Branwen Jeffeys looks at some of the key dilemmas facing the NHS.
Programme 3
Tuesday 15 July 2008
Who should provide healthcare paid for by the NHS? Public vs. Private?
In the last decade the NHS in England has used the private sector on an unprecedented scale while in the rest of the UK the NHS has eschewed private involvement.
Critics say that private sector involvement drives down standards in a bid to maximise profits whereas suporters claim that commerical instinct has brought much-needed efficiency, competition and a focus on treating patients as consumers.
Should the NHS be wary of private sector involvement or should it be more fully embraced?
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Have your say
Who should provide healthcare paid for by the NHS? Public vs. Private
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Ben Ross I wonder if any private treatment centre would have allowed me to have had the complicated and dangerous heart surgery, which I, at 78 years old, had last year. I worked in the NHS for 56 years and I am saddened by what this government is doing to it.
W J Dickens - Lowestoft The NHS should be funded by the tax payer and all private business, especially US American avoided
Sally I worked some years ago for a firm of 'Management Consultants.’ They were keenly into working out how to maximise profit from a medical service which would on the surface be offering caring efficient services at a central point instead of the current visiting home service for children disabled by various diseases. The central clinic would superficially be able to offer a wider range of treatments and better access to equipment. Patients would visit a centre rather than have treatment at home. The reality at the centre would be a shorter time span allotted to each person and treatment by a changing range of medical staff which would veil accountability. Profit would be gained by not ever giving quite the level of care/treatment needed thus resulting in more repeat visits for treatment - each visit paid for by the NHS. Pragmatism and profit-making work best where people are the most vulnerable. Research had shown them that this practice, already operating in certain places in Europe worked very profitably and after all what did it matter about lack of proper treatment as the span of life for many of these patients was limited anyway. They planned an initial development in rural Ireland, England not being quite ready for this concept yet. Once the Irish model was accepted, it would be wheeled out in England.
The Labour Party will lose the next election if they continue to push for the NHS to be run by the private sector. Some voters myself included only vote for them because of the NHS. Perhaps we need better Labour MP's
William Savage There was much talk about evidence but so little given in this discussion. The NHS 1948 model is not delivering the standard and quality of service or treatment required and yet there was no challenge to the failure of the nationalised service. Instead Alysson Pollock delivered her usual hysterical ideological rant against profit and American business which seemed to be the panel's default position. The NHS must change. The new model has never been coherently spelled out with all the issues of quality, equity and cost faced. The new model needs new people who can deal with private sector negotiation and then monitoring by an independent NHS free of politicians. The country is in a fog of nostalgia for a 1948 NHS myth. We need private services and private sector people involved from root to branch otherwise the nationalised NHS will be swept away by a tide of patient dissatisfaction
John C, Liverpool In all these private hospitals, are there Intensive Care Units? In case these surgeons make a mistake who picks up the cost? It’s my understanding that the private patients are then rushed into NHS ITU units. In other words, the private system is not a holistic system. They are not integrated fully to deal with emergencies, but the NHS is.
Ralph Gee, Nottingham Although the provenance of the protagonists of continuing public service was given in this morning's feature, we were not told who pays the salaries of those arguing for further extension of NHS privatisation - and I cannot believe they are doing whatever they do for nothing, paid by no-one. Is the source of their bribes therefore a commercial secret? I think is a foreboding of the future clandestinity of the privatised NHS - and it is irresponsible of the BBC to pretend that those spokespeople are so objective that we need not know whose hats they wear. We must know who is paying them if we are to accept or reject their arguments on the viability of US-owned health operators. Any camouflage is a continuing deceit.
Linda Kaucher, London These programs are missing the big picture - trade agreement commitments on the liberalisation of health investment. You are only talking at the consumer level, not the investment level driving it
Mr Skipper, Oxford I have just listened to the debate, Allyson informed us that we are in receipt of one hospital having paid for three! Why was this not picked up? The situation is beyond belief.
Karen Skinner Comments: I am a nurse working in the NHS in acute medical care. All the discussions regarding involvement of the private sector seem to reflect what is happening with surgical care. Nobody seems to consider in broadcast discussions how the private sector can manage medical care, e.g. patients with diabetes, cardiac conditions, asthma and other respiratory diseases, epilepsy, pneumonias, viral infections, cancer not requiring surgery or post surgery, neurological conditions, hepatic and renal disease and all the other conditions which bring patients into the acute hospital setting. These patients may get better following one hospital admission, but many go on to develop chronic conditions which require management for the rest of the patients' life. A price cannot be put on the treatment of these individuals in the same way as can be applied to the one-off cost of treatment of many surgical treatments and the private sector and insurance companies have shown very little interest in picking up the care of these patients, indeed often excluding them from insurance cover. Who should provide their healthcare? There is no justification for diverting resources to contract and regulate the private sector to deliver service for the NHS -- resources that should be used to provide health services directly to the public. It's staggering that despite the lessons and appalling experience of private health care provision in the US -- these same US private companies are being invited to guide UK health care provision.
Dee Coombes I have been a patient in both the private sector (on a waiting list initiative) and the NHS. The private hospital was wonderful. It was clean and friendly and pleasant and everyone who worked there was helpful and concerned - just like the NHS hospitals used to be before they were virtually privatised and broken into so many privately owned, profit-making businesses. What the Private hospital had going for it was that everyone there had the same employer and they had had an ethos of focusing on the patient - just like the old NHS.
John The case made against privatisation has been much more persuasive. The deceit by the government is appalling
Anon, Caterham Surrey Three cheers for Allyson. This is an example (and there are several others) of the Blair government being entirely subservient to American influence. I can't use the word I feel describes it, but we don't want any American influence here. From what I know of the American health system, we should leave it alone.
Lindsay, Staffordshire Why do you not challenge the continued use of the nonsensical phrase "free at the point of need"? Of course it's free to need healthcare, what costs money is receiving it. We need to know whether this phrase is used and tolerated because of ignorance, thoughtlessness or deceitfulness.
Phil, Ribble Valley I was in hospital for 2 months last year during a transitional period when the local PFI provider was taking over. I learned that a washbasin in the x-ray dept. was to be replaced at a cost 8 TIMES higher than that previously quoted a few weeks earlier by the previous NHS on site works dept. I asked lots of informal questions ... there were other similar examples of massively increased charges.
A&E consultant Lanarkshire Two of the three hospitals in this region are PFI. Huge money is spent to service the debt incurred. Staffing levels on the ground suffer and bed numbers are curtailed causing compromise of patient care and staff welfare.
Sylvia, West Midlands My doctor and her partner have both trained long and hard to become GPs. They both complete their training in practice next month and, due to the government's changes in GPs' contracts, neither has a permanent position to take up. What a waste of talent. My husband and I have been delighted with our doctor's caring attitude and efficient handling of our health requirements. Just listening to your programme, I wondered whether this is a suitable place to raise this further example of the sad state of the NHS.
Michael Watson Essex Why do programmes such as your concentrate almost exclusively on hospital care and only operations there. People are far more likely to see their GP in the course of the year and more likely to complain when they can’t find an NHS dentist.
Daisy, Isle of Wight American press such as The New York Times have for years published articles of the failures of US health provision, the rising costs. It has been the US health industry that has been pressing to enter European health provision through the World Trade Organisation (WTO). The WTO has pressured the European Commission to enable US private health providers to have more and more access to the NHS, our government has not told us about this. With private health care provision will we ever know the real cost. The private sector will always talk about “commercial confidentiality” when it comes to finding out the real cost comparison with the NHS.
Rae, S London What about preventative health care - smoking cessation, cancer screening, healthy eating education.. What will happen to these aspects if private companies make decisions about where money is spent since surely preventing disease is not a profitable exercise.
Jock, Stornoway Comments: If the idea that the Private sector makes things so much better, why are the trains still rubbish? Private companies only want to make money for shareholders - if Private enterprise can make the WHOLE NHS work, then let those models be adopted by the Government, and have the 'profit' back in the public purse - offer percentage bonus on profit to those who effect it. However, this is where the idea that all types of medical care can turn profit comes into question, and your correspondent's point about 'cherry picking' is right enough. In short, hands off the NHS, keep it public through and through. Or we'll be sorry!
Paul, Cambridge I listened to both points of view. I'm not convinced by the spin placed on the private sector argument that it has been involved from the start - of course it has and the drug companies have made a fortune on the soft target that is the NHS. 35% - 40% cost as opposed to 6% when the private sector was not involved seems to me indicative of where UK Plc is again ripped off by the corporate leeches.Let's face it - apart from a very few, when there's money to be made easily and no real regulation of the corporate rip off that is Britain 2008, all arguments appear to be hollow. It is about time that we were Governed by people who genuinely cared as apposed to what they are going to make personally once they are no longer in Government - cynical I know but then it is so widespread now, how can anyone avoid the cynicism. By the way, I am very much an entrepreneur who has always created jobs and run my own business, so please don't think I have an axe to grind. The problem is, money and not service is the controlling factor and until you get rid of this material mindset as the only reason, the NHS will continue to be ripped off by the private sector.
Keith,East Herts One of the major problems of the private sector involvement is the fact the NHS still has to pick up the pieces of the failed operations. If something should go wrong, they don't handle any emergencies but hand them over to the NHS to provide the care, and more importantly, the cost! Secondly, the private sector companies will only provide care for the operations that are most likely not to cause complications, leaving the NHS to provide care for the high risk, and most notably, high cost, care. So in the end, the only beneficiaries are the private care companies and the losers are us tax payers. We lose both for the care, and the cost. We also lose because NHS provides all the training, but loses the qualified personnel to the private care institutions. Consequently, we the tax payers ultimately bear the cost as does the NHS, and the private companies have lower costs. Ultimately, we cannot hand over our healthcare to profit motivations. Healthcare that is profit based results in a system like the US where treatment is only provided if the patient can afford it. In summary, a profit driven approach will result in a system where the NHS is responsible for the HIGH RISK issues, low income groups, and emergency service. An NHS that also provides the low risk healthcare facilities allows costs recoup some of their costs. However, allowing profit motivation prevents the NHS from recouping any costs from low risk healthcare operations.
Tony, Health Policy Analyst, London It may be efficient to use the private sector in the NHS but not if the civil service are doing it against a clock set ticking by ministers. Judged by contracts for GPs and Consultants, civil servants do not make good negotiators. We need much more transparency and experiment to make sure we get value for money and efficient services where we use the private sector for the NHS.
Terry, South Wales Here in Wales we have free prescriptions - what a stupid idea! Zero cost equals infinite demand. There should always be a cost for medical services albeit affordable.
Robert Howard, Nottingham Doctors are not businesses. They are highly paid, very skilled, workers. I have no problem with them being self-employed, but this is very different from a large private health business whose primary obligation is to their shareholders. Profit and health-care are contradictory. The NHS is very English insomuch as it is about mutual self-interest.
Paul Bale, London SE Agree with no private contribution. Else winners and losers follow & equitability and competence are compromised. However MMR could be avoided under private health care.
Alan Woodburn, Truro NO to the private sector. Illness is not something to be making money from. Keep the NHS.
Will Davies, London I entirely agreed with the sentiments of your guest, Allyson, who was attacking use of private contractors, but sadly she was making very little sense. She had evidently been briefed on a few technocratic policy buzzwords ('market failure', 'incomplete contracts', 'risk aversion') but didn't know what any of them meant. For instance, the fact that some people are excluded from a market is not (as she said) a 'market failure', it's just undesirable, which is not the same thing. To say, as she kept doing, that there is no 'evidence' that private contracting won't damage the NHS is a gross misunderstanding of what it's possible to do with evidence. Policy debate is already damaged by excessive use of economics, without it also being seized by those who don't understand it.
Stuart, Derbyshire For many years we have been under the illusion that then NHS is improving. I have seen the opposite I have to pay for glasses and dentistry, as a smoker, drinker the inference is that should I fall ill due to either of these life choices I will be charged or find my self in a post code lottery should treatment be allowed. I think we should provide without reservation the funding needed from British pockets and then we may benefit from the research. This would keep our institution for the UK free at the point of need not budgeted by an outside contractor how would ultimately pick and choose the most profitable area of the business and close or vastly reduce patient care, according to the balance sheet.
John, Hailsham If Private companies can make a profit from NHS services then it is a sad reflection upon the management which is far too top heavy that it cannot use that profit margin to provide a better service. If however a person wishes to purchase drugs that the NHS cannot afford it should not restrict them from enjoying what they have paid for all their lives. It is no more than making a donation toward the cost of their care. I had an operation in the Private sector, and ended up in the ICU of a NHS hospital because the private one had no facilities to deal with the emergency that arose.
Peter Duerden, Darwen How can PFI be good for the public? My local hospital cosy £113million to build using PFI but over the next 30 years will have to pay back £680 million,They have already had to close units and wards due to a shortage of money. How can Brown pretend that this is a benefit to people health care?
Kailash Chand Government's main strategy is– the privatisation of clinical services and their sale to the highest bidder. Lord Darzi's review is another nail in the destruction of everything that the NHS has stood for in last 60 years.
Trevor, West Sussex We need to obtain healthcare from what ever source provides a quality services. It is vital that outcome audits are regularly undertaken and compared with other 1st world countries. Look at Neurology services, the UK is still in the 3rd world
Greg, London Even beyond the ideological flaws whereby Private is driven by financial, not social, outcomes, the private sector has no evidence-base for improving the NHS. ISTC’ s for example have simply sucked money away from NHS hospitals. Payment by results and the 'internal market' has in turn reduced collaboration and trust between hospitals rather than increasing efficiency. On top, the least successful hospitals that all this 'market forces' dogma was meant to improve have still done poorly because health always was and is linked to wealth/poverty.
Received by SMS
Every service which has been privatised, GPO, railways, dentists, water, care of elderly, on and on is less efficient, more expensive and many are sabotaged by government interference to bring about a case for privatisation. My husband and myself both experienced this in care sector and GPO. Please God not this route. We have not had a dentist for two years.
Private health care and funding has to be involved I need treatment NHS cannot provide . Only get it in Europe USA. My PCT not helping, have to sell my home to get cancer care
My 91 year old mother had a serious stroke last Sept. Despite her poor prognosis she has had countless hours of Speech Therapy, Occupational Therapy and Physio. Because of my nursing background I know that 10 years ago we would have had to fight for all these things because of her age. Don't tell us that the private sector would have been willing to invest in the future of a very old lady
There+is+only+1+option++n.h.s.
On the question of judging outcomes for GP's. How is this possible, when some practices drop elderly and costly patients as a matter of routine? A C. Grimsby
I am a GP & my partner works 60 hours a week as an ITU registrar. I teach at our local medical school because quality of care is dependent on medical education. As a patient I would ALWAYS WANT TO BE IN A TEACHING ENVIRONMENT.
It is illness for profit and the inevitable insurance plan to support the system that worries me. Louise in Derry
No until governance is clear and patient holds own data and have access to actual performance re medics. NHS System does not work well and services are inferior while managers hide behind words. The conversation is about service and patients like in reality are the last. Lilly Evans NO
NHS surgeons are happy to treat patients in private hospitals at high tariff, but unhappy if the NHS contracts for patients to access such capacity at the lower NHS tariff which effectively limits the payment per case to the surgeon. NHS contracts with the independent sector, if done well, deliver value. PCT Commissioner, NW
I was a nurse and proud of the NHS. My family at the moment has 4 doctors. 3 nurses and 1 midwife all giving excellent service. All complain of great waste of money and managers who do not understand the health service requirements because they have no personal experience of patients needs. You can’t beat the NHS with the family doctor and hospitals governed by consultants and matrons along with finance officers in local hospitals.
I think your two samples were skewed. I would be certain that if you would fund all hospitals to the level of a half private/half public per patient everyone could have a bathroom between two! What’s wrong with the profit motive, any profit would be taken out of the tax money put in or a shortening of care given. I would like to see private healthcare banned in this country. Robin
No no no to privatising the NHS
Re NHS debate . Only a fool could believe that letting us big business run the NHS will be successful . It will be a disaster . No evidence needed just common sense
As a diabetic for 42 years it is obvious now that private is swallowing a huge part of the NHS money with no recourse to questioning them when they refuse you treatment. Alison
Alison is entirely correct and bases her argument on solid evidence, not as Paul et al does on vacuous sound-bites slurs and dodgy ideology. As a research scientist, I trust the rigorous analysis of evidence. Paul is just wrong, the market does not work for patients in medicine and healthcare. P Maclean , bristol.
Americanise the NHS! No thanks !
As NHS physio there is no longer access to care for patient at point of need... Waiting list allowed to be 6 months long due to lack of replacement of staff.
Thank you for an excellent programme. Those advocating private involvement are economically solvent enough to pay for private care and insurances that go with that structure. Lets remember the NHS trains about 95% of those who defect to work in the private sector. If it's more effecient or effective managers that the NHS needs why don't we train staff to do this? It would be far more cost-effective. Private is portrayed as better but it's the same trained staff that work in it. Private is an expensive con. Paul, Edinburgh
Many people come from abroad and receive free treatment when they have to pay in there own I think they should earn the right to that treatment through contributions paid from their wages and insurance like they do in their own country we have to when we go abroad from Theresa Rapley
Quality is only improved under privatisation for a portion of society who fit in with their profit motive. Those who don't will not experience it.
A patient of NHS for all my 33yrs, fantastic care, sadly seen increase of managers & PFI projects taking essential money away from &affecting services. Dawn Essex
Private provision is simply wrong. Medical decisions should be made on medical criteria. The logical result of introducing financial criteria into what should essentially be a system of triage can be seen in American A+E. Private health care operates by reintroducing anxiety and fear to its subjects and their families. BUPA have now commenced the Cancer adverts!
The private sector is a major cause of ill health ie alcohol, tobacco, unhealthy food. Profit first! Let them in the health service? No way. Eric
I was a Harkness fellow in health policy. I spent a year in the USA studying their systems which leave millions without adequate care. Many Americans envy us the nhs. From a distance they see the its great advantages whereas we see only faults. We need to re-affirm the NHS model, and improve it, not destroy it with private investment. Many health workers think the NHS is already terminally ill. This whole debate is really about political lobbying, not health or public finance.
Private Medicine is like running a garage. Quick oil change & maybe gearbox repair but don’t touch rusty jalopies. So Private Medicine not likely to touch elderly with multiple diagnosis or long term mentally ill which is where growth lies.
Health care is paid for through tax. It’s not free. If people make profit it obviously means less money available for delivery of health care. We ought to vote on it
Margaret Thatcher brought in internal market with a great increase in admin costs. Previously the service was centrally funded with minimum costs. Keithsimpson 41 years in nhs.
Evidence from 1930s is clear - market brought dislocation of service and wastefulness and bankruptcy Liz, Oxford
I am completely against the introduction of the private sector. It undermines the NHS. Profit will distort goals and commissioning definitely distorts. Please ask the Gov't to stop the increase in PFI. GPs are having to become big businesses in order to compete. I'd rather they stayed small and got on with being doctors in their small communities. N. Benenson
I work in a private practice. Insurance companies dump on the health service. They do not want to know you if you are sick or old and if you have a pace maker they will not pay for the battery checks the NHS has to do it. They change their terms at will and patients are forever complaining about the stress they cause at the very time in life when they don’t need it believe me there is no alternative to the NHS.
Two points.......private health has an incentive to keep people ill (or devise a need for regular testing eg colonoscopy). Two.......we refer to 'the NHS' when complaining we should name staff and name hospitals he we want improvements.
A 6 month waiting list for a hernia operation at William Harvey Hospital Kent. How come. Roy, Folkestone
I don't want business making a profit from my illness and old age Liz Robertson
I would rather trust Allyson and her version of events Roger Allen
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Ben Ross
I wonder if any private treatment centre would have allowed me to have had the complicated and dangerous heart surgery, which I, at 78 years old, had last year. I worked in the NHS for 56 years and I am saddened by what this government is doing to it.
W J Dickens - Lowestoft
The NHS should be funded by the tax payer and all private business, especially US American avoided
Sally
I worked some years ago for a firm of 'Management Consultants.’ They were keenly into working out how to maximise profit from a medical service which would on the surface be offering caring efficient services at a central point instead of the current visiting home service for children disabled by various diseases. The central clinic would superficially be able to offer a wider range of treatments and better access to equipment. Patients would visit a centre rather than have treatment at home. The reality at the centre would be a shorter time span allotted to each person and treatment by a changing range of medical staff which would veil accountability. Profit would be gained by not ever giving quite the level of care/treatment needed thus resulting in more repeat visits for treatment - each visit paid for by the NHS. Pragmatism and profit-making work best where people are the most vulnerable. Research had shown them that this practice, already operating in certain places in Europe worked very profitably and after all what did it matter about lack of proper treatment as the span of life for many of these patients was limited anyway. They planned an initial development in rural Ireland, England not being quite ready for this concept yet. Once the Irish model was accepted, it would be wheeled out in England.
The Labour Party will lose the next election if they continue to push for the NHS to be run by the private sector. Some voters myself included only vote for them because of the NHS. Perhaps we need better Labour MP's
William Savage
There was much talk about evidence but so little given in this discussion. The NHS 1948 model is not delivering the standard and quality of service or treatment required and yet there was no challenge to the failure of the nationalised service. Instead Alysson Pollock delivered her usual hysterical ideological rant against profit and American business which seemed to be the panel's default position. The NHS must change. The new model has never been coherently spelled out with all the issues of quality, equity and cost faced. The new model needs new people who can deal with private sector negotiation and then monitoring by an independent NHS free of politicians. The country is in a fog of nostalgia for a 1948 NHS myth. We need private services and private sector people involved from root to branch otherwise the nationalised NHS will be swept away by a tide of patient dissatisfaction
John C, Liverpool
In all these private hospitals, are there Intensive Care Units? In case these surgeons make a mistake who picks up the cost? It’s my understanding that the private patients are then rushed into NHS ITU units. In other words, the private system is not a holistic system. They are not integrated fully to deal with emergencies, but the NHS is.
Ralph Gee, Nottingham
Although the provenance of the protagonists of continuing public service was given in this morning's feature, we were not told who pays the salaries of those arguing for further extension of NHS privatisation - and I cannot believe they are doing whatever they do for nothing, paid by no-one. Is the source of their bribes therefore a commercial secret? I think is a foreboding of the future clandestinity of the privatised NHS - and it is irresponsible of the BBC to pretend that those spokespeople are so objective that we need not know whose hats they wear. We must know who is paying them if we are to accept or reject their arguments on the viability of US-owned health operators. Any camouflage is a continuing deceit.
Linda Kaucher, London
These programs are missing the big picture - trade agreement commitments on the liberalisation of health investment. You are only talking at the consumer level, not the investment level driving it
Mr Skipper, Oxford
I have just listened to the debate, Allyson informed us that we are in receipt of one hospital having paid for three! Why was this not picked up? The situation is beyond belief.
Karen Skinner
Comments: I am a nurse working in the NHS in acute medical care. All the discussions regarding involvement of the private sector seem to reflect what is happening with surgical care. Nobody seems to consider in broadcast discussions how the private sector can manage medical care, e.g. patients with diabetes, cardiac conditions, asthma and other respiratory diseases, epilepsy, pneumonias, viral infections, cancer not requiring surgery or post surgery, neurological conditions, hepatic and renal disease and all the other conditions which bring patients into the acute hospital setting. These patients may get better following one hospital admission, but many go on to develop chronic conditions which require management for the rest of the patients' life. A price cannot be put on the treatment of these individuals in the same way as can be applied to the one-off cost of treatment of many surgical treatments and the private sector and insurance companies have shown very little interest in picking up the care of these patients, indeed often excluding them from insurance cover. Who should provide their healthcare? There is no justification for diverting resources to contract and regulate the private sector to deliver service for the NHS -- resources that should be used to provide health services directly to the public. It's staggering that despite the lessons and appalling experience of private health care provision in the US -- these same US private companies are being invited to guide UK health care provision.
Dee Coombes
I have been a patient in both the private sector (on a waiting list initiative) and the NHS. The private hospital was wonderful. It was clean and friendly and pleasant and everyone who worked there was helpful and concerned - just like the NHS hospitals used to be before they were virtually privatised and broken into so many privately owned, profit-making businesses. What the Private hospital had going for it was that everyone there had the same employer and they had had an ethos of focusing on the patient - just like the old NHS.
John
The case made against privatisation has been much more persuasive. The deceit by the government is appalling
Anon, Caterham Surrey
Three cheers for Allyson. This is an example (and there are several others) of the Blair government being entirely subservient to American influence. I can't use the word I feel describes it, but we don't want any American influence here. From what I know of the American health system, we should leave it alone.
Lindsay, Staffordshire
Why do you not challenge the continued use of the nonsensical phrase "free at the point of need"? Of course it's free to need healthcare, what costs money is receiving it. We need to know whether this phrase is used and tolerated because of ignorance, thoughtlessness or deceitfulness.
Phil, Ribble Valley
I was in hospital for 2 months last year during a transitional period when the local PFI provider was taking over. I learned that a washbasin in the x-ray dept. was to be replaced at a cost 8 TIMES higher than that previously quoted a few weeks earlier by the previous NHS on site works dept. I asked lots of informal questions ... there were other similar examples of massively increased charges.
A&E consultant Lanarkshire
Two of the three hospitals in this region are PFI. Huge money is spent to service the debt incurred. Staffing levels on the ground suffer and bed numbers are curtailed causing compromise of patient care and staff welfare.
Sylvia, West Midlands
My doctor and her partner have both trained long and hard to become GPs. They both complete their training in practice next month and, due to the government's changes in GPs' contracts, neither has a permanent position to take up. What a waste of talent. My husband and I have been delighted with our doctor's caring attitude and efficient handling of our health requirements. Just listening to your programme, I wondered whether this is a suitable place to raise this further example of the sad state of the NHS.
Michael Watson Essex
Why do programmes such as your concentrate almost exclusively on hospital care and only operations there. People are far more likely to see their GP in the course of the year and more likely to complain when they can’t find an NHS dentist.
Daisy, Isle of Wight
American press such as The New York Times have for years published articles of the failures of US health provision, the rising costs. It has been the US health industry that has been pressing to enter European health provision through the World Trade Organisation (WTO). The WTO has pressured the European Commission to enable US private health providers to have more and more access to the NHS, our government has not told us about this.
With private health care provision will we ever know the real cost. The private sector will always talk about “commercial confidentiality” when it comes to finding out the real cost comparison with the NHS.
Rae, S London
What about preventative health care - smoking cessation, cancer screening, healthy eating education.. What will happen to these aspects if private companies make decisions about where money is spent since surely preventing disease is not a profitable exercise.
Jock, Stornoway
Comments: If the idea that the Private sector makes things so much better, why are the trains still rubbish? Private companies only want to make money for shareholders - if Private enterprise can make the WHOLE NHS work, then let those models be adopted by the Government, and have the 'profit' back in the public purse - offer percentage bonus on profit to those who effect it. However, this is where the idea that all types of medical care can turn profit comes into question, and your correspondent's point about 'cherry picking' is right enough.
In short, hands off the NHS, keep it public through and through. Or we'll be sorry!
Paul, Cambridge
I listened to both points of view.
I'm not convinced by the spin placed on the private sector argument that it has been involved from the start - of course it has and the drug companies have made a fortune on the soft target that is the NHS. 35% - 40% cost as opposed to 6% when the private sector was not involved seems to me indicative of where UK Plc is again ripped off by the corporate leeches.Let's face it - apart from a very few, when there's money to be made easily and no real regulation of the corporate rip off that is Britain 2008, all arguments appear to be hollow. It is about time that we were Governed by people who genuinely cared as apposed to what they are going to make personally once they are no longer in Government - cynical I know but then it is so widespread now, how can anyone avoid the cynicism.
By the way, I am very much an entrepreneur who has always created jobs and run my own business, so please don't think I have an axe to grind. The problem is, money and not service is the controlling factor and until you get rid of this material mindset as the only reason, the NHS will continue to be ripped off by the private sector.
Keith,East Herts
One of the major problems of the private sector involvement is the fact the NHS still has to pick up the pieces of the failed operations. If something should go wrong, they don't handle any emergencies but hand them over to the NHS to provide the care, and more importantly, the cost! Secondly, the private sector companies will only provide care for the operations that are most likely not to cause complications, leaving the NHS to provide care for the high risk, and most notably, high cost, care. So in the end, the only beneficiaries are the private care companies and the losers are us tax payers. We lose both for the care, and the cost. We also lose because NHS provides all the training, but loses the qualified personnel to the private care institutions. Consequently, we the tax payers ultimately bear the cost as does the NHS, and the private companies have lower costs. Ultimately, we cannot hand over our healthcare to profit motivations. Healthcare that is profit based results in a system like the US where treatment is only provided if the patient can afford it.
In summary, a profit driven approach will result in a system where the NHS is responsible for the HIGH RISK issues, low income groups, and emergency service. An NHS that also provides the low risk healthcare facilities allows costs recoup some of their costs. However, allowing profit motivation prevents the NHS from recouping any costs from low risk healthcare operations.
Tony, Health Policy Analyst, London
It may be efficient to use the private sector in the NHS but not if the civil service are doing it against a clock set ticking by ministers. Judged by contracts for GPs and Consultants, civil servants do not make good negotiators. We need much more transparency and experiment to make sure we get value for money and efficient services where we use the private sector for the NHS.
Terry, South Wales
Here in Wales we have free prescriptions - what a stupid idea! Zero cost equals infinite demand. There should always be a cost for medical services albeit affordable.
Robert Howard, Nottingham
Doctors are not businesses. They are highly paid, very skilled, workers. I have no problem with them being self-employed, but this is very different from a large private health business whose primary obligation is to their shareholders. Profit and health-care are contradictory.
The NHS is very English insomuch as it is about mutual self-interest.
Paul Bale, London SE
Agree with no private contribution. Else winners and losers follow & equitability and competence are compromised. However MMR could be avoided under private health care.
Alan Woodburn, Truro
NO to the private sector. Illness is not something to be making money from. Keep the NHS.
Will Davies, London
I entirely agreed with the sentiments of your guest, Allyson, who was attacking use of private contractors, but sadly she was making very little sense. She had evidently been briefed on a few technocratic policy buzzwords ('market failure', 'incomplete contracts', 'risk aversion') but didn't know what any of them meant. For instance, the fact that some people are excluded from a market is not (as she said) a 'market failure', it's just undesirable, which is not the same thing. To say, as she kept doing, that there is no 'evidence' that private contracting won't damage the NHS is a gross misunderstanding of what it's possible to do with evidence. Policy debate is already damaged by excessive use of economics, without it also being seized by those who don't understand it.
Stuart, Derbyshire
For many years we have been under the illusion that then NHS is improving. I have seen the opposite I have to pay for glasses and dentistry, as a smoker, drinker the inference is that should I fall ill due to either of these life choices I will be charged or find my self in a post code lottery should treatment be allowed. I think we should provide without reservation the funding needed from British pockets and then we may benefit from the research. This would keep our institution for the UK free at the point of need not budgeted by an outside contractor how would ultimately pick and choose the most profitable area of the business and close or vastly reduce patient care, according to the balance sheet.
John, Hailsham
If Private companies can make a profit from NHS services then it is a sad reflection upon the management which is far too top heavy that it cannot use that profit margin to provide a better service. If however a person wishes to purchase drugs that the NHS cannot afford it should not restrict them from enjoying what they have paid for all their lives. It is no more than making a donation toward the cost of their care. I had an operation in the Private sector, and ended up in the ICU of a NHS hospital because the private one had no facilities to deal with the emergency that arose.
Peter Duerden, Darwen
How can PFI be good for the public? My local hospital cosy £113million to build using PFI but over the next 30 years will have to pay back £680 million,They have already had to close units and wards due to a shortage of money. How can Brown pretend that this is a benefit to people health care?
Kailash Chand
Government's main strategy is– the privatisation of clinical services and their sale to the highest bidder. Lord Darzi's review is another nail in the destruction of everything that the NHS has stood for in last 60 years.
Trevor, West Sussex
We need to obtain healthcare from what ever source provides a quality services. It is vital that outcome audits are regularly undertaken and compared with other 1st world countries. Look at Neurology services, the UK is still in the 3rd world
Greg, London
Even beyond the ideological flaws whereby Private is driven by financial, not social, outcomes, the private sector has no evidence-base for improving the NHS. ISTC’ s for example have simply sucked money away from NHS hospitals. Payment by results and the 'internal market' has in turn reduced collaboration and trust between hospitals rather than increasing efficiency. On top, the least successful hospitals that all this 'market forces' dogma was meant to improve have still done poorly because health always was and is linked to wealth/poverty.
Received by SMS
Every service which has been privatised, GPO, railways, dentists, water, care of elderly, on and on is less efficient, more expensive and many are sabotaged by government interference to bring about a case for privatisation. My husband and myself both experienced this in care sector and GPO. Please God not this route. We have not had a dentist for two years.
Private health care and funding has to be involved I need treatment NHS cannot provide . Only get it in Europe USA. My PCT not helping, have to sell my home to get cancer care
My 91 year old mother had a serious stroke last Sept. Despite her poor prognosis she has had countless hours of Speech Therapy, Occupational Therapy and Physio. Because of my nursing background I know that 10 years ago we would have had to fight for all these things because of her age. Don't tell us that the private sector would have been willing to invest in the future of a very old lady
There+is+only+1+option++n.h.s.
On the question of judging outcomes for GP's. How is this possible, when some practices drop elderly and costly patients as a matter of routine? A C. Grimsby
I am a GP & my partner works 60 hours a week as an ITU registrar. I teach at our local medical school because quality of care is dependent on medical education. As a patient I would ALWAYS WANT TO BE IN A TEACHING ENVIRONMENT.
It is illness for profit and the inevitable insurance plan to support the system that worries me. Louise in Derry
No until governance is clear and patient holds own data and have access to actual performance re medics. NHS System does not work well and services are inferior while managers hide behind words. The conversation is about service and patients like in reality are the last. Lilly Evans NO
NHS surgeons are happy to treat patients in private hospitals at high tariff, but unhappy if the NHS contracts for patients to access such capacity at the lower NHS tariff which effectively limits the payment per case to the surgeon. NHS contracts with the independent sector, if done well, deliver value. PCT Commissioner, NW
I was a nurse and proud of the NHS. My family at the moment has 4 doctors. 3 nurses and 1 midwife all giving excellent service. All complain of great waste of money and managers who do not understand the health service requirements because they have no personal experience of patients needs. You can’t beat the NHS with the family doctor and hospitals governed by consultants and matrons along with finance officers in local hospitals.
I think your two samples were skewed. I would be certain that if you would fund all hospitals to the level of a half private/half public per patient everyone could have a bathroom between two! What’s wrong with the profit motive, any profit would be taken out of the tax money put in or a shortening of care given. I would like to see private healthcare banned in this country. Robin
No no no to privatising the NHS
Re NHS debate . Only a fool could believe that letting us big business run the NHS will be successful . It will be a disaster . No evidence needed just common sense
As a diabetic for 42 years it is obvious now that private is swallowing a huge part of the NHS money with no recourse to questioning them when they refuse you treatment. Alison
Alison is entirely correct and bases her argument on solid evidence, not as Paul et al does on vacuous sound-bites slurs and dodgy ideology. As a research scientist, I trust the rigorous analysis of evidence. Paul is just wrong, the market does not work for patients in medicine and healthcare. P Maclean , bristol.
Americanise the NHS! No thanks !
As NHS physio there is no longer access to care for patient at point of need... Waiting list allowed to be 6 months long due to lack of replacement of staff.
Thank you for an excellent programme. Those advocating private involvement are economically solvent enough to pay for private care and insurances that go with that structure. Lets remember the NHS trains about 95% of those who defect to work in the private sector. If it's more effecient or effective managers that the NHS needs why don't we train staff to do this? It would be far more cost-effective. Private is portrayed as better but it's the same trained staff that work in it. Private is an expensive con. Paul, Edinburgh
Many people come from abroad and receive free treatment when they have to pay in there own I think they should earn the right to that treatment through contributions paid from their wages and insurance like they do in their own country we have to when we go abroad from Theresa Rapley
Quality is only improved under privatisation for a portion of society who fit in with their profit motive. Those who don't will not experience it.
A patient of NHS for all my 33yrs, fantastic care, sadly seen increase of managers & PFI projects taking essential money away from &affecting services. Dawn Essex
Private provision is simply wrong. Medical decisions should be made on medical criteria. The logical result of introducing financial criteria into what should essentially be a system of triage can be seen in American A+E. Private health care operates by reintroducing anxiety and fear to its subjects and their families. BUPA have now commenced the Cancer adverts!
The private sector is a major cause of ill health ie alcohol, tobacco, unhealthy food. Profit first! Let them in the health service? No way. Eric
I was a Harkness fellow in health policy. I spent a year in the USA studying their systems which leave millions without adequate care. Many Americans envy us the nhs. From a distance they see the its great advantages whereas we see only faults. We need to re-affirm the NHS model, and improve it, not destroy it with private investment. Many health workers think the NHS is already terminally ill. This whole debate is really about political lobbying, not health or public finance.
Private Medicine is like running a garage. Quick oil change & maybe gearbox repair but don’t touch rusty jalopies. So Private Medicine not likely to touch elderly with multiple diagnosis or long term mentally ill which is where growth lies.
Health care is paid for through tax. It’s not free. If people make profit it obviously means less money available for delivery of health care. We ought to vote on it
Margaret Thatcher brought in internal market with a great increase in admin costs. Previously the service was centrally funded with minimum costs. Keithsimpson 41 years in nhs.
Evidence from 1930s is clear - market brought dislocation of service and wastefulness and bankruptcy Liz, Oxford
I am completely against the introduction of the private sector. It undermines the NHS. Profit will distort goals and commissioning definitely distorts. Please ask the Gov't to stop the increase in PFI. GPs are having to become big businesses in order to compete. I'd rather they stayed small and got on with being doctors in their small communities. N. Benenson
I work in a private practice. Insurance companies dump on the health service. They do not want to know you if you are sick or old and if you have a pace maker they will not pay for the battery checks the NHS has to do it. They change their terms at will and patients are forever complaining about the stress they cause at the very time in life when they don’t need it believe me there is no alternative to the NHS.
Two points.......private health has an incentive to keep people ill (or devise a need for regular testing eg colonoscopy). Two.......we refer to 'the NHS' when complaining we should name staff and name hospitals he we want improvements.
A 6 month waiting list for a hernia operation at William Harvey Hospital Kent. How come. Roy, Folkestone
I don't want business making a profit from my illness and old age Liz Robertson
I would rather trust Allyson and her version of events Roger Allen