Forms-of-nhs-privatisation-you-should-know-about

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http://nhaspace.com/2015/02/19/5-forms-of-nhs-privatisation-you-should-know-about/

5 FORMS OF NHS PRIVATISATION YOU SHOULD KNOW ABOUT

Anyone who knows what’s happening to the NHS should know that a large part of its budget is now controlled by CCGs, who are forced to offer NHS contracts up to private companies. You’d be forgiven for thinking that was the only form of privatisation taking place in the NHS. It’s not. Here are five forms of NHS privatisation that you really should know about.
1 – PropCo
NHS Property Services Ltd (PropCo) was launched in April 2013 and now owns £3 billion worth of NHS land and buildings. These assets were once held by the now-abolished Primary Care Trusts and Strategic Health Authorities; now PropCo is responsible for selling them off to property developers. Furthermore, while the government currently owns all of PropCo’s shares, the Act that created PropCo allows for private firms to buy the majority of these shares. Thus large swathes of NHS land could quickly pass into private hands.
2 – PFI/PF2
You’ve probably heard of the Private Finance Initiative and its sequel, PF2. You may think these are merely expensive loans with Wonga-style interest rates. Certainly these deals are bad value for the taxpayer and have pushed many hospitals into the red, but they’re more than just that. For at least the 25-30 year repayment period, the private firm providing the loan actually owns the hospital. Thus, more than a hundred NHS facilities are owned by banks and shell companies.
3 – Clinical Support Units
Although CCGs were created by the 2012 Act to decide where the money goes, it is the CSUs that provide the infrastructure. CSUs are there to run tenders, manage contracts, provide IT and HR services and other back-office admin functions. The Act created CSUs as part of the NHS structure, but from 2016 the CSUs will become independent businesses to be bought out by private firms. In fact, the sale of has already begun. If private firms take over the CSUs they will have a huge influence on the funding and rationing of healthcare in this country.
4 – Personal Health Budgets
Personal Health Budgets (PHBs) – in which an individual is allocated a limited amount of money to cover their healthcare needs – are already being introduced in England. While there is the obvious spectre of ‘top-up’ payments for those who exceed their allocated budget, there is another issue here. The classical pattern of funding in the NHS is that money is allocated to Trusts according to the amount of work they need to do. PHBs allow for a move to the private insurance model, where everyone pays in a premium (in this case their PHB) and the private firms then decide who gets treated/which claims to pay out on. You can just imagine the worried well opting to pay their PHB into a private insurer in return for cheaper gym membership and money off their holidays. Meanwhile, the genuinely-ill would end up paying top-ups to access increasingly rationed basic NHS treatment. Combine universal PHBs with privatised CSUs and you get an American-style health system.
5 – Foundation Trusts and Mutualisation
If the land, buildings, back office and budgets have all been privatised, what does that leave? That’s right, the NHS Trusts themselves. All hospital trusts now have a mandate to become independent businesses known as Foundation Trusts. These are standalone organisations which have to keep themselves in the black, and can do so by taking on as much private work as they want. As with the CSUs, the FTs are units ripe for privatisation, which in this case is dressed up as warm and fuzzy “mutualisation“. This means passing from public ownership into the hands of ‘stakeholders’ – that’s right, privatisation.

NHAspace thinks that the NHS should be publicly funded, owned and regulated. If you agree, please consider following the blog and joining or donating to the NHA. Thank you.

What happens when politicians try to run an organisation they don’t understand

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We are in a Kafka world.
• There is not enough money in the system and Trusts are punished if they overspend.
• They have to overspend to get staffing levels up to new ‘safe’ standards.
• As there are not enough staff in the system they have to go to agencies to buy-in the same staff they once employed in the NHS, now at twice the price.
• Many Docs and nurses don’t want to work in the system because being an agency staffer creates flexibility and freedom not found in the consolidated ranks who are pressured, shoved around and the butt of everyone’s ire.
Hospitals can’t find enough staff and the CQC spend a fortune (that could be used on patient care), turn up with 80 people (who could be working in the NHS providing care) and say; ‘You don’t have enough staff, therefore this place is dangerous and we want new leadership’.

New leaders are found who hire more staff and overspend. Monitor (who spend a fortune that could be spent on patient care) turn up with an army (who should be working in the NHS) and say you have overspent and we want new leadership.

New leaders are found who balance the books by cutting the staffing levels and the CQC turn up and say; ‘You don’t have enough staff, we want new leadership’. The old leader gets the sack and …. around we go again.

The rise of the £300,000 NHS fatcats

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REPORT IN THE DAILY TELEGRAPH 27 DECEMBER 2014

The rise of the £300,000 NHS fatcats

Investigation discloses doubling in number of NHS managers being paid equivalent of at least £300,000 a year, with some on as much as £620,000 annually
Email

In 2010, Ian Miller was the highest paid NHS manager in the England, earning £310,000 for nine months’ work for the South East Coast Strategic Health Authority in 2009-10 — which equates to £400,000 a year.

Last year he was paid £251,000 for five months’ work as director of finance at Maidstone and Tunbridge Wells — the equivalent of £602,000 a year.

David Cameron says this is not happening and bureaucrats and administrators have been reduced. He is lying.

Patients’ groups said the “exorbitant” rates could not be justified, and nursing leaders said the sums were a “kick in the teeth” for junior staff who were refused a one per cent pay rise.
Katherine Murphy, chief executive of the Patients Association, said the spending was “unacceptable.” She added: “Investment is urgently needed on the front line.”
Dr Peter Carter, chief executive of the Royal College of Nursing said: “For sums this large to be spent instead on paying temporary managers is a kick in the teeth to nurses and a blow to patient care.

Maidstone and Tunbridge Wells said the sums paid to Maxentius specialist financial support, which provided Mr Miller’s services, “provided independent financial expertise that was essential in helping the Trust achieve £23.5 million in efficiency savings last year without impacting on patient care”.
Without impacting on patient care? Do they think the public are stupid ?

All figures taken from trusts’ annual reports and other documents

IMPORTING USA – STYLE HEALTHCARE INTO ENGLAND -A WARNING

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IMPORTING USA – STYLE HEALTHCARE INTO ENGLAND
-A WARNING

Uniquely the British NHS was set up so that doctors had no direct
financial interest in the clinical decisions made about you.
I was a GP for 30 years and I only ever wanted to work in our NHS for that reasons.

The elephant in the consulting room is now money.

Privatisers ask whether it matters who provides the service. Yes it does.
What’s the priority , good quality care or the shareholder’s
profits ? The latter. It’s written in law.

Since the passing of the Health and Social Care Act

• your GP may have a financial interest in the care delivered , but not in the best way clinically

• the doctor you could trust to be your committed advocate may now be rationing your care , limiting investigations ,
treatments , and referrals either because of outside pressures
or for financial gain or both.

if you do get referred , it may not be to the most appropriate specialist but where there is a financial link

• those deciding who provides the care (or indeed whether the care is provided at all) may have a financial interest in the
company awarded the contract . This is true of some Clinical Commissioning Group (CCGs) Board members.

• and the specialist who you may end up infront of may have
other pressures on him or her : this could be in the form of
being told what to do by managers , or being instructed
what and where investigations are done , and the company
may be making extra money by keeping it all “in-house” —- something you may be totally unaware of. The NHS logo is above the door of the private companies so how are you to know ?

So if the consultant, the referrer or the commissioner of
your care may be making money from the way you are dealt with
clinically , how can you then be sure your care is purely “in
your best interests” ?

I wanted no part in this so I resigned as a GP last year. I realised no mainstream political party any more believed in Bevan’s principles.

This produces the bizarre situation where in primary care , which has suffered cuts of £1 billion since 2010 , you struggle to get what is clinically appropriate , or any care at all , run the risk of being under-investigated, under treated or under-referred but if you get through that barrier you find yourself before a
secondary care doctor who may over-investigate or over treat.
Both situations a direct result of how the market operates and the pulling power of making more money.

At a time when all possible funds should be directed to frontline
care , taxpayers’ money is ending up in shareholders’ pockets and
several hundred parliamentarians who promoted and voted for this Americanised system have financial links to companies that are getting the contracts and acting like vultures ,
cherry picking the most profitable services.
They will enrich themselves and don’t seem the least embarrassed
by this. Nor does the queue of ex-health ministers now on the Boards of the companies they gave business to.

And so we end up with an expensive , bureaucratic , unaccountable , unfair , irreversible and less effective health care system replacing
the most cost-efficient system in the World , as demonstrated recently by the Commonwealth Fund.

Then the worst of the American system , which ranks 47th in the
world , creeps in where the pharmaceutical and insurance companies rule and control prices in a totally anti-competitive manner. Over-the-counter products are expensive . Some medications we , in the UK , would regard as ordinary household remedies are only available if you see a doctor , so add a consultation fee to your bill.
Insurance is linked to employment , and the company choses which insurer , not the individual. Lose your job or retire and you lose your cover , which most times doesn’t cover the full costs anyway.
“Medicals” are mandatory to do many things . To be allowed on Scout camps your child will be subjected to a full expensive physical. Or to get your anti-hypertensive drugs.
The bureaucracy is breathtakingly inefficient , and failure to pay affects your credit score.
Hospitals won’t start treatment with expensive cancer drugs until they have a down-payment .

It’s possibly the only commodity accepted (no choice) by the “customer” before having any idea of the price. You pay a fee to enter the shop chosen for you, and if it is cheaper elsewhere , tough. You eventually get charged whatever amount the shop dreams up. They can charge you $7 for a swab which they buy for 19 cents , or $157 for a blood test costing £11 (typical true examples)

Scandalous examples of poor treatment and abuse are plentiful.

• I know of a paramedic who , uninvited , attended a child who fainted whilst out to lunch with his doctor parents. He recovered immediately but the paramedic told the parents if he wasn’t allowed to take the child to his hospital , they would be arrested for child-neglect.
• The old people kept alive on life-support making doctors richer and sometimes in collusion with relatives who gain financially. Families may get a social security cheque when their relative is in hospital but not when transferred to a nursing home
• These old folk get daily multiple “opinions” from a variety of specialists , and their mates. They all submit bills , and beware of the “ward round”. You will get invoiced by all , just for them being there. One cardiologist was seen performing a 30 second examination with a stethoscope without bothering to put the ear pieces in . His bill ? $ 500.
• An old man admitted from home goes through multiple expensive tests. He is sent home although his problem hasn’t been properly dealt with so he gets re-admitted a week later . He is put through all the tests again. Double profit and discharged when he can no longer make the hospital or doctors money.
• Safeguards are useless. The hospital gets fined if readmitted with same diagnosis within 30 days so they make sure the patient has a different diagnosis. The fine anyway is far outweighed by money they make. They do more tests to compensate
• 7 billion tests at a cost of $70 billion are done per annum in the U.S. meaning everyone has 16 on average a year , at $223 each.
• Mark-ups of 1000% are not uncommon. A heart stent is about $1000 , but the patient is charged $10,000 An ECG about $800. Actual cost probably 1% of that. It is estimated overcharging costs Americans $750 billion a year. Medical fraud costs $95 billion.
• What possible clinical relevance or benefit is an annual PSA (prostate) and stool sample except to the bank balance of the doctors ? Screening like this has been discredited. These “fishing” expeditions are just to get their mates more work. It’s corrupt and dangerous and may be in a town near you soon. It probably already is.
• Psychiatric patients are a nuisance. I know of one escorted off hospital premises in Los Angeles and left on the street corner , as he would cost the hospital . Supposedly he signed an AMA (“Against Medical Advice” form), but he signed it Simba . He thought he was the Lion King. A seriously ill citizen abandoned.

Doctors who bring the money in can’t do anything wrong in the hospitals’ eyes (they seem always above suspicion even when they make errors)
Emergency Room (ER) physicians sit behind computers most of the time ordering tests done by assistants , but guess who profits ?

How far off is it before the insurance companies take over in England and we see this sort of thing ? Not long.
The next phase is , under a NHS banner , to reduce services to core essentials , with top-up insurance being introduced for “extras” , initially voluntarily. Then the number of services paid for by ever increasing insurance premiums expands and multiplies until there is no state service at all , except perhaps for the very poor.

They’ve won , you’ve lost , unless you have shares in healthcare companies and don’t mind your clinical care being inappropriate, financially driven , sometimes dangerous and producing frustrations In total we will all be paying a lot more.

I am proud I was an NHS GP. I believe the way a society delivers it’s healthcare defines the values and nature of that society. In the USA healthcare is not primarily about looking after the Nation’s health but a huge multi-company money-making machine which greatly enriches some , but neglects millions of it’s citizens. That defines and explains their society and we are being deliberately dragged in that direction

This is one of the biggest failures of democracy in my lifetime