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So....here we are... the future of the NHS

Discussion in 'Personal' started by HelenREMfan, Jun 16, 2019.

  1. florian gassmann

    florian gassmann Star commenter

    I think you will find that they were able to do so because hospitals have always been able to charge for the use of their services, not least because not every patient has National Insurance. The range of private facilities has undoubtedly increased in recent years (one hospital near here offers ensuite private rooms for a hotel-like charge, but with NHS medical services, and has done so since 1994).

    However, a study published by the Centre for Health and the Public Interest found that while private patients have brought in a worthwhile increase in hospital funding, the proportion of completed treatments for private patients in 2016 (after the Health and Social Care Act 2012 gave hospitals power to greatly increase the amount of private services they could offer), the proportion of private patients has actually decreased since 2009/10 and accounts for only 0.5% of NHS hospital admissions.

    Last edited: Jun 17, 2019
  2. Duke of York

    Duke of York Star commenter

    That may be the case, but it doesn't disprove my assertion that consultants rule the roost.

    I've mentioned before that Thatcher wanted to implement NHS reforms and used the hospital I worked in as a pilot for them.

    The consultants opposed her reforms and refused to co-operate. Despite her sacking the hospital management team on four occasions, sacking the board of governors twice, she was unable to implement her reforms.

    Each new team of managers were more ruthless and dictatorial than their predecessors. The cabinet eventually refused to support her plans and eventually after some five years, the plans were dropped.

    It's 30 years now since I left the NHS, the reason I decided to was primarily because the atmosphere generated by the fourth managemant team had become unpleasant. I wasn't privvy to any of the discussions taking place between the consultants and hospital managers, but I heard plenty of stories through the grapevine.

    Most of the staff had little choice other than do what the management bid them to and I didn't understand at that time why the consultants weren't prepared to knuckle down under the new regime as everyone else had to, but after I left, there was a sudden demand to clear backlogs of clinical coding and it suddenly twigged what the reforms were all about. It was all in aid of privatisation.

    I suspect the consultants' opposition to Thatcher's reforms were simply that they could see them losing control of the cozy arrangement they had, which enabled them to maximise their income from their private work. I very much doubt they were paying the hospital for the use of its facilities, or if they were, it will only have been on a peppercorn rental of them.
  3. racroesus

    racroesus Star commenter

    Not 100% effective and efficient?
    The horror!
    needabreak likes this.
  4. florian gassmann

    florian gassmann Star commenter

    These days there are different levels of private service available on discretion in NHS hospitals. The sort to which you refer involves the consultant invoicing the patient for his or her time, plus the hospital invoicing the patient for use of their facilities. The consultant doesn't pay to use the hospital facilities - the patient does.

    That is not the type of private care being discussed in this thread, which is not a private patients service - it is a service provided entirely by the NHS, using consultants employed by and paid by the hospital. Income from procedures is paid into the NHS and is not paid to consultants. Consultants are required to treat such patients as part of their agreed hours of work for the Trust.
  5. needabreak

    needabreak Star commenter

    I haven't claimed anyone was lying, you just said that and it is quite clear why you would like to sensationalise my scepticism of the under utilisation you mention since you have not yet provided any substantiated evidence for it.

    Actually if the NHS needs to close unused wards then so be it, then funds should be reallocated to areas of need within the service, such rationalisation is in my view more appropriate than entering into contractual arrangements with private hc providers which is not what I understand the NHS aims and objective to be (though as I said I could be wrong if those key objectives have been altered).
  6. needabreak

    needabreak Star commenter

    Efficiency may require less than 100% utilisation to allow for fluctuating unforseen demand.
  7. racroesus

    racroesus Star commenter

    I have said that maximum efficiency comes with optimal use of resources.
  8. racroesus

    racroesus Star commenter

    Which is why I think this is also nonsense.

    Tom Burkard
    A good teacher makes use of every minute of class time

    With no-one gazing at the ceiling.
    needabreak likes this.
  9. chelsea2

    chelsea2 Star commenter

    Many of the procedures listed ARE generally available on the NHS.

    Why would there be people more ready on the list of those who pay than those who don't? It's not unknown for people to get a phone call asking them to come to the hospital the next day as there's been a cancellation. I got a very quick physiotherapy appointment last year due to a cancellation.

    I'm not being argumentative or critical here for the sake of it. And I don't expect you to have all the answers.

    I just don't understand why filling empty slots by treating people who are paying is a more efficient method than just filling empty slots with those who have been waiting longest and/or who are in the greatest need.

    It still seems to be that those who pay are more likely to be treated sooner.
    needabreak likes this.
  10. Duke of York

    Duke of York Star commenter

    That's the whole point. It was ever thus.
  11. florian gassmann

    florian gassmann Star commenter

    You claimed that the spare capacity was "alleged", so don't be mealy mouthed about it - you clearly think the Trust is lying when it says that only spare capacity is used. What evidence you have is anyone's guess.

    Personally, I would not be surprised that the Trust's hospitals have spare capacity as they have exceptionally short waiting times for planned procedures.

    I am truly shocked that you wish to deny additional funds to the NHS and instead prefer to see NHS facilities closed down.
  12. needabreak

    needabreak Star commenter

    I expect there is but unless they know precisely what it is at any given point, reasons why and in which facilities the decisions as to whether they need to be offloaded or streamlined would remain unclear... Although to be fair there's so much information failure or asymmetrical information in private and public sectors it's hard to know what's for the best which actually makes headline news and threads like this fairly limited in impact and pretty useless to anyone outside the service.
  13. florian gassmann

    florian gassmann Star commenter

    Very rarely in most of the cases listed as they are classified as Low Priority Procedures that will only be funded in exceptional cases. For details you need to look at the other data from the Trust to which I linked: for example, hip replacement will only be done if the patient is in pain and is suffering limited mobility. The My Choice scheme offers the chance to pay for hip replacement before those criteria are met.

    If the slots are empty, it means that the hospitals concerned don't have waiting lists full of people waiting for surgery. As it says in the documentation provided, if the slots are not filled somehow, they will be removed and the hospital's operations scaled back accordingly. It is worth noting that the NHS itself says that Warrington Hospital "has low infection numbers and short waiting times for most specialties". Obviously, a Trust with long waiting lists and long waiting times would not be able to offer the type of self-funding services offered by this Trust.
    Last edited: Jun 17, 2019
    agathamorse likes this.
  14. needabreak

    needabreak Star commenter

    Two clear deliberate or mistaken misreading of what I have said, firstly I was asking for the links to the reports you sited to identify the issue not name calling so don't detract from my point.

    Secondly don't partially quote me to try to put words in my posts, go back and read it again. I would not deny the NHS anything but if it needs to be reorganised and resources reallocated more efficiently within it then so be it, but let's not pretend there's a good reason for selling NHS resources on a peacemeal basis to the private sector without actual capacity utilisation figures such as that the appears to be the case here.

    Such misleading posting tactics are a tad unbecoming, though there is a chance you have genuinely misunderstood my posts.
  15. chelsea2

    chelsea2 Star commenter

    Well, I've had a least two of those procedures - one more than once, including just a few weeks ago. Waiting time on this occasion - 3 weeks, which was actually shorter than before (6 weeks).
    There was never any suggestion that the procedure wouldn't happen unless I paid.

    If they don't have waiting lists full of people waiting for surgery then no one needs to pay to have surgery sooner than would otherwise be the case, surely? Because they won't have to wait anyway.
    needabreak likes this.
  16. florian gassmann

    florian gassmann Star commenter

    If you want to know the utilisation figures for the Trust concerned, I suggest you put in a Freedom of Information request.
  17. florian gassmann

    florian gassmann Star commenter

    All CCGs are legally obliged to have in place and publish arrangements for making decisions and adopting policies on how particular healthcare interventions are to be accessed. This includes drawing up lists of what used to be called PLCPs (Procedures of Low Clinical Priority), now described as CBCTs (‘Criteria Based Clinical Treatments’) which will not generally be offered to patients unless there is particular need. The procedures on the Warrington list are CBCTs. I'm pleased that your GP was able to argue that you should have the procedures you did, but they are not available to most patients these days unless there is a particular need. If you don't have such a need, some trusts are nevertheless able to offer them on a self-funding basis - just as some NHS hospitals are able to offer private rooms to NHS patients on payment of a fee. If you interested you can read more about CBCTs here:


    Exactly. It is one of the reasons why, as I mentioned earlier, the take-up for these self-funded procedures is only 0.5% of NHS hospital patients, which is lower than it was a decade ago.
  18. needabreak

    needabreak Star commenter

    I don't. I was seeking clarification and evidence to support your assumptions. If you will make assertions of this nature perhaps you might consider providing evidence to substantiate them, we all have opinions based on media coverage but they have limited value as you know.
  19. florian gassmann

    florian gassmann Star commenter

    I already have but you didn't like it. There are plenty more, such as the recent:
    which points out that the NHS could carry out 291,327 more operations per years with better theatre utilisation.

    I wonder why you are so against the NHS receiving additional money from those who can afford it?
  20. chelsea2

    chelsea2 Star commenter

    Thank you - that's really interesting.

    So these medical issues are CBCTs 'unless there is particular need' and then people can get them done on the NHS.

    That's fine for things like 'removal of skin tags' and some of the other cosmetic procedures on the list.

    But we now go round in a circle - hip / knee replacements, heavy menstrual bleeding, steroid injections for joints, etc - well, of course there will be a particular need - no one has these procedures done for fun. Surely that's true of all medical interventions - they're done because there's a 'particular need'. I find it hard to understand why they (and some of the other things) are on the same list as 'removal of skin tags'.
    agathamorse likes this.

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