Privatisation of the NHS discussion

[underbank]

Healthcare and the NHS should not be a political football kicked about by any politician

There's no way to stop a public sector service being political.

 

[Typhoon]

Also, NHS patients don't get to request particular brands. The doctors prescribe purely on medical grounds. At least I hope they do!

I suspect not (or not always). My prescription was changed, I have asked numerous medical staff why, did not get any sort of response until I asked a pharmacist. He told me the new one was usually cheaper.

 

[Dai Corner]

I suspect not (or not always). My prescription was changed, I have asked numerous medical staff why, did not get any sort of response until I asked a pharmacist. He told me the new one was usually cheaper.

I don't have a problem with that, as long as the new one was equally effective.

I remember my GP remarking that one of the drugs I'd been prescribed by a hospital consultant was one of the best, most expensive ones. She's happily renewed by prescription for the last four or five years though.

 

[Typhoon]

I don't have a problem with that, as long as the new one was equally effective.

Nor do I. I would just like to be told why, not fobbed off. If the new medicine does the same job and has no side effects but is cheaper, I think we need to be told that is what will be prescribed. Maybe we all need to be told that the NHS is cash strapped, that doctors will prescribe the cheapest version of the medicine to do the task, and show the alternative US vision, where a vial of insulin costs £210 (https://www.bbc.co.uk/news/world-us-canada-47491964). If people want a different product because its got a multi-coloured box or the actors in the advert make it sound good, they should buy it privately.

 

[underbank]

If people want a different product because its got a multi-coloured box or the actors in the advert make it sound good, they should buy it privately.

Indeed, but a lot of the time, people have good reason. There've been times when both my wife and myself have been prescribed "generic" cheaper versions of drugs which have caused side effects, such as irregular heart-rate, indigestion, etc - not dangerous as such. Every time it's happened, the GP has simply tried a different version until they find one without the side effects, usually the "real" brand in our experience. We've had GPs tell us that the problem is usually in the artificial colours used for the coating for identification purposes as it's well known that some types of red/blue colourant do cause palpatations and stomach discomfort. Maybe the use of cheaper additives is how they can make them a lot cheaper?

 

[Typhoon]

We've had GPs tell us that the problem is usually in the artificial colours used for the coating for identification purposes as it's well known that some types of red/blue colourant do cause palpatations and stomach discomfort. Maybe the use of cheaper additives is how they can make them a lot cheaper?

That's interesting. The obvious question must be why they use those particular colours.

Side effects are certainly an issue, which is why this should be taken into account. The point is

Every time it's happened, the GP has simply tried a different version until they find one without the side effects, usually the "real" brand in our experience.

The GP tried to find the cheapest effective treatment, not rushed to the known brand - after all, it is not unknown for branded products to cause side effects.

 

[greyman42]

Can you imagine the social media outrage when an OAP with dementia or a woman with inoperable cancer gets a fine or struck off a GP list for missing appointments? It's just not going to happen.

As long as they contact the surgery to cancel the appointment then there won't be a problem.

 

[coppercapped]

All that's fine, and shows excellent knowledge, but likely to be irrelevant as we are leaving the EU and it's clear the americans want to get their hands on our NHS in return for a deal. https://www.theguardian.com/us-news/2019/jun/04/trump-says-he-turned-down-corbyn-request-to-meet
However further down the article those comments have been "rown back" although I take whatever Trump says with a dose of salt the size of Kent.
If we could end up with a German system (for example) and no US input whatsoever that may be far more palatable.

The systems allowed in Europe would potentially not be acceptable under a US trade deal. You would potentially have rules requiring mutuals to compete with American health providers on terms which were largely set by the US health providers. More importantly, the ability of the NHS (or mutuals) to act as a syndicate buyer and tame the excesses of the US drug industry would be hobbled, and we may even struggle to make safety-grounds arguments for not allowing some of the drugs which we currently ban or severely limit. Irrespective of the actual form of the health system, we could end up with something that costs everybody a significant multiple of the NHS, and can't protect us from idiocy like the current US opioid crisis

Yeah but we are leaving the EU.

I simply described an alternative approach to funding health care, nobody in the EU has suggested that we adopt it so it is irrelevant whether or not the UK leaves the EU.
As the NHS stands it is a government - i.e., state controlled - organisation. It is a political hot potato and has much public support. I cannot foresee a model whereby all or part of it is converted to an insurance model on US lines. Nevertheless I can see the NHS sub-contracting some treatments to a US financed body, but that body would be based in the UK and operate under UK law. Regarding payment - unless there is a sea-change in the public's attitude to the NHS such a body would invoice the NHS and not the individual.

The NHS has made some limited use of services of some health organisations in the EU but it doesn't seem to have been a resounding success, probably because of logistic and language issues. I cannot see UK patients being flown to the US for treatment on a routine basis even if the language is similar.

'Trade deals' are concerned with tariffs, non-tariff barriers to trade and related issues such as intellectual property rights in trade between countries. They do not impinge on a country's internal structures and laws.

This being the case any EU-US trade deal (son of TTIP?) would not affect in any way the insurance-based systems current used in Germany, Belgium and France that I described in my earlier post. And it would not affect the organisation and structure of the NHS whether we remain in the EU or not. What could happen on the continent is that a US insurer could set up a 'Mutuelle'/'Krankenkasse' in one or more of the EU member states - but it would be bound by exactly the same laws and regulations that are currently in force in those countries. It would not be in a position to remit large profits back to the US as the whole point of the structure is that there are no large profits.

 

[takno]

I simply described an alternative approach to funding health care, nobody in the EU has suggested that we adopt it so it is irrelevant whether or not the UK leaves the EU.
As the NHS stands it is a government - i.e., state controlled - organisation. It is a political hot potato and has much public support. I cannot foresee a model whereby all or part of it is converted to an insurance model on US lines. Nevertheless I can see the NHS sub-contracting some treatments to a US financed body, but that body would be based in the UK and operate under UK law. Regarding payment - unless there is a sea-change in the public's attitude to the NHS such a body would invoice the NHS and not the individual.

The NHS has made some limited use of services of some health organisations in the EU but it doesn't seem to have been a resounding success, probably because of logistic and language issues. I cannot see UK patients being flown to the US for treatment on a routine basis even if the language is similar.

'Trade deals' are concerned with tariffs, non-tariff barriers to trade and related issues such as intellectual property rights in trade between countries. They do not impinge on a country's internal structures and laws.

This being the case any EU-US trade deal (son of TTIP?) would not affect in any way the insurance-based systems current used in Germany, Belgium and France that I described in my earlier post. And it would not affect the organisation and structure of the NHS whether we remain in the EU or not. What could happen on the continent is that a US insurer could set up a 'Mutuelle'/'Krankenkasse' in one or more of the EU member states - but it would be bound by exactly the same laws and regulations that are currently in force in those countries. It would not be in a position to remit large profits back to the US as the whole point of the structure is that there are no large profits.

I'm afraid you badly underestimate what is up for grabs in modern trade deals. A deal the US made with Europe may well not affect the EU health sector because they have actual bargaining power, but we'd have very little power to withstand anything that American companies wanted put on the table. Virtually any regulation or standard we put in place on health grounds would get taken straight to arbitration on competition grounds, and the arbitration would be conducted by a wholly unaccountable transnational organisation. The fact that a US provider has to put boots on the ground in the UK to provide the service is irrelevant - they can still leverage their international "experience" and access to extranational "justice" to get their way, demanding that ever more areas of healthcare are out to tender. Ultimately we will still struggle to avoid paying over the odds for third-rate care.

 

[Dai Corner]

I'm afraid you badly underestimate what is up for grabs in modern trade deals. A deal the US made with Europe may well not affect the EU health sector because they have actual bargaining power, but we'd have very little power to withstand anything that American companies wanted put on the table. Virtually any regulation or standard we put in place on health grounds would get taken straight to arbitration on competition grounds, and the arbitration would be conducted by a wholly unaccountable transnational organisation. The fact that a US provider has to put boots on the ground in the UK to provide the service is irrelevant - they can still leverage their international "experience" and access to extranational "justice" to get their way, demanding that ever more areas of healthcare are out to tender. Ultimately we will still struggle to avoid paying over the odds for third-rate care.

Surely if these American healthcare companies try to charge over the odds when services are put out to tender they won't get the business?

 

[takno]

Surely if these American healthcare companies try to charge over the odds when services are put out to tender they won't get the business?

When has accepting the lowest bid ever resulted in paying less or getting better service. They put in a bid to do half the job badly, take it to court if they're bargain basement bid isn't accepted, and you have to start a whole new contract to actually do the half of the job they didn't fancy doing properly. That's before we even get started on drugs and processes they have US patents for if we have to align our patent systems.

 

[Dai Corner]

When has accepting the lowest bid ever resulted in paying less or getting better service. They put in a bid to do half the job badly, take it to court if they're bargain basement bid isn't accepted, and you have to start a whole new contract to actually do the half of the job they didn't fancy doing properly. That's before we even get started on drugs and processes they have US patents for if we have to align our patent systems.

I'm assuming those writing the specs, reviewing the bids and making the decisions are sophisticated enough to realise all that. Which might not be a safe assumption, come to think of it

 

[fowler9]

I'm assuming those writing the specs, reviewing the bids and making the decisions are sophisticated enough to realise all that. Which might not be a safe assumption, come to think of it

With the greatest of respect it is a very poor assumption.

 

[yorkie]

As long as they contact the surgery to cancel the appointment then there won't be a problem.

But what if they forget to do so because of their dementia?

 

[Bletchleyite]

As long as they contact the surgery to cancel the appointment then there won't be a problem.

GPs are so oversubscribed that people not showing up aren't actually a problem, in any case. Like with overbooked flights, if everyone actually did show up there'd be a problem - the surgery would run so late that those at the end of the day wouldn't even get seen.

The only thing it's a waste of is about 30 seconds of admin putting the appointment on the computer. GPs can and do overbook to their usual level of no-shows, or the slots are used for on the day emergencies on a "turn up and wait for someone to no-show" type basis.

 

[underbank]

GPs are so oversubscribed that people not showing up aren't actually a problem, in any case. Like with overbooked flights, if everyone actually did show up there'd be a problem - the surgery would run so late that those at the end of the day wouldn't even get seen.

At our surgery, although the headline number is big, when you divide it over the number of branches, number of sessions, etc., it's only one missed patient per doctor/nurse per session, so basically it's all a lot of hot air over nothing that doesn't make any difference. But, then, a poster saying 176 missed appointments last month makes it look more of an issue than saying 1 missed appointment per doctor/nurse session!

 

[Geezertronic]

My GP is great, I just hardly ever get to see her as everyone seems to get farmed off onto the Locum who are generally ok 50% of the time, or the Nurse Practitioner. The thing that does my head in about my GP surgery is that everyone has to ring at 0815hrs if they want an appointment for that day - no booking for tomorrow - and ringing up (or getting through) at 0820hrs means all appointments are gone.

 

[fowler9]

Was chatting to a friend in the state's today. She had a hornet in her porch and had no Epi pen (She is allergic). Her insurance doesn't cover epi pens. I asked her how much it would cost to buy one in her situation. $650-$700 apparently.

 

[greyman42]

But what if they forget to do so because of their dementia?

I think common sense would be applied in cases such as this and charges would be waived.

 

[Tom B]

I'm assuming those writing the specs, reviewing the bids and making the decisions are sophisticated enough to realise all that. Which might not be a safe assumption, come to think of it

A very unsafe assumption. Look at how many contracts are let now by an overworked and short staffed public sector, to companies who have highly paid specialists ensuring that the contract is just the way they like it (and they know exactly how to get the ticks in the performance boxes, and get the KPI scores up etc). If that's a contract for buildings maintenance or cleaning, for example, you might end up with a shoddily maintained library or municipal lavatories not cleaned... if that's a contract for healthcare, the implications can be far more severe.

 

[yorkie]

I think common sense would be applied in cases such as this and charges would be waived.

Exactly, so we are back round to:

Not sure how you're going to fine the young & old who are exempt, the disabled, the unemployed, and those with MH issues. So it basically leaves workers who are the ones paying the most into the system anyway. It'd take a brave politician to try to charge/fine the most vulnerable! I'd love to see statistics of which groups of society are the ones most likely to miss appointments - the information must be there within the NHS systems, just ready to be mined - I suspect it's the ones who'd be exempt who are the ones causing most of the missed appointments.

Why would they be exempt?

So would they be exempt or not? I really don't know what you are trying to say!

 

[underbank]

I think common sense would be applied in cases such as this and charges would be waived.

So surely such people need to be excluded from the waiting room "shame" posters re numbers of appointments missed if they're effectively unavoidable? The NHS doesn't help itself when it, itself, makes political statements especially with their current "blame the patient" mentality to divert blame away from their own inefficiency. That's why I mentioned upthread about how interesting it would be to see breakdowns of the number of missed appointments as to reasons and types of patient. With proper information, more informed decisions can be made as to how to deal with it rather than blanket statements.

 

[greyman42]

Exactly, so we are back round to:


So would they be exempt or not? I really don't know what you are trying to say!

I am trying to say that, in my opinion, there are a high percentage of people who miss appointments for no good reason.

 

[87 027]

And based on experience, some "missed appointments" are actually where the patient has notified that they can't make the appointment and asked to reschedule, but the system has not processed that notification. Happened to my dad recently - rang up to rearrange an appointment, then a few days later got asked why he'd missed the old one he'd changed!

 

[telstarbox]

This is a text I regularly get from my NHS hospital which is a useful guilt trip:

We are expecting you at $Hospital on $date andtime. Not attending costs the NHS £160 approx. To cancel or rebook call 020xxxxxxx

For NHS repeat prescriptions you can now order via an app and the medicines arrive in the post, rather than having to go to a high street pharmacy.

 

[underbank]

And based on experience, some "missed appointments" are actually where the patient has notified that they can't make the appointment and asked to reschedule, but the system has not processed that notification. Happened to my dad recently - rang up to rearrange an appointment, then a few days later got asked why he'd missed the old one he'd changed!

Happened to me too. My infant son had an appointment with the GP and I had an appointment with the same GP for about an hour later. A few days before, my wife phoned to cancel my son's appointment and re-arrange it (I was within earshot when she phoned). When I attended my appointment, first thing the GP said once he saw and obviously recognised the name/address, was a rant about how my son had failed to attend and how it was a wasted appointment which cost the NHS blah, blah, blah, and was then pretty narked when I firmly put him in his place and told him the appointment had been re-arranged and made him look up the new appointment on the booking system to prove I was right! They really don't like it when they're proved to be in the wrong!

And the old chestnut of your hospital/specialist appointment card landing on your doorstep on the day of the appointment itself! That must have happened to me and my family several times. A bit idiotic of the NHS administrators to put a second class stamp on a letter posted the day before an appointment, not to mention that these days, the postman doesn't come till mid-day and even if by some strange miracle the letter does arrive before you leave home that morning, you may actually not be able to just drop everything to attend due to other commitments.

 

[fowler9]

Happened to me too. My infant son had an appointment with the GP and I had an appointment with the same GP for about an hour later. A few days before, my wife phoned to cancel my son's appointment and re-arrange it (I was within earshot when she phoned). When I attended my appointment, first thing the GP said once he saw and obviously recognised the name/address, was a rant about how my son had failed to attend and how it was a wasted appointment which cost the NHS blah, blah, blah, and was then pretty narked when I firmly put him in his place and told him the appointment had been re-arranged and made him look up the new appointment on the booking system to prove I was right! They really don't like it when they're proved to be in the wrong!

And the old chestnut of your hospital/specialist appointment card landing on your doorstep on the day of the appointment itself! That must have happened to me and my family several times. A bit idiotic of the NHS administrators to put a second class stamp on a letter posted the day before an appointment, not to mention that these days, the postman doesn't come till mid-day and even if by some strange miracle the letter does arrive before you leave home that morning, you may actually not be able to just drop everything to attend due to other commitments.

Totally understand where you coming from. I smile the middle man in the company I work for and hear it all the time although it is not in health care. Customer cancels the appointment but it doesn't actually get cancelled. Subcontractor cancels appointment and doesn't tell the customer and then arranges a new date and doesn't tell the customer or tells them on the day of the new appointment. I could go on for hours, immensely frustrating for myself as well as the customer.

 

[johntea]

The trouble with the NHS is there are so many separate IT systems in play! (I should know, I work for NHS IT third line support!)

So your details will initially get logged on System X, but you might check in using System Y and the department your appointment is at will be using System Z! In theory there are 'messaging' processes happening in the background between all these systems keeping everything up to date but it doesn't always work or sometimes breaks down and causes a huge backlog of messages until fixed!

Sadly 'System XYZ' that does everything will never ever be a reality!

 

[Dai Corner]

My rant about NHS hospital outpatients.

I saw my GP

The trouble with the NHS is there are so many separate IT systems in play! (I should know, I work for NHS IT third line support!)

So your details will initially get logged on System X, but you might check in using System Y and the department your appointment is at will be using System Z! In theory there are 'messaging' processes happening in the background between all these systems keeping everything up to date but it doesn't always work or sometimes breaks down and causes a huge backlog of messages until fixed!

Sadly 'System XYZ' that does everything will never ever be a reality!

Didn't they spend millions trying to create 'System XYZ' before giving up?

I wish there was integration between GPs and pharmacies for prescriptions. I have to request a repeat prescription using my GP's system, collect a piece of paper a few days later from the surgery and queue up with it at the pharmacy to get my drugs.

I can get a pharmacy to do all the running around for me but apparently that's paper based too and one local one actually employ someone to drive round all the local surgeries, though he does deliver drugs to customers' homes too.

Wouldn't it be great if I could select a pharmacy when using the GP's system and have the prescription sent electronically to them so the drugs were ready and waiting for me? It could even check stock and suggest an alternative pharmacy if necessary. Argos can do that if I want to buy a kettle, why not the NHS?

 

[radamfi]

I wish there was integration between GPs and pharmacies for prescriptions. I have to request a repeat prescription using my GP's system, collect a piece of paper a few days later from the surgery and queue up with it at the pharmacy to get my drugs.

I can get a pharmacy to do all the running around for me but apparently that's paper based too and one local one actually employ someone to drive round all the local surgeries, though he does deliver drugs to customers' homes too.

Wouldn't it be great if I could select a pharmacy when using the GP's system and have the prescription sent electronically to them so the drugs were ready and waiting for me? It could even check stock and suggest an alternative pharmacy if necessary. Argos can do that if I want to buy a kettle, why not the NHS?

I use

https://patient.emisaccess.co.uk/

to request repeat prescriptions and they are ready to be collected at my nominated pharmacy a couple of days later.