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Is the NHS being privatised?

Is the fine line what is called outsourcing?

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JustLyn  Female  Cheshire
24-Sep-2020 08:59 Message #4793086
On another thread, and quite a few others, it crops up that the NHS is being privatised.

I can't at this point say "correct" from my own point of view and knowledge, especially as I have had what amounts to 26 years on and off, in the NHS since 1970, when I was a 16 year old cadet nurse. But I can say when I worked in the NHS between 1970 and 1980 when I first left to have my eldest child, I don't recall any other services that were not under the NHS labelled umbrella, but that doesn't mean there were any or not as I wasn't looking or thinking about it.

When I returned to the NHS in 1995, my first experience of privatisation influence, and as a returnee having just completed a combined Information Technology and Health related degree with the Open University, was that Information Technology and computers were becoming "useful" and recognised in health care.

I know there is a lot more than just this point in privatisation, but I feel this point of my experience is a good representative example of why I have had a bad experience of how privatisation influenced care, though there maybe other good examples.

In this experience, I arrived quite daunted. I had been away from nursing and the NHS for 15 years and saw what my interviewer, the manager of the Division of Heart Surgery described as advances in what they now called "computer care planning", so I questioned myself on would I be up to it.

Anyway, there is a lot I could write about that journey, some of it quite funny, but basically the I.T at that hospital was terrible, my home laptop would do more!
I naively started to reflect and observe, and even did my final assignment to upgrading my nursing training "Critical Incidents in Healthcare", using the example as my project.

Basically, the hospital had bought into the services of an American information technology company called HBO. I say I was naive, because I was new to the idea that people didn't actually care about the patients, but keeping their jobs in a bad system. As the most junior nurse on the ward, and expressing my experience with their system on my study day to learn the system, I was told to keep my mouth shut because jobs depended on the rubbish system continuing to be honoured.

The other enlightening thing I came across, was we had a management team at the hospital buying into what they thought was a suitable service but the people choosing it had no knowledge in what they were spending those thousands of money on.

The nurses trying to use the system were so frustrated with it, and because it was a bad system it took care away from patients as they were forced to struggle to use what was a slow and user unfriendly system. Also bear in mind, that nurses in 1995 were not familiar with computers and had never heard of email.

JustLyn  Female  Cheshire
24-Sep-2020 09:08 Message #4793087

as time goes on, what is the NHS.

Maybe we see it as a whole, or separate parts?

And we have separate parts, such as outsourcing or privatisation, whatever you choose to call it, does this not make it less compatible, with the interchanging parts the NHS used to have, such as staff sharing in bad times, shared meetings to share resources and good working practices?

One branch I see as outsourcing, or is that privatisation, is the company Care UK who many of us might be referred to, to see a consultant, as I was for ear, nose and throat (ENT), but then my doctor hardly spoke English and had flown in for the shift from Hungary, or so he told me.

But the nurses who work in these outsourced organisations are not NHS because they are not entitled to pay into the NHS pension, so that isn't NHS is it, but a way of taking away good employment practice from staff who, if working in the NHS would have other standards under Agenda for Change?

There's lots more, but just thought I'd pick up on this issue of whether we see the NHS is being increasingly influenced by companies who look to make a profit from health services, and in my view and experience, are more hangers on than part of a sharing system?
Hierophant  Male  East Anglia
24-Sep-2020 09:13 Message #4793089
I dunno, but all this "protect the NHS" stuff seems odd to me, I thought the NHS was supposed to protect us.
We're all staying away while hospitals, dentists and the rest are like ghost towns....
Pboro Trevor  Male  Cambridgeshire
24-Sep-2020 09:17 Message #4793090
The success of outsourcing depends on how well NHS Managers draft the contract.

In Leeds a service was outsourced to a private company. Part of the contract involved terms which stated that he company must update and improve the service. The Contract was for £180m over 5 years.

The company updated and improved the service, increasing throughput by over 50%.

The NHS saved £180M, serviced more patients, and did not cost any jobs.

The company made a profit, over the 5 years, of £65M.

So, if outsourcing is properly negotiated, all can benefit.

Templar2013  Male  South East London
24-Sep-2020 09:21 Message #4793092
The answer to the initial question is no. The NHS is not being privatised and no party has ever indicated a wish to do so.
It is obvious to everyone that the NHS is now providing a lot more treatments and medications than it was ever intended for. If using private contractors to provide some services within the health service which takes the pressure off the NHS financially and logistically than that has to be worthwhile as we don't want to see the health of many suffer for the sake of not accepting outside help on principle.
A national health service was always the intention of all parties long before the war and the war itself brought about the use of medical facilities nationally and no party has ever indicated they want the NHS privatised.
Maglorian  Male  North Yorkshire
24-Sep-2020 10:20 Message #4793108
"A national health service was always the intention of all parties long before the war " (Templar2013)

Churchill's Tories voted against the formation of the NHS 21 times before the act was passed, including both the Second and Third reading. Churchill sincerely believed that the NHS was a"first step to turn Britain into a National Socialist economy."

Templar's bias over rules his understanding of truth.

Last year privatisation in the NHS rose to an all-time record high of £9.2 billion.

The Tories repeatedly lie through their teeth when they say stuff like "the NHS is not for sale" because the reality is that they're busy privatising it right now, right under our noses, faster than ever.
NoSaint  Female  Devon
24-Sep-2020 10:27 Message #4793110
.Maglorian, AvitoDauphine, Wandering4Fun, Witheflow, withgoodintent, to use just a few of your names, you cannot escape your neo liberal cabal by pretending to have socialist ideals and pretending to care about others and pretending to want to help the poor. You really nasty piece of work.
You mock council house tenants? You laugh at littered communities? You make racist comments? You make snide homophobic remarks? You hate seeing the poor being helped and attack every thread where caring people try to help others. The use of fake images, verbal insults to “non-agreers”, multi profiles including a female one with access to the “ladies” room.
The only contribution you have made to the forum is reviving all the excellent votes which float around whenever one of the abhorrent trolls makes an unwelcome appearance.

Oh how our resident sneaky sniper hates the truth. He hates facts. He hates it when a poster is right and he is caught on the back foot.
Now am I addressing Maglorian or Michael or one of the others?
SQL  Male  Devon
24-Sep-2020 10:50 Message #4793114
Yes it's quite obvious that Maggs doesn't really know what the NHS really is, if he/she did then he/she would understand that privatisation is not possible.

A direct question to the aforementioned Maggs - do you know that many of the G.P.s working in the UK when the NHS was first proposed where vehemently against it's formation?

But of course it suits your methodology to extract a minority sentiment or data and parade it as the will of the huge cohort that you despise.

Another question - If a private company can offer a better and/or cheaper service than the NHS can provide then should the NHS refuse to allow that business to operate for the benefit of the patients?

Yet another question for Maggs - Have you any idea of the size of the NHS? Just count up the number of nurses, doctors, porters, consultants, registrars etc. and then look up the annual budget.

I don't really expect a sensible response, such things are well beyond the realms of reason with some people.

JustLyn  Female  Cheshire
24-Sep-2020 13:29 Message #4793130
Phobo Trevor,

I have not read subsequent posts, but why could the NHS have done the same thing, and instead of the £65m going to shareholders and profit, effectively into fresh air, the money be put back into the services?

I don't understand how one organisation can save £180M, whilst a separate one can profit £65M.

With the right managers, the improvements should be possible anyway?

Could the reduction in cost have been at the expense of staff seen as disposable, contract driven, consequently having an effect on pension saving, ability to take on a mortgage, the usual things that a long term job allows.

I would also raise the question maybe the onset of contract work is a factor in costing more in insecurity and mental health?
JustLyn  Female  Cheshire
24-Sep-2020 13:34 Message #4793131

Your answer is typically assumptive and is only an opinion.

There is no black and white answer such as "no" yet.

And nothing is "obvious" to anyone, which is why the subject warrants critical analysis, raising questions, and evidence, not opinion.

There are deeper implications as in my previous post and it is not a superficial issue where we should assume has to be worthwhile because we hope it is.

There has to be more to it.
JustLyn  Female  Cheshire
24-Sep-2020 13:47 Message #4793134

I haven't studied social history to be conversant with what Churchill did. I suppose my impression is based more in working within the NHS system and subjective observation and feel.

I have felt the increasing disjointedness as more services appear good to the patient, but in reality is at the expense of another service having to move out.

One example was the closing down very valued and used sexual health and contraception services in my health centre, then a privately owned scanning service, I mean heart scans moves in. If you need a heart scan locally at the GP it seems wonderful, but all those kids needing contraception ad hoc lost out and in the poor area we just ended up with more teenage pregnancies.

Although I am "left", I don't like conforming to all Tories because some have their hearts in the right place when I hear them as individuals, but they have this weird vote system where they have to tow the line. I recall hearing a few Tories who were unhappy about the consequences of the benefit cuts and didn't expect anything so severe.

I am not against some privatisation, but I do think a lot more is surreptitiously being brought in as NHS ad people do not realise the subtle infiltration going on.

I do recall the comments about Thatcher "selling the countries china and silver" to make a quick buck to boost the economy and I fear this may happen to the remains of the NHS to a Government like that led by Trump who is happy to turn a country into a business opportunity.
BOYDEL  Male  Surrey
24-Sep-2020 13:48 Message #4793135
Lyn - undoubtedly some NHS services are subbed out to other providers who will in some cases as you rightly suggest not be paying their staff the same relatively generous overall remuneration packages as the NHS.

The final salary NHS pension is a very valuable benefit on it's own - though I do know that contribution rates have increased substantially - last time I checked they started at 5.6% of salary and over about £28k rose to 9.3% and topped out around 14.5% (they may have increased since then).

I am guessing that NHS cleaning/catering have been subbed out for many years - and if that saves costs overall for NHS then for the NHS per se it is a good thing - though I have to agree with your point around no man is an island...but of course the core business of NHS is healthcare provision per se rather than being an extension of the welfare system.
JustLyn  Female  Cheshire
24-Sep-2020 13:59 Message #4793136

Since I have worked for and with what amounts to 24 GPs directly and many other indirectly I am pretty sure that 50% go in for medicine to help people and 50% for the status and money. I have evidence but it's personal and lengthy.

GP's as I am sure you know have an interesting history, starting out as low status blood letters with dangerous knowledge, or lack of, to an area of medicine where it was OK to snatch bodies to practise.

GP's, pre NHS era were mostly financially orientated and like many dentists are financially impacted (excuse the pun) by seeing NHS patients, so were and are GPs and other medical professionals. Many, even now, cash in, on areas they can get away with charging a fortune to unfortunately souls where the NHS has gaps in service.

One broader example of the mentality of people who go in for medicine happened a few years ago when Manchester were trying to improve a service. The nurse and physio's turned up in their own time because they wanted to learn, and none of the GPs turned up because they didn't get paid.
JustLyn  Female  Cheshire
24-Sep-2020 16:22 Message #4793144

I have read down your post and in response, especially about the cleaners. A great point and it reminded me of that experience, as NHS employed cleaning services were indeed replaced with a privatised one. This has happened in my observation twice, oddly, at the same hospital I referred to earlier between 1995 and 1999, then again in Primary Care around 2009 approximately as I was at that health centre from 2004 to 2020.

When I arrived at the heart ward in 1995 we had familiar and friendly cleaners who "belonged" to the ward and were under the ward manager (senior sister). They knew the patients, the ward was very clean, and if anyone was sick, they had a rota where one of them was on call to do additional cleaning. They were not idle in between as they cleaned anything that was asked of them, including telephones, desks, equipment, and they often "helped" patients by befriending them and spending a bit of time chatting.

But when the younger ones were offered new contracts with the private incoming service, the work that previously was extensive and was a days work for at least one person, became 2 hours a morning for 2 cleaners which involved mopping and top dusting. Nursing staff, or untrained nurses had to pick up where they could, that which didn't get done in the 2 hours, and grimy bits started to occur in dark corners. There was a quick turnover of staff so there was no time to develop a rapport or get to know staff.

Moving on the health centre, I knew the two cleaners who emptied my bins and swept the floors. They were getting on a bit, but took pride in their work. But when they retired a private cleaning service arrived, again with a quick turnover, so often the cleaning staff had no time to know the routine. I knew one of them quite well as a patient, and when the one in charge was off sick, it was J who took over. Then a couple of years later J told me she had no increase in pay for taking on the leadership role, yet she was excellent and did a great job, polite and caring to her juniors, but then she too was "junior" because the private company did nothing to recognise her ability of flexibility of helping them out.

Although it might be more expensive in money terms to give good working conditions, it also is good for morale, mental health, physical health, peoples worth, so running people into the ground might save in £'s initially in the accounts, but not if it drives them onto sick pay or as it stands now Universal Credit.

FirmButFair-TrollPatrol  Male  North Yorkshire
24-Sep-2020 17:05 Message #4793146
The success of outsourcing depends on how well NHS Managers draft the contract.

In Leeds a service was outsourced to a private company. Part of the contract involved terms which stated that he company must update and improve the service. The Contract was for £180m over 5 years.

The company updated and improved the service, increasing throughput by over 50%.

The NHS saved £180M, serviced more patients, and did not cost any jobs.

The company made a profit, over the 5 years, of £65M.

So, if outsourcing is properly negotiated, all can benefit.


A good example Trevor and one repeated throughout many industries and showing many benefits on money savings and better utilisation of skilled staff.
BOYDEL  Male  Surrey
24-Sep-2020 18:46 Message #4793153
Lyn - I did accept your point earlier around "collateral damage" - when I alluded to "no man is an island".

The NHS per se though does not have as it's core remit anything more than reactively dealing with health issues - though of course it's future case load would be minimised if all UK citizens had an optimal income and a generally nice life.

The NHS only strays in to proactivity via health advice eg around diet/exercise etc.

So when taxpayers pump cash in to the NHS the expectation is that NHS will focus on core purpose.

A good analogy is the way the Silent Witness TV show has morphed from it's core pathology role to one where the core cast have latterly taken on the role of private investigators.
wonderoushen  Female  Gwynedd
24-Sep-2020 18:58 Message #4793155
I think the loss of sexual health and contraceptive services covers a lot more than unwanted pregnancy, I think I'm right that STD's are rising? Theres more to contraception that the pill or condoms, fitting an IUD is something not every doctor or nurse is trained to do and these are still an important part of contraception and womens health in general, helping with things like heavy periods. Its important for women and couples to be able to talk through thier options with someone more specialist than a nomal GP or practice nurse. I wonder how many women open up about other issues like DV in the privacy of a sexual health and contraception clinic?
JustLyn  Female  Cheshire
24-Sep-2020 19:52 Message #4793159
I agree WH, and without any prior notification, none of the GPs in the 3 practices within the building had previously needed to train in contraception especially. Patient usually got the same thing offered and all the GPs I worked with at that point were all due to retire and not interested.
Hierophant  Male  East Anglia
25-Sep-2020 09:05 Message #4793173
One thing this pandemic has clearly showed is how clunky and slow to react the NHS and government departments are.
Maybe the NHS would benefit from being broken up into manageable pieces....
Pboro Trevor  Male  Cambridgeshire
25-Sep-2020 09:17 Message #4793175
JustLyn - to answer your question as to why the NHS could not have done the same as the private contractor - the NHS is a bureaucratic organisation, that is self centred and just doe snot have the management expertise that private organisations have. It would be almost impossible for the NHS to have done the same as the private company did.

JustLyn  Female  Cheshire
25-Sep-2020 10:48 Message #4793190

If the NHS was broken up, how could that speed up the process as they need to cooperate with each other?

Government departments do seem slow, but could they be privatised if that speeds up processes?

I suspect it's the staid mentality and lack of progressive thinking rather than the system. It needs more vitality but also not knee-jerk meaningless change for the sake of it where the same people are employed under a different banner such was when Cameron changed Primary Care Trusts into Clinical Commissioning Boards where the same people appeared in my email box under a different title.

Somehow, we need to retain experience and skill, but allow new ideas to have a voice?
BOYDEL  Male  Surrey
25-Sep-2020 11:08 Message #4793193
It's a somewhat chicken/egg question as to whether staid thinkers are attracted to the public sector or whether they just get lulled in to that by the system once they have been there for a while - a rather natural outcome for sectors which neither have to compete for customers nor funding.
JustLyn  Female  Cheshire
25-Sep-2020 11:15 Message #4793194

How is a private organisation less self-centred and bureaucratic than say, a Nationalised one?

Again, another example from my field.
Somewhere along the line around the Cameron era and commissioning, we had private 'out of hours' GP support replacing GPs who chose to drop out of evening, week-end and night visits. I worked for one for a couple of years to earn a bit extra. None of the nurses were valued and treated like fodder. The management acted like back in the Victorian days, very much them and us, staff leaked like water so much, I wondered when they would run out of applicants. Two entrepreneuriale GPs, the type I alluded to earlier, not in it for the patients but the money, ran the place with their eyes clocking up the £ sign as their motivation. When that team saw patients, they had no access to a complete medical history because if such services are fragmented, then so is access to our medical records, or lack of.

I see the problem is our bureaucracy needs to be more transparent and open to criticism.

The problem we have we a lot of things, and I don't know the solution, is we have lots of people making judgements on things they don't actually have any training or knowledge about. I noticed this in the management of IT at the big hospital, and the powers GPs hold because they have a medical degree in management of business in general practice, even down to we, the voters, having a vote on issues some of us may never have taken the time to check facts on or learn about, including myself.

One thing I notice, is people not in "the system" of whatever it is, are quick to moan about excessive bureaucracy. Take the nurses in 1995 who didn't know what email was. We used to write a sentence about each patient, often repetitive, "slept well", whereas when forced to document other aspects in a proforma, they might have to write how well the wound is healing, if they had taken their medications. So this involved sitting down at the nurses station longer. The difference is, one nurse might see patient care as solely by the patient bedside holding the hand, but not have any foresight that the next nurse taking over the shift has a "need to know" of what took place, or didn't on the previous shift. The essence is being able to do both and that both is care of the patient, not one or the other, but those nurses saw computers as an imposition. We had a lovely ward manager, but she had no vision of how using a good computer system could enhance care of the patient not diminish it. Had I been a the divisional manager that took me on, or been in charge of that hospital, I would see it has my job to motivate staff to also allow them access to training to know about progress in areas that would not have crossed their mind in those days. Had they had a vote, all the computers would have been removed.

I'm not sure management would be any different in private or national systems, but my idea of socialism is "the many" being on board of progress rather than "the few" or "bottom up" working as opposed to the "top down" dictatorial Victorian approach where the employed are treated ore like machines and disposable?
MrQuiet  Male  Northamptonshire
25-Sep-2020 11:50 Message #4793200
Theoretically I would like to see more nationalised industries but history has shown both here and in other countries that it simply does not work. Nationalisation had only ever brought problems and have very soon been dictated to by the unions making an incompetent organisation into an even more incompetent organisation.

Even Stalin had to admit defeat on that issue.
Maglorian  Male  North Yorkshire
25-Sep-2020 17:15 Message #4793215
In March the professional body for medical lab scientists wrote to the Department of Health to discuss how to expand coronavirus testing. They never received a reply (presumably because 'this country has had enough of experts').
Instead of consulting with the experts to devise a plan, the Tories decided to bring in their corporate mates (Serco, Sitel, Deloitte, Mitie, G4S, Sodexo, Boots, Randox, Amazon, and TransUnion ...) to cobble together a Test and Trace system.
Six months later and the system that was needed during the first wave, still isn't fit for purpose in time for the looming second wave.

And now the Tory government admit that they've blasted a whopping £13,000,000,000 on this shambolic failure of a system.
You might think that ignoring the experts to waste 13 billion quid on a system that doesn't work properly represents a catastrophic failure, but it's actually a roaring success if you see it in Tory terms.

Ever since Thatcher and the radical right took control of the Conservative Party, the core purpose of their entire political operation has been to transfer as much public wealth as possible into private ownership, and this shambles of a scheme has successfully transferred £13 billion from the public finances to the balance sheets of profiteering private corporations.
In terms of developing the means to contain the virus, providing value for public money, saving lives, preventing another economically catastrophic lockdown ... this privatised Test and Trace shambles is a horrifying and outrageous failure.
But in terms of enriching their corporate mates, it's one of the best scams the Tory party has ever pulled on the British public. Going by a couple of boot licking tory die hards on here, £13 Billion squandered is good business.

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