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[D]

As someone who works for the NHS and has had concerns about the Health and Social care act since its launch, it was just as worrying to sit though an hour watching Lucy Reynolds speak out about the changes in the NHS and what it may mean for the future of healthcare.

http://youtu.be/OkTnCtg_Omk

The video is in excess of 1 hour, but addresses a lot of concerns that medical staff and CCG's currently have.

The woman speaking has an academic background at the London school of hygiene and tropical health.

Working in a central London teaching hospital, I have grave concerns about Lewisham A&E closing down as well as the other A&Es in North London. I know from personal experience that year on year, the number of patients attending A&E have gone up, so how can the current government consider it sensible to close such departments? Where will all these patients go to or end up at?

[STMO123]

According to Mid Yorks health trust, they are losing 200 beds because people don't need to be in hospital. They can be treated much more efficiently at home.
Now, when you consider that they have to save £24,000,000, what do you think efficiently means?

[Nickbat]

Your don't understand how the upper echelons of the NHS and the Department of Health actually think do you?

They like to deal with "Issues". That's why they are always banging on about alcoholism, smoking, obesity, sugary foods, cancer and so on. That way, they can get plenty of telly time, can attend loads of meetings with PowerPoint presentations and have lunches with ad agencies and PR companies. That's well-paid fun, isn't it?

I mean, who wants to deal with severed limbs, elderly heart attack/stroke victims and so on? How can they have focus group meetings about that sort of thing? And, what's more, these accident and emergency victims don't follow a 9-5 schedule (which is frankly pretty mean of them). The thing is, they may have further to go for their treatment. Big deal. Yes, they may well croak on the way, but at least they then won't show up in the mortality stats, so no problem.


Actually, I think the closure of A&E departments is criminal and it makes my piss boil.   

[Rods2]

All of this is easily solved while still having a free at point of access system. I would privatise all hospitals, every current employee at a hospital would have shares according to their salary. When you arrive at a hospital as a patient you effectively have a cheque stapled to your forehead, saying treat me and the Government will pay you for the treatment. Countries that have implemented such systems have found that through efficiency savings treatment costs have halved, staff requirements have gone down though efficiency savings and medical outcomes have improved. Instead of department budget shortages and surpluses where these are pre-set, the money automatically flows to where it is needed.

Local A&E are then market driven, so demand means it is worthwhile a hospital having one. Profits are invested in better equipment, systems and treatment with the remainder paid as a dividend to the staff. You can choose from a range of hospitals for your treatment, so a hospital has to treat patients well in all respects of they don't get the patients, so their is an inherent quality control mechanism. Market solution like this are ALWAYS better for staff and customers (patients), so what is there not to like about it.

This is much more like the French system. People I know that live and have been treated over there say it is brilliant and makes the NHS look like the 3rd world system that it is. Only in state monopolies do you end up with systems like the Liverpool pathway and 1200 killed with virtually nobody batting an eyelid, apart from the poor victims families. 

[ozzycat]

we will end up with ambulases queing down the road of the a&e:s that are open
we have a simula problem down here they are shuting 3 cotage hospitals with 150 beds between them because the new hospital theve built in newton abbot is 25% empty wich is about 59 beds this was decided in a report wich looked at the figures over 1 week yes 7 days so they said it wasnt been used to its capacity so well close 3 hospjtals  it wasnt till a doctor coulnt get a very ill lady jn to N/A hospital and did some enquires all of a sudden theve had a look again and the place has been full to bursting point every week  bar one wick was the week they did there survey now all of them are been kept open they havent got the sence they were born with they sould leave the running of the hospitals to a matron like the olden days and not some shopkeeper trying to make a profit the nhs should be run as a non profit organizeation and not a bloody supermarket how can you make a profit out of sombodys health makes my blood noil

[D]

All of this is easily solved while still having a free at point of access system. I would privatise all hospitals, every current employee at a hospital would have shares according to their salary. When you arrive at a hospital as a patient you effectively have a cheque stapled to your forehead, saying treat me and the Government will pay you for the treatment. Countries that have implemented such systems have found that through efficiency savings treatment costs have halved, staff requirements have gone down though efficiency savings and medical outcomes have improved. Instead of department budget shortages and surpluses where these are pre-set, the money automatically flows to where it is needed.

Local A&E are then market driven, so demand means it is worthwhile a hospital having one. Profits are invested in better equipment, systems and treatment with the remainder paid as a dividend to the staff. You can choose from a range of hospitals for your treatment, so a hospital has to treat patients well in all respects of they don't get the patients, so their is an inherent quality control mechanism. Market solution like this are ALWAYS better for staff and customers (patients), so what is there not to like about it.

This is much more like the French system. People I know that live and have been treated over there say it is brilliant and makes the NHS look like the 3rd world system that it is. Only in state monopolies do you end up with systems like the Liverpool pathway and 1200 killed with virtually nobody batting an eyelid, apart from the poor victims families. 

So I take it that you havent even bothered to look at the clip before rambling on about privatisation?

The French system spends more per GDP than the UK, and we have a higher efficiency driving than France as well. So not really comparable. If I may counter with the argument that US patients turn up with a cheque stapled to their head and hence they get treated till the cheque lasts, then when the money run out they get thrown out. Having worked in that system, it is shameful and a disgrace. People on ventilators are taken off when your so called cheque runs out! How would you like that happen to yourself, when your so called insurance policy cannot sustain a stay in ICU for more than 8 weeks? If on the other hand you are talking about the govt paying for private healthcare, then whats to regulate cherry picking of lucrative specialties by private firms, leaving the cumbersome non lucrative jobs to the govt. to sort out. And if you had any idea about how NHS commisioning works now, you would realise that how NHS trusts get paid now is exactly how you describe. i.e. payment by results or national tariffs to treat patients. Hence when a patient turn up in AnE with a heart attack, there is already a standard payment associated with that disease that the NHS trust will get paid. What then is the difference? Other than perhaps having a Virgin logo on your discharge letter when you leave hospital? I would suggest you have a listen to someone like Dr Reynolds who has understood the system inside out, rather than just see it as a consumer.

Market solutions are not suitable for healthcare. The reason being that to have an equality between supply and demand you need both the supplier and user to be on a even footing in terms of knowledge. In healthcare that is very difficult.

Virgin won the contract for child healthcare care in the south west. The very next day unsolicited texts and phone calls were going out to colleagues who work with children with in London about whether they would consider moving to the SW and work for Virgin. Companies like Virgin healthcare have highly paid lawyers who will use every clause in the book to ensure they win the contract. And if they dont, then they will go to court and sue as already evidenced for rail contracts in the past. All they care about is profits. And healthcare should not be about profits. I have several examples of what happens in private care and the state in which these patients are then dumped onto the NHS when things go wrong. Unfortunately I cannot openly state these examples for obvious reasons.

And from the shameful disgrace at Mid Staffs we have already seen what happens when you incentivise the healthcare system. Management only worry about targets and goals and dont give a hoot about patients. Is that what privatisation will bring?

I dont know enough of the French system to compare. Hearsay from friends who say it is brilliant is not good enough to give the go ahead to destroy an already existing system.

Quoting the Liverpool care pathway without understanding the real meaning of what it means and only reading sensationalised headlines is a prime example of a little knowledge being dangerous in the hands of someone with a mob mentality.

[D]

we will end up with ambulases queing down the road of the a&e:s that are open
we have a simula problem down here they are shuting 3 cotage hospitals with 150 beds between them because the new hospital theve built in newton abbot is 25% empty wich is about 59 beds this was decided in a report wich looked at the figures over 1 week yes 7 days so they said it wasnt been used to its capacity so well close 3 hospjtals  it wasnt till a doctor coulnt get a very ill lady jn to N/A hospital and did some enquires all of a sudden theve had a look again and the place has been full to bursting point every week  bar one wick was the week they did there survey now all of them are been kept open they havent got the sence they were born with they sould leave the running of the hospitals to a matron like the olden days and not some shopkeeper trying to make a profit the nhs should be run as a non profit organizeation and not a bloody supermarket how can you make a profit out of sombodys health makes my blood noil

But that is what started with Labour and is continuing with the present govt. Someone will make a killing from these changes, but you can assured it will not be the patients!

[D]

And so much for GPs spearheading health spending:

http://www.bmj.com/content/346/bmj.f1569

With so many vested interests, aren't we just playing into their hands?

[ted_one]

My wife was a nurse manager up until last year,she came up through the ranks, not parachuted in from the private sector,she was constantly under pressure from senior management to save money by cutting staff and services.She found the constant battle with them and their blinkered views became to much and decided the grief factor was'nt worth the fight with them and the fact that Virgin Care was about to take over her PCT,they have also secured a deal in Devon so Ozzycat may see the difference in services...to the good? let's wait and see. Got a feeling that Virgin are seeing things through rose tinted specs and will soon find out that cherry picking the the good stuff won't work in the NHS.
Why does every one think that privatising the NHS is the answer? Virgin are in this for one reason and one reason only,and it's not for our good....think about it

[D]

The sad thing is that Virgin healthcare are responsible for children with learning difficulties, mental health issues and disability.

I am sure with the years of experience they have had with caring for children with the above issues, they should fit into the grand scheme of things quite well.

[ted_one]

Exactly...Virgin may be able to run all of their other interests efficiently,but running a PCT..hmmm.My wife is in touch with all of her ex collegues and what they are saying is not good,with more cuts in services and staff planned and doubling of workloads etc on the nurse managers.The attitude is ''well if you don't like it'' it's tough, as my wife says there will be no NHS as we have perceived it since it's formation in 1948,it will become a commisioning body who will seek out the 'best deals' from the private sector and award companies like Virgin or even foreign companies contracts for their services.Hang on people,think we're in for an interesing next few years

[jerry]

With my brother and his wife both quite high up in their NHS region, Ive been hearing increasing concerns over the years. Certainly the various ins/outs are far more complicated than outsiders might imagine from the press. That said, from my personal point of view, I feel that it is important that the NHS is still a "service" not a "business". This does not mean that basic business principles should not apply however. Some of the stories around waste that Id heard in the past were truly shocking to anyone with the slightest experience of business management within the private sector-lack of basic management procedures/controls, lack of real accountabilities, mini "empire" building etc etc. Since then much has changed, but not all for the better .Sound business practices need to be applied in order to run an efficient service but this should not mean feathering the nests of the few in the process! The whole culture also clearly needs changing too. The management strata at the top who busy themselves meeting various targets (financial or otherwise) are far too divorced from the "shopfloor" itself. Its no good saying that following such inncidents as Stafford that the govt will set them yet another target, this time on patient care,  which will come in the form of yet another tickbox. Its about changing the culture. Its almost like they have so many pressures around so many areas that theyve forgotten what their purpose is. When I worked in hospitals (many years ago admitedly  ), the ward sister/staff nurse (see, told you it was a long time ago!) in charge wouldve had an absolute sh*t fit if thet had seen some of the things that are now common place in our hospital wards-old food lying on the floor for days not picked up ("what do you mean, theres no cleaner everyday? So what, clean it up yourself! What do you mean, its not your job! Clean it up!" "Why hasnt that patient been changed?" "Chase that consultant up now ! "). In my day it was a good mixture of TLC and cleaning. It was their ward and they saw they were run properly. Now, before we go on about long hours and staff shortages and lack of funding and other excuses let me just say that things were tight then too . The biggest difference is attitude and attitude is driven by culture and that is driven from the top. Lets give an example from retail:

Treat your staff with respect, listen, train, coach,challenge, encourage, involve, engage (pay is of course a factor but oddly not the major one)----happy workforce----perform better/offer better customer service----increased sales
 
Treat your staff badly (bullying/setting unrealistic targets/ JFDI management style (thats Just F*cking Do It  to th uninitiated )/lack of praise/poor pay)...unhappy workforce....underperformance/poor customer service.....decrease in sales

It isnt rocket science. Toyota have been championing it for years and it was around long before them too so its a culture that will work in any business or service. I know that the NHS today has far more "customers" than it did when I worked in it, I know that the funding of the NHS is far more challenging than it was. Its just that I believe that the root cause of many of its current problems is because its senior management/ ministers have forgotten what the purpose of the NHS is and what it wants it to do and over the years the many changes in organization have led to its very culture being warped.Of course there are very many excellent managers/doctors/nurses working within the system but its the system and culture that need changing and this government are not the ones to do it. As my brother queried, for example, some years back when the idea was first being mooted,  who an earth would think that giving GPs so much control could be a good thing? Like any group there are good and bad GPs but there are too many who would take the opportunity to feather their own nests in the process at the detriment of others  and who would assume that there were sufficient numbers of GPs with the relevant experience and ability to oversee such "healthcare purchasing" in the first place? (There is also the issue of many GPs having substantial interests in such healthcare providers themselves. Who would have thought eh? . I know this all sounds a bit simplistic and I do understand some of the complexities of the problem as D has stated,not least because the NHS is such a large beast with so many arms to it,  but I do believe that change of culture is one key area where change is needed. And also what the whole purpose of the NHS should be. If it is to provide a service then how can "outsourcing " certain services to private companies be part of this? Surely the whole point of such private companies is to make a profit? But if its a service, the NHS doesnt need to make a profit,so, if it is cheaper to outsource a particular service to a private concern to save money and be more cost-efficient, surely that can only mean one of two things-1) the private company offers either substandard services or else pays its staff poorly or 2) the NHS cannot run this particular service as well "in house" because of its own mismanagement in that sector in which case those involved should be dealt with? Maybe its me

[D]

I would really urge anyone with any semblance of an interest in their healthcare and what happens to it, to have a look at the video I posted. I have no affiliation with the speaker at all. My understanding is that she doesn't work in the NHS currently, but is upset and talking out about proposed changes to her healthcare system (without any involvement of her or the public it affects).

Ironically the Health and Social care act 2012 states "No decisions about me without me". Isn't changing the healthcare act a decision about "me"? Where was the public consultation before the healthcare act was launched. Were the public consulted? What about NHS employees? Maybe GPs? Or patient support groups? No one was consulted and now that it has been passed, no one can do anything about it.

The BBC failed us too. Where was the national coverage re: the proposed changes and the opening of the market to private care providers?

As a group of tax payers we have been misled and fooled into believing the changes are good for us. I am angry about the whole thing, not as a physician, but as a tax payer that I have been misled and lied to.

[Lizzie_Zoom]

I would really urge anyone with any semblance of an interest in their healthcare and what happens to it, to have a look at the video I posted. I have no affiliation with the speaker at all. My understanding is that she doesn't work in the NHS currently, but is upset and talking out about proposed changes to her healthcare system (without any involvement of her or the public it affects).

Ironically the Health and Social care act 2012 states "No decisions about me without me". Isn't changing the healthcare act a decision about "me"? Where was the public consultation before the healthcare act was launched. Were the public consulted? What about NHS employees? Maybe GPs? Or patient support groups? No one was consulted and now that it has been passed, no one can do anything about it.

The BBC failed us too. Where was the national coverage re: the proposed changes and the opening of the market to private care providers?

As a group of tax payers we have been misled and fooled into believing the changes are good for us. I am angry about the whole thing, not as a physician, but as a tax payer that I have been misled and lied to.

I have viewed the video D and I am suitably disturbed by what the young lady is explaining. Times have changed since the conception of the NHS in 1948 under a Labour government. But it seems that by what is being stated, and I take it on face value by someone who seems to understand completely what is transpiring, privatisation is coming in by default and active support from the powers within the NHS and government.

I believe in a completely state run and paid for health system that is "free at the point of delivery".  It seems though that other European countries have surrender that ideal for business interests and not what is best for the patients. It will be a criminal act in my opinion for any British government to destroy the NHS on the principles it did operate on, and allow, what appears also to be creeping in under stealth, a system based on purely business ethics not medical ones. The closure of A&E departments, let alone maternity units, is just one symptom of what is transpiring. A recent in-patients stay at my favourite hospital, where I am a trust member, also highlighted how medical staff are now dispensing meals to patients as three weeks ago the catering staff were dispensed with. So highly trained, valued, medical staff were torn between treating patients and dispensing hot meals. That has been done purely for business reasons and nothing to do with aiding patient healthcare.  It is wrong and I have written to the trust to say so.  Just one more slow and creeping movement into a purely business arrangement for the NHS, as the lady in the video is explaining. 

This issue needs to be brought to the fore in the next General Election as us, the people of this country, needs to stop the rot a.s.a.p.  The trouble is who will take on a non-privatisation policy in their manifesto. Labour would have done in the past, but now post New Labour, I doubt they can be relied upon to do so. So who?

Let's all start to voice our feelings on this and join local pressure groups or trusts as I have done.

[D]

I would really urge anyone with any semblance of an interest in their healthcare and what happens to it, to have a look at the video I posted. I have no affiliation with the speaker at all. My understanding is that she doesn't work in the NHS currently, but is upset and talking out about proposed changes to her healthcare system (without any involvement of her or the public it affects).

Ironically the Health and Social care act 2012 states "No decisions about me without me". Isn't changing the healthcare act a decision about "me"? Where was the public consultation before the healthcare act was launched. Were the public consulted? What about NHS employees? Maybe GPs? Or patient support groups? No one was consulted and now that it has been passed, no one can do anything about it.

The BBC failed us too. Where was the national coverage re: the proposed changes and the opening of the market to private care providers?

As a group of tax payers we have been misled and fooled into believing the changes are good for us. I am angry about the whole thing, not as a physician, but as a tax payer that I have been misled and lied to.

I have viewed the video D and I am suitably disturbed by what the young lady is explaining. Times have changed since the conception of the NHS in 1948 under a Labour government. But it seems that by what is being stated, and I take it on face value by someone who seems to understand completely what is transpiring, privatisation is coming in by default and active support from the powers within the NHS and government.

I believe in a completely state run and paid for health system that is "free at the point of delivery".  It seems though that other European countries have surrender that ideal for business interests and not what is best for the patients. It will be a criminal act in my opinion for any British government to destroy the NHS on the principles it did operate on, and allow, what appears also to be creeping in under stealth, a system based on purely business ethics not medical ones. The closure of A&E departments, let alone maternity units, is just one symptom of what is transpiring. A recent in-patients stay at my favourite hospital, where I am a trust member, also highlighted how medical staff are now dispensing meals to patients as three weeks ago the catering staff were dispensed with. So highly trained, valued, medical staff were torn between treating patients and dispensing hot meals. That has been done purely for business reasons and nothing to do with aiding patient healthcare.  It is wrong and I have written to the trust to say so.  Just one more slow and creeping movement into a purely business arrangement for the NHS, as the lady in the video is explaining. 

This issue needs to be brought to the fore in the next General Election as us, the people of this country, needs to stop the rot a.s.a.p.  The trouble is who will take on a non-privatisation policy in their manifesto. Labour would have done in the past, but now post New Labour, I doubt they can be relied upon to do so. So who?

Let's all start to voice our feelings on this and join local pressure groups or trusts as I have done.

Nail on the head! But it needs to be everyone, not just a few folk like you and me.