Live Labour broadcast on the future of the NHS

[exiledinboro]

Nano, what Labour are suggesting from why I can understand is privatising services in the same way the Andrew Landley act was used

So that means Labour will have to introduce legislation to force NHS services to bid for the running of a service. An example will be MSK/physiotherapy, podiatry, or rheumatology. Or whatever the service is

So the local teesside integrated care system will be forced to put out the services for tender and the NHS will be bidding against private contractors. And you can put in a lower bid, but there's a clinical shortage which this whole discussion misses the point of. How is the serial health team working on private and not NHS contracts give people a better service. You're transferring the staff to a different contract and you haven't fixed the retention and staffing crisis

*Integrated care systems is the local region such as Teesside where decisions at local level are decided

*services are the specific speciality of care: Rheumatology/Orthopaedic which will be likely be team's such as foot and ankle, spinal, elbow and wrist, hip etc

 

[exiledinboro]

but moving nurses into the private sector is not what Nano was proposing. Nano specified non-clinical, by that it's all the ancillary stuff that an org needs, but not anything to do with the end purpose of the NHS, looking after patients and making them better. Back office stuff, infrastructure projects, cleaning and catering services, things that are not core business could all be done better and cheaper. But I don't think Nano is advocating moving a single nurse out to the private sector.

Which is what is already happening now so how have you improved patient care?

It's tinkering around the edges when you need to fill the vacancies

 

[BoroMart]

Which is what is already happening now so how have you improved patient care?

It's tinkering around the edges when you need to fill the vacancies

It's not, if you read the rest of my post I talk about how people have been disincentivized from joining. The government strategy was to break it. I suggest we stop breaking it, make it a worthwhile career again, get the vacancies filled.

 

[exiledinboro]

It's not, if you read the rest of my post I talk about how people have been disincentivized from joining. The government strategy was to break it. I suggest we stop breaking it, make it a worthwhile career again, get the vacancies filled.

I agree. The Tories really have made a mess and I blame Cameron more than any other leader

Worst prime minister in my lifetime

 

[BlindBoyGrunt]

There is little hope. When senior labour figures are financed by private healthcare companies and when the Labour party are urging the Tories to use the private sector more for NHS patients, there is little hope.

 

[Corcaigh_the_Cat]

I don't disagree but it's simply not the case of private being bad. There are some things that don't need to be NHS and can be run more efficiently by a private company. It wouldn't make sense to have the NHS making its own version of Microsoft Office so we use that and pay the licence. We don't build our own buildings, we don't deliver our own mail etc. What is required to be a NHS run service and what isn't is often blurred by what has been done historically. There are companies with radiology equipment that the NHS doesn't have that can do those scans that the NHS can't. Does it make more sense to spend the fee for them to do it or to train staff, but equipment and do it in the NHS (even if it is the same cost). That money can be better spent elsewhere.


That's only one side of the coin. If every NHS service that didn't make a profit handed back the contract there would be no more services running. Pretty much every hospital is operating at a significant loss. Services can not survive if they only received the tariff. We talk all the time about an under funded NHS and this is one of the consequences. The difference is that if the private company says they don't want to run a service anymore then the NHS has to take it back on and carry that loss. The services that are being run well privately you don't even notice and they aren't coming back.

I'm not saying private is bad but private = money to shareholders rather than staff.

'Pretty much every hospital is running at a loss'?

 

[Nano]

I'm not saying private is bad but private = money to shareholders rather than staff.

'Pretty much every hospital is running at a loss'?

Yes, massive loss. Hospitals get paid for the activity they do via a tariff. That tariff is nowhere near enough to cover the costs. There are hundreds of schemes running to make up the difference such as joint ventures with councils and local authorities, bonuses from central NHS for meeting certain activity targets, block contracts etc but nobody is getting anywhere near truly breaking even. Trusts aren't reporting the massive deficits because of these deals but the underlying deficit aka the true position when using traditional funding mechanisms are massive. If a specific service was contracted to a private company they wouldn't be getting those deals, they'd have to hit their contract or they don't get paid so that is why they are failing and handing them back.

 

[Corcaigh_the_Cat]

Yes, massive loss. Hospitals get paid for the activity they do via a tariff. That tariff is nowhere near enough to cover the costs. There are hundreds of schemes running to make up the difference such as joint ventures with councils and local authorities, bonuses from central NHS for meeting certain activity targets, block contracts etc but nobody is getting anywhere near truly breaking even. Trusts aren't reporting the massive deficits because of these deals but the underlying deficit aka the true position when using traditional funding mechanisms are massive. If a specific service was contracted to a private company they wouldn't be getting those deals, they'd have to hit their contract or they don't get paid so that is why they are failing and handing them back.

And it's all bollox introduced since we became a neo liberal nation, and that's why we're spending billions on managers/accountants.

Get rid of the market when it comes to health care. There's no need. There's a reason the system is as it is now, to make it fail.

You're there to do a job that you have no chance in succeeding with.

 

[equaliser]

There are companies with radiology equipment that the NHS doesn't have that can do those scans that the NHS can't. Does it make more sense to spend the fee for them to do it or to train staff, but equipment and do it in the NHS (even if it is the same cost). That money can be better spent elsewhere.

I'm no expert but I instinctively disagree with this. The Government is the biggest procurer of services there is and can always raise money because it has millions of taxpayers obliged to cough up. As such, the bits of service provision the private sector likes to cherry-pick - such as the MRI scanners owned by Alliance Medical that are popping up in the car parks of hospitals- that offer a 'clean' predictable profit (as opposed to say, social care) should be those bits that stay in-house - exactly the kind of large infrastructure investment we should be making. Every time a doctor sends a patient for an MRI the private provider probably makes a £200 profit. If we owned the machines, all that stays in house.
Another thing the NHS should own are the buildings. my friend runs a 'therapy centre' in London, housing osteopaths such as herself, massage therapists, counsellors etc. She takes a cut of each booking for providing the room and the visible business space. This kind of local treatment centre seems to be the kind of preventative solution being proposed by Labour - and is clearly the way to go with healthcare. For me, the NHS should be the landlord here. Therapists come and go, operating as private contractors, with low costs, and local cooperatives of therapists, or small private firms, should be servicing the bookings, precluding the need for long-term staff contracts, but also locking out extractive big business. In order to retain 'staff' however, qualified people would be guaranteed a salary 'floor' by a local procurement board that audited local provision. So a physio, say, would have their basic NHS rolling 'contract', that essentially paid their mortgage, and could take on private work according to demand/life choice. This eliminates the need for a lot of large-scale centralised bureaucracy and pay settlements.
But what do I know?

 

[Laughing]

but moving nurses into the private sector is not what Nano was proposing. Nano specified non-clinical, by that it's all the ancillary stuff that an org needs, but not anything to do with the end purpose of the NHS, looking after patients and making them better. Back office stuff, infrastructure projects, cleaning and catering services, things that are not core business could all be done better and cheaper. But I don't think Nano is advocating moving a single nurse out to the private sector.

The government needs to make the sector a better proposition for people to join....but lets be honest it isn't by accident that it has become an Industry where we don't have enough skilled people to fill the role. It was Tory ideology to stop people working in the NHS, disincentivize them, so that it broke.

I do wonder if, in the short term some of the folks who have left could be tempted back to a well funded, well run NHS.

With the waiting lists we have, outsourcing may be the only option available to save lives. Like most I wouldn't want that as a standard operating model but if you are waiting for cancer treatment or a heart operation I don't suppose you care too much about how it's funded and who profits from it.

 

[Andy_W]

Without watching the video but being part of a finance team in the NHS I have experience if privatisation of services. My view is that at times it makes sense. We don't need NHS employees in every hospital doing routine tasks like processing invoices so having a single, central company don't that makes sense. That company being private or NHS run doesn't make much difference. It's probably cheaper private because staff will get paid less and they won't have the NHS benefits like pension and sick pay etc. Whether that is a good or bad thing is up to you.

When it comes to clinical services it is a bit different. An NHS service will tender based on the cost of delivering the service. A private company will tender based on a price they will accept. It could cost more to do it privately but they will accept a loss because they know that once the NHS service is gone then it being recommissioned will never happen so they can then bump up their prices and there is no competition.

Other times a private service like opthalmology already has some specialist equipment that the NHS doesn't. It makes sense for them to run the service because the cost is much lower than being the NHS service to also buy the equipment.

There is obviously the huge issue about profits being taken out instead of reinvested. The NHS is already running on minimum service provision so if a private company can do it cheaper and pay out dividends then they must be cutting corners.

I'm summary, some privatisation is good, others are bad. Too much nuance to definitively say which ones and impossible to do it without some privatisation.

Great post, agree with all of this, and not watched this through either yet.

The only thing I would say is that private companies could maybe improve efficiency in some areas, this is just what private companies do. They pay a heavy price to have the best people running them and have no budget constraints for that, but ultimately they do better for it.

Paying out dividends isn't a crime, and it's also not that difficult when dealing with such large sums of money. It's not like they're going to be making 20-50% profit overall etc, it will probably be more like 1-5%, basically like how private contracts run on highways etc, I expect (which are 1-2%).

There would be private companies tendering against each other too, probably 5 of them I expect, or a minimum of three, and probably doing it on a lump sum contract including the 1-2% or a cost plus 1-2% etc? Then see how this compares with the NHS.

We will have to bump up funding for all of this though, as 15 years of Tory underfunding and under-recruitment is where the problems have been caused, not necessarily from private aspects running some parts.

The key to privatisation (or any privately run contract) is how it's managed, how the contracts are worded and how well the client ultimately does its job (the government), and with what intentions. Obviously, I'm putting trust in Labour to do this in a more care-oriented way, rather than the Tory way of shuffling money out the back door to their mates.

The NHS probably doesn't even have the staff, the capacity or the equipment to catch the waiting lists up, and these things take a long time to build back up.

People need to understand that we're not going to get out of 15 years of Tory rule for free, and it's certainly not going to be instantaneous. There's a lot of rewinding to do.

 

[Corcaigh_the_Cat]

The money spent on right wing propaganda hasn't been wasted.

 

[Scrote]

The only thing I would say is that private companies could maybe improve efficiency in some areas, this is just what private companies do. They pay a heavy price to have the best people running them and have no budget constraints for that, but ultimately they do better for it.

Paying out dividends isn't a crime, and it's also not that difficult when dealing with such large sums of money. It's not like they're going to be making 20-50% profit overall etc, it will probably be more like 1-5%, basically like how private contracts run on highways etc, I expect (which are 1-2%).

Where has private ever improved efficiency in non-profit services?

You can make an argument for privatisation of something like Gas (or even Water) because there is a bunch of infrastructure and 'manufacturing' that could, theoretically, add enough value to make it worthwhile (not that it ever happened that way).

There is no profit in something that, by it's nature, is just a money sink.

Capitalism (and the private sector) relies on the addition of value when something moves from state_1 to state_2. As a simple example, you can dig up some rocks, smelt them, work with the metal and produce nice things (or weapons). Each state has more value than previously.

A heart operation, for instance, has no intrinsic added value. You start with an ailing person and you (hopefully) end up with a working person. Unless you then indenture the ex-patient into service, there is no additional value created by the process directly. The 'value' is more social. Having more fit people improves the economy (at a basic level).

The only way to give medical treatments value is to either subsidise from government or use an insurance model that allows providers to charge people out of healthcare if they are too high-risk.

The NHS exists to remove the profit aspect that meant people had to decide between their health and e.g. feeding the kids.

The starting point for any discussions MUST be 100% free at point of use universal healthcare provided in a timely manner. Anything else is a failure.

That doesn't prevent private practice existing on top but it can't be at the expense of the NHS.

 

[exiledinboro]

First off government spending isn't like household spending and it's not based on taxes and I don't know why Labour have cornered themselves into this trap that they now argue they will make things better but won't borrow money or raise taxes. There argument yesterday is a classic example where AI will save money. That's where they are and that's the level of answers to the NHS crisis AI

Not one mention of staff retention

The problem is nobody believes them anymore because on the one hand they're saying things will be better but they won't change anything not even more spending or if they will it's to privatise the services more. Nobody believes that will make the NHS any better.

You can't run the NHS on the cheap. Have a look at how many NHS jobs and health service jobs are

On indeed there is currently 300 NHS jobs for a 15 mile radius of Middlesbrough for general Healthcare there's almost 1000 jobs advertised

How will shifting contracts to private companies make that any better?

And one classic example of lying is when a politician says they need to use the public sector more which means more privatisation but then don't acknowledge there is no private sector space

 

[BoroMart]

.

The problem is nobody believes them anymore because on the one hand they're saying things will be better but they won't change anything not even more spending or if they will it's to privatise the services more. Nobody believes that will make the NHS any better.

Of course there is a plan to spend on the NHS

 

[Nano]

.

Of course there is a plan to spend on the NHS View attachment 58241

There is still no mention of the biggest issue which is increasing the pay of existing staff. The biggest reason we have so many issues is that retention is dreadful and that is because of two things (which can both be fixed with one thing). 1. Pay isn't high enough. 2. Conditions aren't good enough.

The reason conditions are so poor is because they can't keep hold of staff so people are not only doing a job that doesn't pay very well but they are doing it while covering somebody else's job at the same time so they are being overworked on top of being overworked which makes the pay seem even less.

If we increased the salaries significantly then people would come back to the professions, or reduce the amount of people leaving at least, which would ease the burden on staff and make their pay feel worth it. Budgets will be better because instead of spending 1.5x budget on an agency role they can spend 1x budget on substantives. Another benefit is that it can be done instantly. The list above is needed but doubling the number of medical school places won't see an additional doctor into the service for 5 years.

 

[BoroMart]

There is still no mention of the biggest issue which is increasing the pay of existing staff. The biggest reason we have so many issues is that retention is dreadful and that is because of two things (which can both be fixed with one thing). 1. Pay isn't high enough. 2. Conditions aren't good enough.

agreed. It's an absolute basketcase of an economy they will inherit though. So many issues to fix, so little growth to do it with. Good prioritisation and at least 2 terms in office is required to get the country and all the key services up off it's knees

 

[Andy_W]

Where has private ever improved efficiency in non-profit services?

You can make an argument for privatisation of something like Gas (or even Water) because there is a bunch of infrastructure and 'manufacturing' that could, theoretically, add enough value to make it worthwhile (not that it ever happened that way).

There is no profit in something that, by it's nature, is just a money sink.

Capitalism (and the private sector) relies on the addition of value when something moves from state_1 to state_2. As a simple example, you can dig up some rocks, smelt them, work with the metal and produce nice things (or weapons). Each state has more value than previously.

A heart operation, for instance, has no intrinsic added value. You start with an ailing person and you (hopefully) end up with a working person. Unless you then indenture the ex-patient into service, there is no additional value created by the process directly. The 'value' is more social. Having more fit people improves the economy (at a basic level).

The only way to give medical treatments value is to either subsidise from government or use an insurance model that allows providers to charge people out of healthcare if they are too high-risk.

The NHS exists to remove the profit aspect that meant people had to decide between their health and e.g. feeding the kids.

The starting point for any discussions MUST be 100% free at point of use universal healthcare provided in a timely manner. Anything else is a failure.

That doesn't prevent private practice existing on top but it can't be at the expense of the NHS.

It doesn't need to be non-profit to actually work on budget (the right budget) and with the right amount of manpower. The main problem it seems to have recently had is that the client underbudgeted it, let manpower go, and didn't replace them. There are literally thousands of companies which have had takeovers or been split up in order to succeed.

The key problem is who the client is, if it's run/ funded by Tories, then Tories are going to Tory, but Labour may be able to manage it ok, better than actually managing it and doing it. The problem is of course if and when the Tories get back into power, they'll wreck it that way, like how they wrecked it in private hands for the last 13 years.

The problem with gas and water was that who we sold it to was basically the new client, there wasn't much other control over them, other than through regulation and as always, adding on regulation adds on cost, which then of course gets passed on to us lot.

I wouldn't want the funding to be taken away, as with that we lose control, so we need to continue with the tax-based way, so it's 100% free for everyone.

Agree on the capitalism thing, but you can also do better by improving efficiency. You can treat people better or treat more people by managing better. Put the risk of managing it better on the contractors, for the same target price.

The value of a heart operation is that if you can do 10, instead of 9, then another person lives.

I'm 100% against not charging for use of the NHS, where people are using the right service. But to be honest, if people were using the wrong service then I think a small means-tested charge could be applied. There's a lot of time wasted in A&E and Doctors, by people who don't need to be there, from what my friends in A&E say, as well as a receptionist I know well in my doctors. Whether this could be made better through education, or even additional services or both, who knows.

I think some aspects could be run privately and run well, maybe more the niche aspects, or aspects where there could be a lot of competition so we can get good value.

 

[Andy_W]

There is still no mention of the biggest issue which is increasing the pay of existing staff. The biggest reason we have so many issues is that retention is dreadful and that is because of two things (which can both be fixed with one thing). 1. Pay isn't high enough. 2. Conditions aren't good enough.

The reason conditions are so poor is because they can't keep hold of staff so people are not only doing a job that doesn't pay very well but they are doing it while covering somebody else's job at the same time so they are being overworked on top of being overworked which makes the pay seem even less.

If we increased the salaries significantly then people would come back to the professions, or reduce the amount of people leaving at least, which would ease the burden on staff and make their pay feel worth it. Budgets will be better because instead of spending 1.5x budget on an agency role they can spend 1x budget on substantives. Another benefit is that it can be done instantly. The list above is needed but doubling the number of medical school places won't see an additional doctor into the service for 5 years.

Absolutely.

They should have had their pay kept in line with inflation for most of the time since the Tories came in, and they should have went on strike a long time ago to force that too. I don't blame the staff for not striking earlier though, but why didn't those running the unions act on this?

Same applies with having 5 staff doing the job of 8 or whatever, they should have had a bonus paid to cover this workload/ stress as the budget should be there to pay them, if there's a vacancy there. Loads of them work extra, above and beyond, this should be compensated until the NHS gets to a level where each workers workload is "normal".

The staff have just been shafted in two ways from 2010-2020, pay and workload, then add covid on and it took the **** even further, they should have got another bonus for that too.

I don't think keeping up with current inflation is realistic mind, not short-term anyway, but that's the same for any job I suppose. As much as I hate to say it, everyone's going to have to share (a fair share, unlike now) the price of the load caused by Brexit, Pandemic, War inflation etc, but the NHS staff should at the very least have had their pay backdated to get them into line with where they should have been pre-2020.

 

[Colin Warnek]

Without watching the video but being part of a finance team in the NHS I have experience if privatisation of services. My view is that at times it makes sense. We don't need NHS employees in every hospital doing routine tasks like processing invoices so having a single, central company don't that makes sense. That company being private or NHS run doesn't make much difference. It's probably cheaper private because staff will get paid less and they won't have the NHS benefits like pension and sick pay etc. Whether that is a good or bad thing is up to you.

When it comes to clinical services it is a bit different. An NHS service will tender based on the cost of delivering the service. A private company will tender based on a price they will accept. It could cost more to do it privately but they will accept a loss because they know that once the NHS service is gone then it being recommissioned will never happen so they can then bump up their prices and there is no competition.

Other times a private service like opthalmology already has some specialist equipment that the NHS doesn't. It makes sense for them to run the service because the cost is much lower than being the NHS service to also buy the equipment.

There is obviously the huge issue about profits being taken out instead of reinvested. The NHS is already running on minimum service provision so if a private company can do it cheaper and pay out dividends then they must be cutting corners.

I'm summary, some privatisation is good, others are bad. Too much nuance to definitively say which ones and impossible to do it without some privatisation.

This is the sensible answer., unfortunately too many just use the NHS as a political football and think it should all be public or we’ll end up like the US