Healthcare is this what Cameron wants?

[I1L2T3]

Ok, to clarify opposition parties view, Cameron is going to privatise the Nhs. For a peerage.

 

Cameron, not the Tories are privatising the Nhs, with the full support of the lib dems , whose leader is in a constiuency knee deep with the medical profession, and Tory mps who have marginal seats to win/lose. Cameron, whose family has been helped immensly by the Nhs. Cameron who is mega minted anyway is choosing now to privatise the Nhs. Not reform or just run better, privatise.

 

Is that what the opposition is basically saying ?

 

The opposition are not saying that Cameron is privatising the NHS to gain a peerage. No idea why anybody would think that.

[tinfoilhat]

The opposition are not saying that Cameron is privatising the NHS to gain a peerage. No idea why anybody would think that.

 

Well, you are aren't you ? If I've read it wrong, apologies all round.

 

But the word "privatise" isn't mentioned anywhere that I can see in Tory policy. I don't think any government, let alone a coalition government could privatise the Nhs, a year into their term.

[libuse]

I don't believe there is any intention to stop the NHS treating whoever presents no matter what they presnt with. But, I do get a bit tired of the "privatisation of the NHS" rhetoric when a big chunk of the NHS budget, as all public sector organisations, go into the private sector. The loons are getting their knickers all twisted up about privatisation.

 

At the end of the day if the reforms mean patients still get treated and the NHS costs less it's job done for the government. Obviously the vested interests and loony lefties will squeal and squawk uncontrollably.

 

Isn't part of the idea of the reform to get rid of the postcode lotteries whereby some PCTs fund some treatments and others don't despite NICE recommendations?

 

It would be great if the reforms would end the disgrace of the so called postcode lottery, but the evidence, sadly, is to the contrary. As I'm sure you're aware, the iniquities in the current system arise because we have 152 commissioning PCTs, commissioning services and treatment as they view best. There is no evidence that this will improve with the switch to CCGs, of which it is expected there will be more than there are currently PCTs.

 

However, as I'm sure I've said before, unlike the current obligation on PCTs, the CCGs will have no geographical obligation. So, the current system means that a patient in the next town might not get the treatment you get, because their PCT doesn't fund it. In the future, it's likely that a patient in the same town might not get the same treatment as you because their presentation is higher risk or more complex. Unless, of course, they (ahem) top up their fees. As you yourself have already said, in your experience of dealing with clinicians "The idea that they work in the best interests of patients is laughable. I have personal experience of dealing with some of the brightest and best from a number of royal colleges and they always put themselves before all else." so I can't see any safeguards against cherrypicking there.

 

I'd genuinely like to hear your thoughts on the increased bureaucracy arising from the reforms, and the lack of geographical obligation in the bill. I'd certainly prefer that to you simply calling me a "loon"

[I1L2T3]

Well, you are aren't you ? If I've read it wrong, apologies all round.

 

No I'm not. Yes you did read it wrong. Thanks for the apology.

[Jim Graham]

It would be great if the reforms would end the disgrace of the so called postcode lottery, but the evidence, sadly, is to the contrary. As I'm sure you're aware, the iniquities in the current system arise because we have 152 commissioning PCTs, commissioning services and treatment as they view best. There is no evidence that this will improve with the switch to CCGs, of which it is expected there will be more than there are currently PCTs.

 

However, as I'm sure I've said before, unlike the current obligation on PCTs, the CCGs will have no geographical obligation. So, the current system means that a patient in the next town might not get the treatment you get, because their PCT doesn't fund it. In the future, it's likely that a patient in the same town might not get the same treatment as you because their presentation is higher risk or more complex. Unless, of course, they (ahem) top up their fees. As you yourself have already said, in your experience of dealing with clinicians "The idea that they work in the best interests of patients is laughable. I have personal experience of dealing with some of the brightest and best from a number of royal colleges and they always put themselves before all else." so I can't see any safeguards against cherrypicking there.

 

I'd genuinely like to hear your thoughts on the increased bureaucracy arising from the reforms, and the lack of geographical obligation in the bill. I'd certainly prefer that to you simply calling me a "loon"

 

 

 

I can't claim to know the fine print of the reforms but from personal experience doing away with the local PCT's can only be a good thing. In addition to the postcode lottery that the PCT's cause there is an issue with certain areas not being able to attract the best clinicians. I know from personal experience that some health services in Sheffield particularly suffer by not being able to attract good consultants. Obviously London attracts the best people. Sheffield does not. Consequently we get second or third rate care in certain disciplines. At the moment we have to accept what is on offer from our local PCT.

 

The management of PCTs is patchy at best. I hope by doing away with them GPs will have access to a wider range of services, better services and better value. Yes, there will be a bureaucracy in doing that and the people in it will certainly be feathering their nests. But, I think the idea behind it is sound if it is to jolly up some of the clinical services that are less than good, such as mental health in Sheffield. If they aren't very good they will not get referrals and they'll die out in favour of better managed facilities.

 

I am not suggesting I want to be referred to Exeter for a minor affliction but I would be prepared to go where the best treatment for something serious is available.

[I1L2T3]

I can't claim to know the fine print of the reforms but from personal experience doing away with the local PCT's can only be a good thing. In addition to the postcode lottery that the PCT's cause there is an issue with certain areas not being able to attract the best clinicians. I know from personal experience that some health services in Sheffield particularly suffer by not being able to attract good consultants. Obviously London attracts the best people. Sheffield does not. Consequently we get second or third rate care in certain disciplines. At the moment we have to accept what is on offer from our local PCT.

 

The management of PCTs is patchy at best. I hope by doing away with them GPs will have access to a wider range of services, better services and better value. Yes, there will be a bureaucracy in doing that and the people in it will certainly be feathering their nests. But, I think the idea behind it is sound if it is to jolly up some of the clinical services that are less than good, such as mental health in Sheffield. If they aren't very good they will not get referrals and they'll die out in favour of better managed facilities

 

I am not suggesting I want to be referred to Exeter for a minor affliction but I would be prepared to go where the best treatment for something serious is available.

 

That's all pie in the sky theory. It doesn't follow that facilities in an area will improve. In fact they may disappear completely. And having access to a better service 50 miles away for example will simply not be a practicable solution. Areas with low population will not be attractive targets for profitable provision. The whole thing really is deeply flawed and the idea that anything is better than a PCT...............

[libuse]

I can't claim to know the fine print of the reforms but from personal experience doing away with the local PCT's can only be a good thing. In addition to the postcode lottery that the PCT's cause there is an issue with certain areas not being able to attract the best clinicians. I know from personal experience that some health services in Sheffield particularly suffer by not being able to attract good consultants. Obviously London attracts the best people. Sheffield does not. Consequently we get second or third rate care in certain disciplines. At the moment we have to accept what is on offer from our local PCT.

 

The management of PCTs is patchy at best. I hope by doing away with them GPs will have access to a wider range of services, better services and better value. Yes, there will be a bureaucracy in doing that and the people in it will certainly be feathering their nests. But, I think the idea behind it is sound if it is to jolly up some of the clinical services that are less than good, such as mental health in Sheffield. If they aren't very good they will not get referrals and they'll die out in favour of better managed facilities.

 

I am not suggesting I want to be referred to Exeter for a minor affliction but I would be prepared to go where the best treatment for something serious is available.

 

Thank you for giving me a straight answer. It would appear, however, from your answer that you don't actually know what PCTs do.

 

As you have written with apparent authority on the NHS earlier in this thread I thought you would realise that since TCS, PCTs do not provide services - they can't provide services - they simply commission them. So clinicians don't, generally, work for PCTs (obviously some do in consultative or managerial/directorial roles, but not actually in service provision). If you believe that there are poor quality clinicians in Sheffield then that is down to the relevant FTs not attracting them, and nothing to do with the PCT.

 

Under the reforms, the PCT will be replaced by one or more CCG, which will commission services from the same FTs that you believe can't attract good clinicians, in addition to the "any willing provider" as described in the bill.

 

Do you have any thoughts yet on the lack of geographic obligation placed on CCGs in the bill?

[Jim Graham]

Thank you for giving me a straight answer. It would appear, however, from your answer that you don't actually know what PCTs do.

 

As you have written with apparent authority on the NHS earlier in this thread I thought you would realise that since TCS, PCTs do not provide services - they can't provide services - they simply commission them. So clinicians don't, generally, work for PCTs (obviously some do in consultative or managerial/directorial roles, but not actually in service provision). If you believe that there are poor quality clinicians in Sheffield then that is down to the relevant FTs not attracting them, and nothing to do with the PCT.

 

Under the reforms, the PCT will be replaced by one or more CCG, which will commission services from the same FTs that you believe can't attract good clinicians, in addition to the "any willing provider" as described in the bill.

 

Do you have any thoughts yet on the lack of geographic obligation placed on CCGs in the bill?

 

 

PCTs are regional bodies set up by statute to cover a certain area. The CCGs will be smaller more flexible bodies representing the GPs who sign up to them, if not run by the GPs themselves. So straight away the bureaucracy of the PCT has gone along with a good chunk of the cost.

 

Some FTs have made good living in an area knowing that the PCT for that area will commission from them irrespective of outcome for the patient. Some second rate clinicians and managers have made a good living providing second rate services. You know very well that FT after FT has been branded not fit for purpose as scandal after scandal has been uncovered. Stafford, Liverpool, Bristol to name but a few. Standards are very very low in some areas and patients are being let down every single day despite the massive cost of the NHS. Survival rates are not good in some FTs.

 

Under the proposals the GPs will commission from whoever offers the best outcome for patients and their budget. That won't necessarily be the same FTs they have to use now. If that means going to "any willing provider" so be it. In my experience GPs want the best for their patients whereas FTs want the best for their consultants. If other providers wish to come in I'm all for that as long as they are properly regulated by the CQC. Let's not forget that when consultants ran the NHS the waiting lists were massive as they rationed the number of medical posts to ensure they stayed in control.

 

Removing geographical limitations opens up the commissioning process to competition but in practice patients will want to be treated locally so the beneficial effect may end up being muted.

[I1L2T3]

PCTs are regional bodies set up by statute to cover a certain area. The CCGs will be smaller more flexible bodies representing the GPs who sign up to them, if not run by the GPs themselves. So straight away the bureaucracy of the PCT has gone along with a good chunk of the cost.

 

Some FTs have made good living in an area knowing that the PCT for that area will commission from them irrespective of outcome for the patient. Some second rate clinicians and managers have made a good living providing second rate services. You know very well that FT after FT has been branded not fit for purpose as scandal after scandal has been uncovered. Stafford, Liverpool, Bristol to name but a few. Standards are very very low in some areas and patients are being let down every single day despite the massive cost of the NHS. Survival rates are not good in some FTs.

 

Under the proposals the GPs will commission from whoever offers the best outcome for patients and their budget. That won't necessarily be the same FTs they have to use now. If that means going to "any willing provider" so be it. In my experience GPs want the best for their patients whereas FTs want the best for their consultants. If other providers wish to come in I'm all for that as long as they are properly regulated by the CQC. Let's not forget that when consultants ran the NHS the waiting lists were massive as they rationed the number of medical posts to ensure they stayed in control.

 

Removing geographical limitations opens up the commissioning process to competition but in practice patients will want to be treated locally so the beneficial effect may end up being muted.

 

More pie in the sky. New provision cannot magically spring up out of nowhere. Local hospitals and clinics provide services because they are the local hospitals and clinics that developed to meet a demand for services in the locality they are situated. They are where they are because that is where the demand is. For core services local people want local provision. It's blindingly simple. For specialised provision people know they may need to travel - they know for example that aggregation of specialist services into regional centres of expertise can make sense - but the moment you start asking people to travel 30, 40, 50 miles for routine care just because the commissioning services can buy the provision more cheaply from those delivery locations then the system is royally screwed. You'd end up with ridiculous situations where local provision with many services concentrated in one place becomes spread over multiple locations that might be tens of miles apart. Hospitals and clinics in big towns could close, people forced to travel to get basic services.

 

This won't work and the government knows it too as their own internal reports made public in the last 3 hours amply demonstrate. The bill has to be dropped

[lolli_pop]

The UK's GDP has gone down over the last 4 years so the NHS cost should go down accordingly. The Tories have not cut the cost of the NHS yet so the % against GDP is rising automatically.

 

And yet still the NHS consumes a small percentage of GDP compared to other healthcare systems. Most industrialised countries face exactly the same problem of an ageing population and the associated cost; this is hardly unique to the UK.

 

At a time when the NHS is being asked to find significant savings, it does appear to be a very strange time to carry out such a substantial reorganisation.