Forum Topic

"Our NHS is not for sale"?

The Daily Mail (the Daily Mail!)  reports that an analysis for the GMB union has shown that private firms were awarded contracts worth £3.6bn last year alone, an increase of 89% since 2015, and that two thirds (61 per cent) of the £23.9bn spent on services since 2015 was handed to private companies. And still the Conservatives claim that the NHS is not for sale. Of course it's not up for sale en bloc, which enables them to mouth the lie, but piece by piece it's being dismantled. https://www.dailymail.co.uk/health/article-7739283/Private-companies-won-15BILLION-NHS-contracts-2015.html

Richard Carter ● 2538d22 Comments

outsourcing has been a very successful strategy for Wandsworth Council, so why is NHS outsourcing such a no-no? If (and that's a big if) it improves services and saves money, why not?

Adam Tripp ● 2538d

Its nothing to do with improving services (for which, by the way, there's no evidence at all) but about cutting costs - which firms to by paying staff less and providing worse conditions of work.

Richard Carter ● 2538d

"by paying staff less and providing worse conditions of work" I would be interested to see some evidence of this Richard, thx. perhaps one of your famous links :))

Adam Tripp ● 2538d

Richard, I had a look at the DM article, it mentions "service contracts" repeatedly. Presumably these contracts have 'Service Level Agreements' and renew dates, so it's up to the Gov. to ensure NHS standards are applied. I just can't see the problem, if a company doesnt meet the terms of the contract, find a new supplier.

Adam Tripp ● 2538d

Here are just three examples - and before you claim that TUPE regs protect workers, they can be evaded. https://www.theguardian.com/society/patrick-butler-cuts-blog/2014/sep/22/outsourcing-same-job-same-hours-less-payhttps://www.ft.com/content/b0cfca2c-be7a-11e4-a341-00144feab7dehttps://smithinstitutethinktank.files.wordpress.com/2014/09/outsourcing-the-cuts-pay-and-employment-effects-of-contracting-out.pdf

Richard Carter ● 2538d

This subject always depresses me hugely.  The NHS - healthcare free at the point of use - is a wonderful idea that we should rightly be proud of and never lose.  The hysteria  that surrounds any attempt to change, alter or improve, however, is utterly counter-productive and costs lives. Right now, advances in healthcare, are happening at breakneck speed.  AI robots can now spot cancers better than consultants; the likes of Google have mined millions of pieces of data to produce programmes that can predict the likelihood of people developing heart disease far better than humans, whilst just last month there were reports of an 19 year old non-medical student who has developed a programme that has been proven to spot the early signs of Parkinson’s purely from facial recognition.  All of these advances - and hundreds like them - have the potential to save and improve millions of lives, but all of them have been developed by private, profit-making companies.  There is no way the NHS can keep up with the pace of developments - and nor should they try to.  Instead isn’t it better to allow others to fund developments and innovation and then work with the best?  I think it’s great news that the NHS is seeking to partner with companies like those I’ve mentioned (and in some cases is already doing so.) Yet, such partnerships are rarely talked about openly, because they’re always met with cries of ‘privatisation.’  Personally I welcome any partnerships that improve lives and outcomes for people.  How I wish we could just stop using the NHS as a political football. 

Craig Fordham ● 2538d

Adam. To effectively manage outsourcing and SLAs one has to understand how to negotiate and monitor such arrangements. Just remember the issues created in the NHS by the Carillon collapse (I suspect adequate financial due diligence would have shown the contracts weren't viable) and the criticism of the Atos benefit assessments - what oversight was being provided by the DWP? Outsourcing should be done to provide a better, more efficient service but not necessarily cut costs. One still has to refrain the necessary expertise to negotiate, manage and supervise outsourced activities. One also has to recognise that you'll get no more than you contracted for, and if you're not vigilant you may well get less. I suspect many in the NHS operating outsourced activities are either managers who don't understand what's been outsourced or are medical practitioners who don't understand the finer complexities of of outsourcing contracts. I'm basing that on a short time spent in an NHS service area that was effectively an internal "outsourced" service. 

Michael Ixer ● 2538d

Remember all those letters and referrals from doctors which were outsourced to a private company and which were just put into storage? There must have been a million of them.  How many people's lives were adversely affected as a result of that?  They would have died anyway?  Well bravo - we all know that we are all going to die sometime - it is just it needn't have been so soon and we could have sent more time together.

Philippa Bond ● 2538d

Spot on Michael.  If there are issues around current outsourcing arrangements, it’s due to the NHS’ capability to negotiate good value deals and manage them effectively

Craig Fordham ● 2538d

And presumably some  of the supply contracts are for food for patients or is it suggested the NHS should buy some farms and grow their own?

Andy Pike ● 2538d

And bedding and surgical instruments and trolleys and beds etc etc or should they open their own factories.??

Andy Pike ● 2538d

I have been using Queen Mary's for a long time.  The eye department.  Some time ago ,2-3 years, I can't remember exactly,  Moorfields eye hospital became responsible for delivery of services.  Likewise podiatry went to other suppliers.  My Putneymead medical practice has people to manage their new website, which is now far easier to access and navigate and carries much more information. If the NHS were to stop doing cosmetic surgery and stick to medical problems there would be more money.  Also health tourists should pay for treatment. Doctors should be allowed to be doctors.

Barbara Shillabeer ● 2538d

'Doctors should be allowed to be doctors.'I wasn't aware they aren't 'allowed to be doctors'?

Lucille Grant ● 2538d

Hello Adam,Outsourcing became a fashion in the late '90s I think and, from my own experience, it ended up being more expensive compared to the original system.  As the saying goes, if you want something done properly, do it yourself.Comparing outsourcing in Wandsworth Council to that in a hospital is really a non-starter.  What is good for the goose, in this case, is certainly not good for the gander.An example is paying a bill of £1,250 to contractors to change a light bulb or £700 to change a fuse.  No no no!From experience, catering at a hospital.  The offer was pre-packaged curries prepared at Heathrow warehouses, a salad consisting of iceberg lettuce leaves with plastic cheese or mashed potatoes made from packages.  This is not what I call healthy food for patients trying to recover from whatever.While in theory a private company would supposedly be more efficient at running its operation (profits must be made), by definition the NHS is contributing to the profits of that particular company before considering the infrastructure of its own hospitals and the well being as well as quality of its staff.I can give you an example from my audiology consultant. He was the Head of the Audiology Department at an important hospital in London.  He is no longer there because of the pressures in the system - buildings being run down because maintenance had been outsourced and not much was happening, staff being appointed who could not write a coherent sentence let alone transmit a message properly.Without proper management, outsourcing really cripples you (or the NHS Trusts).Another case of course, is the asset stripping of Queen Mary's Hospital.  But this post is long enough at the moment.

Ivonne Holliday ● 2538d

Hello Barbara,I was not aware that Moorfields was delivering the service at Queen Mary's.  But Moorfields is part of the NHS, is it not?As for cosmetic surgery, I would be wary of putting a full stop to this.  Somebody who has suffered an acid attack on his/her face, why not cosmetic surgery.  Or becoming disfigured due to an accident.I have experienced plastic surgery (I know, it is not the same as cosmetic surgery), but when you need it, you need it.If a woman who had breast cancer needs and implant, why not? But I do agree that, if something goes wrong with a breast implant provided by a private clinic, they should rectify it and not the NHS.  I do agree, however, if somebody wants cosmetic surgery for vanity purposes, the NHS should reconsider.  I do not, however, understand your statement that doctors should be allowed to be doctors.

Ivonne Holliday ● 2538d

Don't be so pedantic.  I shall spell it out.  They should be allowed the time to practice medicine and not have to become computer experts, work out human resources and do all other administration work too.

Barbara Shillabeer ● 2537d

Ivonne.  Apologies.  you are quite correct.  Most of Moorfields is NHS but certain departments are private.  Not as many as I had understood there to be.Happy to be put right.  I did actually mean vanity treatment.  Breasts.noses etc. Being deformed  I didn't include

Barbara Shillabeer ● 2537d

It was a serious question Barbara. But thank you for  your explanation.I don't think doctors have to become  'computer experts' just as computer expert aren't expected to be doctors. And hospitals rightly or wrongly have managers  who deal with human resources and administration.

Lucille Grant ● 2537d

The eye clinic in Kingston hospital is also run by Moorfields and highly expert and efficient it is too. Moorfields is a world class centre of excellence.

Jonathan Callaway ● 2537d

Nice try (tries) Andy and Adam, but you've actually missed the point. Of course the NHS has always bought in supplies from (private) manufacturers but this is about selling off services, a very different matter.

Richard Carter ● 2537d

Richard, correct, I was talking about outsourcing operational processes not purchasing materials used in those processes. Sometimes outsourcing is sensible. IT is an area where it makes sense if done correctly, and probably many peripheral NHS services wouldn't have been hit by the Wanna Cry ransomware if they'd outsourced their IT to a reputable service provider, or at least they could have gained compensation if they'd had a good contract (I understand the core, centrally managed, NHS IT facilities weren't affected). Cleaning and meal services can be more problematic, if it's a well written contract fine but if nurses on the ward don't have a means of remediation for non performance of the contract then  it may not work. 

Michael Ixer ● 2537d

Meal services can leave wards without access to food for patients.  Food is delivered on a trolley which sits until the right time permeating the wards with food smells which can reduce the appetite.  It is swiftly dispensed in the best of circumstances with help from additional staff who can help by making sure it is placed where patients can reach it and so that if it is packaged that packaging opened including the mini ketchup and salad dressing packets which can if they make it to bedside make the chopped iceberg lettuce and other unpalatable and dry food more inviting when you are desperately trying to get well and out of hospital.  When you leave pizza in a hot trolley for long it turns rigid and impossible to bite into and dangerous to teeth!  The contract may mean that the person delivering the food from the kitchen has just a certain amount  of time to get it all out and delivered and then all the plates collected again and back - no flexibility.

Philippa Bond ● 2537d