I'm curious if this marks a 99% retreat from the Tory GP-commissioning idea (which seemed dead in the water) or if it's something that was being put forward on a parallel track and which would not prefigure anything on broad NHS "reform".
It's competition-bonerism, certainly, but I don't see it being noticeably hurtful in itself - the products and services are pretty ancillary and segregated from the principal realm of hospital and physician services.
I'm interested (mostly about what "adult hearing in the community" means) but I don't quite understand the controversy. What's the problem, now?
Right now NHS is not just public payer but public provider - its hospitals are government-owned and operated. Not sure how it works with physicians - there it's a bit more contractual maybe but still relatively collective. Tories don't dare touch the payment side but there's more historical push for rationalization schemes in provision that might possibly lead to private providers cashing in and making the system more like Medicare, that miracle of cost control, or for that matter Germany or France. Thatcher's notion was an "internal market" of public providers competing against each other. I don't know what the ideal system would be; probably per Kenneth Arrow competitive markets are vanishingly unlikely to improve health care much, so you're more likely to get quality through central organization and planning, but OTOH wheelchairs I imagine are close enough to being consumer goods that some market participation could be suitable. Less so talk therapy and several others on the list.
I suspect there's some historical New Labour impetus for this kind of thing in a more limited, slightly less camel's-nosey way - shouldn't put it all on the Tories.
What's the problem, now?
The problem is that I am underinformed, though I assumed that there was some camel-nosing going on for increasingly rendering health care in the UK US-like (or something with a similar effect).
"And three: the compulsory scientific measurement of all adult male knees! Not for the true-born Englishman the bony angular knee of the so-called intellectual, not for him the puffy knee of the criminal classes. The British knee is firm, the British knee is muscular, the British knee is on the march!"
Hm. Well, I'm reading around, but I don't feel much smarter.
Is it only children who get to pick their wheelchairs? What about the adults?
And only adult hearing services? What about the children?
I'm guessing I'll be able to find more out about this tomorrow.
This paragraph, for example:
There were also major savings that could be made, the department said. It cited the example of chronic leg wounds, where the NHS pays out £18,000 per patient over four years, often without curing them. One not-for-profit company - Wound Healing Centre in Sussex - treats patients successfully for £720.
Etc.
OT: Dear mods, could we get a(nother) D.C. meetup thread, please?
Hopefully in a few hours our Brit friends will awaken and give some much needed context.
The paragraph quoted in 7 is what struck me as well when I read about this the day before yesterday, because how is it possible that treatment that in the NHS cost tens of thousands of pounds can be done that much cheaper. The article linked to in 8 doesn't really make that aspect much clearer, but even assuming that this centre can deliver these savings, how much would it need to scale up to reach the entire NHS and how well can it be scaled up?
(Where the NHS does fall down often is providing adequate after care; they'll patch you up but won't always tackle underlying problems, as we know from personal experience...)
In general, what everybody is afraid of/outraged by is the idea that this is the thin end of the wedge. People aren't that stupid that they don't see that the services the government has selected for competition were picked because they can be easily outsourced without too much resistance and their succes can then be used to argue for outsourcing of core functions. Everybody including the government sees this as a way to get around the resistance against the initial much more broad plans to introduce further competition in the NHS.
And they know what that means.
Trying to do things cheaper than the NHS is already a bloody stupid idea. The NHS is just about the cheapest healthcare system of any major Western country [and has some of the best health outcomes]. Although as Martin says, and as I know from personal experience, it's far from perfect. The NHS is howlingly good value for money already.
And also what Martin says re: the thin end of the wedge. I don't think anyone doubts that the Tories intend to privatize.
14: ttaM is of course right. There is a reason that the NHS (and the BBC) are the closest the British get to a national religion, and that is not because we are irrationally wedded to outdated socialist centralised planning instead of modern rational competitive markets, but because they are really bloody good. For the Tories, there are three main problems with the NHS (and the BBC);
first, they seem to suggest that the state can do better than the private sector, which can't possibly be true;
second, they make the masses think dangerous things like "hey, the NHS and the BBC are really good, maybe there are some things that the state can do better than the private sector";
and third, and most gallingly, they interfere with the natural flow of money from the masses to Conservative friends, allies and supporters, such as (for the NHS) the 'outsourced service providers' like Capita and Serco, and (for the BBC) News Corporation.
I hate the fact that it's all so simplistic, but it is.
A "chronic leg wound" is an ulcer or infected sore, and they don't get better in NHS hospitals because the nurses are generally too busy[1] for the time-consuming business of looking after them. I can actually totally believe that a typical NHS hospital might end up wasting £18k on failing to manage a wound and that a specialist clinic could to a much better job (although £720 looks like a bid-for-the-contract number, not a delivery number).
The trouble here is that a general hospital ward is a really poor place to do wound management. The trouble with the trouble is that lots of people with chronic leg wounds have to be in a general hospital ward for their other health problems (I would hazard a guess that the majority of CLWs in the NHS system are infected pressure sores caused by hospital beds).
The NHS is very efficient - I've often said it's a second-rate healthcare system delivered for the price of a third-rate one - but one of the reasons it's so efficient is by little kaizen improvements and outsourcing wound management to specialist clinics could be one of these (although for the reasons above, people with chronic leg wounds who don't need hospitalisation for other reasons are a subset and so the savings will be limited). An overall blast process of tendering everything, whether or not there's any identified reason for doing so, is of course about as sensible as it sounds.
[1] Or in the case of the bitches who basically killed my dad, too lazy. Long story.
15.three: You Brits with your social contracts and the like always want to ignore the externalities of competition.
it's a second-rate healthcare system delivered for the price of a third-rate one
What's that make the USian one? A combination first-rate/fifth-rate system, delivered for the price of twelve billion ponies wearing diamond-encrusted tuxedos?
Wasn't there an old song about a former Superbowl winner who ended up in Sing Sing prison on a case of mistaken identity because he was just too stubborn to comply with a simple request to prove he was who he claimed to be. "Sing, sing or show us your ring", it was called. They still perform it at rugby matches.
I do wonder about the privatization of psychological services which are vastly underfunded there (and really everywhere). One of the things about the NHS which feels really foreign to me--and it is probably a feature and not a bug--is the way that you are either completely in the system or out of it. In the U.S., if you want more sessions than your insurer provides you can pay for them out-of-pocket. And sometimes, these might not qualify as fully "medically necessary". Of course, in the U.S. you also have a lot of the better, more experienced psychiatrists and therapists not accepting insurance at all because of the hassles of dealing with insurance companies and low reimbursement rates. But my impression is that middle-class people go to the private sector for therapy and get no support from the NHS.
But my impression is that middle-class people go to the private sector for therapy and get no support from the NHS.
I got 6 or 8 sessions of CBT on the NHS, but I did have to wait about 8 months or more for them. Which kind of worked out because other stuff had happened by then, and it was really useful.
21: Right, and you ought to be able to get that within a couple of weeks, and they should extend it to 24 or 50 per year really quickly if you want it. You can't get anything like that on the NHS.
I've also heard that serious rehabilitation for people with schizophrenia is pathetic.
21: based on a quick google, that has improved quite a lot. The average (average!) waiting time for psychological services used to be anything up to 18 months (as of 2007). Since they brought in IAPT it's now down to four weeks and 10 days in emergencies.
23: Better yes, butt meh. Also, Claudia Hammond did a program where relatives of mentally ill people called in to express their concerns that the new Conservative policies were going to screw them over.
butt meh
I hear Gold Bond medicated powder works for that.
22 - oh yeah sure, I was offering that as support for your point. I couldn't get my 9 year old any help from the NHS - she wasn't actually self-harming, and worrying that she seemed likely to start wasn't deemed needy enough.
Speech and Language therapy for children is another area which is hopelessly limited on the NHS.
Opticians seem like a reasonably successful model of the choice and competition method, I think? Everyone pays the same for an eye test (those who have to pay, anyway), everyone gets the same service and will get the same lenses, and then you can pay more for your frames or fancy lenses if you can. Those who are entitled to free services fill in the forms at the opticians.
I imagine adult hearing services working along those lines. There are already plenty of places to pay privately for hearing tests and aids - might work out better to have them claim for their NHS patients, rather than having to spend money running hearing clinics in hospitals.
If I sound positive about all this, it's because I am so fucking fed up with bad news.
Also, people with chronic leg wounds - they're mostly not in hospital are they, because that article said £18K over 4 years to not cure it. I was assuming they are people like my grandfather-in-law who had an ulcer on his leg for pretty much all the 15 years that I knew him and had district nurses changing the dressing regularly. Sometimes they would try a new cream on it, but I don't think anyone thought it would get better, they were just managing it.
If I sound positive about all this, it's because I am so fucking fed up with bad news and am trying to look on the bright side for some reason.
25: How could powder on the butt not feel like a bad day at the beach?
25: How could powder on the butt not feel like a bad day at the beach?
I have many questions about butt powder.
Speech and Language therapy for children is another area which is hopelessly limited on the NHS.
Really? Because I know an NHS speech therapist and she says that there's been massive amounts of new investment there under Sure Start and things like that. It used to be pretty poor 10 years ago but since 2007 it's really picked up.
I know (well, not random acquaintances) two kids from different families who since 2007 have been classed, by the NHS, as needing intensive SALT. Which translated into an hour a month. Which might well count as intensive by NHS standards, but isn't the usual interpretation. They both went private (using their Disabillity Living Allowance money).
Perhaps it still depends on where you are, these two are both local to me. And fortunately (?) these two children were both diagnosed with autistic spectrum disorders, so receive middle rate (I think) DLA and thus can afford to pay for stuff like SALT.
26: I know someone who went to a private hearing clinic and spent a couple of thousand pounds on a hearing aid. I was surprised, because he was 85 (in '98) and was such a strong believer in the NHS. I think she felt guilty for going private. She returned it in the end, because it didn't work as well as the big one from the NHS.
32: hmm. There may be quite a lot of variation from place to place, as you say.