Lewes Forum thread

Go on, tell 'em what you think

Lewes Forum New message

It's started.

On 17 Jan 2011 at 6:22pm Red Ken wrote:
The Tory destruction of the NHS. Whatever you do over the course of this governments tenure don't get ill or old.
On 17 Jan 2011 at 7:14pm Clifford wrote:
Unfortunately you're right, Red Ken. We're seeing the winding down of everything or parents and grandparents managed to gain for us. And I'm afraid most people won't realise until it's too late. Thatcher was just a beginning - this lot are here to finish the job.
On 17 Jan 2011 at 7:36pm 'ere be monsters wrote:
You're right, even though it is too inefficient and corrupt to save anyway.
On 17 Jan 2011 at 7:37pm SHS wrote:
The removal of waste, actually. Incredibly, front-line services can remain, even be vastly improved and availability widened, whilst simultaneously costs are cut. One sticking point may be the refusal of some public bodies to lay-off unnecessary jobsworths, recruited in vast swathes whilst the private sector was cutting back during the recession.
On 17 Jan 2011 at 8:52pm Newmania wrote:
At a time when the country is trying to recover from New Labour`s years of reckless squander the Conservative Party undertook to ring fence the NHS. Many of us thought this was a bizarre step and as I see the little " World owes me a living ", brigade are whining anyway I wonder why we are not cutting back.
There has been little improvment for the endless cash thrown at this behemoth , except the the standard of living enjoyed by Doctors
On 17 Jan 2011 at 8:58pm Matt Kent wrote:
It certainly has started. But will it ever end?!
Do you reckon Doctors have got enough time to run Health Authorities? They haven't got enough time and resource to treat people properly, let alone decide the future of NHS services. The patient is rarely considered when such changes are proposed. Its wrong, and the NHS is at tipping point before any of this.
On 17 Jan 2011 at 9:06pm Matt Kent wrote:
Newmania, the Tories promised to keep the NHS budget in line with inflation, and with the cost of fuel and goods on considerable increase, budgets for the NHS are effectively on the decline. So inevitably the NHS will shrink and front line staff will have to be lost, over and above the culling of middle management.
I also suppose with Lewes being the administrative centre of a PCT, you also look forward to the increase of unemployment in this town and region. Not to worry eh, I'm sure the private sector 'white knight' will sweep them off their feet!
On 17 Jan 2011 at 10:53pm Brixtonbelle wrote:
So what happens if your doctor is bad at managing budgets and messes up their accounts, losing money. Who is accountable ? And do patients still get their care ?
All those working for PCT's will end up doing very similar jobs for less money on the private sector, as the work is contracted out by GP'S to the lowest bidder. And
TAXPAYERS MONEY will go on making sure shareholders in private companies (prpbably in the States) running GP services get their dividend as the NHS becomes yet another way to make profits.
Show me the evidence that doctors running the NHS will be any better than the PCT's ? It will lead to wide disparities in quality of healthcare across the country, and will also lead to losses of small local hospitals which will be more expensive to run than larger anonymous monolithic institutions.

It's the end of free healthcare, cradle to grave. Very sad and unbelievable really.
On 17 Jan 2011 at 11:30pm Clifford wrote:
Yes, the main thing will be to ensure the shareholders are looked after - as with the railways where our taxes go as subsidies to the rail companies and through them into the bank accounts of the shareholders as dividends.
On 17 Jan 2011 at 11:32pm Newmania wrote:
Sigh Brixton Belle ....the profit motive delivered us from serfdom. Only under monopoly conditions that super normal profits are available and the biggest monopoly in Europe is the NHS( biggest employer as well). You would expect profiteering then and you would be right. Expenditure (2000-1 to 2009-10)doubled until today the NHS eats up about £100 billion pa . 43% of that additional cash went on increased salaries (15% above National rise rate). There are 84% more managers numbering 44600 on an average of 60,000 each. Productivity has of course fallen. This is service that has become a cash cow to add to its sacre bovinity
This at a time when private sector wages are falling and bureaucratic costs elsewhere have been cut to ribbons by new technology There is only one point to the NHS delivering health. It is not a tattered flag of the post war settlement out for one last wave or a means of providing non jobs and impoverishing the country.If you think it could go on without reform I think you may need a Doctor yourself .
( I `ll bring grapes )
On 18 Jan 2011 at 12:20am Corker wrote:
NHS was developed in a era when appendectonies and amputations were the only form of emergencies.
Throughout the decades (and raidly increased by Blair's Britain). we now have huge numbers of obesity related illnesses and infertile/old women seeking IVF treatment and the system cannot cope (not to mention the number of elected caesarian sections and gastric bands).
The system cannot cope and something needs to be done.
We (as a nation) are no longer able to rely upon the honesty of the British public (who seem to be predisposed to claiming for whatever ailment they can so as to "benefit" themselves with the welfare state).
Bring back workhouses!
On 18 Jan 2011 at 8:34am Annette Curtin-Twitcher wrote:
SHS, wahat is wasteful about doing joint replacements for people with arthritis and so on? They are is among the procedures that 57 NHS trusts will no longer be carrying out because of the cuts (along with hernias and quite a few other painful conditions).
This will mean more people disabled, more people having to give up work because of it, more old people having to go into care homes instead of living independently, more money spent in care home costs and benefits for those who can't work. And a life of pain for very many people, who've paid into the NHS all their lives.

It might present a saving in the NHS budget, but it may well lead to greater expense overall, and to a tremendous amount of suffering.
I suppose I should declare an interest: I have arthritis in hips and knees, have had since I was in my 40s, and am likely to need a replacement or two before very much longer.
On 18 Jan 2011 at 9:12am 'ere be monsters wrote:
Paying consultants £2k a week in overtime is possibly quite a drain on NHS resources. Inefficient and corrupt, but it's what keeps huge parts of the economy going. Especially black parts.
On 18 Jan 2011 at 10:07am Ed Can Do wrote:
EBM, that's racist.

Whilst I am a bit concerned about the potential reduction of services from the NHS, I'm not going to write the whole idea off before it's happened. I think it's actually really refreshing that we have a government who aren't afraid to put through potentially unpopular ideas rather than just pandering to the media to keep popular opinion behind them.

The stagnation across the public sector caused by years of mis-management from an army of largely pointless bureaucrats is a massive drain on our economy and something needed to be done. Labour could never do anything because the Unions would revolt and withdraw their support but now there's actually a chance to re-jig the whole thing properly, not just by chucking more money at it and employing another layer of needless pen-pushers.

Yes, there'll be redundancies but if all these management types are even vaguely competent then they'll find employment elsewhere in the private sector because apparently there's a huge dearth of talent in the country these days because all the kids are too busy getting drunk and stabbing each other to care about furthering themselves. I don't see why everyone automatically assumes that devolving power to GPs means that the first thing they'll do is sack all the nurses and keep the managers in place. That's just ridiculous. Also why is it a bad thing that doctors will be able to choose where to buy their services? Surely the more savings they can make by contracting a private firm, the more money they'll have to provide other services?

I don't doubt that initially there will be a surplus of companies looking to make a quick buck providing "easy", more profitable services but healthcare at that level is not exactly the sort of thing that just anyone can start a business in. I doubt anyone would argue that private hospitals aren't better than NHS ones and some of the reason for that is better investment in training and facilities that the NHS never had the cash for. Now perhaps some of that expertise will be passed on to the rest of us, who knows at this point?

Also, the way market forces work, once all the contracts for easy stuff have been taken on, someone will realise the huge gap in the market for providing more niche services, move into that, make a ton of profit for a couple of years until another big company sees what they're doing and undercuts them, eventually ending up with a cheaper, better service all round.

People these days are so quick to focus on short term difficulties rather than looking at the long term, bigger picture, a symptom I suspect of sensationalist media headlines and a parliamentary system that means any party in power is terrified of enacting any changes that won't produce positive benefits within five years, in time for the next election. It's the same with the NHS reforms as with the cuts as a whole, they'll be hard at first and people might have to shift their expectations in the short term but the long term benefits will hopefully far outweigh the short term misery.

As we're talking medicine, I'd rather have a short, painful treatment and feel better afterwards than suffer a slow, lingering deteriation and eventual death. I do appreciate though that some older members of the community might not see it that way, as they may well not survive long enough to actually reap the benefits of the reforms...
On 18 Jan 2011 at 10:27am 'ere be monsters wrote:
Voting for you next time round Ed, even if you are a winker!!
On 18 Jan 2011 at 11:31am Newmania wrote:
Well there you go some sense from Ed can do it , wonders will never cease , as they say. I think a context is required here . The country cannot afford another doubling of expenditure on the NHS that is quite obvious but the aging population is presenting a larger and larger drain on resources producred by a proportionately smaller Labour force
Older commenters might ask themselves to what extent it is fair for the young and families to keep them in new hips and viagra when such a wrap around services will be long gone by the time we need it . It is quite impossible to fund this position sustainably so there simply has to be some thinking about who gets what and who should be paying now
Frankly the NHS ring fence is yet another demographically driven sop to the all powerful baby boomer lobby .The pig in the pipe and I cannot see that it is fair wyhen welfare , housing , family benefits , education and public order are being hacked to the bone and beyond.
On 18 Jan 2011 at 11:49am Clifford wrote:
'The country can't afford' Newmania? But funny how the country can afford Trident and the cosy little tax-dodging deals between HMRC and the big corporations. It's a matter of priorities and political choices.
On 18 Jan 2011 at 12:24pm 'ere be monsters wrote:
Newmania. Why couldn't you just say you agreed with what Ed can do had to say? That's the problem with your's and most other party driven peoples's politics, slag everyone off even if you agree with them. Pathetic.
On 18 Jan 2011 at 12:38pm Brixtonbelle wrote:
For you newmania - i know you love her columns
For Corker - the NHS has always treated serious ailments - my granny had breast cancer shortly after it started and despite the basic treatment in the 50's (as it was then), she survived another 35 years. Thank you NHS.
For Ed Can Do. I'd like to see private hospitals providing some of the more 'difficult' aspects of NHS care. Like A and E. Funny how none of them provide that aspect of healthcare, why is that ? Thank you NHS for all the time my family has had to use A and E.
I'd personally like to thank the NHS for three operations in the last 5 years, all of them succesful, all of them carried out by excellent surgeons and cared for by fantastic nurses and all, despite waiting lists, carried out within six weeks of seeing a consultant. In all my encounters with helath professionals I've never had anything other than exceptional care and concern and I want to protect that from turning the NHS over to companies whose first concern is PROFIT, not patient outcomes.
On 18 Jan 2011 at 1:08pm Newmania wrote:
BB -I daresay you were still dreaming of dishy NHS Doctors when read that article on the train.
EBM - I did say I agreed old sausage, enjoyed that comment though.
Clifford - the country can afford Newmania, you have no idea how cheap and tatty I am.
On 18 Jan 2011 at 1:20pm 'ere be monsters wrote:
The point was Newmania that you couldn't just agree, you had to chuck in a personal insult.
On 18 Jan 2011 at 1:56pm Clifford wrote:
Come of it Newmania, we've been reading you long enough now to know even more about you than you realise.
BB - the NHS isn't perfect but I'd rather put my life in their hands than in some combination of Virgin and Crapita, which is what we're likely to get if the Tories and their LibDem sidekicks aren't stopped in their tracks.
On 18 Jan 2011 at 2:21pm 'ere be monsters wrote:
Another example of "It's a Tory/Lib idea so it's rubbish" Where were you when Lab were lashing it up Clifford? I'm not sticking up for any of them, none of them are worth sticking up for.
On 18 Jan 2011 at 3:37pm Clifford wrote:
Where was I 'ere be monsters? I was slagging them off for beginning the process of privatisaton. As you rightly say, 'none of them are worth sticking up for'. So don't imagine that I am. The only difference between the parties is the speed at which they do what the bosses want.
On 18 Jan 2011 at 7:39pm 'ere be monsters wrote:
I'm pleased to hear someone else doesn't trust any of them. Sounds like you and me better take over the NHS!! Wonder how long it would take to earn our first million.... doh!!
On 19 Jan 2011 at 8:36am Matt Kent wrote:
Has anyone not learnt from the failings of privatisation of public assets yet? Take cleaning contracts of NHS. In some attempt to save money and offload the burden of front line staff, infection rates soared and quality decreased. The outcome? Cleaning has been brought back in house at some hospitals has greatly improved.
And of energy providers? There is a lack of competition there also. They just hold us to ransom. And the rail industry? As soon as the inflation cap was removed the prices went through the roof. Who benefits? The shareholder and not thr customer!
On 19 Jan 2011 at 9:43am 'ere be monsters wrote:
Buy shares then.
On 19 Jan 2011 at 9:45am Ed Can Do wrote:
The problem is not privatisation itself, it's the way contracts are handed out. Privatising rail transport was never going to lead to actual competition since you can't very well have a load of operators running trains up and down the same line so there's no real competition, other than the choice between catching a bus, train or driving. Likewise with energy, you're still getting the same electricity and gas into your home, you just choose who to pay for it. Like with rail travel there are pretty massive barriers to entry to starting an energy company, primarily the monster amount of capital you need to start up.

With cleaning contracts in the NHS, you had the same bunch of ineffective middle management who are about to be replaced handing out contracts but stupidly focussing on cost over quality of service. Had they actually shopped around a bit rather than just going straight for the first big company to come along and promise huge savings, the problem would not have arisen.

The issue is not giving work to private companies, it's giving control of massive sums of money to people who get into the mentality that it's their money. It's the same throughout the public sector. Departments will spend aas much money as possible for fear that if they underspend then the next year their budget will be reduced. It's absolutely crazy and why nobody has ever thought to introduce some kind of reward for people not spending their whole budget I shall never know. If you don't believe me, just wait until March when we suddenly get hundreds of tv ads from government departments as they desperately try to spend the last of their budget before the year end in April.

Anyway, one would hope that with GPs running things, their focus might be on patient care, rather than just financially motivated. Of course at first they are likely to plump for the cheapest option but surely if that option turns out to be rubbish then a bunch of doctors wouldn't just sit back watching people die for the sake of their budget.

Of course there is a risk with healthcare as there is with energy providers, that the barriers to entry to the market are pretty significant and so the actual choice available to the doctors might be limited to only a few companies. What's important then is for whatever regulatory body is in place to monitor the whole situation is given effective powers to prevent cartels forming and actually, with all the ranting about how this marks a death sentance for free healthcare in this country, nobody has really raised the question of how it's all going to be regulated.

I fear that the biggest risk in the new system is all the MPs who will now go and join the boards of directors of big healthcare companies and use that influence to try and win contracts (Like how they do with the defence companies and IT suppliers). Luckily, with the choices being made by theoretically, politically neutral doctors, that risk is significantly less than when it's civil servants handing out the contracts.

I have no more faith in most politicians than anyone here so I think that any moves to devolve power to people who actually know what they're talking about (In this case doctors) can only be a good thing. If only there was 7 years of study involved in becoming a banker our economy might not be quite as screwed as it is at present!
On 19 Jan 2011 at 10:58am Clifford wrote:
No, the issue with privatisation is that services of this kind should not be given out to businesses whose first interest (indeed, first duty) is to ensure their shareholders are making money. It stands to reason that if there is to be a rake-off for shareholders then something must suffer - and in the case of the NHS it will be patients. You can't blame the managers for taking on the cheapest cleaning contracts when all the pressure was on them to.... take on the cheapest. That is exactly what will happen with treatment - the cheapest and the easiest will dominate. Look at the healthcare available in the US for people who can't afford private insurance.
On 19 Jan 2011 at 1:19pm Matt Kent wrote:
Bingo Clifford. Bingo.
Yep. I slight conflict of interest me thinks.
On 19 Jan 2011 at 1:49pm Matt Kent wrote:
@ Ed Can Do. What authority have OfWat or OfGen or the FSA ever had over failing, low quality money guzzling service providers and banks, for example? Very little. So what next OfDoc? Another pointless Quango with no authority whilst the rest of us wriggle in pain getting C-Diff and low grade medical care. Lets all run the NHS into the ground eh?
On 23 Jan 2011 at 7:49pm Hoodie Hugger wrote:
Clifford, I don't understand why you assume that any company making money is inherently doing a bad job. Logically, it's quite the opposite.
Ed Can Do is totally correct - the problem came about because unaccountable managers were in charge. The doctors, on the other hand, come face to face with the public they serve, so the incentive is there to chose a company that provides value for money. In other words, they'll weigh up the pay-off between higher costs and better service.
On 30 Jan 2011 at 12:31pm Old Cynic wrote:
Right, Im speaking as a former private healthcare employee on a 27 bedded cardiac ward in London and a private mental health hospital in Sussex. You get sub-NHS standard care in a nice room (if you are lucky) for which you (or insurer/funder) pay top dollar - the sole aim is NOT to make you better per se but to screw as much cash out of you as possible and get you out of the door as soon as possible - and if it goes wrong, well, there is a nice complaints system in place but be prepared for your trip to court as there is not much in the way of accountability. If you need fixing after we have botched your bypass, the NHS can mop up the mistakes. Value for money in the private healthcare means simply how cheap can we get that bandage for and how much can we charge the patient after all we have share holders and profits to think about. Thinking the private sector can do healthcare so much better than the NHS is stupid - they've made such as great success of elderly care, mental health haven't they?

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