' are of paying a private company for something which by your own admission they will provide more expensively than the state sector, and which (having paid them) the state will not even own?

[ben_]

Of course, at least one of those 'added benefits' will be that the PFI consortium makes a profit. As a private organization with shareholders, they are legally bound to attempt to do this. This means that taxpayer's money goes directly to improving the bottom line for these companies. This is not the free market (which works well, for most things); it is state-sponsored corporatism.

[ben_]

OK I hear you but you must ensure that you think with your head rather than your heart (and remain critical about what you read in the papers). Here are several reasons why it is not necessarily a bad thing and why, in fact, may emergency doctors are in favour of the centralisation of A&E services. Consider them as a package rather than individually...

The fact is that while cutting corners to improve profits (which is what the closure of A&E is - an entirely logical choice for a rational private organization seeking to maximise its shareholder returns) may not always lead to disastrous medical outcomes, this is pure coincidence and cannot be relied upon. It bears repeating: any private company is going to take the necessary steps to gain the best returns on investment. This is extremely likely to sometimes conflict with what is best for the patient.

There is no necessary relationship between the profits of the company and the provision of patient-oriented healthcare - especially when (as in PFI) the company is operating a state-sponsored monopoly and therefore lacks effective competitors.

[Arch_Angel]

That's right. It's not like borrowing money from a bank, because at the end you own the house. The government is renting these hospitals at a much higher cost than buying them. Renting makes sense if you're moving on soon or can't afford to buy, but when you can afford to buy and you sign a contract for 25 years lease....you're a moron.

It's nothing more than giving taxpayer money directly to share holders.

[art-of-the-table]

That's right. There is always a danger that things won;t work out and that costs will spiral. There is also another more perverse disadvantage to PFI. We all know from previous discussions that PFI has higher costs and that they are fixed. So, lets imagine that the PFI runs a debt. The PCT will need to ensure that they don;'t go out of business so they will force business their way to keep them afloat. And that business will come from cuts at local NHS hospitals so that the patients can be dealt with by the PFI hospital. So a PFI is acting like a big sponge and may lead to cuts in nearby NHS hospitals

[jcarver1]

With the possible flaw that this is probably not very helpful for the original poster trying to find out "NHS 101", this is the most interesting thread.


What I dont quite understand is the role of a PFI. From earlier posts I got the notion it was a private company entrusted with managment duties etc Non-immidiate patient care. From the post above it sounds like PFIs actually treat patients. Are Private Funding Initiatives just privatised hospitals?

In terms of closing down localised care to create more substantial hospitals, is this not already happening with foundation hospitals? Personally I can only see it being beneficial to long terms patients who spend alot of time in hospitals and require a multitude of services. Most people will probably just find its extra hassle to have a local hospital further away. (hassle which ill people can do without)

[art-of-the-table]

What I dont quite understand is the role of a PFI. From earlier posts I got the notion it was a private company entrusted with managment duties etc Non-immidiate patient care. From the post above it sounds like PFIs actually treat patients. Are Private Funding Initiatives just privatised hospitals?

The difference is as follows;
Foundation trusts are trusts which have gained independence from the NHS. They are not private because they in fact belong to the local community (i.e. they have patient representatives on their Board etc) They are simply ex-NHS hospitals that have demonstrated that they could be trusted with patient care and with the management of their finances. There is a target for all NHS trusts to eventually become foundation trusts and start working independently. There are many differences between NHS and foundation trusts but the main ones are that:
1 - Foundation trusts are more financially independent and can in fact sell assets and land. They can also borrow money (which an NHS hospital cannot do)
2 - Foundation trusts have an obligation to provide certain protected services (e.g. obstetrics, A&E, etc) but for some less "important" services they can be more flexible. So for example, a foundation trust might decide that a service which is not profitable can be scrapped (for example because there are only a handful of patients in the area who need it and therefore do not justify a full service) or on the other hand, they may have determined that there is a specific need for a service and they can then set it up without having to beg the government for money.
3 - Foundation trusts fall under a different governance regime. They do not answer to the department of health but some other body.

So essentially, you can consider that foundation hospitals are NHS trusts who now operate as private businesses, even though their ownership is not private.

PFI is imply a financial tool which enable anyone (and by that I mean that it is not just in medicine) to borrow money from the private sector. SO for example, if I want to build a new hospital and it si going to cost £30bn then no one except the government or the private sector will have that kind of money. So, a trust will go to the private sector to obtain what is essentially a mortgage. There are advantages such as the fact that the financial risk is taken away from the NHS and placed upoin the private sector, the fact that maintenance of the infrastructure is the responsibility of the private owner of the building, but obviously there is an interest rate attached to this, which can place a burden on the system. Only foundation trusts can really ask for PFI, though they don't have to if they prefer to finance their operations in different ways, which is why PFI and foundation trusts are often confused.

PFI is a system, not an institution. It only impacts on patient care to the extent that it places a financial burden on the trust, who might struggle to then provide the services it should provide.

I hope this answers your question.

[jcarver1]

It does Thanks!

[art-of-the-table]

That's right. It's not like borrowing money from a bank, because at the end you own the house.

It's nothing more than giving taxpayer money directly to share holders.

That is not correct. It is only true if you are buying a freehold property, otherwise, with a leasehold (i.e. for flats for example) you don't actually own the house, you are buying a long-term lease of 99 years or so. PFI is mostly about cashflow. The major problem for any entity who wants to survive is the availability of cash. The NHS budget is 100bn. A new hospital can cost £35bn. Building a new hospital would take out 1/3 of the NHS budget. That is why the government is borrowing, that is why you take out a mortgage which is effectively a long lease. Another of its advantages is building maintenance. A PFI is miore likely to be state of the art than an NHS hospital built on the cheap. So the perception that a PFI hospital is more expensive is also linked to the fact that there are less false economies.

Now of courses PFI has major disadvantages which you all mentioned in one way or another, that is undeniable. But it does provide more freedom too. The question (difficult to answer) is where the balance lies between risks and benefits and this, we won;t know until much later.